It might be a unanimous best practice to listen, listen, listen to
what the wheelchair user says during an ultralightweight chair
evaluation, and to make the user the center of the eval process.

But what do you do if a user is too stunned, scared, stressed or
sad — maybe all of the above — to contribute to the conversation?
What if he or she refuses to participate?

Focusing on the Present

“We saw that a lot in rehab,” said Angie Kiger, M.Ed, CTRS, ATP/SMS, Clinical Strategy & Education Manager for Sunrise Medical.
“With pediatrics, we saw that from the families, but also from the
teenagers who were selecting their new chairs.”

Kiger suggested talking with other members of the client’s
healthcare team: “A lot of times, we would lean on the social
workers to help discuss things with [the clients]. I wish the social
worker or a psychologist was a part of the CRT provision process.
Because they’re going to be able to help us discuss these things.”

She recalled meeting with a team whose patient was a girl who
had nearly drowned. “When the physician said, ‘What are your
goals?’, the mom said, ‘I would like my daughter to walk out of
here,’” Kiger remembered.

In those cases, Kiger said, it can be helpful to keep conversations
rooted in the present, while focusing on the immediate
situation. “I absolutely respect that, and I will hope with you and
I will pray with you that that is what’s going to happen,” she said
of the mother who wanted her daughter to walk again. “However,
when it comes to looking at her equipment and what’s happening
with her right now, I need to best set her up for success so she
can continue to work on rehab.”

Kiger added that she has told other clients, “I would love for
you not to need this manual wheelchair. But if you want to get to
that point, we have to look at you today. This is what you need,
and we have to pick out the best one for you right now because I
want to set you up for success, too.”

Taking It Slowly

Lisa Cordero, PT, ATP, National Seating & Mobility, said she tries
to meet clients where they are, while talking very practically of
small mobility goals. “We’ve been in those situations when we’ve
said to the person, ‘Well, you may say you’re not getting out of
bed again, but you still have to think of how you’re going to get
from point A to point B,’” she said. “Try to ease them into that
situation of, ‘Well, you still have doctor appointments. You may
find that a family member needs you, and you need to be able
to participate in something with that family member. You may
not look at this as a way to get back into every activity you did
before, but we want to set you up to be successful, to be able to
participate in some of these smaller activities as a stepping stone
to maybe being more open to being more mobile and more independent
in other aspects of your life.”

Empathy, Cordero added is key in these conversations. “It’s
overwhelming for them, and it’s hard to put yourself in that
position,” she acknowledged. “I try to think to myself, ‘If this were
me and my whole world was turned upside down, some of these
questions would seem asinine.’ But it’s trying to pull someone
out a little bit to let them know there is life beyond what they’re
seeing right now.”

She tells clients, “People still want your interaction, and they
still want you participating in your life. Let’s take it one step
at a time. We don’t have to build you a chair right now to play
basketball in. We need to build you a chair right now that you
can manage and that we can adjust with you as you change and
that can help you become more mobile and independent as your
abilities change.”

Kiger sometimes tells clients about a personal goal of hers, and
how she depends on her circle of family and friends to help her:
“Give them an example: ‘I have this long-term goal for myself, and
I love when my family members and my friends support me in it,
and as your therapist, I’m going to do the same thing. I’m going
to support you. But the reality is, we’ve got to think about today.”

And of course, reluctant clients need to be treated with kindness.
Kiger added, “You do have to approach it with grace and
respect.”