by John V. Rider, PhD, OTR/L, MSCS, CEAS and Bradley Boe, BS
Traveling with a spinal cord injury (SCI) can seem overwhelming, especially the first time after injury. This is why addressing travel considerations for wheelchair users with SCI is so important. Even though advocacy efforts have successfully increased access for wheelchair users over the past few decades, there are still barriers and concerns for travelers with SCI that require careful planning. Occupational therapists (OTs) can leverage their unique training in activity analysis and environmental adaptations to help clients with SCI prepare for the challenges they may face when traveling. OTs routinely address leisure exploration and participation, community mobility, and social participation in rehabilitation settings. These skills can also support clients with SCI to travel safely and independently in diverse environments.
Whether traveling for work or leisure, traveling is an important occupation and one that should always be addressed within rehabilitation. The following considerations can help wheelchair users with SCI prepare for their next adventure, whether hitting the open road, flying to a new destination, or booking an exotic cruise. OTs can use these considerations to guide their evaluation and interventions.
By taking a few preventive steps, wheelchair users with SCI can ensure a safe and fun trip. The most important consideration is to plan. OTs can support clients by helping them consider aspects of their destination contexts, such as environmental and personal factors, that may support or inhibit safe travel and participation in desired occupations. The following suggestions can be used as a guide to support wheelchair users with SCI as they prepare to travel.
Individuals should always check with their doctor about the effects travel may have on their health and obtain medical clearance before traveling. They should also tell their physician about their chosen mode of transportation, where they plan to travel, and any planned activities. To be safe, they may want to consider asking whether there are any SCI specialists in the region where they are traveling.
Filling prescription medications while traveling is often challenging. It is important to have enough medications to last a few extra days than the planned trip in case of delay. It may also be beneficial to talk to their physician about having an extra prescription on hand for emergencies. Ensure the individual has a list of all their medications and physician’s contact information in case of emergency.
The same advice applies to urological and bowel management supplies. Ensure they have enough supplies for unplanned delays and areas where they can’t purchase these supplies. Plan time and accommodations for established voiding schedules to prevent bladder or bowel irritations. If they are prone to urinary tract infections (UTIs), consider asking about a prescription for antibiotics and consult with their physician on the best ways to avoid UTIs based on where they are traveling.
Autonomic dysreflexia is a life-threatening complication associated with spinal cord injuries. In short, autonomic dysreflexia is an involuntary and abnormal reflex of the autonomic nervous system. The abnormal response is due to a problem in the body below the level of spinal cord injury and causes a potentially dangerous increase in blood pressure. Understanding autonomic dysreflexia, how to prevent it, and how to treat it is crucial for anyone with a spinal cord injury, as well as their family, friends, and caregivers.
If a client has a neurologic level of SCI at or above the sixth thoracic vertebra level, they are at risk for autonomic dysreflexia. They should ensure that anyone traveling with them, including themselves, knows how to avoid common causes, recognize symptoms, and what to do if autonomic dysreflexia is suspected. Providing education and resources on this topic is an excellent way for OTs to address health literacy. Consider creating an emergency card describing autonomic dysreflexia to educate emergency departments, medical personnel, or anyone unfamiliar with the condition that may need to assist in an emergency. Include the level of injury, normal resting blood pressure, and information on recognizing and treating autonomic dysreflexia.
Wheelchair users should research their destination for the services they utilize at home and any they may need in an emergency. They should not rely on advertised accommodations. Contact potential destinations and services and ask specific questions about their needs. Don’t assume that a “handicapped” hotel room will be fully accessible. It is often necessary to get everything in writing. If they contact hotels, car services, airlines, etc, to discuss accommodations, have them send an email with the agreed-upon services and items for the trip.
Consider researching where the nearest hospital, medical supply vendor, pharmacist, and wheelchair repair shop are located and whether the client’s insurance will be accepted. Accessibility guides, chambers of commerce, departments of tourism, centers for independent living, and internet travel websites are all resources that may have information about the accessibility of the destination. Consider using a disability-specialized travel agency, especially if the client will be visiting a new or unfamiliar destination.
Clients should pack all medications, personal supplies, extra tubes, chargers, wheelchair tools, and other medical equipment in their carry-on luggage in case their checked luggage is lost or delayed. Medical equipment typically flies free. Consider specific needs for showering and toileting and whether they will need to bring a shower/commode chair if the hotel does not provide one.
It’s also important to plan for extreme temperature changes when packing. Severe cold or heat below the level of injury can cause autonomic dysreflexia. If the client plans to be outside, they should be prepared to cover their body below the level of injury for protection from extreme temperatures. Regardless of the temperature, gloves can be very beneficial if using a manual wheelchair as streets and sidewalks may be dirty or tough on the hands. Also consider having them bring their accessible parking placard to use with rental vehicles.
When making hotel reservations, clients should inform the agent that they are a wheelchair user and what their needs are regarding any reasonable accommodations, especially regarding the bathroom. If possible, have them call ahead and ask specific questions about available rooms and services.
