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Functional Mobility versus Exercise: Should Propelling a Manual Wheelchair be Exercise?

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To answer this question let’s 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 wheelchair to move around in your environment. Using myself as an example - in order 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, then the same thought process should hold true for a person who uses a 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”.

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. We will explore this more in later blogs specifically about shoulder injury prevention.

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.”

 

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Power Wheelchair Travel Checklist

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Disclaimer: The following travel tips are for informational reference only. Permobil does not make any clinical, operational or warranty claims about any product, feature or service mentioned below.
 
Travelling with a power wheelchair can be downright stressful, but with our Travel Checklist we hope to make the process a little less painful. We’re splitting our checklist into four categories: before you go, travelling by car, travelling by plane, and if something happens to your chair. Let’s begin!
 
Before You Go
 
  • Fully charge your batteries
  • Pack your charger. If you are traveling abroad, check that your charger is compatible.
  • Make sure your chair has been recently serviced.
  • Located a Permobil authorised dealer where you will be travelling.
  • Write down you serial number and keep it with you.
  • Consider getting bag hooks, armrest pouches, or a Permobil essentials carrier for extra storage.
 
Travelling by Car
 
  • If you are travelling with your chair outside of the vehicle, make sure that the chair is protected with a waterproof cover.
  • Ensure that your chair is properly secured to the vehicle.
  • Consider using safety lock if you plan on leaving your chair unattended with your vehicle.
 
Travelling by Plane
 
  • Contact your airline ahead of time to plan for the transport of your chair. Make sure to describe the type of chair you use and consider the airplane size to make sure it fits your needs.
  • Be aware that some airlines may ask you to sign a waiver regarding their responsibility for your chair during transport.
  • Write down the type of batteries installed on your chair and how much your chair weighs, some airlines may ask for this information.
  • Take photos of your chair’s condition prior to checking in at the airport.
  • Allow an additional hour to check in with your wheelchair and be assisted at the gate before boarding.
  • Make sure to inform the check-in attendant of any medical equipment you have, that way they can mark as fragile.
  • Request that your chair travels upright in a stable position.
  • Remove the top portion of the backrest shell and lay it in the seat to decreased the height of your chair and allow it to be loaded/unloaded more easily.
  • Position your joystick to the inside of the armrest to further protect it during transit.
  • Put the chair’s drive motors into freewheel mode and switch off the chair’s circuit breaker to allow airline personnel to move your chair without driving it.
  • Make sure your chair’s seating system is shrink wrapped prior to loading in order to keep the backrest and other chair components together during transit.
  • Use bubble wrap when needed for more protection, such as headrests, omni displays, or other accessories.
  • Attach a tag to your chair and any removable parts with your contact information.
  • When you get to your gate, ask the gate attendant if you can talk with the ramp supervisor. You can give them the checklist and explain how to take care of your chair.
  • Take your cushion with you on the plane for increased comfort while you travel.
  • Remember, make sure to advocate for yourself. Because what works for others may not work for you.
  • Some airlines have hoists to assist with transfers on the aircraft, if required check with the specific airline to confirm if this is available.
  • If travelling with a service dog advise the airline prior to travel to have approval for the dog to travel on board.
 
If Something Happens to Your Chair
 
  • Remain calm. Remember, having the right attitude can do a lot of help resolve an otherwise stressful situation.
  • File a claim with the airline or other travel provider before you leave the airport.
  • Contact a Permobil authorised dealer in your area or the local Permobil representative. They will do whatever possible to help you get back up and running. To find the nearest Permobil Dealer, visit http://www.permobil.com/en/Corporate/
Please refer to your owner’s manual for additional safety tips and transportation guidelines.
 
 
 
 
Key Contributors
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Key contributors to the blog are Malcolm Turnbull, a Permobil advisor and wheelchair user, and Rachel Fabiniak, Permobil Clinical Education Specalist and physiotherapist.
 
With years of end user experience, involvement in the supply of assistive technology, and training in the areas such as pressure care, seating, and shoulder injury prevention, Malcolm brings an end user focus to clinical training.
 
Rachel recently relocated from Permobil USA to Australia as a Clinical Education Specialist for Australia and New Zealand and brings with her years of experience as a physiotherapist in a spinal cord injury rehab hospital and homecare.

While the blogs are meant for short, quick learning, the Permobil Academy has several other opportunities for in-depth and focused learning. Please check out the Permobil Academy page for more information regarding courses.
 
