Overview
As clinicians, we need to determine if the client is an appropriate candidate for a power mobility device. I do not think it is nearly as hard as doing driving assessments with actual vehicles. However, there are safety concerns and we want to make sure that this person is appropriate for power mobility. We need to determine the appropriate power wheelchair as there are a lot of them on the market, the components that need to be part of that power wheelchair, and the actuators. Actuators are power seating options like a power tilt in space system or power recline with elevating leg rests. We then need to be able to justify the recommended equipment to get funding and that means we need to know how to document this information. Finally, we have to provide adequate support and training so that this person can have a successful outcome, and hopefully that is independent mobility. Once that chair is delivered, our job is not over. We need to then provide that mobility training.
In a mobility assessment, it is important to look at the client's goals, and often the caregiver's goals as well. We also need to review current mobility skills; there are a number of related factors we will discuss; medical and cognitive issues, the future needs of the client, the age of the client, any mobility training requirements; and finally how to get this equipment funded. It is easy for me to want to start with my goals, but it is important to remember that first we start with our client's goals.
Client/Caregiver Goals
Our client and caregiver goals do not always match up. I work primarily in pediatrics. I do see adults as well. A lot of the information that we are dealing with today could apply to both populations as we are determine the power wheelchair needs. The client might have a goal such as “I want a fast wheelchair.” I remember when I evalulated Justin. He needed his second power chair. He was in late elementary school at the time, and he knew exactly what chair he wanted, because his chair had lost during their wheelchair Olympics at school. He wanted the chair that won. His mom was much more concerned about the state of the walls in the home. Oftentimes, we need to build consensus during a power mobility evaluation.
Current Mobility Skills
Does this person have any form of independent mobility? It could be that this client is ambulating, but perhaps they need to augment that ambulation with power mobility. This does not mean that funding is not available, even if this person is ambulatory or is able to use a manual chair. What we are looking at is efficiency. Can this person be efficient with their mobility? Efficiency means the amount of effort and the amount of time. Let's take a high schooler getting from Math class to English class. If it takes them too much time, they are late for class. If it takes them too much effort, they are worn-out and cannot pay attention to the teacher. In that case, whatever their ambulation method is, it might be that it is inefficient for them and that a different mobility category is required.
A lot of people who are using manual chairs but still need a power chair are people that primarily push with one hand, and because of that, tend to go into circles. People who are used to propelling a manual chair with one hand when they first get into a power chair often tend to put the chair into reverse. When you are in a manual chair and can only propel with one hand, you pull one of those wheels back and then push forward again to repeatedly correct your course. It may take some additional training to let them know that that is not required on the power chair to change course. On some of these electronics, we can even temporarily disable reverse so that that is not an issue.
It is also important to know if this person has had any prior power mobility experience as well. If that experience was not successful, we want to reassure the client that we will stick with them and try to make this positive and beneficial experience for them.
