Page 22 - Mobility Management, July/August 2021

ATP Series
24-Hour Follow-Through
24-hour postural plan,” she said. “As an old-school therapist, posi- tioning was always part of my treatment plan, and I think thera- pists intuitively do that. But by creating a positioning plan, which is 24-hour postural support, I think it really does draw attention
to the need, whereas it almost seems like it’s secondary now. By saying we have 24-hour postural management, we’re attuned to that. Some kids might have [entered] the pandemic without having a plan in place. This pandemic really drew attention to that.”
Setting up a formal plan could remind the team to check all
of a client’s environments and activities, rather than just the activities happening in the wheelchair. “It’s difficult in many cases to look at the whole picture, especially if we’re seeing such a snapshot of things,” Harkness said. “We don’t see the person in bed most of the time; we don’t see what that looks like.”
A crucial factor to check, Harkness added, is transfers.
“I had issues in [a] long-term care [facility] where I had one person say to me, ‘There’s a problem with the chair.’ I always try to look at the [pressure] wound if I can, and there was a perfect imprint of the shape of the sling on this person’s bottom. That’s not the chair; that’s the sling. So all of those pieces need to be looked at equally, and it’s not always just the chair’s issue.” Harkness said she scrutinizes how clients transfer, because clients who can’t properly transfer onto their sitting surfaces
won’t reap the benefits of that positioning. “I also see the person in their home, and it’s amazing how often there will be some- thing you didn’t think of when you’re doing that wheelchair prescription. I’m dispensing the chair in the person’s home. I often see what that transfer looks like. You can transfer them beautifully in the seating clinic, and then you go into the client’s home, and you don’t have that capability.”
Harkness also picks up clues by people watching: “One of my favorite things to do is to sit and observe. You watch and you see how people shift. And you say, ‘I just saw you shift this way. Why did you do that?’ A lot of times they won’t be even cognizant of what they do or why they do it.”
For people with complex postures, everything matters. “Early intervention is important, especially for our population with cere- bral palsy,” Rhodes said. When we have a fixed windswept defor- mity or pelvic deformity, that affects all our joints surrounding that. So now we’ve possibly introduced non-reducible pelvic rota- tions, hip obliquities and scoliosis or things we can’t get back to neutral anymore... because [they] weren’t lying in bed correctly.” “You do need to look at the whole day, how someone trans-
fers, how they live their life,” Harkness said. “You can’t look at one piece in isolation, because one thing affects everything else. 24-hour is the key.” m
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