Thursday, July 18, 2019
Shoulder Preservation: Functional Mobility versus Exercise
As we continue our discussion on shoulder preservation one common question that comes up from therapists, end-users, and families frequently is: Should Propelling a Manual Wheelchair be Exercise?
This question comes in many forms. Often the therapist has the dilemma of worrying about the end-user being as independent as possible, the idea of maintaining the end-users’ function, and keeping in mind the costs associated with different product options. I have also heard a few therapists’ express concerns that if their client does not maintain an “active lifestyle” they could gain too much weight and not be able to fit into their system. The end-users and families usually tell me that they are concerned about the idea that “if they don’t use it, they will lose it”. This is a common statement that we as an industry made popular and unfortunately continues to be used every day.
Let’s now go back to the question: Should Propelling a Manual Wheelchair be Exercise? To answer this, we must start by defining what functional mobility is. Functional mobility is the ability for someone to move around in their environment. We ALL have to move around in our environments, whether it is our home or community, to be able to complete all of our daily activities. For an individual with a mobility impairment, this might mean that you need a walker, orthotics, or for this discussion, a manual wheelchair to move around in your environment.
Using myself as an example – for me to complete my daily activities I will move around by walking. This is not exercise for me. I need to be able to move around all day. Now imagine if I had to skip or run every time I moved. This would be not only exhausting, but also a lot of work for my body. I would likely not be able to complete all the tasks or participate in all the activities that I wanted to each day if I had to skip or run everywhere. Therefore, my options would be to either rely on someone else to help or I would simply not be able to participate.
Keeping this theory in mind, the same thought process should hold true for a person who uses a manual wheelchair as their means of mobility. If it is exercise to propel the chair, then you can become exhausted before the day even begins. You might not be able to participate in certain activities or engage in your community if you are exhausted because you are constantly “exercising”. What happens over a period of time to the shoulders? Are the shoulders meant to be exercising this many hours a day?
Functional Mobility should not be exercise! Functional mobility is a right for all of us, no matter what form of mobility we use. Pushing a wheelchair can be exercise, like a brisk walk or jogging. But remember, not all able-bodied people choose this as their exercise. Also, the upper limbs are more vulnerable to injury than lower limbs so “pushing for exercise” needs to be done in a way that does not present a danger of upper limb injury.
So, am I saying that no one should be in a manual wheelchair? NO! Instead, what we need to do is consider the individual, their environment, and their goals. Many end-users are able to propel their manual wheelchairs throughout the day, but some end-users may be working too hard to complete this mobility. In this case, we need to consider other options to help the end-user preserve their shoulders, reach their goals, and maintain their independence. Next week we will discuss one of these options – Power Assist!
Per Udden, the founder of Permobil, said it best:
“Every person has the right to have his or her disability compensated as far as possible by aids with the same technical standard as those we all use in our everyday lives.”