Case study: Developing national guidelines for the provision of AT

The situation: people in PNG face challenges in accessing appropriate accessing technology that meets their needs.

 Assistive Technology (AT) includes any item, piece of equipment or product that helps a person carry out daily tasks and activities. It is intended to help reduce the impact of impairment and increase, maintain or improve the ability of people with disabilities to do their family activities, and be an active part of family, community and civil life.

Based on WHO statistics, it is likely that over 1 million PNG citizens would benefit from hearing, vision and mobility related AT. This number will continue to rise due to population growth, ageing, and increasing rates of non-communicable diseases and injuries (World Health Organization, 2011). However, access to AT for PNG citizens is limited leaving many people without the AT they need to participate equally in society.

PNG stakeholders have been working for many decades to ensure people are equipped with the AT and services that benefit them. However, service providers in PNG face limitations in the number and capacity of personnel necessary to provide AT, available budget and challenges in reaching those people who require AT (Motivation Australia, 2014).

When the need is not met, persons with disabilities are isolated and do not have access to the same opportunities as others within their own communities” (World Health Organization, 2008) 

What was the response?

Mandated by The National Policy on Disability 2015-2025, PNG stakeholders agreed to develop a framework for a national standard of care in appropriate AT provision, for people with mobility, hearing and vision impairments.

Through an Australian Government funded project, a PNG multi-stakeholder Steering Committee was formed, chaired by the national disabled person’s organisation PNG Assembly of Disabled Persons (PNGADP). The Steering Committee’s role was to ensure the Guidelines complied with the UN Convention on the Rights of Persons with Disabilities (CRPD); aligned with existing PNG guidelines, policies and systems; was culturally and contextually appropriate and that decisions were made with the best interests of users in mind. Motivation Australia partnered with PNGADP and the Steering Committee to provide technical knowledge, ensure international practices in quality AT provision were shared, facilitate consultations and lead the drafting of the guidelines.

Between 2015-16 consultations were held with more than 250 people from more than 50 organisations and/or departments across the four regions of PNG. Stakeholders, particularly PNG citizens who use or require AT, contributed their personal experience and knowledge about what is needed and why.

 

“It’s my right to have an education. At first I used glasses but they were not helpful enough and I used to take a lot of time to study. I now use a laptop to help me with braille, I also use NVDA and JAWS. I can now type up notes, exercises and assignments by myself. It (AT) helps me to study. I also use it (AT) to listen to music and play card games.

Collin, an AT user in PNG

 

What were the outcomes?

In a first for PNG and the Pacific Region, stakeholders worked together to develop the National Guidelines for the Provision of Assistive Technology in Papua New Guinea.

The guidelines provide practical guidance and recommendations on how to strengthen:Cover page of guidelines

  • Rights based governance, policy and leadership relevant to AT provision
  • Maximum user involvement at every step
  • Equitable AT service systems and service reach
  • Minimum AT training requirements for local personnel
  • Recommended AT for the PNG context

PNG stakeholders are now using these guidelines to:

  • Advocate for improved services and access to AT
  • Provide information to help users have choice about what AT will help them in their daily activities and to be active participants in PNG society
  • Support improvements in the quality of AT that is procured
  • Guide the minimum standards expected of AT services
  • Set minimum training requirements of AT service personnel
  • Negotiate and coordinate donor support for improved quality of AT

What were the challenges?

Huge demand and unmet need for AT. Despite the great need, PNG stakeholders made a deliberate choice to focus these Guidelines on key recommended hearing, mobility and vision AT. This gave them the potential to reach the greatest number of people within the service systems that currently exist. It is intended that these Guidelines be expanded in the future to address other AT priorities.

Consultations need to be accompanied with awareness. Providing in-depth information about AT products and services was necessary during consultations to ensure that PNG stakeholders had the information to make informed decisions. Raising awareness on ‘appropriate’ AT provision, types of AT and international standards, better enabled stakeholders to effectively advocate for quality hearing, mobility and vision AT services for their local context and provide valuable input into the Guidelines

Diverse and decentralised policies, roles and responsibilities. The diverse geography, competing priorities and limited resources of stakeholders, as well as the decentralised system of PNG presents challenges to accessing AT services. During the drafting process key policies, roles and responsibilities of all stakeholders were identified. This assisted the Guidelines to be designed around the people, places and systems of PNG within the context of existing legislation, policies and plans, while still drawing on international standards and resources.

