How to Get the Finest Wheelchair Setup for Your Life-style

The wheelchair choice means of getting fitted for and selecting the very best seating system (wheelchair, cushion and backrest) could be a daunting course of. To make it easier to take advantage of out of the subsequent time you choose a wheelchair, or to maximise the match and efficiency of your current chair, we put collectively an inventory of questions that handle info we want we knew once we began out, and posed them to 3 longtime consultants within the wheelchair trade. 

Our listing of consultants:  

Rory Cooper is the founder and director of the Human Engineering Research Laboratories, FISA Foundation, a Paralyzed Veterans of America Distinguished Professor on the University of Pittsburgh, and a senior analysis profession scientist on the U.S. Department of Veterans Affairs. He is in his forty fifth 12 months as a T7-8 para. 

Justin Kimrey has been a full-time assistive know-how skilled for Stalls Medical in Raleigh, North Carolina, for 12 years. He is in his twenty second 12 months as a T12/L1 full para. 

Jenny Lieberman is the senior medical specialist for wheelchair seating and positioning on the Department of Rehabilitation and Human Performance at Mount Sinai Hospital. She has a Ph.D. in occupational remedy, has been an OT for 29 years and has held an ATP certification for 21 years. 

New Mobility: When you’re eligible for a brand new wheelchair, what preliminary steps must you take to ensure you find yourself with the very best wheelchair to your wants? 

RC: Consult with a peer group or native advocacy group and ask who to go to for a seating clinic and ATP/DME vendor. If you’ve a possibility, attempt completely different chairs to see what you want. Have your listing of what you need, however understand that no single chair will meet 100% of your expectations and desires.

JL: Do your analysis, ask your pals, go to reveals like the Abilities Expo, discover what makes you are feeling “good” after which work along with your workforce of therapists and seating professionals to make sure a holistic setup of design and assist. The essential consideration needs to be stability and assist, and insurance coverage solely considers what’s medically essential. Keep this in thoughts as your workforce makes suggestions for protection whereas making an attempt to satisfy your private wants.  

JK: If there are a number of DME’s in your space, name all of them and see which one you want. An vital query to ask the DME vendor is, “Is the ATP you will be working with willing to spend time with you at the vendor showroom (if there is one) looking for the equipment you are interested in?” 

JL: Insurance will solely pay for a brand new chair each 5 years. If you aren’t capable of finding seating clinic and wheelchair seller in your space, it’s value a protracted drive and evening or two in a lodge to get the correct match and setup. Unfortunately, throughout the nation there are lots fewer seating clinics than there have been 20 years in the past. 

JK: Choosing the correct gear needs to be a win/win, workforce strategy with the therapists and technicians you’re employed with — however on the finish of the day you’re the boss. If your workforce isn’t aligning along with your wants, discover a new workforce. 

RC: You wish to be organized to be able to take part in or lead the method, and never miss something crucial. Know what your wants are and be capable to articulate them clearly. Create an inventory of the actions that you simply carry out or want to have the ability to carry out. Know and be capable to describe the challenges you might be encountering. If you at present use a chair, listing what works properly for you and what could possibly be improved.  

JL: Before you go to your analysis, create an inventory of what you need and what you want in a chair, but additionally be open to the workforce’s suggestions and their recommendation. We attempt to match what the individual needs, however typically we are able to’t. Discuss along with your workforce why the alternatives of chair and setup are being made, so you might be all on the identical web page. 

NM: What are the important thing concerns for becoming a wheelchair to greatest fit your wants? 

JK: Depending on how lengthy you’ve been a wheelchair person, you’ll in all probability have completely different wants or concerns. A brand new person is normally involved about weight, operate, caregiver issues and luxury. A extra skilled person could also be involved about diploma of customized choices for a extra precision match, sturdiness, weight and look. 

RC: Form, operate, and becoming into your life-style. Cost needs to be a secondary issue. The chair must make you cellular and assist your exercise life-style. You wish to make certain you should utilize it in your house and neighborhood. Also, how straightforward is it to carry out transfers and customary actions of each day dwelling?  

JL: The very first thing is you wish to be certain you are feeling steady. You ought to have stability level the place you may elevate your fingers up and attain and do issues with out feeling like your physique goes to fall over or the chair goes to tip over. The subsequent factor is whether or not the wheelchair is comfy and protects your pores and skin integrity. Those are more durable and take sitting time to find out. 

NM: How do you discover the very best mix of enhancing operate and posture? 

