Purpose
A guide for occupational therapists and physical therapists to quickly size and select a wheelchair for your patient in acute care, acute rehab, and skilled nursing facility.
What this Guide is NOT
This is NOT a guide to selecting a wheelchair for long-term use such as for those with spinal cord injuries, degenerative conditions (e.g., ALS), or any other patient who will be prescribed a wheelchair through insurance (e.g., Medicare). This guide is intended for therapists to quickly choose a wheelchair for temporary use during therapy. Follow best practices for prescribing a more ‘permanent’ long-term use wheelchair for your patient.
The Scenario
We’ve all been there before. We may have a new evaluation and a patient is a candidate for wheelchair use temporarily. For example, a patient with a newly diagnosed stroke affecting their lower extremity and/or balance will likely need a wheelchair in the beginning until they progress and can safely ambulate for functional activities.
Another scenario is you may be wish to walk with your patient or perform an activity with them out of bed and would like to have a wheelchair for a wheelchair follow or for back-up in case of fatigue. This may even be for a patient in cardiac rehabilitation who has poor endurance but is not expected to need the wheelchair upon discharge. There are many reasons for why a wheelchair may be beneficial for patients in acute care, ARU, or at a SNF. The problem is, we often have a very limited amount of time to choose one.
A Wheelchair You Grab…
- Depends on what your facility actually has that is in service and not broken.
- Will likely not be the best fit, but will be ‘good enough’.
- We are not aiming for perfection, only minimizing harm and promoting function with a wheelchair.
- Some parts may not be perfect and may be oversized.
- It is better to be oversized and undersized as this may cause discomfort and injury to the skin, e.g., rubbing.
Electric vs. Non-electric
- You most likely be choosing a non-electric wheelchair.
- If a patient used an electric wheelchair at baseline, then you may consider using an electric wheelchair.
- Conditions that may be good candidates for electric wheelchairs include spinal cord injuries and degenerative conditions (ALS, Huntington’s).
- Patients who can benefit from practicing using electric wheelchairs in the community.
- Patients who will be using electric wheelchairs should have sufficient cognition for safety and operation.
- Electric wheelchairs make transfers different due to parts often not being easily removable, e.g., leg rests.
Tilt in Space vs. Regular
- Depends on the patient’s ability to self-initiate and self-relieve pressure.
- Tilt is more appropriate for patients at high risk or currently have pressure ulcers.
- Tilt is for patients less likely to self-propel the wheelchair.
- Tilts are unable or more difficult to fold up to save space.
Sizing
- You will most likely size is based on patient’s width.
- Common widths: 16″, 18″ (Standard), 20″, 22″, bariatric
Height
- Standard or lowered: look at the axle of the wheel and whether it is installed on the lower (standard height) or the upper setting (lowered height).
- Most people will be using the lower setting for standard height.
Weight
- While often an important consideration, this is likely not a major factor unless your patient is bariatric.
Things to Check
- Brakes (test test test!)
- Clean or looks like it needs to be cleaned
- Anti-tippers
- Tire pressure
Don’t Forget
- Armrests: correct ones chosen (left vs. right) and correctly installed (not inside out)
- Arm troughs (e.g., CVA)
- Leg rests (regular vs. other)
- Seat cushion (regular, ROHO, etc.)
- Residual limb supports for amputees
- Tagging or marking the wheelchair for extended use with patients name or room number.
- Assist transferring the patient to the WC and check skin for prolonged contact due to incorrect sizing of a wheelchair width or adjustments needing to be made such as with the legrests.
- If you are unable to transfer the patient onto your chosen WC, let staff or caregivers know or they will assume the therapist (you) chose the most optimal one, when in reality, it may not be the case and the patient may be left using an in appropriate wheelchair. This may result in discomfort, harm, or even injury!
