ATP Series

Taking the SMS Exam

RESNA's Specialty Certification Recognizes the True Seating & Mobility Expert. Are You Up to the Challenge?

SMS ExamIt’s designed to measure and recognize precisely what you’ve dedicated your career to: the science and art of seating & mobility.

It’s difficult to encapsulate all the talents and skills required to create a mechanical means of independence, movement, exploration, learning and socializing for people with the most severe physical disabilities. It’s even more difficult to distill all those qualities into an exam that can be administered by computer. But it does separate seating & mobility experts from various other assistive technology professionals, such as those who specialize in communications, computer access, adaptive automotive access or universal design.

And it’s also an exam that can polarize — with some embracing it as much as others dread it.

A Certification of Your Own

The Seating & Mobility Specialist (SMS) certification is offered by the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA), which also offers the broader Assistive Technology Professional (ATP) certification required by Medicare, among other payors, for certain types of mobility equipment.

Eric Nepomuceno, RESNA’s certification manager, and Andrea Van Hook, the organization’s communications & marketing manager, say the SMS exam debuted in 2009, and currently, “There are 122 active SMS certificate holders in the U.S. and Canada.”

While that number may seem small for an exam now in its fifth year of being offered, Nepomuceno and Van Hook tell Mobility Management, “RESNA anticipated from the beginning that this would be a smaller certificate program than the ATP, because it is an advanced exam for a specific niche of assistive technology, essentially complex rehab/seating & mobility. That being said, the number of new SMS exam takers has risen over time, and last year (2013) was the largest year in terms of people obtaining their SMS.”

People in very different fields of assistive technology expertise can qualify to take the ATP exam. The ATP application’s list of “Most Relevant Academic/Professional Training” includes such diverse possibilities as audiologist, attorney, biomedical engineer, counseling, nurse, orthotist, psychologist, rehabilitation engineer, social worker and speech & language pathologist. Assistive technology practice specialties on the application include hearing, vision, transportation & driving, orthotics, prosthetics, employment & workplace modifications, and tele-rehab & tele-monitoring, in addition to the seating, positioning & mobility designation most familiar in this industry.

Nepomuceno and Van Hook say the SMS exam “is an advanced exam for a specialty area, whereas the ATP is designed as a broadbased exam that establishes a basic body of knowledge and expertise in assistive technology.”

And they add that the SMS has “significant support within the industry, particularly from [the National Coalition for Assistive& Rehab Technology] and others involved in complex rehab. It’s important to note that the SMS is not a requirement for [the Centers for Medicare & Medicaid Services] or insurers. However, certain providers who work with complex rehab patients have begun to state a preference for an ATP/SMS-certified professional to perform assessments. We are also finding that professionals who specialize in this area are eager for an advanced certification, and find obtaining their SMS certification very worthwhile.”

What’s in the SMS Test?

The ATP exam has 200 questions in a multiple-choice format on a wide array of assistive technology topics, including augmentative communications, electronic aids to daily living, computer access, recreation, and yes — seating & mobility.

The SMS exam has 165 questions and includes “pictures and videos,” Nepomuceno and Van Hook say.

Think of those “pictures and videos” as case studies, say several ATPs who now have the “SMS” certification after their names.

John Phillips, senior market & training manager for Ottobock Mobility Solutions, is one of the most recent ATPs to add SMS to his résumé. Phillips says the exam “was pretty much what I expected,” and added, “A lot of case stories needed to be dissected and evaluated to determine the best solution for the client.”

Angie Kiger, M.Ed., CTRS, ATP/SMS, clinical education specialist for Sunrise Medical, had a background in recreation therapy when she took the ATP exam in March 2004. When she sat for the SMS exam in September 2013, she was ready for those case studies.

“One of my friends took it a year before I took it,” Kiger says, “and she said, ‘Be prepared: They’ll show you images, and you’re going to have to imagine having your hands on that client. Basically, ‘You have a client who presents with [a clinical description]. You can do one of these four options. What would you do?’”

Kiger’s next comment is good natured, but factual: “So you find yourself sitting at the computer, reading that scenario and putting yourself in that posture while trying to figure it out. All my friends who’ve taken it have said that: ‘You’re squirming in your chair in an attempt to get into that pelvic obliquity….’”

