Page 21 - Mobility Management, February 2019
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                                                                                                     “But if you are considering the benefit of the tilt feature for an individual, you don’t have to rule out those lower-level chairs,” Pucci said. “Tilt in and of itself, if you can justify that feature as medically necessary, you do not have to rule out a lower-level chair.
“Most people, when they’re trying to justify tilt for an individual, they only think about tilt as being beneficial in providing pressure relief, as a form of pressure relief for skin protection. But there are so many other benefits to having an adjustable seat angle. Adding that little bit of seat slope can help stabilize someone’s pelvis position when they’re foot propelling or hemi propelling so they maintain good postural alignment during their mobility.”
“That’s true during static sitting as well,” Prewitt added. “That little bit of seat slope, especially [for] someone with a kyphotic posture, for example, can be helpful. If you can drop the back of their seat down just a little bit, you can stabilize their posture in that chair a little bit better. Ideally, you might bring their head up a little bit better so they have better visual access to their envi- ronment, and they can see and interact better with what’s going on around them.”
“One of the things we talk about with the ability to change that seat angle is also good head positioning for swallow,” Prewitt said. “A lot of individuals post-CVA have swallowing issues,
so helping them to achieve a head position for more successful swallow could be another justification for an adjustable seat angle. That’s part of the coverage criteria: mobility-related activi- ties of daily living, such as toileting, feeding, dressing, grooming. Feeding is specifically mentioned.”
Getting Everyone On Board
Given its additional benefits, a more fully functional chair might sound like an obvious preference for stroke clients. But that’s
not always the case. Other expectations, including cultural ones, might influence the decision-making process.
For instance, when a stroke patient is older, family members might question how much additional function or independence is practical or desirable. Or family members might feel duty bound to take on more responsibility, such as pushing a wheelchair.
“But if we could get people into better equipment, ultimately how much more access and independence could we give them?” Prewitt asked. “Granted, that family member might still have to be involved with pushing that chair, at least for longer distances. But maybe inside the home, we could give them something so Mrs. Smith doesn’t have to push Mr. Smith around for as much of the day. She only needs to help him when it’s time for transfers.”
“In a lot of cultures, seniors are people that we need to care for,” Pucci said. “We need to care for Mom, we need to care for Grandpa. If they need me to get them from point A to B, that’s my duty to do that. There are a lot of cultures that perceive that.”
“That’s an admirable thing,” Prewitt added. “But the down side is if [the patient] becomes dependent on someone to do that,
and even if that person feels it’s their duty and their motives are perfectly altruistic, it can sometimes be a disservice to those folks and their ability to help with their own rehabilitation.”
Bollinger would like to see a change in how the medical profession perceives stroke patients. “With the elderly/stroke patient, there needs to be an industry shift with regard to independent mobility,” she said. “Nursing home administrators/ therapists must see the value of fitting more individuals with adjustable/modifiable wheelchairs as opposed to standard equipment. If we can provide independent mobility, we will not only improve these patients’ quality of life, but we can also improve efficiency in nursing homes.
“Another industry shift may be to teach family the value
of independent mobility. Often the family is not focused on
the individual’s independence. They might prefer a transport chair due to weight for their own ease. We know that there is a relationship between independence and perceived quality of life. Sometimes families assume that the individual is not capable of independent mobility and do not want to be inconvenienced by the process, size of equipment, transporting equipment, etc.
“Education to the patient and family needs to start at their first appointment. I discuss goals for the patient, family and therapists at intake. I explain the process including timelines for me, the RTS, approval process, ordering, etc. I also use demos to show the difference between independent mobility and dependent mobility as part of the education.” m

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