Lecterns probably felt a little left out at the Abilities International Accessibility Conference in Long Beach, California.
They were present in the breakout rooms and ballrooms at the Long Beach Convention Center, March 26-27. But they weren’t focal points of the educational sessions, aside from displaying continuing education unit (CEU) codes at the end. Even presentations that did have significant numbers of slides — Dan Fedor’s Documentation LIFE Preserver series, understandably, as one example — also leaned heavily on peer-to-peer conversations throughout.
Here are the highlights of the sessions I attended last week. Spoiler alert: I loved every one.
— Interdisciplinary Collaboration in Equipment Evaluation: Panelists in this opening plenary represented the perspectives of consumers, clinicians, providers and policy/reimbursement entities. But the consumer’s viewpoint was at the center of this hour.
Todd Hargroder — founder of Accessible Designs Inc., co-founder of Soul Mobility, and wheelchair rider since sustaining a spinal cord injury 40 years ago — reminded attendees that to seating and wheeled mobility clients, “Ordering a wheelchair is probably the worst day of your life.”
That set the tone for the conference: The wheelchair rider needs to be at the center of all conversations and decisions, and each wheelchair rider is unique, with different goals, environments, concerns and dreams.
— Manual Wheelchair Setup, Adjustment and Impact on Function: This series was led by a team from the International Seating Symposium/University of Pittsburgh/University of Pittsburgh Medical Center: Julie Gallagher, DPT; Juli Harrison, OTD, ATP; Rachel Hibbs, DPT, NCS, ATP/SMS; Rebecca Russell, DPT, ATP; and Lynn Worobey, Ph.D., DPT, ATP.
The session started with a few slides, including Rachel’s tongue-in-cheek description of “Newton’s 3rd law” as “For every configuration adjustment, there is an opposite effect on skills.” But after that, attendees broke into smaller groups and — with a range of ultralightweight wheelchairs to work with — chatted about such topics as how to change seat slope without altering the wheelchair frame, and how rear axle location affects tippiness. How tippy is too tippy or not tippy enough? Fascinating stuff.
— Positioning with Purpose: 24-Hour Posture Care Management: First, I can’t imagine any seating education duo having better chemistry than Lee Ann Hoffman, Ed.D., OTD, MSc, OTR/L, ATP/SMS, CAPS, and Tamara Kittelson, MSc, OTR/L, ATP/SMS.
Second, Lee Ann and Tamara are obviously passionate about this topic, which advocates for managing posture at all times, not just when the client is in the wheelchair. This is not merely about client “comfort,” though Lee Ann also pointed out that discomfort “is the number-one reason for equipment abandonment.” While “good” posture supports maximum performance, requires minimal energy, and doesn’t cause harm, the effects of distorted posture can include constipation, respiration problems, contractures, pain, internal compression, pressure injuries, decreased endurance, and of course psychological impact.
Tamara shared a case example of a child with Aicardi syndrome whose mother had been told to reposition her daughter every two hours all night long — and had done so for more than a decade. But because that child still wasn’t optimally supported, distortion still resulted. “Gravity will always win,” Tamara noted.
I also learned from Tamara — whose daughter Eleanore was born with cerebral palsy and profound deafness — to say “distortion” rather than “deformity.” Also: “non-reducible vs. reducible postures,” not “fixed” postures.
— Ethics in Action: When the Going Gets Tough: Andrea Van Hook, executive director of the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) led attendees through a series of hypothetical situations tied to RESNA’s code of ethics, which includes protecting the public, doing no harm, and advancing the duty of care.
The “in action” theme of the session challenged attendees to apply those ethics — which seem very clear as words written on a page — to real-life situations that Assistive Technology Professionals (ATPs) face. Does an ATP supplier who takes part in the seating evaluation have an ethical complaint if the client then decides to work with another supplier instead? Can an ATP specializing in seating and wheeled mobility make recommendations for other types of assistive technology, such as communications devices? Engaging, nuanced and enlightening conversations here.
— Home Accessibility: Universal Design Solutions: Cindi Petito, OTR/L, ATP, CEAC, CAPS, director of home accessibility for VGM Group, led a whirlwind tour of how to improve accessibility throughout a home, starting with entrances and exits, and including bathrooms, bedrooms, kitchens and doorways.
Among the top things I learned: vertical platform lifts (VPLs) are now able to rise to greater heights, giving them an increasing advantage over inclined platform lifts. An accessible space/room should have two safe means of egress … but be careful about considering egress windows for basement bedrooms, as these windows can be difficult to maneuver through. Safe egress in case of a fire means not only that the person can safely exit the dwelling, but also that the person can move to a safe distance from the dwelling. And unless they flip up out of the way, beware of built-in seats for showers — they are space hogs that reduce space inside the shower that could be needed for maneuverability of both equipment and the client or caregiver.