RC: Ideally, they go hand in hand. You wish to watch out about including too many equipment. I’ve seen too many individuals use a high quality chair that has been hampered by including each attainable accent. I favor to be a minimalist to enhance operate and reliability.  

JL: As a therapist, we do a correct bodily evaluation to find out vary of movement and postural limitations, each with and with out gravity (i.e., mendacity down versus sitting up). Once we all know how gravity impacts alignment and have true vary measurements, we are able to problem-solve what sorts of cushions and backs will enable for the very best assist. Then we attempt the merchandise, having customers actively attain, propel, and so forth., to make sure that we aren’t interfering in how they’re at present performing mobility-related actions of each day dwelling. 

JK: Ask questions. Communicate along with your ATP and your seating therapists. When a consumer asks a lot of questions, I do know I’m getting issues proper as a result of we’re discussing each resolution. 

NM: Are there any seating choices which might be typically ignored or undervalued by inexperienced technicians/therapists? 

JK: Selecting the correct cushion is particularly vital since your insurance coverage will solely pay for a cushion each 5 years. Ask your ATP and your peer assist group how properly a cushion holds up over the lengthy haul. If it begins to interrupt down, you might be liable to a stress ulcer. Ask to have the ability to have your alternative of cushion pressure-mapped prior to buying. *  

JL: I’m a giant proponent of inflexible again assist — it’s good for assist and alignment and is way more environment friendly for propulsion, very similar to the rationale observe athletes push off of beginning blocks. 

* If insurance coverage doesn’t pay for a cushion when wanted, ask if you may get a reduction for money or look on-line. It is healthier to pay out of pocket than be caught in mattress combating a stress sore. 

How do you make it possible for wheelchair measurements/body selections are working with element selections like cushions and backrests? 

JK: You ought to order your whole parts collectively to get the very best match. You don’t have to make use of the identical producer to your chair and cushion, or your backrest and chair. Order what works greatest for you and ask your ATP to verify the parts match the body. 

RC: Several producers will ship you or the clinic drawings to evaluation to confirm that everybody is on the identical web page. Ask to see these. Whenever attainable, attempt a demo chair that’s the identical as or very near the chair that you simply wish to use.  

NM: What is essentially the most crucial setting/configuration to get proper? What is the most typical mistake to be careful for? 

JL: Because you wish to really feel steady in your chair, essentially the most crucial settings are middle of gravity, depth (size of seat-sling) and width and knee-to-heel measurement (footrest size). For middle of gravity, you need the rear wheel far sufficient beneath you to have good shoulder and arm motion for optimum pushing effectivity, however you don’t need it to date ahead that the chair turns into too tippy and there’s a security threat. For new wheelchair customers, optimum middle of gravity tends to alter (transfer ahead) as their wheelchair-handling abilities enhance. 

Depth and width go hand-in-hand. If the body is simply too deep (lengthy), you sacral-sit and don’t get good again assist; too quick and also you don’t get sufficient thigh assist and get elevated stress into the buttocks. If the body is simply too huge, the wheels are too distant and this can influence shoulder integrity once you push; too slender can lead to stress harm on the perimeters of your hips.  

RC: Settings/configuration ought to concentrate on most operate for the wheelchair person’s skills, which normally enhance (higher stability, stronger arms) within the early months and years after an harm. A standard width-mistake some clinicians make is utilizing a “2-inch rule,” that means the seat width needs to be 2 inches wider than the individual’s hips. A very good rule of thumb for width is to have the ability to slide a hand (roughly ½ to 1 inch wider) between the aspect guard and trochanter (hips).  

JL: For seat depth, for you need as a lot femoral assist as attainable. When seated along with your ft on the footrest, you need about an inch of clearance behind the knees.  

JK: You ought to have sufficient area between the top of the seat pan and the again of your legs so you’ll be able to tuck your ft straight down or perhaps a bit behind with out touching the seat pan or cushion. 

For knee-to-heel (footrest top), make certain your ft are absolutely supported and your thighs are loading onto the cushion. If the footrest top is simply too quick, your knees can be too excessive and there’s extra direct stress into the buttocks. Likewise, if too low, your ft can be hanging and intrude in stability and stability.  

I like my ft to have the ability to tuck again, so my toes are equal to the entrance of my footrest to make a smaller turning footprint. Also, if my ft are protruding additional, I threat catching a toe or foot on one thing after I’m turning, which may lead to a damaged toe or tibia/fibula.  

