I have been working as clinical faculty for University of Southern California and as a rehabilitation specialist in China for over 6 years.

It is typical for patients to receive donated DMEs, especially wheelchairs, in the rehabilitation setting following an injury. The government health insurance does not provide most DMEs in most hospital settings, so hospitals try to keep a number of them available for reuse. However, these DMEs are usually considered for temporary use only. Maybe the patient just needs to get from their room to a treatment room using a wheelchair, or maybe they need to use a shoulder brace for 10 days because of their shoulder pain. Or maybe a rehabilitation specialist needs to use a hemi-walker or quad-cane in the hospital to initially start walking with a patient after stroke.

The goal for most of these patients is that the patient will not need this DMEs permanently. They might use it for a week or a month or until they discharge from the hospital. The goal is that they become more mobile and more independent. 

I have worked with at least 20 patients over the last 3 years in Shanghai First Rehabilitation Hospital that have not had the opportunity to achieve independence in mobility because they were not able to use any DME, or they borrowed the incorrect DME. We worked with them and progressed their mobility in the best ways that we could, but they ultimately were discharged without the ability to achieve the reasonable goals that were given to them by their rehabilitation specialists.

I am working with one patient right now, about 55 years old, who suffered a spinal cord injury several months ago. He is very intelligent, always has the daily newspaper to read while doing the standing table. For a small period of time, he was motivated to work on transferring from lying on the bed to sitting and moving from sitting on the bed to a wheelchair. This patient will likely never walk, so will need to be able to do this transfer from sitting to a wheelchair the rest of his life. The wheelchair that was donated to him does not have removal arm rests. Therefore, attempting to pick up his entire body with his arms and move it from his bed to a wheelchair is almost impossible. We tried borrowing another patient’s wheelchair for a period of time, but the patient became unmotivated when he could not practice on his own (outside of the 10 minutes the therapist practiced with the borrowed wheelchair). When I asked the patient about buying a new wheelchair, explaining the permanent need and importance, he told me he could never afford one. 

This is why I started looking into options. I started learning about the policies in Shanghai. I started asking if anyone else was attempting to fill this need. 

The answer was that he would have to wait at least one year after injury to petition to the government for the right kind of wheelchair. In my mind, this would be too late. This patient would have a very different attitude and motivation regarding rehabilitation—and it is much less likely that he would have medical insurance coverage for training and learning to use the correct wheelchair for independent mobility.  

For this kind of patient, something new had to be considered.

Amanda Ferland, PT DPT