Power to the People

Maintaining Mobility While Aging with a Disability

Aging is a normal process that is challenging for all of us as we try to handle it gracefully while dealing with the many surprises it bestows upon us. Now that people with disabilities are living longer, aging brings along unique considerations and changing needs in addition to the normal stresses of disability. Mobility and wheelchair seating needs often become more complex to adapt to these changes. A question that frequently arises is when should one consider changing from a manual wheelchair to powered mobility?

Recognizing the Signs
There are many factors that influence when an individual may need to make the change. Frequently, the signs are ignored and shrugged off,while the idea of changing to a power chair is met with resistance due to stigma. The power chair is often thought of as a step backwards, giving in to disability or a loss of independence. Being a power chair user brings along many more complications than manual chair use that make the decision unappealing. Making more modifications to the environment, spending more money for complicated repairs, and having to deal with battery maintenance and power lifts are all other reasons the change is resisted. Ultimately, the choice to switch may mean accepting a decline in function,which is difficult for all of us.

Usually one of the first signs that the switch to a power chair is needed is pain. Pain in the shoulders, elbows and wrists is common because propelling a manual wheelchair puts a lot of stress on these joints. Users easily develop cumulative trauma disorders such as Carpal Tunnel Syndrome and rotator cuff tendonitis. Ignoring the pain can cause additionalloss of independence as the user gets older. The joints may develop degenerative changes from the continued stress, leading to loss of motion and contracture. Another source of pain is in the neck, back and shoulders from years of sitting in a kyphotic position or due to progressive postural deformity.

Fatigue is another major problem that may signal it’s time to change. Part of the normal aging process is loss of muscle. Fatigue can come from expending more energy than is in reserve to propel and transfer with a manual wheelchair. Weight gain, lack of conditioning, progression of the original disorder, respiratory problems, heart disease or other underlying medical problems common with aging can also contribute to fatigue.

As everyone gets older our skin loses moisture and elasticity, and becomes thinner. Sometimes with aging, even the best seating system can’t distribute enough pressure to prevent pressure sores. As the skin thins and the muscle is lost, so is the padding that protects bony prominences, making seated individuals more prone to skin problems. If someone has shoulder pain along with aging tissues, they may not be able to perform pressure relief as often or effectively. Some of the pressure relief features that a power chair can offer may necessitate the change for good skin health.

Power Mobility & Quality of Life
The most important factor in the decision of whether or not to switch is quality of life. Often, manual chair users will have a decrease in quality of life without realizing it. They may begin skipping activities to avoid dealing with the resulting pain and fatigue. Gradually, they are no longer participating in activities they enjoy, such as seeing friends or fulfilling family obligations. It is important for the user to decide what their priorities are and how they want to spend their time. Changing to a power chair may result in increased participation in activities and decreased episodes of low energy. Frequently, once the switch is made, the users comment that they were able to interact more with the community, go for long walks or hikes and do things that they would not have considered before.

An important consideration that is often overlooked is the effect of aging with a disability on the caregivers. As we all get older, we begin to need help with some activities. Many people with disabilities need some form of personal assistance from a caregiver, and it is likely those needs will increase with aging. Parents and spouses that are caregivers are aging as well. They may lose some ability to provide care or even require some care themselves.

Planning for the future to meet health-care needs should include openness to equipment changes, including power chair use. Rested muscles can make for easier transfers, allowing the user to assist the caregivers more.

Many manual wheelchair users consider propelling their form of exercise and count on it to stay in shape and prevent weight gain. Concern with weight gain and becoming deconditioned are valid points to consider in the decision to switch to a power chair. But switching to power mobility doesn’t have to mean the end of exercise.

Because the use of a power chair may allow users to have more energy and have less pain, they can often begin a regular exercise program. A therapist can prescribe a program that balances the muscles in the upper extremities and allows cardiovascular conditioning without stress to the joints.

A Unique & Personal Decision
Post-polio syndrome, stroke, spinal cord injury, rheumatoid arthritis, cerebral palsy, muscular dystrophy and disabilities in general all have late-life effects. The aging process is just as unique to each individual as equipment prescription and modification.

There are many equipment options to consider, including pushrim power-assist wheelchairs, using a combination of power and manual wheelchairs, or making the complete switch to a power wheelchair. Try to work with a rehab team to identify problems and help your clients plan for unavoidable changes while maintaining a good quality of life.

About the Author

Susan Cwiertnia, MSPT, has provided assistive technology, performed home evaluations, and developedand managed a wound care program in a rehab setting. In 2007, Susan joined VARILITE as a clinical education specialist.

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