DME

Blog posts of '2021' 'July'

What is a cost effective solution?  

Cost effectiveness is something we need to consider when recommending equipment for a person, but what exactly is cost effective solution? 

cost effective solution is not necessarily a low cost solution, or the cheapest solution of a particular type of equipment.   When considering whether an item is a cost effective solution we do need to consider the initial purchase price, but we also need to consider a range of other factors, for example the features that a product offers (and how these relate to the identified goals), the materials the product is made from and the ongoing cost of maintaining and repairing a product.  For this blog we are going to look at wheelchairs in particular, however these ideas can be applied to other pieces of equipment. 

As part of establishing what is a cost effective option we need to consider the person using the chair and where the chair will be used.  We need to consider whether the person’s needs are stable and the chair will be used in its original configuration for quite some time, or whether we are looking at a teenager who is going to grow out of their chair within a reasonably short period of time or perhaps a person with a progressive condition who may need their chair adapted as their needs change.  We also need to consider where a piece of equipment is going to be used – is it going to be used mostly indoors with occasional outdoor use, or will this person be using their chair extensively outdoors, and is this outdoor terrain flat or are there hills?  These factors can help us determine how durable a solution needs to be and whether we need a solution is adaptable to changing needs over timehelping maximise the length of time a chair can be used by the person. 


When looking at chair options we also need to be mindful of how chairs are promoted and their reported capability, in particular modifications to increase functionality of the chair.  We need to be wary that because a modification can be done, it doesn’t necessarily mean that it should be done, pushing a product past its intended use typically results in issues at some stage, either poor functioning in the short term or repair and maintenance issues in the long term, ultimately defying the intent of providing a cost effective solution.  An important aspect to consider on all equipment is what the safety parameters are on a product, for example lock out parameters on a power wheelchair are in place to keep a person safe while using their chair, over riding these to increase the functionality of a chair is never a good idea.
   
Looking at manual wheelchairs – the materials used in these is an important consideration.  The two common materials we see are titanium and aluminium both of these are strong lightweight materials, however they have different life spans – with titanium being more durable and the higher cost option.  What does this mean for cost effectiveness?  For wheelchair users that use their chairs full time and whose needs are stable, a titanium frame is typically a cost effective option as it a robust solution that will last a number of years, with the frame often having a lifetime warranty and the componentry being the part of the chair that requires attention over time.  However for a person who’s needs are likely to change over time, due to growth or a change in functional ability, they may not use the manual chair long enough for a lifetime warranty to be relevant, hence an aluminium frame is likely to be the more cost effective option, with the person changing chairs before the aluminium frame is at risk of failure.  Where does carbon fibre fit into the cost-effective equation? Carbon fibre tends to be a higher cost option, but it can also be the lightest option of the three, and may prove to be the cost effective option for other reasons, for example if provision of a very lightweight chair means vehicle modifications are not required.  The big consideration with carbon fibre is that a wheelchair user needs to treat it with care, so is only a cost effective option if they are given to the right person.

Establishing cost effectiveness for power wheelchairs can be a little trickier, as we need to ensure we are comparing apples with apples.  Power wheelchairs range in their complexity, purchase cost and ongoing repair and maintenance costs.  A good place to start is to establish what features a person needs in their power wheelchair and then establishing which models fit these specifications, considering aspects such as power seat functions required, power wheelchair performance and what a person’s long term needs might be.   All power wheelchairs have their benefits and their challenges, and we need to ensure that we match these benefits and challenges to the wheelchair user.  Often this process results in a couple of chair options being identified, however sometimes we are faced with the dilemma of do we upgrade to ‘future proof’ the chair (at an additional cost) or do we go with the chair that meets the needs of the person now? 
 
Often, we have a gut instinct on whether we should consider upgrading a chair, however finding the words to justify the increased cost for an upgrade can be a challenge.  This is where consulting with other team members can be helpful, for example consulting with the wider multidisciplinary team if a person has a progressive condition to establish the rate a person’s functional abilities are changing, and hence what wheelchair features may be required in the medium term, then establishing whether it is more cost effective to provide these features now or whether it is something that is cost effective to provide later, such as retrofitting of power seat functions.  If we are considering power wheelchair performance, discussing what demands will be placed on the chair with a technician or dealer can be helpful, this can help align the more technical aspects of a chair with the needs of a user, for example whether 500W motors are going to be a better option than 300W motors for the person who needs to travel up a hill to work each day.
 
