Short answer: A client with a complex spinal cord injury was discharged from GF Strong Rehabilitation Centre to a rural BC community with only trial equipment. Their occupational therapist completed wheelchair trials and a funding submission, prescribed a custom seating system to protect their skin, coordinated home access changes and connected them with a local adaptive paddling program.
The short version
- Who: a client with a complex spinal cord injury moving from GF Strong to a rural community.
- Focus: long-term wheelchair and seating, pressure injury risk, home access and getting back to outdoor recreation.
- Approach: wheelchair assessment and trials, a funding submission, complex seating analysis, home modifications and adaptive recreation.
- Outcome: a properly prescribed wheelchair and custom seating system, an accessible home and a way back onto the water.
Identifying details have been left out to protect the client's privacy.
Background
The client was preparing for discharge from GF Strong Rehabilitation Centre to a rural community in British Columbia after a complex spinal cord injury.
At discharge, only trial equipment was in place. That left real gaps in long-term mobility, seating and access to home and community.
The injury was complex and specialized rehabilitation is hard to reach in rural BC, so comprehensive occupational therapy (OT) was needed. Creative Therapy Consultants coordinated the wheelchair assessment, equipment funding, home access and return to community life.
Occupational therapy assessment and intervention
1. Wheelchair assessment and funding
The trial equipment from discharge did not meet the client's ongoing functional and medical needs. The OT completed a full wheelchair assessment and equipment trials to find the right long-term set-up.
The OT then prepared a detailed funding submission setting out the clinical reasons for the recommended configuration: functional needs, mobility, postural support and long-term rehabilitation goals. This closed the gap between hospital discharge equipment and a properly prescribed mobility system.
2. Complex seating and pressure injury risk
The injury and loss of sensation put the client at higher risk of pressure injuries. The OT completed a complex seating analysis that looked at:
- Postural alignment and pelvic position.
- Pressure distribution.
- Risk of skin breakdown and pressure injuries.
- Trunk stability and functional positioning.
- Comfort and tolerance for long periods in the chair.
- Mobility needs and the demands of daily activities.
Based on the assessment, the OT recommended and arranged a high-end custom seating system, including a pressure-redistributing cushion and a supportive backrest, set up for the client's posture, skin protection and goals.
This mattered because a pressure injury after spinal cord injury can mean further medical complications, time in hospital and a halt to rehabilitation.
3. Home access
The OT identified and coordinated the home modifications needed for the client to get in and out and move around the home by wheelchair, looking at the property, the entry and the practical demands of wheelchair use indoors. These changes were essential to making community living sustainable.
4. Community and adaptive recreation
Outdoor recreation mattered to the client. The OT helped find and set up a local adaptive paddling opportunity so the client could get back to the outdoors and take part in their rural community.
Rehabilitation is about more than mobility and personal care. It also means supporting identity, recreation, social connection and quality of life.
Outcome
- Wheelchair trials completed and a detailed funding submission made.
- A specialized wheelchair seating configuration identified and provided.
- A custom pressure-redistributing cushion and supportive backrest to manage positioning and skin risk.
- Better home access through coordinated modifications.
- A connection to local adaptive paddling.
- More independent mobility and more involvement in rural community life.
The work closed the gap between hospital discharge and long-term community rehabilitation, moving the client past basic equipment toward independence and meaningful participation.
What the evidence says
- Michael, Sytsma and Cowan (2020) note that wheelchair base and seating choices should be based on each person's medical needs, physical abilities, preferences, home and community environment and access to transportation, not on injury level alone [1].
- The Canadian Best Practice Guidelines for pressure ulcers in spinal cord injury identify individualized seating, pressure redistribution, postural support and regular reassessment as core parts of pressure injury prevention. No single cushion suits everyone [2].
Together, this supports thorough wheelchair assessment and individualized seating, particularly for people with complex injuries and higher skin risk.
Why this case matters
Moving from a tertiary rehab centre to a rural community is a high-risk point for people with complex spinal cord injuries. Getting it right takes detailed wheelchair prescription, seating analysis, pressure injury prevention, an accessible home and a way back into the activities that matter.
Creative Therapy Consultants helps bridge the gap between hospital rehabilitation and community living, wherever clients live in BC. See complex seating and wheelchair prescription and occupational therapy, or make a referral.
References
- Michael E, Sytsma T, Cowan RE. A primary care provider's guide to wheelchair prescription for persons with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2020;26(2):100-107. Read the article
- Houghton PE, Campbell KE, CPG Panel. Canadian Best Practice Guidelines for the Prevention and Management of Pressure Ulcers in People with Spinal Cord Injury: A Resource Handbook for Clinicians. Ontario Neurotrauma Foundation; 2013. Read the guidelines
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