Infection control is a critical topic in healthcare these days, but Judy Rowley, VP of Matrx Seating at Motion Concepts, had wanted to add a Clinical Educator with a nursing background and infection control experience to the team for quite a while. The challenge: This nurse would have to be comfortable with wheelchairs and had to have a keen interest in seating and body positioning. In August, Rowley and her team found just the right fit.

Anna Sokol, RN, MN, BScN, BScKin, has a background in nursing and kinesiology, and according to Rowley, could add an “often overlooked” perspective in seating and mobility. Rowley explained, “We were excited to bring in someone with not only a great educational background, but also a deep interest and curiosity about seating and mobility and a desire to help connect the dots through education.”

Sokol spent her first few months with Motion Concepts working with Clinical Education Specialist Stephanie Tanguay, OTR/L, ATP, and the rest of the Matrx team to gain an intensive education specific to seating and mobility. It quickly became clear that Sokol looked at the Matrx line from another angle: She was particularly interested in the infection control features integral to Matrx’s product design. Sokol grouped the Matrx features together, making the line compliant with public health requirements, and was surprised to learn that clinicians didn’t generally consider Matrx products from this angle.

Nursing + Kinesiology

Sokol comes to CRT via a somewhat different clinical route. “I have a dual background: nursing and kinesiology,” she said. “My first degree is in kinesiology, and what I love most there is neurology and biomechanics. I have always been interested in rehabilitation because of my love of neuro and musculoskeletal systems. But when I became a nurse, I formulated a career strategy — to get experiences on the full spectrum of disease and health continuum, from acute and critical health events to rehabilitation and discharge, to the maintenance of chronic conditions and living in the community. And I followed my plan.”

That included working in the hospital emergency department, and on neuro and orthopaedic floors, as well as getting placements at Holland Bloorview Kids Rehabilitation Hospital and the Toronto Rehab SCI [Spinal Cord Injury] unit. Sokol earned a Master’s degree in Nursing with a focus on education and policy development and later took a management position at a home healthcare company.

Holland Bloorview was where Sokol first became familiar with CRT wheelchairs and seating.

“I tried to blend together nursing and kinesiology,” she explained. “[Bloorview] focuses on children with rare genetic and neurodevelopmental conditions and orthopaedic conditions. This placement taught me a lot. Parents are incredibly brave and resilient, as children sometimes have to go through repetitive surgeries and rehabilitation cycles. While some children are there once, others consider Bloorview their second home and even attend school there, because their conditions require constant surgeries and adaptations to new mobility equipment.

“Add growth spurts to this, and you quickly appreciate how much skill is required of clinicians trying to select the right equipment. At Holland Bloorview I learned that strokes may happen to the spinal cord and cause paraplegia or quadriplegia. Children may have a brain stroke, and it may happen as a consequence of severe seizures caused by a high fever. Meeting each child at their level, supporting him or her through painful procedures, and still trying to create positive emotions — this is a specialty that requires juggling multiple factors and tons of knowledge.”

In addition to learning about the conditions affecting her patients, Sokol noticed “very sophisticated equipment in the area of assistive devices, especially power chairs for youth, which I’d never seen before. Children that had quadriplegia had to learn to use very individualized joysticks or alternative controls like sip-and-puff.”

Sokol decided to create an assistive devices manual for nurses “because I discovered there was a gap. Nurses couldn’t go and open a book and learn about it. It wasn’t part of the nursing orientation, either. So I started putting together bits and pieces and learned from orthotists and occupational therapists, but also I had to look for information from manufacturers a lot, and that was a big eye-opener for me.”

Trained in the past to rely on evidence-based knowledge, Sokol realized that assistive technology manufacturers also had valuable input. “If I don’t learn this particular device from the manufacturer,” Sokol reasoned, “how do I know how to operate it?”

Sokol’s wheelchair interest was strengthened when she took a position managing a home healthcare agency. She encountered situations where patients would have two or three wheelchairs and still complained that none of them were comfortable. “The patient didn’t know what to do with them, and this was a bit of a heart-breaking experience. Now that I have a better understanding of the options available, I know that we can do a better job.”

A Personal Journey

During placements at Bloorview Kids and Toronto Rehab, Sokol was on her own rehabilitation journey after a spinal injury. “I was feeling this world from both sides,” she said. “I experienced terrible, unpredictable spinal spasms and was wearing a brace all the time. This experience gave me just a glimpse into some of the challenges faced by individuals with spinal injuries. I remember thinking [spinal spasms] were worse than giving birth.”

