Wheelchairs and Seating

WHEELCHAIR GROUP 3

WHEELCHAIR FITTING 2

Introduction

The Wheelchair and Seating Service (WSS) provides a service to over 24,000 adults and 2,600 children across Lothian, Fife and Borders. The service includes individualised special wheelchair seating for people whose needs cannot be met using off-the-shelf equipment. If you have been issued with one of our wheelchairs, and particularly if you are new to using a wheelchair, you may find the following information useful.

Role of the Wheelchair and Seating Service

The role of the WSS is to satisfy, on an ongoing basis, the needs of the wheelchair user and any seating requirements for those who cannot sit comfortably, safely and/or appropriately within standard wheelchair seats.

The WSS strives to fulfil its role by:

•     providing a patient-focused service that is based on the individual needs of the wheelchair user

•     responding to referrals as rapidly as possible, seeing patients in the order of clinical priority

•     assessing the wheelchair and seating requirements of our patients, taking into account the opinions of the patient, their carers and family and the clinical staff responsible for their care

•     treating our patients with respect, dignity and privacy, ensuring that they, and their carers and family and the clinical staff responsible for their care, are informed about the options available to them, the nature of their wheelchair and seating system(s) and how they should take care of any equipment

•     repairing equipment as quickly as is reasonably possible and ensuring that whenever equipment needs to be removed for repair that, if possible, alternative arrangements are made to satisfy the patient’s requirements

•     consulting with professional user groups and patient and carers user groups

•     ensuring that its staff work to the highest possible professional standards within the resources available

•     meeting all statutory and legal requirements that pertain to the wheelchair and seating systems that it provides

Enabling Technology for Children (ETC)

ETC is the paediatric wheelchair and special seating service for clients up to 18 years of age. The provision of equipment by ETC is based upon the needs of the child and their family. The assessment will be carried out with everyone involved with the child where possible.  The appointments may be in Edinburgh or held locally. Repairs to the equipment are co-ordinated by ETC. We use the same repairs contractor as the adult wheelchair service. ETC and the Adult Wheelchair and Seating Services provides the option of an extended transition period for young people with complex physical needs. A copy of the Policy Document can be viewed by clicking on the following link – Transition from ETC to Adult WSS Policy Document

What sort of equipment is available?

ETC can offer children a range of  wheelchairs, buggies and supportive seating that will meet their postural needs. The  types of equipment we can offer are:

Buggies – usually for young children who are unable to walk. There are a number of  models available which can provide different amounts of support for children who have difficulty sitting.

Wheelchairs – can be self-propelled or attendant-propelled and are available in a wide range of sizes. Some models are also available in a range of colours.

Energy-efficient wheelchairs – for users who propel themselves for a significant part of the day and who can control the stability of the wheelchair, these wheelchairs offer a more efficient means of mobility than the standard wheelchair.

Electrically powered wheelchairs – available in both indoor-only and indoor/outdoor models for users who are unable to propel themselves and unable to walk who can safely control a powered chair. Assessment for this type of equipment will usually involve a test of driving ability. Copies of nationally-agreed eligibility guidelines are available from the clinical staff.

Adult Wheelchair and Seating Service

The adult service deals with people 18 years and over.

The Wheelchair and Seating Service has a fleet of wheelchairs and supportive seating that meets the clinical needs of a wide range of users.

Wheelchairs – can be self-propelled or attendant-propelled and are available in a wide range of sizes. Some are available with running brakes to assist carers.

Energy-efficient wheelchairs – for users who propel themselves for a significant part of the day and who can control the stability of the wheelchair, these wheelchairs offer a more efficient means of mobility than the standard wheelchair.

Electrically powered wheelchairs – available in both indoor-only and indoor/outdoor models for users who are unable to propel themselves and unable to walk who can safely control a powered chair. Assessment for this type of equipment will usually involve a test of driving ability. Copies of nationally-agreed eligibility guidelines are available from the clinical staff.

Wheelchair Seating Systems

The wheelchair seating systems provided by WSS are individually designed, as required, to:

•     provide postural support, enabling the user to sit when he/she does not have sufficient strength and/or sufficient control to do so unaided

•     provide correction, so as to reduce the tendency for the development of orthopaedic deformities and/or to encourage normal postural development in growing children

•     enhance functionality, thereby enabling the user to perform everyday tasks in an educational, workplace or social setting which he/she would not otherwise be able to perform

•     manage the distribution of pressure, so as to reduce the risk of tissue damage resulting from inappropriate loads being applied to the skin

•     accommodate established orthopaedic deformities

The actual components and complexity of any particular wheelchair seating system, of course, depends on the problems that the system has to address.

Specialist Seating

There are many conditions that affect a person’s ability to sit correctly, comfortably and safely.  These include cerebral palsy, muscular dystrophy, poliomyelitis, multiple sclerosis, motor neurone disease, CVAs and spinal cord lesions. Individuals with one of these conditions typically present with multiple involvements, such as muscular weakness, poor sitting balance, strong involuntary movements, orthopaedic deformities, restricted mobility and function, that adversely affect their sitting ability.  Many of these individuals are also at risk of developing pressure sores.  The complexity and individual nature of these conditions precludes the use of standard off-the-shelf seating systems and require the needs of each patient to be addressed individually.

A comprehensive service is provided from initial assessment to delivery and trial. The seating systems provided are assembled and/or manufactured within the SMART centre’s workshop, by skilled and experienced staff. This not only ensures that the service retains control of the quality of the fabricated parts, but also ensures that the seating solution is tailored to suit each patient.

Production of Special Seating

Whenever possible we develop and use simple modular systems, using materials such as wood, foam, metal and plastic, to produce our seating systems.  With our in-house production facilities, the individualised system can be manufactured without unnecessary delay. If appropriate, we may supply a commercially available, modular or specialised seating system.

