Wheelchair Selection and Repair

Posted by Nurse Linda in Life After Paralysis on September 29, 2020 # Mobility, Home Modification

Wheelchairs can be a necessity after spinal cord injury. Some individuals will use a wheelchair for all mobility needs, others will use one part-time, and some will not use one at all. It all depends on your level of injury, functional status, and other health conditions or concerns.

The selection of a wheelchair is often a challenge because the person who needs one has no experience in the process. There are also constraints, including what your payor will allow. Payors usually have guidelines to follow. They also have contracts for better rates when they purchase from specific companies.hand on wheelchair

Your first chair will probably be recommended by the therapist at your rehabilitation hospital. A standard hospital type wheelchair is not very flexible and certainly not easy to mobilize on your own. Specialty chairs are preferred. They come in a variety of types. Each section of the chair can be specified according to your needs and measurements.

Individuals with lower-level injuries typically use manual chairs, while power chairs are used for higher-level injuries. Power chairs might have the tilt feature so you can perform pressure releases by moving your chair instead of your body. Those with middle-level injuries will be provided either type of chair, depending on function. Other considerations include health issues such as cardiac or shoulder injury.

Measurements start with seat and back sections height, width, and depth. The front of the seat should not touch the back of your knees to avoid circulation problems like the development of deep vein thrombosis (DVT) or blood clots in the leg. The composition of materials will vary. Seats are mostly standard as pressure dispersing surfaces are separate items. The back may or may not be pressure dispersing depending on the height needed. Higher backs will require this equipment.

Options abound but are funded based on need. The armrests are typically removable so that transfers can be accomplished. Some armrests are most often completely removable, while others swing out of the way. Both have advantages and disadvantages. The height of the armrest is adjustable to accommodate wheelchair push-ups or pressure releases. For those with higher-level injuries, armrests will be at a height to accommodate the arm to take weight is off the shoulders. Troughs or armrests are attached to support the arm and hands if they are affected by the injury.

Footrests typically swing away for transfers and fit the length of the leg and foot to support the weight of the leg, avoiding joint injury. There may be a support for the calf. If edema is an issue or if using a tilting power chair, the leg rests will elevate to raise the legs.

If support of your head is necessary, this extension will be provided. Careful attention to pressure dispersion is a consideration to avoid pressure injury on the back of the head.

Powering your chair has options as well. Payors will base decisions about funding these based on your needs. The user typically powers a manual chair. People like speed. Be sure to start with your arm straight down and moving it forward for propulsion. It is a good habit to form at any time. This will help avoid shoulder injury in the long term. If you develop shoulder problems or have a bit higher level of injury, a power assist can be added to your chair to help propel it.

Power chairs are much bigger and heavier than manual chairs. A lot of the weight comes from the battery, which must be plugged into an outlet for recharging. These chairs might be driven using a joystick, sip, and puff or another alternative device. Generally, power chairs are used by individuals that have limited arm function and higher-level injuries. If a ventilator is needed, it can be attached to a shelf on the back of the chair. This will make your mobility contained in the space of your chair.

Some accommodations for travel with your chair will need to be considered. A manual chair might be transported by a rack on the back of a vehicle, a top carrier, or even placed on the floor in the back seat. An alternative is the use of an accessible vehicle, which is necessary for a power chair. Power chairs are extremely heavy, so it is difficult for someone to break them down and lift into a vehicle. Plus, it would help if you had a seat that will accommodate your needs, so typically, an accessible van is used.

Accessible vans have an entry at the side or back. Consider your lifestyle for which would be the better use. The vans that have a ramp that opens in the back can block traffic or put you in the way of traffic when entering. Vans with side entry ramps do not always fit in parking spaces. If someone parks next to you, you might not have space to enter your vehicle.

Homes should be evaluated for wheelchair accommodation. Measure your doorways to be sure your chair can fit inside. You will also want to have someone build a ramp if there are stairs to enter your home.

Once you are familiar with wheelchairs and their needs, you will become dazzled with the options that would accommodate your lifestyle. There are chairs that are designed specifically for the beach or use on sand. Rugged terrain chairs are also available for outdoor or off the beaten path activity. Specialty sports chairs accommodate almost all athletics. Some chairs climb steps; others allow standing, so you are eye to eye with friends or business associates. There are covers for wheelchairs that enclose the space like a small car for environmental control. Your payor will not cover most of these options.

Chairs are replaced by the payor every three but more often, five years. The timeframe depends on the payor’s schedule in your policy. Occasionally, chairs are replaced if something happens that really destroys them, but you are responsible for the quality of care provided to your chair. These are expensive devices that need attending to and maintenance.

If there is a problem with your wheelchair, you can contact the vendor that sold it. They should be able to provide repair. Some companies are more responsive than others. If you are not finding satisfaction with your service, think about a different vendor at the next purchase. You might be limited by your payor, so be sure to tell them if there is difficulty with a vendor. Your payor does not want undesirable service either. Ask fellow users or check SCI blogs about vendor service to see if others are having the same issues.

Some individuals do small wheelchair repair issues on their own or with the help of a caregiver. If you do not feel comfortable with this, do not attempt to do it. Your safety should be the primary driver for wheelchair repair. You can go online to see how some repairs are done. This is helpful for self-education to ensure the service person is doing what should be done. Wheelchair brake repair is the number one wheelchair repair issue. Breaks are essential to your safety, so monitor the service to your chair.

I was recently at a seminar where service to wheelchairs was discussed. There is some great information for wheelchair repair and servicing at these sites:

There is even a study that you can participate in for wheelchair maintenance. Collecting this information can help others in their quest for a great chair and service. You can keep track of your own wheelchair maintenance, too:

https://pittplusme.org/studyarms/publicdetails?Guid=24bd3c84-8e57-4270-9bb7-118fa9f40c26

This blog is only a start about wheelchair maintenance and service. Care of your chair can reduce the need for service calls. It can improve your quality of life.

Also, be sure you contact your insurance nurse case manager to discuss your needs for wheelchairs. This person can be reached by calling the phone number on the back of your insurance card. Your health care professional can write a letter of medical necessity if there is something that is specific to your needs that would improve your life for health reasons. Nurse Linda

Pediatric Consideration:

Pediatric healthcare equipment is not just a smaller version of adult equipment. Wheelchairs are necessary devices to increase the independence and mobility of your child. They should be used by your child and not as toys for others. Damage to a wheelchair can hamper the development and freedom of your child.

Children sometimes outgrow their wheelchair before it is time to get approval for a new one. Having the therapist that measures and orders the chair make accommodations for growth is critical. Children’s chairs should have arms and leg rests that can be modified to accommodate size changes. Sometimes, seats can be exchanged for different sizes as needed.

It will be important to keep in contact with the insurance case manager. Maintaining a good relationship will help with all aspects of care needs. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.