Page 272 - Handbook of Electronic Assistive Technology

Chapter 9 • Powered Mobility 261

• Caterpillar-tracked chairs enable even more challenging terrains to be accessed.
• Gyroscopic control has been introduced to the control of powered wheelchairs to
assist with straight line stability, but in a more extreme example was developed in the
1990s to enable a chair to ‘stand’ on its rear wheels (the iBot).

Models of Provision
In NHS services there are often strict eligibility criteria regarding provision of powered
wheelchairs. Therefore the providing service often focuses on the occupant’s ability to
control the chair, and so improve their independence. However, it should also be recog-
nised that enabling the attendant to drive could have a direct impact upon the occupant’s
independence and participation (Care Act, 2014), although anecdotally its application
appears to be taking time to become fully implemented. Where funding for powered
mobility is based on insurance, charitable donations or private means there are fewer
restrictions, which allow the patient and assessor to think more broadly about how best
to meet the identified needs, and the needs both of the person and of their carers or
supporters.
In the United Kingdom the state provides powered wheelchairs through commis-
sioned wheelchair services to those who have difficulty walking. Indoor-only chairs are
used where the person does not have the ability to process the dangers associated with
the additional hazards of the outdoor environment. They are also used where the person’s
home has small doorways, turns or corridors, because the overall footprint of an indoor
chair is usually smaller than that of one designed for use outdoors (as discussed earlier).
Indoor-powered chairs are not provided where the person can push themselves in a man-
ual chair.
Indoor/outdoor chairs are provided where the person has difficulty walking both
outdoors and indoors: they are not provided where the person can mobilise indoors or
where they can manoeuvre themselves around (indoors or outdoors) in a manual self-
propelling chair.
These are the typical rules applied to provision, but there are variations in commission-
ing arrangements in some areas of the country.

Assessment

There is a significant level of complexity to determining which powered wheelchair will be
most suitable for an individual. As such, it is critical that sufficient time be allocated to the
process of assessment (Frank and De Souza, 2014).
Why is this so important? Because rushed assessments mean that information might be
missed and so corrections must be made later. This is both inefficient and unsatisfactory
to the person who will use the wheelchair, to the assessor and to the person paying for the
assessment, which could be a statutory organisation funded by taxpayers, an insurance
company, charitable funds or the individual themselves.