Wheelchair 411

ALLIE BISHOP, SPT

 • Initial w/c eval: Need a referral from
pt’s PCP
• Repairs: a referral or prescription is also
needed

• A pt is eligible for a new w/c every 5

When & years
• EXCEPTION: pt develops a new
How4 qualifying diagnosis
• EX: a patient has a complete L5
SCI, but then is diagnosed with
MS
• Progression of the current
diagnosis is NOT sufficient
• A patient is eligible for a new cushion
every 2 years
Proper W/C Fitting2
1. Can fit 2 fingers between
the edge of the seat and
the pt’s popliteal fold
3
2. Can fit the width of your
hand in a vertical position
between the pt’s thighs and
armrest of w/c
2
3. Can fit 4 fingers between 1
the top of the seat and the
pt’s axilla
 • Promote and educate on importance
of pressure relief techniques
• Every 2 hours for 2 minutes or every
15 minutes for 30 seconds.

• Pressure mapping referral = x-ray for

Wound Health back/knee pain
& Pressure • However, pressure mapping can
Relief/Mapping be beneficial in select cases, but
often only when it is with the
patient’s cushion in the patient’s
w/c

• Promote high protein diet and smoking

cessation
Insurance
Approval &
Accessibility
• Medicare and most other insurances
• A power w/c has to be able to get
inside the home or have a strategy
to accommodate home
accessibility in order for a patient to
be approved
• Home > community amb

• Medicaid
• Home = community amb
Manual w/cs
Folding, Rigid, Ultra
Light, & Smart Drive 1
• Ultra Lightweight
• Level of activity dependent

• Rigid
• > durable
• > efficient with propelling
• Recommended if pt is non-ambulatory to preserve
shoulder strength
• Lateral transfers
• Long term w/c users
• Foot plate for patients with SCI
• Folding
• >#
• Preferable if pt can stand during transfers
• > easily transportable

• Smart Drive
• Minimum of 1 year in manual w/c before qualifying
• Cognition
Power w/cs
Group 2 & 3

• Group 2
• “captain seat”
• Exertional-related respiratory
dx
• COPD
• Does not require PT justification
• Can be provided through
MD justification with DME
company
• Group 3
• Qualifying neurological dx
• PT/ATP referral/evaluation
required
• Purpose: QoL for w/c users with MS using the PIDAS
• Results:
• Participants who were independent with propulsion reported >
satisfaction scores
• Overall, patients with MS who use w/cs appear to have a positive
impact on QoL in all 3 categories
• Confidence/self-esteem did rank the lowest, however
• Power mobility and tilt in space capabilities also demonstrate > QoL5
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Ambulation with a w/c can allow our patients to live a healthier
life and have more independence!!!
Cont…

• This article also found that w/cs are often the most
frequently abandoned mobility aids
• Predictors
• Lack of consideration for the user’s opinion, change in their needs, or poor
device performance.
 W/C Skills Test
• Manual • Power
• Looked at the relationship • This study looked at the inter
between w/c skills and and intrarater reliability for the
QoL/community power w/c skills test
engagement • Results
• Showed excellent
• Results inter/intrarater reliability
• > skills test score • Suggests this OM can be a
predicted better self- reliable tool for research and
perceived health, life within the clinic to evaluate
satisfaction, and the w/c users capacity for
community selected skills6
engagement3
References

[1] Comparing Ultra lightweight wheelchair frames. Sunrise Medical. https://www.sunrisemedical.eu/education-

in-motion/resources/comparison-wheelchair-frames. Accessed October 16, 2022.
[2] Ferrara N. Wheelchair seating and fitting basics for physical therapists. Core Medical Group.
https://www.coremedicalgroup.com/blog/wheelchair-seating-patient-positioning. Accessed October 13, 2022.
[3] Hosseini SM, Oyster ML, Kirby RL, Harrington AL, Boninger ML. Manual wheelchair skills capacity
predicts quality of life and community integration in persons with spinal cord injury. Arch Phys Med
Rehabil. 2012;93(12):2237-2243. doi:10.1016/j.apmr.2012.05.021
[4] Michael E, Sytsma T, Cowan RE. A Primary Care Provider's Guide to Wheelchair Prescription for Persons With
Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2020;26(2):100-107. doi:10.46292/sci2602-100
[5] Rachel Devitt, Betty Chau & Jeffrey W. Jutai (2004) The Effect of Wheelchair Use on the Quality of Life of
Persons with Multiple Sclerosis, Occupational Therapy In Health Care, 17:3-4, 63-79, DOI: 10.1080/J003v17n03_05
[6] Smith EM, Low K, Miller WC. Interrater and intrarater reliability of the wheelchair skills test version 4.2 for power
wheelchair users. Disabil Rehabil. 2018;40(6):678-683. doi:10.1080/09638288.2016.1271464