OT.qxd
11/4/02
9:54 PM
Page 1
Rural Spinal Cord Injury Project
A collabora t i ve pr o j e ct betwe e n :
Prince Henry & Prince of Wales Hospital
R oyal North Shore Hospital
R oyal Rehabilitation Centre Sydney
November 2002
A u s t ralian Quadriplegic A s s o c i a t i o n
Pa raplegic & Quadriplegic Association of NSW
An overview of
Occupational Therapy
intervention
for adults with Spinal Cord Injury
Useful Strategies for
Occupational Ther a p i s t s
© Authors: Daria McIntosh, Occupational Therapist,
Paraquad, Annette Keay, Occupational Therapist, Paraquad
& Shirley Ford, Occupational Therapist, Royal North Shore
Hospital.
Project funded by the Motor Accidents Authority of NSW
OT.qxd
11/4/02
9:54 PM
Page 2
Functional independence following
spinal cord injury (SCI)
A person’s functional independence has a major impact on their quality of life, sense of
self wo rth and consequential social participation. Some people will have the ability to
achieve a high level of independence and others limited by their physical capacity will
be able to achieve a level of independence through dire cting their care. Whilst it is
reasonable to ex p e ct that the degree of functional independence achievable is
dependent on a person’s lesion level, a person’s neurological level should not be viewe d
as strictly pre d i ctive but rather as indicative of potential function. It is important to avoid
comparisons between individuals with similar levels of injury, as there are many fac t o r s
i m p a cting on an individual’s functional performance (see Table 1).
Table 1: Fa ctors Impacting on Fu n ctional Pe rf o r m a n c e
• N e u rological level (tetraplegia versus para p l e g i a )
• D e g ree of impairment (i.e. complete vs incomplete)
• Age and gender
• Other injuries or medical conditions
( e . g . f ra ct u res, nerve injuries, cardiac disease, arthritis, etc)
• P h ysique (body pro p o rt i o n s / weight distribution)
• Cognition/motivation (e.g. Traumatic Brain Injury (TBI), depre s s i o n )
• Mental illness (e.g. schizophrenia, personality disord e r )
• Drug and alcohol abuse
• Social support s / c u l t u ral e x p e ct a t i o n
• Financial re s o u rc e s
• E n v i ronmental fact o r s
It is important to note that a person’s level of function may change with ageing. There is
a complex intera ction of age at injury, duration post-injury and impairment. It is there f o re
essential to factor in functional decline with ageing. Musculo-skeletal problems with
overuse syndromes are common (e.g. 30% at 5 yrs, > 50% at 15 yrs in persons with
complete paraplegia). On average, the need for assistance doubles over 25 yrs. The last
f u n ctional skills mastered are often the first to go!
Models of Occupational Thera py Pract i c e
In OT, there are a number of theoretical models or fra m eworks from which to base clinical
p ra ctice. The NSW Spinal Unit OT Departments operate within the following basic clinical
f ra m ewo r k :
O C C U PAT I O N A L
THERAPY
SELF CA R E
ACTIVITIES OF DA I LY LIVING
1
P RO D U CT I V I TY
LEISURE
WO R K
R E C R E AT I O N
E Q U I PM E N T
HOME M A I N T E N A N C E
AC C O MM O DAT I O N
E D U CAT I O N
C O MM U N I TY A C C E S S
OT.qxd
11/4/02
9:54 PM
Page 3
SELF CARE
E x p e cted Levels of Fu n ctional Independence and Associated Equipment Needs
N o t e : Tables 2a-g below are not absolute nor prescriptive – people will have differe n t
needs depending on the factors outlined above in Table 1. It is important to contact
t h e rapists working in the field of SCI management if queries arise.
Not included in this table is assistive technology (computer equipment and enviro n m e n t a l
c o n t rol units), however this may be indicated at all levels of SCI.
Table 2A: E x p e cted Levels of Fu n ctional Independence and Equipment Needs for
C 1-4 L e v e l s
Ta s k / Act i v i ty
To i l e t t i n g
E x p e cted Fu n ctional Outcome
Total assist
Bed mobility
Total assist
Bed/wheelchair tra n s f e r s
Total assist
E l e ctric hoist with sling
P re s s u re r e l i e v i n g / Po s i t i o n i n g
Total assist; may be independent with
equipment
Power tilt-in-space wheelchair
Specialised pre s s u re relieving cushion
Po s t u ral support and head contro l
s ystems. Specialised bed and
p re s s u re relieving mattre s s
Hand Splints
Eating/feeding
Total assist
D re s s i n g
Total assist
G ro o m i n g
Total assist
S h owe r i n g
Total assist
Padded seat tilt-in-space showe r
commode. Handheld showe r
Mobility
Manual: Total assist
Manual wheelchair
Power: Independent with highly
specialised equipment
Power tilt-in-space wheelchair and
light wieght manual wheelchair with
ventilator tray and specialised
positioning and control equipment
(ventilator tray only for C1- C 3 )
Tra n s p o rt
Equipment
Padded seat tilt-in-space showe r
commode chair (head rest re q u i re d
for C1- 3 )
E l e ctric hi/lo bed with Tre n d e l e n b e rg
and side ra i l s
Total assist
Modified access van with appro p r i a t e
lock in sys t e m
Assistance re q u i re d
Personal care
h o u s e ke e p i n g
N o t e : C 1-3 Level will re q u i re 24 hour Ventilator Assistance. C4 Level can
b reathe unaided.
2
OT.qxd
11/4/02
9:54 PM
Page 4
Table 2B:
E x p e cted Levels of Fu n ctional Independence and Equipment Needs for C5 Le v e l
Ta s k / Act i v i ty
E x p e cted Fu n ctional Outcome
Equipment
To i l e t t i n g
Total assist
Bed mobility
Total assist
Bed/wheelchair tra n s f e r s
Total assist
P re s s u re r e l i e v i n g / Po s i t i o n i n g
Total assist; may be independent with
equipment
Eating/feeding
Total assist for set up, then
independent eating with equip
D re s s i n g
Lower: Total assist
Upper: Moderate assist
Padded seat shower commode chair
Adaptive equipment
E l e ctric hi/lo bed with Tre n d e l e n b e rg
and side ra i l s
E l e ctric hoist with sling
Power tilt-in-space wheelchair
Specialised pre s s u re relieving cushion
Hand splints
Po s t u ral support and head contro l
s ystems
Specialised bed and pre s s u re
relieving mattre s s
WHO wrist cock-up splint
Adaptive feeding equipment
(eg palmar band)
Adaptive techniques and equipment
G ro o m i n g
M o d e rate to total assist
Adaptive techniques and equipment
S h owe r i n g
Total assist
Padded seat tilt-in-space showe r
commode Handheld showe r
Mobility
Manual: independent to some assist
dependent on ground and floor
s u rface
Power: Independent with highly
specialised equipment
U l t ra lightweight rigid or folding
f rame wheelchair with modified push
rims
Power tilt-in-space wheelchair with
arm drive (with WHO wrist cock- u p
splint in situ)
Tra n s p o rt
Independent with highly specialised
equipment
Modified access vehicle with
a p p ropriate hand controls to drive
Assistance re q u i re d
Personal care
h o u s e ke e p i n g
3
OT.qxd
11/4/02
9:54 PM
Page 5
Table 2C:
E x p e cted Levels of Fu n ctional Independence and Equipment Needs for C6 Le v e l
Ta s k / Act i v i ty
E x p e cted Fu n ctional Outcome
Equipment
To i l e t t i n g
Total assist
Padded seat shower commode chair
or shower chair with cut out for access
Adaptive equipment
Bed mobility
Total assist
E l e ctric hi/lo bed or
King single size std bed
Bed/wheelchair tra n s f e r s
Total assist or moderate assist
(occasionally independent)
E l e ctric hoist with sling may be
re q u i red, Sliding board (various)
P re s s u re r e l i e v i n g / Po s i t i o n i n g
Total assist; may be independent with
equipment
Power wheelchair may be re q u i re d
Specialised pre s s u re relieving cushion
Po s t u ral support equipment
P re s s u re relieving mattress or overlay
Eating/feeding
Total assist for set up, then
independent with equipment
Adaptive feeding equipment and
techniques (palmar band or ringed
cutlery)
D re s s i n g
Lower: Moderate to total assist
Upper: Moderate assist
Adaptive techniques and equipment
G ro o m i n g
Minimal to total assist
Adaptive techniques and equipment
(eg C Clip)
S h owe r i n g
M o d e rate to total assist
Padded seat shower commode or
s h ower chair. Handheld showe r
Mobility
Manual: independent to modera t e
assist dependant on ground and floor
s u rface
U l t ra lightweight rigid or folding
f rame wheelchair with modified push
rims
Power: Independent
Power wheelchair with arm drive,
p ower tilt-in-space may be re q u i re d
Tra n s p o rt
Independent driving from wheelchair
or in vehicle seat
Modified hand controls to drive,
adaptive technique to transfer self
and chair into vehicle or with chair
hoist
Assistance re q u i re d
Personal care
h o u s e ke e p i n g
4
OT.qxd
11/4/02
9:54 PM
Page 6
Table 2D:
E x p e cted Levels of Fu n ctional Independence and Equipment Needs for C7-8 Le v e l s
Ta s k / Act i v i ty
E x p e cted Fu n ctional Outcome
Equipment
To i l e t t i n g
Independent to minimal assist
Padded seat shower commode chair
with cut out for access. Ad a p t i v e
equipment may be useful (suppository
i n s e rt e r )
Bed mobility
Independent
E l e ctric hi/lo bed may be indicated or
King single or larger ensemble bed
Bed/wheelchair tra n s f e r s
Independent to minimal assist
With or without sliding board
P re s s u re r e l i e v i n g / Po s i t i o n i n g
Independent to minimal assist
P re s s u re relieving cushion
Po s t u ral support equipment as
indicated
P re s s u re relieving mattress or overlay
Eating/feeding
Independent
With or without adaptive equipment
and techniques
D re s s i n g
Independent to minimal assist
With or without adaptive techniques
and equipment
G ro o m i n g
Independent
With or without adaptive techniques
and equipment
S h owe r i n g
Independent to minimal assist
Padded seat shower commode or
s h ower chair without armre s t s .
