When we are considering a manual wheelchair, are we considering a power assist option?
We have been discussing shoulder preservation and how it relates to the weight of the wheelchair, the configuration of the wheelchair, and to the individual and their pre-morbid shoulder health. We have also discussed how mobility is NOT and should NOT be exercise. So, how do I know when I should be considering a power assist option? First, we have to look at each individual end-user/client, their goals, environment, and any current shoulder pathologies.
This is one of the most important pieces of information that we need to understand from the assessment. As the therapist we can often just ask the question about what goals the end-user has, but do we really hear all the goals? Often the client may be able to express all of their goals, but just as most of us, we are not always able to express or understand our goals. I like to think about this as when someone approaches me and asks, “Where do you want to be in 5 years?”. This is a difficult question if I haven’t had time to think and prepare an answer and often it is hard to know this answer without having a deeper discussion.
This can be the same when talking about goals for the client. If this is someone going into their first manual wheelchair, they may have no idea about what is possible. They may have goals that they want to achieve, but believe it is not an option. Or, perhaps they are not able to even generate a list of goals. They might list a goal or two when asked just to appease their therapist, or just to try to participate.
Then we have to think about the clients with cognitive or communication deficits. Does this mean that they don’t have goals? It is crucial that we as the therapist or as any member of the team spend time to discuss goals with the end-user, their carers, and family. Their goals will help us to better understand the needs of their mobility device and if power assist should be considered.
If you are a therapist going into the community, you are able to see first-hand the client’s home environment but remember there is a lot more to someone’s environment than just their home. I like to think about this like 24-hour positioning. I need to consider every typical environment that the end-user encounters not only just in a one-day time stamp but does this change across different days of the week. Like myself, on the weekdays I may only encounter my home, car, and work environments, but on my weekends, I prefer to spend my time outdoors.
As a therapist, it is important that we are able to ask the right questions to better understand the environments that will be encountered.
Have you ever asked someone if they are in pain and they respond no, but then within minutes you find out they take pain medication daily? There are many reasons that pain is not discussed during an assessment. This can range from the question not being asked, the client not wanting pain to keep them from their goals or activities, the client may forget that they are taking pain medication, etc…. No matter what the reason is, it is crucial to determine if the client has any underlying shoulder pain or pathologies.
This doesn’t mean that they are not appropriate for manual mobility, but it does help to determine if a power assist option should be considered.
While there are still many other important aspects of the assessment to consider, this is a good starting point. Take this information you gather from the assessment and determine if the client is at a risk of further shoulder pain/problems, not being able to navigate in their environment, or if they are not able to achieve their goals without the use of a power assist device. If the answer is yes to any one of these, then discuss with your client and dealer/supplier power assist options.
I often hear that therapists just don’t think about it during the assessment of trial. I know there can be a LOT to consider, but power assist can truly change a client’s life.
Rachel Fabiniak, PT, DPT
Director of Clinical Education – Permobil APAC
Rachel Fabiniak began her studies at The Georgia Institute of Technology, where she graduated with her Bachelor of Science in Biology in 2009. Rachel then went on to receive her Doctorate in Physical Therapy from Emory University in 2013.
After receiving her doctorate, Rachel went into clinical practice as a physiotherapist in the Spinal Cord Injury Day Program at Shepherd Center in Atlanta, GA. There she developed a passion for seating and mobility which ultimately lead to her career with Permobil.