Given that there is no such thing as a perfect wheelchair or seating system (Garber 1985; Garber & Dyerly 1991) a multitude of variables must be considered to obtain the best fit. Studies support that wheelchair and seating equipment needs should be determined on an individual basis and modified to meet the needs of the user (Hastings et al. 2003; Janssen-Potten et al. 2001). It is suggested that clinicians use objective evaluation, clinical judgment and client input in the prescription and set-up of the equipment (Garber & Dyerly 1991; Garber 1995; May et al. 2004).
There is a growing body of research evidence to augment clinical decision making for wheelchairs and seating equipment (May et al. 2004). While the growth of level 1 and 2 evidence research in the recent years assists to advance this field, it is important to recognize that not all aspects of wheelchairs and seating can be controlled and that level 3, 4 and 5 evidence research continues to be critical for understanding the unique and person-based aspects of this field. This growth of research is exciting and important to the advancement of the field; however, it is resulting in an ever-growing length of this chapter which needs to be managed. For this reason, in sections where there is a mix of levels of evidence, and the level 5 evidence studies do not add novel or compelling evidence, their contribution will be summarized just prior to the discussion section under the subheading of Summarized Level 5 Evidence Studies. This assures the reader of all the studies reviewed and acknowledges the important contribution of all studies to the field of wheelchairs and seating. Please note that the contribution from these studies will not be included in the related discussion or conclusions.
The Wheeled Mobility and Seating Equipment chapter is a synthesis of studies that explore various aspects of wheelchairs and seating for individuals with SCI. The chapter has been organized to be as clinically relevant as possible. The studies reviewed in this chapter are organized into subsections: 1) manual wheelchair technology including propulsion, ‘set up’ or configuration, training, and use; 2) power mobility technology, including power mobility use, driving controls, power positioning devices and alternate power mobility options; 3) seating equipment including the use of pressure mapping, postural implications and impact of seating equipment on function, cushions, and changes in pressure during static sitting and dynamic movement while sitting; 4) alternate forms of mobility; 5) position changes for managing sitting pressure/postural issues, fatigue and discomfort and; 6) wheelchair and seating provision and service delivery process.