Mobility aids unit 1 deck 1 - TBC

Question 1

Describe the overall organization of the national wheelchair service in the UK

Answer 1

1. Wheelchairs are provided by and maintained by the Health service.
2. The whole organization is then ran by the Government

Question 2

What is the main aim of the wheelchair service team ?

Answer 2

To ensure the wheelchair user regains in part at least their mobility despite the restrictions of their medical condition

Question 3

A potential wheelchair user will be referred to the wheelchair service usually by a doctor, community therapist or hospital practitioner.

What are the 2 main referral patterns to the wheelchair service ?

Answer 3

1. Direct referral for a specific chair
2. Or referral for full assessment by team members of the wheelchair service

Question 4

What is the difference in assessment of potential wheelchair users who live within Dundee city who are referred to the wheelchair service compared to potential users who live outside dundee city but within Tayside ?

Answer 4

All potential wheelchair users from the city visit a wheelchair clinic to see a specialist medical clinician and an OT and/or Rehabilitation engineer

Whereas those from outside the city are seen by a rehabilitation engineer during a home visit, but in some circumstances the referring clinician may be asked to prescribe the person a specific chair using referral documentation posted to them

Question 5

Who are the exception to the rule of where you live determines who you see when referred to the wheelchair service in tayside ?

Answer 5

Children - regardless of where a child lives within tayside they will be seen in the wheelchair clinic like those living in dundee city

Question 6

What age are the vast majority (51%) of wheelchair users ?

Answer 6

Over 65

Question 7

What 2 main problems are the majority of wheelchair users diagnosed with ?

Answer 7

1. Neurological deficity (51%)
2. Musculoskeletal problems (20%)

Question 8

In elderly people who form the majority of referrals, neurological deficits caused by e.g. CVA (stroke) are common, what type of wheelchair is often required for them?

Answer 8

A wheelchair which is pushed by an attendant

Question 9

In young people with neurological deficits caused by e.g. CP or musculoskeletal problems caused by e.g. muscular dystrophy, what is the difference in wheelchair requirements compared to elderly patients and why ?

Answer 9

• They require continued reassessment and maintenance of the appropriate chair for them.
• This is due to being more active and still growing and developing

Question 10

Who comprises the wheelchair service team ?

Answer 10

1. Medical clinician
2. Therapist e.g. OT
3. Rehabilitation engineer
4. Technical support staff
5. Administrative staff

Question 11

What is the most common age at referral of wheelchair users in Tayside ?

Answer 11

86

Question 12

What is the main diagnosis for a wheelchair being prescribed ?

Answer 12

Neurological deficits (51%)

Question 13

What does formal assessment of potential wheelchair users ensure ?

Answer 13

Correct prescription and the continuity of provision

Question 14

What are the requirements for the environment for formal assessment of a potential wheelchair user ?

Answer 14

1. A designated clinic area - as this helps to reduce fears
2. Quiet & friendly atmosphere
3. No interruptions during assessment

Question 15

What should be displayed in the clinic area of the wheelchair clinic and why?

Answer 15

Examples of wheelchairs so the wheelchair user can see the potential wheelchairs available to them

Question 16

Who should accompany a potential wheelchair user to the assessment and why?

Answer 16

A carer or relative to help in the choice of chair and assessment

Question 17

List the priority cases to be seen in the wheelchair clinic ?

Answer 17

1. Children
2. All patients from dundee city (within 15km of clinic)
3. All cases requiring special seating
4. All self propelling chairs
5. All potential power chair users

Question 18

Where should the assessment of a potential wheelchair user ideally be undertaken ?

Answer 18

Where the wheelchair service is based in that area this may be e.g. the hospital, an artificial limb & appliance centre or a specalised rehab unit

Question 19

When there is a concentration of potential wheelchair users away from the wheelchair service centre in dundee what is done ?

Answer 19

Satellite clinics are set up e.g. at special schools, nursing homes, residential accommodation

Question 20

What needs to be completed at the end of each visit of a wheelchair user to the wheelchair clinic ?

Answer 20

Concise documentation to ensure continuity of assessment and prescription - known as wheelchair prescription form

Question 21

What needs to be included in the documentation after each visit to the wheelchair clinic?

Answer 21

1. Personal data e.g. name, DOB etc
2. Pathological diagnosis
3. Domestic circumstances e.g. alone at home, with relatives etc
4. Environmental considerations
5. Availability of transport e.g. has a car, access to taxi etc
6. Carers fitness - if being pushed by carer
7. Personal fitness - if user propels the wheelchair by themselves or controls an electronic wheelchair

Question 22

The physical characteristics of a potential wheelchair user need to be measured accurately in order to ensure correct wheelchair selection - what are the essential physical measurements which need to be taken?

Answer 22

1. Height and weight of user - many wheelchairs max weight is 100kg
2. Hip width + 4cm to avoid users hips pressing on the sides (a)
3. Thigh length minus 2cm to give ideal depth of chair to allow space behind the knee for clearance of the seats forward edge (b) - sacrum to popliteal fossa
4. Shank or calf length ideally the footplate height must enable the patient to sit with the feet flat on the plate and the thigh horizontal (c) - popliteal fossa to ground (shoes on and feet flat on ground)
5. Shoulder to seat length (back rest height) (d) - inferior edge of scapula to seat to provide comfort and make self-propulsion easier. Sometimes an extended backrest and headrest may be used
6. Arm height (e) - seat to elbow with patient sitting with upper arm vertical and elbow flexed to 90 degrees - allows patient to rest arms comfortably
7. Cushion needs should also be assessed - this can alter seat to ground or seat to footplate heights

Question 23

Illustration of thigh length - 2cm

Question 24

What position must the potential wheelchair user be in during physical measurement ?

Answer 24

Person sitting down with feet firmly supported on the ground

Question 25

Which 3 factors are important in creating a favourable environment for a wheelchair assessment clinic ?

Answer 25

1. Designated clinic area which is comfortable, quiet and friendly
2. Examples of wheelchairs on view and for trial
3. Presence of a carer/relative

Question 26

What is the max weight limit of many standard wheelchairs?

Answer 26

100kg

Question 27

What are the essential measurements needed to select a wheelchair ?

Answer 27

1. Hip
2. Thigh
3. Shank
4. Back height
5. Arm rest height

Question 28

Ultimately what must the prescription of a wheelchair take into account ?

Answer 28

1. The needs of the potential wheelchair user and their future aspirations
2. The needs of the carer
3. The environment in which the wheelchair will be used in

Question 29

Using the measured physical dimensions of the potential wheelchair user what should be offered ?

Answer 29

A range of wheelchairs if available if matching their physical measurements