Donated AT that do not meet needs, may cause harm, are abandoned and create greater waste management issues for PNG. PNG stakeholders are strongly against donated AT provided without consultation with local partners and users, outside the service system and without the presence of trained personnel. They state that ‘this is not the rights based way!’. Sorting through containers of unrequested donations “takes service providers away from actually delivering the needed service” (PNG service provider).

What did we learn?

  1. The Steering Committee facilitated invaluable multi-stakeholder engagement, collaboration and coordination across sectors and government and non-government organisations.
  2. The leadership of PNGADP as chair of the Steering Committee was critical in working in the spirit of the CRPD and ensuring AT users were front and centre of the process. Over time respect and trust amongst stakeholders strengthened, ensuring understanding of the value and use of the Guidelines for them.
  3. The consultations provided the opportunity to gather information for the Guidelines and to increase awareness and knowledge amongst stakeholders about the AT that is available or could be procured at low cost to PNG and what services exist and how to access them.
  4. Strengthening AT services and implementation of Guidelines such as these will take long-term commitment, collaboration, time and investment of many stakeholders.

Acknowledgements

We acknowledge the Steering Committee, the PNG Assembly of Disabled Persons (PNG ADP), users of AT who shared their stories, and all those from Government Departments and the community who contributed to the Guidelines. We also recognise the investment from the Australian Government in partnership Government of Papua New Guinea through the Strongim Pipol Strongim Nesen (SPSN) program who provided funding for the development of these Guidelines.

WHO wheelchair service training package: Links to download

The World Health Organisation’s (WHO) Wheelchair Service Training Packages (WSTP) are at the foundation of MA’s wheelchair service training courses. MA training programmes use the WHO methodology in teaching safe, appropriate and sustainable approach to wheelchair service provision in our region.

Where did the training packages come from? A key document that was developed by the WHO to guide the sector was the WHO Guidelines on the provision of manual wheelchairs in less resourced settings, published in 2008. The Guidelines recognised that while the wheelchair is one of the most commonly used assistive devices for enabling personal mobility, there were very few training opportunities for service providers to ensure that wheelchair users can attain personal mobility with the greatest possible independence, be productive and enjoy a high quality of life.

Basic and intermediate level training courses were developed to assist services to implement the Wheelchair Guidelines, by giving the opportunity for wheelchair service personnel in less resourced settings to be trained in comprehensive wheelchair service provision and enable increasing numbers of adults and children to receive a wheelchair which meets their needs.

WHO also recognises that trained personnel require support from managers and national stakeholders to ensure appropriate wheelchair provision is established and sustained within a country. To raise awareness and promote good practice, WHO developed a training package for managers, and a training package for stakeholders.

Links for download

Wheelchair Service Training Package – basic (WSTPb): designed to support the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who have mobility impairments but can sit upright without additional postural support.

Wheelchair Service Training Package – intermediate (WSTPi): designed to support the training of personnel to provide an appropriate manual wheelchair and cushion for adults and children who need additional postural support to sit upright.

Wheelchair Service Training Package – managers (WSTPm): designed to guide managers to effectively support appropriate wheelchair provision. This includes raising awareness among stakeholders and promoting their involvement in establishing appropriate wheelchair provision in their country/region. It can be delivered in a minimum of two days.

Wheelchair Service Training Package – stakeholders (WSTPs): designed to create awareness and develop the skills and knowledge of all stakeholders in establishing appropriate wheelchair provision in their country/region.

Wheelchair Service Training Package – Training of Trainers (WSTPtot): designed to develop the skills and knowledge of trainers to be able to deliver the WSTPb, WSTPi, WSTPm or WSTPs.

 

 

Training in Assistive Products (TAP): A WHO GATE initiative

Motivation Australia is delighted to be actively contributing to the development of TAP, an online learning resource by the World Health Organisation’s Global Cooperation on Assistive Technology (GATE).

