U - WHEELED MOBILITY
U.1.1
The assessment for wheeled mobility should be completed by a clinician with training in wheelchair prescription and experience working with individuals with SCI, physical therapist and/or occupational therapist. (Adapted from OTA 2013, p.13; Level C)
U.1.2
The clinician should assess the prospective wheelchair user's functioning, consider the individual's goals and environment, involve the individual with SCI and relevant others, apply clinical reasoning, use research evidence to guide decisions, keep appropriate records of the intervention, and consult with other specialists where appropriate. (Adapted from OTA 2013, p.13; Level C)
U.1.3
Assessment for the prescription of a wheelchair, power assist device, or scooter should include trials for an adequate period while performing activities in environments that are usual and relevant to the individual with SCI and their caregiver (including the home environment or similar and surroundings, and anticipated modes of transport). (Adapted from OTA 2013, p.23; Level C)
U.1.4
Assessment for the prescription of a wheelchair or scooter should include consideration of the seating system and its integration with the wheelchair and consideration of referral to a seating specialist for individuals with complex postural and control needs. (Adapted from OTA 2013, p.24; Level B)
U.1.5
Wheelchair satisfaction and safety should be reassessed by a clinician with experience in SCI at 3-months post-procurement of a wheelchair, and at each follow-up visit, as needed. (Adapted from OTA 2013, p.24; Level C)
U.1.6
The clinician with SCI expertise should consider an individual’s behaviour, psychological status, cognitive status, and perceptual skills when considering the risk of causing harm to themselves or others prior to and during the trial of a wheelchair or scooter and refer to a suitable health professional, as needed. (Adapted from OTA 2013, p.28; Level C)
U.1.7
In instances where an individual with SCI does not have the cognitive or perceptual capacity to independently operate a powered wheelchair over different environments or an extended period of time, controls for the support individual as well as the client should be considered. (Adapted from OTA 2013, p.29; Level C)
U.1.8
Refer individuals with SCI to other specialist services (e.g., optometrist, ophthalmologist, audiologist, mobility trainers) when a vision or hearing impairment is identified. (Adapted from OTA 2013, p.31; Level C)
U.1.9
The individual with SCI should be trained to use compensatory techniques when a visual deficit exists, and their safety to use the device should be reviewed in the environment the device will be used, including the road. (Adapted from OTA 2013, p.31; Level C)
U.1.10
A clinician with SCI experience should educate the wheelchair user and their caregiver about the risks of upper limb pain and injury, the means of prevention and risk minimization treatment, and the need to maintain fitness. (Adapted from OTA 2013, p.38; Level C)
U.1.11
The individual with SCI and caregiver should be informed that alcohol, cannabis, prescribed medications (where relevant), and illicit drugs may impact their capacity to safely operate a wheelchair or scooter. (Adapted from OTA 2013, p.40; Level C)
U.1.12
SCI clinicians should prescribe seating systems based on individual considerations and assessment. (Adapted from OTA 2013, p.46; Level C)
U.1.13
SCI clinicians should consider personal factors, activities and wheelchair features when considering and evaluating a wheelchair for an individual's sitting and ride comfort: personal factors, activities, and wheelchair features. (Adapted from OTA 2013, p.47; Level B)
U.1.14
The factors that should be considered with respect to foot propulsion include pelvic stability and posture, and the ability to recover a better posture. In order to achieve foot propulsion, symmetry of posture may be compromised, which has potential long-term musculoskeletal implications. (OTA 2013, p.54; Level C)
U.1.15
Power-assisted wheelchair wheels should be considered as they may improve functional mobility and performance for wheelchair users with reduced upper limb function. (OTA 2013, p.54; Level B)
U.1.16
SCI clinicians should assess stroke propulsion pattern, positioning used, energy expenditure and efficiency, and determine the optimal wheelchair and propulsion pattern for the individual with SCI to minimize the risk of injury to their upper extremities for all manual wheelchair users. (CAN-SCIP 2020; Level C)
U.1.17
Prior to rehabilitation discharge, the clinician with experience with SCI should facilitate the provision of client/support individual training on the wheelchair or scooter to improve skill and performance. (Adapted from OTA 2013, p.60; Level A)
U.1.18
We recommend that wheelchair training for individuals with SCI includes: elements of instruction, practice sessions, and experience in the community/potential environments delivered by an experienced SCI clinician. (Adapted from OTA 2013, p.60; Level A)
U.1.19
At a minimum, the novice wheelchair or scooter user should receive training delivered by a clinician with experience with SCI on wheelchair use for an average of three to four hours over a number of weeks in approximately 30-minute sessions. The practice sessions are in addition to individual training time. (Adapted from OTA 2013, p.61; Level A)
U.1.20
Face-to-face wheelchair skills training should primarily be conducted on an individual basis, although practice sessions can involve buddy/paired or peer methods. (Adapted from OTA 2013, p.62; Level B)
U.1.21
The therapist should ensure that the individual with SCI is provided with information regarding the options for and availability of maintenance and repair service, plus who to contact. (OTA 2013, p.72; Level C)
U.1.22
The therapist should inform the individual with SCI and caregiver that the wheelchair or scooter should undergo at least one maintenance service prior to the expiry of the manufacturer’s warranty period. (Adapted from OTA 2013, p.72; Level C)