Manual Wheelchairs - World Health Organization

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3.2.2 Understanding individual user needs Table 3.3. Postural needs of users related to the need for personnel skill and support User Needs Users of manual wheelchairs without modifications Children or adults who can sit well without any postural deformities or abnormalities. Users of manual wheelchairs with supportive seating Children or adults with mild to moderate postural deformities or tendencies. If unaddressed, these deformities will limit comfort, health and function. Users of complex supportive seating and mobility equipment Children or adults with complex, fixed postural deformities. even with support, many cannot sit normally. Mobility and postural support for comfort, function and the prevention of postural problems associated with permanent wheelchair use. Mobility and postural support provided through a well-fitted wheelchair and seat cushion. Mobility and postural support to stabilize posture for comfort, function and prevention of further postural problems. Supportive seating provided through individual modifications to a basic wheelchair, or a specialized seating system. Mobility and individually prescribed and customized wheelchairs to provide postural support and accommodate fixed deformities. servIce delIvery I 77 When planning wheelchair service delivery, it is important to recognize that each user has a unique set of needs. These needs can be categorized as: • physical – the user’s health situation and postural and functional needs; • environmental – where users live and where they need to use the wheelchair; and • lifestyle – the things users need to do in the wheelchair to lead their chosen way of life. Physical needs. Some users will have a more complex mix of physical needs than others. Users with postural deformities, reduced skin sensation and problems with muscle tone (for example spasticity) will require an assessment conducted by personnel with appropriate skills and knowledge. These users will also require more frequent follow-up and support. Three degrees of postural need and their relationship to the skill and support required from the personnel are described in Table 3.3. Increased need of skill and support 3
78 I guIdelInes on the provIsIon of manual wheelchaIrs In less resourced settIngs Environmental and lifestyle needs. These factors require consideration during the assessment. They will influence the choice of a wheelchair, based on performance characteristics, durability and other features. This is discussed in Chapter 4. Box 3.3. Needs for wheelchair modifications and postural support additions in South Africa How many users require more than basic wheelchair provision? Owing to a general lack of statistics, it is not possible to state accurately how many users fall into each of the groups described in Table 3.3. However, in a survey of 147 users conducted at the Western Cape rehabilitation Centre in South Africa in 2006, it was found that 58% of users required some form of wheelchair modification or basic postural support. Some 22% required complex postural support, while only 20% were able to use a basic manual wheelchair without any modification. A supervisory chief physiotherapist states: “Since our service began, we have found that many users need more than just a basic wheelchair. Many have deformities from living so long without a wheelchair and now need their wheelchair modified so that it fits them. We also have more and more children with cerebral palsy coming to us, and they need wheelchairs with extra postural support.” 3.3 Good practice in wheelchair service delivery This section of the guidelines can be used to help in planning and initiating wheelchair services and in evaluating existing services. Recommendations are presented in nine areas: good practice in overall service and for each of the eight key steps in wheelchair service delivery. 3.3.1 Overall service Good practice in wheelchair service includes the following. • Wheelchair services recognize users as clients of the service and adopt a “client-centred approach”. This means, inter alia, that: • users receive information about the process the wheelchair service will use to provide a wheelchair, and the rights and responsibilities of the user in this process; • users are actively involved as members of the service team in all steps leading to the provision of their wheelchair; and • services actively collect feedback from users about their opinion of the service and how it may be improved. • The service is equally accessible to all users, regardless of gender, age, ethnicity, religion or social status. • The service has personnel trained in its clinical, technical and training roles, who work closely with users to provide advice, assessment, prescription, fitting, training and follow-up. • The service has a designated service manager or coordinator. • A referral network is in place. • The service is well integrated with other rehabilitation and health services. • Services are knowledgeable about the range of wheelchairs available locally. • Services are able to offer more than one type of wheelchair, giving the user a choice based on the assessment.
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Other resources Cooper RA. Wheelcha
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Manual Wheelchairs - World Health Organization

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