ABC’s of OT: WHEELCHAIRS and WALKERS

We’ve already talked about how to address posture and positioning as it relates to identifying an appropriate seating system for our patients. So today we’re talking about the different types of wheelchairs and walkers, and how to know which ones to use/prescribe to our patients.

Let’s start with the types of wheelchairs.

Disclaimer: there are many more types of wheelchairs available for use. The five that I have outlined below are the styles that I use/prescribe the most frequently within the SNF setting.

1. Standard Wheelchair: a standard chair is exactly what you think it is. We’re talking a basic, sling-back chair who’s only bells and whistles are standard cushions and standard leg rests. This kind of chair is perfect for patients who are able to maintain an upright seated position for prolonged periods of time, and who are able to learn how to self-propel with their arms and/or legs.

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2. High-Back/Reclining Back Wheelchair: similar to a standard chair, however the back of the chair is significantly higher than a standard chair and is able to recline back to allow for off-loading of the pelvis and spine (as the name would indicate). This type of chair is perfect for patients who are unable to maintain an upright, seated position for prolonged periods of time.

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3. GeriChair: this chair is like a lazy chair on wheels. It is able to recline, and includes a solid elevated footrest to allow for even greater off-loading/re-positioning in the chair. As illustrated in the image below, the chair is pre-cushioned and has large armrests that keep the patient safely in the chair. This type of chair is perfect for patients who are not able to maintain appropriate positioning independently and who are typically unable to safely bear weight through the lower extremities. This chair requires the use of a Hoyer for all transfers in and out of the chair, and requires an attendant to propel the chair as patients are unable to reach the wheels from a seated position in the chair.

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4. Broda: this chair is very similar to the GeriChair. It provides many of the same features and is typically indicated for the same types of patients. However, Brodas tend to be a bit less bulky and clunky than GeriChairs, and they also allow for more customization to each patient because the cushions are removable and adjustable.

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5. Electric Wheelchair: these are the Cadillac’s of wheelchairs. They allow all the same off-loading and cushioning features as a Broda, but with more of the independence that a standard chair would provide. It is important to note that an electric chair typically requires some active muscle engagement from the patient. The patient also needs to be able to consistently demonstrate the cognitive ability to safely drive the chair through various environments/around various obstacles (this type of assessment is within our scope of practice). These chairs are incredibly expensive, and there is often an in-depth insurance application process when attempting to obtain financial coverage for the chair.

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When we think about what type of chair to prescribe a patient, we need to consider the patient’s age/developmental status, the nature of the patient’s disability (is this a temporary condition or a progressive disease?), the patient’s level of education and work interests, the patient’s leisure interests, the patient’s daily routine, the patient’s goals, and any adaptive equipment that may need to be included in the seating system.

Now let’s talk about wheelchair cushions.

Before we prescribe a cushion, we need to remember that an assessment of the pelvis must be completed first. From this assessment, we can differentiate between flexible deformities (meaning one that we can correct through manual techniques) and fixed abnormal postures (meaning one that we cannot correct through manual techniques). From there we can determine what types of cushions and lateral supports can best benefit our patients.

1. Linear Cushion: this is a flat, non-contoured foam cushion that provides a firm, rigid seating system. This type of cushion is perfect for patients who are active in wheelchair mobility and transfers, and who demonstrate limited musculoskeletal needs/deformities.

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2. Gel Contour Cushion: this type of cushion enhances postural alignment while decreasing abnormal posture and providing pressure relief. While these cushions provide excellent postural support, they can be difficult to independently transfer on and off of. These types of cushions are perfect for patients who exhibit moderate to severe CNS or neurological dysfunction that result in poor posture.

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3. ROHO Cushion: this is an air-filled cushion that provides little postural alignment but provides excellent off-loading of pressure throughout the pelvis. This makes it perfect for patients who do not have postural deformities but who are at risk for skin breakdown.

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4. Wedge Cushion: just as they sound, these cushions are designed in a wedge-shape to keep the posterior pelvis lower than the knees which helps to prevent the patient from sliding forward out of the chair.

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Some wedge cushions come with a bolster that sits between the knees to prevent internal hip rotation. These are known as Posey cushions.

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5. Pelvic Guide: these are designed to sit on the interior sides of the wheelchair to keep the patients hips stable.

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6. Lateral Support: these are small foam wedges that sit on either side of the patient’s trunk, just under the armpits to prevent side bending while seated in the chair.

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Let’s wrap things up by talking about walkers.

1. Rolling Walker: the basic standard aluminum walker that we all envision, these are lightweight, foldable, portable walkers that provide slow, steady support when ambulating. They sometime come with two front wheels or four wheels, and typically glide best over smooth, even terrain. Rolling walkers tend to have a bit of drag to them, which all for greater control of the device while ambulating.

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2. Rollator: these are the Cadillac’s of walkers. They are always equipped with four caster wheels that allow for quick turns and greater ease when ambulating over uneven terrain. Rollators are typically equipped with a built-in seat that usually has a small compartment underneath to carry personal items. The posterior wheels are constructed with brakes that are engaged by hand clamps attached to both handles. Because of the speed and agility of the Rollator, they can tend to get away from the patient. This means that patients need to demonstrate a greater ability to maintain standing balance before the Rollator is indicated.

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