By John V. Rider PhD, OTR/L MSCS, CEAS, and Bradley Boe, BS
It can be overwhelming to travel with a spinal injury (SCI), especially for the first time. It is important to address travel considerations when dealing with wheelchair users who have SCI. Even though wheelchair users have had greater access to public transportation in the last few decades due to advocacy efforts, travelers with SCI still face obstacles and need careful planning. Occupational therapists can use their unique training in environmental adaptations and activity analysis to prepare clients with SCI for travel challenges. In rehabilitation settings, OTs address social inclusion, community mobility and leisure participation. These skills will also help clients with SCI travel independently and safely in a variety of environments.
Traveling is a very important activity, whether it’s for business or pleasure. It should be included in rehabilitation. Considerations can help wheelchair users who have SCI prepare for their new adventure, whether they are traveling on the road, taking a flight to a different destination or booking a cruise. These considerations can be used by OTs to guide their assessment and interventions.
Wheelchair users with SCI who take a few precautions can have a fun and safe trip. Plan ahead. OTs support their clients by assisting them to consider factors of the destination context, such as personal and environmental factors that could support or hinder safe travel and participation in desired professions. As a guide, the following suggestions are intended to help wheelchair users with SCI prepare for travel.
Before traveling, individuals should consult their doctors to determine the possible effects of travel on their health. Tell your doctor about the mode of transport you plan to use, where you are going, and what activities you have planned. They may also want to ask if there are any SCI experts in the area where they will be traveling.
It can be difficult to fill prescriptions while on the road. In case of a delay, it is essential to carry enough medication to last for a few days more than the trip planned. Talk to your doctor about keeping an extra prescription for emergencies. In case of an emergency, ensure the person has a complete list of their medications as well as contact information for their physician.
This advice also applies to supplies for bowel and urological management. Be sure to have enough supplies in case of unplanned delays or areas where these supplies are not available. To avoid bladder or bowel irritations, plan time and accommodations to accommodate established voiding routines. Ask your doctor about antibiotics for those who are susceptible to urinary infections. Also, consult their doctor on how to prevent UTIs in the destination they will be visiting.
Autonomic dysreflexia can be a potentially life-threatening condition that is associated with spinal injuries. Autonomic dysreflexia, in short, is an abnormal and involuntary reflex of the autonomic nerve system. This abnormal response occurs when there is a problem below the level where the spinal cord injury occurred. It can cause a dangerous rise in blood pressure. Anyone with a spinal injury and their family members, friends and caregivers must understand autonomic dysreflexia and know how to prevent and treat it.
Autonomic dysreflexia can occur if a client’s SCI is at or above the 6th thoracic level. They should make sure that everyone traveling with them knows what symptoms to look out for, how to avoid the common causes and what to do in case autonomic reflexia is suspected. OTs can promote health literacy by providing education and resources about this topic. Consider creating a card that describes autonomic dysreflexia in order to educate emergency departments and medical personnel or anyone who may be unfamiliar with this condition. Include information about the severity of the injury, resting normal blood pressure and how to recognize and treat autonomic dysfunction.
Users of wheelchairs should check out their destination to see if they can get the same services as they do at home, and if they need any in an emergency. Accommodations advertised should not be relied upon. Ask specific questions to potential destinations and services about your needs. Do not assume that “handicapped hotel rooms” will be fully accessible. You should always get everything in written form. When they make contact with hotels, car service, airlines, etc. to discuss accommodation, ask them to send you an email with all the services and items agreed upon for the trip.
If the client has insurance, you should research the location of the nearest hospital, pharmacy, medical supply store, wheelchair repair shop, etc. There are many resources to help you find out about accessibility. These include chambers of business, tourism departments, independent living centers, internet travel websites, and accessibility guides. Consider using a disability-specialized travel agency, especially if the client will be visiting a new or unfamiliar destination.
In case checked luggage is delayed or lost, clients should make sure to pack all their medications, personal supplies and medical equipment, including extra tubes, wheelchair tools and chargers. Medical equipment is usually free to fly. If you are unsure about the specific requirements for toileting or showering, ask if they need a chair to use if your hotel doesn’t provide one.
When packing, it’s important to consider extreme temperatures changes. Autonomic dysreflexia can be caused by extreme cold or heat below the injury level. The client should cover the body to protect themselves from extreme temperatures if they plan to go outside. Gloves can be useful regardless of temperature if you are using a manual chair as the streets and sidewalks could be dirty or hard on your hands. Consider having them also bring their parking placard for use in rental cars.
Clients should tell the hotel agent when making a reservation that they use a wheelchair and their requirements for reasonable accommodations. This is especially true in regards to the bathroom. Ask them to call ahead of time and ask about the available rooms and services.
Think about if the person needs a roll-in or shower chair, grab bar in the shower or a low toilet seat. Depending on the amenities offered by the hotel, it may be necessary to adapt transfer techniques. OTs will work with their clients to make sure they are able to transfer safely at different heights and from both sides.
