When a chair isn’t just a chair

The assumption that a “wheelchair is just a wheelchair” often leads to secondary disability, due to pressure sores, collapse of the spinal column, lung and kidney complications, amputation of limbs and sometimes even death

Good seating is a very individual-specific arrangement. Factors such as age, health, medical history and functional needs all play a part in the process of determining wheelchair choice. The device must therefore be set up in such a way to support posture, provide balance and give comfort.

“Good seating” is not a once-off procedure. As wheelchair users grow and mature, the setup of their equipment must be adjusted to their changing needs. Sound clinical reasoning skills and accredited seating training, in addition to a professional qualification and a good understanding of anatomy, are crucial elements.

The following factors form part of selecting the correct device as well as setting up the user in their device:

• Functional needs of the user
• Environment in which the device will be used
• Durability of the product
• Diagnosis and prognosis
• Posture support needs
• Age, sex and personality of the user
• Type of disability
• Support system available
• Finances available
• Abilities of the user such as balance, wheelchair skills, hand function and cognitive abilities

The setup of the cushion is one of the most critical key elements to “good seating” and is vital for pressure relief, postural control and comfort. This must be adapted for the individual user.

Discomfort in a wheelchair has both physical and emotional implications that can impact the quality of life of the wheelchair user. If a person is uncomfortable in the seating device, they will avoid using it – this can result in isolation, lack of integration into the community and further psychological complications such as poor self-esteem and depression.

Physical complications include:

• Scoliosis, extreme lordosis or extreme kyphosis of the back
• An increased risk of pressure sores, which can lead to hospitalisation and even amputations
• Pain
• Increased pressure on the bladder and kidneys
• Lung complications
• Poor balance
• Fatigue and poor sitting tolerance

Common mistakes:

• Un-adapted cushion or no cushion used
• Incorrect backrest height
• Seat depth not supporting the full thigh
• Poor access to the rear wheel
• Insufficient side support for the trunk
• Incorrect frame design for the environment

The international trend is to deliver wheelchair services that meet the standards described in the World Health Organization (WHO) Wheelchair Guidelines. This means that each company delivering wheelchair services should review their policies and procedures to ensure that they meet these standards. The standards have been established for low resource settings and should therefore be easily achievable in SA. In addition to setting out service standards, these guidelines also emphasise the need for trained service personnel and appropriate products.

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Consultants employed at Chairman Industries are either qualified therapists or wheelchair users with an in-depth knowledge of seating and products, and they work hand-in-hand with the user of the product and the referring therapist. Even though there are various seating courses available, the consultants at Chairman all follow the Professional Wheelchair Service Delivery Programme, designed by DARE Consult. It’s the only course in South Africa underwritten by the WHO, based on, and incorporating the WHO wheelchair service training packages. It is aimed at professional level training that consists of Basic, Intermediate and Advanced level courses.

Chairman focuses on providing a fully inclusive solution and has an escalation structure for cases which are more complex. Our Monday seating clinics held at our head office in Johannesburg are part of our social responsibility, providing wheelchair users, who would previously not have had access to this care; the opportunity to be assessed by three trained occupational therapists. In many cases, these assessments have been life changing. We have had the joy of seeing a child’s face as he realises that he can mobilise without his parents’ assistance.

Our passion at Chairman is to make a difference by enabling users to become as independent as possible.