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Client Centred or Funding Dictated? 

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Over the past couple months, we have been discussing power wheelchairs. We covered everything from drive wheel configuration to power seat functions and even the integrated technology like Bluetooth. I hope that you were able to learn one or two new facts throughout this time. What happens now? As we move onto the next topic series, I first wanted one more blog to really discuss why this all matters. It is easy to read a blog and then just continue on with our busy days. Do we take the time to read and really think about how our clients can be impacted by the equipment they receive?

This can be a hard discussion to have or to even think about. For many and most countries around the world, we talk about the idea of client-centred care. This means that we are completing our treatments, planning our goals, and prescribing equipment around the client. This is what most of us discussed and learned in our university. However, often we find that we are limited in this client centred approach. What is this limitation? FUNDING! Every country that I have lived in, worked in, or visited have all had the same barrier – Funding. We can allow funding to take over this client-centred approach and it then turns into the funding guiding our decisions on what is best for our client. Why does this matter? Our founder of Permobil perfectly answered this question so many years ago:

Every person has the right to have his or her disability compensated as far as possible by aids with the same technical standard as those we all use in our everyday lives.

  

 

So, does funding have it all wrong? No, this is not a blog to be negative to any funding. We have to remember that funding is guided by a LOT of different pieces. Some of these pieces we cannot change. However, when appropriate we can discuss and demonstrate how important it is to build and design the equipment to the client versus fitting the client into funding. This also means that we can demonstrate to our funding bodies/systems how client centred prescribing can lead to improved outcomes, increased function, increased independence, and an improved quality of life.

Many funding systems will allow the therapist to write an assessment or justification to explain why a piece of equipment is necessary if it is outside of the normal funding amount, code, or list. This can be overwhelming to many therapists to write this justification and for many good reasons. Sometimes we can be aware of the improvements in a client’s function, independence, medical benefits, but we are unable to understand how the equipment is making this change. Power wheelchairs, seating products, manual wheelchairs, they are all complex. A high-quality product is designed utilising the highest amount of research, an understanding of materials, and engineering principles. You might understand that one power wheelchair is easier for the client to maintain their position over uneven terrain versus another, but are you able to discuss how this can be related to the suspension, seating components, and their drive wheel configuration? This is where the challenge can come. How as therapists are we supposed to understand both our clients and the equipment to this high degree? As you continue to prescribe equipment this will become easier and you will continue to learn, but in the beginning remember that you have resources to help!

Reach out to your mentors, educators, manufacturers, etc… to help provide you with this information that you need. Ask the questions! There is so much information and research out there to help explain why your client might benefit from a certain function or design of their equipment.

The final thought I want to end on is to keep pushing. We have to remember how far we have come and that we have to continue to keep pushing for our clients. If we do not attempt to ask for funding on equipment that we believe is justified in improving our client’s lives, then we will never see a change in the funding. The funding system needs to hear that what they are funding is not always enough when that is the case. They may not be aware of new features and new technology and how this impacts your client. Unless you write a justification or assessment to tell the funding system that your client requires something different, we cannot blame them for not funding it. Remember to appeal too! Perhaps your first attempt did not fully explain why this equipment is necessary. If you get a denial, think about if this equipment is necessary to your client. If the answer is yes, go back to your resources, gather more information, and try to explain this again. If we do not appeal a denial, then we are essentially agreeing that this equipment is not necessary for our clients. I know this can be overwhelming at times, but remember we are here to help!

New Zealand Therapists!

I will be travelling across New Zealand at the end of November to come and talk about power wheelchairs and how the design and technology can impact our clients’ lives. Reach out to your local territory sales manager if you are interested in attending the event near you! You can always reach out to me directly at Rachel.Fabiniak@permobil.com.

 

Rachel

Why Switch from Switch Control?

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Mouse Emulation on an iPad?  Moving a cursor on a screen on an iPhone?  Did I just read that correctly?  Yes, you did!

