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Our home and handicap modification division can make your home, office, or even your yard, easily accessible by those on crutches OR in wheelchairs. Call today for more information on updating your home to the needs of those that live in it. BE COMFORTABLE!

COMFORT COMPANY VECTOR (VICAIR TECHNOLOGY)

VS.

CROWN THERAPUETICS ROHO CONTOUR SELECT

Client Name:  John Doe Patient

Current Wheelchair: New Quickie Q7 Ultra Lightweight (2 Months Post Delivery)

Current Seating on New W/C: Adjustable Tension Back Upholstery with Roho Contour Select Cushion

Clinical Facility: Hill Country Regional Hospital-Inpatient Rehab/Wound Care Clinic

Pressure Mapping System: Vista Medical FSA UT1010-7306

History

Client is a mid-thirties male who presents with Lower Extremity Paralysis (Paraplegia) due to previous brain stem cerebral vascular accident post approximately 6 years. Slight scoliotic curve at lower/mid thoracic region. Active spasticity in bilateral lower extremities. Very good upper torso balance and very good upper extremity strength most in part from self-propelling previous wheelchair for all activities of daily living. Client lives independently in accessible modular home with son within mostly accessible subdivision and exterior environment.  Client maintains full time employment at regional hospital facility and is very active within the community. Previous wheelchair used was TiLite Titanium Rigid Frame Ultra Lightweight wheelchair with Sling seat and adjustable tension upholstery. Wheelchair cushion utilized was Jay Seating Jay 2 Standard Profile Cushion.

Previous wheelchair was in need of refurbishing as well as seating was no longer supportive in lower lumbar region, cushion was deteriorated and client was experiencing pain, discomfort and redness in right gluteal/ischial tuberosity. Client also complained of early fatigue during the course of the day.

New W/C Application

New Quickie Q7 Ultra Lightweight Wheelchair was specified and measured for proper fit. Standard equipment included: Tubular armrests, anti-tippers, clothing guard/panels and integral push handles. Optional equipment included: Flip up footboard for ease of transfers and positioning lower extremities, adjustable angle-flip down back for ease of transporting. Non-flared front end due to physical stature of client and risk of impact to frame. Flat free inserts were also supplied due to history of flats on previous w/c wheels. Cushion utilized with delivery of new W/C was Crown Therapeutics ROHO Contour Select Adjustable 4 Compartment Cushion for maximum pressure relief as well as lower extremity positioning.  Client requested adjustable tension back upholstery for adjustability and support even though a modular low profile back was discussed and recommended. New W/C was delivered in January 2012.

Post Delivery Concerns

After 2 months of daily use client made contact to discuss possible concerns of new chair and seating. Client continued to complain of pain, discomfort in right side lower torso although not as severe as previously stated. Continued fatigue late in day accompanied by lower back pain/discomfort.  Upon visual inspection of seating posture, client was found to be “sacral sitting” with posterior pelvic tilt as well as slight, right lower extremity adduction.  Client was positioned too far to back of chair. Observations made included inappropriate posterior thoracic support at lumbar and lower thoracic spine from adjustable tension back upholstery. ROHO Contour Select cushion, even though correctly inflated and adjusted for proper positioning of lower extremities was still not completely eliminating discomfort in right IT even with regular pressure relieving by client. Client was in wheelchair for approximately 8-12 hours a day and continued to be fatigued by end of work day. Client rated new wheelchair and seating at a 6-7 on a scale of 1-10 compared to previous wheelchair and seating which was ranked at 2 before new application.

Recommendations/Reevaluation

After observations and discussions it was decided to replace the adjustable tension sling back with a modular back for rigidity and extra support of lower thoracic/lumbar area thereby reducing strain and fatigue from sitting and self-propelling throughout the day. It was also decided to try a different pressure reducing/positioning cushion with the same seating medium used with the Roho Contour Select which was air. Products chosen were: Comfort Company  12” Tall Actaback with Adjustable Stays for increased lumbar support and Comfort Company Vector Cushion with Vicair technology.  Modular back was installed and positioned for client comfort as well as maximum lower thoracic/lumbar support while sitting and propelling.  Vector cushion was adjusted for lower extremity support as well as maximum pressure relief in sacral/IT areas, paying particular attention to right side compartments of cushion. A pressure mapping session was determined to be crucial in determining if there was any “loading” of client’s right side while in seated position. Client was advised to use new components while mapping system was secured for further assessment.

Client used new seating components for 2 weeks while mapping system was acquired and session was scheduled.  Upon re-evaluation of client at 2 week mark there was marked improvement in pain and discomfort in right side of seating area as well as reduced fatigue and more stamina throughout day. Upon visual inspection of client while seated and propelling, posture and pelvic positioning had improved tremendously and client was seated in slightly forward of midline position which he stated he was able to maintain throughout the day due to back support. This posture allowed client to exert maximum thrust on wheels with his upper extremities instead of relying on upper torso leverage thereby reducing fatigue and increasing stamina throughout day.

