Physical Exam Considerations for People who use Wheelchairs

Source: Yetsa Tuakli-Wosornu^1,2, Jaideep Talwalkar¹; ¹Yale School of Medicine, ²University of Pittsburgh

In addition to the regular checks of a physical exam, examinations for patients who use wheelchairs should be adapted to address their specific needs. This ensures that the patient's mobility, injury risk, and quality of life are not threatened by extended periods of sitting, potentially without proper weight shifts. Such examination needs healthcare providers that understand these requirements, easily accessible medical equipment, and staff who are adequately trained to operate the equipment. For example, people with mobility disabilities are at risk of developing pressure sores. Prolonged sitting on the wheelchair causes increased temperature and moisture in areas of contact with the wheelchair surface. Such injuries are localized areas of skin and soft tissue damage and are common in the occiput, sacrum, and ischial tuberosity of the patient.

If the patient uses a manual wheelchair, bony prominences like elbows and greater trochanters may show abrasions, erythema, and ulcerations. The correct fit in the wheelchair is also important for the patient's comfort, to improve mobility and overall health. While checking for a wheelchair fit, the seat width, depth, and height must be determined to ensure that the patient can sit comfortably in it. Similarly, the armrests, footrest, and backrest height must be decided according to the user's needs. For example, patients with difficulty in sitting upright need a higher backrest. In comparison, a backrest with free movement of the shoulders is required for patients who push the wheelchair themselves.

Additionally, a patient's weight can be an important indicator of the patient's health. A wheelchair scale must be used to weigh patients in a wheelchair who are unable to stand on their own. This measurement must also be taken into consideration because wheelchairs are meant to accommodate a certain weight, which can affect comfort, fit, and overall patient well-being. A new wheelchair or seating adjustment may be required when the patient's posture seems to lead to deformities, pain, or skin abrasions. For example, pain in the shoulder is indicative of a wrong posture while using a manual wheelchair. Overall, most details related to the medical care for people who use wheelchairs are no different than the care provided to every other person. In this video, we will demonstrate how to measure weight, and what specific clinical considerations to take into account while performing a physical examination on a patient who uses a wheelchair.