And Sokol was aware that her professional expertise put her in a very different place than that of many patients. “I constantly had this thought that I have an advantage because I have all this knowledge and access to information,” she said. “I know where to find it, I know what to look for, I know what I’m experiencing. I felt bad knowing the majority of people do not have access to this information.”

Sokol’s road to recovery was long, but she said, “I’m a lucky one; not everyone is as lucky as me. Years of therapy, seven years of active rehab. It’s been a long journey.”

Pandemic-Sized Challenges

One of the results of the COVID-19 pandemic is that everyone now knows the importance of hand washing and disinfecting frequently touched surfaces. The issue of infection control of seating and mobility surfaces has risen in importance, and the Complex Rehab Technology (CRT) industry is dealing with a pandemic while also imagining how it will impact the future.

Sokol said her arrival at Motion Concepts feels like perfect timing. At the start of the pandemic, Sokol started getting questions from vendors, technicians, and therapists.

“After having questions and phone calls from vendors and clinicians, we got the idea of [creating] a presentation that was certified through the University of Pittsburgh for CEUs,” she said. “I talk about the chain of infection transmission and explain the use of protective equipment. This is specialized knowledge, and it’s not easy, even for nurses. So for seating and mobility partners, it turned out to be very valuable. This presentation is actually designed specifically for CRT professionals and offers a lot of information about COVID-19.”

“For sure, experience helped,” Sokol added of her experiences. “In my previous Health Care Agency management role, there was a lot of working with group homes and retirement homes during their respiratory outbreaks, and I had to work with public health units when communicable disease was reported. For example, when tuberculosis was detected in a wound. Or when a nurse reported she walked into a chicken pox situation. Or a needle puncture with a high risk of exposure to HIV.” In so many healthcare environments, both acute care and post-acute care, infection control is a daily concern, Sokol said, noting “the ones that are most prevalent: MRSA, ESBL [extended spectrum beta lactamases], the antibiotic-resistant contact infections.”

But the COVID-19 pandemic is different and requires unprecedented attention to multiple risk factors. “When I worked as a nurse at the emergency department, I remember triaging people who came straight from [Toronto] Pearson airport,” Sokol said. “They were reporting exposure to swine flu on a plane from Mexico. This infection control experience helps a lot now. It helps not to panic. It helps to focus on the most important questions that I formulated at the beginning: Is it droplet or airborne? How long does it live on surfaces? How do I ensure that the disinfectant I’ve been using is actually effective? How can we continue working as a company, as a Motion Concepts team, and make sure it’s done safely?”

Sokol is now sharing infection-control best practices with the CRT industry at large. “When we discussed what to include in the presentation, we thought that it was important to minimize panicking,” she said. “What kind of messages and education can we relay to our clients? How can we explain to them that our products have all the necessary infection control features, and they can continue practicing safely? These discussions gave Motion Concepts the opportunity to highlight infection control features of the Matrx line that were previously just taken for granted.”

The topic of infection control will remain an important one for the CRT industry, Sokol said.

“I hope that these heightened infection control measures will not die off as fast as they did after SARS,” she said. “I intend to continue education in all areas, including homecare and long-term care, about the importance of this, even during non-pandemic times. There are other infections that can appear, and there are so many others that we live with on a daily basis. It’s something that we have to pay attention to collectively.”

Among Sokol’s areas of interest is seating and wheelchair care, whether the equipment is being used by multiple residents in a long-term care facility, or by multiple clients in a seating clinic. “Historically, public health units were focused on hard surfaces for disinfection,” Sokol said. “And lately what I’m seeing is that CDC [Centers for Disease Control] guidelines have been including textiles. Hospitals pay attention to curtains and furniture in waiting rooms now. So, the soft surfaces have become important, too.

“Seating and wheelchairs are regarded as non-critical equipment. So, low- to medium-level disinfection should be sufficient. But everybody wants coronavirus to be killed. Customers want to know how to clean wheelchairs that have soft surfaces, hardware and electronics. This is tricky: Not every disinfectant is effective against COVID-19, plus compatibility of products with different chemicals is not very straightforward. It’s important to pay attention to these nuances. It’s important to make sure that everything can be cleaned and disinfected, including the seating. And manufacturers are faced with heightened expectations. Luckily, Motion Concepts is on top of the game.”