When Apple release iOS 13 in September, in addition to new Memojis, an amazing new accessibility function was also released, which gives consumers who prefer Apple products more choice as to how they interact with their device (consult Apple to find out if your device is compatible with iOS 13)

Prior to this release, options for a person using either direct access or indirect access through Permobil iDevice, they were required to use Switch Control to navigate their icons, menus, and advanced scroll functions.

The best thing about this update, is that those who prefer Switch Control can still use this access method while trying out the new mouse emulation to see which is the most effective or efficient for them. The decision could depend on a few factors: drive input, wheelchair or external switch access methods, range of motion, strength, activity tolerance, what types of activities they will be completing with their phone or tablet, and of course, their individual preference.  

Now, there is a choice!  Consumers can now choose if they would like to use mouse emulation instead when using an adaptive Bluetooth mouse, such as the one that come standard on a Permobil PJSM or CJSM joystick, or OMNI2 display. 

 

To use and explore this great Apple Accessibility function with your Permobil Bluetooth mouse here are a few instructions.

Contact Rachel Fabiniak, your Permobil Clinical Educator, at Rachel.Fabiniak@permobil.com for any Permobil questions.

Phone:

 Download iOS 13 to your iPad/iPhone and make sure Bluetooth is turned on

  1.  Settings->Accessibility->Physical and Motor
  2.  Touch->AssistiveTouch->ON
  3.  Pointer Devices-> Devices->Bluetooth Devices 
  4. Tap Bluetooth Mouse 1

              a. You can change the cursor speed, size, and color

              b. You can also use dwell click

              c. Show onscreen keyboard

              d. Always show menu

              e. Can customise assistive touch menu

 

 

 

 

 

Wheelchair

 

1      On your joystick, go to settings (push and hold top left button) and Turn Bluetooth

        Mouse 1 "ON”

2      Exit settings

3      Toggle to Bluetooth Mode

4      Place joystick into pairing mode (>>>>>)

5      Bluetooth Mouse 1 will appear on your phone’s BT menu.

 

Learn more here:

 https://support.apple.com/accessibility

 https://www.ablenetinc.com/downloads/dl/file/id/798/product/515/ios_13_switch_control_user_guide.pdf

  

Call for accessibility support

 To contact Apple Accessibility Support over the phone in English, use these numbers:

  •          Australia: (61) 1-300-365-083
  •          United States: 1-877-204-3930
  •          United Kingdom: 0800 107 6285

 

 

 

 

Jennith Bernstein

 

Permobil US Clinical Educator Manager

 

 

Jennith Bernstein, PT, DPT, ATP/SMS: Jennith is a Physical Therapist based in Atlanta, Georgia.  She spent 10 years at The Shepherd Center, focusing her time in the Seating & Wheeled Mobility clinic for 7 years. Jennith completed her Masters in Physical Therapy at North Georgia College & State University and return to complete her transitional DPT at University of Texas Medical Branch in 2014.   Jennith has served as a volunteer teacher at the Universidad Mariano Galvez in Guatemala, instructing spinal cord injury curriculum as well as seating and mobility.  Jennith has presented at national and international conferences such as RESNA, ISS, LASS, Expo Ortopedica, and the APTA NEXT conference. Jennith joined Permobil as the Clinical Education Manager for the Central Region in 2016.

 

 

 

 

 

 

Mecenzi’s Story

“I go places and people look down at me, I would rather look them in the face.” – Mecenzi

If we have the ability to fully access and participate in our environment, we may forget that this human right is not possible for everyone.  Think about your daily life.  Can you reach the counter in your kitchen to make a sandwich, or reach inside the refrigerator to grab a drink?  What about reaching up in your closet to get your clothes?  That is just in your home.  Now think about experiences in your community.  Can you look face to face with your friends and family? Can you give your loved ones a hug without an awkward bend over shoulder in your face outcome? How about accessing counters at a restaurant to pay your bill?  For many individuals with a mobility impairment their environmental access is greatly limited.  It’s not just environmental access though.  How would you feel if you had to sit down in a chair at a party while everyone around you was standing and talking? For some individuals with a mobility impairment, they find it difficult to fully interact with their peers when they are unable to look them in the face.  For individuals with mobility impairments it might not just be accessibility and peer interaction but returning to or choosing a career path that typically requires standing throughout the day.  While accommodations can typically be made, what if instead of adapting the environment we adapted the individual’s mobility device?