Developing a Preparation Strategy

Everyone who’s sweated out finals week in college has a test-preparation strategy. The difference may be that in a college course, there’s an assumption that the material on the test has been covered, probably thoroughly, in lectures and labs during the semester.

With the SMS exam, ATPs may be asked about specific diagnoses, prognoses, client demographics and technology choices that they don’t work with on a daily basis — and haven’t for years.

Julie Piriano, PT, ATP/SMS, is director of rehab industry aff airs for Quantum Rehab. She took the ATP test in 1997 and the SMS exam “soon after it was made available, as I firmly believe it is an important step in the right direction for the professionals who practice in this area of assistive technology.”

She recalls of the exam, “My impression was that it was very comprehensive. While clinicians may feel the exam is focused on the seating and wheeled mobility technologies, and providers may have the impression that it is heavily weighted on diagnoses and the physical/functional evaluation, the reality is that it is all of those. This is no different from the analysis and synthesis of information, outcome assessment and follow-up that occurs in the team approach to the provision of seating and wheeled mobility solutions and should be familiar to those who are actively engaged in this process.”

One of the most challenging aspects of the SMS exam is — much as in the real seating & mobility world — the candidate may find himself or herself staring at images and videos of a type of client presentation that he or she doesn’t specialize in.

“They have a plethora of questions that the computer just picks from randomly,” Kiger says. “My test is not going to look like the person’s taking it beside me.”

She adds that her particular version of the exam seemed to have “more adult questions than pediatric” and a lot of content related to power mobility: “You have to know a lot about the different controls, like why you would use a certain control. Would you do proportional, would you not do proportional, or would you switch it? You have to have a lot of hands-on experience to pull from the multiple seating evaluations that you would have done.”

Having anticipated questions about adult clients, Kiger says she brushed up on backgrounds for “spinal cord injury, ALS, CP. I made sure I had all my terminology dusted off for that: You would need to know what a [Gross Motor Function Classification System] level 5 looks like. And knowing what is going to be impacted if somebody ends up with a C5-C6 spinal cord injury: What is that going to look like? How are they going to present? Understanding that is key. As a disease progresses, how is that person going to present?

“[Where] people get hung up is [the exam] pulls up random things that you don’t use on a daily basis, so it’s ‘I’ve done this before, but let me think.’”

In addition, there are basic resources that the ATPs reviewed prior to the SMS exam.

“The RESNA position papers and the AT Journal are a wealth of information and research relevant to what we do,” Piriano says. “While it wasn’t available at the time I sat for the exam, I also believe the new Clinical Application Guide to Standardized Seating Measures and the Glossary of Terms and Definitions for Wheelchairs and Seating will be tremendous resources for those who are studying for the exam.”

Kiger says she “took the University of Pittsburgh/Mark Schmeler’s online class. I took that as a refresher. That wasn’t specifically directed at the SMS, but it was a good general review.”

She adds, “I used a lot of resources listed on RESNA’s Web site.”

RESNA itself suggests a collection of recommended resources at resna.org/certification/sms-exam-preparation-resources.dot.

“I re-reviewed Cook & Hussey [Assistive Technologies, Principles and Practice],” Kiger says. “There were a few chapters on seating that I went ahead and read. You can rent the book now, so I rented it and read it. And my favorite thing to do with Cook & Hussey is to skim the chapter, then go and try to answer the discussion questions at the end of the chapter, and then search for the answers.”

She also suggests taking advantage of opportunities to read or listen to case studies of complex rehab seating & mobility consumers.

“I might recommend reading up on case studies, the sort of ‘What would you do?’ sorts of things,” Kiger says. “I wish I would have gone back and read more [National Registry of Rehab Technology Suppliers] case studies just because it’s fun to see what other people do, but also it’s a way of making you think: ‘What would I have done?’ and ‘OK, it works because of this.’”

Piriano suggests the best defense for the SMS exam candidate could be a good offense: “As a first step, I would recommend complex rehab technology professionals who are considering sitting for the SMS exam know the eligibility requirements (see sidebar), assess themselves using the readiness tool on the RESNA Web site, and prepare for the exam in areas where they may not feel proficient. This is important, especially for candidates who have specialized in a niche area of seating, positioning and mobility, as the SMS exam focuses on the knowledge, skills and tasks across a best practice model regardless of payor, setting or service delivery model.”

