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July 2004

By Wendy Lantz, OT, Holly Spigner, PT, and Pamela Perry, COTA/L

Wendy Lantz, OT.

More than 15 million Americans utilize assistive devices of some type, and products designed to help maintain mobility make up more than half of that total. Reports estimate that wheelchair users comprise more than 2 million of this population group.¹

Losing environmental access or the ability to participate in daily activities translates into lost independence—and that loss can be devastating to a person’s emotional well-being, self-confidence, and quality of life. This is true for members of the geriatric population, who may lose strength, flexibility, balance, stamina, and mobility as they age, as well as for people with non-age-related disabling conditions. It is one reason rehabilitation professionals pay so much attention to the assistive devices that provide solutions, and also why there are so many of these products on the market.

Holly Spigner, PT.

For therapists and other health care providers who are in a position to assist clients in choosing an assistive device, it is important to stay up-to-date and knowledgeable regarding available products and options, as well as maintaining awareness of current industry attitudes toward mobility issues.

STAYING CURRENT
Devices to assist people with mobility limitations have been in existence for many decades; however, the equipment has not always been very comfortable, maneuverable, or adaptable. Since the freedom to move around one’s environment is such an important aspect of life, it is exciting for industry professionals to note that in recent years, manufacturers of assistive technology have begun to focus on adapting these products to meet contemporary needs. As a result, people who must utilize mobility devices will be able to participate more easily and fully in daily living and socializing activities.

Pamela Perry, COTA/L.

For wheelchair users and their caregivers, this change in attitude is very good news, bringing with it more durable materials, better fitting seats, and easier navigation. It is interesting to note that manufacturers and vendors are addressing more than just routine functionality. Serious attention has been focused on enhancing comfort, improving quality of life, and, in some cases, adding an element of personality, style, color, and fun. Some of the recent improvements worth noting include:

Stronger, lighter-weight materials: Wheelchairs have become stronger and lighter in weight as new and better materials have been discovered or developed, such as fiberglass, titanium, and various alloys. These qualities make the chairs easier to propel and maneuver, and for those who live independently, it is also easier to transfer the chair in and out of a car.

Improved navigation/turning radius: Newer chairs offer a much tighter turning radius, improving access in smaller spaces/rooms, and that also means there is less chance of bumping into and damaging furniture and walls.

Hydraulic models: Some manufacturers offer models with a hydraulic system that makes positioning easier, allowing the individual to tilt the chair left or right to relieve pressure over bony prominences, thereby avoiding development of pressure sores. Allowing for correct posture, hydraulic models also have seats and backs that can be adjusted to move up and down.²

Customization: While for some people, functionality may be all that matters in selecting a wheelchair, for others, choice is beginning to be an important factor. An incredible number of options are available for personalizing a wheelchair, including color, pattern, fabric/material, function, and attachments. For instance, custom seat cushions offer individualized comfort and style by offering materials such as Naugahyde, nylon, or mesh, as well as colors ranging from shades of blue, gray, and brown to mauve, burgundy, nutmeg, and jade. Some companies even offer a cushion fabric designed to decrease the risk of pressure sore development by maintaining a lower temperature for the buttock and thigh area.

There are wheelchairs with seats that can be lowered to allow the individual to propel the chair with his or her feet. Other models provide features that allow easier access for maneuvering wheelchairs up and down stairs, elevate the user to another person’s eye level, tilt the chair in any direction, and adjust seat depth and width and/or back height to accommodate the individual’s body type. Antitipping attachments are useful on ramps. In addition, numerous specialized modifications can be made to increase functionality for a person with spinal injuries or other specific needs.

In other words, it is now possible to custom design and build almost anything you want or need in a wheelchair. Whether the device is used in a facility or for independent living in the community, the improvements in aesthetics, comfort, and function affect the chair user’s sense of dignity and self-esteem. Although the costs can be considerable as attachments and modifications are added, even the inclusion of a few lower-cost options, such as a favorite color, contemporary fabric design, or a more comfortable cushion, can have an enormous positive impact for the person in the wheelchair. Furthermore, the high-tech, contemporary “personality” of the newer chairs seems to have a favorable effect on the way people in the community view and react to a wheelchair-bound person.

