Wheelchairs

The provision of a wheelchair for a patient following a stroke can be considered for two main reasons – for correct positioning during early management and for indoor/outdoor mobility during the rehabilitation stage.

“The type of wheelchair appropriate for a stroke patient could include attendant propelled manual wheelchairs and indoor- or outdoor-powered wheelchairs.

Attendant-propelled manual wheelchairs can be used to achieve better positioning and to improve sitting balance on the ward, which is not always possible with armchairs or high seat chairs. A pressure care cushion should always be provided with the wheelchair and monitored throughout the day by nursing staff and therapists. Access to attendant-propelled wheelchairs adjusted for specific patients can also enable patients to be taken off the ward by their visitors for often much-needed stimulation. Ideally, a wheelchair should also be available for the patient to use for outdoor and/or indoor mobility on weekend leaves and on discharge. In some settings patients are discouraged from trying

to propel themselves with their feet, and self-propelling manual wheelchairs are often avoided altogether. It is thought that the patient’s muscle tone will increase when using the unaffected arm and leg in this way. It is best to discuss the approach.

Indoor-powered wheelchairs could be considered for patients with severe physical disability and those with chronic heart and lung conditions. A patient’s cognition and visual perception should be fully assessed as part of the wheelchair assessment. The use of a powered wheelchair in hospital can help increase motivation and might be considered as an intervention option for spatial awareness problems and inattention.

A combined indoor/outdoor- and outdoor-powered wheelchair would require a full assessment by the hospital-based occupational therapist and specialised wheelchair therapist, carefully taking into consideration the patient’s vision, perception and cognition.

These wheelchairs can be issued to patients with severe, long-term mobility problems. When assessing any type of wheelchair on a long-term basis, the home environment and local area in which the patient will be living should always be taken into account. The access to the patient’s home, the type of accommodation, the width of all internal/external doorways, the layout of the furniture and other fixtures/fittings, the door thresholds and the floor coverings should be considered for suitability of a wheelchair.”  (Occupational Therapy and Stroke Second Edition Edited by Judi Edmans.)