Handheld showe r
Mobility
Manual: independent to minimal
assist dependant on ground and floor
s u rface
Power: Independent
U l t ra lightweight rigid or folding
f rame wheelchair with modified push
rims
Power wheelchair may be re q u i re d
Tra n s p o rt
Independent driving from wheelchair
or in vehicle
Modified hand controls to drive,
adaptive technique to transfer self
and chair into vehicle or with chair
hoist
Assistance re q u i re d
Personal care
h o u s e ke e p i n g
5
OT.qxd
11/4/02
9:54 PM
Page 7
Table 2E:
E x p e cted Levels of Fu n ctional Independence and Equipment Needs for T1-9 Le v e l s
Ta s k / Act i v i ty
E x p e cted Fu n ctional Outcome
Equipment
To i l e t t i n g
Independent
Padded seat shower commode chair
or shower chair with cut out for access
Bed mobility
Independent
Bed/wheelchair tra n s f e r s
Independent
With or without sliding board
P re s s u re relieving/ Po s i t i o n i n g
Independent
P re s s u re relieving cushion
Po s t u ral support equipment
P re s s u re relieving mattress or overlay
Eating/feeding
Independent
D re s s i n g
Independent
G ro o m i n g
Independent
S h owe r i n g
Independent
Padded seat shower commode or
s h ower chair without armre s t s .
Handheld showe r
Mobility
Independent
U l t ra lightweight rigid or folding
f rame wheelchair
Tra n s p o rt
Independent driving in vehicle
Modified hand controls to drive,
adaptive technique to transfer self
and chair into vehicle or with chair
hoist
Assistance re q u i re d
Personal care (when re q u i re d )
h o u s e ke e p i n g
Adaptive techniques
6
OT.qxd
11/4/02
9:54 PM
Page 8
Table 2F:
E x p e cted Levels of Fu n ctional Independence and Equipment Needs for T10-L1 Le v e l s
Ta s k / Act i v i ty
E x p e cted Fu n ctional Outcome
Equipment
To i l e t t i n g
Independent
Padded seat shower commode chair
or shower chair without armrests
Bed mobility
Independent
King single or larger size bed
Bed/wheelchair tra n s f e r s
Independent
With or without sliding board
P re s s u re relieving/ Po s i t i o n i n g
Independent
P re s s u re relieving cushion
Po s t u ral support equipment
P re s s u re relieving mattress or overlay
Eating/feeding
Independent
D re s s i n g
Independent
G ro o m i n g
Independent
S h owe r i n g
Independent
Padded shower commode or showe r
chair without arms
Handheld showe r
Mobility
Independent
U l t ra lightweight rigid or folding
f rame wheelchair
Tra n s p o rt
Independent driving in vehicle
Modified hand controls to drive,
adaptive technique to transfer self
and chair into vehicle or with chair
hoist
Assistance re q u i re d
Personal care (when re q u i re d )
h o u s e ke e p i n g
7
Adaptive techniques
OT.qxd
11/4/02
9:54 PM
Page 9
Table 2G:
E x p e cted Levels of Fu n ctional Independence and Equipment Needs for L1-S5 Le v e l s
Ta s k / Act i v i ty
E x p e cted Fu n ctional Outcome
Equipment
To i l e t t i n g
Independent
Padded toilet seat
Bed mobility
Independent
Ensemble bed
Bed/wheelchair tra n s f e r s
Independent
With or without sliding board
P re s s u re relieving/ Po s i t i o n i n g
Independent
P re s s u re relieving cushion
Po s t u ral support equipment as
indicated
Eating/feeding
Independent
D re s s i n g
Independent
G ro o m i n g
Independent
S h owe r i n g
Independent
Padded shower commode, bench or
s h ower chair
Handheld showe r
Mobility
Independent
U l t ra lightweight rigid or folding
f rame wheelchair
Tra n s p o rt
Independent driving in vehicle
Modified hand controls to drive,
adaptive technique to transfer self
and chair into vehicle or with chair
hoist
Assistance re q u i re d
h o u s e ke e p i n g
Adaptive techniques
Adapted from: Pa ralyzed Ve t e rans of America (1999) and Reading from:
Hammell, K.W. (19 9 5 ) .
Refer to: The Motor Accident Authority “Guidelines for Levels of Attendant Care for Pe o p l e
who have a spinal cord injury and can claim under the New South Wales Motor Ac c i d e n t s
Scheme”. www. m a a . n sw. g o v. a u / p d f s / s p i n a l _ c o rd _ i n j u r y. p d f
8
OT.qxd
11/4/02
9:54 PM
Page 10
Skin Management
Fo l l owing SCI:
• Skin sensations are felt differently or not at all
• D e c reased mobility causes pre s s u re on the skin not to be relieved as
it normally would be
• Spasm may cause shearing damage as it is rubbed against bedding,
clothing & W/C part s
• Muscle wasting causes tissue to lose vitality
• C o m p romised blood circulation delays healing
After SCI, the skin is much more vulnerable to bre a kd owns. Pre s s u re areas will develop if
p recautions are not taken. When skin bre a kd own has occurred it is important for the client
to have a full re v i ew from all members of the multi-disciplinary team. Please seek
specialised medical and/or nursing advice re g a rding reasons for skin
b re a kd own and recommended tr e a t m e n t.
A person with a pre s s u re area is placed, where possible, on complete bedrest (positioned
off the site of pre s s u re). When the pre s s u re area has been healed, they are then placed
on a seating protocol to grade their return to sitting in a wheelchair.
Once the person’s pre s s u re area has healed, from an OT perspective, it is important to
re v i ew their equipment to reduce the risk of recurring skin bre a kd own. Things that need
to be considered are :
• A re they getting adequate pre s s u re relief? All seating surfaces need to be assessed –
car seats, wheelchair cushions, toiletting and showering equipment.
• M a t t resses – Are they getting adequate pre s s u re r e l i e f ?
• Transfers - Are they clearing all surfaces we l l ?
• Ability to check their own skin? Long handled mirrors or assistive techniques can assist.
• H ow is their seated posture? For example: someone with a pelvic obliquity may bear
m o re weight (and more pre s s u re) on one ischial tubero s i t y.
• Does the equipment suit their needs?
• Is the equipment poorly maintained or ill-f i t t e d ?
• Have they had a decline in funct i o n ?
When assessing these surfaces it may be useful to use a system to measure inter f a c e
p re s s u re, such as the Ta l l ey meter, or a pre s s u re mat mapping system such as the FSA. This
may re q u i re a r e f e r ral to a seating clinic. For further information on pre s s u re area care ,
and or prevention, contact one of the spinal units, Pa raQuad or AQ A .