Today I want to share with you Mecenzi’s story of herself and her new F5 corpus VS.

Mecenzi’s story, as you will see in the video below, illustrates how with the assistance of the F5 Corpus VS, Mecenzi has greatly improved not only her independence, but how being able to stand up makes her feel. 

 

 

The F5 Corpus VS may not be for everyone, but it is time for everyone to have access to products that will allow for the greatest independence possible.  In this case, the F5 Corpus VS has given Mecenzi the mobility that she requires to meet her goals and allow her the freedom and ability to access her environment. 

Apart from the social benefits Mecenzi and her family love, standing wheelchairs can also deliver potential health benefits. We will explore some of these in future blogs.

Please check out the link below for more information on the F5 Corpus VS: 

https://permobil.co.nz/2019-f5-corpus-vs

“Every person has the right to have his or her disability compensated as far as possible by aids with the same technical standard as those we all use in our everyday lives.” Dr. Per Uddén, Permobil Founder

 

Rachel

 

Independent Repositioning Mode: Getting the Most Out of Your Power Seat Functions

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We have been discussing the importance of power seat functions for the past couple blogs and what those power seat functions can do for the user. Often because of the limited mobility of the individual utilising the power wheelchair, power seat functions are used for pressure management. Pressure management or shifting weight off the user’s bottom is crucial to help to decrease the risk of skin breakdown. There are numerous research studies that discuss which combination of power seat functions are best for pressure management. The research shows that superior pressure relief may be achieved by utilising both posterior tilt and recline. Based on research by David Kreutz in 1997, the individual is recommended to initially move to a fully tilted position to stabilise the pelvis, and then follow with activation of the recline system so as to minimise loss of postural stability. Then reverse this order for coming back up to a driving or functional position: Recline and then tilt. This order is important because if the user starts for example with power recline they may lose their stable seated position or increase shearing to their sacrum. Commonly, users will have access to power posterior tilt, power recline, and power elevating legrests. In this case, the user should complete the following sequence for pressure management: posterior tilt, elevating legrests, recline. Then, reversing this order for coming back out to an upright driving position. When the user is fully tilted and reclined, this position is also helpful to reposition the user. Many users may be able to unweight their pelvis and shift their own hips in this unweighted position.

So, what is the challenge with utilising the sequence of posterior tilt, elevating legrests, and recline to maintain postural stability during pressure management? This sequence can be difficult for the user to remember, or maybe the user does not know the difference between recline and posterior tilt if they were not educated by their therapist or other seating specialist. This can create a fear for therapists and many will prescribe just posterior tilt in order to prevent the potentially negative effects of the 3 power seat functions when not used in the right sequence. Or, maybe the user is given all 3 power seat functions, but instructed to only use tilt for their pressure management. This is where it is important for manufacturers to see this limitation and develop a solution.

This solution for Permobil is called Independent Repositioning Mode or IRM. IRM comes standard on every F series, M3 and M5 power wheelchair.  This mode can be turned on to where the user can press a button on the controller, hit a switch, or use the actual joystick to enter the independent repositioning mode. Because the chair has smart actuators, when the switch for example is hit, the chair will take the client into a pre-set or therapist set amount of tilt, legrest elevation, and recline in the proper sequence one after the other. The user only has to know in this case to hit one button.  Users no longer have to worry about going all the way into posterior tilt before elevating their legs and then reclining. This feature is designed to take the stress and difficulty away from the user, but also empower the user to be able to be independent with their own pressure management.  Independent repositioning mode can also help with exactly what it says – repositioning. For some users, they are able to hit a button and go into this position so that they can independently repositioning their seated posture.  While the user can be set up for the standard IRM position, the therapist can also choose the final position of IRM so that this feature can be utilised for every users’ needs.    

