Assistive technology, wheelchairs and home modification

In short

Assistive technology (AT) is any device, equipment, software or service that lets a person perform an activity they could not otherwise do, or do it more safely and independently; home modification changes the physical environment instead of the person. In occupational therapy both are environmental interventions — the compensatory end of the practice spectrum, used when remediation of impairment has plateaued or when the demand is permanent (spinal cord injury, stroke, cerebral palsy, arthritis, amputation, ageing). The occupational therapist is the professional who matches person, occupation and environment: measuring the client, prescribing the wheelchair and seating, specifying ramp slope and grab-bar heights, and training the user and family. It is examined in BOT papers on the OT process, in rehabilitation technology and community-based rehabilitation papers, and in viva where measurement figures and slope ratios are asked directly. In India it is practised against the RPwD Act 2016, the Harmonised Guidelines for Barrier-Free Built Environment (2021), NBC 2016 Part 3 (the general building requirements that carry the barrier-free provisions), and the ADIP scheme through ALIMCO and DDRC centres.

Explained

What assistive technology is, and how it is classified

• Definitions: *assistive product* — any product whose primary purpose is to maintain or improve functioning and independence (WHO). *Assistive technology* = assistive products plus the service of assessment, fitting and training. *Rehabilitation technology* is the broader engineering field.
• High tech vs low tech: high tech = powered/electronic and usually custom-programmed (power wheelchair, eye-gaze communication device, environmental control unit); low tech = simple, cheap, often fabricable in the department (built-up handle, long-handled sponge, reacher, dycem mat). Prefer the simplest device that works — lower cost, fewer failure modes, no charging.
• Commercial vs custom vs fabricated: off-the-shelf (ALIMCO tricycle), modified commercial (cushion cut to relieve an ischial area), department-fabricated (plastazote hand splint, PVC toilet seat raiser).
• ISO 9999 is the international classification of assistive products by function (personal mobility, communication, housekeeping, environmental improvement, recreation) — the standard framework an exam answer can quote for "classify assistive devices".
• Functional categories to enumerate: mobility (sticks, crutches, walkers, wheelchairs, scooters, prostheses), seating and positioning, self-care/ADL aids, transfers and lifting (sliding board, hoist, trapeze), communication and AAC, computer access, cognition (pill organisers, alarms, labelled drawers), sensory (magnifiers, screen readers, hearing aids, vibrating alerts), environmental control and home automation, vocational and recreational.
• AT service delivery steps (examined as a process): referral → evaluation of person, occupation and context → feature matching → trial of candidate devices → prescription and funding → fabrication/procurement → fitting and adjustment → training of user and carer → outcome measurement → follow-up and reassessment (growth in children, disease progression in neuromuscular disease).
• Models that frame the reasoning: HAAT (Human–Activity–Assistive Technology within Context), MPT (Matching Person and Technology), SETT (Student, Environment, Tasks, Tools — school AT), and PEOP/PEO for environmental fit. Abandonment is the key outcome failure — commonly 30% or more of devices stop being used; causes are no user involvement in choice, poor performance, easy procurement without training, and change in need. Quote the drivers, not an exact percentage.
• Outcome tools: QUEST 2.0 (satisfaction with device and service), PIADS (psychosocial impact), FEW (Functional Evaluation in a Wheelchair), WhOM (Wheelchair Outcome Measure), COPM and FIM for occupational performance.

Mobility aids below the wheelchair

• Walking stick/cane: held in the hand opposite the affected leg; takes roughly 20–25% of body weight. Height = distance from greater trochanter (or ulnar styloid with arm at side) to floor with footwear on, giving 20–30° elbow flexion.
• Quadripod/tripod cane: wider base, more stability, used in hemiplegia; slower gait, needs level ground.
• Crutches: axillary (temporary, non-weight-bearing on one limb; 2–3 finger-breadths — about 5 cm — gap under the axilla; pressure must be taken on the hands, not the axilla, to avoid radial/brachial plexus injury) and elbow/forearm (Lofstrand, long-term use, frees the hand). Gait patterns: four-point, two-point, three-point (non-weight-bearing), swing-to, swing-through.
• Walkers: standard pick-up (most stable, slowest), front-wheeled/two-wheel rollator (smoother, less lifting), four-wheel rollator with hand brakes and seat (for cardio-respiratory limitation, not for poor balance), reciprocal walker, forearm-support walker for painful wrists.
• Rule for all: handgrip at the level of the ulnar styloid / wrist crease with the arm hanging; elbow 20–30° flexed.