9
OT.qxd
11/4/02
9:54 PM
Page 11
Self care equipment - funding processes
Equipment for people with Spinal Cord Injuries is provided through one of four main
s o u rc e s :
1. PADP (Pro g ram of Appliances for Disabled Pe o p l e )
“The Pro g ram of Appliances for Disabled People (PADP) is a NSW Government pro g ra m
for people with disabilities. The role of PADP is to assist eligible residents of NSW who
have a permanent or long-term disability to live and participate within their community
by providing appropriate equipment, aids and appliances” (NSW Health, 2001).
• Initial equipment for people with new spinal cord injuries are provided through the
Spinal Set-up Funds attached to the two acute spinal units in NSW at Royal North Shore
Hospital (RNSH) and Prince of Wales Hospital (POW). Fo l l owing discharge from
hospital, equipment and ongoing repair services are provided from the local area PA D P
Lodgment Centre .
• A copy of the PADP Policy is available from local Lodgment Centres or on the NSW
H e a l t h Web at www. h e a l t h . n sw. g o v. a u / f c s d / r m c / c i b / c i rculars/2000 (Circular 10 3 )
C o m m u n i ty Options may be able to assist with purchasing urgently needed items when
PADP have no money available. Look up your local office in the White Pages under
Community Options.
2. Privately funded by the client (if not eligible for any other assistance)
3. Department Of Ve t e rans Affairs (DVA ) See contact list for DVA details
4. Compensation for Personal Injury
a . T h i rd Pa rty Personal Injury Compensation (CT P )
See www. m a a . n sw. g o v. a u / p d f s / s p i n a l _ c o rd _ i n j u r y.pdf for details re g a rding the
Motor Accident Authority Guidelines for CTP claims.
b . Wo r kers Compensation
See contact list for WorkCover details.
c . C o m m o n - l aw Negligence Actions
See contact list for Law Society details.
d . S p o rting Injuries Insurance Scheme
See contact list for details.
e . V i ctims Compensation Scheme
See contact list for details.
10
OT.qxd
11/4/02
9:54 PM
Page 12
Self care - Types of equipment
bedroom equipment
Beds
Fe a t u re s :
• H i - Low function (electric or manual)
• Tre n d e l e n b e rg function
(horizontal tilt of complete bed surf a c e )
• Knee bend
• Head ra i s e
• S e l f-help pole
• Head board and foot board and
bolster
C o n t rol Options: (See pict u re below )
E l e ctric beds can be customised to be
c o n t rolled by any switch, and in some
cases through an environmental contro l
s ystem. Where this is available, it can
g reatly enhance a person’s life. Exa m p l e s
of the type of switch adaptations
available for persons with limited hand
f u n ction are Sip and Puff, Joystick, Rocke r
and To g g l e .
• Cot (bed) sides
• Switch adaptations
• Compatibility with an environmental
c o n t rol unit (ECU)
C o n s i d e ra t i o n s :
When prescribing a bed it is important to
consider the follow i n g :
• High – low height for safe functional tra n s f e r s .
This may also decrease the incidence of shoulder injury over a period of time.
• A person may be able to independently adjust their position (eg. Sitting up, lying dow n )
which can decrease the amount of care re q u i re d .
• Head raise for persons who are unable to sit up independently. Knee bend to pre v e n t
sliding down the bed. Leg elevation for persons with oedema.
• Under bed clearance to enable hoist access for tra n s f e r s .
• Castor size for manoeuvra b i l i t y. La rger castors are easier to manoeuvre .
• Minimum and maximum height for independent transfers and carer OH&S.
• Size of bed to enable personal care tasks to be completed (by a carer or bed user).
• Attachment sites for over night drinking system, or mattress pump etc.
• Size of the bed to enable partners to continue to sleep in the same bed, or in some
cases the attachment of a partner bed.
pressure care mattresses and overlays
11
Ty p e s :
P re s s u re care mattresses are designed to relieve or reduce interface pre s s u re. Pre s s u re
relieving mattresses are segregated into either mattress replacements or mattress overlays .
A mattress overlay is used in addition to an existing mattress. Different mediums can be
used, for example air and foam. Types include a RoHo mattress or AutoXcell.
A mattress replacement is used in place of an existing mattress. Different mediums can be
used, for example air and foam. Types include a Nimbus III alternating air mattress or a
Va p e r m .
OT.qxd
11/4/02
9:54 PM
Page 13
C o n s i d e ra t i o n s :
In addition to pre s s u re care, a mattress must also enable a person to maintain their level
of independence. For example consider:
• Stability of surface for function, ie transferring onto wheelchair
• S u rface height for functional tra n s f e r s
• Any change in surface level for carer’s OH&S
• Stability of surface for bed mobility and dressing
• Bed size and height for part n e r s
NB: Pre s s u re mattress suppliers include Huntleigh Healthcare, Pegasus Wooltech, Starwe l l
& Roho
Hoists
Ty p e s
Manual
E l e ct r i c
Ceiling mounted
Pivot fra m e
Yolk spreader bar
Ve h i c l e
Mobile
Slings
S t a n d a rd type
Toiletting type
Two piece
Banana type (for
pivot spreader bar)
Customisations
‘Silk’ or ‘sheepskin’ sleeve
for inner sling/thigh
(minimise shear)
Some companies custom
m a ke slings, to
m e a s u rements and/ or
have a large range of
various sized slings (ie
small/long, ex t ra
l a rge/long etc)
Clinical Rationale:
A hoist may be re q u i red for the following re a s o n s :
An inability to transfer due to increasing age, decrease in upper limb strength, shoulder
overuse injuries, carer limitations, increased we i g h t, frailty (of client or carer), presence of
p re s s u re ar e a s .
It may be that a more expensive and specialised hoist may decrease human cost and
i n c rease quality of life for the user. This is wo rth considering, especially for people with
a high level SCI.
C o n s i d e ra t i o n s :
The type of hoist and sling re q u i red is dependent on the follow i n g :
• Level of injury/funct i o n
• Age, height, we i g h t
• Skin integrity
• C a rer’s abilities and availability
• Psychosocial needs
• Ability to comply with usage
• E n v i ronmental considerations and a place where transfers need to take place ie. bed,
c h a i r, vehicle etc. Clearance for mobile hoist under bed and circulation spaces.
12
OT.qxd
11/4/02
9:54 PM
Page 14
• Client comfort when using hoist
• C a rers OHS re q u i re m e n t s
• Cost efficiency
Suppliers of Commonly Prescribed
P romed Elf with standard yolk
Hoists for SCI
(see contact list for supplier details)
A R J O : Trixie, Lisa, Tempo &
Bianca (ceiling Hoist)
AMS: P romed: Delta, Skipper, Alpha &
Vo yager (ceiling Hoist)
mobility equipment
Manual Wheelchairs for people with a SCI
For a person with a SCI, who uses a manual wheelchair (MWC) for mobility, it is essential
for them to have a custom made lightweight wheelchair. This is to maximise
independence in wheelchair propulsion, tra n s p o rt a b i l i t y, skin care and to minimise
shoulder wear and tear. Ty p e s :
• Rigid fra m e : A rigid frame is the lightest frame and the most energy efficient for
p ropulsion. A rigid frame is the easiest option to dismantle and position in a car
independently for a person with a SCI.
• Folding fra m e : A folding frame is less energy efficient for wheelchair pro p u l s i o n ,
h owever it can be folded, stored, and also can be used with car hoists, eg WYMO hoist.
Quickie GPV
13
Quickie XTR & Jay Extreme back
A checklist of features of Manual Wheelchairs ( Adapted from Ka rcz, 2002)
Wheels
Adjustable axle position – alters position of rear wheels. This can change the centre of
g ra v i t y, wheel camber, wheelbase, seat height. Thus it can increase a wheelchairs
responsiveness.
Camber - Degree of tilt of the wheel in relation to the frame. The higher the degree, the
m o re responsive the chair is to propel. However camber affects the overall width of the
OT.qxd
11/4/02
9:54 PM
Page 15
wheelchair and must be considered for door widths etc.
Type of wheel- affects the maintenance, the endurance of the tyre and the weight eg.
S p y n e rgy spoke or mag wheels.
Quick release – detaches wheels for tra n s p o rtation
Type of Ty re
Pneumatic tyres (give a softer ride, but may punc t u re)– standard, high pre s s u re (slightly
h a rd e r, easier to push), bush’n’beach (like BMX tyres) Solid tyres – can be heavier to
push, providing less cushioning, however they do not punct u re.
