Blog posts of '2021' 'March'

Individual (noun)  

-       a person who thinks or behaves in their own original way

-       a single person or thing, especially when compared to the group or set to which they belong


Last week saw Permobil launch their latest brand video ‘Innovating for Individuals’ which includes a message that goes beyond marketing and extends into good clinical practice. 

‘We are all individuals with unique interests, needs and goals’..."Instead of searching for the things that we do the same, lets champion the things that set us apart’

Humans are interesting creatures, many of us love being a part of something greater than ourselves – we take great pride in the sports teams we follow or the ethnic or religious groups we associate with, however we also love being seen for who we are as individuals. None of us like being referred to by a label, nor are we happy when others make an assumption about us based on a group that we may belong to. 

As therapists we are typically loyal to our profession and will often playfully tease other professional groups, however each profession is made up of a diverse range of individuals. 

The same holds true of those with a disability – some may associate strongly with others with the same condition, but each is an individual with their own unique hopes and dreams. 

In recent years there has been a shift in how we refer to those who access health services, from ‘patient’ to ‘client’ to more recently the ‘person’, reflecting the person who exists outside their need to access health care. The person who has a family and friends, hopes and dreams, wishes and desires like each of us reading this blog. The person wants to be seen for who they are, not by the health challenge they have or the intervention they require.  

As therapists we know this to be true, however sometimes the nature of how organisations operate or the funding models we obtain equipment from can impact on how well we ‘see’ a person – we might be contracted to provide an intervention that may or may not be what the person actually needed or wanted, or we may be focused on ‘functional’ or ‘essential’ mobility instead of a person’s goal to play cards with their friends at the local bridge club.

Thinking of a person as an individual is incorporated into the ICF model, in particular identifying the personal factors about that person. ICF personal factors include gender, age, coping styles, social background, education, profession, past and current experience, overall behaviour pattern, character and other factors that influence how disability is experienced by the individual.

Taken from the ICF manual, ‘the functioning of an individual in a specific domain reflects an interaction between the health condition and the contextual: environmental and personal factors’, with a complex, dynamic and often unpredictable relationship between these entities. In other words, how the different aspects of the ICF interact with each other is complex, with a person’s environmental and personal factors helping give context to how the person is functioning. 

Like the other ICF domains, personal factors include factors that are modifiable and non-modifiable, with aspects such as age, race, and time since injury being non-modifiable. Other factors such as level of education, marital status and personality are deemed modifiable, reminding us that as humans a part of us will change over time. The review by Smith, Sakakibara and Miller (2016), which explored factors influencing participation in social and community activities for wheelchair users, the one personal factor identified related to the level of education. Higher levels of education were associated with increased access to employment opportunities, which is likely linked to greater levels of participation in the community in general. 

These personal factors can be what makes clinical practice meaningful – many of us enjoy meeting and getting to know new people and helping them achieve their goals in what can be some challenging times. The personal factors mean that providing a power wheelchair for a person with Cerebral Palsy becomes facilitating Andy being able play with his friends on the field at lunchtime. Or providing a manual wheelchair for a person with Multiple Sclerosis becomes helping Jane remain employed in a job she loves.

I still remember the lesson from physio school about how different people with the same problem can present differently – the example given was how 10 people with a sprained ankle may need 10 different strategies to manage their injury. The same holds true for wheelchair prescription – 10 different people with the same presentation of Motor Neuron Disease may require 10 slightly different solutions – and these differences can be the difference between a person achieving their goals and thriving, or potentially abandoning their equipment in favour of a different means of managing.  An example that comes to mind was the mother who requested a manual tilt in space chair in place of a power wheelchair – as they did not have the means to transport a power wheelchair, and being able to watch her children play sport was more important to her than independent mobility around her home. 

Innovate (verb)

-       to develop a new design, product, idea etc

-       to introduce changes and new ideas


Innovation is what has helped the industry move forward with new solutions, often prompted by wheelchair users wanting to achieve more. As science and technology move forward so do our solutions – we have power assist solutions that are lighter weight, more reliable and more durable.  We have manual wheelchairs that are lightweight yet strong, and we have power wheelchairs that are ‘smarter’ and going further. However, the journey towards better products is ongoing, with manufacturers continuing to show innovation either with developing new products or improving on their existing, not content that what we have now is the best that can be achieved.

Innovation can be also something we strive for in clinical practice, particularly when we have a person who requires more than what off the shelf items can offer. It might be that we are modifying an existing item, repurposing an item or having an item custom fabricated by a technician or manufacturer. Whether it’s the arm support that sits at just the right height in just the right place to maintain an independent transfer, the custom swing away tray that allows a person to carry items independently but also transfer independently out of their chair. Or the alternative drive controls that set up and programmed just so to keep a person driving. 

While the “Innovating for Individuals” brand video is ultimately a great marketing tool, it has also captured the sentiment of the industry, an industry many of us are part of as:

‘We believe everyone should have the right to live the life they want for themselves’. 


