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When Do We Consider Renting AT Equipment?

Today we will discuss some situations where rental may be a beneficial option to consider. Over the years I have been contacted frequently about renting Assistive Technology (AT) for mobility and seating, from basic entry level through to complex solutions.


Interim Use

Interim use often refers to short term use whilst waiting for your regular equipment to be funded or repaired. In these situations, someone needs something and needs it now, How would you get about your day, complete all the activities and tasks that you need to do if your mobility was suddenly taken away? Could you sustain your daily activities of life? How would you be impacted not being able to go to school, to work, to the supermarket, out to see friends or attend appointments? Whilst there are various funding models, each of these works in slightly different ways and have different processes.

There are also different waiting times within each model and whilst most will offer funding or a means of repairing equipment how can someone continue with their day to day life without access to equipment to support their mobility?

Some disability service providers, hospitals or community groups may have loan pools where members or clients can access various AT for short term use. These vary and often include donated equipment so may have limitations in sizes and features. Whilst they may include equipment that is adjustable, they don’t always have someone available to reconfigure to a user’s specific needs.

This can be a great solution if you can match the users essential short term needs to equipment available however the more specific the users needs the more difficult this can be due to resources and availability of complex equipment. As seating therapists, we are usually striving to fit the equipment to the individual and their needs, rather than fit the individual to the equipment. Let’s consider scenarios where someone may want or need to rent for interim use.

 


Repairs and Maintenance

Whilst we don’t like to compare a mobility base to a motor vehicle in terms of functional use, when we look at the mobility base independently it also requires ongoing servicing and maintenance and can require mechanical repairs. Just like a car, maintenance may require waits for parts or completion of work to ensure it continues to be reliable and to meets client requirements. The service provider completing repairs and maintenance may have a mobility base that can be borrowed however if the user’s mobility base has certain features or specific configuration, a non-complex loaner may not meet their functional needs.

In this situation a user may want to consider renting a chair that is more specifically suited to their needs. Seat-to-floor height or seat elevate, for example, may be essential for the user to maintain independent transfers, the user then may require additional support not usually required. The impact of not having access to a mobility base that meets their needs is potentially not only affecting their mobility, but on them getting into or out of bed which could additional support and resources.

It is important to have a plan for what happens if the user doesn’t have access to their essential equipment as breakages and mechanical repairs are not always predictable! Do you have a plan for your clients if things go wrong?


Waiting for the Funded Solution

As discussed earlier there are different funding processes and the biggest difference between Australia and New Zealand’s government funding for disability is the order that the process takes when applying for equipment; In Australia an assessment is completed, equipment trialled and then an application is made for funding. Once funding is approved the equipment is ordered and an average of 6-8 weeks later, the equipment is delivered. In New Zealand the assessment takes place and the application to trial specific options is submitted, once approval is given a trial will be set up and there is an opportunity to keep the trial chair if it is successful.

As such the wait times and where the wait times occur do differ. An interim use chair may be required based on the users needs while they await assessment, funding or delivery of new equipment.

Renting equipment can also assist therapists and users identify how certain features or configurations can impact on function and assist in identification of potential solutions to trial. In Australia the trial time is limited to an appointment with the supplier which only provides a small snapshot of the user’s life and function. It may be appropriate to consider options for a longer trial period to fully identify what works and doesn’t work for a user.

We are aware of several users that have rented complex mobility bases before proceeding with funding as they wanted to ensure certain features where used or considered in multiple environments.


Short Term Use

Short term use is when the user doesn’t need their equipment long term, it may be part of rehab or assist someone in getting home from hospital post-surgery. This equipment is usually less complex and if required for hospital discharge is often loaned or rented from the hospital or arranged by the hospital staff. Short term rental is often considered when it is more cost effective than purchasing equipment that won’t be needed in the future.

Short term rental can also be an option when someone is travelling and not wanting or able to take their equipment with them. Travelling and resources may mean that someone takes a manual chair but wants a powered chair to explore and independently access the locations as they would normally at home in their power chair. 


Intermittent or Occasional Use 

Off road or all terrain chairs and beach chairs are often essential to access certain locations. How frequently will they be used? These chairs will not usually be practical for everyday use, so can be a large cost for occasional use that don’t meet some funders’ criteria. What will be the most cost-effective solution? If someone lives on a farm or rural location, they will potentially be using the equipment daily. But if it’s for an annual holiday to the beach or to the farm, renting may be an option to consider.

How can I rent mobility and seating solutions? 

  • Funding for rental may be available in some situations, this is best to addresses with your specific funding body
  • Talk to your therapist or service provider about potential options 

If you want to discuss any essential clinical features and options you feel are essential in an interim or short-term mobility or seating base, contact us at education.au@permobil.com. If you are looking at renting any Permobil products you can find more information on our Rental page.


Tracee-Lee Maginnity
Clinical Education Specialist

Tracee-Lee Maginnity joined Permobil Australia in July 2019, as a Clinical Education Specialist. She graduated Auckland University of Technology with a BHSc (Occupational Therapy) in 2003 and has since worked in various roles related to seating and mobility including assessing, prescribing and educating. 

Tracee-Lee is passionate about maximising functional outcomes with end users and the importance of education within the industry.

Alternative Funding Options 


It is important that as prescribers we understand the funding criteria and can articulate both the clinical justifications and how these can or cannot be met within the funding framework. Why do some applications fail to get approved and what are the options in these circumstances? Sometimes a person’s equipment needs may not fit within the funding requirements. In other cases it’s that a clear picture of the needs hasn’t been articulated. 

Either way, not getting funding approval for Assistive Technology (AT) doesn’t mean it’s not needed. In fact, if we have assessed and identified a specific need and identified a feature as a necessary part of a solution, we need to ensure that the end user understands the why’s and how to’s to inform future decision making. Today’s blog discusses some of these options and challenges. 

Funding not approved for essential equipment needs 

If a funding application has been declined and you feel it fits within the funder’s criteria and has been clinically justified through assessment, most funding processes have ways to appeal and this should be considered. In these situations, we initially need to understand why. Is it a mis interpretation of the criteria or has the justification not been clearly articulated? Consider what reasoning and feedback was provided by the funding body. 

