Problematic clinical features of powered wheelchair users with severely disabling multiple sclerosis

Abstract

Purpose: The aim of this study is to describe the clinical features of powered wheelchair users with severely disabling multiple sclerosis (MS) and explore the problematic clinical features influencing prescription. Method: Retrospective review of electronic and case note records of recipients of electric-powered indoor/outdoor powered wheelchairs (EPIOCs) attending a specialist wheelchair service between June 2007 and September 2008. Records were reviewed by a consultant in rehabilitation medicine, data systematically extracted and entered into a computer database. Further data were entered from clinical records. Data were extracted under three themes; demographic, diagnostic, clinical and wheelchair factors. Results: Records of 28 men mean age 57 (range 37-78, SD 12) years and 63 women mean age 57 (range 35-81, SD 11) years with MS were reviewed a mean of 64 (range 0-131) months after receiving their wheelchair. Twenty two comorbidities, 11 features of MS and 8 features of disability were thought to influence wheelchair prescription. Fifteen users were provided with specialised seating and 46 with tilt-in-space seats. Conclusions: Our findings suggest that people with severe MS requiring an EPIOC benefit from a holistic assessment to identify problematic clinical features that influence the prescription of the EPIOC and further medical and therapeutic interventions. ä Implications for RehabilitationPeople with multiple sclerosis (MS), referred for an EPIOC, require a full clinical assessment to identify problematic clinical features that are potentially treatable and/or can be accommodated through specialised seating and tilt. The beneficial effects of TIS should be considered for all EPIOC users with MS and particularly for those with comorbidity Poorly controlled spasticity, when identified in people with MS, should be managed through positioning in the chair, pressure-relieving cushion and referral for medical management.

Clinical features of electric powered indoor/outdoor wheelchair users with spinal cord injuries: A cross-sectional study

“…In this study, tilt-in-space chairs were provided to almost 40% of the cohort and specialised seating to about 18%. These findings were comparable to a similarly aged cohort of multiple sclerosis EPIOC users (De Souza & Frank, 2015).…”

“…In this study, we found additional clinical features that may be associated with ageing, such as osteoarthritis and ischaemic heart disease, and this may add to evidence that people with SCI experience 'accelerated ageing' (Charlifue, Jha, & Lammertse, 2010). However, this finding may also be due to long term disability and wheelchair use as similar co-morbidities have been reported for EPIOC users with multiple sclerosis (De Souza & Frank, 2015) and cerebral palsy (Frank & De Souza, 2017). This cohort are older than population-based groups of people with SCI and similar to reports of older people with SCI and parallel medical conditions such as heart disease, diabetes and obesity (DeVivo, 2012) which were also found in our EPIOC users.…”

“…EPIOC provision was limited to those who were unable to walk safely around their own home, unable to self-propel and were judged safe to use their chairs in public places (Frank et al, 2000). Details of the clinical service are provided elsewhere (De Souza & Frank, 2015;Frank et al, 2000). All individuals with a diagnosis of a SCI living in the community who had been prescribed an EPIOC and were currently using their chair at the time of this retrospective review were of interest to this study.…”

“…heart disease) (DeVivo, 2012) amongst other factors. Due to the ambiguity of categorising these conditions as comorbidity, a corollary of the SCI, or a feature of long-term severe disability, they have been referred to collectively as additional clinical features (ACFs) (De Souza & Frank, 2015).…”

“…Electric powered wheelchairs are not only important in their ability to enhance personal independence and participation but are now also considered to be significant therapeutic tools (De Souza & Frank, 2015Dicianno et al, 2015). Features such as specialised seating (SS) (to promote an optimal seating posture and enhance comfort) and tilt-in-space (TIS) (for pain control, pressure reduction and fatigue management) are transforming the lives of EPIOC users who may sit in their chairs for up to sixteen hours a day (Frank et al, 2012).…”