Wheeled Mobility Assessments
Jenna Kazmaier, SPT
BACKGROUND:
During a clinical rotation at the UNC Center for Rehabilitation Care, I was able to observe several wheeled-mobility seating evaluations. An afternoon spent with an Assistive Technology Practitioner further opened my eyes to the complexity and depth of knowledge required for this area of rehabilitation. This past year, I have had the opportunity to work with several individuals who use wheeled mobility, and have been exposed to the benefits mobility devices provide, the frustrations accompanying them, and the inevitable creativity, advocacy and ingenuity required to maintain them.
For those utilizing wheeled mobility, a properly fitted mobility device allows them access to equality in participation, socialization and independent movement. The United Nations Convention on the Rights of Persons with Disabilities highlights that access to high quality mobility devices are an essential and basic human right.1 Unfortunately, our healthcare system places restrictions on how often someone can receive new mobility devices.1,2 Even with insurance coverage, cost is a major inhibitory factor for individuals seeking wheeled mobility, particularly because mobility devices require frequent and cost-incurring repairs and maintenance.1,2 Working within restrictions of the system then, it is imperative that an interdisciplinary team work together to ensure an appropriate and durable mobility device is provided for wheeled mobility users. As physical therapists, we play a vital role in the prescription of mobility devices, and therefore in the access to full and equal participation within society for our patients.
OVERVIEW/PURPOSE:
There are more than 3-million individuals in the United States who use wheeled mobility devices.1 These are unique and complex pieces of equipment which require a thorough evaluation by multiple healthcare clinicians. In addition to providing a means of mobility, these devices have been evidenced to improve an individual’s participation and activity domains within the ICF model.3 Physical therapists need advanced knowledge in the area of wheeled mobility assessments in order to properly prescribe devices for patients and to optimize patients’ participation and activity capabilities.
The purpose of this capstone is to provide a 10-step wheeled mobility guide for students as a resource when performing wheeled mobility assessments. Through the 10-step guide, a case study is utilized featuring an individual with a chronic traumatic brain injury who requires a complex seating system. The goal is to introduce students to common seating issues and common solutions, as well as to more complex seating challenges.
STATEMENT OF NEED:
Dr. Karen McCulloch provides students with an excellent introduction to wheelchair evaluation and fitting during the Neuromuscular Intervention and Assessment course. The intention of this capstone is to expand upon this lecture by providing an in-depth guide to performing wheeled mobility assessments, as well as a case-study to illustrate specific steps, interventions and challenges for a complex patient.
Through discussions with my capstone committee members, Dr. Karen McCulloch and Dr. Audrey Osinski, we concluded that this learning module is best suited for students going on inpatient rehabilitation or neurological outpatient rotations, in order to better prepare them for wheeled mobility assessments.
PRODUCTS:
- The PowerPoint, titled “Wheeled Mobility Assessments: Guidelines + A Case Study” is the main product. Per the objectives of the guideline, I hope it helps students feel less intimidated by complex seating evaluations by outlining key components of an assessment as well as common seating issues and solutions.
- A Pre-Test and Post-Test allow students to test their knowledge prior to and following reading through the PowerPoint.
EVALUATION:
Throughout this process, my capstone committee members were instrumental in providing me with well-thought out feedback to improve my materials.
Finally, an evaluation form was provided to classmates who donated their time to providing me with feedback regarding the effectiveness of the materials, quality of content, overall organization, and whether the material was appropriate from a health-literacy perspective.
SELF-ASSESSMENT:
Initially, I struggled with coordinating times to observe wheeled mobility assessments in the clinic due to a long series of cancelled appointments. Ultimately I realized this was a testament to the complexities of these evaluations within our healthcare system. Due to scheduling back-ups, patients needing wheeled mobility assessments had to be scheduled many weeks out. Inevitably, those individuals either decided to go elsewhere for an evaluation or forgo the evaluation all together. In addition to scheduling conflicts, this process helped me witness first hand all the other challenges with seating systems. For example, my case study featured CZ, who lives in a skilled nursing facility with constantly rotating caregivers. Thus, re-positioning and proper maintenance of his chair is challenging and requires extensive caregiver education. Due to the complexity of his needs, his seating system requires lots of parts, which increase the likelihood that vital parts will break. Working with him and his mother has illustrated the need for advocacy, patience and creativity to keep his seating system functional. I am grateful to have seen their hard work and dedication to advancing CZ’s independence and mobility.
Researching the key components of assessments, observing and learning from assessments was fascinating, but I think my key takeaway from this project has been that perfection is not realistic. As therapists, we have to include the reality of the situation in our plans, and remember that in order to optimize a patient’s mobility and independence, we have to attend to each patient’s complex and unique needs.
Ultimately, I am pleased with the work I have put into this project and am proud of the final product. Despite initial set-backs, I’ve learned flexibility in the unexpected and honed communication skills with clinicians and family members. I plan to continue gaining knowledge regarding wheeled mobility assessments and hope to use this information in future practice.
ACKNOWLEDGEMENTS:
I am forever thankful for the mentorship, guidance and expertise from Dr. Karen McCulloch. In addition to providing critical feedback, she been instrumental in sparking my interest in working with neurological populations and encouraging me along the way. To my committee member, Dr. Audrey Osinski, it has been so valuable to watch your passion and expertise in working with individuals with complex neurological diagnoses. The knowledge and guidance from KMac and Audrey have been indispensable during my DPT educational experience. Â In addition, I want to thank the entire rehab team at the UNC Center for Rehabilitation Care, including Dr. Courtney Matrunick and Dr. Corinne Bohling, who have inspired me with their tireless efforts to provide the best care to each individual they work with. Finally, this Capstone would be nothing without the contributions of CZ and his family. CZ, you are sweet, witty and full of personality, and working with you over the past year has been a great adventure!
