Page 18 - Mobility Management, April/May 2020

ATP Series
Setting Up a First Ultralight
being level and draw them out,” Richard said about initial meet- ings. “That was always my first job, to go meet the person, even
if I didn’t have a demo chair. Most of the time, I wouldn’t even bring a demo chair the first time. I don’t know this person yet; why would I bring a demo? I would just get to know them a little.
“I could say, ‘How are things going so far?’ Just talk to them as a human being, peer to peer, not as a patient. That opens chan- nels. It also helps that I was in a chair; I’m not going to overlook that fact. Because they can look at me and say, ‘This dude’s had to walk the walk, so to speak. He’s done it.’ And they’d ask me about things, and the channel was open just a little bit.”
Richardson used those openings to gather info on what the optimal chair for that client could be like. “I’d say, ‘You got injured riding a motorcycle?’ or ‘You were injured riding a horse?’ Whatever it might be. It gave me a little insight into their psyche and what they were involved in. You just try to get to know them: ‘What kinds of things do you like to do? What’s your environ- ment at home like?’ Then you start to get in your mind, ‘Okay, maybe I’m thinking these demos and see what the PT thinks as well’. So you’re a little more focused when you do actually start to work with them. You’ve already got a little rapport. For me, that was important. If I had the time to do it that way, that’s what I really liked to do.”
Learning & Predicting vs. Guessing
Angie Kiger, M.Ed, CTRS, ATP/SMS, Clinical Strategy & Education Manager for Sunrise Medical, acknowledged the chal- lenges in fitting someone for a first wheelchair.
“You’ve got to think about diagnosis and about age,” Kiger said. “The first [type of client] that most people think will end up in
a K0005 chair would be somebody who has a spinal cord injury that leaves them paraplegic. That’s pretty common.
“It gets a little bit stickier when you’re attempting to determine the best K0005 when you move up to a cervical level spinal cord injury when they’re a quad. There are plenty of functional quads who propel ultralights and aren’t in power chairs. It’s looking
This industry is so much more about the person than it is about the technological aspects of a chair
— Todd Richardson
at the level of injury in trying to ‘predict’ — and I say that in
air quotes because it’s hard to do — how they are going to get through and thrive or maybe not thrive post injury and rehab. Some of it can be looking at their social and emotional history, meaning beforehand they were more sedentary and they were content to hang out and play video games with their friends, versus the kiddo, teenager or adult who was the athlete or serving our country in the military or was extremely active.”
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Improvements to trauma medicine and spinal cord injury treatments can also be a factor.
“You want to know how far they may come and how fast
they may come in the recovery process and with their muscles regaining function,” Kiger said. “You have to think about complete versus incomplete injuries. It used to be many years ago, people would talk about completely losing function and not feeling anything below their legs. When you watch TV shows, it’s like that: all or nothing when it comes to function. That’s
not how spinal cord injuries work, unless [the spinal cord] is completely severed or there’s some sort of complete insult that’s happened in the injury process.
“I think now with the life-saving techniques that we have and being able to preserve and hopefully prevent the spinal cord from being completely being severed and having a complete injury, we’re seeing more and more of ‘I don’t know how this is going to go because you are considered to have an incomplete injury, but you may be able to do a stand-pivot transfer, or you may be able to ambulate some.’ There are a ton of factors.”
Adjustable vs. Fixed
Kiger said she once asked an audience of therapists their greatest fears when recommending a client’s first ultralight chair. “They said they don’t want to mess it up, because the person’s stuck with the chair for five years,” she recalled. “It’s scary.”
One way to cope with that fear of failure is to choose a chair that offers some adjustability.
“I like to know all the ins and outs of adjustability, because
I need some leeway,” Kiger said. “It’s figuring out which wheel- chair has the most adjustability. The hard part is when you
start talking about rigid versus folding. We as an industry have camped out with the notion that of course, it has to be a rigid chair. It’s got the best ride and energy transfer. However, we also have to think about growth, meaning [the client becoming] bigger or smaller. What can be changed? Do I need to be able
to change their center of gravity as they get a better sense of balance, or am I worried about them gaining or losing weight once they’re discharged home?”
Kiger likes to collect information on any possible need for adjustability.
“Ideally, if it’s an in-patient setting, talk to other therapists,” she suggested. “Find out how [the client is] seated and positioned while they’re eating their dinner; ask the nursing staff what they look like, because dinnertime is after they’ve potentially had a long day of therapy. Maybe it’s ‘I can’t even push myself to the group dining room because I’m just too tired.’ Or they’re extra tippy or off balance other times of the day.”
And Kiger recommended teaming with manufacturer reps to learn the fine details of each ultralight frame and system.
“I think a lot of people don’t realize that manufacturers have different frames and such for a reason,” she said. “You’re going to have different adjustability, potentially, with different models of wheelchairs, even though they’re by the same manufacturer.
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