Pressure Mapping of Cushions

It was decided to proceed with the pressure mapping session to solidify the presence of increased pressure in clients right IT area while using both cushions during the mapping session to attain the best results and utilize the cushion with the most support as both were adequate for positioning of the lower extremities but the Comfort Company Vector seemed to alleviate 80-90% of pressure related pain and discomfort.

A Vista Medical FSA UT1010-7306 Pressure Mapping Interface System with FSA Flexible Pressure Wheelchair Mat was utilized for mapping sequence conducted at Hill Country Regional Hospital in the Inpatient Rehab/Wound Care Clinic with clinical staff present. Client switched to Roho Contour Select Cushion which was reassessed and inflated to proper pressures for maximum support and positioning and “pressure map” was captured.  Client then switched to Comfort Company Vector Cushion which was used with previous adjustments and currently utilized by client for daily use. The Comfort Company Vector Cushion was then “captured” by mapping sequence.

After mapping had been completed and compared it was noted that client had a moderate/severe pressure or “loading” area while seated in Roho Contour Select Cushion which was unable to be improved even with multiple adjustments to pressure within the select compartments of the cushion. On the other hand, while seated in the Comfort Company Vector Cushion, the “load” area was noted but to a much lesser extent with even distribution of pressure gradients throughout the area in question.  Both cushions were “mapped” on new Quickie Q7 with Comfort Company Actaback installed and adjusted.

Summary/Conclusion

The right combination of seating components were successfully integrated with new wheelchair frame to offer client comfort, support and correct posture while he is seated for extended hours every day.  It was discovered on further assessment that client also had a slight right side scoliosis at the mid-thoracic area which was associated with the “loading” or increased pressure on the right IT/gluteal area.  Once this condition was addressed and properly supported with modular back and lumbar support was increased to compensate for the posterior pelvic tilt, the loading area was decreased but not to the point that it was properly supported with the Roho Contour Select Cushion.  The Comfort Company Vector with Vicair Technology proved to be the better choice for client to evenly distribute surface pressure across the entire cushion area while maintaining lower extremity positioning to prevent adduction.  Client reported less pain and discomfort and more stamina with less fatigue at end of day with the combination of Comfort Company Actaback and Comfort Company Vector Cushion. Pressure mapping of both cushions clearly illustrate the right side “loading” area on the Roho Cushion versus the Comfort Vector Cushion as well as the lower overall average “pressure” gradient across the entire sitting area on the Vector compared to the Contour Select.

Results from ROHOResults from Vicair

Justice was sitting in his driveway on a rainy Monday morning waiting for the school bus to pick him up and start the new week. His normal sitting spot while awaiting the bus was at the end of his yard next to the curb of the cul-de-sac. Today was different. It had been a rainy morning and the ground was saturated. Instead of waiting on the covered porch Justice decided to await the bus while sitting at the end of the driveway on the concrete with his backpack strapped to his shoulders and a small umbrella to protect him from the rain.
His neighbors shared a common driveway between the two homes and, on this morning, Betty, the neighbor, had to leave for work early to make final preparations for an important presentation with the board of directors. Betty’s company was struggling financially and Betty was under increasing stress of getting transferred or, worse, potentially being downsized and laid off. Betty left the house in a rush, opened the door to her Cadillac and quickly started the engine and backed out of the driveway.
She took no notice of her surroundings with the exception that she checked her mirrors and saw nothing evident through the blur of the rain covered glass. The thought did not occur to her that the elementary school bus picked up the children on her cul-de-sac at about this time each morning. After backing out of the driveway, she quickly threw the transmission into gear and accelerated toward the intersection.
At the intersection, she heard some kids yelling and carrying on but took no particular notice. Besides, the work meeting and her company’s financial position were foremost on her thoughts. Just before reaching thirty miles per hour, two children jumped in front of her car waving frantically. Betty slammed on the brakes, stopped the car, and got out thinking “What are you kids doing?” Before she could speak, one child yelled “Justice is caught on the back of your car!” and she saw the other boy run to the passenger rear corner of her fender. Betty gasped in horror as she saw a young blond boy dangling from the fender of her Cadillac, apparently caught and dragged along by his backpack for somewhere between her home and the middle of the street.
Judy, Justice’s mother, asked around to her friend who worked for a local durable medical equipment company, to see if she could get some advice on wheelchairs. Judy indicated that her son had received third degree burns and had been at Children’s hospital for the past week receiving burn treatments for damage to legs and shoulder areas. Following an extended hospitalization, Judy met with the elementary school administration who instructed her that her child needed to begin attending classes immediately or he would be required to either [1] attend summer school or [2] repeat the forth grade next year. Judy felt that in no way was her son ready to attend classes. He struggled with walking and needed to keep his left leg elevated to reduce pain and swelling.
Even though the wheel chair provided to Judy’s son was simple in design, not customized, and did not necessarily fit perfectly, Judy was grateful for the prompt service and delivery of a wheel chair that would provide a solution for her son’s immediate need.

