SWM Online Resources
Many online courses in seating and wheeled mobility are now available online. In order to support clinicians in their learning, the CTF Education Workgroup has compiled and reviewed these courses, listed in the spreadsheet link. Each of these courses has been rated for the following 2 items based on guidelines from the World Health Organization:
- The wheelchair user's level of need
- The clinician's level of expertise
Graduates of occupational and physical therapy programs should be able to provide a seating and mobility assessment and equipment for Basic Wheelchair Users.
A. Basic:
This wheelchair user has good sitting balance, achieves neutral sitting posture, does not require hands or seating/postural modifications to support sitting posture (also known as hands-free sitter). Basic users require a wheelchair that fits properly, provides appropriate mobility, back support and seat cushion with skin protection. For example: An older adult without fixed contractures, or people with low level spinal cord injuries that can sit upright.
For the basic wheelchair user, the clinician should be able to:
1) Wheelchair Users and Services:
• Identify wheelchair users: basic, intermediate, complex wheelchair users
• List steps of service delivery process
• Understand that wheelchairs/seating typically are funded through 3rd party payors depending on the setting, and how to research funding possibilities
• Identify characteristics of appropriate wheelchair and benefits
• Identify members of the wheelchair service delivery team
2) Sitting Posture
• Describe reference neutral posture vs person's optimal posture
• Identify benefits of optimal sitting posture, negative consequences and causes of poor sitting posture
• Identify neutral pelvic posture, and postural deviations: posterior, anterior pelvic tilt, lateral tilt and rotation and consequence trunk postures.
3) Pressure Injuries
• Describe pressure injury and the stages, causes, risk factors
• Describe methods to prevent pressure injuries including cushions, weight relief, sitting posture, shear, temperature, seat to back support angle
4) Exam & Evaluation Part 1: Assessment and Screening
• Perform interview, history, environments, communication current technology
• Perform functional, mobility and balance assessment: sitting/standing
• Identify propelling abilities of the wheelchair user and how it relates to equipment (Independent? Dependent? Manual or Power Wheelchair?)
5) Exam & Evaluation Part 2: Physical Evaluation
• Assess physical aspects: Sensation, pain, strength, skin integrity, neuromuscular status
• Assess current sitting posture: pelvis, trunk, hips, legs, arm, head
• Perform basic supine mat assessment: PROM/joint and spine flexibility: pelvic mobility, hip flexion to 90, knee ext to 90, hip abd/add to neutral, ankle dorsiflexion/plantarflexion
• Accurately utilize the terms "fixed" or "non-reducible and "flexible" or "reducible" and ROM requirements for sitting posture
• Understand basic concept of accommodation of limited range of motion; limited hip flexion and tight hamstrings causing PPT/kyphotic posture if not accommodated
6) Exam & Evaluation Part 3: Assessment and Plan of Care
• Perform hand simulation: assessing flexibility and postural support needs in sitting
• Take basic linear measures of the seated person while supported in optimal posture: Buttock/thigh depth; lower leg length, hip width, seat to inferior angle of scapula
• Translate body measures into seating dimensions
7) Basic Wheelchair/Seating Technology Options
• Identifying the type of user who is appropriate for DME vs CRT
• Identify the differences between DME and CRT wheelchairs
• Identify different categories of wheelchairs (frame types, adjustability options) understand basic clinical indications for major wheelchair types and features (independent vs dependent mobility bases; reclining, tilt, recline; scooters; power chair vs manual)
• Identify basic differentiating features of seat cushions (shape and materials), and basic clinical indications/goals: pressure distribution and/or postural support, method of pressure distribution, materials and contours
• Identify basic features of back supports and clinical indications
• Be aware of off-the-shelf vs. custom contoured seating systems
• Understand how to collaborate with the local rehabilitation technology supplier (RTS) to identify the best "person-technology match"
• Understand therapist's role in the wheelchair service delivery process
B. Intermediate:
Fair sitting balance, achieves close to neutral posture, requires postural support, uses hands on supporting surface to support (also known as hands-dependent sitter) For example: people with cerebral palsy or head injury without contractures or significant tonal issues (spasticity, athetosis) requiring basic seating postural support (without complex modifications).
For the intermediate wheelchair user, the clinician should be able to:
1) Understand and perform all the skills and concepts for assessment of the basic wheelchair user
2) Understand the benefits of postural support: communication, eating, mobility, respiration, etc
3) Further analyze hip ROM limitations, ie: hip abduction/adduction and rotation
4) Further analyze trunk ROM limitations, ie. fixed lateral flexion/rotation (scoliosis), fixed kyphosis
5) Further assess intermediate user in the sitting posture utilizing hand simulation: flexibility and postural support
6) Provide basic intervention strategies for the following issues:
• Flexible posterior pelvic tilt (sacral support)
• Fixed or flexible lateral pelvic tilt or obliquity (shelf under high IT)
• Mild limitation in hip flexion (ie. -10-15° from 90°) (open seat to back angle)
• Knee extension limitation (ie. -10-15° from 90°) (cut back front edge of seat cushion)
• Trunk spine with lateral flexion that corrects to neutral (lateral trunk and hip supports)
• Legs that adduct or abduct (medial and lateral thigh support)
• Head that falls to one side (posterior and lateral head support)
7) Understand three-points of control for lateral spinal curvature (flexible) and for posterior pelvic tilt
8) Understand angles of pull of pelvic positioning belt and ankle straps and supports
9) Take linear measures of the intermediate user (in addition to those of basic user): shoulder width, chest width, internal knee width, external knee width, shoulder height, occiput height, elbow height, foot depth
10) Measure current wheelchair seating angles; understand the impact of seating angles on sitting posture: seat to back support angle, seat to lower leg support angle, lower leg to footrest angle
11) Translate range of motion values into desired body angles and wheelchair seating angles
C. Complex:
Poor sitting balance, unable to achieve neutral posture, needs custom supports (also known as prop sitters) For example, people with significant tonal issues, contractures and deformities.
For the complex wheelchair user, the clinician should be able to:
1) Understand and perform all the skills and concepts for assessment of the basic and intermediate wheelchair user
2) Have experience with more complex technologies of material simulation, complex seating, molding.
3) Determine seating strategies and features required to address user's more complex needs such as fixed spine and rib distortions; lower extremity contractures (hip abd/add, IR/ER)
