The OT’s Perspective: How a specialist occupational therapist can help with wheelchair assessments
Home adaptations specialist Stuart Barrow talks with wheelchair expert and Occupational Therapist John Fitzpatrick to discover the ins and outs of wheelchair assessments and prescriptions.
As an occupational therapist, I look at mobility in detail and assist my clients to overcome physical barriers within their home environment.
I rarely become involved with wheelchair provision as often my clients already have wheelchairs and I am asked to achieve an environment where a client can maximise their independence at home with the use of a wheelchair.
However, over the years, I’ve learnt first-hand just how important wheelchair assessments are, and in order to help the community with this, I’ve decided to ask wheelchair expert and occupational therapist John Fitzpatrick for his professional opinion on wheelchair prescription, as well as the key things retailers and manufacturers should consider when working with their clients.
John is Director of Silver Fern Therapy and has exhibited with us at the Occupational Therapy Adaptations Conference (OTAC), and he really knows his stuff.
Here are my questions, and his hugely helpful answers:
Stuart: Why is a wheelchair prescription so important?
John: “An appropriately prescribed wheelchair will increase function and enable the user to mobilise in the most efficient way possible. It will also minimise the chance of further disability – whether that be soft tissue overuse injury, muscle shortening, or pressure ulcers.
“Not everything is possible when it comes to wheelchair prescription, but having our clinical input often means the best possible compromise can be reached.”
Stuart: What process should accessors go through when prescribing a wheelchair?
John: “We use a six-step process when it comes to wheelchair prescription:
- Referral. We accept referrals from anyone, and once we’ve received one, we contact the client to make arrangements for an assessment, which is usually in the form of a visit.
- Assessment. An assessment is crucial – no recommendation can be made without a full evaluation of the client’s needs.
- Trial. Following the assessment, we’ll have an idea of the right type of equipment, but an adequate trial is vital to ensure that the equipment will stand the test of time – generally, we’ll have most trial equipment in stock, but if necessary, we can order more from a retailer or manufacturer.
- Prescription. We’ll gather all the data from the referral, the assessment and the trial, and prescribe a wheelchair that meets the needs of the client.
- Delivery. The retailer delivers to us, allowing us to make any necessary adjustments, and then we’ll do a full handover with the client.
- Review. This is an important part of our process. We recommend a six-week review because by this point, the client will be used to the new equipment and any necessary tweaks will be obvious. Ideally, you’ll also do a six-month review, particularly for children or clients with a changing presentation.”
Stuart: What are the most important things to assess?
John: “Broadly speaking, the assessment can be divided into two parts: assessment of the client themselves, and assessment of the environment.
“We’ll take into account the client’s medical history – this allows the therapist to see how the past how shaped who the client is today, and how their history will influence their future.
“The physical assessment is clearly vital – a clear knowledge of their anatomy and physiology is important. Getting the right right-sized wheelchair needs very accurate measurements and in order to achieve those, it’s best to see a client sat on a flat surface; this helps us to see how clients sit without postural support.
“Support is then added where necessary, helping to determine where support will need to be positioned on the new equipment – our vans all have mobile therapy tables for this reason.
“In terms of environmental assessments, it’s very much similar to what adaptations specialists do.
“Clearly, there’s no point recommending a 30” wide wheelchair for a home with door- widths of 27”, and there are dozens of examples of limitations within a home which need to be accounted for when prescribing equipment.
“Equally, it’s important to also consider other environments – social situations, workplaces and other frequently attended areas.”
Stuart: What process do you go through when prescribing a wheelchair?
John: “Before prescribing anything, all of the relevant information gathered during the assessment process needs to be collated.
“Once it has been collated, a recommendation can be made; but it’s important that the product is trialled adequately before any purchase is agreed.”
Stuart: How do you fit a wheelchair?
John: “We know that the first few days of a new wheelchair are vital – if a client can adapt to it quickly, then it’s done its job; if it’s not right, and they don’t use it, then that’s bad news.
“As a result, we always ask retailers to deliver wheelchairs to us; that way we can make any adjustments needed, and – crucially – complete a detailed handover that ensures that the client is comfortable.
“We’ll regularly check back in, and will make further adjustments as needed as the client gets used to the product.”
Stuart: How can you help people, and how can they get hold of you?
John: “Silver Fern Therapy provides wheelchair assessments and expert witness services on all aspects of wheelchair provision, as well as locum occupational therapy.
“If you’d like to talk to us about any of the above, you an email us at firstname.lastname@example.org or give us a call on 02921 660346. During the coronavirus crisis, please rest assured that we are still available.”
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