Q&A with Theresa Berner, Ohio State University, and Andrew Frank, Vista Medical

Q: For what types of clients is pressure mapping a helpful technique?

Theresa Berner: I work with a lot of neuromuscular diseases or trauma cases, and I think anytime someone has a lot of atrophy, a lot of bony prominences, (pressure mapping is) going to be really helpful because they’re the ones that are going to be more at risk.

Andrew Frank: The whole reason pressure mapping was developed was to deal with people who are insensate and immobile. That’s how it started: They can’t tell us how they feel and they can’t move themselves, so that brings us into the realm of having to come up with a surface that protects them. How do we make a choice about that surface?

Q: What special benefits does pressure mapping offer to clients? For instance, might pressure mapping be especially helpful for clients who are non-verbal or have a difficult time expressing their discomfort?

TB: Patients like it because you see the light bulb go off. You’re telling them about offloading their sacrum, and they don’t understand that. When you say, “Lean forward,” and they see the colors (on the actual pressure map) change, it’s like an “Aha!” moment, like biofeedback.

AF: You can have a geriatric situation in which someone is complaining in the hall, and the nursing staff says, “They’re just complainers.” But in fact, they’re in pain, but they can’t tell you where or how much. They’re uncomfortable or they’re at risk for skin trauma, and they can’t communicate. And there’s no feedback to tell the clinician where the problem is and how to solve it, or when the problem’s solved, for that matter. They might stop groaning or tearing apart the equipment from spasms, but we’re making assumptions. If you don’t have an objective tool in the mix, you’re guessing.

Q: Let’s talk about pressure mapping as a tool that can provide objective measurements and information…

TB: It’s awesome for documentation. Physicians love it, because physicians are used to MRIs, lab values, reports. If you have a therapist who says, “I think they should have a ROHO,” (the physician may say), “Well, why? What are you basing that on?” The pressure mapping is one of several pieces of technology that helps give us quantifiable information to support our clinical judgment.
In terms of suppliers, too, it gives them a baseline. So if they (supplied) a cushion and they mapped somebody and a year later, the person breaks down, they can remap and say, “When I delivered the chair to you, this is what it looked like. Something must have changed.” As opposed to it being the vendor’s fault for picking the wrong cushion. It’s more documentation.
Q: At the same time, pressure mapping itself isn’t usually reimbursable for seating & mobility suppliers, correct?

TB: I have wheelchair suppliers that have the pressure mapping system. I think sometimes it hurts them because patients are constantly calling them up and saying, “Map me.” Well, they’re not getting paid to map people. It’s kind of a value-added program for them to have it. But as a therapist, as long as there’s a skilled need and if I’m problem-solving on a person who has recurrent pressure sores, pressure mapping is awesome. So I’ve found that the pressure mapping tool, even though it costs something, pays for itself in new referrals you can get into your facility.And it’s a service that sometimes I can’t provide without using the pressure mapping tool. (The alternative) is just your clinical judgment. So if I have someone coming in saying, “I’ve been on a (certain type of cushion) and it’s not working, and they go down their list (of complaints) — through deductive reasoning, if I know the different media, I can probably hypothesize and say, “I think this cushion will help you.” But if I put them on pressure mapping, I can see what their hot spots are, I can see how to offload them. It gives me that very clear answer. So it’s a tool I use to help me clinically problem solve. While I’m doing that, I’m making my clinical decisions on what my recommendations are.

Q: So even if suppliers and clinicians can’t always bill for doing the pressure mapping, there are definite other benefits?

TB: I think if someone is going to invest in that, it shows credibility, that they’re invested in the patient’s best interests. Because the vendor does not get paid for that. He’s not making money from the pressure mapping, it’s just increasing the quality of his work.It’s not hard to learn. The programming is easy to use; you just have to be able to use a computer. But you have to be able to understand what you’re looking at and at least get some training in skin. The one caution about
pressure mapping is that it does not show you (whether the problem is) shear or temperature related or moisture. There are a lot of different factors. Sometimes people can misinterpret because they’re not looking at all components of the skin.
I have a surgeon that I will work with who will not schedule her patients for skin flap surgery until they have gotten pressure mapped and she is sure that their equipment is all straightened out. That same physician will refer back to me once that patient’s getting ready for upright power. For me that’s an awesome referral base.

AF: It’s a tool (for suppliers to use) to position themselves in the market. There are other dealers who don’t focus on rehab, but are still messing around in it — (the ability to pressure map) kind of sets them apart and says, “We’re committed to this market, we’ve invested in the tools to do the job. We have confidence that we can get you good information.” l

— Theresa Berner, MOT, OTR/L, ATP, is the rehabilitation team leader, Spinal Cord Injury System of Care & Outpatient Neurorehabilitation, at Ohio State University Medical Center.
— Andrew Frank is VP of sales and
marketing at Vista Medical.