CL I NI CAL EDITOR IAL
FIRST THINGS FIRST! IMPORTANCE OF THE INITIAL THERAPY EVALUATION Written by: KELLY WAUGH, PT, MAPT
As a physical therapist involved in wheelchair service provision for 40 years, I have witnessed a shift from the clinician-driven process that was typical 20 years ago, to a supplier-driven process more prevalent today. We all agree there is a lack of clinicians experienced in wheelchair assessment who are available to participate in this process. I both value and rely heavily on the expertise and opinion of my (Assistive Technology Professional) ATP Supplier partners. However, like all other health care services and products, I believe wheelchair service provision should be both clinically driven and client centered. So, how do we promote a more experienced workforce of physical therapists (PTs) and occupational therapists (OTs) who understand their critical role as the expert on the person’s body structures and functioning? I would like to propose one simple thing that may help to reverse this trend: encouraging therapists to do a separate initial therapy evaluation prior to meeting with the ATP Supplier for the wheelchair assessment. Referring to the specialty assessment as “The Wheelchair Evaluation” implies a one visit session requiring knowledge of wheelchair equipment. Instead, let’s teach (and practice) a different model, where the PT/OT evaluation is a separate but critical first step of the wheelchair assessment process. To this end, it is useful to think of the wheelchair assessment process in two primary parts: • The initial PT/OT evaluation. • The technology assessment. These are billable services for a therapist, using PT/OT evaluation and treatment codes. The ATP Supplier does not need to be present at the initial evaluation, as the therapist can summarize assessment findings at the beginning of the technology assessment. The primary benefits of completing the PT/OT evaluation prior to the technology assessment with the ATP Supplier are: 1. Allows the therapist to do what they are good at regardless of their experience and knowledge of equipment options and features. This makes the process less intimidating for therapists and facilitates their skill development. In a recent clinical
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DIRECTIONS 2023.6
editorial, Susan Johnson Taylor, OTR/L (2023), reminds us that therapists already have most of the knowledge and skills needed to participate in a wheelchair assessment: • The process for the therapist is the same as for any other (PT or OT) evaluation: evaluation, goals, treatment plan and follow up. (The treatment plan is the application of technology to address clinical objectives.) The therapist’s unique set of skills for assessing people’s impairments, activities and participation leads to problem-solving and clinical reasoning. (p. 32) A therapist’s primary role and responsibility is to bring this expertise to the wheelchair assessment process. After a thorough evaluation, the therapist is well-positioned to help educate the consumer on the pros and cons of different equipment features and options (as presented by the ATP Supplier during the technology assessment) and relate those pros and cons back to client’s impairments, abilities, goals and priorities. 2. Establishes a client-centered approach and process that is clinically driven. A separate initial session allows the therapist time to really listen to the client, and they in turn feel heard. When a therapist goes into the wheelchair technology assessment without having completed the therapy evaluation ahead of time, the process is more likely to become product driven with insufficient time for listening, feature matching, product trials and team problem-solving. The therapist’s responsibility is to ensure the client’s goals and priorities are honored during the assessment. In this way, the clinician becomes the driver and protector of this clientcentered approach throughout the wheelchair service delivery process.
