DME

Blog posts of '2020' 'October'

Mobility is a Human Right. Why we can’t ignore this topic anymore 

 


Did you ever attend a course, read an article, or hear a topic and think to yourself, “Yes, this is important. I need to remember this.”? But within a couple weeks this new topic or idea has left your mind. It happens to all of us. We get motivated by hearing someone’s passion, but how do we then take that motivation and implement it? 

Today in this blog what we are going to discuss mobility. It is something that I feel incredibly passionate about, but it is also something that we can no longer just forget. We, whether that is a clinician, family member, member of the industry, or the end-user, we have to find a way to remember. The research is there. We can no longer pretend that mobility does not impact well-being, health, independence, and function. We have the research, we have the equipment, now we have to act. Mobility is no longer just something that we hope to provide someone. 

Mobility is Human Right 

Now, to really help us to remember this, we need to first define what mobility is. I have given this definition in a previous blog, but I believe now that I was slightly wrong. Today, I am talking about independent mobility. My old definition of mobility was getting from point A to point B in the most efficient, safe, and timely manner. This definition does still hold true, but how we think about what point A and point B are can really make the difference. At first, I thought point A to point B was this distance say from the bathroom to the kitchen. This distance to be travelled. That is one form of mobility. There is also another way to think about mobility that I had missed.

 Let’s consider that point A is a moment or position in space and point B is a different one. What does this mean? What is the definition trying to say? We don’t have to define mobility as just getting from location to another location, but instead someone’s mobility could also mean their ability to move their body in space. Someone that is unable to move at all and utilises a power tilt independently to relax. Is this a form of mobility? I say YES! I believe we have missed out on some great opportunities to provide individuals with a form of independent mobility by missing what should be the definition of mobility. 

Now that we have this definition lets go back to our statement: Mobility is a Human Right. 

It can be easy for us as human beings to understand that someone that can walk should be allowed to walk. It can also be pretty easy to explain that when someone has the ability to push a manual wheelchair and we provide them a wheelchair, that we have given them independent mobility. But, what about the “harder” situations that we might come across as a clinician? What about someone that is “old” and lives in an aged care centre, should they really have a powered wheelchair or other appropriate device to move around? I often hear “Why does an old person need to be able to move?” 

Have we tried to give this “old person” a mobility device? Or is this an assumption based on another experience or perhaps our thoughts? Just because someone is older by year of age does not mean that they will be inappropriate for all mobility devices. Maybe the traditional idea of independent mobility is not an option due to cognition or safety, but what about having the ability to shift their own weight, move their legs or backrest position, or change their height?

Just because someone requires supervision or assistance to move their wheelchair does not mean that we can’t give them some form of independent mobility. You have to trial options. It might require some out of the box ideas, or perhaps you even have to spend time explaining why to a funder. 

Mobility is Human Right. It does not have an age limit where it all of a sudden doesn’t matter anymore. Put yourself in their position. Are you okay with losing your independent mobility once you hit a certain age? 65? 68? 72? At what age are you okay with no longer having the ability to move independently if there is a way to help you move? This goes for the other end of the spectrum as well… 

 


Age does not define your right for mobility.

We have to then also consider this for our youngest individuals. At what age should mobility begin? Let’s remember what the definition of mobility is: the ability to move in space. When a typical developing child begins to move, they learn and explore their environment. We don’t have to wonder what the impact of exploration is on development as it has been researched and reported. We don’t even have to wonder at what age we should start thinking about mobility devices as we can see the research describing this as well.

So, what is it that is holding us back in this age category? Is it parents? Or, is it us? Funding? It is easy for us to sit here and think of all the reasons why there are children that are 2, 3, even 4 years old that have never been given a chance for independent mobility. What impact does this have on the child? It is our responsibility based on our education and understanding of mobility and development to keep working towards access for everyone regardless of their age.

So, lets go back now to the beginning of this blog when I discussed the definition of mobility. We know now that we cannot just take away or limit someone’s mobility based on their age, but there is still a large group of individuals that are not young or old that have been forgotten. This is the group that might not be able to independently drive or propel their wheelchair. But do they have the capacity to move independently?

Can they activate a switch or button on the wheelchair and change their position? Can they maybe have their wheelchair programmed to drive at only a low speed? Just because an individual cannot independently drive a powered wheelchair at 10km/hr or propel a manual wheelchair up a hill, does not mean that we should give up on the idea of mobility for this individual.

Instead of focusing on what they can’t do, let’s focus on what they have the potential to do. I have seen some of the most incredible, out-of-the-box ideas across Asia and the Pacific to get an individual just a small amount of independent mobility.


I know this can be overwhelming and where we often start to let this motivation go and not turn into action. We are here to help. Whether it is a mentor, another clinician, or someone in the industry. Reach out for help.

If you don’t know where to start you can also contact your local Permobil representative to start discussing how to best give mobility to your client. You can also reach out to your Permobil Clinical Education team for support at Education.AU@permobil.com


Rachel Fabiniak, PT, DPT
Director of Clinical Education – Permobil APAC

Rachel Fabiniak began her studies at The Georgia Institute of Technology, where she graduated with her Bachelor of Science in Biology in 2009. Rachel then went on to receive her Doctorate in Physical Therapy from Emory University in 2013.

After receiving her doctorate, Rachel went into clinical practice as a physiotherapist in the Spinal Cord Injury Day Program at Shepherd Center in Atlanta, Ga. There she developed a passion for seating and mobility which ultimately lead to her career with Permobil. 

