No Assumptions: The Lesson of the Green Handbag
When clients have profound cognitive involvement, it
can be tempting to skip some steps during the “getting to know
you” interview or the seating & mobility assessment. Why waste
the time of the rehab team, the client, caregivers
and aides when it’s “obvious” that so many assistive
technology interventions won’t apply?
Given the limited time allowed for assessments,
taking shortcuts might seem like common sense.
But skipping steps might also deprive you of critical
information about the client, or might deprive the
client of interventions that could make an enormous
difference in health or quality of life.
Lee Ann Hoffman, OT, MSc, got confirmation of that
while working with an adult client named Alan, who’d been confined
to bed in a state of low consciousness for many years following a brain
“We were unsure of Alan’s vision, as there had been no formal assessment
carried out in over 20 years,” Hoffman said. “His sister reported
that he used to wear glasses.”
When Hoffman was running late one day for an appointment with
Alan, she got a peek into his visual acuity.
“I came rushing into the room where Alan was,” Hoffman recalled.
“The rest of the team had been trying to see if Alan would turn his head
— no success. I hurried up to Alan to greet him and apologize for being
late. He turned his head and looked at my OT green handbag!”
Alan subsequently received an adapted visual assessment,
“and has a smart new pair of glasses, all the better to see me
with,” Hoffman said. That sort of improved ability could
give a rehab team another tool as they make equipment
The moral of that incident? “Too often, we are quick
to make snap assessments and fast-track assumptions
of the ‘outcome,’ based on the fact that the individual
may not be able to formally communicate verbally in
the method we all seem to take for granted at times,”
Hoffman said. “Almost ‘expecting less’ of the individual.
It happens, for whatever reason, based on time, financial
resources or just lack of understanding the individual, their function,
activity and participation levels in the context of their own personal
and environmental settings. Your best tool here as part of the seating & mobility team is observation. Observe the individual in their environment
and record your findings. Ask team members to do the same.
“Creativity can go a long way to understanding the individual and
aspects of their function, with the assistance of their family and caregivers
to help determine and explore preferences for the appropriate
equipment provision. That can have such a significant impact on the
individual’s routine and ability to participate, with assistance in activities
of daily living and wheeled mobility.”
This article originally appeared in the May 2016 issue of Mobility Management.