 

Rachel 

 

References:

Kreutz, D. 1997. Power tilt, recline or both. Team Rehab Report, March: 29–32.

 

 

 

Power Seat Functions: Elevation

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Today we will look at the power seat function for elevation.  When we talk about elevation, we are referring to the raising up of the seat pan. You may also hear elevation referred to as seat elevate, or lift. Elevation can be beneficial to the user for functional, psycho-social, and physical benefits.

Let’s start with the functional benefits. The first benefit is the improvement of or independence with transfers.  Many people need to complete lateral transfers, where they slide across from their wheelchair to another surface such as the bed, toilet, or car. The difficulty with lateral transfers occurs when the user has to go from a lower surface to a higher surface. With seat elevate, most transfers out of the wheelchair can now be level or with a slight decline. The seat elevate can also be helpful with sit to stand transfers. Another great function benefit of elevation is the improvement of the user’s vertical reach.  Often with sitting in a wheelchair, activities or tasks will become overhead.  This means that the user has to be able to reach overhead to complete this task or activity. Seat elevation may allow the user to increase their independence by completing overhead activities, and this can also lead to additional physical benefits. Overhead reaching could increase the user’s risk of shoulder impingement or perhaps the user does not have the strength in their arms or trunk to complete this task or activity, and with seat elevate this will no longer be a problem.  It’s not just about the shoulder.  There is also a large impact on the neck, or cervical spine, with constantly performing overhead activities or looking up throughout the users’ day. Seat elevation can reduce the potential problems of overhead reaching.


Finally, let’s touch on the psycho-social benefits. In a previous blog, I discussed this topic of being able to come to eye level with your peers. This seat elevation allows the user to come to eye level with their peers, promoting the user to be part of the conversation. Seat elevation gives the user the power to choose at what height they want to be.

There are of course are a few limitations even when the user is able to elevate.  Many times, I hear people talk about how with seat elevate they will be able to reach into all of the cabinets in their kitchen.  Now, this could be true, but for many users they can now get up to open the cabinet, and reach the first few items, but they will have difficulty reach all the way into the cabinet.  This is because the user is typically seated back and would have to lean forward in order to reach further into the cabinet. This is one example, but we can see that seat elevate while very beneficial for independence with some functional activities may not provide the solution for all tasks or activities. Last week we briefly discussed ActiveReach™ and its benefits with vertical reach. For those clients that are looking to get that further reach, have better access to their sink and kitchen, and to even further enhance their participation through active posture, ActiveReach™ that includes both elevation and anterior tilt might be the right choice.

Remember, not everyone will need seat elevate, but it is important to assess each individual and determine if the function is appropriate. 

 

Rachel

 

Power Wheelchair Suspension: What you need to know and look for?

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Over the past 2 weeks we have talked about drive wheel configuration and some tips on how to decide which option is right for you. This week we are going to discuss power wheelchair suspension.  The suspension can vary from chair to chair even within each manufacturer, but there are some key points that we should discuss. 

Most power wheelchairs on the market are going to use compression springs for their suspension. There are two types of compression spring that are typically used: Linear and Non-linear.

Non-linear springs as seen in the photo below allow for changes in compressive load at different points of the range.  What this means is that you can have the looser spring coils at the beginning phase to help with climbing over obstacles.  The trade-off will be that you will lose some of the overall stability of the chair when not climbing.  Many manufacturers will use one non-linear spring as their suspension.

