Page 21 - Mobility Management, May 2017

starts with\] demographics, then insurance infor- mation, because those are pertinent, and then diagnosis codes, because that’s going to help us drive funding and figure out what is available
when I’m working with the ATP and insurance.
But then I’ll ask: What are your life goals? What are you doing every day?”
Newly injured clients come to their assessments while still adjusting to their new lifestyles; they may be full of questions. Clients who have lived with SCI for years might be coming in for assessment prior to ordering their second or third chairs; they may believe they’ve already decided what they want.
Merring says the two groups need to be asked
different questions.
“For a first-time user, you have to determine
what they need to accomplish daily,” he said. “What do they need to get done during the day?” For experienced wheelchair users, “You have to
determine what they can accomplish in their current system, and then what more they would like to accom- plish from a new or improved seating system. If we were to get
you a new seating system or an improved seating system, what don’t you accomplish throughout the day that we can help you accomplish if we applied better technology and better fitting and better posture to the
new seating system?”
Answers will vary for a lot of reasons.
The Case for Client Conversation
Josh Anderson, Permobil’s VP of marketing, splits his time between Pasco, Wash. (where TiLite has been headquartered) and Lebanon, Tenn., Permobil’s North American home.
That’s what a brief biography might say.
But dig deeper, and Anderson will add that he spends a
lot of time in St. Louis, where ROHO has been based, because he oversees marketing for Permobil’s power mobility, manual mobility and seating brands. He spends a lot of time on airplanes and regularly travels to Sweden, where Permobil is based.
His medical record would show that Anderson has a C5/C6 incomplete spinal cord injury, and that he’s 6'9" tall. But that’s just a small part of his story.
“Overachieving” in an Ultralight
Anderson has used custom-built TiLite ultralightweight chairs for years (he was VP of marketing at TiLite when Permobil acquired the company). Given his level of injury, is it fair to say he exceeds clinical expectations by self-propelling rather than using a power chair? And that the precision fit of his chair makes a difference?
“Absolutely,” he said. “I think that’s a large part of it. I equate it to scuba diving. Some people are just naturally good swimmers, so they do well at scuba because they just possess great swim- ming skills. Others possess expert knowledge of their equipment and are better divers because they know how to use their equip- ment to their advantage.
“I see myself as the latter. \[Paraplegics\] are like the expert swimmers: They have all the muscle, they move really well, they can push any \[chair\] and do well — that doesn’t mean I want them to push just anything, because there are still advantages to a para having a better chair. It keeps their musculature and physique intact a lot longer. But it really matters to somebody with a higher level of injury, because it’s the ability to push or not to push at all.”
Anderson’s height is a second challenge. Despite his stature, he needs a reasonably low seat-to-floor height to move efficiently
through a not-always-accessible world. As a result, his knees take an unusual position while he’s seated. Anderson knows his posi- tioning doesn’t fit textbook definitions.
Understanding All the Parameters
“It’s understanding all the parameters,” Anderson said. “With somebody who has an injury at my level, with my height — you take those two factors, you put them into
a funnel, and in a year there are maybe a
couple of people like that who are seen by therapists. How do you deal with those extreme cases? How do you combine these things?
“My \[wheelchair\] frame, if we went by
typical dimensions, would be enormous.
How practical is that? We made a chair that
fit to a textbook standard, 90-90-90, yet
I can barely turn around in a wheelchair-
accessible restroom. Combine that with the fact that I travel to places that even in the U.S. may not be completely up to \[accessi- bility\] standards, and it is certainly a different level of accessibility in Europe, and then in Asia.”
Anderson said he discusses finer points like those when he talks to new therapists.
“As a clinician, you know the textbook standard, you know the anatomy, you know how to do a mat assessment. But you need
a line of questioning with everyone, even if they’re 5'8" and 160 lbs., which is the standard size for an average male. Still, ask what they do and want to do.”
As an example of how much wheelchair users can vary, and how important it is to know those differences, Anderson recalled a friend who is a wheelchair user — and a welder. As a result of flying sparks and metal shavings, he frequently got flat tires. So his seating team fitted his chair with solid tires.
“I’ve never used solid tires,” Anderson said. “But because of his environment, we did something a little different for him.” m
Josh Anderson
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