In consideration of this story, I think about how something as seemingly simple as prompt delivery and service to a family in need of a basic item both helped in reducing the stress that this mother was going through and solved an immediate need by providing a means for Justice to attend school while his leg healed over the next two weeks.
Now project a little further into this scenario: a person, loved one, who has had a debilitating accident or progressively debilitating disease and has lost most functioning in his or her arms and legs. The miracle of the previous story is that the child survived the accident and, even during the painful recovery, remained hopeful of a full recovery in a relatively short time. Many disabled persons are not entitled to such hope. Their lives remain forever complicated by their disability and reliance upon others for assistance. Those of us who work in the rehabilitation / mobility device industry must keep our paradigms intensely focused upon client outcomes. Consequently, what many of us frequently forget is that outcomes are very much dependent upon processes. A friendly, interactive face, promises kept, and client centered customer service go al long way toward making a person’s experience positive, no matter how difficult their situation. Positive outcomes are not mutually exclusive of a favorable process. Take the case of the young boy and the wheel chair. The medical device solved the physical problem of temporary mobility; however, I would contend that the value of the customer service remained equally as important so at least the stress could be reduced by knowing and trusting fully that their mobility needs were being met.
Here at Active American, we pride ourselves on taking every individual case personally, trying our best to empathize with the client and their story through customer service and communication. It is difficult enough to admit that you are currently in a situation in life that you have to depend on equipment for mobility or actually need help from others to get through whatever the situation might be… working with a company that offers great customer service we feel is an absolute must.

by Robert Barr, ATP

With multiple storefronts throughout the Greater Houston Area, AAMobility guarantees our products and our services. Check out our new website at http://aamobility.com.

The answers to these questions could be defined as “Rehab-X” factors that client’s, physicians, therapists and referrals will judge us by. In all cases my professional relationships and professional network is only as strong as my ability to manage each account as if each is my only account.  This skill set is something I work on daily because I’m not as gifted in time management as I should be.  If I’m able to maintain a high level of contact with my client’s and all those involved, I will certainly develop one “Rehab-X” factor that will stand on its own merits.

Hopefully it will be these types of qualities that will have referrals and clients seeking me personally and the company I work for with any and all their Complex Rehab mobility and accessibility needs.  With most things being equal from one provider to another, I should be sharpening my ATP knowledge every day.  I can do my part in several areas.  Each area should present itself as “Rehab-X” factors that clients will gravitate towards.  Here is my “Top 3” list of what I think “Rehab-X” factors are from the provider’s perspective.

1. Be a “15 minutes” before you need to be there,  ATP

I know that this alone is next to impossible when you never know what each appointment or evaluation will bring.  It’s one thing to be scheduled with enough time between each appointment for the day given allotments for traffic and weather conditions.  However, if you can do this efficiently it speaks volumes that you care about your clients and families.  As always, if you’re running late, CALL and inform everyone that needs to know.

1. Have everything you will need to provide a complete evaluation with your first visit.

Know what mobility equipment you’re going to be accessing for along with the past history of what equipment the client may already have or did have in the past.  Most diagnoses will give you a clue as to what equipment will most likely be evaluated.  Return visits do happen if you need to confirm any changes with a client if the process for Insurance authorization takes longer than expected or physical changes that were not anticipated at first.

1. Present yourself in the upmost professional character, honesty and clarity

As a Resna certified ATP, I represent a small segment of the Complex Rehab Industry.  In the state of Texas there are just over 280 certified ATP’s. The registered 2010 state of Texas population was 25,145,561, In Houston alone 2,099,451 persons made the census.

Nationwide here are some stats regarding Spinal Cord injuries. A percentage of these numbers can be translated into actual clients that I will have opportunity to work with.

Number of New SPI Injuries per Year
32 injuries per million population or 7800 injuries in the US each year.

Most researchers feel that these numbers represent significant under-reporting. Injuries not recorded include cases where the patient dies instantaneously or soon after the injury, cases with little or no remaining neurological deficit, and people who have neurologic problems secondary to trauma, but are not classified as SCI. Researchers estimate that an additional 20 cases per million (4860 per year) die before reaching the hospital.

