Page 15 - Mobility Management, May 2019

Choosing the Best Path
With all the various options for alternative drive controls, what is best for an ALS client? According to Rotelli, that really depends on the individual client because as she stated, not “every ALS
What happens a lot of the time, especially when you’re dealing with ALS clients: They’re using a joystick that is configured for a different population — Gabriel Romero
patient takes the same path. But I am not a fan of a standard head control for a patient with this diagnosis. We are always trying to set up systems that can cause the least amount of fatigue.
“We like to separate the controls so there is a resting compo- nent built in. The greatest challenge is keeping up with the technology needs. No matter how the drive control might change, how can we maintain the ability to access seating for position changes, communication, computer and phone access,
even when a patient may have only one consistent access point?” This again underscores the importance of using adaptive
controls, which can be fine tuned to a client’s unique needs. Norton, for instance, explained, “There are clinicians who will go straight to a switched driving system. Looking at the patient’s
history and ‘Where were we six months ago, where are we now?’ can give us a better idea of how fast we’re progressing. So sometimes clinicians will say, ‘You know what? Let’s just go ahead and go to a switch system because even if we put a head array on, we’re only going to use it for a month and then we are going to be at the switched system anyway ... There are times where we go ahead and go to what would be considered the most advanced or the most customizable option. Just because, yes, we know that they’re going to get there really soon.”
The alternative driving controls that support a seating and mobility plan for ALS clients are not necessarily specific to that population. Norton said, “These same types of recommendations are the same pieces of equipment that are utilized for a wide variety of diagnoses. The difference with ALS is the progressive nature of it, and so you have to be ready to adapt ... The equipment is the same; the progression is what you have to watch out for.” m
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