Consider if they need a roll-in shower, shower chair, grab bars in the shower, or a lower toilet seat height. Plans may need to be made to modify transfer techniques based on what the hotel offers. OTs can work with clients to ensure they can transfer at different heights, from both sides, and in different bathroom setups safely.
Airlines and other transportation companies may provide accommodations at no extra charge with advanced notice. Individuals should contact the airline and be prepared to tell the agent what kind of wheelchair they will be traveling with, where they prefer to sit, and if they will need help getting on and off the plane with an aisle chair. Whenever possible, they should try to book direct flights to avoid hurried layovers and loss of medical equipment, and also request bulkhead (front row) seating for ease of transfers and additional room to perform pressure relief. If they cannot book a direct flight, allow at least 1.5 hours between flights, and consider requesting a “Meet and Assist,” which will notify the airline personnel to have an employee ready to assist them in getting to their connecting flight. To prevent damage if they are traveling with a power wheelchair, search online or contact the manufacturer for a travel checklist of tasks to complete before stowing the wheelchair.
Many rental car companies provide a variety of adaptive driving devices when requested in a timely manner. These include hand controls, left foot accelerators, spinner knobs, and pedal extenders. It is still rare that rental car companies offer lift-equipped vehicles, but it doesn’t hurt to ask. Research specialty companies if a lift or a ramp-equipped vehicle is needed.
Airport Arrival, Boarding, and Flight Considerations
Wheelchair users should arrive at the airport at least an hour earlier than recommended. To avoid pressure sores and maintain independence, they should not check their wheelchair with their regular luggage. Instead, inform the airline that they would like to gate tag their wheelchair. Doing so will allow them to sit in their wheelchair up until they need to hand it over at the gate. Consider taking pictures of their wheelchair as proof of its good condition in case of damage during the flight. Remember that they will be in the preboarding group and plan their bladder and bowel voiding schedule accordingly.
To avoid autonomic dysreflexia, individuals should tell the airline workers how they should be transferred. They can consider using their wheelchair cushion on the airplane seat and should check sources of discomfort after getting situated on the plane (eg, check clothing, catheter, seatbelt, positioning of legs, armrests, etc, to prevent autonomic dysreflexia or tissue damage). Most aisle seats will have removable armrests, allowing lateral transfers from chair to chair. If the individual has limited trunk mobility, consider using additional straps in the aisle chair and the airline seat.
Consider stowing their wheelchair in the aircraft cabin to avoid damage whenever possible. If their wheelchair must be stored in the cargo hold, remove cupholders, arm canes, side guards, backrests, and other easily detachable parts and store them in the overhead compartment. If they are traveling alone, be sure to have their emergency card ready and provide one to airline staff.
It is important that individuals know their rights when traveling. Refer clients to the US Department of Transportation’s Aviation Consumer Protection and the Air Carrier Act for more information. Flight attendants are not required to help with any personal needs (ie, feeding, medication management, catheterization, etc.). However, they can assist with retrieving equipment from the overhead bin and hang a privacy curtain if the bathroom is not accessible.
To prepare for deplaning, the client should have the flight attendant radio ahead to ensure that their wheelchair is brought to the jetway. Wheelchair users are typically the last to depart the aircraft. When the client’s wheelchair is brought to them, they should immediately inspect it for any damage. If there is damage, they need to insist on speaking with a complaint resolution official prior to leaving the airport.
Many wheelchair users with SCI have enjoyed traveling and have had positive experiences with airlines, rental agencies, hotels, and destination attractions. Many individuals share their good and bad travel experiences and offer additional tips and tricks online. Encourage individuals to use their peer support system and talk to other individuals with SCIs about their travel experiences. Utilize online resources and see what other people say about accessibility at potential destinations.
There are a few apps for wheelchair users that may be beneficial. For example, iAccess Life is a platform for users with disabilities and wheelchair users to share experiences at establishments around the world and comment on locations that can accommodate wheelchair users and are accessible. Wheelmap is another app designed to find wheelchair-accessible places and rate them across the globe. Google Maps has a feature called Accessible Places, which makes wheelchair accessibility information more prominently displayed and indicate accessible entrances, seating, restrooms, and parking. Lastly, Uber now has a feature called WAVs (wheelchair-accessible vehicles) to serve wheelchair users better. UberWAV drives are also certified to help wheelchair-bound passengers. Hopefully, this list continues to grow, and OTs can assist clients in exploring technology and services to support them locally and when traveling around the globe.
John V. Rider, PhD, OTR/L, MSCS, CEAS, is an occupational therapist and associate professor at Touro University Nevada. He works as a community-based therapist, serves on the board of directors for the High Rollers Adaptive Sports Foundation, and volunteers with his local quad rugby team.
Bradley Boe, BS, is the president of the High Rollers Adaptive Sports Foundation and a quad rugby player who has extensive travel experience as a C4/5 quadriplegic.
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