Wheelchairs: parts, types and prescription measurements

• Frame types: rigid (lighter, fewer moving parts, efficient propulsion — active users) vs folding cross-brace (easier to transport by car and in Indian housing). Materials: steel (ALIMCO basic, heavy, cheap), aluminium, titanium/composite (very light, costly).
• Types: attendant-propelled transit chair; self-propelled manual; hemiplegic/low-seat chair (seat height lowered to allow foot propulsion); one-arm-drive (both handrims on one side — for hemiplegia with one good arm); tricycle/hand-cycle (common in Indian community mobility); reclining-back chair (for orthostatic intolerance, hip that cannot flex); tilt-in-space (tilts the whole seat-back angle, keeping hip angle — true pressure redistribution and head control); standing wheelchair; sports chair (cambered wheels); powered wheelchair (joystick, head array, sip-and-puff, chin control) with programmable controller.
• Key components: seat, back (sling vs rigid, height to below the inferior angle of the scapula for active users, to mid-scapula/shoulder for supported sitting), armrests (fixed, desk-length, removable/flip-up for lateral transfer), legrests (swing-away, elevating), footplates, castors (small = manoeuvrable indoors; large = better over Indian uneven ground), rear wheels (pneumatic = comfortable, needs inflation; solid = maintenance-free, harsh), handrims (plain, projection knobs for weak grip), anti-tippers, brakes (push-to-lock), camber, axle position.
• Five core measurements — measure the client seated on a firm surface, hips and knees at 90°, then apply the allowance:
  • Seat width = widest point across the hips/thighs + 2.5 cm (1 inch) on each side, i.e. +5 cm total. Too narrow → pressure over the greater trochanters; too wide → wide push angle, shoulder strain, cannot pass doorways, trunk slumps sideways.
  • Seat depth = posterior buttock to popliteal fossa minus 5 cm (2 inches), so 2–3 finger-breadths clear behind the knee. Too deep → popliteal pressure, sacral sitting; too shallow → thigh unsupported, high ischial pressure.
  • Seat height / footrest clearance = popliteal fossa to heel + 5 cm cushion/clearance, with at least 5 cm of ground clearance under the footplate. Thighs should rest level — weight shared along the thigh, not concentrated on the ischial tuberosities.
  • Back height = seat surface to the required support level: for an independent propeller, to just below the inferior angle of the scapula (classically, seat surface to the axilla minus about 10 cm) so the scapulae move freely.
  • Armrest height = seat surface to the olecranon with the elbow flexed 90° + about 2.5 cm. Too high → shoulder elevation; too low → trunk leaning and kyphosis.
• Fit checks after delivery: two fingers under the thigh at the front edge; hand flat between hip and side-guard; elbow 100–120° flexed with the hand on the handrim at top-dead-centre (the efficient propulsion position); no sacral sitting; brakes reachable; the user can self-relieve pressure.
• Cushions and pressure management: foam (cheap, bottoms out in 6–12 months), gel (good redistribution, heavy, temperature-sensitive), air/cell-based (best redistribution, needs checking of inflation, puncture risk), honeycomb, alternating-pressure powered, contoured/custom-moulded for fixed deformity. Pressure-relief schedule: weight shift every 15–30 minutes (push-up, forward lean, side lean) for 1–2 minutes, or tilt the chair back 30° or more for 1–2 minutes; skin inspection twice daily. Pressure injury risk is highest over ischial tuberosities, sacrum, coccyx, greater trochanter, heels and scapula. Climate note: in hot, humid Indian conditions moisture and maceration add to the risk — breathable covers and air cushions over sealed gel are usually preferred.
• Seating and positioning principles: stabilise proximal to allow distal function; seat the pelvis first (neutral pelvic tilt, level, no obliquity/rotation) then the trunk, then head, then limbs; 90-90-90 baseline (hips, knees, ankles) and deviate deliberately; pelvic belt at 45° to the seat across the anterior superior iliac spines, not across the abdomen; lateral trunk supports in three-point pressure for scoliosis; solid seat insert to correct hammocking of a sling seat.
• Wheelchair skills to train (and examine): propulsion on level and slope, turning in confined spaces, castor pop/wheelie, kerbs, ramps, braking, transfers (stand-pivot, lateral/sliding board, dependent and hoist), folding into a car, wheel and tyre maintenance, puncture repair. WSTP/Wheelchair Skills Test is the standard framework.
• Mobility for children: prescribe early — self-initiated mobility supports cognitive, spatial and social development; build in growth (adjustable width/depth kits) and reassess every 6–12 months.

