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 (6-8weeks) After first year of being home –more insight into the type of wheelchair to suit needs + lifestyle Wheelchair service 1st point of call post discharge.

Posture and Seating Clinic - Assessment Skin Posture Cushions Pressure mapping

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

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