 
 
 
 
 
Pediatric-Blog-6-SmartDrive-Title

 

 

A conversation between the Director of Clinical Marketing Stacey Mullis, OTR/ATP and Devon Doebele, PTA, our resident power assist expert at Permobil.  Focusing on power assist and how it can enable efficient independent mobility.

Devon is a PTA and has spent the past five years educating therapists and end users on the benefits of power assist, specifically SmartDrive. He has done a fantastic job of keeping up with end users who use SmartDrive and has had the privilege of seeing the long-term benefits. Today we are focused on the paediatric population, and I asked Devon several questions that I had regarding children using a SmartDrive. Check it out.

Stacey Mullis: What is SmartDrive?

Devon Doebele: SmartDrive is a power assist technology that attaches to the rear of a manual wheelchair. It helps with the push phase of manual wheelchair propulsion, making it easier for manual wheelchair users to propel their wheelchair.

Stacey: At what age would you consider power assist with kids? Is the size of SmartDrive always the same regardless of the size of the chair?

Devon: I’ve seen some pretty young kids do very well with SmartDrive. It works great because it can go on their small chairs and be programmed for safety. So long as the kids have the physical and cognitive capabilities, it is a great option. But as far as age? I’d say if they are independent with a manual wheelchair but need a little extra help, it’s worth a shot. 

Stacey:  Yeah, I can see that. If lack of endurance keeps them from being independently active, I could see it being a great solution. I’m just thinking of those tiny chairs for two- to three-year-olds. Does a SmartDrive fit on those?

Devon: And yes, endurance as well as strength for ramps/hills. No more having to get pushed by mom or dad!

The SmartDrive can attach to the TiLite Pilot ultralight wheelchair with the following measurements: 9” wide or greater, 22” or 24” wheels, rear seat-to-floor height greater than 13.5”.

Stacey: What lifestyle advantages are there to using power assist?

Devon: One great advantage is transport. If a child can transfer, she probably prefers to sit in the car with her family or friends rather than in her wheelchair with tie downs.

Another great advantage is efficiency at school, being able to do what we take for granted: getting to class on time. And not all sweaty from pushing! And getting through heavy school doors, or holding the door for the ladies and still being able to keep up with my buddies.

The coolest part is they don’t HAVE to use it in the classroom where not needed.

Then there is hopping in your friend’s car to go the mall or park or movies. Can’t do that in a power chair. And once there, you don’t need friends to push you around. So now they have much more independence and opportunity for participation with peers.

Then, work age comes around. Depending on the job and environment, there may be vocational aspirations that can’t be met or challenging to achieve without the help of SmartDrive

Then there is dating...who wants to have to be pushed up the ramp at the pier?  Not me.

And to be able to hold your partner’s hand on a walk? Can’t be done without a SmartDrive. Little things like that have a major impact on self-esteem and quality of life. Things we take for granted.

Stacey: What physical advantages are there to using power assist?

Devon: The shoulders, elbows and wrists were not designed to be pushing manual wheelchairs. And over time the manual chair user may start to develop overuse syndrome. What does this mean? Increased pain and fatigue from pushing. This leads to slowing down, doing less, and participating less. It creates a downward spiral that can lead to big life changes: like needing to transition to a power wheelchair, the last thing that someone who is independent in a manual chair wants to do. Having a SmartDrive early in a wheelchair users life in a manual chair can help to prevent this and facilitate a high level of independence and quality of life long into the future.

Stacey: This is great information. Thanks for visiting with me today.

Devon: It was my pleasure.

 

As you can see it was a great conversation and my enquiring mind got some answers! If you have further questions about how SmartDrive could work for your child, please contact customer service.

 

Stacey Mullis.jpg 

Stacey Mullis, OTR/ATP
Director of Clinical Marketing
 

Stacey is Director of Clinical Marketing. She graduated from Western University in London, Ontario, Canada with a BA Linguistics and BSc Occupational Therapy and has practiced as an OTR for over 20 years. With experience in paediatrics, inpatient/outpatient rehabilitation, long term care, and home health, Stacey has faced the challenges first hand of providing appropriate seating in various clinical settings. This led her to pursue an apprenticeship at Care Partners Seating Clinic in Asheville, NC to advance her skills, and she obtained her ATP certification in 2012. Mullis is a member of the NCOTA, CTF, NRRTs, RESNA, and AOTA.

