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Dolan M.J.,Southeast Mobility and Rehabilitation Technology Center
Disability and Rehabilitation: Assistive Technology | Year: 2013

Purpose: To develop rigorous clinical standards for National Health Service (NHS) wheelchair and seating services in Scotland. Method: Clinical standards and an evaluation tool were developed by a working group using a well-established methodology. The available evidence was reviewed and a person-centre, iterative, consensus decision-making approach was employed to draft the standards. A public consultation was undertaken. The draft evaluation tool was tested during pilot visits to two wheelchair and seating centres. Results: The majority of the 34 consultation responses were supportive, recognising the need to encourage and measure improvements and for a consistent approach to service delivery. Piloting found that the standards were challenging but achievable. The finalised standards and evaluation tool have been issued to health boards in Scotland. Conclusions: Following a structured, interdisciplinary and consultative process, the first clinical standards for NHS wheelchair and seating services in the Scotland were developed. They emphasise the need for an anticipatory approach, shifting from a reactive model of service delivery to a proactive one. Although developed in the Scottish policy context and service delivery model, many aspects of the standards will be applicable to services based in other parts of the UK and beyond. © 2013 Informa UK Ltd. Source


Dolan M.J.,Southeast Mobility and Rehabilitation Technology Center | Henderson G.I.,Southeast Mobility and Rehabilitation Technology Center
Disability and Rehabilitation: Assistive Technology | Year: 2014

Purpose: To characterise the provision of wheelchair seating both pre-and post-clinical intervention and compare and contrast the two largest diagnostic groups. Method: The case notes of those attending a wheelchair seating clinic for adults over a defined period were reviewed retrospectively. A classification system was devised that delineates between the complexity and type of equipment to gain a better understanding of provision. Results: 146 patients were included; mean age 45 years (SD 16); 53.4% male. The two most prevalent primary medical diagnoses were cerebral palsy (CP) and multiple sclerosis (MS); 48.6% and 20.5%, respectively. The MS group, in comparison to the CP group, were significantly more likely to be older, new to seating provision, have been seen more recently, have a powered wheelchair, self-propel their manual wheelchair, have low rather than high complexity equipment and have their equipment changed following assessment. Conclusions: The equipment classification system will allow results from different studies to be readily compared. The results for those with CP and MS reflect the respective stable and progressive nature of these conditions. Referrals for those with MS should be prioritised. Wheelchair seating users with MS should be reassessed ∼18 months after provision.Implications for RehabilitationA detailed classification of wheelchair seating equipment based on a recognised standard vocabulary, such as the one proposed, is required to gain a better understanding of provision.Wheelchair seating equipment budget and staffing levels should reflect the diagnostic make up of a service's patient population.Referrals for people with MS should be prioritised as their current wheelchair seating provision is more likely not to be meeting their needs.People with MS should have a clinical review 18 months after wheelchair seating provision. © 2014 Informa UK Ltd. Source


Dolan M.J.,Southeast Mobility and Rehabilitation Technology Center | Henderson G.I.,Southeast Mobility and Rehabilitation Technology Center
Disability and Rehabilitation: Assistive Technology | Year: 2016

Purpose: To determine the prevalence of control devices for electrically powered wheelchairs (EPWs), related characteristic features and users’ views on their utility. Method: Postal survey of users of a regional NHS wheelchair service using a purpose-designed questionnaire (n = 262, ≥18 years old). Results: Mean age 54.4 years, female 56.8%, mean duration EPW use 10.1 years, mean usage 6.7 days per week and 9.2 h per day. Largest diagnostic groups: Multiple Sclerosis 28.3%, Cerebral Palsy 13.8% and Spinal Cord Injury 11.7%. Control device types 94.6% hand joystick, 2.3% chin joystick, 2.7% switches and 0.4% foot control. 42.4% reported fatigue or tiredness and 38.8% pain or discomfort limited EPW use. 28.0% reported an accident or mishap. Conclusions: This is the first study of control devices on a large, general population of EPW users. The majority have control devices that meet their needs, with high levels of user satisfaction, though some might benefit from adjustments or modifications to their current provision and others might benefit by changing to a different type of control device. High proportions reported fatigue or tiredness and pain or discomfort limit their EPW use. The study provides indicators for prescribers and manufacturers of control devices for EPWs.Implications for RehabilitationMost users have control devices that meet their needs, with high levels of satisfaction, but some would benefit from adjustments or modifications or a change of type.A high proportion reported fatigue or tiredness and pain or discomfort limit their use of their EPW and prescribers need to be mindful of these issues when determining the most suitable type of control device and where it should be positioned.The vast majority of users have a hand joystick as a control device with alternative control devices (such as chin joysticks and switches) being far less prevalent.Adverse incidents may arise due to difficulty with manoeuvring or accidental activation of the hand joystick that can lead to collisions and even entrapment. 2016 © 2106 NHS Lothian Published by Informa UK Limited, trading as Taylor & Francis Group Source


Dolan M.J.,Southeast Mobility and Rehabilitation Technology Center | Henderson G.I.,Southeast Mobility and Rehabilitation Technology Center
Medical Engineering and Physics | Year: 2013

Wheelchairs are, for users, a primary means of mobility and an important means of performing activities of daily living. A common, accepted vocabulary is required to support and foster evidence-based practice and communication amongst professionals and with users. The international standard for wheelchair vocabulary, ISO 7176-26:2007, specifies terms and definitions with the purpose of eliminating confusion from the duplication or inappropriate use of terms. The aim of this study was to assess its impact and, based on that assessment, critically appraise the standard. Two databases were searched returning 189 and 283 unique articles with wheelchair in the title published between 2004-2006 and 2009-2011 respectively. Compliance, based on title and abstract usage, was poor, ranging from 0 to 50% correct usage, with no significant difference between pre- and postpublication. A review of prescription forms found only 9% correct usage. A survey of NHS wheelchair managers found that only 30% were positive that they had a copy despite 67% agreeing that the standard is important. The ISO wheelchair vocabulary standard was found not to be achieving its stated purpose. It is recommended that it be revised taking into account the findings of this study including the need for targeted dissemination and increased awareness. © 2012 IPEM. Source


Hollington J.,Southeast Mobility and Rehabilitation Technology Center | Hillman S.J.,Southeast Mobility and Rehabilitation Technology Center
Journal of Rehabilitation Research and Development | Year: 2013

Interface pressure mapping (IPM) is a clinical tool that assists the selection of seat cushions for pressure management for wheelchair users. Clinical pressure measurements are almost always made under static sitting conditions, although this does not consider the time-dependent properties of some cushion materials that may behave differently under the dynamic conditions of self-propulsion. This study investigated the potential for such differences by collecting seat IPM measurements from eight wheelchair users using four different seat cushion designs during static sitting and self-propulsion. Mean pressure corresponding to the approximate anatomical location of the ischial tuberosities was used to rank the four cushions under the two conditions. The two sets of rankings for each participant were then compared using correlation. Dynamic data from four participants was judged too inconsistent to be interpreted reliably and demonstrates the practical difficulties associated with dynamic IPM measurement when variations in individual propulsion technique cannot be controlled. Strong correlations were observed between rank orders for the remaining four participants and suggest that the statically derived pressure measures can be used for clinical decision making when selecting cushions for self-propelling wheelchair users. Source

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