A KW Therapy client case study.

 

A Case Study in Custom Wheelchair Adaptation and Innovation

For individuals with complex mobility needs, finding a wheelchair that delivers the right balance of postural support, comfort, ease of movement, durability, and safety can be a daunting task. This is without even considering the client’s intended use of the wheelchair, the environments they navigate, transportation needs, and the circumstances of their family or caregivers. Our client exemplified this challenge, having tried multiple wheelchairs yet never finding a solution that truly met all their needs.

We were tasked with finding a wheelchair that not only accommodated the client’s physical limitations and intolerances but also withstood the strain they placed on it.

 

Initial Assessment

At the initial assessment, the Occupational Therapist (OT) met with our client, along with one of his key workers, who provided insights into his care needs. This collaboration allowed the OT to form an understanding of his medical conditions and daily lifestyle requirements. Unfortunately, during this visit, we were unable to carry out a full postural assessment with the client, which we prefer to undertake to understand the client’s postural needs outside the wheelchair. This helps us identify their requirements for a wheelchair more accurately.

 

Issues Highlighted

• Postural Support: Slipping out of the wheelchair, poor positioning, spasms, and internal rotation in seating indicated the need for better support and alignment.
• Movement: The client demonstrated good range of movement in their head, neck, and back. They could pivot for transfers with the help of two people. However, their left hand displayed no movement, and the right hand retained enough function to hold a drink or cigarette with assistance from an aid.
• Existing Wheelchair Issues: The footplates frequently required repair due to the extreme force applied, and the client tended to hit the back of the chair when agitated. The upholstery of the current chair was in poor condition due to spillages, cigarette burns, and picking/scratching.
• Safety: The powered controls on the current wheelchair were removed due to staff safety concerns, leaving the chair manually operated. Reported problems with distance vision made it difficult for the client to navigate the wheelchair independently; further vision assessment is required. Postural supports are used in the shower chair to prevent falls during seizures.

Lifestyle Needs

During the visit, it was important to identify what the client would be doing, what they wanted to do but couldn’t, and where they would want to go to ensure the wheelchair met all their needs.

The client resides in a single-story building with wider-than-average doorways, facilitating easier wheelchair access. Historically, the client has displayed an intolerance to static chairs, preferring to move around unrestricted using their wheelchair. Intolerance was also observed toward other restrictions, such as seat fastenings and trays.

The client reportedly enjoys going out in the wheelchair three to four times a week. Despite requiring frequent repairs, the current chair has been surprisingly durable and handles well on grass. When using a wheelchair-accessible vehicle (WAV), the chair is loaded via a winch system.

 

Finding the Right Wheelchair

The OT needed to explore options that would accommodate all the client’s needs. It was clear from the outset that the chair would need to be heavily customised. We began a consultation with a supplier specialising in wheelchair adaptation and customisation.

A second meeting was arranged with the OT, the client, the wheelchair sales manager, and the key worker to discuss potential solutions. Involving the right key support worker—someone with in-depth, day-to-day knowledge of the client’s preferences, intolerances, and history with wheelchairs—was crucial to this process.

The client currently has access to two wheelchairs, ensuring a backup when one fails. Both chairs are only two years old but have already undergone multiple repairs.

The wheelchair sales manager recommended another Sunrise Medical IBIS chair due to its robust frame. Additional adaptations were discussed, which the key worker believed the client would accept if they were purposeful and not overly restrictive.

A plan was developed to build a customized chair and trial it with the client over a few days. This approach allowed for a gradual introduction, testing the chair in various environments and at different times of the day, avoiding pressure on the client to make an immediate decision.

 

Wheelchair Adaptations

Postural Support

• A four-point padded pelvic belt to maintain pelvic position, which the client can fasten/unfasten independently. This helps maintain proper pelvic alignment, even during frustration or anger.
• Increased the backrest height by 4” to provide additional support, reduce overextension, and offer more tactile feedback.
• A wider base for enhanced durability to meet the client’s needs.

Durability

• Softer armrests made with pick-proof material and heavy-duty steel instead of aluminum.
• A heavy-duty strut under the main base to absorb more force.
• Removable, washable, and wipeable durable covers.
• Reinforced covers on the side panels to prevent damage from cigarette ash.
• A rebound feature adjusted to the weight of a heavier person for added durability.
• Tension-adjustable straps in the backrest to absorb postural extension.
• Reinforced, heavy-duty leg rests and footplates.

Safety

• Heavy-duty anti-tip wheels at the back of the chair.
• A slightly wider chair for added stability.
• A manual wheelchair with attendant control, allowing the client to foot-propel.

 

Wheelchair Handover

On the day of delivery, the client was unwell and unable to sit in the chair. The wheelchair sales manager handed the wheelchair over to the key workers, educating them on its features and benefits. The team trialed the chair for three to four days and reported back.

During the trial, frustration and behavioral difficulties were observed with the two separate footplates when the client tried to propel with their right leg. Staff also struggled with removing and reattaching the heavy-duty leg rests.

To address these concerns, the footplates were replaced with a reinforced, singular plate similar to the previous design for improved functionality and client comfort.

 

 

Conclusion

Finding the right wheelchair for clients with complex and heavy-duty needs requires specialised knowledge, technical expertise, and a collaborative approach. Through careful assessment, customisation, and feedback from the client and support team, a tailored solution was developed that balanced support, durability, and safety while respecting the client’s preferences.

This case study underscores the importance of understanding client needs, involving knowledgeable caregivers, and leveraging specialist expertise to meet unique medical and functional requirements, ensuring sustainable mobility solutions.

 

If you need help with finding the right wheelchair or powerchair contact us to ARRANGE YOUR ASSESSMENT