Linear springs on the other hand allow for consistent stability throughout the compression range.  For Permobil, these springs are also adjustable. The factory will set the suspension spring resistance based on the weight of the user and then the supplier or manufacturer representative will have the ability to further adjust depending on the needs of the user. With the Permobil M and F series, the suspension will be composed of multiple linear springs to achieve optimal traction and suspension.

 

Why does this matter?  The shape and the coil distance have an impact on how a spring works and effects the user.  The better the suspension, the greater the decreased forces on the end-user. This could lead to increased seating tolerance, pain management, spasticity management, and decreases the risk for loss of balance or position in the wheelchair.  One of the biggest points that I think about is driving over any uneven terrain whether it is just a sidewalk or grass at a park. It is important that as the chair goes over each bump that this bump is not felt by the user or limited as much as possible.  If each bump is transmitted up to the user, then the user will likely not maintain their seated position.  They will also feel all this vibration.  According to one study by Wolf and colleagues in 2007, this vibration can lead to many impairments including fatigue and pain.  

 

 

The final thought that I believe is one of the most crucial points to make is that the suspension on the wheelchair should always be there for you or your client.  We know how important suspension is and the negative impact that not having this suspension could be to our clients.  Therefore, we need to make sure that the wheelchair will maintain its suspension in any position and over all surfaces.  No matter what position the user takes the Permobil power wheelchair to, such as elevate, posterior tilt, active reach, or standing, the suspension remains the same.  If you want to drive your wheelchair in elevate, active reach, standing, or other positions, you want to be sure that your suspension will continue to support you in those positions and not lock out. 

It is important to know that each manufacturer will have different suspension set up on their chairs.  As a client, therapist, or carer make sure you ask about the suspension to determine which option is best for you.

 

Rachel

 

 

Part 2: Power Wheelchairs - Where is my Drive Wheel and Why Does it Matter?

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The drive wheel on a power wheelchair is the larger wheel if you are looking at your wheelchair or client’s wheelchair.  The location of this drive wheel can have a large impact on how the power wheelchair drives and manoeuvres in different environments.

There are three main types of drive wheel configurations on power wheelchairs: front-wheel drive, mid-wheel drive, and rear-wheel drive. In this blog today, we will focus on mid-wheel drive. 

 Mid-Wheel Drive:

The mid-wheel drive power wheelchair is the most recent technology developed for power wheelchair bases. It attempts to combine the positive aspects of front-wheel and rear-wheel drive into a hybrid product. Mid-wheel drive has many benefits.  The most well-known benefits being the small turning radius and intuitive driving.  The mid-wheel drive power wheelchair has the smallest 360  ̊ turning radius which can improve manoeuvrability for many individuals in their home or smaller spaces.  The intuitive driving benefit is due to the placement of the drive wheel. Typically, in the mid-wheel drive, the client will be sitting directly over the drive wheel, which is where the chair will turn/rotate from.  This axis of rotation being directly under the individual is what makes the driving intuitive or often people will say “easier to learn”.  It is important to remember that in some cases the mid-wheel drive may not line up directly below the client and therefore may lose some of that intuitive driving.  The final benefit to discuss for mid-wheel drive is the stability.  Because a mid-wheel drive wheelchair has 6 wheels on the ground, this chair will offer superior stability. This can be the case whether ascending, going up, or descending, going down, ramps or inclines. 

 

While there are many benefits for mid-wheel drive power wheelchairs, there are a couple considerations when deciding if mid-wheel drive is right for you or your client.  In being a superior option for stability, the 6 wheels on the ground also means that more energy from the ground is transferred to the client. Imagine going over a bump, because there are 6 wheels you could feel that bump 3 times versus the 2 of the front-wheel drive.  This could potentially limit the ride comfort for the individual in the chair.  Luckily, depending on each manufacturer, we have suspension to help decrease the impact of having 6 wheels on the ground.  I LOVE talking about suspension and we will have a blog post coming soon to talk all about suspension in power wheelchairs and the importance of the suspension.  The other comment I hear about mid-wheel drive power wheelchairs is the potential for “high centring”.  This term is used to describe when the centre drive wheels lose traction and may not be able to move in certain situations. This is particularly a risk with uneven terrain and was previously the biggest disadvantage of the mid-wheel drive power wheelchair. However, depending on your manufacturer, newer technologies and suspension can compensate and have greatly decreased the risk of this occurring.

