Wheelchairs and Cushions Michelle Clarke Senior Occupational Therapist

Wheelchairs and Cushions Michelle Clarke Senior Occupational Therapist National Spinal Injuries Centre Stoke Mandeville Hospital

Sitting Posture • A correct wheelchair and cushion system is essential to maintain good posture, and to prevent long term problems occurring. Good posture Poor posture

Slouched Sitting • Restricts movement • Gravity pulls head forwards and down causing neck pain • Stomach muscles work hard • Pushing ability compromised • Reduced respiratory function

The process during rehab…. • Allocation of a wheelchair and cushion which are on loan whilst in the NSIC. • Wheelchair and cushion depends on level of injury; skin; posture, functional ability + lifestyle. • Trial of various wheelchairs + cushions - under guidance of therapy staff : physio for manual and OT’s for powered wheelchairs

Local Wheelchair Service • Referral to local wheelchair service is made • Each service holds own budget • Following assessment recommendations made to local wheelchair service • Wheelchair and cushion need to be delivered and ready, prior to discharge (6 -8 weeks) • After first year of being home –more insight into the type of wheelchair to suit needs + lifestyle • Wheelchair service 1 st point of call post discharge.

Posture and Seating Clinic - Assessment Posture Cushions Pressure mapping Skin

Pressure relief ●Allows blood to circulate - O 2 ●Takes pressure off sitting bones ●Reduces risk of pressure ulcers Supported Tilt Forward lean Side to side lean

Cushions • Provided and replaced by local wheelchair service • Recommendations given initially from therapist Offer • Skin protection + pressure relieving qualities • Correct and maintain good posture • Comfort

AIR FILLED : Roho • • • High Risk Roho - needs re-setting Vicair - once set, leave Vicair

GEL OR FOAM GEL: eg Jay • High to mid risk • Pummel gel daily • Place on wheelchair correctly • Washed with soapy water • Lasts 2 -3 years FOAM : eg Flotech • Low risk • Place on wheelchair correctly • Lasts 2 years

Varieties of wheelchairs • Lightweight wheelchair • High performance wheelchair

Tilt-In-Space wheelchair • Body supported for people with high level injuries • Improved breathing • Improved visual field • Pressure redistribution • Prevents forward slide • Maintains hip/knee/ankle range of movement

Hybrid wheelchairs • Emotion Wheels – powered assist • Powerpack add on

Powered wheelchairs • Re-assessment of needs and home environment by wheelchair service before provision • Indoor /Outdoor • Basic back up manual wheelchair • Assessment and recommendations given to wheelchair service.

Funding Wheelchair service provision • Wh/ch service Voucher scheme • Partnership option - % cost of wh/ch but WCS carry out repairs + maintenance • Independent option- complete cost but patient takes responsibility for repairs + maintenance • Reviewed as clinical needs change • EPIOC - powered wheelchair with back up manual wh/ch. Often WCS assess discharge address before provision. Alternatives • “Access to work” (government scheme) if returning to work • “Motability” scheme - higher rate Mobility Allowance • Aspire “Human Needs fund” - % contribution ( spinal injuries) • Private purchase

Thank you