TAP aims to support global efforts to increase access to Assistive Technology; through equipping community level workers with the knowledge and skills to enable them to provide a range of basic assistive products, including many of those listed on the WHO Assistive Products List. TAP also aims to support users of assistive products directly with readily accessible information about basic assistive products.

As we know, it is really important that assistive products match the needs of the individual user. If it does not, it is likely to be of no benefit or abandoned, and may even cause physical harm.

This is why TAP will cover four key steps of service provision: assessment, fitting, user training and follow-up. Each online training module will support personnel in learning how to help those who use assistive products to select and use the most appropriate device; as well as to provide an ongoing, quality service when maintenance or repairs are needed. It is envisaged that TAP will be most effective when combined with face to face training and/or mentoring.

Throughout 2018 WHO will be conducting pilots of the first modules, working with national partners in different contexts. The first pilot focuses on walking aids and reading glasses, and will be in Bangalore, India in February.

For more information about the GATE initiative, including TAP, visit the WHO website. For more information about Motivation Australia’s involvement in TAP, please contact Kylie Mines.

Keep Moving training resources

The Keep Moving project was developed in response to the need to build the capacity of personnel working to prevent lower limb amputation as a result of diabetes; and to support the return to mobility of men and women who have had an amputation.

The project began with an analysis of the prevention and management of lower limb amputation; including identification of six phases and a range of interventions possible during each phase. Training resource development for most, if not all of these interventions, would be beneficial for the Pacific context; however. this was not feasible within the project scope. Early consultation with stakeholders in the Region and a review of existing materials was therefore carried out in order to prioritise and focus resource development.

As a result, the Keep Moving project developed training resources for three topics :

  • Offloading foot ulcers
  • Shoes for healthy feet
  • Mobility without a prosthesis

Keep Moving resources were developed in partnership with the College of Medicine, Nursing and Health Science, Fiji National University (FNU) and the International Society of Prosthetics and Orthotics’ Australian Member Society – Outreach Committee (ISPO Australia Outreach). The project was funded by the WHO Western Region Pacific Office. The modules have been peer-reviewed.

If you would like to download e-copies of the Keep Moving training resources, please fill out your details below. Once you click ‘submit’ you will be re-directed to a page with links to the Keep Moving files.

Additional modules of the Keep Moving training resources are being developed, Motivation Australia will emial you as they become available.

Additional information about Diabetic Foot Care:

Case Study: Diabetic Foot Care in Samoa

DFC Research Summary


 

Dr Lloyd Walker, Chairperson

BE (Hons) Mech; MThSt(Bioethics); PhD (Bioengineering); CPEng (Biomed) FIEAust; GAICD

 

Lloyd is the Director of Assistive Technology at the National Disability Insurance Agency (NDIA) based in Geelong Head Office. Previously he spent five years running his own company (Tech4Life) focused on enabling people through assistive technology. Lloyd continues to lead assistive technology standards work in both Australia and internationally on assistive technology.

Lloyd was previously Director of NovitaTech, Australia’s largest specialist Rehabilitation Engineering and assistive technology centre.

Nas Campanella

BA (Communications)

Nas Campanella joined the Motivation Australia board in 2018. She has completed a Communications degree at the University of Technology Sydney, majoring in journalism. Nas is a journalist and newsreader with the ABC and Triple j. She lost her sight when she was six months old. Nas also has a sensitivity condition called Charcot-Marie-Tooth which means she can’t read Braille.

Nas also works as an MC and public speaker, presenting at schools, conferences and charity fundraisers on topics such as inclusive education, adaptive technology, accessibility and supporting women to climb the corporate ladder. Nas has supported young people with vision impairments to transition into mainstream schooling. She also works as a mentor to people with disabilities and mental illness.

Her strong interest in travel has seen her publish articles with Lonely Planet and the Sydney Morning Herald. She’s also given advice on accessible travel to members of the tourism industry. In 2016 Nas was part of a Disability Empowerment Skills Exchange in Fiji where she worked in a media communications and advocacy role with the Spinal Injury Association in Suva. During the month-long exchange, Nas devised a social media strategy for the organisation, assisted in the design and launch of a disability awareness training program for the United Nations and ran workshops in public speaking, press release writing and interview skills.