One last aspect of cost effectiveness doesn’t relate to the chair at all, which is the effect on the persons environment.  The subtle differences between chair specifications can cause significant ripple effects through other parts of a person’s life, for example a 1” increase in seat to floor height or in overall width can make the difference between a person accessing their modified vehicle, or not.  The decision between a power wheelchair and power assist can be influenced by a person’s home environment and what changes may need to be made to accommodate a larger power wheelchair base.  Or provision of an additional power seat function can result in maintaining, or even decreasing, the level of a support a person needs to function.
 
Establishing whether a solution is cost effective can be tricky with many different aspects to cover, please feel free to reach out to our team if you are wanting to discuss a solution further on education.au@permobil.com 
 

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.

 


Cognitive load theory is a theory of how the human brain learns and stores knowledge. When our brains process and store information, it takes place in one of two ways.

One way, known as our working memory, is where small amounts of information are temporarily stored. Scientists believe that at any one time our working memory has the capacity on average to store up to four pieces of information e.g. reply to the email I received earlier today, listen to the voicemail and return the call, finish the article for the blog and pick up the dry cleaning on my way home.

The second is known as long term memory. In this type of memory, larger amounts of information are stored for long periods of time. Some information sticks around forever, some we eventually forget. What we continue to ‘know’ is dependent on not only how often we use this piece of information, but also how it was stored in the first place.

The ability of our brains to recall information from our long-term memory is determined by ‘schemas’. A schema is a group of linked memories, words or concepts and become a cognitive shortcut. This leads to having the ability to store new things in our long-term memory and therefore being able to remember and retrieve this information in the future, is much quicker and more efficient.  

 


Sometimes, when we are learning, you’ll hear people say, or perhaps you have said something similar yourself “I’ve read this over and over again, I just don’t get it, my brain hurts!” 

This is a concept known as cognitive load, which describes that our brains have a limit to how much information can be in our working memory at any one time. If a learner, or a teacher or presenter can be mindful of this and present information in way which does not overload the learner, only offers up necessary, usable chunks of well explained information, it reduces cognitive load, which allows the learner to move the information into long term memory to create the schema. 

Cognitive load theory and research has made several recommendations regarding instructional techniques that can be used when teaching. One suggestion is coined the ‘redundancy effect’.

“Students do not learn effectively when their limited working memory is directed to unnecessary or redundant information. The ‘redundancy effect’ occurs when learners are presented with additional information that is not directly relevant to learning, or with the same information in multiple forms.

An example is a textbook which includes both text and a diagram that needlessly repeat information, or a PowerPoint presentation in which the presenter reads the text presented on the screen. Requiring learners to process redundant information inhibits learning because it overloads working memory. Cognitive load research shows that best practice is to remove redundant information from learning material.” See here for further information.


The Permobil Education Team deliver education using a variety of methods, such as:

  • face to face – classroom style teaching 
  • hands on demo, practical and theory 
  • written material in the form of a blog or instructional guides 
  • online education presented either as a live or recorded webinar or via Microsoft Teams 

With cognitive load being front of mind, we considered some alternatives which has resulted in the launch of our new and additional format for delivering education – Permobil Express Learning!  

 


We have created our first express course, each module is only 10-15 minutes in length, meaning we only cover what you need to know without all the other fluff!   

Our first course for 2021 consist of 10 express modules and is titled – Seating and Positioning Needs of the Aged Care Population.   

We begin with laying the foundations with an overview of the healthy skin followed by the ageing skin. We cover postures and the impact on the seated individual in relation to their ability to function, before delving into risk factors contributing to wound development. We focus on pressure injury risk and classification, along with other causes of skin damage. Then we wrap up the course with two express modules covering the recommendations and types of support surfaces available.

Click here to find out more and to register for our upcoming Express Learning Course. 


 

Dee Smith
Clinical Education Specialist

Dee is a Registered Nurse with almost 25 years’ experience in a variety of specialties and is passionate about mentoring, educating and empowering health care professionals to provide safe and quality care.

