From Evaluation to Delivery and Beyond: Manual Tilt-in-Space Wheelchairs

The evaluation process for providing a wheelchair is a multi-step procedure sometimes requiring several healthcare providers. This process is a proven method to ensure a good fit between the end user and their necessary mobility equipment.

There are multiple resources available for clinicians to help guide them through this process including the RESNA wheelchair service provision guide as well as the WHO service provision guide.

Typically, clinicians use these guides when evaluating and prescribing complex mobility equipment including powered mobility – e.g., group 3 or group 5 powered wheelchairs as well as K5 ultralight manual wheelchairs.

What if I told you this process is just as important for mobility scooters and/or manual tilt-in-space wheelchairs? There are traditional conceptions regarding manual tilt-in-space wheelchairs including: these chairs are solely for those dependent on others for propulsion, persons dependent for weight shifting, or for those persons who are severely medically compromised. Or, that manual tilt-in-space wheelchairs are too heavy and bulky to be self-propelled or not suitable for everyday use.

I have been guilty of this type of thinking in the past. It is important to understand the same process of evaluation, fitting, and training that goes into providing a powered wheelchair or an ultralight manual wheelchair should be applied to a manual tilt-in-space manual wheelchair. This includes the evaluation and sometimes often-missed components of the wheelchair service provision process: Fitting, Education, and Delivery – which are detailed both in the RESNA Wheelchair Service Provision Guide and the Wheelchair Provision Guidelines by the WHO.

The Evaluation 

Briefly, for a client-centered, best-practice wheelchair evaluation, there is an interview component, including: an inquiry of their goals, roles, as well as environment of use. It also includes a postural assessment in several positions as well as assessing the skin, and the client’s sensation. This is information the client’s medical team uses to best align their needs to the most appropriate equipment.

The Trial

Another part of this process is using a demo wheelchair to see if the goals discussed as well as proposed equipment works in practice. The demo wheelchair may not be an exact match of what the client requires but it is also an integral part of the process for determining the right fit. Using a demo wheelchair is also a great way to remain client centered as it gives the client and his/her family the opportunity to make some reasoned choices. Sometimes what works on paper does not translate to the real world.

Choosing what type of tilt is required when determining the best fit for a manual tilt-in-space wheelchair. Manual tilt-in-space wheelchair models come with multiple options for tilt including center of gravity (COG) pivot tilt as well as knee pivot tilt. For more information on the different types of tilt please refer to this blog.

Further, manual tilt-in-space wheelchairs can have varying options for the available degree of tilt e.g., 20 degrees, 45 degrees, or even 50 degrees. How the client propels (or is propelled) as well as their functional needs can affect the choice of tilt, e.g., is the client a foot propellor? Propelling by hand? A combination of both? Or dependent for propelling? Does the client need to be able to get their knees under a table in a tilted position? Do they need to have their feet on the floor in a tilted position?

Having a demo wheelchair can help determine if the type of tilt is appropriate and it is a great chance to also see what other adjustments are necessary, including a possible change of center of gravity. Where the center of gravity is adjusted can have a profound effect on the propulsion performance of the chair and even if the end user is dependent on propulsion, this setting can affect the caregiver who is propelling the chair.

Once the right equipment has been determined, funding is the next step of the process.

Fitting, Training, and Delivery

An often-missed element of the wheelchair service is the fitting, training, and delivery. Having the ATP and the clinician present at the wheelchair delivery can help ensure the functional aspects of the wheelchair are working as intended. Adjusting the proper fit of the wheelchair and seating and positioning is integral to safe use of the wheelchair. E.g., are the primary and secondary supports adjusted for the proper function of the end user? Is the client or the caregiver able to access tilt controls? Or something as simple as – can the client actually get their feet on the floor – for transfers and/or propulsion? Without going through the fitting process, the wheelchair and positioning may not operate as intended and can even pose a risk for skin breakdown or other issues if not considered.

Lastly, training is also incredibly important so that the client and their caregivers understand how to operate the elements of the wheelchair and positioning, making sure that safety and function are considered. For example – is the client and their caregiver able to properly adjust their tilt, wheelchair cushion, or any other aspects of the wheelchair? Have the client and their caregivers been trained on a tilt schedule? Are they aware of the maintenance necessary (including a maintenance schedule) for all the elements of the wheelchair and positioning? Do they know who to contact in the event of an issue? These are all elements of the training that are very important.

Knowing these steps and why they are important can help ensure the wheelchair and its positioning are working as intended and can ensure the safest use of the equipment to protect skin health and maintain the function of the client at the wheelchair level.