Positioning Priorities: An ATP Supplier's Perspective

child profile looking down

SAD CHILD: DEPOSIT PHOTOS/ZURIJETA

Mobility Management asked Brian Perkowski, CRTS, ATP, Branch Manager of National Seating & Mobility’s Wall Township, N.J., office, how he prioritizes the many different positioning needs a Complex Rehab seating and wheeled mobility client can have.

Q: How do you determine what functions the seating system needs to achieve? Do you start with a list of functions that all wheelchair users need, then add more specific needs (e.g., head positioning) according to each specific client?

Brian Perkowski: It’s extremely important to listen to the client and caregiver for direction as to what functions their seating system will require. Understanding their goals is critical for a successful outcome. Incorporating their goals, therapist and physician recommendations, and supplier knowledge of product ensures the end user has a comprehensive seating system that provides support, is aesthetically appealing, and most importantly, meets their functional needs.

Q: All positioning goals, from preventing pressure injuries to supporting transfers, seem vital. But building a seating system is often give and take. How do you prioritize?

BP: Prioritizing goals is no easy task, but again, listening to the client often provides clues as to what is most important to them. Professionally educating the client through the use of demo or trial equipment, historical experience and the use of technology via pressure mapping or 3D scanning may help to guide a client towards making a decision that the entire complex rehab team is comfortable with for the seating system.

New wheelchair users and their caregivers, regardless of age or functional and cognitive ability, tend to refer back to the therapist or ATP to assist in deciding on proper seating systems, as their understanding of their needs and products is new and developing. However, more experienced end users will often come to the evaluation with an idea, and sometimes a very specific idea, of what it is they are looking for in their seating system.

My experience has shown that changing a cushion for someone that has used a particular style or brand with good results for five to 10 years is often not a good idea. The Complex Rehab seating teams that I work with always provide education on new products so that all options are on the table.

Q: Can you think of situations in which other circumstances impact your prioritization? For example, if you’re seating a young child, cognitive, social and emotional development are crucial.

BP: Considering social and developmental goals for all clients, especially in pediatrics, is very important. Designing a piece of equipment that meets functional needs and provides the ability to be the most barrier-free primary means of mobility for a young child can be the difference between full inclusion at recess or sitting off to the side.

Another point to consider would be what I call “customer buy-in.” If the customer doesn’t like the product, for any reason, they are less likely to use it. It seems like common sense, but sometimes we might try to recommend a product that the client is just not fully on board with yet.

In our professional minds, we justify the end result, but non-use is a failure to all. This carries over to the caregiver, especially with clients who are dependent. A home environment that is not set up for an appropriate, but very large, heavy, and bulky piece of equipment can result in non-use and actually create a situation where the client is in bed more often than in their seating system, resulting in contractures or other medical issues.