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.”
