Page 33 - Mobility Management, March/April 2021

The Negotiation Process
But identifying goals, product choices, and transport- ability is just the first step.
“There is a lot of give and take between Mom/Dad and the therapist,” Tucker said. “We know positioning is paramount — so in my eyes, that needs to come first. That has been our way of doing business since day one. If we can offer all the functions of a wheelchair — tilt, recline, laterals, thigh guides, medial blocks, etc. — on a stroller-type frame, everyone is happy.”
“When I do show families equipment,” Sabet said, “I might say, ‘This fits one goal you told me: This umbrella stroller makes it easy for you to go as a family. But this stroller over here is something your child is more likely
to be comfortable in if you’re out all day because it provides this type of support.’ So it’s letting them see the difference and really giving them the power to be a big part of that decision. Then it’s not necessarily my recom- mendation. It’s ‘Here are these considerations: This is really awesome for your family because you’re on the go. This is really more comfortable for your child and maybe is more beneficial long term because it provides more positioning.’ And then you can have a conversation about that, and it’s very different from coming at it from a standpoint of ‘This is my recommendation; you can accept that or go a different road.’”
“Most — not all, but most — parents are very focused on weight and the ability to transport the stroller,” Butcher said. “This seems to be the biggest concern for them, and we try to dig down into exactly how they are planning on using the device, and what vehicle it will be going in. Sometimes this will push us one direction because of the constraints of the vehicle it must go in. If the ideal stroller won’t fit in the vehicle it must go in, then it really isn’t an option, and we need to find something that will fit and provides the positioning and medical needs required.”
Butcher said appearance is enormously important to parents: “If this is a first-time device, almost 100 percent are concerned with how it looks. They do not want an institutional-looking device that makes their child look ‘handicapped.’ The parents are dealing with a lot of emotions or denial, and how their child appears to others is important.”
On a practical level, Butcher added, “What the device can carry is important to them as well, as they usually are coming into clinic in a baby stroller with a very large boot (basket) underneath that is filled with items. The stroller has become a pack horse that needs to carry a lot of extras. We have had this be the deciding factor between
two equal strollers.”
So what is most important to the clinician, supplier and
manufacturer isn’t necessarily what’s most important
to the family. “Most of the time, the positioning aspects seem to be least important to the parents,” Butcher said. “This is not to say that the parents do not care about how their child is positioned, but it certainly isn’t what they want to address first.”
Reaching a Consensus
Sabet said trying strollers in real-world settings can be helpful in reaching a final decision. “A lot of times, we come into a clinic with a lot of preconceived ideas,” she said. “The way I like to get around that is we do a lot of equipment trials. So if a family is very interested in a stan- dard basic stroller, we often can create an opportunity where they can try that over a weekend, and we will give them a form to fill out: Rate how easy it is to get in and
Most — not all, but most — parents are very focused on weight and the ability to transport the stroller — David Butcher
out of your car, how you felt your child was positioned throughout the day. Were they able to function, were they able to participate? Sometimes that trial really is an eye-opener for families.”
“When there is a difference of opinion on what the family wants and what the team is prescribing, we will usually go through the medical requirements again,” Butcher said. “If the family still wants a device that is not going to be safe/appropriate, we will do several things.”
That includes telling the family the physician won’t approve a medically inappropriate device; offering
to provide an appropriate device via the payor, but helping the family find a more basic device via another funding source, such as a charity, if doing so won’t endanger the child; giving the family time to do their own research; and suggesting the family self-purchase a simpler device and return to clinic if they later want a positioning stroller.
“We try to be resources for them, and we never force them into getting a device when they are not sure,” Butcher said. “We have some families who leave without making a decision, then return once they have had a chance to research on their own or speak with other families.” m
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