Smith, E.M, Sakakibara, B.M. & Miller, W.C. (2016) A review of factors influencing participation in social and community activities for wheelchair users. Disabil Rehabil Assist Technol.  11(5): 361-371 

How to use the ICF – A practical Manual for using the International Classification of Functioning, Disability and Health (ICF) downloaded from 

Rachel Maher
Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and a Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service.

Rachel moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.


This is something that I recently thought about when teaching a course on power assist. This topic does not just relate to power assist but to all Assistive Technology (AT).

First, let’s define what I mean when I say proactive versus reactive. The dictionary defines proactive as “taking action by causing change and not only reacting to change when it happens”. While reactive is defined as “reacting to events or situations rather than acting first to change or prevent something”. What approach should we be taking when consider assistive technology? This is not always just a simple answer. We may be seeing an individual who this is not their first prescribed AT device and maybe we feel that we would have made a change sooner to the prescribed AT.

We also need to consider the funding and where the funding is coming from for the individual using the AT. Can there be a potential to be too proactive and cost additional money to the funding system/body? How do we weigh the options and know if something will be required or needed in the future?

The simple answer is that we have to use our best clinical judgement. This should not just be based on the individual’s diagnosis or the clinician’s past experience with similar cases, but it should be based on numerous factors that when looked at together can help to determine the necessity of an AT solution. One of my favourite ways to really look at all these factors is to use the ICF model as shown below. This can help to determine if there are any current changes that need to be made to the individual’s AT (reactive) or whether we need an immediate change to the AT to prevent any impacts to an area in the ICF model. Let’s look at an easy example to start.


Case 1

A cushion in a wheelchair. Now, I’m not talking about a specific cushion but just a cushion in general in a wheelchair for someone that is a full-time wheelchair user and perhaps has limited sensation. We know the importance of a cushion to help protect from a pressure injury (PI), but should we go ahead and get the cushion before anything is wrong or let them sit without a cushion and wait until they develop a pressure injury? I would hope everyone reading this would say “of course, the individual requires a cushion for their wheelchair”.

We understand the challenges of healing a pressure injury, the cost associated with the PI, and the impact it has on someone’s health and well-being. So, we can see the need for being proactive and not waiting for the event (PI), but instead working to prevent it. This can be an easy way to discuss how proactive AT solutions can often save overall lifetime costs and allow the individual to maintain their lifestyle, independence, health, and well-being.


Case 2

What about those cases or AT solutions that are not as straight forward? Let’s look at another case example. A 42-year old female who has been using a manual wheelchair for more than 10 years, but suffers from shoulder pain with limited range of motion. Due to limited propulsion resulting in decreased independence, you are suggesting that she is prescribed a power wheelchair. It is also the first time you are working with this client.

You prescribe a power wheelchair with the power seat function tilt for this individual. You were not able to prescribe the power wheelchair sooner since this was your first time with the client, but have you been proactive in your approach? Have you considered all the options? What was one key that I had listed? Limited range of motion in the shoulders. If we moved the client to a power wheelchair because of shoulder dysfunction, did we think proactively about the power seat functions that she will need to access her environment? If the client has limited shoulder range of motion and pain, are we considering their goals and functional capacity in relation to the position they are seated in their wheelchair and the power seat functions they have access to? Does the client ever need to reach overhead in her environment?

If they need to reach overhead and we do not prescribe a power seat function that assists them, then what happens to the client? Maybe they continue to try to reach overhead with pain or perhaps they cannot due to the range of motion and their independence is limited. Despite just seeing the client for the first time, is it a proactive approach? Or, reactive? If we are reactive, have we really made change and reacted to address the whole situation if we only include power tilt?


Case 3

One final example. A client that is a 28-year old male who is about to get his second manual wheelchair. He recently moved and now lives outside of the city but travels into the city daily. He takes public transport, but he still has to push quite a distance to and from work daily and for all his community activities that he enjoys. He would like to have a replacement of his manual wheelchair. You complete a full assessment and note that he has no pain and full range of motion throughout his body. The client also reports that he is able to achieve all of his activity and participation goals, but that it is getting harder now that he has moved. It often takes twice as long to get to where he wants to go and feels quite fatigued, so he has been going out less.

When you hear this case, what comes into your mind? Are you thinking about how the client could get around more efficiently if he had something like a power assist device? The client states that he does not have pain, but is that the only reason for someone to get a power assist device? After the shoulder pain begins, how much harder will it be to address the issue? We might be proactive here in trying to decrease the risk of shoulder pain, but what else are we doing? The client stated that he is already having a change in his activity and participation level, so is this truly proactive or are we just proactively trying to prevent shoulder dysfunction and being reactive to the changes in the client’s activity and participation level?

It can be a challenge to be truly 100 percent proactive, but are we looking at the whole person and environment and considering all the options? We have to determine the impact of being proactive versus reactive and how that balances with prescribing an AT device. I love using the ICF model to consider how the AT device might positively or negatively impact the individual. This can create my platform and reasoning for justification to funding as well. Remember to also utilise your clinical best practice guides and research to support your decisions, especially when making a proactive decision.

Have questions about funding? In NZ Reach out to or


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.