The mid-wheel drive power wheelchair is the most popular drive wheel configuration and for good reason.  As technology continues to progress, the mid-wheel drive continues to have greater benefits with less limitations. 

Keep in mind that not everyone will benefit from the same drive wheel configuration and it is important to ask questions and complete an evaluation to determine which drive wheel would be best for you or your client. 

 

Rachel

 

 

Power Wheelchairs - Where is my Drive Wheel and Why Does it Matter?

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The drive wheel on a power wheelchair is the larger wheel if you are looking at your wheelchair or client’s wheelchair.  The location of this drive wheel can have a large impact on how the power wheelchair drives and maneuvers in different environments.

There are three main types of drive wheel configurations on power wheelchairs: front-wheel drive, mid-wheel drive, and rear-wheel drive. In this blog today, we will focus on front-wheel drive. 

 Front-Wheel Drive:

The front-wheel drive power wheelchair is typically going to be good for maneuverability indoors and optimal for outdoor use.  This is because of the larger drive wheel being the first wheel to overcome the uneven terrain versus the smaller casters.  Because the front wheels are connected to the drive motors, these pull the casters over obstacles and through various terrains versus if the casters were the front wheel.  In the case of the casters being in front, the casters are being pushed, the force generated is forward and downward.  This would be similar to a plowing effect and can increase the likelihood of becoming stuck in certain situations. For individuals looking to go over all terrains, the front-wheel drive wheelchair may offer the best solution.

Another benefit of front-wheel drive is the smoothness of the ride.  Look at how many wheels are on the ground.  In the case of front-wheel drive there are four wheels versus the six wheels with a mid-wheel drive chair. This means that as the end-user goes over a bump in a front-wheel drive chair, they would feel the force of that bump two times versus three in a mid-wheel drive. This can also be important for individuals that may easily lose their positioning when going over any uneven terrain.

We could talk about front-wheel for hours, but the final benefit to mention is the front-wheel drive chair’s smallest front turning aspect.  In all the configuration options, the chair will turn on its drive wheel.  The photo below shows an example of a bathroom.  In this bathroom the sink is positioned against the wall.  Because the wheelchair turns on its drive wheel and the end-user can only pull themselves so close to the wall before turning, we can see the only chair to gain full access to the sink is the front-wheel drive.  Does this mean that everyone should have a front-wheel drive wheelchair?  No, but it does mean that it is important for clinicians, suppliers, and clients (end-users) to consider the environment that the client lives in. 

 

  

Often, I hear that people stay clear of front-wheel drive because it doesn’t have as small of a turning radius as mid-wheel drive and it is harder to learn to drive.  Both of those statements are true.  The front-wheel drive will have a slightly larger 360 degree turning radius, but as you saw above it has the smaller front turning aspect which may be utilised more than someone turning in a full circle.  Front-wheel drive may be less intuitive to learn how to drive versus mid-wheel drive, but with a little practice and a few key tips, many users find front-wheel drive to be just as easy to learn as mid-wheel.  The two key points I like to teach someone when learning to drive a front-wheel drive wheelchair is:

  1. Hug the corner.  When going through a doorway the end-user will want to “hug” the corner or keep a tight turn.
  2. Turn towards the problem. For example, when positioned adjacent to a wall/barrier, turn toward the wall/barrier, then slightly reverse to allow the rear casters clearance for turning in the desired direction.  This might sound complicated, but if you remember to turn into the problem you will easily maneuver away from the problem.

Keep in mind that not everyone will benefit from the same drive wheel configuration and it is important to ask the questions and complete an evaluation to determine which drive wheel would be best for you or your client. 