Home modification and barrier-free design

• Process: referral → interview on routines, roles and priorities → home visit with measurements and photographs (doorway clear widths, thresholds, corridor width, turning spaces, toilet and bath layout, kitchen counter height, light levels, floor surfaces, electrical switch positions) → list barriers against the client's actual occupations → prioritise with the family → recommend the minimum effective change (behaviour change, equipment, minor modification, major structural work) → cost and source → implement → train and verify in use → follow up.
• Hierarchy of solutions, cheapest first: change the method (bathe seated, sleep on the ground floor) → add equipment (shower chair, raised toilet seat) → minor modification (grab bars, threshold ramp, re-hang a door to open outward) → major modification (widen a door, rebuild the bathroom, install a ramp or lift).
• Key dimensions used in Indian practice (Harmonised Guidelines 2021 / NBC 2016):
  • Ramp slope 1:12 maximum for new construction (1:15 or 1:20 preferred for long ramps and for self-propelling users); minimum clear width 1,200 mm; landings of 1,500 × 1,500 mm at top, bottom and every direction change; a maximum rise of about 750 mm per flight before a landing; handrails on both sides at about 760–900 mm with a 300 mm extension beyond the ramp; kerb/edge protection and a non-slip surface.
  • Doorway clear opening 900 mm (absolute minimum 800 mm for internal doors); corridor 1,200 mm; wheelchair turning circle 1,500 mm diameter (1,500 × 1,500 mm clear space).
  • Accessible toilet: clear floor 1,500 × 1,750 mm or more, WC seat 450–480 mm high, grab bars at 750–850 mm, outward-opening or sliding door, wash basin rim about 800 mm with knee clearance, lever taps, flush and call-bell within reach.
  • Reach ranges: comfortable forward reach 400–1,200 mm above floor; switches and controls at 900–1,200 mm; sockets not below 400 mm.
  • Tactile warning blocks, braille signage, audible-visual lift announcements, lift car 1,100 × 1,400 mm with controls at 900–1,200 mm, accessible parking 3,600 mm wide — the access-audit checklist items.
  • Figures follow the Harmonised Guidelines and Standards for Universal Accessibility in India, 2021 (which superseded the 2016 Harmonised Guidelines). Where an exact dimension differs between a State building bye-law and the Guidelines, quote the Guidelines and note that local bye-laws apply.
• Bathroom and kitchen specifics: grab bars — horizontal for pulling along, vertical for standing up, diagonal for a sit-to-stand arc; never use a towel rail or soap dish as a support; fix into masonry, not tile alone. Non-slip flooring, a shower seat and hand shower rather than a bucket on the floor, a long-handled hand shower, a lever mixer tap set to limit hot water. In a kitchen: counter 750–850 mm with knee clearance for a seated user, pull-out shelves, items in the 400–1,200 mm band, induction/auto-cut-off appliances, task lighting.
• Fall-prevention modifications for older adults: remove loose mats and door thresholds, light the route to the toilet (night lights), handrails on both sides of stairs with contrasting nosing, raise the bed to 450–500 mm, declutter walkways, treat wet bathroom floors, correct footwear.
• Universal design (Ronald Mace) — seven principles: equitable use; flexibility in use; simple and intuitive use; perceptible information; tolerance for error; low physical effort; size and space for approach and use. Universal design designs for everyone from the start; accessible design meets a code; adaptive design modifies afterwards for one person.
• Indian housing realities to address in an exam answer: squat toilets (commode conversion seat or a raised frame over the pan), high thresholds in older houses, narrow 700–750 mm internal doors, steep stairs with no handrail, courtyard-level changes, rented accommodation where structural change is not permitted (use removable ramps, clamp-on rails, free-standing frames), and monsoon-wet surfaces.