If you give advance notice, some airlines and transportation companies will provide free accommodations. Contact the airline in advance and tell them what type of wheelchair you will be using, where you prefer to sit and if an aisle chair will require assistance getting on and off. They should book direct flights whenever possible to avoid having to rush and risk losing medical equipment. Bulkhead seating (front row) is also recommended for easier transfers and more room to relieve pressure. Allow at least 1.5 hours to get to the connecting flight if they can’t book a direct flight. They may also request a “Meet & Assist” which will alert airline staff to send an employee to help them. If you are traveling with a wheelchair powered by electricity, contact the manufacturer or search online for a checklist.
Rental car companies will provide adaptive driving devices if requested quickly. Hand controls, left-foot accelerators, spinning knobs and pedal extenders are some of the adaptive driving devices that rental car companies offer. Although it is rare for rental car companies to offer vehicles with lifts, you can always ask. If a vehicle with a ramp or lift is required, research specialty companies.
Arrival at the Airport, Boarding and Flight Considerations
Wheelchair users are advised to arrive at the airport an hour before recommended. In order to avoid pressure ulcers and to maintain their independence, wheelchair users should not check in their wheelchair with regular luggage. Tell the airline you would rather gate tag your wheelchair. This will allow the wheelchair user to remain in it until they are ready to return it at the gate. Take pictures of the wheelchair to prove its condition, in case it is damaged during flight. Plan their bladder and bowel emptying schedule according to the fact that they are in the preboarding group.
Individuals should inform airline staff how they wish to be moved in order to avoid autonomic reflexia. You can use your wheelchair cushion to sit on the plane seat. After settling in, you should look for any sources of discomfort (e.g., clothing, catheters, seatbelts, leg positioning, armrests etc.) and take steps to avoid autonomic reflexia. The armrests on most aisle seats can be removed, making it possible to transfer from one chair to another. Consider using extra straps on the aisle chair as well as the airline seat if the person has limited trunk movement.
If possible, store the wheelchair in the cabin of the aircraft to prevent damage. If the wheelchair is to be stored in cargo, remove the cupholders and any other parts that can be removed. Store them in the overhead compartment. Be sure they have an emergency card and give it to the airline staff if they are travelling alone.
Travelers should be aware of their rights. For more information, refer clients to the US Department of Transportation Aviation Consumer Protection Act and the Air Carrier Act. Flight attendants do not have to assist with personal needs, such as feeding, medication, catheterization or other medical procedures. They can help retrieve equipment from the overhead compartment and hang a curtain for privacy if there is no access to the bathroom.
The client should radio the flight attendant to make sure that the wheelchair is delivered to the jetway. Wheelchair users tend to be the last passengers to leave the plane. They should inspect the wheelchair immediately upon receiving it. They should insist that they speak to a complaint resolution officer before leaving the airport if there is any damage.
SCI wheelchair users have reported positive experiences when traveling with airlines, hotels, rental agencies and attractions. Online, many people share their positive and negative travel experiences. They also offer tips and tricks. Encourage people to talk to others with SCIs and use their peer support network to discuss their travel experiences. Use online resources to find out what others have said about accessibility in potential destinations.
Some apps may prove useful for wheelchair users. iAccess life, for example, is a platform that allows wheelchair users and users with disabilities to share their experiences in establishments all over the world. They can also comment on accessible locations and places that are able to accommodate wheelchair users. Wheelmap is another app designed to find wheelchair-accessible places and rate them across the globe. Google Maps offers a feature named Accessible places, that makes wheelchair accessibility more prominently visible and indicates accessible entrances and seating, restrooms and parking. Lastly, Uber now has a feature called WAVs (wheelchair-accessible vehicles) to serve wheelchair users better. UberWAV drivers are certified to assist wheelchair-bound passengers. This list will hopefully continue to grow and OTs are able to assist their clients with exploring technologies and services that can support them both locally and while traveling across the globe.
John V. Rider is an associate professor and occupational therapist at Touro University Nevada. He is a community based therapist and serves on the board for the High Rollers Adaptive Sports Foundation.
Bradley Boe is a quad-rugby player and a C4/5 paraplegic with extensive travel experience.
Article Originally Published: https://rehabpub.com/conditions/neurological/spinal-cord-injury/travel-considerations-for-wheelchair-users-with-sci/?utm_term=RM%20Rehab%20Today%20May%202023&utm_campaign_type=newsletter&utm_hsid=415264501&utm_medium=email&_hsmi=260157100&_hsenc=p2ANqtz-9uG8F5iRTgXnQe0tNMZ8TbxmvF4mhKg8h1QMkWuyWH-mbla_liK8C_BrkyhIIhHW84r56vCA2azzO_XFlrFwFn92XdCw&utm_source=newsletter