Page 30 - Mobility Management, May 2017

ATP Series
Justify It: Power or Manual?
Continued from page 23
A Boost from Power-Assist
In the question of power vs. manual mobility, power-assist systems for ultralightweight chairs can offer a sort of hybrid intervention, while possibly broadening the population of wheel- chair users who can self propel.
“Power-assist is becoming more prevalent, for good reason,” Merring said. “I consider power-assist at every assessment, even as low as initial injuries at T3-T4. If you think of where T3-T4
is, that’s the nipple line. Think of folding over, where you have muscle on top and paralyzed muscle underneath: You’re kind of folding in the middle. So postural strength is very compromised, and then because the postural strength is compromised, bilateral upper extremity is very compromised as well.
“As you bend in your thoracic spine, you collapse the space between your scapula and your ribcage. If you collapse that space, you are inhibiting the ability of the scapula to do upward rotation. Basically, kyphosis causes an impaired joint that allows for a lot of impingement to happen. If your muscle below T3-T4 doesn’t work, you’re already pre-dispositioned for a non-optimal shoulder propulsion.”
Enter the power-assist system, which Merring said he considers whenever he’s thinking about recommending an ultralightweight chair, regardless of the potential user’s age or shoulder history.
Merring said of power-assist, “Can I get this ahead of time
to decrease the demand on the shoulders and also improve the ability for this person to go longer distances for longer times? It definitely crosses my mind for each evaluation.
“A lot of the \[younger SCI patients\] that I see \[in clinic\] are college students. They have to be able to get from one class to another relatively quickly. They’re trying to manage phone calls, they’re
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30 MAY 2017 | MOBILITY MANAGEMENT
propelling, they’re carrying backpacks. Any sort of device that saves the physical demands and exertion, and allows them to be more functional, should be brought to the table during the evaluation.
“As the technology continues to get better and smaller and hopefully cheaper — reimbursement also sometimes comes down to the costs of things — hopefully, power-assist becomes more reimbursable. And as the evidence shows that someone who pushes 2,000 to 3,000 times a day can, without a doubt, be assisted in maintaining their shoulder integrity and postural integrity and be more functional and give back into society, we should start to see more chairs \[using\] it.”
What Is the Better Option?
Manual and power mobility have their strengths and weaknesses. Ultralight chairs undoubtedly have an easier time fitting into smaller everyday spaces indoors and into cars; power chairs conserve a consumer’s energy and offer powered positioning and pressure relief.
“Every decision starts with that person and what their MRADL needs are specifically,” Merring said. “That’s what’s going to drive your decisions, ultimately. What do you need to do the majority of the time?”
Merring acknowledged that choosing a power chair can make transportation plans more complicated, and he said that as a rehab director, he made sure to provide new power chair users with resources, such as community transportation options. “The worst-case scenario is we give them a power chair for home, and, because that’s all their funding will cover, they buy a hospital chair to go to doctor’s appointments,” he said. “That’s the worst- case scenario.”
But despite those potential inconveniences, he said he would recommend power mobility if it was the better choice overall.
“If \[using a manual chair\] is really compromising function and compromising health, and the medical necessity is there for power, I’d much rather be the advocate for power so the mobility isn’t sacrificed, and function isn’t sacrificed, and pressure relief isn’t sacrificed,” he said.
Because deciding between manual and power mobility is such a critical decision, Merring said he encourages the seating and mobility team to take the time needed to gather all the informa- tion they can.
“When I do my evaluations, I do a 90-minute evaluation the first time, and I try not to put any pressure on myself or the patient or the ATP to make all our decisions that day,” he said. “We’ll bring \[the client\] in, we’ll do the initial evaluation. If
it takes 90 minutes just to discuss what the problems are and what the current chair is, and we only do a measurement, that’s perfectly fine with me. And then I bring them in for a second and third visit and start getting some of that other information.
“Don’t feel like you have to do this in one day. Ask the tough questions. Have a conversation with the person. And know that there’s no one specific formula for \[finding the right answer\], just trial and error.” m
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