Law, schemes, standards and funding in India

• Rights of Persons with Disabilities Act, 2016 (with the RPwD Rules, 2017) — recognises 21 specified disabilities, defines reasonable accommodation and barrier-free access, requires accessibility of public buildings, transport and ICT, mandates provision of aids and appliances, and sets up Commissioners at Centre and State. Non-provision of accessibility is actionable.
• Accessible India Campaign (Sugamya Bharat Abhiyan) — the access-audit and retrofitting programme for government buildings, transport and websites; also Sugamya Bharat app for reporting barriers.
• ADIP scheme (Assistance to Disabled Persons for Purchase/Fitting of Aids and Appliances) — Government of India subsidy for assistive devices through ALIMCO, DDRCs, National Institutes and implementing agencies; full or partial assistance by income slab, with a UDID card and a disability certificate as the usual documents. Slabs and ceiling amounts are revised periodically — state that eligibility is income-linked rather than quoting a figure that may have changed.
• ALIMCO (Artificial Limbs Manufacturing Corporation of India, Kanpur) manufactures wheelchairs, tricycles, crutches, prostheses and orthoses at low cost; DDRC (District Disability Rehabilitation Centres) and CRCs/National Institutes (NIEPMD, NILD Kolkata, NIEPVD, SVNIRTAR, IPH/AYJNISHD) assess and distribute them.
• UDID (Unique Disability ID) card — the single identity document for scheme access; benchmark disability is 40% or more for most entitlements.
• Standards and codes: Harmonised Guidelines and Standards for Universal Accessibility in India, 2021; National Building Code of India 2016, which contains the requirements for accessibility of the built environment; ISO 9999 (classification of assistive products) and the ISO 7176 series (wheelchair testing and dimensions) are the device standards referred to in prescription. BIS has Indian Standards on wheelchairs and on barrier-free built environment; quote the subject rather than a number unless the current IS number is verified, as several have been revised or withdrawn.
• Professional regulation: occupational therapy in India is regulated under the National Commission for Allied and Healthcare Professions Act, 2021, which replaced the earlier voluntary AIOTA-registration-only position; AIOTA remains the professional association and WFOT the world body. OT prescription of wheelchairs and home modification sits squarely within the scope listed for the profession.
• Other funding routes: CSR and NGO programmes, insurance/ESIC and employees' compensation routes for work injury, State disability welfare boards, Ayushman Bharat for admitted rehabilitation care (device cover is limited), and employer reasonable-accommodation obligations under the RPwD Act.

Communication, computer access and environmental control

• AAC: unaided (gesture, sign, eye pointing) and aided — low tech (communication board, alphabet board, PECS, E-tran frame) to high tech (speech-generating device, tablet app with symbol grid, eye-gaze, switch scanning). Access methods: direct selection (fastest, needs control), scanning (one or two switches; row-column scanning), encoding, head pointer, mouth stick.
• Switch selection is the core OT skill: find a reliable, repeatable, fatigue-free movement site (finger, head, cheek, foot, eyebrow, breath) and match switch type (mechanical, proximity, sip-and-puff, EMG) and mounting.
• Computer access: keyguard, expanded or mini keyboard, sticky keys and filter keys, on-screen keyboard, word prediction, speech recognition, trackball/joystick/head mouse, screen reader (NVDA, JAWS, TalkBack) and magnification, switch-adapted mouse. Indian-language screen-reader and text-to-speech support is improving but uneven — confirm language support before prescribing.
• Environmental control units (ECU)/smart home: control lights, fan, TV, door, bed and phone from one interface (switch, voice, phone app); low-cost smart plugs and voice assistants have largely replaced dedicated ECUs for domestic use. Essential for high cervical SCI and advanced neuromuscular disease.

