Introduction to module 5

Welcome back! I hope that everyone is doing well. Let’s get started with the 5th module. Using the GET WISE framework, the following items will be covered in the 5th module:

G – Goals will be set regarding wheelchair/scooter maintenance.
E – Exercise program will be reviewed during the online discussion.
T

W – The influence of wheelchair/scooter set up and maintenance will be discussed
I – Continued discussion will be held during the online discussion regarding engagement in
desired activities.
S
E

I hope that you enjoy the materials for this week!

Video 5b: Wheelchair Set Up

In this module we are going to discuss how the set-up of your wheelchair can influence a fall. There are many adjustments that can be made on your wheelchair – we will discuss how items can be adjusted or equipment used to prevent falls from occurring. Unfortunately, few adjustments can be made to scooters so this discussion will primarily be about wheelchairs. Please feel free to talk to the trainer about specific issues you might be having during the online discussion.

Please now turn to page 123 of the manual

The way that your wheelchair is set up can have a big influence on falling. Today, we will discuss some of the most common components that can influence the occurrence of a fall. When you are selecting a new wheelchair, please consider these various items. If possible, work with a therapist who is a certified Assistive Technology Professional (ATP). The website to find an Assistive Technology Professional is listed on the program manual.

We will now talk about a few components of your wheelchair that can be adjusted to aid in fall prevention.

First up is Manual wheelchair rear axle position

On some manual wheelchairs, the axle associated with the large rear wheels can be moved back and forth. Getting this set up correctly can influence how easily your chair can tip over.

• When the axle is moved forward (towards the small wheels) the chair is less stable.
• Moving the axle backwards, (further away from the small wheels) makes the chair more stable.

It is very important to strike a balanced position. It may be tempting to put the wheel in the most stable position to prevent a fall, however, this can make the chair more difficult to push.

When the rear axle is moved further forward, the shoulder joint is in better alignment to push the chair, preventing the development of upper limb injuries. It also makes it easier to do several of the wheelchair skills that have been taught to you during this course.

Therefore, you want to try to move the rear axle as far forward as you feel comfortable, but you should also make sure that the chair is stable enough that it doesn’t easily tip over backwards. As you become more proficient with your wheelchair skills, you can work to move the axle position further forward with the assistance of your wheelchair vendor.

In addition, adding heaving items on the back of your manual wheelchair, such as a heavy backpack, can make it easier for the chair to tip over backwards.

The next thing to consider is manual wheelchair caster size

The size of the wheelchair front wheels (casters) can also have an influence on falls. Smaller casters allow for more mobility. They make it easier to do quick, small turns and are useful in tight locations. However, small casters can get caught in the sidewalks more easily. Larger casters don’t get caught as easily but can be more difficult to maneuver. Again, reaching a balance between functionality and stability is necessary! There are plenty of “mid-sized” options available!

Wheel locks:

Wheel locks or brakes are an important component of a manual wheelchair to increase the stability of the chair while doing activities. You can find a wide variety of wheel locks to fit your specific needs. For example, some wheel locks are pushed to engage while others are pulled to engage. Please talk with your therapist and/or wheelchair vendor to find a device that can work best for you.

For a wheel lock to provide stability, it must be engaged! Before performing a transfer or any other activities that requires your chair to be stable, take a moment to think if your wheel locks are engaged.

Power wheelchair seat elevators:

The use of a device that elevates the seat of a power wheelchair can be beneficial for the prevention of falls. The seat elevator allows an individual to raise the height of the chair, which can make performing a transfer easier by allowing a user to transfer in a downward direction. A wheelchair user can also use the elevation feature to more easily reach for items above shoulder level. Some power wheelchairs also have the ability to tilt the seat of the chair in an anterior (forward) direction. This further helps a wheelchair user to safely reach necessary items.

A note about scooters:

While a scooter can be very convenient and break down to fit into a car, the stability of the device is limited. When using a scooter be very careful when making sharp turns or reaching for items. Even small shifts in body weight can cause the device to fall over. If you are getting a new device, please consider the use of a power wheelchair. We recognize that there are a lot of changes that will need to be made, particularly associated with transportation. If you use a scooter, please talk with the trainer further about the benefits of a power wheelchair and how to make the transition as easy as possible.

Please now turn to page 126 of your manual. You will see a brief worksheet that will help guide your thinking about your current wheelchair or scooter and if there are any changes you think are needed to help prevent falls. Please complete this worksheet before the next online discussion.

Funding of Fall Prevention Equipment

Welcome back. In this module we will discuss how to fund equipment to assist in fall prevention. Please turn to page 127. Getting the necessary equipment, such as wheelchairs, reachers, tub benches, etc. to help prevent falls can often be challenging due to limitations in insurance coverage. Unfortunately, as a result of declines in budgets that fund both private and government-based insurance policies, the problem will likely get worse.

To have the best chance of getting insurance coverage for necessary equipment to prevent falls, it is essential that you work with a knowledgeable clinician who has experience writing letters of justification for equipment.

A good place to start is to work with a therapist who is a certified Assistive Technology Professional (ATP). A website is provided in your manual to help you find an ATP in your area.

