No Assumptions: The Lesson of the Green Handbag

seating and mobility assessment

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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 injury.

“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 decisions.

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.

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