Wheeled Mobility Assessments

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.  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

1. 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.
2. 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.
3. 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.