C LI NI C IA N TASK F OR C E
“DON’T TELL ANYONE I DID THIS CHAIR” Written by: AMBER WARD, MS, OTR/L, BCPR, ATP/SMS, FAOTA, AND PENNY POWERS, MS, PT, ATP
One of the most frustrating things about providing seating and wheeled mobility services is when the relationships between the following do not add up: • Client desires. • Client medical and functional needs. • Therapist and supplier evaluation results. • Client and caregiver preferences and opinions. • Funding and other resources available equipment within constraints. As “experts” in the field with years of experience and research to back us, we justifiably recommend products to assist, support and provide comfort for clients. The client is an “expert” in their own body, needs and what they need to be functional. The caregivers and other team members may understand what has worked in the past. What happens when the needs and goals of each member of the team do not match up, much less with the equipment we consider appropriate? Who makes the decisions, and what is the decision-making process? The Human, Activity and Assistive Technology (HAAT) model notes the interaction between these factors and the context in which the factors exist (Cook, Polgar, & Encarnação, 2020). Figure 1 provides a visual representation of the model’s components as a reminder. This model makes sense when one considers the complicated factors involved in the evaluation process and the attempts to “get it right.” Unfortunately, when any part of the model does not receive adequate consideration and “buy in,” the chances of the equipment working for the client decrease dramatically. In these cases, the SWM evaluation process can turn into a fight for control and the working relationship may become strained or fractured. In the idealistic phase of our seating and mobility career, we wanted a client to have the best posture, the most effective pressure redistribution and the product that would match the mat evaluation findings — all with an amazing outcome. In those days, however, the client’s voice may not have been fully heard, because as the experts in SWM, of course we knew best. This unfortunately led to poor outcomes — for example, power chairs that became furniture and were never used and clients sitting in the “old” chair and cushion
FIGURE 1
The HAAT Model
to maintain their functionality and comfort. It can take a while to realize there is no right or best equipment solution — just the one that maintains the interaction of the HAAT model components and ultimately works functionally for the client given the environment and lifestyle. Let’s delve into some of the reasons for the potential mismatch between the well-meaning team, the available product, the opportunities or constraints of the environment, and the medical needs of the client. Here are some common examples: CHANGING FROM A PWC WITH NO POWER SEATING TO A COMPLEX PWC WITH POWER SEATING This transition can be a challenge, as scooters or basic power wheelchairs can seem simpler to control, “smaller and less bulky,” less stigmatizing and weigh less for transport. The job of the team is to help clients consider the options available through trials in the clinic and at home with consideration of all the factors, limitations and resources. Clients may feel and acknowledge the benefit of power seating but not fully realize the impact of seat-to-floor height or weight of the chair on day-to-day functionality. Make sure to spend adequate time understanding how daily tasks may change with the new equipment. If someone is needed to help the client and caregivers with changed transfers and other safety issues, consider home health therapy. A trial in the home environment may prove to be a good investment and move the decision making toward the best outcome. CHANGING FROM A SLING SEAT AND/OR BACKREST TO MORE SUPPORT Certain clients maintain this configuration for a long time, even with other options available. It may seem, from the outside, like an CONTINUED ON PAGE
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DIRECTIONS 2022.3