Pushrims
Distance from hub is important to allow the space for thumb when pushing. Finish
slip resistant or plastic coated / hard anodised can assist someone with decreased hand
f u n ction.
Diameter of tube - a larger diameter can assist grip
Push handles
T h ey can be used to assist with balance, by hooking the arm around the back.
Height - important for care r
Castors
Solid – No maintenance. Often narrow, which can get caught in gutters. In most cases for
SCI, solid castors are recommended, with a 4 or 5 inch size Pneumatic - re q u i re
maintenance, but have a softer ride and are heavier to pro p e l .
Roller blade - more usually found on sports style wheelchairs - decrease wheelbase,
i n c rease manoeuvra b i l i t y, not great outdoors or on uneven terrain. Persons with high
wheelchair skills may elect to use these and do wheelstands over object s .
Size – will affect manoeuvrability outdoors
A r m re s t
F i xed or detachable or swing awa y. Often no armrests as they can interf e re with funct i o n
B ra ke s
Push or pull on - choice depends on users ability
High or low mounted - consider reach of user and whether bra ke interf e res with tra n s f e r s
or with propulsion (jamming thumbs).
Extended handle - to assist with limited reach or hand func t i o n
Scissor bra kes – fold under frame when not in use, re q u i res dexterity and balance to
manipulate. Good for transferring wheelchair into car and for hand clearance when
pushing.
14
OT.qxd
11/4/02
9:54 PM
Page 16
Footplates and Fo o t h a n g e r s
F i xed or sw i n g - away and/or detachable
Height adjustable
Heel or calf support (often a calf strap is indicated)
Angle adjustable footplates - eg for fixed ankle contra ct u re s
The “hanger angle” (ie 90° s t raight down and 70° out in front) is important for the overa l l
turning circle of the chair. However a smaller angle may be indicated due to spasm, pain
or comfort .
B ac k rest
S t raight or angled backrest canes
Height /Angle - adjustable or fixed, seat to backrest angle
Fold down - reduces overall size of folded chair, however it can affect strength of backre s t
Can consider custom made or commercially available rigid backrest if re q u i red
eg Jay back. These add weight to the wheelchair. Adjustable upholstery may be an
alternative postural solution.
Accessories
Tray / La p b o a rd - removable
S p o ke guard s
Anti tippers - standard on many wheelchairs
Frame pro t e ctors (for front / legrest hangers)
Frogs legs (castor fork with suspension)
C l o t h e s g u a rds - plastic or material
Manual or power stand up wheelchair
Commonly Prescribed Manual Wheelchairs for people with SCI
See contact list for supplier details. (These can be used as a re s o u rc e )
Power Wheelchairs for people with SCI
15
Quickie Manual
E&S Hyde Wheelchair
Sales
Rigid & Fo l d i n g
Mo b i l i ty Plus
GTK Rehab
Rigid & Fo l d i n g
Mogo
Mogo Wheelchairs
Customised
Rigid & Fo l d i n g
I n vac a re Action
RGK manual & sports
Colours Range
Glide Wheelchairs
N o rthcott/Dynamic Living
Designs
DeJay Medical & Scientific
Rigid & Fo l d i n g
Rigid & Fo l d i n g
Active Mobility Sys t e m s
Specialised wheelchair
company
Rigid & Fo l d i n g
OT.qxd
11/4/02
9:54 PM
Page 17
( Adapted from Independent Living Centre Power Wheelchair Guidelines)
Powe red wheelchair options
• Indoor/Outdoor
• Outdoor Heavy Duty
• Fro n t-Wheel Drive
• Stand-up
• Mid-wheel drive
• Reclining back (manual or elect r i c )
• Rear wheel drive
• Powe red wheelchair with manual option
• Elevating-seat
• Attendant contro l l e d
• Four wheel drive
• T i l t- i n - S p a c e
M1 Roller c h a i r
Points to consider
• Consider the nature of a person's disability, their level of injury and function
• Method and ability to transfer
• Ability of the carer to dismantle and maintain wheelchair and charge batteries
• The user's environment. Will they be able to access hallwa ys, doors and under benches
etc.
• Can the wheelchair be loaded into a car or van?
• Will a hoist and/or ramps be re q u i red to tra n s p o rt?
• W h e re will the wheelchair be stored eg? in the home and/or in a vehicle?
Fe a t u res of powe red wheelchairs
Design
• Is it folding?
• Is it a base unit with
detachable rigid seat?
• What is the overall
weight and weight of
heaviest part ?
Seat
• Is it a sling seat or a
rigid seat?
• What postural support s
a re r e q u i re d ?
A r m re s t s
• Detachable or fixe d
• Ad j u s t a b l e
• Flip-up
• Desk style to increase
under tables
Batteries
• What is their range
b e f o re r e c h a rging is
re q u i re d ?
• Recommend 36 a/h
(min) or 50 a/h for full
time user.
• What is their we i g h t ?
• What is their life
ex p e ct a n c y ?
Mo t o r
• H ow responsive is it? This
can be pro g rammed for
each individual.
• What weight is it?
• H ow easy is it to
re m o v e ?
• What is the capacity?
B ra ke s
• A re they elect ro - m a g n e t i c
b ra ke s ?
• Is there an additional
manual hand bra ke ?
C o n t rol Method
• J o y-stick or adapted
hand contro l
• Chin contro l
• Sip-puff contro l
• Head contro l
• Attendant contro l
B ac k re s t
• F i xe d - a n g l e
• Reclining
• Fold dow n
• Removable
• Type (standard or
p o s t u ral back eg Jay
Back)
Fo o t p l a t e s
• F i xed or detachable
• Adjustable height
• Elevating legre s t s
• Heel/calf support
16
OT.qxd
11/4/02
9:54 PM
Page 18
Wheels
• The choice of wheels and castors affects the manoeuvrability and smoothness of the
ride. Consider the environmental re q u i rements eg. farm, stre e t, indoors.
• The overall wheel size affects the clearance and ability to traverse rough terrain.
• Smaller wheels are more suitable for indoor use as they have tighter turning circ l e s .
• Wheels can also be solid (no punct u res) or pneumatic (which give a smoother ride).
Commonly Prescribed Power Wheelchairs for people with SCI
(See contact list for supplier details)
Quickie Power
Wheelchairs
Lifestyle & Rehab
R o l l e rchair Powe red
Wheelchairs
GTK Rehab
Glide Powe r
Wheelchairs
Active Mobility Sy s t e m s
Commonly prescribed Pre s s u re Cushions for People with a SCI
• A person with a SCI who is a wheelchair user should sit on a
p re s s u re cushion.
Single valve HP Roho
• P re s s u re cushions provide pre s s u re relief as they distribute body
weight more evenly over a larger surface area. They prevent all
the pre s s u re being taken over the Ischial
Tu b e rosities (IT’s) (Queensland Spinal Cord Injuries Service,
2 0 01). They also enhance function as they support the trunk for
upper limb function through the maintenance of posture.
• A cushion and w/c should be considered together, as they
f u n ction as a unit for pre s s u re relief and postural support
(Queensland Spinal Cord Injuries Service, 2001 ) .
Types of Cushions
D i f f e rent cushions provide varying levels of pre s s u re relief depending on their design, and
the material from which they are manufact u red (Queensland Spinal Cord Injuries Service,
2 0 01). Some cushions may use a combination of materials to improve their perf o r m a n c e .
The most common materials used for pre s s u re cushions:
• Gel Filled - various viscosities, heavy, may be floppy to handle, absorbs and conducts
h e a t, airf l ow is more limited. eg Action cushion
• S t a n d a rd Foam – Low cost, various densities are available, has contouring pro p e rties,
a l l ows good airf l ow, stable, maintenance free, limited life ex p e ct a n c y, needs pro t e ct i o n
f rom incontinence, can retain heat.
• C o n t o u red foam - Provides good stability, and postural support. Less maintenance and
good dura b i l i t y. Eg Infinity ra n g e .
• Custom foam – made in a seating clinic for individual. Eg. Pe rth cushion. Low cost of
materials and can provide high pre s s u re care. Needs to be replaced more fre q u e n t l y.
17
OT.qxd
11/4/02
9:54 PM
Page 19
• Air filled Villous dynamic air cushion (adjustment re q u i red) eg High and Low profile
ROHO cushion. Very high pre s s u re relief. But not as good heat dissipation or stability as
other cushion options. May punct u re. More expensive pre s s u re cushion option. Require s
education to set up and maintain pre s s u re care setting.
• C o n t o u red foam with fluid insert eg Jay cushion. Provides good stability and dura b i l i t y.