Not meeting funding criteria 

Both New Zealand and Australia have really good funding systems. In fact, when compared to other countries around the world we could say we have some of the best funding opportunities for AT internationally. But funds are not infinite and to ensure that essential needs for more people are met there are certain limitations within each system. This can be difficult for someone to understand who has needs and requirements viewed from the perspective of their lived experience. As such we do need to be able to have clear, open communication around what can be funded. Whilst we may still identify a need there may be an ethical requirement to seek alternative options.

When prescribing AT it is important that we understand the criteria of the funding body. If someone is not going to meet the criteria, then we need to have the discussion early on and support the user to make an informed decision about their options. There are often options in this scenario such as co-funding where certain features are not fundable. But if the provision of the AT or a feature is essential to the user you may need to seek alternative funding.

Self Funding

In communities where equipment is routinely funded it is sometimes hard to have conversations around self funding. We shouldn’t assume that someone doesn’t want or can’t financially contribute to their equipment. If a colour choice or accessory is not within the criteria but important to the user they may wish to self fund the up charges. It is important they are aware of the options and choices around this. As a mum I would have definitely considered paying for light up castors for my child’s wheelchair for the annual school disco, but as a therapist this would have been something I potentially wouldn’t have felt comfortable justifying.

Crowd Funding and Fundraising

Self funding also doesn’t necessarily mean someone has the financial means to pay themselves. A popular fundraising movement of crowd funding has seen communities come together to help raise funds through online and digital platforms which often reach beyond a person’s community. Others may opt with more conventional fundraising through local events, family and friends.

Charities

There are many charities that contribute to assisting people financially. These also often have criteria and some prioritise equipment needs not funded by government funding agencies. Knowing these organisations and requirements can help us to identify potential options. Most require a supporting letter or application from the therapist involved. Is the user involved in any local organisations that may have funding or sponsorship opportunities?

Local support groups and associations for specific disabilities or impairments may also be an avenue to consider as a resource of financial support and advice in relation to equipment needs.

As mentioned earlier we are fortunate with our funding systems across Australia and New Zealand. The take home message is that if something is assessed and will assist someone in living their best life we should consider all options and know the funding parameters and alternative options available.

If you are wanting to know more about funding in AU and NZ, we are currently running a webinar series on this topic. The feedback and response shows how important a part of the AT prescription process this is! Part 3 is live next Thursday, 10th December – don’t forget to register here. If you missed Part 1 and 2, don’t panic! These were recorded so you can keep an eye out on the replay schedule here. 


 

Tracee-Lee Maginnity
Clinical Education Specialist

Tracee-Lee Maginnity joined Permobil Australia in July 2019, as a Clinical Education Specialist. She graduated Auckland University of Technology with a BHSc (Occupational Therapy) in 2003 and has since worked in various roles related to seating and mobility including assessing, prescribing and educating.

Tracee-Lee is passionate about maximising functional outcomes with end users and the importance of education within the industry. 

Clinical Reasoning in Wheelchair and Seating Prescription 


This week we are taking a quick look at clinical reasoning and how it applies to prescription of wheelchair and seating items.  Clinical reasoning is a tricky concept to define, and while universal to all health professions, the exact process appears to vary a little between professions.  There is some research available into clinical reasoning, however most of it involves clinical reasoning for medical professionals or exploring how clinical reasoning is taught to students.

Looking at the research does help give us a definition for clinical reasoning, Gummesson, Sunden and Fex (2018) state clinical reasoning may be explained as being the professional thought process, or the decision-making process, that a clinician undertakes when working with a person.  Delany and Golding (2014) state that clinical reasoning involves gathering and analysing information as well as deciding on therapeutic actions specific to the patients circumstances and wishes, Young and Thomas et al (2020) state clinical reasoning reflects the thinking or reasoning that a health practitioner engages in to solve and manage a clinical problem.   Cited in Edwards and Jones et al (2004), clinical reasoning can be described as a process in which the therapist, interacting with the patient and others (such as family member or others providing care), helps patients structure meaning, goals, and health management strategies based on clinical data, patient choices and professional judgement and knowledge.

Clinical reasoning can differ between therapists of different levels of experience, for example students mainly use a more analytic way of reasoning, where they seek answers from their theoretical knowledge to explain their findings, while more experienced therapists tend to rely on patterns they recognise without full analytical thought process, however experienced therapists will engage in an analytical thought process when presented with something unfamiliar.  (Gummesson, Sunden and Fex 2018)

Edwards and Jones et al (2004) explored clinical reasoning processes in a group of experienced Physiotherapists with different specialities (musculoskeletal, neurology and community) and proposed that physiotherapists use a mixture of hypothetical-deductive reasoning along with narrative reasoning, to acquire an understanding of the person as well as the disease

Hypothetical-deductive reasoning can also be known as diagnostic reasoning, where a therapist attempts to diagnose the underlying concern, and throughout the treatment process will continually evaluate as to whether this reasoning continues to hold true, for example, assessing the impact of an intervention and checking whether the response is in keeping with the initial diagnosis.

Narrative reasoning on the other hand seeks to understand the unique lived experience of person through their stories or narratives, to allow the therapist to gain insight into the person’s experience of pain or disability and their subsequent beliefs, feelings, and health behaviours.   

The combination of these two models of clinical reasoning balance the need to optimally diagnose and manage person’s presentation but also understand and engage with the person’s experience of that disability and pain. 

In our Funding 101 webinar we explored the use of the ICF framework as a means of collecting the wide range of information required to assist in writing a funding report.  A funding report also requires us to demonstrate our clinical reasoning process, so in other words showing our thinking as to how the identified solution will meet the persons identified needs and goals.  This clinical reasoning process needs to incorporate information obtained during our assessment process and may incorporate both a hypothetical-deductive reasoning approach and a narrative approach.  Clinical reasoning to support provision of a wheelchair is often the easy part – a person may have a complete spinal cord injury and is no longer able to walk, hence they require a wheelchair for all functional mobility.  In addition to showing rationale for provision of a wheelchair, we also need to demonstrate clinical reasoning to justify additional features or the additional cost of a higher specification chair  – for example our person with a complete spinal cord injury requires a scripted chair to allow for optimal configuration to maintain shoulder health (as per the RESNA position paper), and they may also require a power assist device to allow them to continue to work in their large workplace or to be independently mobile in their community to allow them to attend activities with their children. 