Dee graduated from Sydney University with a Bachelor of Nursing in 1997 and in 2001 gained a Post Graduate Certificate in Infection Control. She has Certificate IV in Training and Assessment. 

Dee worked within the Aged Care Industry as a Clinical Nurse Consultant in Infection Prevention & Control. She developed and delivered education and training of evidenced-based practice in Infection Prevention and Control, Wound Care and Pressure Injury Management. 

Dee joined Permobil in 2020 as the Seating and Positioning BDM and in 2021, joined the Asia Pacific Clinical Education team as Long Term Care/Aged Care Clinical Specialist. 

The Olympics are due to start in a few weeks followed by the Paralympics. This year's event is due to take place in August in Toyko, Japan, after having been postponed due to the global pandemic which prevented them going ahead last year as planned. Some believe the Paralympics were so named as a joining of the words paraplegia and Olympics, in reality they are so named because the word “Paralympic” derives from the Greek preposition “para” (beside or alongside) and the word “Olympic”. Paralympics are the parallel Games to the Olympics and the two movements exist side-by-side.

Whilst the first Olympics have a long history that we learn about in primary school, less is known about the Paralympic movement. 

Following World War II, the British government opened a spinal injuries centre at the Stoke Mandeville Hospital, and in time, rehabilitation sport evolved to recreational sport and then to competitive sport. On 29 July 1948, the day of the Opening Ceremony of the London 1948 Olympic Games, Dr. Guttmann - who started the spinal centre - organised the first competition for wheelchair athletes.  This event was named the Stoke Mandeville Games and involved 16 injured servicemen and women who took part in archery. The Stoke Mandeville games went on to become an international competition in 1952 when a group of Dutch ex-service men joined the event.

In 1960 the Stoke Mandeville games became the Paralympics, with 400 athletes competing in the Rome, Italy games. The Paralympic Games have been run next to every Olympic Games since then. That same year an ‘’International Working Group on Sport for the Disabled’ was set up to study the problems of sport for persons with an impairment, this group went on to become the International Sport Organisation for the Disabled (ISOD) and advocated for the inclusion of athletes with a range of impairments to be included in the games. Other groups advocating for sport later joined ISOD and formed the International Co-coordinating Committee Sports for the Disabled in the World" (ICC) in 1982. Seven years later the International Paralympic Committee (IPC) was founded as an international non-profit organisation in Dusseldorf, Germany, to act as the global governing body of the Paralympic Movement.

So how do the Paralympics be inclusive and fair for athletes with different impairments? Classification. “Classification is the cornerstone of the Paralympic Movement; it determines which athletes are eligible to compete in a sport and how athletes are grouped together for competition. In Para sports, athletes are grouped by the degree of activity limitation resulting from the impairment. This, to a certain extent, is similar to grouping athletes by age, gender or weight. Each sport has its own classification system and code that reflects the specific requirements for that sport. Initially classification was medically based on the athlete's diagnosis, but has evolved into a functional classification system. Wheelchair rugby is one of the most popular Paralympic sports and one of the first to develop a robust and evidence based functional classification system.

Wheelchair rugby is played on a court. It is a fast and high impact game and popular spectator sport. A wheelchair rugby team consists of up to 12 players however there are only ever 4 players per team on the court at one time. Each athlete is classified into one of seven sport classes based on their functional capacity. Each class has a number value from 0.5 to 3.5 (0.5 being the class with athletes with most impairment), where the added value of these numbers determines who can be on court playing at any time - the total value cannot exceed 8.0 per team. Over the years that I have been involved in Paralympic sport, I have seen first-hand how hard our athletes train and work to overcome a multitude of barriers; physical, emotional and financial to make the national teams and represent their country. You can find out more about wheelchair rugby at IWRF Wheelchair Rugby Ready the official ruby federations page.

Pool draw for wheelchair rugby at this years Paralympics.

We would like to wish all the Athletes competing this year the best of luck. Follow our Facebook and Instagram pages for updates on our Permobil ambassador competing and general news from the games. We will be closely following and supporting you all.

Tracee-lee has been involved with wheelchair rugby classification in Australia and New Zealand and has been part of international classification panels in Asia, USA and Europe. She also trained in Boccia classification.

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.