Clinically Speaking Series

Creating Assessment Success

In Complex Rehab Technology, Getting the Intangibles Right Can Make a Big Difference

optimal seating evaluationShe’s nervous.

He’s scared.

You can see it in their eyes, which make contact with yours, then quickly look away. You can feel it in their handshakes. Her hand is cold. His hand grips yours briefly and then lets go.

They’re somewhere they don’t want to be: in a seating and wheelchair clinic, in a conference room at their child’s school, in the hallway of yet another hospital or medical center. They’re here for evaluations, maybe for themselves or for a loved one — their child, their spouse, their parent. Though the assessment process was explained to them, they still don’t really know what to expect. They’ve been given so much bad news lately, so much talk about diagnosis, prognosis, life changes. It’s been hard to listen to all that, and to absorb it, so they can’t exactly remember what they were told you were going to do.

You are the clinician specializing in seating and wheeled mobility. You’re an occupational or physical therapist. Or maybe you’re the Assistive Technology Professional (ATP) who will be acting on the clinician’s upcoming recommendations, doing the fitting, making equipment suggestions, building the system.

The assessment is the first concrete step in determining and then providing the optimal seating and wheelchair. So how can you make the evaluation as successful as possible?

Mobility Management asked Stacey Mullis, OTR/L, director of clinical marketing, Business Region Americas, Permobil, for suggestions on conducting an effective assessment, including paying attention to those intangibles that don’t involve a tape measure. On the other end of the equipment process, U.S. Rehab and the University of Pittsburgh have teamed to evaluate the outcomes of wheelchair provision, as expressed by the consumers who use the technology.

— Ed.

Q&A: The Seating & Mobility Evaluation with Stacey Mullis, OTR/L

Q: In addition to taking measurements needed to recommend/fit the ideal seating and mobility system, what other information do you seek to gain from a seating and mobility assessment? What other topics are important to discuss?

A: Since an ideal seating and mobility system directly impacts function, it’s important to find out what “a day in the life” of our client looks like. Do they have a desk job that requires a certain seat-to-floor height? Do they drive daily and independently transfer themselves and their chair to their car? Do they break down their chair, or is it important that it all stays together?

It’s always critical to ask questions about their lifestyle and daily tasks to ensure that the equipment selected is functional for them.

Q: Ideally, who do you like to include/invite to the assessment besides the client? For example, do you want caregivers to be part of the discussion? Clinicians from other specialties? Why?

A: Anyone involved in the care of the end user is helpful to have in the assessment.

A good example of this is a school therapist. Although they may not be directly doing the seating evaluation, they can provide insight into our client’s needs when they are at school. For example, does Johnny need a tray to perform school activities, or does he pull up to a table? What is the height of that table top that he needs to fit under? How far does Johnny need to propel within a school day? Does he do this independently, or does he have help?

If I only have access to a parent, or home caregiver, I may miss some important details and make equipment choices that work for the home, but not his life at school.

Q: If a clinician is new to the seating and mobility evaluation, what can he/she do to prepare?

A: Seek out resources! Utilize a local ATP who can help with the process and justification requirements. And reach out to your nearest seating clinic to see if you can shadow and spend time in the clinic. Seasoned therapists will love to share their knowledge and experience, and it’s a great way to gain real life experience. And lastly, Permobil is actively developing courses and resources to equip new therapists in the provision of seating and wheeled mobility. We have people dedicated to equipping new therapists from the basic principles to more complex. We would love to hear from you!

For videos and blog posts on how to conduct seating assessments, go to Recent posts from Stacey Mullis and Ana Endsjo, MOTR/L, CLT, have included “Posterior Pelvic Tilt: Palpating the Pelvis”; “Pelvic Obliquity: Palpating the Pelvis”; and “Performing the Mat Evaluation: Palpating Body Landmarks.” As Endsjo says in a post, “Often it is at the mat evaluation where you gain the client’s trust or lose their faith forever because it is an intimate moment and area where you are placing your hands. We want them to feel confident in our skills and trust our judgment and future recommendations.”

This article originally appeared in the March 2018 issue of Mobility Management.

In Support of Upper-Extremity Positioning