Wheelchair Assessment - Physical Assessment

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Introduction

The Physical Assessment is the second part of the Wheelchair Assessment process and includes:

1. Skin Check - Identifying the Presence, Risk of or History of Pressure Areas;
2. Identifying the Method of Propulsion;
3. Taking Measurements - Often known as the MAT (Mechanical Assessment Tool)

When completing an intermediate wheelchair assessment on an individual that requires additional postural support from their wheelchair then there is an further step to the physical assessment to determine how much additional postural support the wheelchair user needs.

4. Assessment of Sitting Balance and Determine Additional Postural Support Required through:

• observation of sitting posture without support;
• carrying out a pelvis and hip posture screen, which identifies how any problems around the pelvis or hips may affect the wheelchair user’s sitting posture;
• carrying out hand simulation to ‘simulate’ the support that a wheelchair and additional postural supports may provide;

Information from each of these sections will help wheelchair service personnel to decide how much support the wheelchair user needs.

Skin Check; Identifying the Presence, Risk of or History of Pressure Areas

If a wheelchair user highlights that they have a pressure area, always ask to see it. Ensure this is done in a private area. A wheelchair user is at risk of developing a pressure area if they cannot feel or have other risk factors including:

• decreased sensation;
• decreased mobility and/or paralysis;
• moisture from sweat, water or incontinence;
• poor posture;
• previous or current pressure sore;
• poor diet and not drinking enough water;
• ageing;
• weight (underweight or overweight).

A skin check is indicated if there is a history or risk of skin breakdown. Many sitting-acquired pressure areas develop against seating support surfaces such as the cushion and back support. A skin check for redness or evidence of skin damage is conducted in supine or side lying position to assess these sites.

Mark on the body diagram:

• areas where the wheelchair user cannot feel; like this: ////
• areas where the wheelchair user has had a pressure sore in the past; like this: O
• areas where the wheelchair user has a current pressure sore; like this: •

Identifying the Method of Propulsion

It is important to find out what method of propulsion the wheelchair user will use to push, as this can affect the choice of wheelchair and the way it is set up.

Taking Measurements

Five measurements from the wheelchair user are needed to choose the best available size of wheelchair for for a wheelchair user that does not require additional postural support and has good trunk control.

Measuring Tools

• Use a retractable metal tape measure
• clipboards/books can be used to help measure accurately (see How to take body measurements).
• Large callipers are an additional tool that can be very useful. These can be made locally from wood.
• Foot-blocks can be used to support the wheelchair user’s feet at the correct height.

How To Take Body Measurements

• Ask the wheelchair user to sit as upright as possible.
• The wheelchair user’s feet should be supported on the floor or on foot-blocks if they cannot reach the floor comfortably.
• For all measurements, make sure the tape measure is held straight and the wheelchair user is sitting upright. Holding a clipboard/book on either side of the wheelchair user can help in obtaining an accurate measurement.
• Bend down to ensure you are viewing the tape measure at the correct angle.

Assessing Wheelchair Skills

• Finding out how the wheelchair user sits and what additional postural support they may need through:
  • Observing sitting posture without support;
  • Carrying out a pelvis and hip posture screen. Pelvis and hip posture screening helps to understand how any problems around the pelvis or hips may be affecting the wheelchair user’s sitting posture;
  • Carrying out hand simulation. The wheelchair service personnel uses their hands to ‘simulate’ the support that a wheelchair and additional postural supports may provide; 
  • Taking Measurements.

Resources

References