Ask how the foot field (footrest space) is measured. Is it measured from the within of the tubes or the surface of the tubes? This makes a giant distinction, and also you don’t desire a foot field that’s too small. 

RC: The most typical aim errors are: including too many equipment, ordering a body that’s too huge, a seat that’s too flat, and/or setting rear axles too far again. For rear axles, a rule of thumb is when sitting upright within the seat along with your again in opposition to the backrest, your center fingers needs to be at, or simply under the rear axles. This is an efficient place to begin for each fore-aft and seat top/dump variables. 

In phrases of a seat that’s too flat, the seat dump is a trade-off between propulsion, transfers and and useful duties. The most typical preliminary setting of seat dump is the rear of the seat at about 1 ½ – 2 inches decrease than the entrance, which ends up in a reasonably flat seat. For transfers, this flatter setting (much less dump) tends to be higher, because it brings the seat top up and makes it simpler to maneuver to the entrance portion of the seat. Athletic customers and extra expert wheelchair customers are likely to go along with 3 inches of seat dump. Caveat: This is for the common grownup chair with a seat pan depth of 16 to 18 inches. 

JK: The two match configurations I see that needs to be averted are (1) ordering a chair body that’s too huge or (2) too deep, that means the seat pan (sling seat) is simply too lengthy. For me, too deep is the worst. When the seat pan is simply too lengthy, your chair goes to be considerably longer than wanted, which makes it heavier and harder to switch. 

NM: What are the professionals and cons of an adjustable body versus a extra fastened one?  

JK: The professionals of an adjustable chair are having the ability to set it up for stability if you’re a brand new harm, then after six months or a 12 months later you may readjust the chair so it feels sportier, like an entire new chair. The essential con is that it’s normally heavier. 

The professionals of a hard and fast body chair are it’s quieter, lighter and stronger than an adjustable chair. The draw back is you must get the measurements good. Another draw back for a hard and fast chair is they’re dearer and normally insurance coverage received’t cowl it.  

RC: Fixed chairs are extra responsive and fewer more likely to break down. However, they should be fitted very fastidiously and shouldn’t be the primary chair.  

JL: Usually, by your third chair, going fastened is a greater choice as a result of there are fewer transferring components, propulsion is extra environment friendly, and there’s much less upper-body put on and tear and again pressure. Also, a hard and fast body chair lasts and lasts and lasts. If you might be tremendous lively and throwing your chair out and in of the automobile, it’s arduous on the chair, so that you want a chair that can final. 

NM: Any recommendation for navigating insurance coverage and Medicaid? 

JL: Get your insurance coverage plan and browse it so you recognize what they cowl and below what circumstances. You can search for Medicaid and Medicare protection simply on-line.  

RC: Seek recommendation from organizations like United Spinal’s Resource Center and your native middle for unbiased dwelling. If you’ve any doubts about eligibility or advantages, deliver an knowledgeable and vocal advocate to your medical appointment. 

JL: If you get a denial: attraction, attraction, attraction, advocate, advocate, advocate. Insurance is relying on you accepting a denial, and as a rule folks simply settle for the denial. If you attraction, you’ve an opportunity of getting what you need, and it sends a message for you and for others that the gear you might be advocating for is vital.  

JK: Ask your therapist, ATP and peer assist group for recommendation for advocating. The ATP, the clinician and the physician can be joyful to ship the insurance coverage firm paperwork they request, however an attraction from a buyer goes lots farther than something an ATP or clinician can do. You are the insurance coverage firm’s buyer. They give you the results you want. 

JL: When insurance coverage corporations don’t see any appeals or denials, it reinforces their resolution that they have been proper to disclaim. 

NM: What’s the one piece of recommendation you’d give to assist somebody guarantee they get the very best seating setup attainable? 

JL: Unfortunately, insurance coverage impacts a variety of our choices and solely considers what’s medically essential. Keep this in thoughts as your workforce makes suggestions for protection whereas making an attempt to satisfy your private wants. While there are some limitations to what insurance coverage will reimburse, typically (not all the time) you may pay for what you need even in case you can’t get it via insurance coverage. Exploring different technique of funding is an efficient factor to look into, like grants, GoFundMe, native organizations.  

JK: Ask in case you can see a pc aided design (CAD) drawing earlier than your chair is constructed. Some producers provide this; some don’t. When your chair is delivered, if it isn’t proper, or isn’t full and appropriately adjusted, don’t signal for it! It is your proper to refuse a chair till it meets your satisfaction. Once you signal for it, it’s yours.