This clinical reasoning process can help identify what parameters a solution requires, for example the person needs a power assist device that is easily transported in their standard car, or a solution that works well on the varied terrain in their community.  Identifying the parameters of a solution required then matching a particular product to those parameters can assist with documenting our clinical reasoning, as opposed to just stating that a person requires a particular product. 

Another component of clinical reasoning involves considering alternative solutions and balancing up the benefits and challenges of each solution identified.  For example, each power assist device comes with its benefits and challenges, not to mention an actual power wheelchair may be also be a potential option.   This can be where our narrative reasoning can help us – for example incorporating a person’s desire to remain self-propelling or whether or not they are willing to change their vehicle to accommodate a proposed solution.  This narrative reasoning can also expose some challenging issues, such as the person who refuses to consider trialling a power wheelchair despite their lack of functional mobility in a manual wheelchair, or the person who wants to trial of a piece of mobility equipment that is potentially beyond their ability to safely manage due to their progressive condition.

When it comes to how we explain our clinical reasoning in our reports, a study by Delany and Golding (2014) provides a little insight.  Delany and Golding looked at a group of educators working with students – these were educators from a variety of health professions, who explored their own clinical reasoning processes and looked at how to translate this into teaching of their students.  A point that emerged from this study was how the educators had to be more concrete and explicit about their knowledge and reasoning when describing their clinical thinking to a colleague from a different discipline, for example a Physiotherapist needed to explain their clinical reasoning clearly to an educator that had a Social Work background in order for the Social Worker to understand their clinical reasoning process.  This might be something we need to keep in mind when writing our reports – in that the person reading the report and approving the funding may not have the same professional background as the person writing the report.

Where the trial occurs in the report writing process varies across funding options, however the trial does give us a chance to add information to our clinical reasoning process – for example if we are exploring use of a power wheelchair as a means of reducing fatigue, a trial will allow us to establish whether this proves to be true.  In some cases a trial can be a source of new information – for example a persons cognitive abilities may  become clear when trialling a power wheelchair, or new goals may emerge when a person realises what opportunities a change of mobility solution may offer them.

Many of us will have the clinical reasoning abilities discussed here, however how well we are able to articulate them, or document them in a report, will vary.  A useful strategy for improving on your ability to articulate or document your clinical reasoning is to discuss your reasoning with a person who is not familiar with the person you are writing the report about, this can help identify any gaps in your reasoning or challenge any assumptions you have made.  This is likely to result in a report that is easier for the funders to follow and reduce the time taken to get approval for a solution, allowing the person to receive their equipment and fulfill their goals sooner.

For more information on writing successful funding reports, please join us for our next webinar.

Funding 102: How to write successful funding reports in 

Thursday 26 November 2020 starting at 12.00pm 

Register HERE

 


References

Gummesson, C., Sunden, A., & Fex A. (2018). Clincal reasoning as a conceptual framework for interprofessional learning: a literature review and a case study.  Physical Therapy Reviews 23 (1) 29-34

Delany, C., & Golding, C. (2014). Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators.  BMC Medical Education 14 (20) https://doi.org/10.1186/1472-6920-14-20

Young, M.E., & Thomas, A. et al (2020). Mapping clinical reasoning literature across the health professions: a scoping review. BMC Medical Education20(107) https://doi.org/10.1186/s12909-020-02012-9

Edwards, I., & Jones, M. et al (2004). Clinical Reasoning Strategies in Physical Therapy. Physical Therapy 84 (4) 312-330 


Rachel Maher
Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and a Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010. 

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service.

Rachel moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.


 

Worldwide STOP Pressure Injury Day 

Thursday 19th November marks the Worldwide STOP Pressure Injury Day – a day to raise awareness of pressure injuries, and to promote education and collaboration to prevent their occurrence.   Many of us will be familiar with pressure injuries and their implications, both their impact on the person’s quality of life, and the cost to the health sector in treating them.  Worldwide STOP Pressure Injury Day offers us the chance to learn more about pressure injures and how we can assist in their prevention. 

One important source of information on pressure injuries is the ‘Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline’ released last year, which gives an evidenced based overview into the prevention and treatment of pressure injuries.  This guideline is available online for purchase or is accompanied by a quick-reference guide that is free to download.  For therapists, one aspect of pressure care we are frequently involved in is the recommendation of support surfaces – both for lying and sitting, hence it is worth us consulting the guideline and ensuring we are following best practice. 

One challenging aspect of support surfaces in the ongoing need for education on the correct use of any support surface.  For me, November has been a busy month for education about ROHO products, with the most common enquiry being ‘how do I know a ROHO cushion / mattress is inflated correctly’ closely followed by ‘how do I clean the ROHO cushion / mattress and its cover’.  Many of these enquiries have come from nursing staff who are new to working with ROHO, however many caregivers in the community are likely to have the same questions.  Part of our role when working with people who are dependent on a specialised support surfaces to assist in managing their pressure relief, is ensuring the person, and their wider team, understand how these support surfaces work and how to care for them.  We need to ensure they know how to check their support surface is working correctly, how to identify when it is not, and who they need to contact if they need help with repairs or maintenance.  In some instances, this can be a challenge due to high turnover of staff in some areas, meaning trainings may need to be frequently repeated, or written information provided that is easy for new staff members to follow. 

For those who frequently prescribe support surfaces, either mattresses or cushions, this week is a good opportunity to evaluate what tools you use, or resources you have, to assist in preventing pressure injuries.  What tools do you use to help identify who is at risk of developing a pressure injury?  Or what resources do you have to complement use of support surfaces?  Alternatively, this week could be a good opportunity to link in with your community nursing or wound care team - an excuse to meet if your paths don’t often cross despite often working with the same group of people.  This collaboration can be time well spent, as collaboration across teams or different departments often result in a more co-ordinated approach to service delivery, which ultimately benefits the person requiring the service.

So for this weeks Worldwide STOP Pressure Injury day, make sure you take some time to learn and some time to reflect.  Take some time to attend an event at your local hospital, or join an online webinar, or browse the Clinical Practice Guidelines or Quick Reference Guide.  Take some time to reflect on your practice and your contribution to preventing pressure injuries – because if each of us takes pressure injuries seriously we can reduce their incidence and prevent the reduction in quality of life that typically accompany them.

