Clinically Speaking

Confronting Limitations to Successful Outcomes in Pediatric Seating & Mobility

Despite the preparation, assessment, documentation and intentions of even the most experienced therapist or ATP, there are times we fall short of how we thought our pediatric client would “be” once their equipment was issued. Maybe we took a chance on a new product that did not live up to its claims, worked with a different DME provider or therapist, anticipated a different course of physiological change, or were not involved in the process and recognized mistakes that could have been prevented. By taking a critical look at areas that can limit our success, we can better prepare for these variables, prioritize and place them into a plan to increase our consistency for providing the most appropriate and adaptable pediatric seating & mobility.

Lack of Knowledge

Although I know some DME providers that prefer to work with novice therapists, and I know passive therapists that prefer to have a DME provider call most of the shots during the evaluation process, that does not help in creating the best outcomes for our pediatric clients.

It is important to take a critical look at your skill base and identify areas of strengths and weaknesses to discern how you can better contribute to the evaluation processes. Expand your knowledge of pediatric disabling conditions, how they progress, are managed or treated and how that will relate to your therapeutic goals for seating & mobility. Learn to perform a mat evaluation and to translate those findings into an appropriate positioning plan. Too many times have I seen a windswept deformity “fixed” by a new seating system only to have to deal with secondary effects on the trunk not anticipated by the evaluating therapist.

Expand your knowledge of equipment and how different choices will impact therapeutic objectives. Therapists must know how to maintain and adjust the equipment they prescribe and should not be calling DME providers to make simple adjustments. If the equipment is too difficult to adjust, seek options with more user-friendly hardware.

Know which manufacturers have generous return policies should you need to replace an item secondary to an unexpected change in growth or orthopedic condition upon fitting. Increase your knowledge by seeking a mentor; reading literature; attending CEU courses, professional and trade conferences; and seeking and sharing information with DME providers, therapists, end-users and caregivers through online social networking and message board sites.

Lack of Collaboration

Few things are more frustrating to a school-based therapist than a student coming to school in a brand-new wheelchair that is neither what you expected nor what you would have chosen. This equipment may have been issued by a seating clinic or an outpatient therapist without the school therapist’s input.

Therapists in different settings need to consult with each other prior to the prescription of equipment. They also need to interview parents, teachers, aides, nurses, bus drivers and school administrators. It can be as simple as “We are in the process of getting Taylor a new wheelchair. Is there anything you would like this new chair to do that her old chair didn’t?”

Effective collaboration continues with seeking the most qualified DME provider. It is unfortunate that there is not greater competition and choice for providers specializing in pediatrics. I do not fault the providers; working with pediatric clientele is labor intensive and can be emotionally and financially draining. Develop a relationship with one with whom you can comfortably share ideas, be challenged, debate choices and count on when service is required.

Lack of Evidence

With shrinking funding sources and the approval process seemingly becoming more difficult, evidence-based practice may be more important than ever.

To better prove the efficacy and necessity of products and techniques, there is a need for more evidence, even singlesubject case studies. We need to keep extensive documentation of the impact of seating & mobility systems on baseline functional abilities and changes occurring over time.

We need to be recording how our equipment is performing given the wear and tear of use, with what population it is most appropriate, ease and frequency of modifications, etc. This information needs to then be shared with manufacturers’ representatives and through presentations at conferences, online forums and contributions to trade publications to assist other therapists in their clinical decision-making.

Lack of Activism

Finally, this is a call for more therapists to enlist end-users and join with DME providers to make our concerns known to policy-makers. Let them know who you are by writing and calling their offices often. Stay current on new policy proposals and how they can impact the types of services and equipment you are able to provide your pediatric clientele.

This article originally appeared in the Pediatric Handbook August 2010 issue of Mobility Management.

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