Can be very high pre s s u re pro t e ction and can provide stability and postural support.
M o re expensive pre s s u re cushion option.
Points to consider when selecting a pr e s s u re cushion
• I m p a i red or nil
sensation in buttocks
i.e. risk
• Whether w/c is set up
c o r re ct l y
• History of pre s s u re areas
• Weight/shape of
wheelchair user
• Continence issues
• Heat dissipation
• User’s ability to relieve
p re s s u re
• Transfer technique and
cushion’s stability
• Po s t u re
• P re f e rence of cushion user/
c o m f o rt
• Replacement /dura b i l i t y
• Weight of cushion for
t ra n s p o rt i n g
• Wheelchair design / size
• Pain in sitting
• Cushion care / adjustment
and user or carer’s abilities
• Cost
(QLD SCI Service, 2001 )
An important point to remember with the ROHO cushion, is that while they provide very
high quality pre s s u re r e l i e f, they need to be inflated corre ct l y. When the cushion is both
over or under inflated, the cushion user is at risk of pre s s u re areas.
NB: A number of pre s s u re re l i eving cushions should be trailed (with skin
c h e c ks) to determine which is the most suitable. If the user is at high risk of
p re s s u re areas, a Seating Clinic appointment may be indicated to map
p re s s u res, where possible.
Suppliers of Commonly Prescribed Wheelchair cushions for SCI
(See contact list for supplier details)
J ay, Roho,
I n vac a re Infinity
GTK Rehab
J ay
J ay, Roho
E&S Wheelchair Sales
Lifestyle & Rehab (L&R)
J ay, Roho,
J ay, Roho, Custom Ma ro o n
commode cushions
Able Rehabilitation
Roho, Invac a re Infinity,
Pindot
N o rt h c o t t / D L D
A u s t ralian Surgical Aid
18
OT.qxd
11/4/02
9:54 PM
Page 20
Sliding Board s
The sliding board is a simple device designed to assist
a person transfer with or without assistance. This may
include wheelchair, bed, shower commode or vehicle
t ransfers. There are two basic types of sliding board s ,
the straight and the over-wheel. The over-wheel is
unique, as it pro t e cts the user’s skin from abrasions on
the wheel during transfers. This type of slider, howe v e r,
is not recommended for commode transfers, a stra i g h t
slider is recommended. A material cover may be used,
to pro t e ct skin, made from satin or satin/ silk like
material
Over wheel side board
Sheepskin sliding mats are another piece of equipment that can be used by a person to
t ransfer in/out of a vehicle, particularly when a person is unable to physically assist with
the tra n s f e r. When doing this tra n s f e r, the assistance of two carers would also be
n e c e s s a r y, to ensure a safe tra n s f e r.
Both the over-wheel and straight sliding boards can be purchased from Pa ra Q u a d
Engineering. The sheepskin sliding mats are available from PECS. See contact list for
supplier details.
bathroom equipment
Commodes:
Types Recommended:
• Folding for tra n s p o rt / or fixed fra m e
• Attendant pro p e l l e d
• S e l f- p ro p e l l i n g
• Tilt in space
• Fro n t, right or left side opening
• Closed seat with cutout
• Closed seat with no cutout (for
persons with a colostomy)
• F i xed recline/angle in the backre s t
• Higher back rest heights
• Elevating legre s t s
• Pan and pan carrier
Clinical indications:
• For showering and bowel care
• Reduce the need for transfers
• C a rer occupational health and safety for clients who are dependent in self - c a re
A person with paraplegia may elect to use a self - p ropelling commode to reduce the
number of transfers and there f o re reduce shoulder wear and tear to maintain
independence. For a person who is unable to self - p ropel a shower commode, an
attendant propelled shower commode is recommended. An attendant propelled showe r
commode is also indicated if there is limited space, as with four small wheels it can move
in four dire ctions, thus making handling easier for care r ’ s .
19
OT.qxd
11/4/02
9:54 PM
Page 21
Customisations:
If the commode seat does not provide adequate
p re s s u re care, cushions can be added to the seat,
such as a Roho commode cushion or a padded
gel seat, or gel can be added inside the custom
made cushions.
K- c a re Tilt in space commode and
s e l f- p ropelled, with right side opening
custom maroon seat.
Push handles at the rear of the commode can
assist with function for a person who has re d u c e d
sitting balance.
For high level lesions postural support can be
indicated, such as t roughed armre s t s, for access
to the upper limb for hygiene, as well as to assist with comfort and posture.
Head re s t s can be added for persons with limited or no head control. B ack e x t e n s i o n s
can be added to the commode to increase its back height. Also the back- rest can be fixe d
in 3-15 degrees of recline to enhance posture. Back rests can be 1 or more str a p
removable ex t e n s i o n s .
A tilt in space commode is indicated if a person has a history of postural hypotension, or
has high seating needs, and re q u i res the tilt to stabilise their posture. Rake or front to re a r
angle can be added to increase seating tolerance. Some commodes have this as a
s t a n d a rd feature .
Padded legrests can be added to assist with pre s s u re care for the lower limbs. Elevating
l e g rests are also available.
A n t i -tip bars can be placed on the rear of the commode to enhance safety where
indicated. A pan and pan carrier is recommended in the event that the user cannot
access a toilet.
The seat is the most important part of the commode in terms of pre s s u re care. In order to
maintain good pre s s u re care, the seat is designed to distribute as much pre s s u re thro u g h
the greater trochanters (GT’s) whilst maintaining the Ischial tuberosities (IT’S) to “float” in
the cutout. A hand made padded seat is essential and can be customised to suit an
individual’s specific needs. These seats have no joins on the surface where the client will
be sitting and thus reduce the risk of pre s s u re care. A double foam layered seat, called
a maroon custom seat, is recommended as the foam covers the inside edge of the cutout,
which is better for pre s s u re care. This seat has a higher quality foam and a longer life
span. K- c a re is the most commonly prescribed commode for persons with a SCI.
alternate showering / toiletting equipment.
Types re c o m m e n d e d :
S h ower chair with no armrests and a padded seat
B a t h b o a rd with foam overlay/insert with shower hose
Transfer bench with closed cell foam and no seams
Padded toilet seat
J i f fy Biffy Pads – portable toilet seat cushions
S h ower tro l l ey
•
•
•
•
•
•
20
OT.qxd
11/4/02
9:54 PM
Page 22
Clinical indications:
For a person who can transfer independently, shower transfer benches, or shower chairs
with no armrests and padded seats may also be used. Client pre f e rence is essential to
consider in any equipment prescription. However adequate education is re q u i re d ,
s u p p o rting the risk of shoulder over use injury associated with transfers. The use of a
commode in the morning care routine reduces transfers from seven to thre e .
computer equipment
Computers are a useful tool for communication, study,
vocational opportunities and domestic duties (such as
Internet shopping and banking). Most TAFE institutions have
a disability officer, who can assess each individual’s
specific need. TAFE have a commitment to continue courses
s t a rted in the spinal units, or support new courses at a local
level. Computer equipment that is commonly used by
people with a SCI include: trackballs, cherry key b o a rd s ,
v o i c e - a ctivated softwa re. For updated information it may be
useful to look at the following we b s i t e s :
Trackball mouse
• w w w.abilitycorp.au • w w w.tecsol.com.au • w w w. n o rthcott.com.au • w w w. o t e n . e d u . a u
• w w w. a ra t a . o rg.au • w w w. re g e n c y re h a b . c c a . o rg.au • w w w. t s c n sw. o rg . a u
environmental / domestic equipment
E n v i ronmental Control Units
• E n v i ronmental Control Units (ECU’s) aim to increase the level of independence in the
home environment. Domestic appliances are controlled using a single switch or a voice
command input into the ECU which sends an output command to the appliance to
o p e rate it as re q u i red. Devices controlled may include lamps, lights, air conditioners,
heaters, televisions, videos, stereos, electric doors, electric beds, page-turners, computers
and telephones.
• T h ey can vary from cheaper switch operated varieties to more complex voice act i v a t e d
s ys t e m s .
• Voice Activated Systems can be controlled from wheelchair or bed level. Options include
‘Simplicity’, ‘Sicare Pilot or Light’ and ‘Nemo’.
• Scanning devices can be used in combination with mouthsticks or a variety of sw i t c h e s
(eg GEWA Prog ECU)
• La rge remote controls that are pro g rammable are also cheaper options for those with
adequate functional ability.