Resources

Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline or Quick Practice Guide link  https://pppia.org/guideline/

New Zealand Wound Care Society – Clinical and Public resources https://www.nzwcs.org.nz/resources/stop-pi-day

Wounds Australia – https://www.woundsaustralia.com.au/


Rachel Maher
Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and a Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010. 

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service.

Rachel moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

What Matters When Scripting a Manual Wheelchair?

Scripting ultra-lightweight manual chairs can be a challenge – what frame material do you choose? What frame design? And then there are all the measurements that you need to get…

When first learning to script manual wheelchairs, it can be hard to know what to focus on, however a recently published article by Lin and Sprigle can help give us some direction.


Lin and Sprigle’s study researched the operator and wheelchair factors on wheelchair propulsion effort, taking a group of 36 people and exploring which factors influenced their propulsion effort over a modified figure eight course.

Lin and Sprigle were keen to explore which factors really matter to everyday wheelchair users. The modified figure eight course was compromised of both tile and carpet surfaces, and thought to be more reflective of the stopping, starting and turning that wheelchair users do in their daily lives. The study group was made up of 23 existing manual wheelchair users who completed the study in their own chairs, and 13 able bodied people who were randomly assigned a pre-configured chair.

Both operator and wheelchair factors were explored. Operator factors included aerobic capacity, muscle strength, maximum propulsion strength and their shoulder position relative to the axle. Wheelchair factors included the mass of the chair, the weight distribution over the chair – given as a percentage weight over the rear wheel, and system friction. 

These factors were assessed over two separate sessions and included five minutes of propelling around the modified figure eight course. The results from these were then statistically analysed, and which factors that influenced propulsion effort identified.   

The results of this study showed that shoulder position of the user relative to the axle, and weight distribution of the chair had the largest influence on propulsion effort, particularly on the tiled surface. So, in other words, where the axle position was placed and where this position was relative to the user’s shoulders mattered.  And in this case, it mattered more than the overall weight of the wheelchair and the fitness of the user.

This result obviously applies to these particular testing conditions. Under different conditions, factors such as the user’s strength and fitness may have more influence.  Of note, the influence of weight distribution and axle position was less pronounced when the person was propelling on carpet, where the carpet itself was a significant factor in the person’s propelling efficiency. The chairs used in the study had a variety of castors and rear wheels with different amounts of friction produced which also produced some impact when propelling on carpet but was not as significant.

The weight distribution on a chair is related to the axle position, with a more forward axle position resulting in more weight over the rear wheels, and vice versa – where the influence of weight distribution on turning resistance is most noticeable when too much weight is towards the front of the chair.

The axle position relative to the shoulder is crucial for maximising the ergonomics of the person self-propelling, with both the axle position relative to the back posts and the height relative to the user being important. Establishing where to set the axle position for new users is often challenging. A more forward axle position results in a chair that is more ‘tippy’ which can be difficult for a new user to manage, while a more rearward axle position can result in a chair that feels ‘heavy’ to push and turn.

This is where adjustable chairs are useful and the axle position can be changed as a user becomes more confident in using their chair, allowing the chair to be configured for optimal efficiency over time.

The seating used on the wheelchair can also contribute to the relative axle position. A change of cushion can change the user’s height relative to the wheel, while a change of back support, or changing between a solid back support and an upholstery back (not to mention an upholstery back that becomes saggy with time) can change how far forward the axle sits.

Another factor that impacts on weight distribution on the chair is the body shape of the user itself – a person who has had both legs amputated above the knees will have no weight towards the front of the chair, while a person with oedematous legs may have more than usual. A bilateral above knee amputee can be challenging to set up as the chair needs to be stable, yet the rear wheel placed in a position to ensure efficient self-propelling. For this group, learning good wheelchair skills is important, while others may need anti-tips to ensure stability of the chair when using on uneven surfaces.

So, what is the one thing we need to get right when scripting a manual chair? The position of the axle – this can make a world of difference to the end user and how easy their chair is to manage. Not sure how to get this right? Consider starting with an adjustable chair and ask your local supplier or dealer with help to set it up. Then trial the chair in the places the person needs to use the chair to ensure that the set-up is just right.

Still wondering about the weight of the wheelchair? We’ll come back to this in a later blog!

Reference

Jui-Te Lin & Stephen Sprigle (2020) The influence of operator and wheelchair factors on wheelchair propulsion effort, Disability and Rehabilitation: Assistive Technology, 15:3


Rachel Maher
Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and a Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010. 

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service.

Rachel moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

The WhOM and Funding Reports  

Our last three webinars for 2020 are looking at funding and how to write successful funding reports.  Writing reports is a skill that some of us struggle more with than others, where understanding what information is vital to the funding report can be a challenge. In today’s blog we are taking a look at the WhOM and how it can assist with writing funding reports. 

Writing funding reports for wheelchairs can seem simple on the surface – a person is unable to walk, or does not have functional mobility, hence requires a wheelchair.  However the world of wheelchairs is not so simple, with wheelchairs being available in all sorts of sizes, configurations and with different features, and hence we need to be able to communicate to the funders why a particular chair at a particular cost is essential to meet a person’s needs.

In a previous role I worked as a Paediatric Physiotherapist, and worked closely with the local Orthotist, a very experienced person who was often very direct with his thoughts, and often in our joint appointments he would ask me outright – Rachel, what are we wanting to achieve here?  Which brings me back to the WhOM.

For those who are new to the WhOM – the WhOM is an outcome measures that focuses on participation – often the ICF domain that is most meaningful to end users.  The WhOM can be a means of establishing ‘what are we trying to achieve’ with a wheelchair, where mobility is expanded from moving from point A to point B, to ‘I want to be able to go into town without my parents’ or ‘I want to be able to cook my own meals’.  For our younger wheelchair users and their families, there is a modified version – the WhOM-YP.

The goals identified through the WhOM will be as diverse as the range of people we work with, and some of these goals will relate to funding guidelines, while others won’t – but each goal deserves to be acknowledged.  

