Page 20 - Mobility Management, July/August 2021

ATP Series
24-Hour Follow-Through
open seat-to-back angle, and they’re supported, but in a kind of relaxed position. But when you think about what position you require for the process of elimination, the posture is more flexed. So our traditional shower chair doesn’t necessarily translate over to a toileting system. Firefly just came out with a toileting system [GottaGo, which provides ‘supported squat’ positioning] that incorporates these positions. It’s looking at the different activities and what the need is for those activities — certainly providing all that support in body-neutral positioning, but also what is required to do that activity.”
24-Hour Support for Alternative Positioning
Sometimes, the goal is not to emulate wheelchair seating while out of the wheelchair, but rather to achieve another clinical benefit altogether.
“Currently we’re trying to get children into hip abduction, when we stand them to try to develop that hip socket, the acetab- ulum,” Bollinger said. “We’re offering up another position. We’re
trying to develop the hip with abducted standing to prevent orthopaedic issues down the line. If we can get a good hip socket, we can also hopefully prevent that hip dysplasia that comes sometimes with kids that have overlying neurological issues.”
“We know that bones of young children are soft and moldable, and we also know that an undeveloped acetabulum is more shallow than a developed one,” Rhodes said. “Upright standing without abduction does not deepen that acetabulum adequately, making the femoral head reliant on soft tissues to hold the large joint in place.
“We see children with cerebral palsy born with very typical hips. It’s lack of weight bearing, it’s fluctuations in tone that so often cause the dislocated hips we see at an early age due to a shallow and hardened acetabulum.”
Creating a 24/7 Positioning Plan
Bollinger believes 24-hour postural management should be a formal part of the seating team’s strategy.
“I want to express the value of alternative positioning as part of a
Funding for 24-Hour Posture Management
While there are many benefits of managing posture 24 hours a day, getting funding for this equipment can be a challenge.
“There are frustrations over preventative measures with some funding sources,”
said Ryan Rhodes, MS, OTR/L, ATP/SMS, Pediatric Sales Specialist for Leckey at Sunrise Medical. One example: “Some won’t pay for a cheap shower chair for our elderly population because third-party funding does not find it medically neces- sary. But they’ll pay $100,000-plus for surgeries, hospital stays, therapy and home care when [the client] falls and breaks a hip.
“Same thing with postural supports.
If we’re only sitting them in a beanbag
or a chair, five years from now, we
could be doing full-on spinal surgery
with Harrington rods, or we may have a permanently dislocated hip that we now have to manage with pain medication and palliative care, which is not cheap and that we could have avoided with a $2000 piece of equipment 10 years ago.”
Rhodes recalled working as an occu- pational therapist is Louisville, Ky., when “we were very blessed with what was funded. When a kiddo came in, I would write a letter for a new mobility piece of equipment, some sort of specialty bed with a specialty mattress, a car seat if necessary, a bath chair, a standing frame, a gait trainer, an activity seat — all of it for
24-hour positioning.
“We’d talk about activities of daily living,
bathing, toileting. ‘Mom and Dad, how are you doing with these transfers? What can
I help with on that?’ All while looking into the future with the lens of avoiding further complications to improve quality of life.”
Matching the Optimal Equipment to the Activity
Linda Bollinger, PT, DPT, ATP/SMS, Pediatric Sales Specialist for Leckey
at Sunrise Medical, said some payors question the need for multiple pieces of positioning equipment.
“We’re challenged by funding approving all these devices,” she explained. “‘Do you need a stander and a gait trainer?’ Well, yes: For standing, we want to try to develop the hip, and we’re looking to try to elon- gate, and with a gait trainer, we’re trying
to increase functional gait and ambulation. They’re not mutually exclusive. Funding is sometimes also a challenge for bath seats, the Sleepform [sleeping] system, toileting systems: ‘Why do you need a bath seat and a toileting seat?’”
Bollinger said she still recommends the equipment she believes will best serve the child. “Every funding source is different, but as a therapist, I recommend what they need and let the chips fall where they may in trying to get funding,” she said. “Look
for alternative funding: Is there a waiver, is there a great aunt who can pay for it, is there a fundraiser?
“I think sometimes therapists are reluctant to recommend so much equipment, but if we make those clinical recommendations and then address the funding afterwards, I think the outcomes are better. If the therapist is comfortable with the seating system being the same in the mobility base and the activity [base], then that works out. But if they’re looking for two alternatives — so in the mobility base, I want this to be achieved, and in the activity seat, I want this — then that might be a challenge. That’s for the clinical team to decide. Are they looking for multiple [pieces of equipment] because they’re trying to achieve alternative positioning? Or are they looking to have that same position and consistency? It just depends on how they’re approaching each child. Every child has different needs.” m
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