The main goal of client rehabilitation is to assist a client in developing and regaining independent function. For some clients, however, this is not possible due to their diagnosis or condition. This is when Rehab Professionals need to create ways to maximize and maintain current function to help an individual optimize their daily independence. Assuming a client is a candidate based on diagnosis or condition, power mobility devices provide a great opportunity to increase the functional independence of an individual.
Once it is determined that a client qualifies for a power mobility device, there are many steps that must be taken prior to delivery of the device. There is no single mobility base or seating configuration that is appropriate for every individual with a mobility impairment based on diagnosis, prognosis, deformity, disability or level of function. The power mobility device, including seating and drive control, needs to be as unique as the individual.
There are many items Rehab Professionals need to know in order to move forward with the initial client evaluation. We must first understand the client’s diagnosis. Is the diagnosis progressive? What is the stage of disease process? Are there secondary diagnoses? These are just a few questions that can help us to better understand a client’s unique needs and current condition. Next, we need to understand what the prognosis is. Will the client’s condition improve, deteriorate or remain static? After this we need to review the client’s medical and surgical history as well as any possible future surgeries or treatments that may affect the client’s mobility device. The medical history from the client’s chart may help give us insight into other factors specific to the client such as neurological status, orthopedic status, sensation, skin integrity, vision, cognition, and functional status to name a few. Also, reviewing a client’s medical history prior to the initial meeting may also provide valuable information regarding the client’s level of readiness and motivation. This information is very important because it helps us prepare our approach for the initial evaluation.
Initial Evaluation & Meeting
Observation is one of the most important tools we have at our disposal. It helps us determine many things about our client within the first minute of meeting them. Important factors such as caregiver status, sitting posture, skeletal issues, hygiene and personal motivation should become quickly apparent. A clear, working knowledge of a client’s communication skills, cognition and personality will also help determine how to approach the evaluation.
If the client is cognitive and can communicate, he or she will be able to play a large role in their mobility solution. This is an important factor because the more a client is involved in their mobility product selection, the better the chances are that they will like it and use it to its full capacity. Client input will also offer vital information regarding past and current equipment. Most clients will be very honest as to what they liked and disliked about their past and current equipment.
Physical Motor Assessment
The physical motor assessment is when we really get to evaluate the client’s function and abilities. Reviewing items such as movement patterns, consistent repetitive movements, strength and range of motion will determine the client’s seating needs and drive control requirements. This evaluation will allow us to assess the client’s sitting balance during the mat evaluation. The mat evaluation determines how the client will need be to be supported in the seating system. Being able to successfully support and position a client will give us the best result in finding the best access point for drive controls. The best access point for an individual to drive a power mobility device is the point which the client is able to continuously interact with the most strength, range, function, and safety throughout the day.
Once all of the initial evaluation items are complete, it is time to evaluateº the client in multiple power mobility devices to see which works the best. It is important to work with mobility manufacturers to ensure that you have multiple samples for the client to be evaluated in. As noted above, it is very important to find the best access site for the client to control the chair. Physical Trials will determine this access site and provide the information necessary to determine what type of drive control works the best for this client and gives them the most consistent function independence.
There are numerous drive controls available to allow a client to operate their mobility device. Depending on the client’s level of injury and whether they qualify for expandable controls, there are countless ways to configure drive controls to deliver maximum functional independence. Proportional drive controls are ideal because they offer the most as far as maneuverability, quick access, and control. If the client is able to safely operate their chair with a proportional control, it is definitely a great choice for that individual. On the other hand, some clients are able to perform and operate their chair very easily with switched drives. One of the positive things with switched controls is that they are much easier to learn and allow a client to quickly access chair functions. It is very important that clients with advanced requirements are evaluated with different drive controls to assess what works best for them.
Again, there is no single power chair, seating system or drive device that meets the needs of every individual. It is very important to weigh the client’s needs, wants, and ability before determining what system fits them best. We are fortunate that we work in an industry that continues to offer advancement in technology. It is important that we stay up-to-date on all of the technology advancements in order to be able to best serve our clients.