The WhOM asks a person to score each goal on how important it is to them, and how satisfied they are with how they complete each goal.  Asking a person to rate how important a goal is to them can help differentiate between a goal that has been identified by another person (eg a caregiver or support worker) and what is meaningful to them, as well as prioritise intervention if different goals contradict each other – for example indoor and outdoor goals that are not able to be achieved in one mobility solution.  Asking a person to rate how satisfied they are with how they perform each goal will hopefully give you the opportunity to demonstrate that your intervention was effective – as their satisfaction score will hopefully improve post intervention. 

How well the WhOM influences the outcome can depend on what we do next.  The WhOM has helped us identify what we want to achieve, the next step is to work through is how we will achieve it.  Once we have established our goals we then need to work through each goal and analyse what is required to achieve it.  For our young person who is wanting to go to town on his own, it may be that we are looking at power assist for their manual chair, or time spent on improving wheelchair skills to manage on/off busses or crossing the road safely and independently. For our person who is wanting to cook meals independently we may be looking at ActiveReach or power standing, or adaptive equipment and strategies to compensate for reduced hand function. In other words, while the WhOM is an outcome measure that is designed for wheelchair users, the intervention that results from completing it may or may not be related to the wheelchair. 

This analysis often provides information to support a funding request – for example our person who is wanting to cook, as part of analysing this goal we have looked whether the person can access their kitchen in their wheelchair, confirmed that they have the hand function to complete the required tasks safely (with or without assistive equipment), they have the range of movement in their legs for ActiveReach, and alternative options have been considered, such as whether a caregiver is required to assist.  Failing to complete this analysis typically results  in funding reports that are lacking in information – and remember, the person who is reviewing the funding report has not met the person who requires the wheelchair – hence if the report does not contain the required information the funding body will not be able to support funding for what can be a high cost solution.   

Ultimately everyone involved in the wheelchair prescription and funding process is wanting to facilitate good outcomes for end users, our role as therapists is to be able to identify what these good outcomes might look like and communicate how a piece of equipment is going to achieve them in our funding reports.

The WhOM manual and assessment form is freely available online, for more information please see https://millerresearch.osot.ubc.ca/tools/mobility-outcome-tools-2/the-wheelchair-outcome-measure-whom/

For more information on our upcoming webinars



 

Rachel Maher
Clinical Education Specialist 

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and later gained her Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service, working with children aged 0 to 16 years.  

Rachel later moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.  

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

Mobility is a Human Right. Why we can’t ignore this topic anymore 

 


Did you ever attend a course, read an article, or hear a topic and think to yourself, “Yes, this is important. I need to remember this.”? But within a couple weeks this new topic or idea has left your mind. It happens to all of us. We get motivated by hearing someone’s passion, but how do we then take that motivation and implement it? 

Today in this blog what we are going to discuss mobility. It is something that I feel incredibly passionate about, but it is also something that we can no longer just forget. We, whether that is a clinician, family member, member of the industry, or the end-user, we have to find a way to remember. The research is there. We can no longer pretend that mobility does not impact well-being, health, independence, and function. We have the research, we have the equipment, now we have to act. Mobility is no longer just something that we hope to provide someone. 

Mobility is Human Right 

Now, to really help us to remember this, we need to first define what mobility is. I have given this definition in a previous blog, but I believe now that I was slightly wrong. Today, I am talking about independent mobility. My old definition of mobility was getting from point A to point B in the most efficient, safe, and timely manner. This definition does still hold true, but how we think about what point A and point B are can really make the difference. At first, I thought point A to point B was this distance say from the bathroom to the kitchen. This distance to be travelled. That is one form of mobility. There is also another way to think about mobility that I had missed.

 Let’s consider that point A is a moment or position in space and point B is a different one. What does this mean? What is the definition trying to say? We don’t have to define mobility as just getting from location to another location, but instead someone’s mobility could also mean their ability to move their body in space. Someone that is unable to move at all and utilises a power tilt independently to relax. Is this a form of mobility? I say YES! I believe we have missed out on some great opportunities to provide individuals with a form of independent mobility by missing what should be the definition of mobility. 

Now that we have this definition lets go back to our statement: Mobility is a Human Right. 

It can be easy for us as human beings to understand that someone that can walk should be allowed to walk. It can also be pretty easy to explain that when someone has the ability to push a manual wheelchair and we provide them a wheelchair, that we have given them independent mobility. But, what about the “harder” situations that we might come across as a clinician? What about someone that is “old” and lives in an aged care centre, should they really have a powered wheelchair or other appropriate device to move around? I often hear “Why does an old person need to be able to move?” 

Have we tried to give this “old person” a mobility device? Or is this an assumption based on another experience or perhaps our thoughts? Just because someone is older by year of age does not mean that they will be inappropriate for all mobility devices. Maybe the traditional idea of independent mobility is not an option due to cognition or safety, but what about having the ability to shift their own weight, move their legs or backrest position, or change their height?

Just because someone requires supervision or assistance to move their wheelchair does not mean that we can’t give them some form of independent mobility. You have to trial options. It might require some out of the box ideas, or perhaps you even have to spend time explaining why to a funder. 

Mobility is Human Right. It does not have an age limit where it all of a sudden doesn’t matter anymore. Put yourself in their position. Are you okay with losing your independent mobility once you hit a certain age? 65? 68? 72? At what age are you okay with no longer having the ability to move independently if there is a way to help you move? This goes for the other end of the spectrum as well… 

 


Age does not define your right for mobility.

We have to then also consider this for our youngest individuals. At what age should mobility begin? Let’s remember what the definition of mobility is: the ability to move in space. When a typical developing child begins to move, they learn and explore their environment. We don’t have to wonder what the impact of exploration is on development as it has been researched and reported. We don’t even have to wonder at what age we should start thinking about mobility devices as we can see the research describing this as well.

So, what is it that is holding us back in this age category? Is it parents? Or, is it us? Funding? It is easy for us to sit here and think of all the reasons why there are children that are 2, 3, even 4 years old that have never been given a chance for independent mobility. What impact does this have on the child? It is our responsibility based on our education and understanding of mobility and development to keep working towards access for everyone regardless of their age.

So, lets go back now to the beginning of this blog when I discussed the definition of mobility. We know now that we cannot just take away or limit someone’s mobility based on their age, but there is still a large group of individuals that are not young or old that have been forgotten. This is the group that might not be able to independently drive or propel their wheelchair. But do they have the capacity to move independently?