Rachel joined Permobil in January 2018 relocating to Sydney, Australia in June 2018 as the Clinical Education Specialist for Australia and New Zealand. In February 2020 Rachel moved into the role of Director of Clinical Education for Asia-Pacific.  

The Importance of Learning

 


As clinicians, there are elements of education interwoven within many of our roles, teaching foundation skills or ways to use assistive technology to enable engagement in activities of daily living for example. An OT undergraduate program includes learning about how people learn and techniques to assist in the learning process.

Within the wheelchair and mobility prescription role the prescribing therapist is not just an assessor. The assessment, trial and clinical justification/funding report are all an integral part of the role but the delivery and teaching of how to use and maintain the device is also part of this scope and relative to the end user’s lived experience. Whilst the delivery of Assistive Technology (AT) may signal the end of the process for the health professional, it is often the beginning for the end user, especially if it involves a new piece of AT.

 

 
The Clinician as an Educator

Within the assessment process you may identify that an end user is struggling with a transfer. Task analysis may guide you to consider trialling a new feature within a mobility base to assist in this task. The trial may show that this feature is indeed functionally beneficial but may also identify that the task requires further adaptation. Based on the end user’s experience, functional capacity and support requirements, they may require help in task adaptation or it may be as simple as providing guidance in learning how to operate the feature and the task adaptation will develop from ongoing use.

Support workers may need to be taught how to operate the mobility base or position it appropriately for a hoist transfer. Whilst there are similarities in operational access between wheelchairs, there are also variances. Those supporting the task also need to learn how the equipment works and the specific way it will be used for the individual end user.

 

 

While literature discusses multiple different learning styles, there continues to be debate around the ideology of learning styles. Do we have a specific style that we learn best from or is it the content of the learning matched to the style?

We do know people learn in different ways. Riener and Willingham’s article, The myth of learning styles (2010), argues that there is no credible evidence that learning styles exist. Further, they argue that learners differ in their ‘abilities, interests, and background knowledge, but not in their learning styles’.

Other academics, such as Richard Felder, believe that while learning styles do not provide a complete portrait, they can potentially provide an outline or framework. However, addressing learning needs is infinitely more complex than implied by learning styles ideology.

Less debated is that we use a combination of styles when learning. The three most cited learning styles are: Visual, Auditory and Kinaesthetic and we may use one or a combination when teaching. A quick reminder, or for readers not familiar with learning styles:

Visual learners: who prefer images, pictures, diagrams, films and videos or demonstrations.

Auditory learners: who learn best through the process of listening.

Kinaesthetic learners: who learn by doing.

Let’s consider the delivery of a wheelchair. It’s the first wheelchair for a gentleman with a progressive neurological condition. He is still walking but experiencing falls. His wife is struggling with the sudden and rapid changes going on. Neither has any experience with a wheelchair but both understand that with his falls lately it will be best to use one. The wheelchair will be initially used for community access. We could just talk through how to disassemble the chair to put it into the car trunk. We have told them how to do it, we even remind them that they must disengage the wheel locks before removing the wheels…is this enough?

Most of you would combine this with a demonstration. But to ensure understanding and that they can manage the task, many of you would also get the client and his wife to have a go at doing it. The value in this is that you can ensure they can do the task but also the kinetic hands on learning this offers. The “doing” is important as the task involves doing a new activity with a new piece of equipment and will impact on the ability to use the chair in the community.

For more complex equipment training or where multiple carers are involved, you may have developed resources to assist in the facilitation of learning such as photos of equipment or positioning.

 

 


The Clinician as a Learner

We often put thought into the best techniques and styles to support learning for clients but do we also apply this to our own learning opportunities? Continuing Professional Development (CPD) requires us to complete hours of ongoing learning. We need to make these hours as beneficial as possible, so as well as matching content to our learning goals it is also important to consider the delivery of the content and what will best work for you. For me personally, I like to get hands on with equipment to understand its adjustments and capacity especially when it’s a new piece of equipment I haven’t previously worked with.

2020 has brought new challenges to ways of working and learning. We know how important ongoing professional development is and so in March this year we increased our bi monthly webinar program to bring a new live webinar every week. This was a great way to continue to offer theoretical concepts as learning opportunities however makes it more challenging in some areas. Therapists at workshops who are new to seating assessments have consistently said how beneficial doing and having the assessment done for them can be.

Applying case study concepts to hands on experiences with equipment is also very highly rated in the clinical workshops. But following social restrictions and recommendations has unfortunately limited these opportunities within countries globally.


O2O and Education Opportunities

This month we are excited to be launching our very first Online-2-Offline (O2O) event. This form of learning begins with an online component led by our Clinical Education team, followed by a hands on session with your local experienced sales team to enable you to apply clinical learning in a practical and supportive environment. The education team will remain online throughout the event to answer any questions.

This format has already proven successful with fantastic feedback from both our Chinese and Australian markets. You can hear a bit more about this event below.

 


 


 

Tracee-lee Maginnity
Clinical Education Specialist

Tracee-lee Maginnity joined Permobil Australia in July 2019, as a clinical education specialist. She graduated Auckland University of Technology with a BHSc (Occupational Therapy) in 2003 and has since worked in various roles related to seating and mobility including assessing, prescribing and educating.

Tracee-lee is passionate about maximising functional outcomes with end users and the importance of education within the industry.