We Need To Revamp Wheelchair Assessments

Brunel University have released the findings into a study about wheelchair assessments for people with multiple sclerosis (MS). The study, which included 91 participants with MS has suggested that a more ‘holistic’ approach to wheelchair assessment.

The study is one of the first in the UK to suggest that assessment teams need to look at patients long-term prognosis of MS, to prevent the development other long-term conditions is potentially ground breaking.  The team of researchers led by Professor Lorraine De Souza, identified 10 10 health problems including fractures, stroke, amputation and chronic joint pain that would benefit from a medical evaluation in addition to the usual assessment by a multi-professional team of therapists and engineers.

Professor De Souza explained. “We tend to treat MS as symptoms develop but, by looking ahead at those severely affected, we can see what we can do now to prevent or delay other potentially life-threatening health problems. We can also see where healthcare could do more to help those with advanced MS live a fuller and more comfortable life for longer.”

In my experience researching Cerebral Palsy, both myself and colleagues have report similar need for a farsighted approach to try and prevent other long-term secondary conditions from developing. Dr Robert J Palisano, the noted Canadian researcher, reported in 2007 that long-term thinking was needed in the treatment of patients with CP to prevent the development of secondary conditions. It is nothing but a good thing that we are now in a place, where we no longer accept secondary developments as part of the course for any given condition. These things are preventable but they are not reversible.

Personally, my experience of wheelchair assessments have been a real mix bag. Some have been a battle and some have been great.The incident that really sticks in my mind is two wheelchairs ago. My Kushall K4 was dying, the wheels were literally coming off and the old girl had led me into some very awkward situations. So, I knew that it was time to get a new one. We booked an appointment at wheelchair services in my hometown of Doncaster. The lengthy waiting list meant that it was 4 weeks before I could get in, which given current circumstances was less than ideal.

Now to be fair, I went into said assessment with very clear ideas of what I wanted. I wanted a higher seat because I no longer wished to have conversations with people’s gentiles. I also wanted a much lower back rest so that I would be forced to sit upright. These two elements are the little things that really matter. Better posture whilst in your chair is crucial to so many things such as breathing, organ function and digestion to name but a few. Given that said user has use of their back muscles, they should be using them and a low back rest allows you to do that. The height of the seat compliments this. Ensuring that the knee is at 90 degrees if the user has long legs. This all leads to good posture, which goes a long way to combating many of developmental conditions highlighted above.

However, when I attended the aforementioned assessment, the two therapists who greeted me knew nothing about that. Due to my background in sport, they mistook my requests for me wanting a sports wheelchair, even going so far as writing not for sport on the prescription! It was bizarre frankly. They wanted to prescribe a high back rest and a seat belt. The back rest, I have already discussed but the seat belt, anyone who has use of their abs should never wear a wheelchair seat belt.

Not only do seat belts inspire lazy posture, they can be quite dangerous. If a person falls out of their wheelchair wearing a seatbelt, the chair will fail on top of them. Needless to say their injuries will be far worse with, than without! I dread to think what kind of chair I would have ended up with had we followed their original prescription.

But the sad truth of the matter is that many people would take those recommendations at face value, and that is how we get to people being prescribed wheelchairs that poorly fit their needs. If this study by Brunel goes some way toward changing those sorts of scenarios, then that will be genuine progress.

 

Read the Brunel research paper here: http://informahealthcare.com/doi/full/10.3109/09638288.2014.949356

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