David Constantine MBE

MDes RCA, FRGS, FRSA

David is Co-Founder and President of Motivation UK. As a wheelchair user and designer, David has in-depth knowledge of the importance of appropriate technology. In 2009 David was awarded an MBE for services to people with a disability.

 

Mona Girgis

BA(Hons), MNSt (Midwifery), DrPH

Mona is the Country Director for Plan International in the Lao PDR, and is Plan’s global Nutrition Expert for the Early Childhood Development Program. Mona has been working for over 18 years in international development with NGOs and the International Federation of Red Cross and Red Crescent Societies.  She currently sits on the Scaling Up Nutrition Civil Society Network management committee, and brings expertise in fund-raising, public health, nutrition and gender equality.  Prior to working in international development, Mona was a nurse and midwife.

Deb Hartley

BApp. Sc, MPH

With 30 years of experience in international health and development, Deb Hartley brings particular expertise in NGO management and systems development. Deb is currently the CEO of an international NGO working in maternal health in addition to her ongoing work as an independent consultant providing technical advisory and capacity development for a range of NGOs and clients such as ACFID and DFAT.

Kylie Mines, Secretary

BApp. Sc. OT

Kylie is the CEO of Motivation Australia. She has worked in the field of wheelchair provision for almost 20 years, and is currently working with the World Health Organisation developing training packages to support wheelchair service delivery in less resourced settings.

Evelyn O’Loughlin

BA (Education)

Evelyn is a respected leader with 24 years’ executive experience across corporate, not-for-profit and government sectors. Since 2008, she has been CEO for one of the State’s largest not-for-profit peak bodies, leading the volunteering sector in South Australia and the Northern Territory.  A passion for community and culture has led Evelyn to the not-for-profit sector after a career spanning many sectors and industries including working overseas for two commercial companies in the United Kingdom and Greece.

Evelyn’s current Board and governance appointments include Premier’s Council for Women, Volunteering Strategy for South Australia, Together SA, Flinders University Business School Advisory Board and Motivation. She has also been recognised on the SA Women’s Honour Role.

 

Peter Stewart

Peter (BNg, MClinRehab, GAICD) is the CEO of The Paraplegic and Quadriplegic Assoc of SA (PQSA), which incorporates management of a commercial enterprise, HomeCare+. Peter has 25 years’ experience in the disability sector via nursing, academic and business management roles.

Volunteer your skills!

Volunteering is a great way to support the work of Motivation Australia in the Asia Pacific Region.

Volunteers contribute in a number of ways, including:

  • Developing or reviewing training materials
  • Supporting the delivery of mobility device training courses
  • Mentoring of in-country personnel
  • Peer mentoring
  • Advising on best practice

Motivation Australia aims to build relationships with our volunteers, and ensure that the experience is positive for the volunteer, our partners and our organisation.

Volunteering on one of our programmes overseas can be a great way to travel and meet new people. It is also an opportunity to experience working in the International Development field and contribute to the development of the sector.

Volunteer categories

Funded, in-country volunteers

When specific clinical or technical support for training or mentoring local personnel is required, we may advertise a funded volunteer position. There are only a few of these opportunities each year.

These positions are coordinated by Motivation Australia’s team. Travel costs will be funded by the programme budget, including: flights, airport transfers, accommodation, travel insurance, visas and per-diem.

Self-funded, in-country volunteers

For volunteers who are motivated to contribute to one of our programmes and are considering funding their own travel, there is more flexibility with dates and destination. Motivation Australia will work with you to tailor a role to suit your interests and expertise

Motivation Australia will provide support before during and after your trip. All volunteers who travel overseas will need to participate in our induction process, including providing a police certificate.

Three people sitting on the grass, listening to music at a Motivation Australia fundraiser.

Australian volunteers

You do not necessarily need to travel overseas in order to contribute to our work. Motivation Australia draws support from allied health and technical professionals through our Clinical and Technical Reference Group (CTRG).

Other volunteer activities include supporting our website development, social media, fundraising and event management, membership and office administration.