• ECU's should be trialled before purchase and should meet the individual needs of the
person.
• ECU's are available from Technical Solutions (Victoria), Northcott Society (NSW), and
Regency Park (SA). See contact list for supplier details.
21
Personal Alarms
A number of people with SCI have personal care support provided by agencies (Home
C a re, Attendant Care) and family and friends. While the person has such support coming
and going, there will be occasions where they will be alone. To alleviate any anxiety in
OT.qxd
11/4/02
9:54 PM
Page 23
such a situation and to encourage independence for the person, an alarm sys t e m
p rovides the person with a system where he/she can call for assistance at any time.
The transmitter can often be adapted to suit the individual needs of a person, depending
on their level of injury. If the transmitter re q u i res individual specifications, it is suggested
that an Occupational Therapist coordinate/consult between the manufac t u rer and an
o rganisation such as TAD (Technical Aid to the Disabled).
An example of a personal alarm supplier who will provide sip/puff and large sw i t c h
adaptations are Vital Call. They cover both the Sydney Metropolitan area and re g i o n a l
N SW. This is just one example of a supplier. Contact the Independent Living Centre for
options and details.
Home Ma n agement - To maximise the independence of a person with a Spinal Cord
I n j u r y, it is essential to modify the home to meet the individual’s needs. (Please see home
modifications section).
A number of pro d u cts are commercially available to facilitate independence in
p e rforming home management tasks. The pro d u cts are especially useful for those people
with tetraplegia and limited hand function. Examples of the pro d u cts include: chopping
b o a rd with attached knife & spikes, large handled knives/ utensils, peeler with table
clamp, jar openers, kettle tippers, Easy reachers, long-handled dustpans & brooms, built
up pens and utensils.
Traymobiles and stable tables can be utilised to tr a n s p o rt items or carry hot items to
reduce the risk of burns on lower limbs. A front loading washing machine, and a lowe re d
clothes line or front loading dryer, can facilitate independence in laundry tasks.
Many of the specialised pro d u cts are available through stockists such as Able
Rehabilitation, Total Patient Care, Smith & Nephew or Lifestyle & Rehab (Refer to Contact
List for suppliers). If SCI clients re q u i re additional customisation of equipment then
o rganisations such as TAD (Technical Aid for the Disabled) could be contacted, either for
assistance or consultation.
For advice on other specialised equipement, you can call The Australian Quadriplegic
Association (AQA) on its toll free number (1800 819 775) and ask the Information Service.
This includes an up to date database and library service. The Independent Living Centre
in Sydney is also a good re s o u rce. They have an equipment
Custom writing splint
information database on their we b s i t e .
functional splints
The provision of upper limb (UL) splints is common pra ct i c e
in spinal injury units. Splints can be applied for a variety of
clinical rationales, depending on the cervical lesion level.
Not all clients are discharged with an UL splint, and
maybe discharged with a ranging (PROM) pro g ram. Most
clients need to be assessed on an individual basis and
re v i ewed if there are any changes in their hand, e.g. if
c o n t ra ct u res start to develop.
22
OT.qxd
11/4/02
9:54 PM
Page 24
In most cases for people with a C4 lesion and above, they will have a WHO - re s t i n g
hand splint at night. This splint is designed to prevent contra ct u res and maintain cosmesis.
It places the hand in the position of rest or function. This is also often worn by people with
C5 and C6 lesions at night.
For most patients with a C5 lesion, where they have weak or no active wrist extension, a
WHO - wrist cock-up splint is used during the day to stabilise the wrist and thus incre a s e
f u n ction. These can be commercially available splints, such as the Fu t u ro or a custom
made leather or thermoplastic splint.
Writing splints and Typing splints, made of thermoplastic may be indicated. Contact a
spinal unit to request a pattern. Both are also available commercially if re q u i re d .
Wheelchair gloves prevent skin bre a kd own and may be essential for effective wheelchair
p ropulsion. These can be bicycle gloves, or commercially available wheelchair gloves,
t h rough health pro d u ct suppliers and also customised gloves available from some spinal
units. For a person with tetraplegia, some commercially available wheelchair gloves fro m
health pro d u ct suppliers are not suitable, as the thumb position can affect a funct i o n a l
tenodesis grasp. Individual assessment is ther e f o re re q u i red. For more detail, please
c o n t a ct AQA, PQ or the spinal units.
work
The Return to Work Pro c e s s
Within the community there are a number of services available that provide vocational
counselling, rehabilitation and work re t raining, and assistance with finding employment.
CRS Austr a l i a p rovide vocational rehabilitation services to people with injuries and
disabilities who are having difficulty accessing employment. Rehabilitation pro g rams are
designed to meet individual needs and are aimed at ensuring that people with
disabilities gain or retain sustainable employment. CRS Australia provide the follow i n g
services: (This information is care of CRS Australia we b s i t e )
•
•
•
•
Assessments
P h ysical Conditioning Pro g ram
Work Tr a i n i n g
Occupational Health and Safety
•
•
•
•
Counselling Services
Return to work pro g ra m s
Vocational Counselling
Job Assistance / Search
E l i g i b i l i ty
Clients of CRS Australia are of working age (14 to 65 years), are permanent residents or
A u s t ralian citizens, have a disability which affects their capacity to gain or re t a i n
employment and who meet Centrelink eligibility re q u i re m e n t s .
23
R ef e r ra l s
C RS Australia has offices in all major regional centres and throughout metr o p o l i t a n
S y d n ey. Referrals can be made dire ctly to the nearest CRS Australia office. Offices are
OT.qxd
11/4/02
9:54 PM
Page 25
listed in the White Pages or for your nearest office phone the
Free Call number 1800 624 824. Web A d d re s s : w w w. c r s re h a b . g o v. a u
AQA Wo r k f o rc e is an employment agency whose goal is to find employment for people
living with physical and sensory disabilities in the competitive labour market.
AQA Wo r k f o rce specialises in the following are a s :
• P re-employment As s i s t a n c e
• Internet Job Searc h e s
• Worksite Analys i s
• C a reer Guidance
• Resume Design
• Post Placement Support
Cost
The pro g ram is free to both employees and employers, as it is funded by the
C o m m o n wealth Department of Family and Community Services Referrals can be made
d i re ctly to AQA Wo r k f o rce by: P h o n e : (02) 9669 5277 or e m a i l : m a ya @ a q a . o rg . a u
Web A d d re s s : w w w. a q a . o rg . a u
driving
• Fo l l owing a spinal cord injury, a driving assessment with a qualified Driving
Occupational Therapist is usually re q u i re d .
• The driving assessment will determine whether a person is ready to resume driving and
to recommend any modifications that are re q u i red to drive, eg hand contro l s .
• Occupational Therapy Driving Assessments can be organised through your local CRS
office or through a specialised Driving Centre.
• C o o rabel Driving Centre and Cumberland Driver Rehabilitation Pro g ram are specialised
driving centres in Sydney that can also be used as an information re s o u rce by people
in rural areas. (See contact list for further information).
• Driving lessons will usually be conducted prior to undergoing the RTA Disability Driving
As s e s s m e n t .
• It is also possible for a person with a Spinal Cord Injury to drive a truck. This depends
on the person’s functional ability.
Car Mo d i f i c a t i o n s
• All modifications have to meet RTA guidelines that comply with Australian Design Rules.
Modifications also have to be certified by a RTA approved engineer.
• C o n t a ct your local CRS unit for a list of people who carry out vehicle modifications in
your local area. Some re s o u rces are:
• Pa raQuad Engineering and Problem Management Engineering complete vehicle
modifications in Sydney.
• Community Occupational Therapists at Pa raQuad and The Australian Quadriplegic
Association (AQA) provide information about suitable vehicles for people with SCI.
24
OT.qxd
11/4/02
9:54 PM
Page 26
Some examples of Vehicle Modification Options:
C-bar spinner knob
• Hand controls to operate accelerator and bra ke. These
may include the MPS Monarch, Push-Pull or Throttle (twist grip)
c o n t ro l s .
• A spinner knob, fork attachment or C bar attachment to
the steering wheel.
• Some vans can have automatic wheelchair lockd own
re s t raints installed, automatic ramp, swivel seat if able to
t ransfer and many other options. A person that is unable to
t ransfer to a drivers seat or swivel seat can still drive
independently with the automatic lockd own system and drive from their wheelchair.
A mobile phone is recommended in case of emerg e n cy whilst driving.