 

Rachel

 

Shoulder Prevention: Are we doing enough?

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We have been discussing shoulder preservation over the past couple months and today I want to finish our discussion with this video. When I watched this video, I became overwhelmed with several emotions. I must have watched this clip 10 times in a row. Over and over, each time thinking about all of my clients, individuals with a mobility impairment, but the thought that I couldn’t stop thinking about was – Are we doing enough?

 

 

Watch this video. Watch it at least twice. The first time you might laugh seeing the challenge for the one end-user at self-propelling up the ramp versus the other end-user who is utilising the SmartDrive power assist. The second time you watch this, what do you see?

For me, I see two things. First, a strong woman pushing to her limits to overcome that ramp. She should be proud, as many of us might not be able to accomplish such a task, but I can’t help but also see someone who has to struggle to achieve the same outcome as the person next to them. Every time I watch this video I think about her shoulders, her goals, her independence. Is she able to get everywhere she wants to go, safely and independently? Or, is she limited because of her environment and her equipment? What happens to her shoulders a year from now? 15 years from now? Will she be able to maintain her independence and navigate in all the environments she encounters? Are we doing enough?

 

 

The founder of Permobil, Dr. Per Udden, so perfectly stated, “Every person has the right to have his or her disability compensated as far as possible by aids with the same technical standard as those we all use in our everyday lives.”. I think about this statement, this video, and I know that as an industry we have to do more.

Now, it’s important to say that many end-users may choose to not have a power assist or prefer even if they have one to propel independently up ramps for example, that is their choice and as a therapist we recommend what we believe to be safe and beneficial to the client. However, how many clients are not able to receive the equipment necessary for them to live their lives to this same technical standard? This is where my question comes in… Are we doing enough?

This question is for everyone: The manufacturers, end-users, therapists, dealers, families, and carers. Are we doing enough?

No matter what your role above may be, we all have to work together to make sure that individuals with mobility impairments are receiving equipment that is necessary for them to complete their goals and to live their lives to the same technical standard.

There is a massive task for manufacturers to continually design and develop products to meet these needs and while gaps exist, we see some amazing products coming out to help support individuals with mobility impairments.

Then there is a gap. We often see many of these products, but end-users are unable to access them. This can be for many reasons, oftentimes this can happen from a lack of knowledge of the products, not understanding the client’s needs or goals, limited resources, and limitations of funding.

No matter where this gap comes from, we have to all work together to help close these gaps. During the actual assessment and evaluation this means working from a team approach. If we have the therapist, client, family, carer, and dealer all working together in the assessment we see the best outcomes, but we can’t just stop there.

Funding. This can be a very hot topic around the world. We see countries with funding systems based on the client’s functional needs, the client’s medical necessity, or given an allocated fund that they can use to their discretion. We see funding systems with strict guidelines in what is/is not funded while other systems are open to understanding why the recommended equipment is necessary.

The purpose of this blog is not to discuss funding and it is not to talk negative about any country’s funding system. While we can shift the question to the funding bodies and ask, “Are they doing enough?”, instead I want us to first shift the question back to our industry and ask again, “Are WE doing enough?”.

 

 

As an industry, have we done enough to show the impact that this equipment can have on an individual’s life? How often do we see videos like the one above? Does the funding system understand the impact that a device or piece of equipment can have on an individual’s life? Has this been explained? For many countries this is discussed by the therapist on the request for funding, but what about after? Once the equipment has been approved and delivered, do we show this impact?

Just as in the assessment we work together as a team, we have to have this same team approach if we want the community outside of our small industry to understand.

If you are a therapist this means educating the community, the clients, and the families. Talk about what it is you do and why you do it. Share your stories of success. Work together with other therapists to share your knowledge and experiences. Attend conferences, seminar, and workshops to not only advance your knowledge, but to support your industry.