More information

We are always interested in hearing from people who would like to support the work that we are doing.

If you would like more information about volunteering for Motivation Australia’s please contact Motivation Australia’s Service Development Manager, Lauren Flaherty.

 

 

Case study: Diabetic Foot Care in Samoa

The situation: diabetic foot ulcers were leading to high rates of amputation

Pacific Islands account for eight of the top ten in the world for diabetes prevalence. In 2014 Polynesia and Micronesia had the world’s highest age-standardised diabetes prevalence rate of nearly 25%. With high rates of diabetes also comes a high prevalence of diabetic foot complications and resultant hospitalisations and amputations. This high rate of diabetes is leading to high rates of diabetic foot ulcers and subsequent amputations. With the growing rate of diabetes related foot ulcers and amputation in the Pacific, action is required to reduce the burden of diabetes on individuals, families, communities, the health system and the economy.

The World Health Organisation statistics show that amputation rates in countries with strong diabetic foot management services have decreased by 40-60% in the last 10-15 years. Unfortunately the same reductions are not being seen in low to middle income countries, where in most cases, amputation rates are steadily increasing. In many Pacific countries the only available treatment for patients with diabetic foot ulcers is life saving treatment through antibiotics, surgical debridement or amputation. Many hospital services around the Pacific are overwhelmed with the number of clients with diabetic foot wounds requiring treatment.

What was the response?

Since 2014 Motivation Australia has been collaborating with the Samoa National Health Service (NHS) to establish the Samoa Integrated Mobility Device Services (SIMDES) funded by the Australian Government. The initial part of this project saw the introduction of a wheelchair and walking aid service. During the early stages of this service, it was noted that a large proportion of the clients receiving mobility devices were amputees who had lower limb amputations due to untreated diabetic foot ulcers.

The first step was a feasibility study in the beginning of 2015 to see whether orthotic offloading could be introduced to reduce the number of amputations in Samoa. From this feasibility study came the launch of the NHS multi-disciplinary Diabetic Foot Clinic (DFC) in June 2015.

The DFC was established at Tupua Tamasese Meaole (TTM) hospital in Apia with a core team of Samoa’s only Podiatrist, nurses and an Australia volunteer prosthetist orthotist (with support as required from doctors). The volunteer was later replaced by a Samoan orthotist following the completion of her studies in lower limb orthotics at Mobility India in Bengaluru funded by the SIMDES project.

The clinic provides 3 main services to clients:

  • Education relating to diabetes management and foot care
  • Wound care including cleaning, debridement and dressings
  • Offloading utilising Total Contact Casts (TCC), total contact removable and non removable shoes, foot orthoses, padding and surgical footwear

What were the outcomes?

The clinic has proven to be a success both for the service users and the NHS. Some of the key short term outcomes of the clinic include:

  • Improved wound healing for clients
  • Exposed NHS staff to a model of multi-disciplinary clinical co-operation
  • Improved behaviour and increased compliance of self care by clients
  • Increased capacity of nurses to manage wounds, through specialised practice under the guidance of a podiatrist
  • Reduced the workload of doctors
  • Raised awareness using a series of posters about diabetic foot care around the hospital
  • Equipped the NHS with the skills, tools, systems and supplies to deliver offloading for diabetic foot ulcers

The clinic also showed that increased client contact time and consistent education helped improve clients understanding of diabetes and improve diabetes control, through lowered blood glucose levels. Clients’ blood glucose levels continued to decrease over time and reported self-care behaviours improved. These changes coincided with improved healing rates, general health and well-being:

“If this program hadn’t been started, maybe I’d be gone by now”

“With their advice on controlling my blood sugar levels in order for my ulcers to heal, it has changed my diet a lot too. Not only do they focus on my foot wounds, but they’re concerned about my health in general as well”

“I find it very helpful for me, not only is it protecting my wound from getting more infected, but it is also helping me to mobilise better”

“I find this clinic very useful for me as I see my leg healing well. I also see this team putting a lot of effort in to taking care of my leg”

Intended long term impact – If general diabetes health care improves, awareness about diabetic foot care spreads in the community, clients present earlier for treatment and the health service continues to support (and even expands) diabetic foot care; then the long term impact should be a drop in the number of avoidable lower limb amputations due to diabetic foot ulcers. Fewer amputations mean a lower demand for prosthetic devices. This will improve the quality of life for many Samoans and reduce the long term costs of providing health care for the Government of Samoa.

