When reviewing the intake information of a new patient, it is common for one of the first questions the evaluating team seeks to answer is, "Will the client need a manual wheelchair or a power wheelchair?" Depending on a number of factors such as age and diagnosis, determining a suitable mobility solution prior to seeing the patient in person for the first time can be relatively cut-and-dry. However, determining manual versus power isn't as straightforward when the individual presents with diagnoses such as a developmental disorder, severe cognitive impairments, intellectual disabilities, etc., in addition to their orthopedic impairments. In these cases, the team will likely need to shift the initial focus to answering the question, "With the proper components, setup, and training, does the client exhibit the potential to be independent with mobility or is a dependent mobility device more appropriate?"
This two-part blog series will focus on identifying when a dependent mobility device is appropriate and tips for selecting the best style of dependent mobility base.
Identifying Needs
Children's, adolescents', and adults' mobility impairment can range from mild to severe, and sometimes traditional complex rehab technology (CRT) is just "too much" for the patient and/or caregivers. One way to narrow down the options is to begin with a functional ambulation assessment. This will provide a jumping-off point for discussion on the optimal mobility base recommendation. The Functional Ambulation Categories (FAC) is one tool that a therapist can use to determine what style base is needed.
The Functional Ambulation Category (FAC) rates patients as the following:
- Patients cannot walk or needs help from two or more persons
- Patient needs firm continuous support from one person who helps carrying weight and balance
- Patient needs continuous or intermittent support of one person to help with balance and coordination
- Patient requires verbal supervision or standby help from person without physical contact
- Patient can walk independently on level ground, but requires help on stairs or uneven surfaces
- Patient can walk independently anywhere
When a patient scores a 0 or 1, the decision to recommend a wheelchair is usually pretty clear. When a patient scores a 4 or 5, you may be less likely to recommend a wheelchair. However, I've often found that when the individual rates in the 2 or 3 categories, the decision for a mobility device can be a little muddier. For example:
- An adolescent with Angelman syndrome who is able to ambulate some of the time at home, but requires the assistance of a caregiver in the community for safety and stability.
- A client diagnosed with cerebral palsy and is on the autism spectrum with significant behavioral problems requiring constant supervision of a caregiver for mobility at school and in the community.
- A child who can ambulate early in the day, but fatigues to the point where he cannot walk or utilize any form of independent mobility device in the afternoon or evening.
- An individual who has seizures leading to times when ambulation or independent wheeled mobility is not possible.
- There are times when the child needs a dependent mobility base, but not extensive seating and positioning support.
- The child needs moderate seating on a dependent mobility base, but the family is unable to transport the wheelchair.
- The family does NOT want the child to use a wheelchair even though the child is completely dependent for all forms of mobility.
All of these scenarios would likely lead the evaluating team of professionals to decide that some form of dependent mobility base is appropriate, which means the next step is determining which style of dependent mobility base. The overarching dependent mobility base categories are adaptive strollers, transport wheelchairs, and manual wheelchairs (i.e., tilt-in-space and standard). In part two of this blog series on dependent mobility devices, my colleague will take a deep dive into each of these categories.
Read Part 2 of this blog: Reviewing Options