On Feb. 25, Mobility Management and Editor in Chief Laurie Watanabe hosted the webinar CRT Defines Innovation, with panelists Stan Arledge, ATP/SMS, at Senior Mobility Aids, a provider in California; Tamara Kittelson, ATP/SMS, an occupational therapist and executive director of the Clinician Task Force; and Julie Piriano, PT, ATP/SMS, senior director of payer relations and regulatory affairs for the National Coalition for Assistive & Rehab Technology (NCART).
Panelists discussed Complex Rehab Technology (CRT) innovation as applied to the industry’s three pillars — people, process and products — and how innovation could and should impact each. In this first Q&A installment, taken from the webinar conversation, Kittelson discusses how CRT can mitigate health risks.
Register to listen to the entire webinar on demand, and stay tuned to Mobility Management for additional Q&A with Stan Arledge, Tamara Kittelson and Julie Piriano.
Laurie Watanabe: When we start talking about CRT benefiting the people who use it, what exactly do we mean? What are we trying to accomplish?
Tamara Kittelson: I actually went back a little bit and did a tiny bit of research, just to get a sense of where we have come from.
I think we all know that time when, for example, a spinal cord injury was pretty much a death sentence, and people died, whether it was from a pressure injury and infection or urinary tract infection. Many of the progressive conditions that we’re familiar with today were not able to be dealt with.
And so first of all, something I always say and we need to be aware of: Whether a person has a non-progressive condition — for instance, a spinal cord injury — or a progressive condition like multiple sclerosis or ALS, no matter what the condition might be, people are going to be at risk for what we could call secondary complications.
These are things that don’t necessarily need to happen, but they will tend to happen if we don’t do something to mitigate their health risks.
So when we talk about health-risk mitigation, people who use CRT have got a bunch of issues. We’re looking at things like pressure injuries, which we now know a lot about, and we’re learning more all the time about how we can not only address and treat pressure injuries, but keep them from ever happening to begin with.
We’re very concerned about repetitive-motion injuries, and some of the technology that we have available to us now can actually be used to prevent those repetitive strain injuries of the shoulders and the wrists.
For people who are self-propellers, obviously we would like to avoid falls. We deal with people in Complex Rehab Technology who may not be full-time wheelchair users, but that doesn’t mean that they don’t need a wheelchair in order to be safe in their daily lives and not be at risk of injuring themselves further because of their mobility issues.
Another area that’s a big one for me — it’s my passion — is postural asymmetries.
We know that most people are born into this world with beautiful, symmetrical baby bodies. And we also know that kids who are born with CP [cerebral palsy], people who have all kinds of different chronic conditions that result in using CRT, very often end up having postural asymmetries that progress to complications like scoliosis, dislocated joints, things of that nature which just magnify every health risk in terms of being able to breathe, being able to eat, being in pain, being able to use more standardized equipment rather than super complex sorts of seating systems to accommodate their very specialized body shape.
The mental and emotional impact of immobility
Tamara Kittelson: And let’s not forget — for these people and all others — the psychological, social aspects of mobility impairments, the sorts of isolation and anxiety and depression that arise when you’re not able to fully participate in society, and when you are dependent on other people for everything that you do.
I would ask all of us to just remind ourselves about how we got ready for our day, starting with getting out of bed in the morning. Were you able to get out of bed this morning by yourself and get up on your feet? Or if you happen to be a wheelchair user, did you get into your chair so that you could be mobile? Were you able to get yourself dressed? Were you able to prepare yourself some food and be able to eat?
These are all the real nitty-gritty things that are the activities of daily living that we clinicians want to be able to see our clients accomplish. But I think we also need to remember the social connections.
I read an amazing essay yesterday that was forwarded to me from LinkedIn. A woman talking about her isolation said she became a full-time wheelchair user and lived in a second floor walk-up apartment. She could no longer see her family, could no longer see her friends, couldn’t go out to the grocery store. These are the sort of things that may not be externally visible the way that a stage 4 [pressure] wound would be, but they are every bit as important and every bit as damaging for the people who suffer them.
How mobility impacts children’s development
Tamara Kittelson: I’d also like to mention developmental delays. There are certainly kids who are born with developmental delays, adults who’ve been born with developmental delays. But do we want to make those developmental delays worse by not enabling them to engage in society, to engage in school, to engage in work?
We now know a lot about development of cognitive and visual abilities in young children when they are not able to move through space independently. When they’re being carried by somebody else, but not crawling or using a power wheelchair or a manual chair. It’s an inherent need for the developmental process for kids to be able to move around on their own. And that’s where CRT comes in as well, and that’s where we’re constantly having to innovate.
As a person who’s been in the wheelchair space for about 40 years and who had a daughter who used a wheelchair: I know how groundbreaking it has become. Now, we almost take for granted getting little kids into chairs so that they can be mobile. It hasn’t always been that way. I look at the Wizzybug ads from the UK, where any child at age 14 months can apply and get a free power chair to be able to whiz around and be able to explore their environment. These are all the things that we’re hoping to support in the people that we work with, and they’re all the things that Complex Rehab Technology has a role to play for these folks.
Laurie Watanabe: You are talking about mobility for development, and we know how important that is for small children. Is there also mobility for mobility’s sake — not just mobility to accomplish activities of daily living, but just moving for the joy of moving?
Tamara Kittelson: Oh, absolutely. In my clinical career, it was not uncommon the first time a child had an opportunity to be in a power chair for them to just spin around in circles. And everybody’s looking at that and saying, “Oh, that’s a waste. She’s just playing. He’s just playing.”
Well, what is wrong with playing? And don’t kids who have no mobility impairments like to spin around and make themselves dizzy as they’re playing?
So yes, I think it’s an inherent human need, and we are depriving people of being able to have that human experience, if we cannot give them that opportunity to move.
Editor’s note: This Q&A was lightly edited for clarity and length.