What were the challenges?

  • Operating a multi-disciplinary clinic involving staff from a range of departments was a challenge for the NHS. The personnel who work in the DFC experienced the benefits for clients of their work on a daily basis and developed a high degree of ownership over the clinic. Whilst health service managers understood the broader benefits of diabetic foot care, they had to manage competing priorities for limited resources.
  • A number of clients presented late with very serious foot wounds and infections, which affected the length and number of appointments. It is hoped that as awareness of the clinic spreads in the community, clients will present earlier for treatment, improving outcomes and reducing both the time required for healing and treatment, and the material supplies required by the DFC.
  • Many of the clients presented to the DFC with very high blood glucose levels. These clients were eating poorly, not taking medication as directed, not attending medical appointments and not undertaking appropriate self-care. The consequences of these behaviours greatly affected the ability of their wounds to heal.

What did we learn?

  1. The importance of early intervention – the later that people with diabetic foot ulcers seek medical advice the higher the risk to them, the longer the treatment (for the client) and the more costly the treatment (to the health service).
  2. That diabetic foot ulcers can be healed with the use of relatively low cost resources. This is an important contribution to the long term sustainability of the service.
  3. That healing diabetic foot ulcers through wound care and offloading, represents good value for money as it costs the health service (according to a 2016 study) approximately eight times less than the alternative of acute hospitalisation and surgical intervention.

Acknowledgements

Motivation Australia would like to acknowledge the work of the Samoa National Health Service (NHS) and NOLA (Nuanua O Le Alofa) on this project. This project is part of the larger Samoa Disability Programme (SDP) coordinated by the Ministry of Women, Community and Social Development (MWCSD). Both the broader SDP and this project are funded by Australian Aid.

Wheelchair considerations: Stroke

All clients should be provided with a safe and durable wheelchair that provides proper fit and postural support and suits their local environment [1].

This online factsheet highlights four key considerations for people who have had a stroke.

Pressure risk

Some people who have had a stroke have impaired sensation and are at high risk of developing a pressure sore. Therefore:

  • Assess the pressure risk for each client carefully considering the person’s skin condition, sensation and ability to relieve pressure
  • For those at risk, provide a pressure relief cushion and check pressure under the user’s seat bones and any other possible pressure areas during the wheelchair fitting
  • Provide a spare cushion if incontinence is an issue.

Wheelchair set up

Many people who have had a stroke are able to stand up to get in and out of their wheelchairs. To make standing transfers easier, clients often prefer wheelchairs with armrests to push up on, and footplates that can flip up or away.An illustration of a man with a stroke, pushing his wheelchair with one hand and one foot.

People who have had a stroke may be unable to propel with their affected arm; however may be able to propel using one arm and one leg (foot propelling). To foot propel, set up the wheelchair so the:

  • Seat height (measured from the top of the cushion) allows the user’s foot to sit flat on the ground.
  • Seat depth allows the user’s foot to reach under the seat to increase pushing efficiency [2].
  • Rear wheels are positioned to allow as active a position as possible, in order to make propelling by user or attendant as easy as possible.

Postural Support

People who have had a stroke need good postural support from their wheelchair to reduce fatigue and prevent secondary complications. Ensure:

  • The backrest, seat, cushion and footrests are correctly fitted.
  • Tension on canvas seats and backrests is maintained to avoid sagging.

Also consider:

  • Support for the user’s affected arm with a cushion or armrest.
  • A pelvic belt to keep the pelvis in a good position and prevent the user sliding forward when pushing.

Client Education

All wheelchair users benefit from learning how to use and look after their wheelchair. Many people who have had a stroke will need assistance from family members, so always involve them in training. Information and skills particularly important for people who have had a stroke includeIllustration of a woman completing a standing transfer from her wheelchair to her couch.

