More MS news articles for Jan 2002

Book Review: Wheelchair Selection and Configuration

December 2001
International Journal of MS Care
page 4, Volume 3, Issue 4

Rory A. Cooper, PhD
424 pp. New York
Demos Medical Publishing, Inc; 1998
$34.95 US
ISBN 1-888799-18-8
This book provides a comprehensive description of the wheelchair from historical, sociological, psychological, functional, mechanical, and medical perspectives. The target audience is students and professionals in the fields of occupational therapy, physical therapy, rehabilitation sciences, and rehabilitation engineering. Because of the inclusion of content on US legislation and international standards for wheelchairs, as well as wheelchair repair and maintenance, this book may also be a resource for wheelchair users to better assess quality and maintain their wheelchairs.

The first chapter describes the meaning, symbolism, societal constructs, and regulations related to the wheelchair. It also touches on the social development of a wheelchair user at school, work, and recreation. The chapter is sensitive to the emotional, psychological, and social adjustments required of the user. For example, a child born with a disability requires no transition, while an adult with a sudden onset of disability experiences a dramatic adjustment to his or her sense of autonomy and is faced with the abrupt challenge of learning new skills. For an adult with a gradual onset of disability, such as patients with multiple sclerosis (MS) who require wheeled mobility, the wheelchair may symbolize acquiescence to the disease. The price of obtaining increased mobility and function may be exacted at great emotional cost. Finally, the importance of the environment and cognitive impairments of the individual are noted, though their implications are minimally discussed.

The contents of chapters 2 through 5 are in-depth discussions of physical measurements, as well as the engineering, biomechanic, ergonomic, and electronic fundamentals of wheelchairs. These chapters provide detailed commentary augmented by diagrams and photographs. The charts included in these sections are clinically very useful. While there is little doubt that chapters 3 and 5, as well as parts of chapter 4, are for the intellectual appetite of the engineer and those studying for the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) credentialling exams, the principles of physics and mathematics are presented in an understandable way for the therapist. Likewise, issues related to human factors, such as the diversity of wheelchair users and uses, are relayed as tangible considerations for the engineer. It should be noted, however, that the example at the end of chapter 2 describing someone with MS is relatively atypical. The first choice of mobility for the majority of those with MS is a scooter. A manual wheelchair is infrequently chosen due to the physical energy required to operate it and the presence of fatigue, upper extremity weakness, sensory anomalies, and movement disorders.

There is an excellent discussion in chapter 6 about wheelchair standards and testing. Compliance with the 22 standards established by the International Standards Organization is voluntary, so the testing of wheelchairs by manufacturers is described in detail. The various tests carried out for strength, fatigue, range, and safety are indicated, and the three classes of "wheelchair failures" are reviewed. This chapter also distinguishes "rehabilitation" from "depot" manual wheelchairs and provides a pointed discussion about the difference in longevity between these and its subsequent economic implications.

Chapters 7 through 10 give thorough treatment to the types of wheelchairs. Each chapter is dedicated to one of the following: manual, power, specialized, or sport (recreational) wheelchairs. For each type of wheelchair, the subtypes are presented, along with descriptions of numerous components and accessories. For practitioners working with people with MS, there are a couple of pages in chapter 8 that directly address scooters.

In chapters 11 and 12, Dr. Cooper turns his attention to accessories for wheelchairs. Chapter 11 discusses issues related to cushions, including measurement, properties, stresses on tissue, and types of cushions. Seat bases, seat base–positioning equipment, and computerized shape-measurement are also addressed. Postural support systems are the subject of chapter 12. The variations and customized options available for complex seating needs are clearly described. The issues addressed in this chapter may also be relevant for some persons in advanced stages of MS.

Theoretical and clinical perspectives on assessment and intervention are outlined in chapter 13. Philosophic approaches discussed include the human activity assistive technology (HAAT) model, the "allocation of functions" approach, the decision-making process for implementing continuous quality improvement, and a framework for disability: an individual and societal relationship. Clinical areas addressed are interviewing, observation, measuring performance, team assessment, computerized assessment, service delivery systems, funding, and documentation.

Chapter 14, the final chapter, deals with the important topic of wheelchair adjustment and maintenance. Topics include adjusting wheel camber and alignment; center of gravity; and seat, back, and leg-rest positions. Also discussed are user maintenance: cleaning, scheduled inspections, repairs, and replacements. There is also a section on manufacturing and modification.

Wheelchair Selection and Configuration serves as an excellent resource for those learning about the “ins and outs” of wheelchairs, or as a refresher for those not regularly involved in recommending wheeled mobility. This book would be a superb adjunct to print or electronic materials about products (wheelchairs and accessories) currently available.

Reviewed by Susan J. Forwell
Senior Instructor
Division of Occupational Therapy
School of Rehabilitation Sciences
University of British Columbia
Vancouver, British Columbia, Canada

© 2001 International Journal of MS Care