The National Muscle Sclerosis Society also has a database of healthcare professionals that are familiar with providing care to individuals living with MS. The website is listed in your manual.

Despite the best efforts of therapists, there are often situations in which insurance companies simply do not provide funding for equipment that can be beneficial for the prevention of falls. For example, it is often very difficult to get funding for a seat elevator.

Next, I will talk about some resources that can help you to get the equipment that you need.

National Multiple Sclerosis Society: The National Multiple Sclerosis Society has some resources for equipment loan programs in which an individual can borrow a piece of durable medical equipment. You can contact the main number listed in your manual or contact your local chapter directly. Information on local chapters (and other support resources) can be found in your manual.

Centers for Independent Living: The Administration for Community Living oversees a nationwide program to promote independent living for individuals with disabilities. These Centers for Independent Living (CIL) are nationwide and provide a variety of resources including durable medical equipment, care partners, etc. free of charge or at very reasonable rates. They can also help you to navigate insurance benefits. A listing of centers for independent living across the country are listed in your program manual.

Assistive Technology Loan Programs: The National Disability Institute supports an Assistive Technology Loan program in which loans are provided for Assistive Technology with very low or no interest. You can find out more about the programs through a website listed in your manual.

If you need a piece of equipment, don’t give up! While the process can be long, there are several resources available to support living well with a disability.

Please now turn to page 128 of your program manual. You will see a brief worksheet that will help guide your thinking about a piece of equipment that might be useful to you to prevent falls and what resources you would use to get that equipment. Please complete this worksheet before the next online discussion.

Module 5 Journal Entry

Please now turn to page 129 of your program manual. For this week’s journal entry, please think about your current wheelchair or scooter. How do you like it? Have you had any problems with the device? If yes, what kinds of problem did you have and how do you think you could solve the problems? Are there any new options you would like to get on your next wheelchair or scooter?

As a reminder, these journal entries will help you to think about the information that was presented during the education session and help you integrate what you have learned into your everyday life.

Wheelchair Maintenance

Welcome back. Please turn to page 130 in your program manual. Properly maintaining a wheelchair is an important component of fall prevention. A recent study of power wheelchair users1 found that wheelchair malfunctions were often associated with falls. Taking an active role in maintaining your chair or scooter will not only help prevent falls but it will also make pushing/driving your wheelchair or scooter easier. To get more information about wheelchair maintenance, the University of Pittsburgh has developed an extensive website on wheelchair maintenance. The web address is listed in your manual.

If you notice any problems with your wheelchair or scooter it is VERY important to notify the wheelchair vendor who sold you your wheelchair/scooter as soon as possible. He or she can perform repairs. At times, a loaner wheelchair or scooter can be provided to keep you going while your chair is being repaired. The vendor can also help you submit the cost of the repairs to your insurance company.

Please now watch either the video ‘Manual Wheelchair Maintenance’ or ‘Power Wheelchair Maintenance’ depending on which type of wheelchair you use most often. These two video were developed by the University of Pittsburgh and provide extensive information on wheelchair maintenance. Starting on page 130, bullet points are provided the summarizes the information presented in the video. Please follow along as you watch the video.

Manual Wheelchair Maintenance

Power Wheelchair Maintenance

Module 5 Goals

During this week’s module, a discussion was held on the importance of wheelchair and scooter maintenance.

It is therefore important that you know the contact information of your wheelchair or scooter vendor in case any repairs need to be done to your chair. Please take a few minutes to locate the name and phone number of your vendor. Often, the vendor will place a sticker directly on your chair/scooter with the company’s phone number. If you need help, please ask a friend or family member to look over your chair/scooter to see if he/she can help you locate the phone number.

Before the next online discuss, please set a goal to find out the name and phone number (and be sure this information is accurate) of your vendor. Please write as much information as possible in the table on page 133.

If you don’t have regular contact with the vendor, please call the vendor to introduce yourself and make sure he/she is able to do repairs on your chair/scooter. If not, ask him/her to give you information of who can do the repairs.

If you received the wheelchair or scooter from a friend or family member or cannot find the information of the vendor, you can also contact the manufacturer. A listing of the phone numbers of the service department of major wheelchair/scooter manufacturers are listed in your manual. If you are having trouble, please talk to the trainer during the online discussion.

Please also take some time this week to practice your transfer and wheelchair/scooter skills you have learned during the past 3 modules. Please remember to have a care partner with you when you practice these skills.

Module 5 Closing Remarks

We are now going to wrap up the material for this module. Before we go, I would like to remind you of a few things to do prior to the online discussion:

• Practice the home exercise program (page 16).
• Continue to work on your fall management plan (page 85).
• Work toward developing a plan to do a desired activity in your home or community (page 120).
• Identify the name of a person to contact if wheelchair/scooter maintenance is needed. (page 133)
• Complete your journal entry reflecting on your current wheelchair or scooter (page 129).
• Think about how you will maintain your new skills in the long-term.

During the next and last module,

G – goals will be set on maintaining skills and setting new goals.
E – Exercise program will be reviewed during the online discussion and progressed for anyone who needs new ideas.
T

W
I
S – Discussion will be held on long term use of exercise to manage MS related symptoms.
E