The OT’s Perspective: When walking aids are no longer suitable
What happens when walking aids aren’t enough? Stuart Barrow shares an occupational therapist’s perspective.
About a year ago, I wrote an article entitled ‘What we look for when recommending walking aids.’ But here’s the problem: sometimes walking aids are not enough. Sometimes, a client simply isn’t able to use a walking aid and, as a result, they need a wheelchair.
With that in mind, I thought I’d jot down a few pointers to help in the process of selecting a wheelchair.
Broadly speaking you’ve got three types of wheelchairs
Self-propelled – the user propels themselves along in the chair
It’s well worth considering one with quick-release wheels, to make transporting the chair much easier.
Attendant propelled – the user is pushed/wheeled
Attendant-propelled wheelchairs have smaller back wheels, so are often lighter and easier to transport.
Powered – the chair has a battery pack or is fully powered with controls.
There are three categories of powered wheelchairs – indoor/portable, outdoor and indoor/outdoor – and it’s important to understand where your client spends their time and recommend the chair that best suits their needs.
Powered wheelchairs are either class 2 (can be used outside on pavements) or class 3 (for use on roads and pavements), and are generally a lot heavier than manual wheelchairs, due to the need to support the battery and other equipment.
Generally, an electric wheelchair will use a joystick as its drive control, and these can be tricky to learn, so it’s vital to give a full tutorial and ensure that the client knows where the instructions are.
The wheelchair battery will need to be charged overnight, so it’s important to have storage space that is near enough to a socket to charge the chair.
How do you decide which wheelchair is right for a client?
Can the patient sit in the chair and propel themselves? They may be able to walk a little and want a chair for around the home but, ultimately, if the patient cannot wheel themselves around the shop, it is likely they would not manage the wheelchair at home.
If the patient needs help, an attendant propelled chair may be better (the chair with the smaller wheels).
Again, the patient needs to try the chair and then the person who is most likely to propel them should wheel them around the shop and understand whether that person is capable and will continue to be capable for the foreseeable future.
As always, environment is key. A great self-propelled or attendant-propelled wheelchair may be unsuitable if the patient lives at the top of a steep hill.
If the client is not keen to go for a powered wheelchair or it doesn’t seem appropriate, then one option is an add-on battery pack that will provide a little extra help on inclines.
However, if an attendant propelled wheelchair is not suitable, an electric wheelchair is probably the next step and it’s important to take that selection process seriously, with a road test around the shop carpark, up and down the street and, if possible, a home visit and demonstration.
The home visit will ensure the property is suitable for the wheelchair i.e. does it need ramps? Are doorways wide enough? Is there storage space?
It’s also important to ask questions about what you can’t see – the person’s medical history, a current medication or diagnosis and so on.
A person with dementia may not be able to use the powered chair as they deteriorate, thus an attendant propelled chair may be required with battery pack.
Similarly, a person with cognitive deficits or learning disability may not be able to manage the powered chair. If in doubt, refer to the NHS wheelchair service and suggest the patient has a full NHS wheelchair service assessment from a qualified professional like an Occupational Therapist.
If there is any doubt that the client will be able to use a wheelchair safely, there should be a clear request to refer the patient back to their GP for a wheelchair assessment.
And then, you need to consider these factors:
- What is their level of cognition?
- How coordinated are they?
- What’s their upper body strength and grip strength like?
- What level of physical endurance can they cope with?
You also need to ensure how appropriate the aid is for the duration of its use…
As an example, a patient may be fine in the morning but some conditions mean by afternoon they are exhausted, thus will need an attendant propelled or powered option.
Other key things to consider when choosing mobility aids:
- VAT relief is available for disabled clients, terminally ill clients and those with diagnosed long-term conditions.
- Some organisations hire wheelchairs, thus may not need to buy one.
Stuart Barrow of Promoting Independence is a member of the British Association of Occupational Therapists panel and a recognised contributor in the field of home adaptations. His experience is sought by manufacturers and service providers looking for an expert opinion. He also runs the Occupational Therapy Adaptations Conference
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