What to Expect on Exam Day

Gone are the days of flying into a conference or tradeshow, attending the whole event, then sitting for your RESNA exam the following day. ATP and SMS exams are now computer based, with scheduling and test locations that should be much more convenient for exam candidates.

RESNA exams are administered by Prometric (prometric.com), which has testing facilities throughout the country. You can find ones near you by going to the Web site’s homepage, choosing the “test sponsor” (aka, RESNA), and then choosing the exam you want to take (since Prometric says not all of its testing sites offer all exams).

Prometric also has a section on what to expect on the day of your exam, such as the check-in and security processes — e.g., bring your government-issued ID, and be ready to empty your pockets and store your personal belongings in a locker while you’re taking the test.

Of course, the first steps are to get your application filled out and submitted to RESNA. Check the application to see when you should plan to take the exam, based on when you turn in your application.

Don’t Be Afraid to Fail It

Perhaps the wisest bit of advice from test-takers sounds a little counter-intuitive: To give yourself the best chance to pass the SMS exam, don’t be afraid to fail it.

“Check your ego at the door,” Kiger says. “The older people get, they get really embarrassed if they don’t pass it and embarrassed about what they don’t know. The biggest thing is don’t be afraid to tell people you’re going to take it. Don’t be afraid to ask who’s going to take it.”

That’s because knowing who else around you is preparing for the test could be a huge help to you.

When preparing for the ATP exam, Kiger says, “Four of us took it together from my [former] hospital, and it was great because we had group study sessions once a week. The OT was able to bring a perspective, I was able to bring a perspective. It was nice to have all the different perspectives.”

Listening to those different perspectives can be important for ATPs who tend to specialize within seating & mobility rather than seeing clients of widely varying ages, diagnoses and anticipated progressions of needs. One possible example: An ATP who is an office’s “go-to guy” for clients with ALS and correspondingly spends most of his week at various ALS clinics.

“If you’re a supplier who only calls on adults, feel free to ask your co-worker, ‘Say, can I ride along with you one day when you go to do pediatrics?’” Kiger suggests. “The SMS covers all different diagnoses of all ages, so you really need to call on your friends and your peers who maybe have a leg up on you in one area.”

Finally, Kiger says, once you’ve committed to preparing for the exam, an upbeat and positive attitude can give you a boost.

“Seek out your peers and encourage each other,” Kiger says of colleagues who may also be preparing to sit for the exam. “Make it a goal and support each other in it.”

“I would tell CRT professionals who want to take the exam to trust your instincts and have the confidence to know that you are a qualified CRT professional that knows this subject matter,” Phillips says. “And don’t be afraid to fail. If you don’t pass it the first time, take it again, and most likely you’ll be better prepared for success the next time.”

“As an ‘early adopter,’ I have been afforded the opportunity to speak with many of my colleagues who are making the decision to pursue the exam,” Piriano says, “and [I] encourage them to go for it.”

Lois Brown: SMS Exam Inspires a New Approach

As the current director of clinical operations & education at National Seating & Mobility — and as an industry education specialist before that — Lois Brown, MPT, ATP/SMS, has perhaps a somewhat different view of RESNA’s Seating & Mobility Specialist (SMS) certification.

For instance, to prepare for the SMS exam, which she took in 2011, Brown says she spent “a few hours reviewing the suggested documents on RESNA’s site,” but then adds, “I intentionally did not prepare, as I wanted to assess the exam’s ability to establish a certain level of knowledge of our everyday clinicians and ATPs without ‘book knowledge.’ I did look over [R. Lee Kirby’s] Wheelchair Skills Test, but I could have studied that more.”

In contrast, Brown said she studied for four months before taking the ATP exam in 2001 and read “Fundamentals in Assistive Technology from RESNA and a manual from a prep course.”

Her impressions of the exam: “I think that clinical decisionmaking is difficult when it is not in a clinical lab setting, but that the patient scenarios were a good attempt to consider an appropriate intervention. The pictures of switches and X-rays were difficult to see; the quality made it difficult to be sure of the correct answer.”

While the SMS exam’s goal is to measure the skills and knowledge levels of a seating & mobility expert, Brown says she herself had a valuable take-away that now impacts how she seeks to teach others about seating & mobility.

“The test format changed the way I approached clinical education of wheelchair prescription: more video, pictures to drive the education of clinical problem solving, engaging the learner,” she says.

This article originally appeared in the March 2014 issue of Mobility Management.

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