In September, I wrote about Best Practices in Seating and Mobility Assessments. If you missed that article, click here.
This month, we will take a more detailed look at the information that should be gathered during the seating and mobility assessment. It must be remembered that the assessment is just one step in the overall process of wheelchair provision.1 A future article of Clinical Corner will address the additional steps identified in the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) Wheelchair Services Provision Guide.
The RESNA Wheelchair Services Provision Guide nicely organizes the assessment into three categories based on the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) model. These categories include: Body Functions and Structure, Activities and Participation, and Environment and Current Technology. 1
Before we look at each of these categories in more detail, let’s remind ourselves of the importance of remaining client-centred. At the outset of the assessment, a clear understanding of the client’s desired outcomes and expectations must be established. These same outcomes and expectations must be kept in mind throughout the assessment process.1
Environment and Current Technology
If the client uses a mobility device at the time of the assessment, it is important to gather information about the piece of equipment currently being used. For example, if the client has a wheelchair the information that would be gathered includes the model and its configuration (width, depth, front and rear seat-to-floor heights, caster and rear wheel sizes and types, and components, such as type of wheel lock and arm support). Other factors, such as age and condition of the equipment, should be noted. Seating and positioning components also should be recorded. If other pieces of technology are used with the wheelchair, such as an augmentative and alternative communication device, this too should be documented.1
Likes and dislikes regarding the current seating and mobility system, as specified by the client and/or caregiver, should be elicited. If the client has had a previous piece of equipment, likes and dislikes related to that equipment should be documented, as well. Understanding what works, and has worked, well for a client will help to replicate those specifics in the next prescription; understanding what has not been well-received will help to avoid similar issues.
Both the physical and social environments must be assessed. The environment includes wherever the wheelchair will be used, both indoors and outdoors. The RESNA Wheelchair Service Provision Guide states:
“At minimum, an environmental assessment should include:
- Ability to enter/exit settings of routine use
- Ability to maneuver within the current /anticipated environments
- Ability to reach and/or access all items, furnishings, and surfaces necessary to carry out daily activities.
- Ability to transfer to/from the wheelchair
- Ability to use personal or public transportation”1 (p. 5)
In terms of the social environment, it is important to understand the presence or absence of social supports, particularly if there is a potential need for assistance with any aspect of the seating and mobility system. In addition, there should be consideration of the “clients’ and caregivers’ attitudes towards disability and assistive technology, their tolerance for change, and their ability to support complex devices in order to facilitate acceptance of the wheelchair and seating system technology.”1 (p. 5-6) A lack of understanding of the individual’s attitudes to assistive technology could lead to future equipment abandonment.
Activity and Participation
The assessment includes an evaluation of the individual’s current and desired level of function with respect to activities of daily living and instrumental activities of daily living. Along with this, it is important to have an understanding of how a wheelchair and its configuration affect function for an individual. In addition, the functional mobility of the individual must be evaluated. For an individual who manually propels a wheelchair, the movement patterns and their effectiveness must be assessed. For power wheelchair use, access points and safe operation of the device will be determined.1
Body Functions and Structures
A seating and mobility assessment includes a thorough medical history. It is important to understand the individual’s diagnosis and prognosis and any co-morbidities. Past medical history, including previous surgeries, should be noted. Any planned surgeries or other interventions should be considered as this may affect the seating and mobility prescription. Medications and allergies also should be documented.1
The physical assessment includes an evaluation of skin integrity and risk for pressure ulcer formation. Current and past issues with skin integrity must be documented. Strength, range of motion, coordination, sensation, tone and spasticity should be addressed. The hands-on assessment also includes an evaluation of anatomical alignment and sitting balance. Endurance and cardiopulmonary status should be noted. Physiological functions, such as digestive and urinary functions, should be considered for any impact on the seating and mobility prescription. In addition, vision and cognition in relation to propelling or driving a wheelchair should be noted. This would include factors such as visual processing and cognitive awareness of the environment.1 Depending upon the client population and presentation, a screening of some physical factors may be sufficient; other client populations may require a detailed assessment in certain areas.
To assist in conducting a thorough seating and mobility assessment, it is a good idea to use a detailed assessment form. Completing an assessment form will help to ensure that all areas of the assessment have been covered. If your organization does not have a seating and mobility assessment form using a guide, like the RESNA Wheelchair Services Provision Guide, to develop a form will help to organize the information into categories, such as Body Functions and Structure, Activities and Participation, and Environment and Current Technology, to address all required areas in the assessment.
- (2011). RESNA Wheelchair Service Provision Guide. Retrieved from http://www.resna.org/sites/default/files/legacy/resources/position-papers/RESNAWheelchairServiceProvisionGuide.pdf.