Importance of good posture including how to:

  • Maintain good posture.
  • Re-position within the wheelchair with and without assistance.
  • Correctly use any additional postural supports that have been provided.

Mobility skills training: Some specific areas to focus on include:

  • Most effective self-propelling method.
  • Helping the user and their family members to feel confident about assisted propelling in different environments.
  • Transferring safely in different situations, focusing on maximising the user’s independence.

Download a copy of the factsheet.

 


For more information contact:

Motivation Australia

info@motivation.org.au

Website: www.motivation.org.au

References:

[1] WHO, 2012. WSTP Reference Manual for Participants – Basic level. WHO Press, Geneva

[2] Zollars, J.A., 2010. Special Seating: An illustrated guide. Prickly Pear Publications, USA.

Wheelchair considerations: Amputees

All clients should be provided with a safe and durable wheelchair that provides proper fit and postural support and suits their local environment [i].

This online factsheet highlights four key considerations when providing wheelchairs for people who have had a single or double lower limb amputation.

Pressure risk

A large number of amputations are due to diabetes complications. Diabetes reduces sensation and blood flow, increasing the risk of pressure sores.

For diabetic amputees:

  • Assess pressure risk carefully
  • Provide a pressure relief cushion
  • Check the overall wheelchair fit for other possible areas of high pressure, paying particular attention to their residual limb and/or foot.

Wheelchair set up

Clients with high or double amputations do not have the weight of their leg(s) to stop their wheelchair from tipping backwards1. Therefore:

  • To improve the user’s balance in the wheelchair and reduce the risk of tipping, position the rear wheel axle in the ‘safe’ position (behind the clients shoulders).
  • For some users, as they gain confidence and experience, it may be possible to review the wheelchair set up and move the rear wheel axle position to a more active position.

For users with a below knee amputation, not using a prosthesis;

  • Provide a stump board to avoid swelling, pressure and contractures of the residual limb.

Postural Support

Good postural support reduces fatigue and can help to prevent secondary complications. Ensure:

  • The backrest, seat, cushion and footrests are all fitted correctly
  • The height of the backrest does not interfere with shoulder movement when the user is propelling.
  • Tension on canvas seats and backrest is maintained to avoid sagging.

Client Education

All wheelchair users benefit from learning how to use and look after their wheelchair.

Information and skills of particular importance for people with diabetes are to:

  • Wash, dry and inspect their remaining foot everyday;
  • Wear an appropriate shoe even when in the wheelchair.
  • Check all areas of skin with reduced sensation for signs of pressure.

Good mobility skills can enable people with an amputation to have greater independence. Illustration of a man with both legs amputated below his knees, transferring safely from his bed to his wheelchair.

Provide mobility skills training, ideally with the assistance of a peer trainer. Mobility skills training should include:

  • Correct pushing technique (long circular push strokes)
  • Propelling over different terrain
  • Managing obstacles (steps, kerbs, rough ground)
  • Transferring in different situations

When carrying out mobility skills training, remember to:

  • Check the wheelchair set up (see Point 2) to ensure the wheelchair is not too ‘tippy’. Adjust if needed.
  • Provide a ‘spotter’ to make mobility skills practice safer. Propelling may feel different if the user is wearing a prosthesis – practise with and without.

Users may also use crutches or a walking frame, and will benefit from gait training to use these effectively.

Download a copy of the factsheet.


For more information contact:

Motivation Australia

info@motivation.org.au

Website: www.motivation.org.au

References:

[i] WHO, 2012. WSTP Reference Manual for Participants – Basic level. WHO Press, Geneva.

Wheelchair considerations: Spinal cord injury

All wheelchair users need a wheelchair that is safe and durable, provides proper fit and postural support and suits their local environment [1]

This online factsheet highlights some key considerations for people with a spinal cord injury (SCI).

