For many people, mobility is as simple as standing up and walking out the door. But for Australians living with physical disabilities, mobility is often a more complex journey—one that hinges on finding the right wheelchair. The process of choosing a wheelchair is not simply a matter of preference or convenience. It’s about restoring dignity, autonomy, and access to life’s essential activities. That’s where occupational therapists (OTs) come in.
Occupational therapists play a pivotal role in helping people find the right wheelchair—not just in terms of physical fit, but in ensuring that the wheelchair enables meaningful participation in everyday life. This means looking beyond medical needs and considering the environments a person navigates daily, their lifestyle goals, endurance, and even their psychosocial wellbeing.
In this article, we’ll explore the OT’s role in wheelchair prescription in detail: the assessment process, the types of wheelchairs available, endurance and terrain considerations, the importance of home and community environments, and how safety adaptations are tailored to each person’s needs.
Table of Contents
Why the “Right” Wheelchair Matters
Wheelchairs are not one-size-fits-all. The right wheelchair is an extension of the person who uses it. It should support posture, conserve energy, prevent injury, and enable daily activities such as cooking, shopping, working, socialising, and exploring the community. A poorly chosen wheelchair can lead to pain, fatigue, pressure injuries, reduced independence, and even social isolation.
For example, someone with shoulder weakness might struggle in a heavy manual wheelchair, while a person using a bulky power wheelchair may be limited by narrow hallways or inaccessible transport options. Choosing the right chair involves a careful balance of features—and that’s where the expertise of an OT is essential.
The OT’s Role in Wheelchair Prescription
Occupational therapists are trained to assess not only physical health but also the functional, environmental, and emotional aspects of mobility. The OT’s goal is to ensure the wheelchair supports a person’s ability to engage in meaningful occupations—activities that bring purpose to life.
Key Responsibilities of the Occupational Therapist:
1. Functional and Environmental Assessment:
- Evaluating strength, posture, endurance, transfers, and range of motion.
- Reviewing the home setup, local terrain, and common destinations like work, school, shops, or social venues.
2. Collaborating with Suppliers:
- Working with local equipment providers to arrange wheelchair trials.
- Comparing different models and modifications.
3. NDIS Reporting and Justification:
- Writing clinical justification reports for assistive technology funding.
- Linking the wheelchair features directly to NDIS goals.
4. Training and Education:
- Teaching safe transfers, propulsion, and usage.
- Educating families and carers about maintenance and safety.
Understanding the Environment: Home and Community Matters
Choosing a wheelchair isn’t just about the person—it’s also about where the wheelchair will be used. OTs carefully consider environmental demands before prescribing a chair.
At Home:
- Door widths and turning space must accommodate the chair.
- Ramps or threshold lips may need modification.
- Kitchen and bathroom access is a key focus for independence.
In the Community:
Does the person need to navigate public transport?
- Are they visiting shopping centres with wide aisles, or older buildings with steps?
- Are paths to work or school smooth and accessible?
Even climate matters—OTs consider whether the wheelchair will need weatherproofing, sun protection, or all-terrain tires for rural areas.
Endurance and Energy: It’s Not Just About Distance
Many wheelchair users find that they can manage short distances but become fatigued over time. OTs assess not only a person’s current ability but also how quickly they fatigue, experience pain, or lose posture over longer distances.
Strategies for Endurance Management:
- Recommending lightweight manual frames to reduce energy output.
- Considering power-assist wheels or joystick-controlled power chairs.
- Educating clients on pacing strategies and when to alternate propulsion methods.
- Including cushioning and support to prevent discomfort over long trips.
The ultimate aim is to preserve energy for what matters most—whether that’s running errands, attending work, or playing with grandkids at the park.
Types of Wheelchairs: Matching Needs to Technology
There are many types of wheelchairs available in Australia, each designed to meet specific user needs. The OT’s role is to explain the differences, trial models, and match features to the person’s function, environment, and goals.
1. Manual Wheelchairs
Best for: People with good upper body strength or those using a support person.
Subtypes:
- Self-propelled: Large rear wheels with hand rims.
- Transit (attendant-propelled): Smaller rear wheels; designed to be pushed.
- Lightweight/Folding: Easy for travel or car transport.
