Clinically Speaking

Don't Lose Sight of Your Consumer's Goals!

A mother who needs to care for her children, a father who desires to work and provide for his family, a teenager looking to go out with friends and participate in age-appropriate events, or a child who wants to play on the playground are valid examples of “activity and participation.” These are also just a few of the goals any person may have, yet they are rarely a top priority to a funding source when considering the needs of persons with a disability.

However, as clinicians and ATPs, we know that these goals are likely far more important to the individual than grooming, dressing, bathing, toileting and feeding. In fact, when we actively participate in the evaluation and recommendation process, assisting the individual in the accomplishment of these goals can be much more rewarding for therapists and ATPs as well. The consumer’s excitement when they achieve a goal that may have been very challenging, or a goal they thought was impossible to achieve, is what drives all of us.

The satisfaction derived from success can reinvigorate the team members and bolster the confidence of the individual who is being evaluated.

So Much More Than “Official” MRADLs

This is not to say that the “mobility-related activities of daily living” (MRADLs) a funding source is most concerned with are not important, because they are. Not only do they allow the individual to “get ready for their day,” they allow them to acquire the device that will lead to and support their new-found independence.

My point is, we cannot lose sight of the other activities the person wants or needs to participate in throughout the day, and we want to be sure we can assist them in achieving those goals as well.

As clinicians, we have to evaluate our consumers for the appropriate device to allow them to perform or participate in the activities that encompass their basic needs, and document the information that funding sources are looking for relative to this. But we also know that activities of daily living (ADLs) have much more to them than the five MRADLs of feeding, dressing, bathing, grooming and toileting. As members of the evaluating team, we can get so focused on these MRADLs or the “medical need” for the mobility base and the options and accessories that are necessary — and that the funding sources look at so closely — that we can lose sight of all the other things that complex rehab technology can bring to the table.

For example, “feeding” is far more than getting to the table and eating a meal prepared by someone else, especially if the individual has the capacity to shop for groceries, prepare the meal for themselves and their family, and do the dishes afterwards.

Clearly, complex rehab provides the opportunity to do so much more from an MRADL perspective for individuals who are impacted by the disability they are living with daily. As clinicians, we need to look beyond the home and consider all the other areas in which that person may use their device. Think of the simple activity of taking money out of the ATM or going to the doctor and the impact that their technology can have on them in these scenarios. Something as simple as driving their power wheelchair on a city sidewalk and being able to see adequately and be seen by elevating the seat to its highest elevated position and driving in that position can be life changing. The functional aspect of what this position provides places the wheelchair user in a safer position to drive and control their power wheelchair through the crowded sidewalks and participate in the “rest of the MRADLs,” like going to the drug store to obtain a tube of toothpaste.

Beyond Reimbursement: The Client’s Goals

We often have our own focus during an evaluation because we know what information is needed in order to get a piece of mobility equipment justified. What we need to remind ourselves of is to look closely at the goals of the individual, beyond the main five MRADLs, which may not be entirely medical or even be one of the MRADLs that their funding source pays for. However, we still need to look at this individual as a person who is no different than we are, find out what all of their goals are and help the person find a way to achieve them.

Remember to look at the person’s entire everyday life. Don’t be afraid to focus on the activities that they want to do, or dream about doing in addition to what they have to do. These are personal goals, and understanding them is a big part of making a difference in someone’s life. I believe there is nothing more rewarding than providing the equipment that will allow a person to achieve a dream, or a goal. We too can be a big part of someone’s life, and making a difference is truly why most of us got into this field in the first place. So go back to your roots and make a difference.

This article originally appeared in the September 2016 issue of Mobility Management.

About the Author

Jay Doherty, OTR, ATP, is the clinical education manager for Pride Mobility Products Corp., Exeter, Pa. Jay can be reached via e-mail at or by calling (800) 800-8586.

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