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We're pleased to be working with Somerset Mobility & Stairlifts, providing their clinical wheelchair and seating assessments.  See the details here about what we can provide alongside their service.

Very pleased to be featured in this article in THIIS Magazine.  At the start of the first lockdown, I had a chat with Stuart Barrow from Promoting Independence who writes a regular column.  

You can see the full article here:  https://thiis.co.uk/the-ots-perspective-how-a-specialist-occupational-therapist-can-help-you-with-wheelchair-assessments/

The chair is a great success for which a very big thank you to you. The carers are managing to sit him correctly and several people have commented on his posture being so much better. I've sent a letter today to TPG thanking them for introducing us to you and to emphasise what a good job you did, so hopefully you'll get more referrals. Thank you again for everything. We'll be in touch if there are any future issues. God bless you, JG

What level of service can I expect after I receive my wheelchair?

NHS

  • Equipment from the NHS is maintained and repaired at no cost to the user. If the user changes in any way where different equipment may be required, they can be re-assessed.

Privately

  • Every wheelchair will come with a manufacturer's warranty. The length of this warranty period will between manufacturers and even between different parts of one wheelchair.  Explanation of the warranty periods should form part of the buying process.  The manufacturer's warranty covers parts but does not cover the time taken by the retailer to replace the parts.   Ensure the sales agreement stipulates who is responsible for the cost of the time to fit parts covered by the manufacturer's warranty.
  • There are also service packages available from most retailers. These are agreements to replace, repair or fix problems with the wheelchair and can include accidental damage.  They are normally underwritten by an insurance company. 
  • Breakdown insurance cover is also available. This can also include public liability insurance, which provides cover for accidental damage to someone or something else.

 

How long should a wheelchair last?

  • This varies a lot and depends entirely on how the wheelchair is used and in what conditions. Expect to use the wheelchair for three to five years before it needs replacing, but it may last a lot longer if it is not often used or used well within its physical limits.

 

How long does it take to get a wheelchair?

  • Very basic wheelchairs will be available for immediate purchase from a retailer, or immediate issue from an NHS wheelchair service. More complex wheelchairs will take much longer and require several appointments before an order is made.  For complex equipment, it is essential to trial equipment prior to purchase to ensure it works as expected and meets the requirements of the user.  There can sometimes be a delay of several weeks waiting for demonstration equipment to be delivered from a manufacturer.
  • Once a wheelchair is ordered it can take up to 12 weeks for it to be delivered. This depends greatly on the manufacturer and the complexity of the equipment being ordered.  Some equipment can be delivered in a few days.

NHS

  • Many people who need permanent use of a wheelchair will be eligible for equipment from the NHS. A list of NHS wheelchair services is available online.  This list is frequently changing however, therefore your GP will be able to point you in the direction of your local wheelchair service.  The criteria for receiving NHS equipment varies from service to service.  In general, full time, permanent wheelchair users will always be eligible.  Most NHS wheelchair services require a referral from a health professional (GP, consultant, nurse, physiotherapist, occupational therapist etc).  They will assess what equipment is needed and prescribe accordingly from a range of equipment available to them. 
  • NHS wheelchair service staff are often made up of a mix of occupational therapists, physiotherapists, rehab engineers and clinical scientists. There will also be support staff in administration and clinical roles.

 

Privately

  • Everyone has the option of purchasing their own equipment. Some retailers are members of the British Healthcare Trades Association, however membership is not mandatory.  Retailers will decide with you which is the best equipment for you to purchase, based on your wheelchair needs, and your budget.  Some will employ occupational therapists or physiotherapists to provide a more clinical approach.  Some retailers will have a limited range of wheelchairs, focusing more on other equipment such as beds or riser-recliners.  Speak to them to determine if they can support your wheelchair needs.
  • Having a clinical assessment prior to purchasing a wheelchair can also be useful. This ensures all needs, future and present, of the user are taken into account prior to purchasing equipment.  A clinical assessment will involve evaluation of posture, pressure relief, technical assessment of any current equipment and the environment any equipment will be used in.  The clinician, normally and occupational therapist or physiotherapist will make recommendations for adjustment or additions to the existing wheelchair or will work with the user to determine the best wheelchair for them to purchase.

 

Finance

  • Some retailers will offer finance, enabling the wheelchair to be paid in monthly instalments over a period of time.

 

Charity

  • Charity funding can be available to some wheelchair users. Many charities will have specific requirements or conditions that need to be met, before they support the purchase of a wheelchair.  Most will only support the purchase of equipment that cannot be funded through a NHS wheelchair service.

 

Motability

  • The Motability scheme enables specific disability benefits to fund the lease of a powerchair. Motability has agreements with specific wheelchair retailers to provide the equipment.  The leases are typically 3 years and include repairs and maintenance. 

 

Access to Work

  • The employer of people with a disability is legally obliged to make reasonable adjustments to ensure you they not substantially disadvantaged when doing their job. If the help you need they work is not covered by their employer making reasonable adjustments, they may be able to get help from Access to Work.
  • They need to have a paid job or be about to start or return to one.
  • An Access to Work grant can pay for special equipment, adaptations or services to help do things like answer the phone, go to meetings and getting to and from work.
  • They may not get a grant if they already get certain benefits
  • Bariatric wheelchairs can simply be larger versions of standard wheelchairs; however some models can be more specific to heavier users. They can have additional, strengthening framework added to increase the durability and enable greater maximum user weights to be achieved.  Parts with greater strength can also be fitted, such as wheels, backrest, footrests, upholstery and brakes. 

