SEATING - SHONAQUIP

THE IMPORTANCE OF THE CORRECT WHEELCHAIR

Ensuring that children have the correct devices means that they are able to attend schools and participate in their communities. Every child and user has unique needs and it is vital that the appropriate chair is prescribed and fitted by trained professionals.

Wheelchairs are meant to function efficiently, meet individual needs, be appropriate to local environmental conditions and provide proper fit and postural support, based on sound biomechanical principles (WHO, 2011).

36% of wheelchairs in low resourced countries are abandoned within 12 months due to inappropriateness, physical pain & breakdown. Secondary complications resulting from inappropriate support (incl. spinal curvatures & pressure sores) can be eradicated by appropriate fitting & regular adjustments by therapists.

Reducing waitlists for children in need of wheelchairs

The waiting list for children in need of wheelchairs in South Africa is often very long, sometimes more than 3 years. For growing children, not having device or having an ill-fitting one with inadequate posture support, can lead to spinal deviations and contractures. This robs the child of opportunities to live, learn and socialize like other children. Fatigue, discomfort, or challenging behavior can worsen the impact. At its worst, inappropriate seating or the lack of regular reviews, may have life-threatening consequences for the child with a mobility impairment.

When caregivers are shown how to position their child correctly during everyday activities and how to adopt a 24 hour positioning routine to prevent secondary complications, they can enable the participation of the child. Devices include active wheelchairs, posture support buggies and wheelchairs, standing frames, school seats, side and vehicle positioners to maintain good alignment when the child is out of his/her wheelchair.

Uhambo works with skilled and experienced seating practitioners and technicians from Shonaquip Social Enterprise to provide wheelchairs backed up by comprehensive wheelchair services. They mentor local therapists to build capacity of local seating service providers.

Assistive Devices

On outreach trips into rural areas, it is typical for our team to come across teens with disabling mobility impairments who have never been fitted with a wheelchair before. Many of these children already have complex deformities, and developmental delays from from being isolated and under-stimulated. They can be counted among the most marginalized youth in the country with few future prospects.

ShonaquipSE assesses each child before selecting the appropriate device, ensures the proper fit of the device, and supports this with caregiver training to ensure the correct use and adjustment of the device. The routine maintenance of devices is integral to responsible seating services and fundamental to mobility, safety and participation.

ShonaquipSE practitioners choose the most appropriate device for each individual child's or centers' needs. This may include products or devices beyond the ShonaquipSE range of products. ShonaquipSE works closely with the Department of Health wherever possible to ensure that children and centers receiving support maintain their relationship with existing government services. All services are aligned with international World Health Organization recommendations.

Repair and Upscaling

Uhambo USA works with the ShonaquipSE trained technicians to ensure that devices are repaired and maintained. When children outgrow their devices, funding is raised to refurbish and upcycle these for other children.

Uhambo USA accepts donations of appropriate, second hand devices for upcycling for other children.

We aim to provide this service for every center that we work with. We are actively seeking funding to support further activity of this program.

Mobile Outreach Seating

Outreach clinics deliver mobile, comprehensive, community-based wheelchair services to people with mobility disabilities. This includes screening, assessment and measurement, procurement, fitting, customization, user and carer training, repair and follow up. Mobile units help to reduce waiting lists, ensure the longevity of devices and dramatically improve the health and well-being of the users.

Transport remains one of the major challenges facing families of children with mobility disabilities. They are not able to access centralized rehabilitation units that are available to support children with intermediate and advanced seating needs.
Mobile units are able to make an amazing difference in the lives of children and their families. In a 3 year study, our outreach seating model of 6-monthly assessments and the provision of appropriate devices has been proven to reduce the development of pressure sores from 2% to 0.26% and new spinal deviations from 35% to 0%.

Outreach seating programs include disability awareness, parent and caregiver training, and support the training of local therapists and repair technicians.

Impact of Low-Quality Wheelchairs

a) The current providing principle is: “something is better than nothing”
The majority of the current providers use the principle that “something is better than nothing” when you are poor. They do not provide wheelchair designs that provide both size- appropriate and adjustable body support together with robust frames that can be effectively used and maintained in under-resourced and remote, sandy and muddy areas of the world.

b) The unintended consequence of ‘donations’
Container loads of second hand, poor quality wheelchairs are donated by well-meaning individuals and charities around the world for developing and poor countries. In the majority of cases these donations create more harm than positive impact. The chairs are distributed with no consideration to the medical implications, clinical support, fitting requirements, modifications, maintenance or repair needs. The wheels and frames often cannot survive the terrain in which they need to be used.