Page 12 - Mobility Management, July/August 2022

ATP Series
CRT in the Classroom
Benefits in the Classroom
Jessica Presperin Pedersen, OTD, MBA, ATP/SMS, Director of Clinical Education for Sunrise Medical North America, noted multiple benefits to using specialized seating in classrooms.
“Modular seating and activity chairs in the classroom allow children to benefit from optimal posture, which in turn opens access activities within the class during the day,” she explained. “These seats enable function for interaction, learning and fun. The child can be integrated with peers, and they can enjoy all of the same activities as their peers.”
The goals of specialized positioning are many, she added. “A floor sitter will provide support for a child, allowing inclusion in reading circles, where the children gather on the carpet to read stories. The child will be able to interact with other children in various floor-play activities, such as cars, trains, or ball play. A stander will bring the child to another level of play for going to the board, standing with peers and interacting. Positioning-wise, the child is able to have hips and knees in a different position than when sitting in the wheelchair. Weight-bearing activities are often promoted by therapists. Evidence shows that physiological benefits include enhanced breathing, digestion, and elimination.
“A system that incorporates a bolster might be used to reduce tone and stretching while encouraging enhanced trunk exten- sion. This may increase reaching activities.”
Fostering Clinician Communication
Angie Kiger, CTRS, ATP/SMS, Portfolio Marketing Manager for Permobil Americas, and Amy Morgan, PT, ATP, Principal Product Manager, Permobil Power Mobility, said questions on CRT used in schools arise from the very start of the procurement process.
“According to the Individuals with Disabilities Education
Act (IDEA), assistive technology services and devices used to maintain or improve a student’s function are covered and should be paid for under a school-based model, and CRT can absolutely fall under that,” Kiger said. “Then there’s also the medical base [of funding], and unfortunately, a lot of people don’t under- stand that. The school therapist will say, ‘I thought you went to Cincinnati Children’s [Hospital, as an example] to get that,’ and vice versa. But the reality is, the school therapist and the clin- ic-based therapist, for ideal outcomes, need to be in communica- tion. That doesn’t always happen, for a variety of reasons.”
Morgan added, “Both [school and non-school] therapists, generally speaking, want to have input into equipment decision making. But they don’t often have direct access to one another. It’s all through the family. So you’re really dependent upon this third party to connect the two to have that conversation.
“The school therapist finds out the kid was evaluated for a new wheelchair a week after the evaluation, and the parents say, ‘We went to Children’s [hospital] and got the evaluation for the wheelchair.’ The decision had already been made, and maybe it’s connecting to what the school therapist would have recom- mended, but maybe it’s not. So that becomes challenging.”
When she worked in a wheelchair clinic, Morgan said she “made many efforts to get school therapist input, specifically during our intake process” and asked parents for school ther- apists’ letters of recommendation that would include their concerns and goals for the child.
“But that rarely happened,” she said. “Maybe they scheduled their appointment in the summer, and they weren’t in school. I wish there was a good solution for this. If we could find a good solution, it would be mutually beneficial.”
Kiger noted that telehealth options could be helpful in bringing school and clinical therapists together. “It is common
in more rural areas for the school therapists to be tasked with leading the wheelchair provision process with the assistance of
a CRT provider. In some cases, a child may travel on an annual basis for specialty services, such as muscular dystrophy clinic, where a wheelchair evaluation is part of the visit. This can be
a double-edged sword, because while the child may have the opportunity to work with professionals who specialize in seating and mobility with access to various equipment to try, those specialists do not have insight into the child’s day-to-day life like his/her school team [does]. This type of potentially sticky situa- tion can happen even if the child’s school is within five miles of the wheelchair clinic. As with most things in life, communication is key. Both the school-based therapist and clinic therapist are dependent upon the family to bridge the communication gap.
“The good news is with the increase in telehealth, there is even more potential to bring folks who cannot attend appoints in-person to participate. Would a school system support that? I’m sure there would have to be all sorts of releases, but for the school therapist: Maybe they can’t leave during the day, but maybe they could telehealth in and be there for the evaluation.”
Pedersen agreed there can be strength in numbers when creating optimal outcomes for a child. “The outside-the class- room clinicians, specifically the seating therapist, appreciate getting input from the classroom therapists and teachers,” she said. “Knowing the activities that the child engages in, as well as the therapeutic goals, helps with the recommendations. In many cases, there is a time conflict that the classroom staff is unable to attend in-person, but with the inclusion of telehealth, it is easier to incorporate others into the evaluation.”
Who’s Paying for This?
Funding, always a complicated issue in CRT, gets even more muddied when the school’s obligations are added in.
“It’s tricky to know the different Medicare or different Medicaid [policies] for every state and all the private insurances,” Kiger said. “Every school system’s budget is different, too. So you get another thing that goes into that mix.
“I have had PTs and OTs that have said, ‘I would love for the child to be able to drive a power wheelchair, but I can’t bring that up during an IEP [Individualized Education Program] meeting.’ Because they have been told the way that school system inter- prets the IEP process is that if it’s said during the meeting, and
12 JULY-AUGUST2022|MOBILITYMANAGEMENT
MobilityMgmt.com