Reduce pressure sore risk

SCI impairs sensation, increasing the risk of pressure sores. SCI can also reduce bowel and bladder control, and the moisture associated with incontinence can further increase pressure sore risk. For these reasons:

  • Assess the pressure risk carefully for each client
  • Provide a pressure relief cushion and manually check pressure under the user’s seat bones
  • Provide a spare cushion if incontinence is an issue
  • Check the overall wheelchair fit for other possible pressure areas

Wheelchair set up

Maximise the ability of a person with paraplegia or low level quadriplegia to self-propel. Set up should ensure that:

  • Rear wheel axle is directly under or in front of the user’s shoulder
  • When user’s hands are on the top of their wheels, their elbows are flexed to 60-80°

Postural support

People with an SCI need good postural support from their wheelchair to reduce fatigue and prevent secondary complications. Ensure:

  • The backrest, seat, cushion and footrests are correctly fitted
  • The height of backrest does not interfere with the user’s shoulder movement when propelling
  • The tension on canvas seats and backrests is maintained to avoid sagging

Education

All wheelchair users benefit from learning how to use and look after their wheelchair. Information and skills of particular importance for people with a SCI include:

Managing pressure sore risk:

  • Relieve pressure every 20-30 minutes for at least 2 minutes using the most appropriate weight shift method
  • Check pressure risk areas daily to reduce the risk of pressure sores developing.

Mobility skills training:

Good mobility skills can enable people with an SCI to live active lives. Provide mobility skills training as part of rehabilitation, ideally with the assistance of a peer trainer, encouraging independence and considering:

  • Correct pushing technique (long circular push strokes)
  • Propelling over different terrain
  • Managing obstacles (steps, kerbs, rough ground)
  • Transferring in different situations

Download a copy of the factsheet.


For more information contact:

Motivation Australia

info@motivation.org.au

Website: www.motivation.org.au

References:

[1] WHO, 2012. WSTP Reference Manual for Participants – Basic level. WHO Press, Geneva.

Motivation Australia: Our supporters and members

Motivation Australia’s vision is of a world where everyone’s right to participation and inclusion is realised. 

Our mission is to work with partners in the Asia Pacific Region to enable people with disabilities to stay healthy and mobile, access Assistive Technology, and achieve full and equal inclusion. 

Motivation Australia highly values the contributions of our supporters and members – made up of people like you who support our vision and mission.

  • You can join us online through our payment gateway, or by downloading and completing our application form.
  • You can become a supporter by joining our mailing list; and receive quarterly updates about our activities by sending an email to Kate Shortt.
  • You can make a donation through our payment gateway.

Find out more about what we do or contact us for more details.

All funds raised through the Australian public help us to match funds provided by the Australian Government through their Non-Government Cooperation Programme. Any individual over the age of 18 who donates $40 or more to Motivation Australia is eligible for membership. Annual renewal is a donation of $40 or more at the beginning of each calendar year. For all donations greater than AU$2 you will receive a tax deductible receipt.  

Kylie Mines

Kylie qualified as an Occupational Therapist in Adelaide, in 1989, and has always had a strong interest in wheelchair provision and supportive seating. Kylie began working in international development in Lithuania in 1991; and joined the Motivation Charitable Trust in 1993 to establish a national wheelchair service network in Cambodia. That first project with Motivation led to seven years of programme work, living and working in Cambodia, Russia, Lithuania, Albania, Romania, Bangladesh and Sri Lanka.

In 2000 Kylie returned to live in South Australia to start a family – however was unwilling to sever the links with Motivation and international development. After working as a short term consultant for the Motivation Charitable Trust on a range of projects; Kylie founded Motivation Australia in 2007.

As well as building Motivation Australia, Kylie has worked as a consultant for the World Health Organisation (WHO). Through this work she contributed to the development of the WHO Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings, and is the co-editor of the WHO Wheelchair Service Training Package (Basic and Intermediate modules).

Role: Kylie is Motivation Australia’s CEO, and also holds a position on the Board of Governors. Kylie is responsible for overall direction and approach; developing partnerships; and inputs into programmes with a focus on training and education tools; policy development; monitoring and evaluation.

What do you enjoy about working with Motivation Australia? Through Motivation Australia I have been able to continue working in a sector that I feel incredibly passionate about – and build a team of people who are just as keen as I am to see people who need an appropriate mobility device get one. I love that my work is now taking me to countries that are in my ‘home’ Region. I love working alongside our neighbours in the Pacific; and am learning all the time.

Connect with Kylie on LinkedIn.