http://mscare.com/a0112/page_04.htm
December 2001
Rory A. Cooper, PhD
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
© 2001 International Journal
of MS Care
International Journal of MS Care
page 4, Volume 3, Issue 4
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.
Senior Instructor
Division of Occupational Therapy
School of Rehabilitation Sciences
University of British Columbia
Vancouver, British Columbia, Canada