In most cases the system is part–fabricated, but not upholstered, before an initial fitting takes place. This allows us to ensure that the system meets its specifications and is safe and comfortable for the user. Once we are satisfied that the system meets the specification, the final fabrication, which includes upholstery, painting and other finishing, can be carried out.

Fitting

The fitting stage is not always necessary but allows a first check on the overall suitability of the system to be carried out. It also allows the position of accessories such as headrests, armrests, powered wheelchair controls, etc., to be accurately determined for the individual patient when they are using a particular seating system.  If modifications are required, they can be carried out most economically at this stage in the production process.

Delivery

At the fitting or delivery stages the wheelchair and seating system is checked for comfort, safety, stability, functionality and the ergonomics of use to ensure that these factors comply with the original specification. The wheelchair is usually delivered to the patient’s home, school, work or day centre.

Trial

Once delivered, the wheelchair and seating system is on trial for a period of four weeks, during which time any problems with the system will be dealt with immediately as part of the same referral.  Any problems identified after the trial period require a new referral.

Accessing the Wheelchair and Seating Service

New clients should be referred using our referral form. Referrals should be submitted either through the patient’s GP, physiotherapist, a hospital consultant, Social Work Occupational Therapists or other NHS professional involved in the patient’s care or who are knowledgeable about the patient’s therapeutic, postural and mobility goals. We would sometimes expect the referrer to attend the initial assessment depending on the individual’s needs.

Established clients of the service should contact us, preferably via their therapist. We will then arrange to meet with you to review the situation.

Waiting Times

Please note that there may be a wait from the time you are referred until the time you are assessed. We aim to meet the waiting time standards set by the Scottish Government. Further information on this can be found on NHS Lothian’s Your Rights – Waiting Times page.

Service Provision

The core elements of the WSS are assessment, design, production, fitting, delivery, trial, and, if appropriate, planned clinic review.

Assessment

The comprehensive assessment of a patient’s wheelchair and seating needs and their abilities is key to ensuring that they receive the equipment which meets their needs.  These needs are determined with input from the patient, if possible, and their carers, therapists, nurses and medical staff, so that a sound definition of the aims of the referral are established.  The patient’s lifestyle, functional needs, postural control, medical condition and tissue viability have to be taken into account in developing the most appropriate solution.

Possible solutions are discussed with all concerned so the one that is most suitable for the individual patient can be determined.  Assessment appointments are usually held in Edinburgh, but can be at the patient’s home, school, work or day centre if this is clinically necessary. Satellite clinics may also be held at other centres where there is an established need for the WSS.

The outcome of the assessment process may involve the issue of a wheelchair which will meet the needs of the user and carer and a complete specification of the seating or other body support requirements which has been agreed between the parties present at the assessment and which must also be agreed by the referrer.  The function, appearance and operation of the equipment will be explained to the patient, if possible, and other relevant persons before the equipment and specification is finalised.

Design of Special Seating

The clinical scientist and/or therapist who conducted the assessment will produce a formal assessment report and specification which will then be used to produce engineering drawings for the components of the seating system which need to be manufactured.  Most components are standard for most seating systems and simply have to be produced in the appropriate size for the individual client. Where standard components are not sufficient for an individual patient’s needs, the clinical scientist will usually specify modifications or produce a new design.  If necessary, externally-manufactured items will be ordered or put aside from stock.

When you get your wheelchair

When you are first issued with a wheelchair, the footplates will be adjusted to the correct height for you, with your thighs fully supported on the seat, and your feet firmly on the footplates. You will have been shown how to fold and unfold your chair. You should also have been given a copy of a booklet which gives some useful information on using your wheelchair.

Wheelchair repairs

Should your wheelchair need to be repaired please telephone the SMART (South-east mobility and rehabilitation technology) centre on 0131 537 9177. We will arrange for our in-house repair service to visit and repair your wheelchair within four working days at no cost to you. If you want to arrange repair yourself we will reimburse you up to a cost of £25. You will need to send us the receipt for us to refund your money.

Common Problems

The wheelchair is too heavy
The weight of the wheelchair makes very little difference when you are pushing it, as the weight of the person sitting in it is always so much greater. Lightweight wheelchairs are easier to lift into or out of a car – the wheelchairs provided by the SMART centre are among the lightest available. Large wheels at the back can make it easier for a helper to get the wheelchair up and down kerbs.

Not comfortable
Check that the footplates are adjusted correctly – thighs fully supported on seat and feet firmly on footplates. A cushion may help. If you find that you are falling to the side, sliding out of the wheelchair or need more postural support contact the SMART Centre on 0131 537 9177. A therapist will contact you and arrange to visit if required.

Wheelchairs are designed to provide mobility and cannot provide the same level of comfort as an upholstered chair. You should not sit in your wheelchair for any longer than necessary. Whenever possible you should sit in a suitable armchair. Your local social work department occupational therapist should be able to advise on different types of armchairs.

The wheelchair pulls to one side
All pavements and roads have a slope on them which will make your wheelchair pull to one side or the other. If your wheelchair has pneumatic tyres fitted and one is softer than the other the wheelchair will pull to the side of the soft tyre. Tyres should be inflated to approximately 45lbs/sq inch. Puncture-proof tyres which do not require to be inflated can now be fitted to most wheelchairs.

Sometimes the wheelchair user sits in such a way that their weight is more to one side than the other so that the wheelchair will pull to the side the person is leaning to. It may be possible to fit extra support on one side to reduce this.

Please contact the SMART Centre on 0131 537 9177 if you have a problem with your wheelchair.

Frequently Asked Questions (Wheelchair and Seating)

Frequently Asked Questions (Enabling Technology for Children)