Wheelchair Assessment - Physical Assessment

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Introduction

The Physical Assessment is the second part of the Wheelchair Assessment Process which consists of four elements, with information from each of these assisting wheelchair service personnel to decide how much support the wheelchair user needs.

1. Skin Check - Identifying the Presence, Risk of or History of Pressure Areas;
2. Method of Propulsion - Identifying How the Wheelchair User will Push Wheelchair;
3. Taking Measurements - Often known as the MAT (Mechanical Assessment Tool)
4. Assessment of Sitting Balance to 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;

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

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. 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).

Mark on 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.

Resources

References