Transcription:
Spinal Cord Injuries & Wheelchairs

Caitlin Whyte: Welcome to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach, so you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Rehabilitation Network.

Offering a full range of physical rehabilitation services, the UM Rehab Network brings together a committed team of experts from across Maryland to help patients recover from illness or injury, such as stroke, joint replacement or traumatic injury. The University of Maryland Rehabilitation Network, bringing world-class comprehensive rehabilitation services directly to your neighborhood.

Today, we are talking about spinal cord injuries and finding the right wheelchair system for you. Joining us is the University of Maryland Rehabilitation Network's senior physical therapist, Karin Seeley. Karin, starting out with this process, what is the right wheelchair for someone with a spinal cord injury?

Karin Seeley: Well, I get asked that question a lot and, unfortunately, there's no right answer. It's really different for every single person. It's the chair that makes it easiest for you to move about your home and your community, that also helps you with your posture and prevents complications, like pressure ulcers, which are like bedsores that you can get in a wheelchair. So, you know, it's really different depending on everyone's size, shape and what they want out of their wheelchair.

Caitlin Whyte: Now, how soon after an injury should you start the seating process?

Karin Seeley: Well, that's a question that all my students ask me and I usually tell them day one. It's really important that they think about it the first time they get a patient out of bed. If you don't have muscles working, that's what holds us up to sit. So if you sit somebody without muscles working, you better give them something to keep them straight and positioned or else they're going to end up slouching over and getting stuck that way.

Caitlin Whyte: Can you tell us more about why fit is so important when it comes to a wheelchair? I feel like I don't really think about fitting in a wheelchair, you know?

Karin Seeley: People are like they see one at the mall or something, just hop in and think they can push around and everything. But if you're, you know, very weak and the wheelchair is too wide for you, it might be really hard for you to reach the wheels so that you can't push as well. Or another thing about fit is that people don't realize that where the axle of the wheelchair is, where the wheel is, can really make a difference of whether it's easier to push the wheelchair. If it's a little too far forward or a little too far back, it can make all the difference in somebody who has weak arms, whether they can push their wheelchair or not.

Caitlin Whyte: So where do you start when it comes to finding the right seating system?

Karin Seeley: I would say that it's kind of like buying a car. You wouldn't just order one off the internet. You really have to test drive everything. So that's why I think it's really important to go to a facility that specializes in products for spinal cord injury or for stroke.

We really have all the equipment in our facility that someone can try and test drive, because you want to see does this brake work better than that brake? Or am I more comfortable on this cushion or that cushion? And if you don't have the ability to try all that, you really don't know what you're getting in the end.

Caitlin Whyte: That kind of leads me into my next question. I mean, what can happen if you don't get prescribed the right system?

Karin Seeley: So you can really be in a lot of trouble. If you don't get the right thing, your insurance isn't going to pay for another one, just because you got the wrong one the first time. And people are really up a creek because the insurance companies don't want to pay for anything for the minimum of every five years, and even then it has to be on repair and they would prefer if you had a significant worsening of your condition in order to get a new wheelchair. So it's so important to get the right one the first time.

Caitlin Whyte: So with all of these different options, you were talking about the axle of the wheel, the cushions, I mean, how important is it knowing all of the products available right out front?

Karin Seeley: So I think it's super important. You have to know how things interface and I'll give you an example. I had a patient who was a college student and he had no use of his arms or his legs. And he wanted to go back to a big college campus and wheel around in a power wheelchair. And there's basically three ways you can drive that wheelchair. You can use your head like buttons on your headrest. You can use like a little joystick at your chin and you can use a straw in your mouth that you sip and you puff in to drive that wheelchair.

Well, all three work perfectly well, but this guy had a big, big bushy beard that he was not getting rid of. So that chin control wheelchair would not have worked very well. And I could tell the minute I met him that the straw and the mouth was not going to work because that guy spoke to every single person that walked by him and flirted with every girl. There was no way that he could go across the campus and not talk to anybody, because his mouth was occupied driving the chair. So really knowing that patient gets you the right product for them.

Caitlin Whyte: So besides, you know, selecting the best features and options, you kind of touched on this with that example, but what are some other factors to consider when shopping around?

Karin Seeley: So I think besides the fit and, you know, making sure you have the right posture in the chair, transportation is one of the big issues, and then home accessibility. So transportation, a lot of people, you know, use cars in our society. Unless you live in a big city, you might use public transportation. But you can't put a power wheelchair in a car. So unless you have a lot of money to buy a van, because insurance doesn't usually pay for them, or you can rely on public transportation, you're kind of stuck with a power chair, you know, not being able to go out, only as far as the house that you can drive in in your power chair.

And also the home, like if you have steps in the front of the home, you can lift a manual wheelchair up and down the stairs. You know, two people can help lift a person, but a power chair, you need to have a ramp and you need to, in your house, make sure that you can cut all the corners sharpen enough and that the turning radius is the right distance to get in those rooms.

Caitlin Whyte: And wrapping up here, what can a patient expect heading to their seating clinic? Who's present for that?

Karin Seeley: So of course the patient is the most important person. We'd like to have any caregivers or family members if they're the ones that are charging the wheelchair or putting them in the chair and know the easiest way to get them in and out of the chair. The therapist will be there, either occupational or physical therapist. And then we have a seating specialists from a good wheelchair company to be the representative for the products. And those are usually people who are ATPs, which are assistive technology providers. They take a special test to really know how all the equipment interfaces and what parts work with each part and things like that and how insurance coverage is. So it's really important to have all those people there.

Caitlin Whyte: Well, it's always good to know all of your options before heading into such a big purchase. Is there anything else we didn't touch on that you want to add?

Karin Seeley: Well, I would say that if you need a new wheelchair and want to get a wheelchair, that you should definitely look for a facility that you have all the products that you can try to test drive. Of course, we have one here at University of Maryland Rehab that you can look online and get the information for. You always need to have a doctor's prescription to get a wheelchair. Otherwise, the insurance doesn't want to pay for it. And some of these chairs can cost upwards of $25,000.

Caitlin Whyte: We so appreciate you being here, Karin, and guiding us through this important process. There's so much to know and so much to consider. Thanks for sharing it with us. Find more shows just like this one at umms.org/podcast. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again.