If you are an end-user, family, or carer – Show and talk about what your equipment does for you! It doesn’t have to be a power assist, this can be your manual wheelchair, your power wheelchair, etc.… We want everyone within and outside of the industry to see the impact that a device or piece of equipment can have on someone’s life. This is how we as an industry become better. This is how we are able to start having those conversations with funding bodies. This is how we can make change happen.

Our world is no longer big. As we continue to progress with technology, we see that our world becomes smaller. We can interact with people across the world. This means that we can work as a team. Maybe you live in a country where you have access to great equipment. Have you thought about how sharing your experiences could help in other countries where funding/resources/awareness is limited?

No matter which part of the team you are, we all have a part to play and just as any team – the more we can work together the better the outcome of success.

If you are an end-user of one of our many Permobil products we want to hear from you! This includes Permobil, TiLite, ROHO, and SmartDrive. Share with us your story of success. Please email Rachel.Fabiniak@permobil.com or your local Permobil Territory Sales Manager.

 

 

Shoulder Prevention: Let’s Talk About Power Assist

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When we are considering a manual wheelchair are we considering a power assist option?


We have been discussing shoulder preservation and how it relates to the weight of the wheelchair, the configuration of the wheelchair and to the individual and their pre-morbid shoulder health. We have also discussed how mobility is NOT and should NOT be exercise. So, how do I know when I should be considering a power assist option? First, we have to look at each individual end-user/client, their goals, environment, and any current shoulder pathologies.

The Goals:

This is one of the most important pieces of information that we need to understand from the assessment. As the therapist we can often just ask the question about what goals the end-user has, but do we really hear all the goals? Often the client may be able to express all of their goals, but just as most of us, we are not always able to express or understand our goals. I like to think about this as when someone approaches me and asks, “Where do you want to be in 5 years?”. This is a difficult question if I haven’t had time to think and prepare an answer and often it is hard to know this answer without having a deeper discussion. This can be the same when talking about goals for the client. If this is someone going into their first manual wheelchair, they may have no idea about what is possible. They may have goals that they want to achieve, but believe it is not an option. Or, perhaps they are not able to even generate a list of goals. They might list a goal or two when asked just to appease their therapist, or just to try to participate. Then we have to think about the clients with cognitive or communication deficits. Does this mean that they don’t have goals? It is crucial that we as the therapist or as any member of the team spend time to discuss goals with the end-user, their carers, and family. Their goals will help us to better understand the needs of their mobility device and if power assist should be considered.

 

 

Environment:

If you are a therapist going into the community, you can see first-hand the client’s home environment but remember there is a lot more to someone’s environment than just their home. I like to think about this like 24-hour positioning. I need to consider every typical environment that the end-user encounters not only just in a one-day time stamp but does this change across different days of the week. Like myself, on the weekdays I may only encounter my home, car, and work environments, but on my weekends, I prefer to spend my time outdoors. As a therapist, it is important that we are able to ask the right questions to better understand the environments that will be encountered.

Shoulder Pathologies:

Have you ever asked someone if they are in pain and they respond no, but then within minutes you find out they take pain medication daily? There are many reasons that pain is not discussed during an assessment. This can range from the question not being asked, the client not wanting pain to keep them from their goals or activities, the client may forget that they are taking pain medication, etc…. No matter what the reason is, it is crucial to determine if the client has any underlying shoulder pain or pathologies. This doesn’t mean that they are not appropriate for manual mobility, but it does help to determine if a power assist option should be considered. 

 

 

While there are still many other important aspects of the assessment to consider, this is a good starting point. Take this information you gather from the assessment and determine if the client is at a risk of further shoulder pain/problems, not being able to navigate in their environment, or if they are not able to achieve their goals without the use of a power assist device. If the answer is yes to any one of these, then discuss with your client and dealer/supplier power assist options.

I often hear that therapists just don’t think about it during the assessment of trial. I know there can be a LOT to consider, but power assist can truly change a client’s life.