Eight Steps to Appropriate Wheelchair Provision
Original Editor - Your name will be added here if you created the original content for this page.
Top Contributors - Ilona Malkauskaite, Naomi O'Reilly, Kim Jackson, Rucha Gadgil and Robin Tacchetti
Introduction[edit | edit source]
In 2008 with input from more than twenty-five wheelchair and rehabilitation expert the World Health Organisation (WHO) released the Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings, which sought to combat the risks associated with wheelchair distribution and to address the challenges of the health sector in providing appropriate care for people with disabilities. The guidelines address manual wheelchair design, production, supply, and service delivery for long-term wheelchair users. In the guidelines WHO outline eight main steps that wheelchair service personnel need to carry out in order to provide a wheelchair:
- Referral and Appointment;
- Assesment;
- Prescription;
- Funding and ordering;
- Product preparation;
- Fitting;
- User training;
- Maintenance, repairs and follow-up.[1]
Referral and Appointment[edit | edit source]
The way that wheelchair users are referred will vary. The system of referral will depend on existing services in the country. Users may refer themselves or be referred through networks made up of governmental or non-governmental health and rehabilitation workers or volunteers working at community, district or regional level. Some wheelchair services may need to identify potential users actively if they are not already receiving any social or health care services or participating in school, work or community activities.The objective of good practice in referrals and appointments is to ensure that users have equitable access to wheelchair service delivery, to increase the efficiency and productivity of the service, and to minimize waiting lists. [1]
Good practise in referral and appointment systems contains:
- A file establishment for user and an arranged appointment or users placement in a waiting list;
- Personnels training in wheelchair service;
- Distribution of a form for referral network agencies to complete when referring users;
- Clear guidelines for appointments priority;
- Targets setting and performance measuring;
- A screening procedure to minimize the sceduling of inappropriate referrals.[1]
Assesment[edit | edit source]
Assessment is the second step in wheelcahair service. Each user needs an individual assessment, taking into account lifestyle, work, environment and physical condition. Information collected from the assessment will help the wheelchair service personnel and wheelchair user to:[1]
- Choose the most appropriate wheelchair from those available;
- Work out what possible additional postural support may be needed;
- Decide what training or support the wheelchair user family member/caregiver;
- May need to use and maintain their wheelchair;
- Assessment at both basic and intermediate level is carried out in two parts;
- Assessment Interview
- Physical Assessment
Good practice in assesment:
- Assessments are carried out in a private, quiet and clean space;
- Assessments are carried out by trained personnel;
- Equipment for the assessment is readily available, including an assessment bed (plinth, mat, table), measuring tape, device for measuring angles (goniometer), foot blocks and infection control supplies;
- Assessment takes into consideration the user’s physical condition; home, school, work and other environments where the wheelchair is used; lifestyle; size and age;
- Assessments are clearly documented on an assessment form and filed for future reference;
- Where a service is unable to meet the user’s needs owing to the lack of an appropriate product or personnel with sufficient skills, the service refers the user to another servicethat, hosts outreach visits of more qualified personnel or documents the user’s needs to help build a picture of unmet needs to guidefutureservice development.
Prescription[edit | edit source]
Using the information from the assessment, a wheelchair prescription is developed together with the user and family members or caregivers. The prescription (selection) details the selected wheelchair type and size, special features and modifications. It also describes the training the user needs in order to use and maintain the wheelchair properly.[1]
Funding and Ordering[edit | edit source]
A funding source is identified, and the wheelchair is ordered from stock held by the service or from the supplier.
Product Preparation[edit | edit source]
Trained personnel prepare the wheelchair for the initial fitting. Depending on the available product and service facilities, this may include assembly, and possible modification, of products supplied by manufacturers or manufacture of products in the service workshop.[1]
Fitting[edit | edit source]
The user tries the wheelchair. Final adjustments are made to ensure the wheelchair is correctly assembled and set up. If modifications or postural support components are required, additional fittings may be necessary.[1]
User Trainer[edit | edit source]
The user and caregivers are trained how to use and maintain the wheelchair safely and effectively.[1]
Maintenance, Repairs and Follow-up[edit | edit source]
The wheelchair service provides maintenance and repair services for technical problems that cannot be solved in the community. It is appropriate to carry out follow up activities at the community level as much as possible. Follow up appointments are an opportunity to check wheelchair fit and provide further training and support. The timing depends on the needs of the user and the other services that are available to them. If the wheelchair is found to be no longer appropriate, a new wheelchair needs to be supplied starting again from step one.[1]