Disabled Pa r k i n g
A disabled parking sticker is available from the RTA and enables a person with a
disability to park in Accessible parking spots.
leisure
R e c reation and leisure activities assist people to not only pursue their individual talents,
abilities and interests but also develop many important relationships and social netwo r k s
in the broader community. The following contact list may be useful in re c reation and
l e i s u re pursuits:
• N SW Sport Council for the Disabled. www. n sw s c d . c o m . a u
• N SW Wheelchair Sports Association www. n sw w s a . o rg . a u
• R e c reation Services staff at Moorong Spinal Unit and Prince Henry Hospitals
(See contact list).
• Technical Aid to the Disabled at Ph: (02) 9808-2366 or www. t e c h n i c a l a i d n sw. o rg.au
• Achievable Concepts (Resource of re c reation equipment for people with disabilities)
• Ph: (02) 9873 0182 or www. a c h i e v a b l e c o n c e p t s . c o m . a u
environment
Home Modification Pro c e s s e s
The spinal units in Sydney are a state wide service. The assistance of rural community
t h e rapists is essential in the home modifications process. The OT’s working on the spinal
units will conduct home visit assessments and make recommendations for modifications,
for clients living in the metropolitan area. For persons who are from rural areas, this is a
g e o g raphical impossibility.
The home visit process is different for each individual, depending on their need, their
housing situation prior to injury and whether or not they have any compensation. It can
also be difficult to ascertain the ex p e cted functional level upon discharge for persons with
an incomplete lesion. For people with a complete spinal cord lesion, where the
25
OT.qxd
11/4/02
9:54 PM
Page 27
anticipated functional outcome can fairly accurately be anticipated, the home visit
p rocess can be started at an earlier time in their re h a b i l i t a t i o n .
Government assistance for home modifications, for persons who own their own home,
is provided under the Department of Ageing, Disability and Home Care (DADHC), under
Home and Community Care (HACC). Any person with a disability is eligible. The funding
is separated into three tiers: Level 1 under $5000; Level 2 $5000-$20 000, and Level 3
over $20 000. HACC has a funding policy, which is specific for ‘high level modifications’.
( For policy updates: www. d a d h c . n sw. g o v. a u )
If a person was living in rental ac c o m m o d a t i o n prior to their spinal cord injury, the
possibility of an accessible home in the rental market is very low, and the majority of
La n d l o rds do not allow modifications. These individuals usually apply for priority housing,
with the Department of Housing. List of local offices: www. h o u s i n g . n sw. g o v. a u
For a person with a c o m p e n s i b l e spinal cord injury, the insurance company may elect to
m o d i fy their existing home, or depending on their living situation, construct a more
suitable home. When a new home is being constructed an arc h i t e ct is usually involved
and in some cases a private occupational therapist will look after the entire pro c e s s .
The role of the rural OT is vital to the smooth transition of clients from rehabilitation to
their home environment. To maintain a client centred approach, the spinal OT’s are
responsible for the home visit recommendations re p o rt. This is because they are able to
liaise closely with both the client (especially if it is their home that is being modified) and
with the rehabilitation team, to ensure appropriate modifications are re c o m m e n d e d
a c c o rding to their level of function. This is important in terms of the func t i o n a l
i m p rovements, which occur during rehabilitation, especially for clients with an incomplete
i n j u r y.
For those people with a SCI who are beyond the acute hospital / rehabilitation phase,
and are wanting to modify their home, information on home modifications specific to SCI
can be received from Pa raQuad, AQA, or any of the spinal units. A guideline for home
modifications for people with a SCI, which was adapted from the Austra l i a n
S t a n d a rds, was written by a group of spinal occupational therapists. This is
available on request from the above sourc e s .
Front gate access
Back y a rd access
Access to back door
The information provided in this factsheet is a general guideline to assist OT’s tre a t i n g
people with SCI. It is important to consider each person as an individual, who within their
e n v i ronment and culture, has their own specific needs.
26
OT.qxd
11/4/02
9:54 PM
Page 28
contact list
Spinal Units/ Community Gro u p s
AQA Australian Quadriplegic
As s o c i a t i o n
Letter Box 40, 184 Bourke Rd
A l exandria NSW 2015
Ph: 9961 8855
Fax: 9661 9598
w w w. a q a . o rg . a u
Info line, Wo r k Fo rce, OT ’ s .
Pa raQuad, NSW
PO Box 63
Auburn, NSW, 214 4
Ph: 9647 19 6 6
Fax: 9637 9802
w w w. p a ra q u a d - n sw. a s n . a u
Spinal Advisors, OT ’ s
The Prince Henry / Prince of
Wales Hospital (PHH/POW )
Spinal Cord Injuries Unit
Occupational Therapy Depart m e n t
Ph: 9382 5930
Fax: 9382 5989
The Prince Henry / Prince of
Wales (PHH/POW )
Seating Clinic
Rehab Engineering Dept
Ph: 9382 5019
Fax: 9382 5434
Mo o rong Spinal Cord Injuries
Unit
Occupational Therapy Dept
Ph: 9808 9269
Fax: 9809 9062
Neil Fitzer Unit
Seating clinic
Bio-medical Engineering Dept
RNSH / Mooro n g
Ph: 9926 72 2 6
27
R oyal North Shore Hospital
(RNSH)
Spinal Cord Injuries Unit
Occupational Therapy Dept
Ph: 9926 878 6
Fax: 9906 14 4 8
Spine Care
Ph: 9809 0444
Fax: 9809 2065
Paediatric SCI
Case management
A b i l i ty Te c h n o l o g y
PO Box 44
145 Sydney Road Fa i r l i g h t
N SW 2094
Ph: 9907 973 6
Fax:9907 9599
w w w. a b i l i t y c o r p . c o m . a u
P ro d u ct s : Assistive Te c h n o l o g y
Ad vo c acyAble Rehabilitation
5 Millennium Court Silverwater NSW
212 8
Ph: 9748 2600 Fax: 9798 5233
P ro d u cts:Roho cushions Jay Cushions
and Backrests, Action cushions, KC a re commodes
Custom Maroon cushions
AM S
12 Joseph Street Lidcombe NSW
Ph: 9649 2111 Fax:9649 2889
P ro d u ct s : P romed mobile hoists
P romed ceiling hoists,
Glide powe red wheelchairs, Pride
p owe red wheelchairs
Quickie powe red wheelchairs, Roho
cushions, Jay cushion
Arjo
Head Office: PO Box 675
Bulimba, QLD, 4171
Sales Reps NSW:
Paul Currie: 0417 663 946
Belinda Hunt: 0417 664 955
Service / Repairs:
(02) 9748 0636
P ro d u ct s :
Arjo Hoists and Slings
Eg: Tr i x i e
C o o ra b e l
R o yal Ryde Rehabilitation Centre
227 Morrison Rd Ryde,
N SW, 2112
Ph: 9808 114 4
Cush’n Sof t
48 Canoelands Rd Glenorie, NSW
215 7
Ph: 02 4566 6198
Fax: 02 4566 612 5
P ro d u cts:Cushioned toilet seats
D e J ay M e d i c a l
1 Prince Willian Dr Seven Hills, NSW
2147
Ph: 9838 8869 Fax: 9838 78 6 9
P ro d u ct s : RGK manual wheelchairs,
RGK basketball wheelchairs
D e p a rtment of
Ve t e rans Aff a i r s
GPO Box 3994
S y d n ey, NSW, 1141
Ph: 133 254 or 9213 7777
N o n - m e t ro: 1 800 555 254
w w w. d v a . g o v. a u
OT.qxd
11/4/02
9:54 PM
Page 29
D r i ver Rehabilitation
P ro g ra m
Cumberland Health and
R e s e a rch Centre
University of Sydney
East St Lidcombe NSW, 2141
Ph: 9351 9282
Dunlop Flexible Fo a m
Lot 103 Frank Stre e t
Wetherill Park, NSW, 216 4
Ph: 9609 6177 Fax: 9725 4264
P ro d u cts:Customised Fo a m
p ro d u cts Cushions, Mattre s s
O v e r l a ys
GTK Rehabilitation
Unit 11/ 14 Boden Rd
Seven Hills, 2147
Ph: 9620 9177
Fax: 9620 9081
w w w. g t k re h a b . c o m . a u
P ro d u cts:Roho cushions
Jay backrests and cushions
I n v a c a re pr o d u cts (infinity
cushions and backrests, ultimate
b a c k rests and powe re d
wheelchairs, etc), Ottobock,
R o l l e rchair Powe red wheelchairs
Mobility Plus Manual,
Wheelchairs, DecPac Ramps,
I n v a c a re beds
Hamatic Bed Company
PO Box 666 Crows Nest,
N SW, 1585
Ph: 9906 6133 Fax: 9906 8889
P ro d u cts: Electric Beds
Huntleigh HealthCare
Ph: 1800 072 040
P ro d u cts:Nimbus III, Auto Exc e l ,
Alpha Excel, Vaperm mattre s s ,
Pe n t a f l ex mattre s s
Independent Living Centre
N SW (IL C )
600 Victoria Rd Ryde
N SW 2112
Ph: 9808 2233
Toll Free 1800 800 523
w w w. i l c n sw. a s n . a u
Information on assistive
equipment for people with a
d i s a b i l i t y.
