Page 20 - Mobility Management, April/May 2020

ATP Series
Setting Up a First Ultralight
in their vehicle, no matter what we think clinically. It’s kind of balancing our clinical judgment with what their functional and practical needs are with their family.”
Depending on the client’s functional abilities, a folding frame’s features might make more sense, Cordero added. “I’ve had post- polio patients who were ambulatory, but now they’re in their first manual wheelchair. I’ve had them prefer the folding because they can fold it, they can pop the casters up and roll it in the backseat behind them. A lot of my spinal cord patients want that rigid because they want to lift up and over. So what’s making them the most independent? What kinds of transfers are they working on?
“Someone who’s doing a nice and easy pop-over transfer might be great with a fixed front end. Someone who is working on weight bearing or has the ability to weight bear and that’s a goal for them, they may want a swing-away front end, which is more common with folding. There are very few rigids with a swing- away front end anymore. They may want that style of footrest
so they can move that footrest out of the way and work on their transfer as opposed to coming up and over a rigid footrest in front of them.
“We have stroke patients that can qualify for a K0005, but they are stand-pivot transferring. They need that safety of those footrests out of the way to come up and forward. Some of that [determination] is also the mechanism of injury that is causing these people to need the wheelchair.”
Person vs. Injury
The common denominator in building a successful ultralight chair — whether it’s a client’s first chair or fifth — is treating each case like the individual one that it is.
“Every eval should start with a thorough mat evaluation and
a history of what was the mechanism of injury,” Cordero said.
“If we’re talking about spinal cord patients, what happened? Or someone with post-polio or spina bifida has maybe been ambu- lating, but now they’re in their first chair. Or a pediatric patient. It’s definitely starting with a good mat eval and getting a good history on what was their presentation before they came into our clinic requiring that wheelchair? What was their body like? We might see a spinal cord patient coming in saying, ‘I was 30 lbs.
We say this isn’t a hit-and-run, this isn’t a drop-and-go. You now have a relationship with us, and we are going to work with you as you’re changing — Lisa Cordero
heavier before this happened.’ What historically is their growth or their weight and management of that?
“My best practice is I always make sure we do a thorough mat eval and take measurements and then talk about what were they
20 APRIL-MAY 2020 | MOBILITY MANAGEMENT
doing prior to this. Were they active? What activities were they participating in? Just try to encourage a conversation about what their goals are, if they’re at that point to think about that.”
Cordero also reassures new clients that she’s with them for the long haul. “Right now, someone may need a higher back because of balance. But we try a shorter back, we try a higher back, and they feel more comfortable with a higher back; their stability is better. But part of that conversation is ‘You’re not locked into this back for life.’ We say this isn’t a hit-and-run, this isn’t a drop- and-go. You now have a relationship with us, and we are going to work with you as you’re changing. As your life and your goals change, we can work with you to make the chair match what those goals are.”
Kiger advised, “Try not to come in with product biases, though it’s super hard. Everyone goes in with a bias, because we know what’s worked: ‘Oh, this reminds me of So-and-So from five years ago, and he did really well with XYZ type of chair.’ I do my best to be as open minded as possible.”
Richardson, who has been on the other end of the assessment when he was newly injured, emphasized that among all the measurements and tech talk about folding vs. rigid frames, the seating team can’t lose sight of the person in the middle of it.
“The guys on their second, third, fourth chairs are typically going to give you a lot of information on what they hate about their chairs and what they love about it,” he said. “But that first chair is so important because it really does help shape that person’s recovery. It’s a big deal. And at the end of the day, it’s about a person. It’s not about an injury, it’s about a person and melding equipment to their lifestyle and goals.
“I hear all the time, ‘He’s a T4.’ No, he’s a human being with a T4-level injury. I think that’s an important distinction to make when you’re looking at a client and speaking with a client.”
That client, Richardson added, needs to be at the head of the team.
“The patient, ultimately, is the director of that team,” he
said. “It frustrates me when a PT or an ATP thinks he or she’s the director: ‘I know mobility, this is my role.’ It’s true, they’re critically important pieces of it, and the patient wouldn’t exactly know what to do without them. But at the end of the day, you empower that patient and you set a precedent in that patient’s mind that they’re in control.
“When you go in for surgery, you’re completely out of control there. The medical staff takes over. But it’s an important step to regain that control and feeling like, ‘Okay, I’m taking charge of my life.’ It’s important to involve them, and when you do, that first chair a lot of times is not the hated monster. It’s a team approach on spec’ing out a chair. We each have our strength in making the best decisions as a team, but ultimately the client is the decision maker, in my opinion. Then when people compare the first one to all their other chairs later on, chances are yes, it will be their least-favorite chair or their starting point. But it will be less of that monster, for sure.” m
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