ATP Series

Compliance & Kids: Looks Matter (to Mom & Dad, Too)

WInnie the Pooh

WINNIE THE POOH: CHUTIMAKUANAMON/DEPOSITPHOTOS

Items in the office of Lauren Rosen, PT, MPT, MSMS, ATP/SMS, Program Coordinator at the Motion Analysis Center, St. Joseph’s Children’s Hospital of Tampa (Fla.), have been carefully curated.

The room houses demo wheelchairs, all of them cute. “One of my chairs has a life-sized Winnie the Pooh sitting in it; another has a blow-up penguin whose name is Bob,” Rosen said. “Scooby-Doo is in another power chair.”

Dolls using wheelchairs sit on shelves. “I do that to take away some of the stigma of using a wheelchair,” Rosen explained. “Because if you see Barbie or an American Girl doll sitting on my shelves, it normalizes it. Oh, look: I didn’t know dolls sat in chairs.”

The Impact of Aesthetics

Compared to functional goals, a wheelchair’s appearance might seem minor. But Rosen, who recalls a 3-year-old client squealing joyfully over her new pink-and-purple wheelchair, disagrees.

“I think aesthetics is one of the largest considerations,” she said. “I don’t care if it’s a kid or an adult: I want you to see my patient first.”

Function is imperative, but Rosen said she still considers appearance. “Obviously, if you need lateral supports and a head support, I have to give you those things,” she noted. “But I even pick and choose those by what looks better. Everything about what I do is looking for the least medical-looking piece of equipment that can accomplish that goal.”

And if a minimalist approach will work, she seizes it. For head support, for example, “I want something that’s got as low-profile hardware on it [as possible].” She referenced some extremely adjustable systems: “The kid is 3 feet tall; I don’t need all the kinks. I just need a little rod that goes from here to there. I will not sacrifice their function or what they need in order to make it cute, but I will definitively size up what they need and then come up with the most cosmetically pleasing version of whatever that is.”

A Constant Learning Process

The wheelchairs in Rosen’s office can also be teaching tools.

“Especially when we’ve had to go from a medical stroller to a tilt-in-space chair, that’s a really hard move for people,” Rosen said, explaining that chair’s “medical” appearance. “But I try to pick seating that’s the least intrusive. I still try to help with that.”

She also tries to ease families into future changes. For example, when she’s recommending a positioning stroller, “they always ask, ‘What happens when she grows out of this?’ And we have the conversation: ‘It depends. We have a lot of options.’” That’s when Rosen will point out other wheelchairs in her collection. “‘We’ve got manual chairs, we’ve got tilt-in-space chairs, we’ve got power chairs. We just have to see what her function is at that point in time, and then we figure that out.’

“I try to set up the expectations, and I try to keep a version of everything that I would possibly do in here so they’ve at least seen it. I like them to see it before it shows up so maybe it’s a little bit less of a shock.”

Rosen added, “When they’re very unhappy with the cosmetics of the equipment, I say, ‘Yes, but see how much she’s moving her arms and her legs now that her trunk is nicely supported? When you don’t have trunk control, you cannot learn how to use your arms and legs, because it’s like trying to use your arms and legs on JELL-O: I lift my arm and my entire trunk falls to one side.’

“There are some people you’re not going to completely get through to. But I try to tell them why everything is on the chair. We’re putting the tray on because it’s an upper-extremity support tray, and it’s there to help with posture because those armrests are too wide and her arms can’t sit on them. So she’ll end up hunching forward [without the tray]. I try to explain why things are there so people will hopefully value them. There’s so much stuff on chairs sometimes that it’s overwhelming for families.”

Even once the chair has been delivered, Rosen keeps checking in. “Every time I see them, I try to re-educate them on the importance of this part and that piece. For people getting their second chairs, I ask, ‘Do you like how this chest harness works?’ I’m not a big fan of the backpack-style chest harness, I’m a bigger fan of the butterfly style. But you might love the H-style. So if I’m changing your chair to a newer chair or even just growing the system, I will ask, ‘What do you like and what do you hate about the chair?’ Then we’ll get into details. I don’t like the foot tilt on the tilt-in-space chairs, but some people love it; they prefer it to the hand tilt.”

It’s all part of the larger mission of using a wheelchair optimally. “My original reason for making the chair smaller to the kid… I was thinking about function,” Rosen said. “But when you put a kid in a chair that the kid likes, that the family likes, and it’s the least intrusive on their lives as it can be, then the chair is empowering from day one.”

This article originally appeared in the March/April 2021 issue of Mobility Management.

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