Wheelchair assessment pdf
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Wheelchair assessment pdf
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K Arm: both right left Foot: both right left. self-propels wheelchair propels with assistance will use on regular basis chair MANUAL MOBILITYStandard manual wheelchair. Standard hemi-manual wheelchair The following supplier ATP was present and participated in this evaluation and recommendation. Functional Processing Skills for Wheeled Mobility Initial assessment. It is also used when evaluating a student Basic_Wheelchair_Assessment_ (0 ×pixels, file sizeKB, MIME type: application/pdf) Sarah Frost, Kylie Mines, Jamie Noon, Elsje Scheffler, and Rebecca Wheelchair Evaluation. Fluctuation (mobility. and possible modiications Capture the client's goals and expectations from the wheelchair evaluation Basic Wheelchair Assessment Form Service provider: Date: Assessor: Client name: Phone number: Diagnosis: GoalsInterview Assessment Lifestyle and environment Describe where the wheelchair user will use their wheelchair (eg: describe house, community, rough/smooth ground, steps, toilet etc) wheelchair assessment that must be used. For additional information about wheelchair assessment, see Gierach (). Policy. Does the wheelchair meet the user’s environmental conditions? Start by entering the client's basic information, such as name, age, and medical history, and document their current mobility status, including the type of wheelchair they use (if applicable) and their daily activities. This evaluation tool was created in collaboration with OT/PTs in Florida’s school system. Supplier Company. Reason for Referral o Current w/c no longer meets needs. Existing wheelchair (if a person already has a wheelchair) Does the wheelchair meet the user’s needs? self-propels wheelchair propels with assistance will use on regular basis chair fits throughout home willing and motivated to use dependent use. Phone. Requires dependent care mobility device. Limitations Identified WHEELCHAIR SPECIFICATION Client’s Name: Sex: M F DOB: Wheelchair Brand: Frame: Rear Wheels: Front Wheels: Brakes: Axles/Axle Plate: Push Handles: Armrests: Upholstery/Seating: Footplates/LegrestsOptions: Headrest Anti-tip bar & roller Tilting bars Carry bag Oxygen bottle carrier Tray Stump support IV pole Straps/belts The least costly alternative for independent functional mobility was found to be: Crutch/Cane Walker Manual w/c Manual w/c with power assist Scooter Power w/c std joystick Power w/c alternative control. This assessment is used when a student is being evaluated regarding his/her current wheelchair and possible modifications. Ambulation not independent, safe or timely o Other. This practice involves the selection and This form is for assessment of wheelchair users who cannot sit upright comfortably without support. Wheelchair users who can sit upright easily can be assessed by a The least costly alternative for independent functional mobility was found to be: Crutch/Cane Walker Manual w/c Manual w/c with power assist Scooter Power w/c std In this questionnaire, you will be asked questions about different skills that you might do in your wheelchair. This assessment is used when a student is being evaluated regarding his/her current wheelchair. Instructions. Non-ambulatory. Does the The development of wheelchair seating as a sub-specialty of rehabilitation services has been happening over the last several ades. Current w/c beyond repair. Disclaimer: This evaluation form is designed to assist individuals in navigating the physical evaluation process. Patient Goals Fluctuating Ataxia/Athetosis. K Arm: both right left Foot: both right left. It is not intended as a substitute for Download the Wheelchair Assessment Measuring Guide. Please refer to the Helpful Links section for access to a downloadable PDF of the Clinical Application Guide to MANUAL MOBILITYStandard manual wheelchair. These skills range from ones that are more basic at the beginning to Instructions.
