Page 31 - Mobility Management, March 2019

A Constant Battle
Wenzel believes in helping clients to conserve energy as much as possible as early as possible — though he acknowledged that fatigue can be a tough concept to pin down.
“The important thing for the wheelchair user is to make sure they understand fatigue and that they’re aware of it and how it’s happening to them,” he said. “Because it’s not going to be the same for everybody. Whether they’re in a power mobility device or a manual wheelchair, it could be different for everybody.
“It’s tough to get wheelchair users to understand that, because there’s not an immediate reaction [to changing position]. For example, if I have pain and I’m sitting on my bottom, if I tilt myself back, my pain goes away — I get an immediate response. Fatigue is something that happens over a long period of time. Energy conservation is critical.”
Sayre said she’d like to see opportunities to assess clients and their changing circumstances more frequently.
“Repositioning is a constant thing we do, and I think people need to be reassessed if not on a yearly basis, then every other year,” she said. “That’s just a personal feeling. Think of the aging process and a little bit of modification you might need. Maybe
you don’t need a whole new system, but if we catch it early enough — it could be a secondary anomaly, like a kyphosis or
a scoliosis starting due to their accommodating their fatigue — maybe it’s flexible enough for us to address it before it becomes fixed or a contracture. Then we’re taking a proactive instead of a reactive approach.”
But step one might be getting fatiguing clients in a rest- deprived society to slow down enough to do a little self assessing. “As a therapist,” Sayre said, “we think holistically about not just their physical capabilities, but also their social and psychological ones. They’re all affected by fatigue, and I don’t think people even think of it as fatigue. That goes back to the responsibility of the person in the chair and the caregiver, too. They’re going to know their lifestyle the best. You know when something is intrinsically wrong with you. They need to be advocates for themselves, and we need to listen to them.
“I know I have changed in the last 20 years. We fatigue just naturally. I’m looking at that person in the chair, and that person is also aging, possibly faster depending on their diagnosis. I think five years of having equipment is way too long. Think of how much we’ve all changed in the last five years.” m
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MOBILITY MANAGEMENT | MARCH 2019 29