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N - Wheeled Mobility

3. Trial/Simulation - Selection of specific equipment to trial, ideally in the user’s environment(s). At least one trial is recommended and, often, several are needed. If specific equipment is unavailable, a simulation of the products and their orientation is required. 4. Prescription – The team (including the user) finalizes and documents final decisions, rationale and details of the seating components and mobility base. 5. Funding - Access and degree of funding varies across Canada, affected by age and SCI characteristics. Often, justification reports and letters of medical necessity are required. 6. Wheelchair Preparation - Once received, the seating and mobility system requires assembly and set-up by the supplier/vendor, guided by prescription specifications. 7. Fitting - Fine-tuning adjustments, such as centre of gravity and back support angles, are customized while the user sits in the new wheelchair, to ensure comfort, postural and functional needs are met. 8. User Training - It is critical that wheelchair users and caregivers have the knowledge and skills to use the seating and mobility system, safely and effectively (see Figure 3.0). Key areas for training include: • Wheelchair handling, such as folding or propelling/driving, and managing obstacles. • Transfer in and out of the wheelchair, on various surfaces (e.g., on and off the bed, in and out of the car). • Regular activities (e.g., pushing up ramps or slopes, and over curbs). • Maintenance, including cleaning and tire pressure • Pressure sore prevention with cushion maintenance and safe, weight-shifting techniques. 9. Follow Up, Repair and Maintenance - Follow-up assessment and review of the training progress are required to ensure that the system operates as intended, with proper comfort, function and physiological supports. If modifications are required because of wear, changes in health or functional status, the assessment process begins, again. FIGURE 3.0 USER TRAINING Current Practice: Wheeled Mobility Wheled Mobility in Rehabilitation The ultimate goal of rehabilitation processes (outlined above and illustrated in Figure 2.0) is to assist the individual with SCI to achieve maximal independence, and to enable participation in activities he/she finds most important and meaningful. Service Providers Every participating E-Scan site (n=12) reports multiple services directed toward wheelchair service provision, although other forms of wheeled mobility were not included, explicitly, in the survey questions. Each site indicates conducting some form of wheelchair skills training and having a specialized seating service. In general, these sites report having multiple service providers involved in service delivery. Figure 4.0 A is a summary of service providers that deliver wheelchair skills training, with consistency of type noted, across the country. Data was collapsed across multiple categories of skills training, which ranged from training both users and caregivers in manual or power wheelchair skills, to training in varying environments or other challenges (e.g., inclines, stairs, confined spaces, doorways, different surfaces, curb cuts, obstacles), and on specific skills (e.g., forward and backward rolling, steering, wheelies). WHEELED MOBILITY | PARTICIPATION 141


N - Wheeled Mobility
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