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N - Wheeled Mobility

Key Clinical Issues: A Roadmap for SCI Rehabilitation and Wheeled Mobility There is significant disparity in wheeled mobility practice across Canada. Several sites are not systematically addressing wheeled mobility, in a manner consistent with available best practice protocols. Substantial challenges also exist in acquiring adequate and timely funding for equipment, and to accommodate the changing needs of individuals, with respect to wheeled mobility options. These challenges vary across jurisdictions, and reflect differences in policy, resources and service delivery models. In addition, many challenges are associated with effective follow up and ongoing assessment, training and customization to meet the changing needs of individuals living in the community, over time. Initially, clinicians prescribe wheeled mobility devices to best serve both immediate and long-term needs, by considering several factors (e.g., functional ability, safety, risk for complications, personal goals). However, individuals with SCI often undergo significant changes, within the first few years of injury, as they adjust to their disability. This may be accompanied by a re-shaping of life goals, new leisure or vocational pursuits or changes in health and wellness (e.g., secondary complications). Individuals may also return to communities that lack the resources available in SCI-specialist facilities. Effective systems may not be in place to assess, train or customize a new solution to address this service delivery gap. Three key clinical priorities, consistent with enhanced rehabilitation practice, would improve programming in wheeled mobility: 1. Reduce disparity through implementation of a standardized approach to wheelchair skills training and assessment, across Canada. • Implementation of the WHO guidelines (including the WSP), in programs not currently offering these services systematically, would standardize service delivery. Some resourcing may be required to assist equipment funding and training, at these sites. 2. Reduce disparity through a professional certification program which requires a minimum standard. • A certification system, similar to RESNA’s and informed by WHO guidelines and standards, would include information on training, follow up and maintenance, and be offered for basic, intermediate, and complex levels of certification attainment. 3. Augment ongoing follow-up services to ensure programs better meet the changing needs of individuals with SCI. • Rehabilitation programming needs to facilitate ongoing service delivery to all individuals, even to those who return to remote communities. This may be accomplished through various service models and requires changes in both policy and clinical application levels. Reimbursement models need to be revised to enable this follow up with wheelchair users – part of which may be facilitated via telehealth applications. However, initial rehabilitation efforts should be directed to encourage a self-management perspective. This approach empowers the individual, and instills an awareness of the benefits of ongoing review to inform modifications to training/ practice regimens, or existing wheeled mobility devices. Creation of appropriate tools and resources, during initial rehabilitation, may enhance adherence and facilitate a return to specialized services. Each of these priorities could be enabled, in part, by inclusion in the Accreditation Canada framework (especially in the context of a specialized SCI “Program of Distinction”). Further development work is important to establish essential best practice indicators that support assessment and monitoring, in clinical practice settings. Table 1.0 identifies possible practice indicators. Table 1.0 Best Clinical Practice Indicators for Wheled Mobility Best Practice Indicators How is it measured? 1. The program adheres to a standardized and validated protocol for wheelchair skills training (e.g., Wheelchair Skills Training Program3), in all suitable individuals. Patient records document assessment and training procedures. 2. Each patient requiring a mobility device has a documented assessment of physical, functional and environmental needs that informs wheelchair selection and procurement. Patient records document assessment findings, analysis and plan. 3. The program follows the WHO Guidelines for Manual Wheelchair Provisions in Less-Resourced Settings,1 thereby enabling equal access to trained personnel, appropriate equipment, and short- and long-term follow-up. Patient records document specific steps, outlined in WHO Guidelines. WHEELED MOBILITY | PARTICIPATION 147


N - Wheeled Mobility
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