What are the most important factors to consider when selecting a wheelchair for someone with spinal cord injury?

Having a wheelchair that is appropriately fitted to that person is so important for them to safely and effectively access the environment in their home, as well as outside of the home. If the wheelchair doesn’t fit appropriately, they’re at risk for developing asymmetrical postures that would eventually lead to contractures—they’ll end up sitting in a crooked position and then end up getting stuck in that position over time. They also could end up with pressure ulcers in those cases because of unequal seating pressure underneath those sitting surfaces. And then if they’re not properly fitted to the chair, it’s very difficult for someone to be able to learn higher-level wheelchair skills like wheelies, which are used to access curbs, and stairs and rough terrain. And so someone who is properly fitted has a better chance of learning those skills; it’s a lot easier and safer for them to learn those advanced skills.

The most crucial factors are to listen to the user of the wheelchair and to understand how and where they’re using the wheelchair, because I can prescribe a very wonderful wheelchair for someone and if it doesn’t fit through their doorways, it’s no use to them. If it doesn’t work on road surfaces, such if they live in Alaska and have very rural conditions, then you need a different type of wheelchair than somebody who’s on the city streets of New York might need. So those are the really crucial factors—is listening to the client and what they’re doing with their wheelchair. But also, watching the client, watching how they’re moving in their wheelchair and understanding how they’re moving their bodies so you can match the wheelchair to allow them to do that. If I do some seating in a wheelchair to improve somebody’s postural support and I over-support them, I can take away function. I could make it so that maybe they can’t dress in their wheelchair anymore, or they can’t do the things they need to do. Or I can do a good prescription to enhance those things and understand the user and the user’s environment.