Confronting Limitations to Successful Outcomes in Pediatric Seating & Mobility
- By Elizabeth Stevens-Persing
- Aug 01, 2010
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.