Can they activate a switch or button on the wheelchair and change their position? Can they maybe have their wheelchair programmed to drive at only a low speed? Just because an individual cannot independently drive a powered wheelchair at 10km/hr or propel a manual wheelchair up a hill, does not mean that we should give up on the idea of mobility for this individual.

Instead of focusing on what they can’t do, let’s focus on what they have the potential to do. I have seen some of the most incredible, out-of-the-box ideas across Asia and the Pacific to get an individual just a small amount of independent mobility.


I know this can be overwhelming and where we often start to let this motivation go and not turn into action. We are here to help. Whether it is a mentor, another clinician, or someone in the industry. Reach out for help.

If you don’t know where to start you can also contact your local Permobil representative to start discussing how to best give mobility to your client. You can also reach out to your Permobil Clinical Education team for support at Education.AU@permobil.com


Rachel Fabiniak, PT, DPT
Director of Clinical Education – Permobil APAC

Rachel Fabiniak began her studies at The Georgia Institute of Technology, where she graduated with her Bachelor of Science in Biology in 2009. Rachel then went on to receive her Doctorate in Physical Therapy from Emory University in 2013.

After receiving her doctorate, Rachel went into clinical practice as a physiotherapist in the Spinal Cord Injury Day Program at Shepherd Center in Atlanta, Ga. There she developed a passion for seating and mobility which ultimately lead to her career with Permobil. 

Rachel joined Permobil in January 2018 relocating to Sydney, Australia in June 2018 as the Clinical Education Specialist for Australia and New Zealand. In February 2020 Rachel moved into the role of Director of Clinical Education for Asia-Pacific.  

The Importance of Learning

 


As clinicians, there are elements of education interwoven within many of our roles, teaching foundation skills or ways to use assistive technology to enable engagement in activities of daily living for example. An OT undergraduate program includes learning about how people learn and techniques to assist in the learning process.

Within the wheelchair and mobility prescription role the prescribing therapist is not just an assessor. The assessment, trial and clinical justification/funding report are all an integral part of the role but the delivery and teaching of how to use and maintain the device is also part of this scope and relative to the end user’s lived experience. Whilst the delivery of Assistive Technology (AT) may signal the end of the process for the health professional, it is often the beginning for the end user, especially if it involves a new piece of AT.

 

 
The Clinician as an Educator

Within the assessment process you may identify that an end user is struggling with a transfer. Task analysis may guide you to consider trialling a new feature within a mobility base to assist in this task. The trial may show that this feature is indeed functionally beneficial but may also identify that the task requires further adaptation. Based on the end user’s experience, functional capacity and support requirements, they may require help in task adaptation or it may be as simple as providing guidance in learning how to operate the feature and the task adaptation will develop from ongoing use.

Support workers may need to be taught how to operate the mobility base or position it appropriately for a hoist transfer. Whilst there are similarities in operational access between wheelchairs, there are also variances. Those supporting the task also need to learn how the equipment works and the specific way it will be used for the individual end user.

 

 

While literature discusses multiple different learning styles, there continues to be debate around the ideology of learning styles. Do we have a specific style that we learn best from or is it the content of the learning matched to the style?

We do know people learn in different ways. Riener and Willingham’s article, The myth of learning styles (2010), argues that there is no credible evidence that learning styles exist. Further, they argue that learners differ in their ‘abilities, interests, and background knowledge, but not in their learning styles’.

Other academics, such as Richard Felder, believe that while learning styles do not provide a complete portrait, they can potentially provide an outline or framework. However, addressing learning needs is infinitely more complex than implied by learning styles ideology.

Less debated is that we use a combination of styles when learning. The three most cited learning styles are: Visual, Auditory and Kinaesthetic and we may use one or a combination when teaching. A quick reminder, or for readers not familiar with learning styles:

Visual learners: who prefer images, pictures, diagrams, films and videos or demonstrations.

Auditory learners: who learn best through the process of listening.

Kinaesthetic learners: who learn by doing.

Let’s consider the delivery of a wheelchair. It’s the first wheelchair for a gentleman with a progressive neurological condition. He is still walking but experiencing falls. His wife is struggling with the sudden and rapid changes going on. Neither has any experience with a wheelchair but both understand that with his falls lately it will be best to use one. The wheelchair will be initially used for community access. We could just talk through how to disassemble the chair to put it into the car trunk. We have told them how to do it, we even remind them that they must disengage the wheel locks before removing the wheels…is this enough?

Most of you would combine this with a demonstration. But to ensure understanding and that they can manage the task, many of you would also get the client and his wife to have a go at doing it. The value in this is that you can ensure they can do the task but also the kinetic hands on learning this offers. The “doing” is important as the task involves doing a new activity with a new piece of equipment and will impact on the ability to use the chair in the community.

For more complex equipment training or where multiple carers are involved, you may have developed resources to assist in the facilitation of learning such as photos of equipment or positioning.

 

 


The Clinician as a Learner

We often put thought into the best techniques and styles to support learning for clients but do we also apply this to our own learning opportunities? Continuing Professional Development (CPD) requires us to complete hours of ongoing learning. We need to make these hours as beneficial as possible, so as well as matching content to our learning goals it is also important to consider the delivery of the content and what will best work for you. For me personally, I like to get hands on with equipment to understand its adjustments and capacity especially when it’s a new piece of equipment I haven’t previously worked with.

2020 has brought new challenges to ways of working and learning. We know how important ongoing professional development is and so in March this year we increased our bi monthly webinar program to bring a new live webinar every week. This was a great way to continue to offer theoretical concepts as learning opportunities however makes it more challenging in some areas. Therapists at workshops who are new to seating assessments have consistently said how beneficial doing and having the assessment done for them can be.

Applying case study concepts to hands on experiences with equipment is also very highly rated in the clinical workshops. But following social restrictions and recommendations has unfortunately limited these opportunities within countries globally.


O2O and Education Opportunities

This month we are excited to be launching our very first Online-2-Offline (O2O) event. This form of learning begins with an online component led by our Clinical Education team, followed by a hands on session with your local experienced sales team to enable you to apply clinical learning in a practical and supportive environment. The education team will remain online throughout the event to answer any questions.

