Page 6 - Mobility Management, May/June 2022

ATP Series
By Laurie Watanabe
A Clinician’s Perspective: An 80/20 Strategy
Seating and wheeled mobility clients are as unique as snowflakes. Each client has unique goals, activities, and priorities... and their functional presentations vary widely, even if formal diagnoses are the same.
That individuality impacts their seating and wheeled mobility. It’s a common Complex Rehab saying that no two wheelchairs are exactly alike. Even when the power wheelchair base is the same, how various components are positioned and dialed in makes every system unique unto itself.
The need for unique power wheelchairs would seem to be a given for clients with amyotrophic lateral sclerosis (ALS). The progres-
sive degeneration of motor neurons that enable voluntary muscle movement eventually robs clients of the ability to walk, talk, swallow and breathe. ALS would seem the perfect example of a condition that needs a “snowflake” seating and mobility approach.
But what if you found enough commonality among ALS clients to home in on the options they most frequently require on their power chairs? If you could anticipate their needs, could you simplify the building and provision process — and get the optimal equipment to these clients faster?
It’s a process that Steve Mitchell, OTR/L, ATP, refers to as creating ice cubes instead of snowflakes.
A Presumption of Service Connection at the VA
Mitchell is an occupational therapist who works as a Clinical Specialist in seating/wheeled mobility and assistive technology for the Spinal Cord Injury & Disorders Service at the Cleveland
Veterans Affairs (VA) Medical Center.
As one of “just a handful,” he said, of VA therapists who are full-
time seating specialists, Mitchell focuses exclusively on veterans with spinal cord injury/disorders (SCI/D) and veterans with ALS. In 2016, he wrote a series of Mobility Management articles on the concept of “Open CRT” — explaining that he’d found enough similarities among his ALS clients to see patterns not just in the seating and mobility they needed immediately, but what they were likely to need as the ALS progressed.
In talking with Mobility Management this time, Mitchell expanded on his “80/20” approach.
His specialization significantly narrows the range of clients
he sees. “The veteran I’m working with is typically going to be a male,” Mitchell said. “They’re going to be roughly 6'0" tall, give or take 3" or 4".” Their weight, he added, usually falls within the same range, “give or take 20 or 30 pounds. We see some female veterans, but we don’t see that many.”
Because most of his clients fall into a relatively narrow size range, “I don’t have to worry about the size of the seat, and there’s enough modularity in today’s designs where you can make those adjustments. So I can really home in on the details. That’s where the big-picture success is, in execution of the details. And there are so many characteristics that my populations have in common that I can really home in on those and address those.”
One fact is well known: On its Web site, the ALS Association states, “Military veterans, regardless of the branch of service, the era in which they served, or whether they served during a time of
6 MAY-JUNE 2022 | MOBILITY MANAGEMENT
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