Testimonial for Silver Fern Therapy:


I found John, from Silver Fern therapy, to have an excellent understanding of my needs after I recently had an assessment with him. The process of assessment was detailed, including looking at my posture out of my wheelchair to see where I needed to be supported. I trialled some seating solutions at his suggestion and my seated position was much improved and I think it will make a positive difference to my long-term health and pain levels. John then wrote a very comprehensive report for me with images to help in explanation. I would recommend Silver Fern Therapy to wheelchair users who need an independent opinion to navigate the myriad of options that are available.

KD, Cardiff

  • Tilt in space wheelchairs can often be fitted with many of the options that other wheelchairs use, however there are some features used more on tilt in space wheelchairs than others.
  • Lateral supports are used to control the position of a user’s spine. They are fitted to the backrest and provide support to the outside of the rib cage.  They can have the effect of preventing a user leaning to the side or can even straighten a scoliosis. 
  • Elevating legrests are often fitted to control swelling of the legs, however simply elevating the legs achieves very little improvement - the legs continue to remain the lowest part of the body for fluid to accumulate. Combined with tilt in space and recline however, the legs can be raised high enough to encourage a reduction in swelling.  This can be an uncomfortable position, therefore many users will opt to transfer to their bed, where they can comfortably raise their legs whilst lying down.  
  • Headrests allow the head to be supported, especially when using tilt in space or recline. In both positions, the users head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
  • Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
  • Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.
  • Standard wheels tend to come with few options, however there are several things to consider.
    • Every wheelchair should have a cushion.  A very basic cushion should be considered a minimum to provide some comfort and pressure relief. 
    • Seat size. Ensure an appropriate seat size.  There shouldn't be much space between the user's hips and the sides or armrests of the wheelchair.  There should be 1-2" space between the back of their knee and the front of the cushion.
    • Backrest height. The backrest should be sufficiently high to prevent the user leaning backwards over the top of the backrest upholstery.
    • Anti-tips. These are two small wheels that protrude close to the ground from the back of the wheelchair.  They prevent the wheelchair tipping over backwards.  This is especially important if the wheelchair is to be used on slopes or if there is any other reason why the wheelchair should be more unstable than normal, such as leg amputees.
    • Headrests allow the head to be supported, especially when using backrest recline. When reclined, the users head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
    • Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
    • Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.
  • Active user wheelchairs are manufactured to be efficient to self-propel, therefore the options available on active user wheelchairs are usually aimed at either being lightweight, or enabling an efficient configuration for self-propelling.
  • Reducing the weight of the chair can be achieved either by reducing the amount of material used or by using a lighter material. For example, many active user chairs have a rigid, non-folding design.  Because a folding mechanism uses a lot of additional frame material, rigid chairs will tend to be lighter.  Another example is the use of aluminium, titanium or carbon fibre to construct the frame of the wheelchair, rather than steel.  Minimising the presence or weight of any accessories such as push handles, tool kits and back packs also reduces the weight of the chair as a whole.
  • There are many ways in which an active user wheelchair can be configured to make it efficient, or easier to self-propel. As described above, being lightweight will help with increasing the efficiency of an active user wheelchair, but there are many other considerations:
    • Seat size. Having a seat width that is too wide means that excessive shoulder movement is required when self-propelling.  A narrow seat width means the wheels are as close as possible, allowing the shoulders to move  in their strongest, most efficient position.
    • Centre of gravity. Many active user wheelchairs have forward-backward adjustment of the rear wheel position, or can be built with a specific position.  It is essential for most active user wheelchairs to have more weight distribution over the rear wheels, than the front casters.  The rear wheels are larger, have a larger tyre and therefore roll with less resistance.  By moving the position of the rear wheels forward on the frame of the wheelchair, the wheelchair becomes more efficient to roll and to self-propel.  This forward position of the rear wheels has the added benefit of improving the position of the shoulders.  They can move with greater strength and efficiency.
    • Seat height. Many active user chairs can be adjusted or configured with specific front and rear seat heights.  The rear seat height determines the height of the shoulders above the rear wheels.  If the rear seat height is too great, the user is required to straighten their elbows more to reach the rear wheels, reducing the strength and efficiency of the arm and shoulder when self-propelling.
    • Backrest height. Excessive height of the backrest restricts movement of the back and shoulders when self-propelling.  However, backrest height is important in creating a stable sitting position.  Therefore if the backrest is not high enough, self-propelling efficiency is likely to be compromised.
    • Standard brakes are positioned to be easy to operate and close to the tyre.  During forceful self-propelling, the thumb of the user can contact the brake, resulting in injury.  Many active user wheelchairs are therefore fitted with brakes that fold away from the tyre when not in use.
    • The wheels transfer energy from the user into movement of the wheelchair, therefore they are important in maintaining efficiency of the wheelchair.  A well-built, lightweight but strong wheel will transfer a greater proportion of energy than a poorly made, heavy wheel.  Being the widest part of a wheelchair, they need to be able to deal with knocks.  A strong wheel will be able to deal with those knocks, when they are attached to the wheelchair and when they're not. 
    • The major decision when it comes to tyres is between pneumatic and solid tyres.  Pneumatic (air-filled) tyres tend to be lighter than solid tyres.  They also have significantly less rolling resistance, making self-propelling much less difficult.  The downside with pneumatic tyres is there possibility of puncturing.  This likelihood can be reduced with thicker tyre tread, good maintenance, liquid infills inside the tube and avoiding certain places where puncture might be likely.  Learning to replace a tube or having someone else that can do this can be a very useful skill.

Affiliations

Affiliations

HCPC
RCOT
Institute of Ergonomics & Human Factors
NHS Wales
Posture & Mobility Group
Call us today on 02921 660346