When it comes to finding the right wheelchair, no two patients are the same. Their needs can vary greatly depending on their condition, abilities, and lifestyle. And given the level of customization and technology available today, the options are virtually endless.
That’s where the UAB Outpatient Therapy Wheelchair Seating and Assessment Program can help. Based in UAB Spain Rehabilitation Center, this unique clinic evaluates patients with complex seating and mobility needs and fits them with custom equipment to help them live more independently. The equipment ranges from manual wheelchairs with custom seatbacks and cushions to power wheelchairs with incredibly advanced control systems.
“We get a lot of referrals from inside UAB, but people from all over Alabama come to see us,” said Cathy Carver, a physical therapist for the program.
Getting mobile
The program helps patients more safely and independently maneuver around their home, for longer stretches of the day than they could without this equipment. Some patients have long-term disabilities and need to replace their current wheelchair or need a new seating system due to a change in their condition. Others are first-time wheelchair users coming out of inpatient rehabilitation.
The program works with adult patients affected by a wide range of conditions, including neurological disorders such as cerebral palsy, multiple sclerosis, and ALS. Others have conditions that can cause muscle weakness, such as muscular dystrophy, spinal muscular atrophy, cognitive impairment, head and spinal cord injuries, amputation, chronic pain, and age-related conditions.
“We’re trying to get people mobile,” said Ashley Matteo, another physical therapist with the program. “And posture is very important, because when you’re up in a chair and positioned correctly, your breathing and digestion are going to be a lot better, too.”
Meeting patient needs
Patients and their caregivers first meet with a UAB Medicine physical therapist to review their medical history and determine what type of wheelchair and accessories best fit their specific needs and goals.
“We spend a lot of time figuring out someone’s 24/7 function – what they do, who’s involved with their care, and what environments they’re in,” Carver said. “Also, we look at how they do their basic home activities like getting dressed, bathing, and eating, and what their activities are outside the home. And through that process, we assess their body, posture, strength, and the different things they need. You can have two people with the exact same diagnosis who end up with two totally different systems because of their family situation, environments, and specific needs.”
Matteo added, “You really have to talk to them or their caregiver about their home setup. What kind of transportation are they going to be using? Are they working? Do they have a hobby? Are they going to be able to get a wheelchair around their house? Things like that matter, because we’re trying to get them what they need to be more independent and healthier.”
For patients who cannot push a wheelchair all day due to upper body limitations, they may use a “group 2” power wheelchair designed for regular indoor use but has limited seating adjustments and power functions.
For patients with more complex conditions who need a wheelchair full-time, a “group 3” model might be a better choice. Group 3 wheelchairs have multiple powered functions to adjust the seating position, recline, or raise their feet, which helps prevent pressure sores. Some models also have elevating functions to move patients up or down.
A complete assessment based on their diagnosis also helps ensure that patients qualify for the level of equipment they need.
“To be eligible for a complex rehab technology wheelchair and seating system, a person needs to have a medical reason that impacts their long-term mobility and function,” Matteo said. “Their loss of function and medical condition may impact their ability to change positions, which can help justify the need for power mobility or power functions.”
Assistive technology
Patients can use a wide variety of adaptive devices to control the wheelchair based on their level of function. These range from joysticks to advanced systems that respond to head or foot movements, breath pressure, or even eye movements.
The program has a large collection of demo equipment, so patients can experiment to see what best suits their needs.
“They can sit in, feel, and test drive equipment,” Carver said. “We have a space where we can take them outside and drive on ramps and sidewalks and curb cuts, as well as a bathroom where they can actually see if the equipment will meet their goals.”
Once the equipment needs are determined, the program works with the vendors and the insurance company to place the order. After the wheelchair arrives, patients meet with a therapist and a representative from the supplier for a final fitting. During this meeting, the patient and caregiver are educated on how the new chair works, the best way to transfer to and from it, and how to perform other basic functions. Most suppliers perform any maintenance needed during the wheelchair’s lifespan, which averages 5-7 years.
“When that chair comes in, the family members just beam and say, ‘Wow, now I can take them out with me’ or ‘Now they can sit up and hold their head up – they’ve never been able to do that before,’” Matteo said.
Carver has witnessed similar reactions from caregivers and patients alike during her 29 years with the program.
“Nothing is more rewarding than seeing someone come in with a heavy burden on their shoulders and then leaving here a little lighter,” she said. “They go from seeing a wheelchair as a stigma to having a tool that’s going to set them free.”
November is Assistive Technology Awareness Month. To learn more about the UAB Outpatient Therapy Wheelchair Seating and Assessment Program, please call 205-975-4922 (option 2, option 2).