Changing chairs: Anticipating problems in prescribing wheelchairs

Purpose: This article presents a framework for prescribing, ordering, and adapting a new wheelchair, focusing on individual, environmental and wheelchair factors that must be taken into consideration to ensure optimal function. Method: A review and analysis was conducted of all factors relevant to the transition to a new wheelchair. Without appropriate planning and implementation, this transition can result in unnecessary expenses, duplication of effort, and possibly even injury to the user and abandonment of the wheelchair. Results: Recommendations are provided to manufacturers, therapists, technicians, users, insurers and physicians, who must work together throughout this process. To the extent feasible, the authors suggest that major changes from the previous wheelchair should be avoided, particularly for people with substantial functional limitations. Therapists and technicians must measure the user accurately, and anticipate those factors that can impede a smooth transition. Insurers and other payors must recognize that changing wheelchairs will often require substantial professional assistance, including several fittings to adjust the new chair to the needs of the user. Conclusion: Additional research and case reporting on outcomes of adjusting to a new wheelchair appear warranted.