How people sit is fundamental to their health

The standard sling seat, sling back, collapsible wheelchair was designed to transport people short distances, for short amounts of time, to assist the person pushing the chair, and to make storage easy.

The chair works for the caregiver, but very poorly for the person in it, particularly if it is used for long periods of time and as the primary seating system for the individual.

When frail elders are properly seated in chairs designed to meet their personal needs, improvement in their health is virtually instant.

  

Benefits of Proper Seating:

Improved Posture

The chest cavity more easily expands if the person is not slumped forward.

Better positioning improves: breathing, swallowing, digestion, lung compression, vascular health, pressure distribution

Good positioning can also improve quality of life

Posture, skin condition, ability to care for self, efficient use of limited energy and endurance, eye contact, socialisation, talking to each other, eating & drinking, watching TV, self confidence, neck/shoulder pain, lower back pain

Prevention of Skin breakdown

Proper cushions and support prevent skin and tissue breakdown by more evenly distributing pressure, thus allowing the individual to be up for longer periods without causing damage.

Improved comfort and wheelchair tolerance

Comfort and physical safety is an important concern for frail elders.

The amount of time the person feels able to be up in the chair can be used as a practical indicator of comfort.

if the person is uncomfortable in the wheelchair or day chair, they will often ask to go to bed sooner and refuse to become more involved in activities.

Oder adults experience more pain due to :

Arthritis, chronic illnesses, fatigue, diagnosed or undiagnosed spinal fractures, muscular atrophy, tendon shortening

Often with proper positioning and support this type of pain can be dramatically reduced.

Persons with dementia may not have the verbal or cognitive ability to express their pain in words or even respond appropriately when they are in pain.  However their behavious is often a good indicator of pain.

Improved Ability to Care for Self

Correct arm rest length and height allow a wheelchair to get under the table so that at meals the persoon can be close enough to reach the food and feed themselves.

A level eye gaze allows them to see in the mirror for grooming.
With the proper chair many people can independently wheel themselves from place to place.

Better Use of Limited Energy and Endurance

Frail elders often have limited stamina, endurance and energy.  When one is not positioned properly, energy is required simply to remain upright.  

A standard wheelchair weighs btween 15-19kg, a lightweight chair weighs 10-15kgs, and an ultra lightweight chair can weigh even less 8-9kgs.

Choosing a lighter weight chair can save energy for use with other activities.  With proper support the person can relax and focus on other activities such as eating or conversing.

Improved Socialisation

this can result from:Ta level eye gaze, ability to move ones self in and out of social situations, increased comfort, choice in accessing activities

Improved Quality of Life

It goes without saying that if a person is more comfortable, more independent and has better function, that person will have improved quality of life and self esteem.

Caregiver Assistance

When properly seated:

Frail elders may be easier to transfer, be able to transfer themselves, be able to toilet or feed themselves, may require less repositioning, tolerate being up for longer periods, have fewer behavioural problems.

 

For more information on seating and positioning please click here Seating products

 

 

 

XXL-Rehab has a wide product range  to cover all needs. All the products have been designed for easy access, independence, safety and on the care­giver terms.

 

XXL-Rehab Minimaxx


- Folds up easily and is easy to bring along. 
- Constructed with high-tech lightweight tubing for highest strength at lowest weight.
- Smooth drive thanks to the rigid folding system and light tubing.
- Drives very well due to the position of the rear and front wheels.
- Low seat height makes it easy to access the chair and still propel it.
- Different arm rests available.

       


 

For more information on the XXL Rehab range please click here.

 

 

 

 

 

 

10 (in)conveniences of using a Wheelchair 

What's the worst thing about using a wheelchair? The chair? Here at Batec Mobility we think the worst part of having reduced mobility isn't the wheelchair itself, but the architectural barriers and obstacles that stop us from going where others go and doing what others do. Don't miss this video: you're sure to recognise these 10 obstacles. We give you our solution to not only overcome them but have fun doing it.

Click here for more information

 

EPUAP 2015 Satellite Symposium
Presented by Amit Gefen, Ph.D.
 

The Effective Wheelchair Cushion: Applying Science to Efficacy

 

 

EPUAP 2015 Satellite Symposium
W. Darren Hammond, MPT, CWS
 

A Clinician's Look at Deep Tissue Injury

 

 

 

EPUAP 2015 Satellite Symposium
Cees Oomens, Ph.D. 

Why Different Types of Wounds Occur