SLCH News: Clinic Evaluates Children's Needs for Custom Wheelchairs and Seating Systems

Therapy Services at St. Louis Children’s Hospital offers a Wheelchair Clinic that provides individualized patient evaluations to develop custom-designed wheelchairs and/or seating systems. The team of Melanie Wood, OT, and Elizabeth O’Neal, PT, oversees the clinic. Both have completed training in how to evaluate children’s needs in regard to wheelchairs and seating systems.

“Our training brought home to us the fact that many St. Louis-area children are not being properly evaluated to determine their requirements regarding wheelchairs,” says Wood. “Both an occupational therapist and physical therapist should be involved in ensuring children benefit from the most comfortable, functional equipment for their particular needs.”

The clinic offers four wheelchair evaluations per month, which are scheduled on Tuesdays and Thursdays; plans are to expand the service in 2012. The evaluations are conducted in Therapy Services on the fourth floor of the hospital and take about two hours. In addition to Wood and O’Neal, a wheelchair vendor is on hand, either one chosen by the parents or one suggested by the clinic.

“We go over patients’ medical histories and any upcoming surgeries that may affect their seating needs. We also gather information about their transportation and environment—does the family have an adapted car, does the wheelchair need to fit inside a trunk, do the patients use the wheelchair to get around their home, how many steps are there to get into the house,” explains Wood.

The therapists then measure patients’ range of motion and their ability to sit with minimal external support while seated on a mat. Some manipulation is done to see if patients can be placed in more comfortable and functional positions without using excessive force. Once the evaluation is done, the therapists talk to the families about how their children’s wheelchairs can be adapted with adjustments like lateral or hip supports, changing the foot and/or head rests or expanding the seat frame.

“For children with skin integrity issues, we can request that the vendors bring along pressure mapping equipment that illuminates where patients’ major pressure points are when they sit on the device. We can then work to eliminate those problems,” says Wood. “We also offer power wheelchair trials to determine whether children can safely maneuver an electric wheelchair and the type of joystick that allows them to move the chair.”

She adds, “Assessing children in regard to power chairs is a matter of gauging whether they run into things because they can’t handle the chair, or whether it’s a matter of them being a toddler exploring their environment—which for any youngster means some collisions and falling down.”

Wood and O’Neal also assess children for their needs regarding bath chairs, adapted strollers and toilets, standers and beds, and they can provide recommendations for prescriptions to physicians for those items. Pediatricians are encouraged to refer patients who they feel would benefit from an evaluation, either for placing a child in a wheelchair for the first time or for patients they think are not functioning as well as they could be in their chairs.

“If children have pressure sores or are not able to maneuver around their environment, if they sit in a slouched position all the time and can’t reach as high as they should—these are all instances where an evaluation would be warranted,” says Wood. “It’s also important to note that a patient can receive a new wheelchair from insurance every five years, which makes it imperative that their wheelchair be the correct fit.”

To refer patients to the Wheelchair Clinic, physicians may fax a prescription for “wheelchair evaluation” to Therapy Services at 314.454.2380 or contact Children’s Direct at 800.678.4357. If pressure mapping or power wheelchair trials would be beneficial, a request for those services should be included on the prescription. In addition, a family may make an appointment at 314.454.6154 and bring the prescription with them at the time of the evaluation.