Page 276 - Handbook of Electronic Assistive Technology

Chapter 9 • Powered Mobility 265

Table 9-1 Assessment Areas for Powered Mobility and Rationale—cont’d

Assessment Area Rationale
Personal care How independent is the person? Do they need to be able to access a wash
basin/vanity unit? Must they be able to have their hair washed from the seat
(i.e., must it tilt and/or recline)?
Physical assessment It is necessary to conduct a physical assessment of the person to determine
their abilities and limitations (Chapter 3). The following critical measures are
highlighted:
• Can the person bend at the hip to the extent that a sitting position can be
obtained (usually 90 degrees)?
• Does this cause their pelvis to tip into posterior tilt? If so, this is likely
to cause a loss of lumbar lordosis, an increased thoracic kyphosis,
an extended neck, a ‘poked’ chin and difficulties with line of vision.
It may also cause the person to slide forward, having implications
for the potential development of pressure ulceration under the bony
prominences of the pelvis.
• Can the pelvis be positioned in neutral with respect to obliquity (one
side higher than the other) and rotation (one side forward of the other)?
Asymmetries in the pelvis must be either corrected or, if fixed, accommodated
to provide a stable base of support to the trunk.
• Can the knees be extended with the hip flexed to the position demanded by
the chair foot support? If they cannot, tight hamstrings are indicated, and
because these muscles run over two joints, the position of the knee will affect
the position of the hip. If the hamstrings have become shortened but the
feet are still placed forward of the knee, the pelvis will tend to be pulled into
posterior tilt, which will have the effects listed previously and will be likely to
cause the person to slide forward (Frank and De Souza, 2016). Where the
person has long legs, the dictated foot position can cause a clash of foot
support and castor wheel.
• Can the hips be placed in a little abduction without causing rotation in the
pelvis? This provides a wider, more stable base of support.
• Are the shoulders level? If not, additional support to the spine may be
required and, where there are bony prominences, accommodation for
shape will also be needed.
• Can the head attain a mid-line position or does it need additional support?
Is the person able to turn their head to look around them as they are
driving?
• Are there restrictions to arm movement? How will this impact upon the
ability of the person to manipulate the controls of the chair?
• Are the ankles fixed in plantarflexion (indicating angle-adjustable
footplates) or can they be positioned in neutral?
Clearly, the level of physical assessment will be dictated by the person’s
complexity of need, but while it is not necessary in every case to conduct a
very detailed physical assessment, ascertaining that there are none of these
critical measures is still vitally important. Where a full physical assessment is
required, suitable facilities will also be needed (i.e., transfer equipment and a
physiotherapy plinth). Crucially, sufficient time must be allowed.
Continued