— Facing Change: The Many Facets of Adjustment in CRT (Complex Rehab Technology): There are so many moving, evolving pieces as a seating team goes through the mobility assessment, recommendation and delivery/fit process … and in the years that follow. Technology certainly improves, with more choices available. More clinical evidence can influence our understanding of function, cause and effect. And consumers themselves change: They age, their conditions might progress, their goals evolve.
This panel demonstrated why it can be so challenging to identify all those moving pieces and bring them together into technology choices that are required (by funding sources) to both answer today’s needs and anticipate and adjust to tomorrow’s. This was a profoundly “human” panel that emphasized the critical need for constant, honest communication.
— From Small Acts to Big Wins: Moderated by National Coalition for Assistive & Rehab Technology (NCART) Executive Director Wayne Grau, this panel featured Jean Minkel, PT, ATP; Julie Piriano, PT, ATP/SMS, senior director of payer relations & regulatory affairs, NCART; and Jenny Siegle, sports producer for Altitude Sports in Denver and a power wheelchair rider since early childhood.
Jean, who said she’s been described as a “velvet steamroller” while advocating for clients, talked about Hope having two daughters: Anger and Courage. She also suggested reaching out to subject matter experts when faced with equipment denials, and checking to see if adequate documentation was included in the claim to address least-costly alternatives.
Jenny — who along with her mother has been advocating for assistive technology her entire life — spoke simultaneously about the need to keep pushing forward without giving up, but also urged attendees to “advocate with grace” for the best outcomes.
Julie, who donned one of the boxing gloves she keeps on her desk at home, added that NCART is adding resources for industry stakeholders of all types to communicate more efficiently with their legislators and funding sources.
— Documentation LIFE Preserver: Dan Fedor, U.S. Rehab’s director of reimbursement and education, managed to cover an incredible amount of ground, from ATP participation and home assessments now needing to take place face to face (but licensed/certified medical professionals can participate via telehealth) to ATP suppliers not being allowed to write justifications for clinicians — and the many nuances involved there.
Dan manages to make incredibly complicated policy requirements very approachable, while also adding his own perspectives, built from helping countless suppliers during his long career. Example: Writing an addendum/amendment for your documentation? Dan recommends doing so within 30 days.
— Pediatric Seating and Mobility: Getting Off to the Right Start: Christie Hamstra, PT, DPT, ATP/SMS, representing the Clinician Task Force, stressed that while mobility is not considered a human right (!) from a medical justification standpoint, there is so much urgency to provide on-time mobility for very young children — because the first year of life is such a critical time for human development. Self-initiated mobility has been linked to language and vocabulary development, for example.
My light-bulb moment from this session was that a typically developing toddler takes 14,000 steps, has 100 falls, and travels the lengths of 46 football fields … in just 6 hours of time. That high frequency of both mobility and failures drives learning for young children. But acquiring mobility assistive equipment for young children with mobility disabilities or delays remains so difficult in far too many cases.
— Community-Level Manual Wheelchair Skills: If there was a lectern in the room where Lee Kirby, M.D., FRCPC, began this class, I didn’t notice it. That’s because after a few minutes of using ultralightweight wheelchairs to climb up and down the equivalent of 2x4s and other small obstacles, the session moved outside to tackle inclines, cross-angle inclines, stairs and the kinds of curbs wheelchair riders face when there isn’t a curb cut to be found.
The takeaway for me was that an optimally configured wheelchair is just the beginning, because the real world is not an accessible place. To be as fully independent and efficient as possible, wheelchair riders need to have accompanying skills to compensate. Which means the wheelchair professionals need to have those skills, too, so they can teach their clients.
— Don’t Be Afraid to Provide Seat Elevation: This class couldn’t have come at a better time, as the CRT community submits comments to the Medicare DME MACs seeking to finalize local coverage determinations (LCDs) for Group 2 power wheelchair codes K0830 and K0831 with seat elevation.
Dan Fedor was back, with assists from Julie Piriano and Permobil’s David Miller, MA, OTR/L, ATP/SMS, to discuss what the industry is officially recommending: Keeping the door open for individual consideration for seat elevation on Group 2 standard chairs, and not tying seat elevation to a relatively narrow band of diagnoses.
Bottom line: I attended 11 classes in two days (plus a “field trip” to the adjacent Abilities Expo consumer event for a couple of hours), and the time flew by. Small class sizes created more robust conversations, fewer lecture-style formats, and a camaraderie that showcased why I fell in love with CRT a long time ago.
My thanks to all the presenters and attendees who made every hour such a wonderful experience.
The next conference is in Edison, New Jersey, April 30 and May 1. Once again, the Abilities Expo will be co-located.
