Is an appropriate wheelchair becoming out of reach? - Part 2

Service delivery for complex rehabilitation technology: a scoping review

PURPOSE

Complex rehabilitation technologies (CRT) support independence for individuals with disabilities by enabling mobility for function, employment, education, and independent living. CRT service delivery is evolving, with changes to funding, provider qualifications, consumer needs, and technological advances. This scoping review investigated service delivery processes for individuals with disabilities who have a mobility impairment, while specifically identifying best practices, barriers, and unique features of health delivery policies and practices.

METHODS

We used a framework described by Colquhoun et. al. for conducting scoping reviews, a six-step process that includes: 1) identifying the research question, 2) identifying studies, 3) selecting studies 4) data charting, 5) reporting results and 6) consultation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was also used for reporting results of the review.

RESULTS

Common categories were identified and organised into a hierarchical structure of four categories and 16 sub-categories. The primary categories included "policy", "consumer", "service delivery", and "wheeled mobility devices". The sub-categories described funding sources, consumer and professional populations, service delivery guidelines, and types of mobility devices. Analysis indicated the data were from 21 countries and 14 combinations of funding sources, and the articles were primarily descriptive studies.

CONCLUSION

This scoping review identified evidence from various countries, health systems, and stakeholder. Currently, this process does not proactively address the needs of individuals with mobility disabilities. The scoping review provides the foundation for the development of a novel policy on the provision of CRT services and devices to address these needs.Implications for RehabilitationExamination of national and international service delivery practices in diverse clinical and funding environments indicate various challenges and opportunities for improvement.CRT consumers are negatively impacted by current service delivery practices, including long wait times, lack of specialised clinical expertise, and limited consumer education opportunities.More consistent and widespread research is needed within the CRT provision industry to grow evidence-based practice related to complex rehabilitation technology and individuals with disabilities.

Wheelchair appropriateness in children with cerebral palsy: A single center experience

BACKGROUND

Although wheelchair appropriateness has been studied in general wheelchair users and spinal cord injury patients, it has not been studied in children with cerebral palsy yet.

OBJECTIVE

To describe the wheelchair appropriateness in children with cerebral palsy.

MATERIALS AND METHODS

Thirty children with cerebral palsy were included. Demographical and clinical features of the children were noted. All wheelchair parts were evaluated by the same rehabilitation physician who has attended a wheelchair-training course. Overall, the wheelchair was accepted as inappropriate if at least three parts were inappropriate.

RESULTS

There were 30 children (15 M, 15 F) with a mean age of 10.8 ± 3.5 years. Seat depth (n= 21, 70%), cushion (n= 17, 56.7%), seat height (n= 16, 53.3%), and footrest (n= 16, 53.3%) were the most common inappropriate parts. Overall, 24 (80%) of the children use inappropriate wheelchair. Two (6.7%) children obtained wheelchairs by prescription, 28 (93.3%) obtained without prescription. Twenty-nine wheelchairs were manual and one wheelchair was motorized. Among 30 children, five (16.7%) experienced at least one wheelchair-related fall.

CONCLUSION

In the light of our results, 80% of the children with cerebral palsy seem to use inappropriate wheelchair. Individually designed wheelchairs should be maintained for these children.