This format has already proven successful with fantastic feedback from both our Chinese and Australian markets. You can hear a bit more about this event below.

 


 


 

Tracee-lee Maginnity
Clinical Education Specialist

Tracee-lee Maginnity joined Permobil Australia in July 2019, as a clinical education specialist. She graduated Auckland University of Technology with a BHSc (Occupational Therapy) in 2003 and has since worked in various roles related to seating and mobility including assessing, prescribing and educating.

Tracee-lee is passionate about maximising functional outcomes with end users and the importance of education within the industry.

 

 

 

Wheeled Mobility Devices Used as Seats in Motor Vehicles – what do we need to know?

Last week we looked at ISO standards – the history behind these and how they apply to wheelchairs.  This week we are looking at one particular standard – ISO 7176-19:2008 - Wheeled mobility devices used as seats in motor vehicles.  This standard is similar to the ANSI/RESNA WC19 standard, the recommended standard in North America, often referred to as WC19.  The standards surrounding wheelchairs and their safety for use as seats in vehicles is something therapists need to be aware of when prescribing wheelchairs for those who need to remain seated in their wheelchairs when traveling in a vehicle.  The ISO 7176-19 is deemed the minimum standard for wheelchairs that are used as seats in vehicles, while the ANSI/RENSA WC-19 has additional components to optimise wheelchair users safety. 

When we purchase a vehicle, we are presented with information as to how safe that car is likely to be in the event of an accident, for example a particular car may have an ANCAP (Australasian New Car Assessment Program) star rating telling us how well the car performed under crash testing, with a five star rating being a safer vehicle.  Manufacturers reduce the risk of death and injury in motor vehicle crashes using a systems approach to occupant protection, in which the vehicle, the vehicle seat and occupant restraint system (ie seat belt) each to contribute to a safety system. 

For wheelchair users who remain seated in the wheelchairs while travelling in their vehicles, a similar systems approach is also used, incorporating the wheelchair restraint system in the vehicle, the wheelchair and seating itself, and again the occupant restraint system. 

The wheelchair restraint system and the occupant restraint system are installed into vehicles by a person certified to complete the modifications to the relevant standard, with the modifications completed being appropriate to the wheelchair used – for example use of a hoist and tie down system that is rated for the type of chair used, with a power wheelchair requiring different specifications to a manual chair. 

The safety of wheelchair users while travelling in a vehicle is dependent on the wheelchair restraint and seat belts being used appropriately, for failure to do so can result in injury in situations where occupants seated in the standard vehicle seat may not be harmed at all.  Potentially a wheelchair that is not restrained properly in a vehicle can tip over if the vehicle turns sharply, or a seat belt that is not applied correctly can mean the occupant can come out of their seat and injure themselves on the interior of the vehicle if the vehicle stops suddenly.

Photo 2 source https://education.nsw.gov.au/public-schools/astp/contractors/safety-requirements

The use of these restraints is complemented by use of a wheelchair that meets the ISO7176-19 or WC19 standard to reduce the risk of injury to the end user.  The test for this standard is to subject the chair a forward facing crash test at 50km/hr with a 70kg crash test dummy.  This test is typically tested with the seating system associated with this chair, however after market seating products can be tested by the WC20 standard to establish their safety under crash conditions.  Chairs that meet the WC19 often use tie down points on the chair, these being four permanently labelled, easily accessible securement point brackets, however docking systems such as Ezi-lock and Dahl are also an option for some users.  Other aspects of the ISO 7176-19 and WC19 standards include use of seating systems that allow the seat belt to be positioned effectively and that there are that there are no sharp edges on the chair that may cause damage to either tie down points or the vehicle occupant restraint system. 

A person remaining in their wheelchair seat is often seen as a convenient means of travel, however use of the vehicle’s standard seat is considered the safest option for a person to travel.  Prior to considering vehicle modifications, questions to consider are 

  • How well can the person transfer in/out of their wheelchair?  Can they safely transfer into the manufacturer installed car seat? This may involve use of a mobility vehicle to allow the person (and their chair) to be transferred up into the vehicle, where they can then transfer into the standard car seat and their chair be restrained for unoccupied travel. 
  • For young children, or those who require assistance to transfer, the risk of injury to the carer when transferring the child/person in/out of the car seat needs to be weighed up against the risk of travelling in the wheelchair – where for many people, the risk of injury during the transfer outweighs the potential risk from travelling in their wheelchairs. 

If travelling in a wheelchair has been established to be the safer solution for the end user, considerations for the wheelchair include 

  • What standard has the chair been certified to?  Has the chair been certified for occupied travel?  Some chairs are only certified for un-occupied travel, meaning it is not intended that the end user remain in the chair while travelling in a vehicle.  Information as to what standard the chair has been tested to is included in each chair’s user manual, or can be obtained from the dealer or supplier. 
  • If a docking system is to be used, has the docking system been tested for the model of chair you are considering?
  • Chairs that are custom built, eg custom manual wheelchairs, may not be certified for crash testing, but may have the features that the standards recommend.  The benefits and challenges of these chairs need to be discussed with the end users to ensure that they are making an informed choice about the crash testing status of these chairs.
  • The pelvic positioning belts and/or harnesses used as positioning aids on the seating system are not intended for use as a vehicle restraint, although may be used in addition to the vehicle restraint system to ensure the user maintains an optimal position while travelling in their vehicle.
  • While travelling in the vehicle, ideally the end user requires access to a head support to prevent injury to their neck in the event of an accident.  For some users, this may be installed as part of the vehicle modifications (eg for those driving their vehicles) however others may require a head support attached to their chair as part of their seating system.  When the head support is attached to the wheelchair, consideration needs to be given to how it is mounted – for example if mounted to the back support, the back support needs to be of sufficient height for the mounting to be effective.  

When the wheelchair is in the vehicle 

  • The wheelchair needs to be restrained using the appropriate restraint system – for example use of tie downs attached to the identified tie down points on the chair.
  • The person travelling in the wheelchair then also needs to be restrained using a certified three-point belt, to ensure they remain in their chair in the event of an accident.  Some wheelchair manufacturers offer the ability to fit a vehicle certified hip belt that a shoulder belt may attach to in a vehicle for ease of fitting. 