Key points

• Assistive technology - products plus the service of assessment, fitting and training; compensatory, not remedial.
• Prescribe the simplest device that achieves the goal - cheaper, more reliable, more likely to be used.
• Abandonment - the chief failure of AT; prevented by involving the user in selection, trialling, training and follow-up.
• HAAT / MPT / SETT - feature-matching models; the device is chosen for the activity and context, not in isolation.
• Seat width - widest hip measurement + 5 cm total (2.5 cm each side).
• Seat depth - buttock to popliteal fossa − 5 cm, leaving two finger-breadths behind the knee.
• Seat height - popliteal to heel + 5 cm, with ≥5 cm footplate ground clearance.
• Armrest height - seat to flexed olecranon + 2.5 cm; back height to below the inferior scapular angle for a self-propeller.
• Elbow 100-120° flexion with the hand at the top of the handrim is the correct propulsion fit.
• Pressure relief - weight shift every 15-30 min for 1-2 min; tilt-in-space redistributes load without opening the hip angle, recline does not relieve shear as well.
• Cane in the opposite hand; axillary crutch leaves 5 cm (2-3 finger-breadths) under the axilla, with weight on the hands.
• Handgrip height for all walking aids = ulnar styloid level, elbow 20-30° flexed.
• Ramp 1:12 maximum, clear width 1,200 mm, 1,500 × 1,500 mm landings, handrails both sides - Harmonised Guidelines 2021 / NBC 2016.
• 900 mm clear door opening, 1,500 mm turning circle, WC seat 450-480 mm, grab bar 750-850 mm, controls 900-1,200 mm.
• Universal design - seven principles, designed for all from the outset; accessible design meets a code; adaptation retrofits for one person.
• RPwD Act 2016 - reasonable accommodation, barrier-free access, 21 disabilities, 40% benchmark, UDID card.
• ADIP through ALIMCO and DDRCs - income-linked subsidy for aids and appliances; Accessible India Campaign drives retrofitting.
• Home modification hierarchy - change the method, then the equipment, then minor works, then structural work.
• Outcome measures - QUEST 2.0, PIADS, WhOM, FEW, COPM; always reassess after fitting, and for children as they grow.

Formulas and examples

Example 1 — wheelchair prescription from raw measurements. A man with T6 paraplegia measures: widest hip width 40 cm, buttock-to-popliteal 46 cm, popliteal-to-heel 44 cm, seat-to-olecranon 22 cm, seat-to-inferior scapular angle 42 cm.

• Seat width = 40 + 5 = 45 cm
• Seat depth = 46 − 5 = 41 cm
• Seat height (with a 5 cm cushion) = 44 + 5 = 49 cm to the seat rail, footplate set so there is at least 5 cm clearance
• Armrest height = 22 + 2.5 = 24.5 cm above the compressed cushion
• Back height = 42 cm (just below the inferior angle of the scapula, so the scapulae are free to propel)

Prescription: lightweight rigid frame, removable/flip-up desk armrests for lateral transfers, air-cell cushion, axle set forward for efficient push, anti-tippers for ramp training.

Example 2 — ramp length and the force to climb it. A house entrance has three steps, each 150 mm high, so rise = 450 mm = 0.45 m.