Law Society of NSW
w w w. l aw s o c n sw. a s n . a u
L i f e S tyle and Rehab
Unit 5/44 Atkinson Rd
Ta ren P o i n t, 2229
Ph: 9526 2522 Fax: 9526 2507
w w w. l r. c o m . a u
P ro d u cts: Jay Cushions and backs
Roho cushions, Quickie Powe re d
wheelchairs
Pride powe red wheelchairs
D e c Pac portable ra m p s
I n v a c a re beds
N SW Sporting Injuries
Committee
Level 8, 400 Kent St
S y d n ey, NSW, 2000
Ph: 9370 5925
w w w. i n f a r m a t i o n . c o m . a u / s i c
N o rthCott DLD
Unit 20, The BellTowe r
194 Pa r ramatta Rd Auburn,
N SW 214 4
Ph: 9737 8080 Fax: 9737 8089
w w w. n o rt h c o t t . c o m . a u
P ro d u ct s : Assistive technology
Action manual wheelchairs
I n v a c a re pr o d u ct s
Roho cushions
Levo standing wheelchairs
4x4 ex t reme (4WD PWC )
Otto Bock
5 Burbank Place
Baulkham Hills, 215 3
Ph: 1300 136 056
w w w. o t t o b o c k . c o m . a u
P ro d u cts: Cloud Cushions
Padded armre s t s
Mo g o
Unit 5, 42 Canterbury Rd
B a n k s t own, 2200
Ph: 9708 5255 Fax: 9796 2479
P ro d u cts: Mogo custom manual
wheelchairs
B a s ketball wheelchairs
Tennis Wheelchairs
Pa raQuad Engineering
164-6 Beaconsfield St
M i l p e r ra, NSW, 2214
Ph: 9772 3888
P ro d u cts: Slider, Ve h i c l e
modifications
Mobility Aids
Motor Accidents Scheme
Motor Accidents Authority
Level 22, 580 George St
S y d n ey, NSW, 2000
Ph: 1 300 137 131
w w w. m a a . n sw. g o v. a u
PECS
Personal Equipment and
Continence Supplies Service
Unit 3/ 41 Vo re St Silverwa t e r
N SW 212 8
Ph: 9647 1966 Fax: 9647 19 5 8
28
OT.qxd
11/4/02
9:54 PM
Page 30
Pegasus Wo o l t e c
Ph: 9567 2980
Fax: 9261 4440
P ro d u cts: Pre s s u re Care Mattresses, Care Wa v e
B i -Wave, Vicalin, Tr i n o v a
P roblem Ma n agement Engineering
8a k o o ka b u r ra Rd
Hornsby Heights NSW 2077
Ph: 9482 2808
P ro d u ct s : Vehicle modifications
R e g e n cy Park Rehabilitation Engineering
PO Box 2438 Regency Park
SA 5942
Ph: (08) 8243 8348
w w w. re g e n c y re h a b . c c a . o rg . a u
P ro d u cts: Assistive technology
Specialised Wheelchair Company
5/26 Wattle Road Bro o kv a l e
N SW 210 0
Ph: 9905 5333
Fax:9905 2208
Mobile: 0408 300 233
P ro d u cts:Glide Wheelchairs; Jay pre s s u re care ;
Roho cushions
S t a r well Australia Pty Ltd
PO Box 274 Arc h e rfield Qld 410 5
Ph: 1800 804 837
Fax: 1800 683 470
S u rgical Synergies (Formerly Smith &
N e p h ew )
PO Box 453
K i n g s g rove, NSW, 14 8 0
Ph: 1800 659 385
Fax: 1800 648 79 6
P ro d u ct s : C o m m e rcially available health pro d u ct s ,
Eg: typing and writing splints.
TAD (Technical Aid to the Disabled)
PO Box 10 8 Ryde, NSW, 16 8 0
For regional contacts refer to
w w w. t e c h n i c a l a i d . o rg . a u
Ph: 9808 2022
Fax: 9809 76 70
P ro d u cts: Creators of adapted equipment for
2 9 people with disabilities
TecSol (Technical Solutions)
109 Ferndale Rd Silvan
VIC 379 5
Ph: (03) 9737 9000
Fax: (03) 9737 9111
w w w. t e c s o l . c o m . a u
The Spastic Centre (TAS C )
189 Alambie Road Alambie Heights
N SW 210 0
Ph: 9972 818 3
www.thespasticcentre.org.au/services/index.htm#tasc
P ro d u cts: Assistive Te c h n o l o g y
T h e rapeutic Bed Company
Ph:9584 0454 Fax: 9584 3466
P ro d u cts: Ad j u s t-A - B e d
Total Patient Care
PO Box 6306 Nth Ryde
N SW 213 3
Ph: 9878 6188 Fax: 9878 679 5
P ro d u cts: Commercially available health pro d u ct s
Eg. Writing and typing splints.
V i ctim Services
Lo c ked Bag A5010
S y d n ey South NSW 12 3 5
Ph: 9374 3111
w w w. a g d . n sw. g o v. a u
Wheelchair Sales
Ph: 9621 8185 Fax: 9676 8460
P ro d u cts: Quickie manual wheelchairs, Jay pro d u ct s
Service Prov i d e r s
Wo r k C over NSW
Ph: 9370 5000 or 131 050
w w w. wo r kc o v e r. n sw. g o v. a u
The following are websites of some of the
equipment manufact u re r s :
• w w w. g l i d e . c o m . a u
• w w w.seatingdynamics.coau (RoHo)
• w w w. i n v a c a re . c o m . a u
• w w w. s u n r i s e m e d i c a l . c o m . a u
• w w w. o t t o b o c k . c o m . a u
OT.qxd
11/4/02
9:54 PM
Page 31
Notes:
30
OT.qxd
11/4/02
9:54 PM
Page 32
References
Dickson, H., Martens, D., Dever, L. & Tonkin, J. (1993). The Prince Henry Hospital Spinal Injuries
Handbook. (3rd Edition). McGraw-Hill Book Company Australia Pty Ltd: Sydney
Hammell, K.W. (1995). Spinal Cord Injury Rehabilitation. Chapman and Hall: Lo n d o n .
Ka rcz, J. (2002). Fe a t u res of manual wheelchairs. Independent Living Journal, 15. Retrieved Fe b r u a r y
14, 2002, from http://www. i l c n sw. a s n . a u / f e a t u re s . cf m
Independent Living Centre (2002). Power Wheelchair Guidelines. Retrieved February 28, 2002, fro m
h t t p : / / w w w. i l c n sw. a s n . a u / e l e ct wc h r. cf m
Queensland Spinal Cord Injuries Service (QSCIS). (2001). Handbook
of spinal cord injuries. (2nd Edition). Queensland Spinal Cord Injuries
Service, Princess Alexandria Hospital District Health Service: Brisbane
Pa ralyzed Ve t e rans of America (1999). Outcomes following tra u m a t i c
spinal cord injury: clinical guidelines for healthcare professionals.
Retrieved January 21, 2002, from
h t t p : / / w w w. p v a . o rg / N E W P VA S I T E / p u b l i c a t i o n s / c p g - p u b s / t ra u m a . h t m
Contributors
C a roline Christofferson (Occupational Therapist RNSH)
Stephanie Mclean (Senior Occupational Therapist Moorong Spinal Unit)
Anne Pa d a yachee (Occupational Therapist AQ A )
Dr James Middleton (Medical Dire ct o r, Moorong Spinal Unit,
R o yal Rehabilitation Centre, Sydney )
Tina Piovesan (Occupational Therapy Manager Pa raquad NSW )
rural spinal cord injury project
P ro j e ct Officer:
Nickie Flambouras
PO Box 63 Auburn 2144 Tel: (02) 9637 9069
Designed by Guy Domenici Mobile: 0415 380 210