A RANGE OF POSSIBILITIES
When it comes to other assistive technology and aids such as walkers, scooters, and canes, choice is once again the key word. Vendors are very conscious of visual appeal and personal preference in the options they offer with these devices. There is not only a proliferation of new products and attachments, but also plenty of variety when it comes to design and functionality. Some examples include:

Rollators and rolling walkers: Walkers of various types have been used for years, but now these popular wheeled versions add a new level of mobility. Made of aluminum and offering convenient seats, backrests, and baskets, plus hand brakes that allow for quick stops—and lots of colors, fabrics, and seat styles—rolling walkers are useful for getting around in a facility setting or in the wider community.

Scooters: Offering a “sportier” means of mobility than a wheelchair, these motorized devices are generally smaller, lighter in weight, and more maneuverable. Scooters can be purchased in three-wheel- or four-wheel-drive models for indoor or outdoor use and come with many customizable features.

Canes: Offered in a wide assortment of colors, patterns, styles, and materials, canes are now also available in collapsible versions that fit easily into a purse or briefcase. Safety lights and ergonomic handles/handgrips that distribute a person’s weight and improve body mechanics are also popular.

HEEDING STANDARDS
In addition to the trend toward personalizing and modernizing mobility aids, manufacturers are very conscious of the standards recently developed by the American National Standards Institute. Wheelchair guidelines, for example, address factors such as the strength of the wheelchair, turning radius, antitipping potential, and proper measurement for seat width and other factors. In fact, we have noticed that many vendors now advertise that their wheelchairs, cushions, and other products meet these guidelines.

Reimbursement varies with each insurance plan, and Medicaid and Medicare programs have specific guidelines. Individuals who are faced with choosing a mobility aid will need to balance their own priorities, parameters, and goals with their insurance coverage and private financing options. The main objective is to be as accessible as possible in the community and/or within the day-to-day environment and also stay within budget.

THE FUTURE OF MOBILITY
What is most important for therapists, facility staff members, and families to remember is that mobility is key to a person’s self-esteem, achievement of daily activities, and general quality of life. For most people, the ability to stay mobile and functional as long as possible is vital to their perception of self. During rehabilitation, it is obvious to us that access to their environment is the major goal for most clients, and for seniors, it can be the critical factor enabling them to “age in place.” The ability to continue moving around on their own offers them the opportunity to remain in their own homes or in familiar surroundings in an assisted living or long-term care setting.

In our rehabilitation work, we look at mobility as a crucial factor in fall prevention, restraint reduction, and maintaining the integrity of our clients’ body systems. Whenever possible, we utilize wellness and exercise programs to improve our clients’ ability to get around on their own, and when an assistive device is necessary, our goal is to ensure that the appropriate product is chosen. One of the major objectives for rehabilitation professionals is to give each person the opportunity to function as independently as possible. The current advances in attitude and awareness within the industry, along with the evolving technology and customization of the devices, appear to offer a much more mobile future for many of the people who would have been severely restricted by the product limitations of the past.

Wendy Lantz, OT, is senior vice president of clinical services at RehabWorks, Fullerton, Calif; Holly Spigner, PT, is lead clinical specialist at RehabWorks, Garden Grove, Calif; and Pamela Perry, COTA/L, is a clinical specialist with RehabWorks, Great Bend, Kan.

REFERENCES

Statistics on the Use of Assistive Devices, Technologies and Related Services, Independence Through Enhancement of Medicare and Medicaid Coalition, 2003. Available at: Fact sheet. Accessed May 14, 2004.
Wheelchair Health and Mobility Design Considerations and Tips. Available at: RM London design. Accessed May 24, 2004.

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