References
- Magasi S, Wong A, Miskovic A, Tulsky D, Heinemann AW. Mobility device quality affects participation outcomes for people with disabilities: A structural equation modeling analysis. Arch Phys Med Rehabil 2018;99(1):1-8. doi:10.1016/j.apmr.2017.06.030.
- Pedersen JP, Harmon D, Kirschner KL. Is an appropriate wheelchair becoming out of reach? PM R 2014;6(7):643-649. doi:10.1016/j.pmrj.2014.06.001.
- Salminen A-L, Brandt A, Samuelsson K, Töytäri O, Malmivaara A. Mobility devices to promote activity and participation: a systematic review. J Rehabil Med 2009;41(9):697-706. doi:10.2340/16501977-0427.
8 Responses to “Wheeled Mobility Assessments”
Jenna Kazmaier
Thank you to everyone who took the time to review my capstone products! This project has reaffirmed my love of working with neurological populations, as well as the importance of continuing to expand our knowledge base to best serve our patients.
KMac and Dr. Thorpe- Thank you for referring the students going to Guatemala to my project – I sincerely it adds to the success I already know the trip will have.
Nikki and Hannah- I am glad you will be able to utilize this resource in the future if you need to do a wheeled mobility assessment. Also, thank you for your encouragement along the way! You are both excellent, driven and compassionate clinicians.
Alison, Olivia and Elise – I do hope this resource is useful in Guatemala. Unfortunately, wheeled mobility assessments are complex and require a hierarchy of insurance companies and parts to find the right “fit” for individuals. I know with your creativity, you all will be able to make positive impacts for those utilizing wheeled mobility in Guatemala. I also hope this project also serves to ignite some passion for advocacy for healthcare reform!
Olivia DeSena
Jenna,
You did an amazing job with your capstone project! Wheelchair evaluations can be incredibly complex, and I appreciate the detailed and practical information you provided in your project. I am saving your presentation as a resource for future clinical practice. In the near future, I agree that this will be a useful resource for our service trip to Guatemala! I think that one of the biggest challenges for us will be to provide positioning supports using available materials rather than wheelchair supports that we have access to in the US. I appreciate how you tied seating to practical needs and mentioned that even with the ideal seating system, perfect alignment all the time may not be possible.
It is clear that you are knowledgeable about this topic and truly care about your patients’ accessibility needs. You are going to be an incredible physical therapist!
Elise Widman
Jenna this project is everything I’d expect from you – thorough, considerate and extremely well researched! I looked at it after Kmac’s recommendation prior to traveling to Guatemala and am excited to use the information you’ve put together in order to better assist those we work with. Despite working with a number of individuals with wheelchairs in the past I know my knowledge of the purpose and optimal positioning techniques still falls short and reviewing this certainly pointed to some past examples of poor positioning tools. With my upcoming inpatient rehabilitation rotation this summer, I expect your research on both measurement and solutions to pelvic tilt and rotation to be valuable and help me feel more prepared as I start in this complex setting. Thanks for your constant dedication to practicality and useful knowledge!
Debbie Thorpe
Jenna
Very informative project that will be very valuable for training DPT students as well as clinicians that have limited experience with fitting wheelchairs. Indeed a valuable resource for the Guatemala trip!
Hannah Manik
Jenna– As someone who has room for growth in wheelchair mobility assessment competence, I learned so much from your presentation! While on my school systems rotation, I witnessed the difference that the optimal wheelchair device, fit, and accessories can make on one’s functional independence and quality of life. Despite this, I have very limited experience in performing seating evaluations but your presentation definitely made these concepts less scary. Your PowerPoint is well-organized, visually-pleasing, and engaging, especially due to your inclusion of case examples from your personal experiences.
You demonstrate a level of empathy, patience, and compassion for your patients and clients that is truly admirable. I respect your tenacity and passion for improving the well-being of patients with complex mobility needs and know that your project will be a valuable resource for myself and others to enhance equal access as we all inevitably encounter one of the millions of US individuals who require a seated mobility device and assessment.
Alison Berglund
Jenna,
Great job on this project!! Your presentation is well organized, easy to understand, and really simplifies the process of conducting a wheelchair evaluation. This will be a great addition to the lecture about wheelchair fittings in Neuromuscular Interventions & Assessment in years to come. It will also be a valuable resource for those of us traveling to Guatemala next week. I am excited to use these guidelines and tips when we conduct wheelchair evaluations on the individuals we see there. I also really appreciate your incorporation of the case study into this project as it definitely kept me engaged. Your descriptions of potential problems and solutions to be aware of when conducting a wheelchair evaluation were also very helpful and I am sure I will be referring back to these slides in the future. Your project reflects your wonderful work ethic and devotion to the individuals you treat. I know you will be an excellent physical therapist and I am so excited to see all that you accomplish during your career! I am confident that you will “improve the human experience” of each and every person who is lucky enough to have you as a therapist!
nicole mogensen
Jenna- I’m so impressed! Your case study is extremely thorough- I will definitely be saving it to review later if I am ever in charge of someone’s wheelchair evaluation. I don’t think I really appreciated the complexity of fitting someone, especially someone with a lot of positioning needs. It has been so amazing to watch you grow throughout physical therapy school and work with so many members of the community. I am not surprised that you were able to incorporate your work in the community into your capstone project. Whoever ends up employing you will be lucky!
KMac
Jenna – This is an excellent project!!!
One of the things we are planning in Guatemala is to do wheelchair evaluations on all of the individuals who we see – so I’m encouraging everyone to review YOUR project before they go!!!
kmac