• At the maximum permitted 1:12: run = 0.45 × 12 = 5.4 m, plus 1,500 mm landings top and bottom → about 8.4 m of total length needed. Slope angle = arctan(1/12) = 4.76°; grade = 8.3%.
• At the gentler 1:20: run = 0.45 × 20 = 9.0 m (angle 2.86°). If the available front yard is only 6 m, 1:20 will not fit; use 1:12 with a switchback and a 1,500 × 1,500 mm intermediate landing.
• Push force for a 75 kg user in a 15 kg chair (total 90 kg, W = 90 × 9.81 = 882.9 N) on 1:12: F ≈ 882.9 × sin 4.76° = 882.9 × 0.0830 = 73.3 N (about 7.5 kgf), sustained for 5.4 m — feasible for a trained user with good triceps. On 1:8 (a typical "contractor-built" ramp) F ≈ 882.9 × 0.1240 = 109 N (11.2 kgf) — unsafe, and the descent is uncontrollable.
• Energy to climb 0.45 m = m g h = 90 × 9.81 × 0.45 = 397 J regardless of slope; the slope changes the force and the risk, not the work.

Example 3 — pressure relief arithmetic. A 70 kg man sits with roughly 75% of body weight on the seat = 52.5 kg = 515 N. If the loaded contact area is 0.090 m², average interface pressure = 515 ÷ 0.090 = 5,722 Pa ≈ 43 mmHg (1 mmHg = 133.3 Pa). With a contoured cushion increasing contact area to 0.125 m², pressure = 515 ÷ 0.125 = 4,120 Pa ≈ 31 mmHg — a 28% reduction, now below the commonly quoted capillary-closing range of about 32 mmHg. Peak pressure over the ischial tuberosities is far higher than the average, which is why schedule and mapping matter more than an average figure.

Example 4 — ADL aids for rheumatoid arthritis, reasoning stated. A 54-year-old homemaker with RA, grip strength 6 kg, painful MCP joints, cannot turn taps or open jars, squat toilet at home.

• Joint protection logic: increase lever arm and handle diameter, avoid tight pinch and ulnar deviation.
• Prescribe: lever tap adaptors, jar opener, enlarged-grip cutlery (built-up foam), kettle tipper, long-handled reacher, trolley to avoid carrying.
• Home modification: commode conversion seat over the squat pan plus a vertical grab bar at 750–850 mm, raised bed to 450 mm, non-slip bathroom floor, lever door handles replacing knobs.
• Order of intervention: method → equipment → minor modification; the bathroom is rebuilt only if the conversion seat fails.

Example 5 — comparison of cushions

Where it is used

• Rehabilitation hospitals and SCI/neuro units (AIIMS, CMC Vellore, NIMHANS, ISIC New Delhi, SVNIRTAR Cuttack, PGIMER): wheelchair and seating clinics, pressure-ulcer prevention programmes, pre-discharge home visits.
• ALIMCO, DDRCs, CRCs and National Institutes: assessment, prescription and distribution camps under ADIP; the OT signs the prescription that fixes the size and cushion.
• Assistive device industry and startups: Ottobock India, Vissco, Karma Healthcare, Callidai, Neomotion/NeoFly-NeoBolt (Chennai; IIT Madras TTK Centre), BeAble Health, Ratna Nidhi and NGO device programmes — roles in product design, clinical trials, fitting and after-sales training.
• Access audits and built-environment consultancy under the Accessible India Campaign and RPwD Act — OTs work with architects on Harmonised Guidelines compliance for metro stations, airports, campuses and hospitals.
• Geriatric care, home health and palliative care (Kerala's community palliative network, corporate home-health providers): fall-prevention home modification, bed and bathroom equipment, carer training.
• Schools and special education, and vocational rehabilitation: AAC and computer access for students under RPwD/inclusive-education provisions; workstation adaptation and reasonable accommodation in IT and BPO employers.

