Getting the right wheelchair can help maintain a patient's independence and even boost their confidence. Hélène Hofmanvisited the Royal Hospital Donnybrook's Seating Clinic to find out more
For the staff at the Royal Hospital Donnybrook (RHD), allowing patients to continue with their everyday activities is high on the agenda. The Seating Clinic, which aims to match patients to the right wheelchair, is central to maintaining this quality of life.
"It's so important for a patient to have the right chair," says Shirley McGurk, a physiotherapist at the RHD who works in the Seating Clinic. "It's important for social reasons so that their family can come and take them up to the coffee shop or take them out. I don't think there's a single person in the hospital who stays in bed all day. We even have chairs for the very compromised so that they can get out for at least a few hours," she says.
The RHD offers rehabilitation services as well as complex extended care and respite services to adults with physical and neuro-disability and older people. As a result, about 95 per cent of the hospital's patients use the Seating Clinic.
Using information gathered from the nurses, occupational therapists and physiotherapists, the clinic pieces together the requirements for a patient's wheelchair. The aim is to provide each patient with a comfortable wheelchair adapted to their physical needs that will also facilitate their daily routines.
"The nurses will begin by assessing their level of disability. Then the physiotherapist can tell if the patient can get up and walk around and how much time they're likely to spend in the chair.
"The occupational therapists then will look at what they need to be able to do. Do they go on home visits, do they need to be able to get through certain widths of doorways? We try to look at all these things. The idea is to make the patient comfortable and safe and ensure they're not going to develop any problems," says McGurk.
The wheelchairs come in different widths and can be fitted with high-pressure relieving cushions that give support where required. Additional arm supports or special foot plates can also be added.
To complement the staff's assessment, the Seating Clinic has access to a state-of-the-art pressure mapping system. McGurk says the system is particularly useful in cases where a patient may not be able to communicate when he or she feels pain.
The pressure mapping system gives staff a computerised visual representation of a patient's pressure spots. This enables them to choose a cushion that takes pressure off those areas, making them more comfortable and preventing painful pressure sores.
Gerard Smith has been living at the RHD for the past five years and visits the Seating Clinic every few weeks. He uses a powered wheelchair which can be elevated to standing level.
"The chair goes up and down which is very handy," Smith explains. "For example, if I'm in a supermarket I'm not asking people 'can you give me a hand?' or 'can you get that off the top shelf'. I can do it myself. That's a big, big step. I can also go up the bar and have a drink there. I'm not straining to look up at people and they're not bent over looking down at me," he says.
In the next few months Smith will be moving out of RHD and into semi-independent accommodation. This means he will have someone to prepare meals and help him get up in the morning and go to bed at night, while the rest of his time he will live independently.
"This clinic has helped me no end in terms of sitting badly, being in pain and not being aware that it didn't have to be that way. People like them [staff at the Seating Clinic] made me aware that changes can be made by something as simple as adjusting a cushion. It makes a huge difference," he says.
According to Heather Walsh, an occupational therapist who runs the Seating Clinic, getting the best possible assessment from the start is essential to making sure a patient has the best chair for them.
"Doing a full assessment gives you the best chance of getting the right chair first time. It may not always be perfect but you get a whole load of issues covered and we can gradually refine it from there. But once you have a really thorough assessment, you stand a pretty good chance of getting a close match to what's best for the patient," she says.