A person being able to use their wheelchair as a seat in a vehicle can be the difference between being able to access the community or needing to stay home, and use of standards can help keep wheelchair users as safe as possible while travelling in their chairs.

   


For further information please see

ANSI/RESNA WC19 - http://wc-transportation-safety.umtri.umich.edu/crash-tested-product-lists/wheelchairs

RESNA Position Statement on Wheelchairs used as Seats in Motor Vehicles - https://www.resna.org/Portals/0/Documents/Position%20Papers/RESNAPositiononWheelchairsUsedasSeatsinMotorVehicles.pdf

Vehicle modifications

Mobility Engineering Australia - https://www.mobilityengineering.com.au/

Low Volume Vehicle Technical Association - https://www.lvvta.org.nz/documents.html#standards

Safety Ratings of Motor Vehicles - https://rightcar.govt.nz/safety-ratings 


 

Rachel Maher

Clinical Education Specialist 

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and later gained her Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service, working with children aged 0 to 16 years.  

Rachel later moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.  

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

ISO Standards – What are they and why are they important?

ISO standards are a term many of us have heard of, and will be influenced by in our daily lives, but potentially do not know much about.

ISO is an independent, non-governmental international organisation, with membership of 164 national standards bodies.  The name ISO is derived from the Greek ‘isos’ meaning equal, with the name ISO being used in all countries around the world, regardless of what language is spoken.

ISO standards started with the essential question: what is the best way of doing this?  The first meeting to discuss international standards was in London in 1946, where 65 delegates from 25 countries met to discuss the future of International Standardisation, with ISO officially coming into existence in 1947 with 67 technical committees.   Today ISO is based in Geneva, Switzerland, with membership of 164 national standards bodies, 792 technical committees and sub-committees and over 23000 standards. 

Each technical committee is made up of independent experts nominated by ISO members, with the goal of each technical committee being to look at products and services with an eye towards ensuring safety, quality, reliability and effectiveness. 

Today the standards cover almost all aspects of technology and manufacturing, with each standard being drafted by a technical committee (TC) or sub-committee (SC) and taking approximately three years to confirm.  Each international standard is reviewed at least once every five years by all ISO member bodies, with the relevant TC/SC deciding whether the standard should be confirmed, revised or withdrawn.  Testing for each standard is reviewed by the technical committee to ensure they are appropriate and reasonable for a test lab or manufacturer to be able to apply, but also that they are meaningful for the end user.  Each standard is not intended to endorse specific solutions, just allow for a direct comparison of specific properties

ISO standards are present behind many aspects of our home and work lives, from the food we eat, the shoes we wear, the toys our children play with, the paper we use in our printers or the credit card we can use around the world.   One of the most popular standards is ISO 9001, this standard sets out the requirements for a quality management system, helping businesses and organisations be more efficient and improve customer satisfaction. 

ISO standards can also facilitate manufacturers working together to produce solutions that make our daily life safer and more convenient, for example, the use of ISOFIX to secure child car seats in vehicles.  Use of child car seats in vehicles is a solution that increases a child’s safety while travelling, however installing these car seats can be a challenge.  ISO 13216-1 relates to the the universal system for anchoring child restraint systems to vehicles, with the purpose of improving the safety of child restraints by making the installation of these seats easier and more reliable.  This standard has resulted in many car manufacturers installing ISOFIX anchor points in their cars (a metal loop hidden in the gap between the flat and upright parts of the seat) and child car seat manufacturers producing a product that installs into these anchor points.  For parents, using ISOFIX provides reassurance that they can install their child car seat correctly to maximise the safety benefits of the seat.  (This was a system that I used with both of my children and had no idea where the name derived from!) 

How does ISO standards relate to power wheelchairs?   The technical committee responsible for wheelchair standards is ISO/TC 173, Assistive products for persons with disability.   ISO/TC 173 was created in 1978, with the scope of standardisation in the field of assistive products and related services, to assist a person in compensating for reduced abilities.  This committee has developed numerous standards for persons with disability ranging from aids for ostomy (surgical opening for discharge of waste) and incontinence to assistive equipment helping people with a visual impairment use pedestrian crossings, to hoists for transferring.

From ISO/TC 173, Subcommittee SC 1 relates to wheelchairs.  This group is responsible development and maintenance of the ISO 7176 series, a 32 part series covering items such as static and dynamic stability, effectiveness of brakes, impact and fatigue strengths, obstacle climbing ability and wheeled mobility devices for use as seats in motor vehicles.

Each part of the standard is accompanied by a document that specifies the test methods and requirements for determining specified standard, for example ISO 7176-30: 2018, also known as Wheelchairs – Part 30: Wheelchairs for changing occupant posture – Test methods and requirements.  These guidelines specify the test methods and requirements for determining the safety and performance of a wheelchair that incorporates technology to alter the posture of the wheelchair user, for example a power wheelchair that offers power standing.

How do you find out what chairs have been tested to what standard?  The user manual of the chair will state what standards and regulations the chair meets the requirements of, including whether it has been tested to the ISO 7176 series.  Alternatively, the supplier or dealer who provide the chair should be able to tell you. 

This testing is often a big point of difference between high and lower cost power mobility options.  Mobility solutions that are lower cost are potentially manufactured from inferior materials or with an inferior design, where typically their user manuals will make little (or no) reference to any ISO testing.  This isn’t to say these mobility solutions are a poor choice, for a low cost mobility device may work well as a useful adjunct to a person’s mobility, for example a basic mobility scooter to allow a person to mobilise around a shopping mall independently.  However, this same device may not be safe or durable for a user who is dependant on a mobility device for their all-day mobility across multiple environments.  These users require a mobility solution that has been tested to ensure it is a safe and reliable device for everyday use, with ISO standards providing an independent means of establishing this. 

Next week we will take a closer look at ISO 7176-19:2008 - Wheelchairs Part 19: Wheeled mobility devices for use as seats in motor vehicles.  We will look at what parameters this standard tests and what other factors need to be considered when a person is using their wheelchair as a seat in a vehicle.


References

https://www.iso.org/home.html

For more information on ISOFIX https://youtu.be/W0sTvpyKgKY


Rachel Maher 

Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and later gained her Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.   

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service, working with children aged 0 to 16 years.    

Rachel later moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.   

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.