Considerations:
- May be tiring over long distances.
- Often best for indoor or smooth terrain use.
2. Power Wheelchairs
Best for: Those with limited strength or needing to cover long distances.
Features:
- Operated by joystick, sip-and-puff, or head control.
- Offers postural support and motorised seat tilt or recline.
Considerations:
- Requires charging and maintenance.
- Some models are too large for certain vehicles or narrow spaces.
3. Power Assist Devices
Best for: Manual wheelchair users who want to reduce fatigue.
Examples:
- Powered rear push drives
- Power-assist wheels
- Clip-on front drives or handcycles
Advantages:
- Keeps manual chair benefits while increasing efficiency and reach.
4. Tilt-in-Space or Custom Chairs
Best for: People with complex physical needs, pressure care concerns, or limited head and trunk control.
Features:
- Adjustable seating angles
- High levels of postural support
- Headrests and lateral supports
Drawbacks:
- Larger and heavier
- Require transport solutions or van access
5. Mobility Scooters
Best for: People who can transfer independently and have sufficient upper body function.
Use cases:
- Outdoor shopping, local transport, long-distance travel.
Limitations:
- Less supportive for posture or transfers
- Not suitable for all terrain or indoor use
Personalised Safety Adaptations: Not Just the Basics
Safety is a priority in any OT wheelchair prescription. While standard safety features are included in most chairs, customising safety features can make a world of difference to the user’s confidence and autonomy.
Common OT-Prescribed Safety Adaptations:
- Anti-tip bars to prevent backward falls.
- Seat belts or pelvic harnesses to support posture.
- Brake extensions for easier reach.
- Headrests or lateral supports for people with poor trunk control.
- Armrest modifications for better transfers.
- Pressure-relieving cushions to prevent sores or ulcers.
- Visibility features like lights and reflective tape for safe road or path use.
OTs also assess the user’s ability to maintain the equipment safely, recommending maintenance schedules or support staff training if needed.
Real-Life Scenario: Daniel’s Story
Daniel, a 45-year-old father of two, sustained a spinal cord injury after a motorbike accident. After rehab, he returned home with a basic manual wheelchair. However, he quickly realised that pushing uphill to his children’s school was exhausting, and the narrow doorways in his home restricted movement.
An OT was brought in to reassess Daniel’s needs. She recommended:
- A lightweight manual wheelchair with a folding frame for car transport.
- A power-assist rear drive to help on hills and long distances.
- Doorway modifications funded by the NDIS to allow better home access.
- A pressure-relieving cushion and seatbelt for posture and comfort.
- A training session to teach safe propulsion techniques.
Thanks to a comprehensive OT assessment, Daniel regained his independence—walking his children to school, going shopping without assistance, and confidently participating in family life.
The NDIS and OT Collaboration
In Australia, the National Disability Insurance Scheme (NDIS) funds eligible participants to access equipment and support services—including occupational therapy and assistive technology.
OT Support in NDIS Wheelchair Funding Includes:
- Assessments and reports outlining functional need and impact.
- Linking wheelchair features to NDIS goals (e.g., community access, employment, self-care).
- AT applications and quote gathering for low, mid, and high-cost items.
- Capacity building supports, such as OT sessions to develop skills in using the new chair.
This ensures participants are not only receiving appropriate equipment but are also supported in learning how to use it and apply it to meaningful daily activities.
Conclusion: More Than a Chair—A Foundation for Living
For someone who doesn’t use a wheelchair, it might just seem like a chair with wheels. But for someone who does, it’s much more—it’s a key to independence, participation, and quality of life. Choosing the right wheelchair isn’t just about features or price. It’s about matching the right equipment to the right person, at the right time, in the right environment.
That’s the expertise occupational therapists bring to the table. They look at the whole picture—health, habits, goals, and environments—and help create a solution that enables rather than limits. With their guidance, wheelchair users are more than mobile—they’re empowered.
If you or someone you know is looking to explore wheelchair options or needs help navigating the NDIS process, connect with a qualified occupational therapist. The right wheelchair might just change your life.
Transform Life is a NDIS registered organisation that provide support for you and your family.
Book your consult with an experienced Therapist at Transform Life to explore how OT, PBS and Speech Therapy can support you and your family.
