Configuring a client’s first wheelchair is like facing a blank canvas: full of promise, but sometimes too full of possibilities.
With that in mind, the Wheelchair Functional Impact Tool (WC-FIT) bridges gaps that can occur from a lack of experience on the client’s side, as well as potentially a lack of wheelchair assessment experience on the clinician’s part.
Multi-faceted decisions
The WC-FIT was created by Mandy McDonald, MS, OTL, ATP, and Tori Fallgren, PT, DPT, NCS, ATP, two longtime members of the wheelchair seating and mobility clinic at Shepherd Center in Atlanta; Stephen Sprigle, Ph.D., PT, professor of the School of Industrial Design & School of Mechanical Engineering at the Georgia Institute of Technology in Atlanta; and additional Shepherd Center occupational and physical therapists.
“Prescribing a first wheelchair is a complex process involving multi-faceted decisions by the client and their treatment team,” McDonald and Sprigle said, in introducing the WC-FIT. “The client has limited or no experiential basis upon which to judge the various technologies and configurations of equipment available, or the ways these factors can impact their function for the better and for the worse. Moreover, clients with sudden loss of mobility often struggle anticipating the various activities and environments that will comprise their everyday lives when they return home.”
WC-FIT’s creators also knew that not all professionals who perform wheelchair evaluations do this kind of work daily.
“Therapists and ATPs [assistive technology professionals] use their clinical expertise to educate clients and make recommendations about equipment options available, but these discussions can vary widely according to the experience and opinions of the treatment team and their familiarity with ever-changing Complex Rehab Technology,” McDonald and Sprigle noted. “These issues can result in a failed prescription that may necessitate a reevaluation or result in a poor outcome for the client.”
The WC-FIT has the following goals:
• Provide a systematic, structured way for clients and their treatment team to explore the impact of mobility devices for people with new-onset mobility impairments.
• Help the treatment team identify gaps in client understanding of the pros/cons of mobility devices.
• Improve clinician understanding of the clients’ life outside the hospital, and of the client’s needs and preferences.
• Empower the client/caregiver to make informed decisions about what mobility device to pursue and strengthen client ownership of the decision.
Those four goals feed into goal #5: Minimize the frequency of client dissatisfaction with prescribed equipment.
Nine categories to consider
“Based on the International Classification of Functioning, Disability and Health, the WC-FIT considers the mobility device as an environmental factor and helps the client and treatment team explore the impact of that device on body functions and structures, activities and participation for the individual,” McDonald and Sprigle said. “The impact of multiple devices can be considered and compared in a structured way.”
The WC-FIT self-report tool “is filled out by clients and caregivers outside of therapy time, then shared with the primary treatment team.”
The tool has nine categories: pain, energy, stress on your joints, posture, independence, moving around using the device, moving around using transportation, feeling good, and getting the device paid for.
For each category, the WC-FIT provides prompts. For example, for the pain category, the prompt is “Pain can have a big impact on people who use wheelchairs. Research shows that wheelchair users with pain report they are less likely to be active; feel good about themselves; be employed; be independent. Think about where you often have pain. Can you use each device without pain?”
For the “feeling good” category, the prompt is “Research shows that people who feel good about themselves tend to do more than people who don’t feel good about themselves. Think about how you feel about yourself when you are using the device. Do you feel good about yourself when you use each device?”
Clients answer those two questions as yes, mostly, sort of, not really, or no.
The tool uses everyday language, such as “The mobility device you can use can change how easy or hard it is to get out into your community. There are a lot of factors to consider, including how difficult it might be to get you and your device into and out of the vehicle, who you will have available to help you, wear and tear on your joints, and whether you want to drive a vehicle.”
Patients are the experts
In her nearly 25 years at Shepherd Center, McDonald told Mobility Management that she’s worked in inpatient and outpatient roles, in a day program, and in seating clinic.
“There is a little bit of a disconnect sometimes between what the therapists don’t know they don’t know,” she said.
And while she believes “We are all doing the very best we can for the patients, she added, “But the patients are the experts on themselves.”
McDonald recalled a client who had needed a sip-and-puff driving control for decades. “What we see consistently is if it’s not what the client wants, it’s not going to work for them, even if it’s really best for their posture or best for this or that,” she said, describing successful equipment provision as “such a holistic thing. And we are so much more successful when we come from a place of what they value and what they want.
“And then we try to work in what we want and what we value. That’s my own personal experience.”
Planning ahead
As a case example of the need to consider all WC-FIT categories, McDonald recalled a young woman preparing to attend college.
“Her treatment team recommended, ‘You want to go through insurance for your power chair, because that’s going to help you get around your campus easier. And we found this beautiful manual chair that just happens to fit you that’s being donated. It’s fabulous: It’s the best of all worlds.’”
Several years later, when the client returned to clinic, “Her chair was falling apart,” McDonald said. “She only ever used the manual chair, and she had no funding to get it repaired, because it was donated. We have to think through the funding and what this is going to look like down the road. We just have to be really mindful of what we’re recommending and be mindful that we make it their decision and not our decision.”
The WC-FIT tool is currently available on the Shepherd Center website; a webinar for health care professionals will debut on Feb. 17, 2026, and then be made available on demand. Scan the QR code on this page for access to both.
McDonald said that when she’s used the WC-FIT, many times the seating team has obtained two devices, one funded through insurance and the other self paid. “It kind of opens everybody’s eyes,” she said, “to the fact that there might not be one magical answer that meets all the needs of the individual.”
