University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Equipment

Undoubtedly one of the most potentially helpful, or potentially harmful, aspects of living with spinal cord injuries is getting, and using, the right equipment to assist with your needs. From something as large as furniture to something as small as a toothbrush, there are probably as many devices available as there are consumers who could use a gizmo that is designed to help them perform tasks more easily and more successfully.

Probably one of the most obvious - and most costly - pieces of equipment for a person with a spinal cord injury is a wheelchair. A number of factors must be considered when deciding on the right chair: what the person's physical needs are, the environment or environments in which they move 1, what would be the most effective system to help the person do pressure reliefs while in the chair 2, and the financial resources available. For instance, getting a power wheelchair might be tempting, but if a person has limited financial means, or else lives in a small space a large chair couldn't easily maneuver in, or has difficulty learning to operate the controls, it might not be the right choice 3. The wrong chair can create injuries that could lead to a pressure ulcer (which means the same thing as "pressure sore" or "bedsore"), such as when Chris got a new chair that allowed him to move around and chafe his hips. Seating is another issue; there are a variety of cushions available, and even more can be customized 4; having the right cushion but without the recommended cut-out in it caused Ken to get a pressure ulcer. As our study participant Frank said of getting the right kind of cushion, "See, everybody's body made different. Some people sit on different types of cushions, different types of weight, different types of build or whatever." He was speaking from experience: when his gel cushion broke, Frank got a pressure ulcer from sitting on the foam cushion he was using as a temporary replacement.

This leads to another important idea to keep in mind about equipment. Whether it's a cushion, wheelchair, mattress or any other device, it is not only necessary to get the correct equipment in the first place, but also vital that you make sure it is not wearing out. As Frank learned, equipment that starts out right but becomes less supportive or loses its proper shape over time can cause a pressure ulcer 2.

A salesperson at a medical supplies store might know a lot about devices or aids such as supportive pillows or utensils with built-up handles or plumbing fixtures with easy-to-use handles, but they very likely don't have the expertise to prescribe a wheelchair or wheelchair cushion. In order to get the chair that is right for you, and any accessories that might be needed (such as cushions, a trunk support, etc.), consulting with a health care professional specially trained to fit equipment, such as a physician, occupational therapist, or physical therapist, is recommended.

A person's home can be customized in many ways to make it more accessible to a person with a spinal cord injury. For instance, other kinds of furniture or chairs, such as an air mattress or commode-shower chair, might be useful for preventing accidents, reducing pain and helping the person to be more independent in tasks like self-care 5. As another example, some states, including California, offer free telephones with special adaptations to make it easier for people with disabilities to stay in touch. (If you live in California and would like to find out if you are eligible for a free phone, call 1-800-806-1191, or go to the website of the Deaf and Disabled Telecommunications Program; para la información sobre los teléfonos libres en el estado de California, llame este número de teléfono: 1-800-949-5650.) Health care professionals, such as an occupational therapist, can evaluate your home for changes, furniture or equipment that would be beneficial 6, but make sure the person you're relying on has the training to give you the right advice; one of the participants in our study, Mitch, was told by a home health nurse what type of bed to get, but it turned out to be the wrong kind, and by time he exchanged it for the air mattress he really needed, he had already developed a pressure ulcer. Your physician might be able to help you find an expert, and to decide on the top priority for your needs if your insurance company limits how much or what kind of assistive equipment you can get 7.

Assistive equipment can also help you to be more productive, such as specially adapted computers 8. Again, there might be limits to what insurance covers, so this is another instance where you might have to speak up for yourself to try to get reimbursement, or else decide if the financial investment would pay off in greater ability to take classes or get (or do) a job.

More information on equipment can be found easily on the Internet, but be aware that some of the websites that will come up on a search engine like Google, Yahoo or AOL might be sponsored by a company that sells equipment, so the pages you find might be commercials to get you to buy their products. Websites sponsored by hospitals or universities are more likely to provide information that is objective, that is, free of preference for one company or another. A few objective pages include Switching to a Power Wheelchair on the website of Craig Hospital in Denver, Colorado, on power wheelchairs; Save Your Butt: Custom Orthotic Seating Can Do What Off-the-Shelf Cushions Sometimes Can't, on the website of New Mobility, an online magazine about issues of importance to people with disabilities, which discusses the personal experiences of several people with spinal cord injuries in using cushions and seating orthotics (that is, custom-made braces or supports); a page about many types of Wheelchair & seating on the website of the Spinal Cord Injury Model System. To learn more about occupational therapy or to find a practitioner, try the Consumer Information page on the website of the American Occupational Therapy Association.

1 Minkel, J. L. (2000). Seating and mobility considerations for people with spinal cord injury. Physical Therapy, 80, 701-709.

2 Consortium for Spinal Cord Medicine. (2000). Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health-care professionals. Washington, DC: Paralyzed Veterans of America.

3 Fehr, L, Langbein, W. E., & Skaar, S. B. (2000). Adequacy of power wheelchair control interfaces for persons with severe disabilities: A clinical survey. Journal of Rehabilitation Research and Development, 37, 353-360.

4 Garber, S. L., & Dyerly, L. R. (1991). Wheelchair cushions for persons with spinal cord injury: An update. American Journal of Occupational Therapy, 45, 550-554.

5 Malassigne, P., Nelson, A. L., Cors, M. W., & Amerson, T. L. (2000). Design of the advanced commode-shower chair for spinal cord-injured individuals. Journal of Rehabilitation Research and Development, 37, 373-382.

6 Lysack, C. L., & Neufeld, S. (2003). Occupational therapist home evaluations: Inequalities, but doing the best we can? American Journal of Occupational Therapy, 57, 369-379.

7 Bingham, S. C., & Beatty, P. W. (2003). Rates of access to assistive equipment and medical rehabilitation services among people with disabilities. Disability and Rehabilitation, 25, (9), 487-490.

8 Kruse, D., Krueger, A., & Drastal, S. (1996). Computer use, computer training, and employment: Outcomes among people with spinal cord injuries. Spine, 21, 891-896.