Interview questions

• Q: How do you measure wheelchair seat width and what happens if it is wrong? A: Widest hip or thigh width plus 2.5 cm on each side; too narrow causes trochanteric pressure sores, too wide causes shoulder strain from a wide push, poor posture and difficulty through doorways.
• Q: Why subtract 5 cm from the buttock-to-popliteal measurement for seat depth? A: To leave two to three finger-breadths behind the knee, avoiding popliteal pressure on the nerves and vessels and preventing the user from sliding into a sacral sitting posture.
• Q: What is the maximum ramp slope for a wheelchair in India, and what else does a ramp need? A: 1:12, with gentler slopes preferred; it needs at least 1,200 mm clear width, 1,500 × 1,500 mm landings top, bottom and at turns, handrails on both sides at about 760–900 mm, edge protection and a non-slip surface.
• Q: Difference between tilt-in-space and recline? A: Tilt rotates the whole seat-back unit while keeping the hip angle, giving genuine pressure redistribution with less shear; recline opens the hip angle, which can increase shear and trigger extensor tone, though it helps catheter care and orthostatic tolerance.
• Q: A T4 paraplegic has a healing ischial ulcer. What do you change? A: Reassess the sitting surface — air-cell or custom cushion, pressure mapping if available, correct seat depth and height, enforce a 15–30 minute weight-shift schedule, consider tilt, and address moisture, nutrition and transfer technique that shears the skin.
• Q: Which hand holds the cane in left hemiplegia and why? A: The right hand — the cane goes opposite the affected limb to widen the base and reproduce reciprocal arm-leg movement, and it unloads the affected side.
• Q: Why is weight on the axilla wrong with axillary crutches? A: It compresses the brachial plexus and axillary vessels, causing nerve palsy and numbness; the 5 cm gap ensures weight is taken through the hands with the elbows 20–30° flexed.
• Q: What is device abandonment and how do you prevent it? A: The user stops using a prescribed device; prevented by involving the user in goal setting and selection, trialling before purchase, correct fit, training the user and family, and scheduled follow-up.
• Q: Name the model you use to reason about an AT prescription. A: HAAT — the human, the activity and the assistive technology interacting within a context; a device that fits the person but not the context (no power, narrow doors, no service support) will fail.
• Q: A family cannot afford a prescribed wheelchair. What do you do? A: Route them through the ADIP scheme via a DDRC/ALIMCO camp with a disability certificate and UDID card, use the income-linked subsidy, and meanwhile provide an interim low-cost or NGO-donated chair correctly sized rather than an ill-fitting free one.
• Q: Client lives in a rented flat with a squat toilet and a 750 mm door. What can you do without construction? A: Fit a commode conversion seat or free-standing commode frame with a clamp-on or masonry-fixed grab bar, use a narrow-wheelbase or removable-armrest chair and a transfer board, a threshold wedge, and rehearse the transfer route; discuss a removable ramp with the landlord.
• Q: What outcome measure would you use after issuing a wheelchair? A: QUEST 2.0 for satisfaction with device and service, WhOM or COPM for the client's own participation goals, and a skills check with the Wheelchair Skills Test.

Common mistakes

• Adding allowances the wrong way round — adding 5 cm to seat depth or subtracting from seat width — which produces exactly the pressure problems the formula exists to prevent.
• Measuring the person standing, or over thick clothing, or without the actual cushion in place, so the finished chair sits too high and the feet dangle.
• Treating a prescription as a one-off: not reassessing after a change in weight, tone, deformity or, in children, growth.
• Quoting "1:12" as desirable rather than as the maximum, and forgetting the landings, handrails and 1,200 mm width that make a ramp usable.
• Recommending expensive high-tech devices without trial, training, local service support or a funding route — the classic cause of abandonment.
• Confusing the roles: a ramp or grab bar is a modification, a reacher is a device, bathing seated is a changed method; exam answers must place the solution in the right level of the hierarchy.
• Prescribing a device without an occupation-based goal, or omitting carer training and a follow-up date from the plan.
• Stating subsidy amounts, IS numbers or scheme ceilings from memory when they are revised periodically — name the provision and say the figure is revised.

Related topics

Occupational therapy assessment and activity analysis · Activities of daily living and therapeutic activities · Orthotics and prosthetics · Spinal cord injury rehabilitation · Community-based rehabilitation and disability law in India · Ergonomics and work-site assessment