Total number of people with Spinal Cord Injury
Current estimates are 250,000 – 400,000 individuals living with Spinal Cord Injury or Spinal Dysfunction.

• 82% male, 18% female
• Highest per capita rate of injury occurs between ages 16-30
• Average age at injury – 33.4
• Median age at injury – 26
• Mode (most frequent) age at injury 19

Causes of Spinal Cord Injury

• Motor vehicle accidents (44%)
• Acts of violence (24%)
• falls (22%)
• sports (8%) (2/3 of sports injuries are from diving)
• other (2%)

Falls overtake motor vehicles as leading cause of injury after age. 45

Acts of violence and sports cause fewer injuries as age increases.  Acts of violence have overtaken falls as the second most common source of spinal cord injury in the last 4 years.

Again with all this being said it’s fair to say that a percentage of these numbers are right here in the state of Texas. In the city and the surrounding areas I work, Houston’s Medical Center is world famous for the highest quality or care and rehab services.

So to further expand on point number 3, an ATP and the company they represent should not just look professional; they should be ready to meet the expatiations and standards that are “World class” for the Complex Rehab Industry they serve.

This small list can easily be 10 or more.  I’m proud to “Who I work for”, “Where I work” and always, ALWAYS, who my work is for!

To all my past, current and future clients, I sure hope I’ll always provide that “X-factor” that lets you know I’m working to be the best I can be. Thanks for the opportunity and I can’t wait for the next step we all take together.

by Mike Duenas, ATP | Active American Mobility and Medical Supply
Houston  San Antonio  Dallas

Research websites:

http://web.resna.org/

http://www.census.gov/

http://www.sci-info-pages.com/

I have seen a lot of rehab equipment manufacturers come and go. Most of this rehab equipment has stood the test of time and gets better as the engineers make advancements with technology. Some equipment however only lasted a few short years and fades away never to be seen again, except for out on someone’s curb for trash pick-up. I came across a YouTube video that caught my attention. I shared it with my oldest son. My son is an army reservist and the video I found showed an “Exoskeleton” that a soldier can wear. This exoskeleton will aid with running and carrying heavy loads without stressing a solider physically. It was the coolest thing I have seen in awhile! It was very compact, light weight and flexible. It allowed the user to do so much more than they would have without using this system. I began surfing around and soon found a company using the same concept for paraplegics.

This company was developing and testing with several clients. It looks like if a client has good upper extremity straight and range of motion, they would benefit from technology! I realize that most clients have “wheeled” mobility and it works perfectly fine for most all they needs. I also know that if we were to be given the choice, most all of us would rather have the ability to walk if we could. This is the next wave of complex rehab that will soon become more than just a topic of conversation during a visit at your next clinic. I sure hope it doesn’t go the way of the “iBot”. I have included a few links that have the video and websites.

http://www.youtube.com/user/berkeleybionics
http://www.argomedtec.com/products.asp
http://www.youtube.com/watch?v=424UCSN3Fjg&feature=related
http://www.ibotnow.com/

Michael S. Duenas – ATP
Active American Mobility
mduenas@aamobility.com

While VPG remains hopeful that taxi authorities, including New York’s Taxi & Limousine Commission, will buy its MV-1, that appears unlikely until other entries to the “Taxi of Tomorrow” competition are evaluated. Submissions were due in May 2010 and a decision is expected by November 2010.

Compliance with the federal Americans with Disabilities Act will be among the key requirements for any vehicle that will eventually replace the more than 13,000 taxi vehicles operating in New York.

The six-seater MV-1, which looks like a minivan but has integrated wheelchair ramps, will be built in Mishawaka, Indiana, at the same AM Genera plant that made the Hummer, once sold by General Motors.

There are many harsh realities to the complex rehab and DME industries. We are faced with an endless barrage of reimbursement cuts, rules changes, and miles of red tape, simply to deliver a piece of equipment to a client in need.

This daunting process could be likened to a marathon runner who is told that the other contestants have to run the 26.2 miles, while he must run 50. Added to the increased distance, the runner must also run with a 200-lb. sack of bricks on his back, and during the race, spectators will try to trip him and make him fall.

Our industry for the first time in our history has coalesced to address these challenges, but much work is yet to be done.

Endangered Providers, New Refugees for Today
Most complex rehab providers will agree that while running this race, service after the sale can often stretch a company to the breaking point.

Earlier this year, I attended a rate hearing at Texas Medicaid with several other companies to argue against the proposed 9.5-percent cut for complex rehab items. The Greater Texas Rehab Providers’ Council (TXRPC) consists of complex rehab providers and partners, with its goal being to ensure provisioning of enabling technologies and accessibility to these technologies for individuals with disabilities. In this rate hearing, about 10 representatives from our industry articulated the access-to-care issues that would result from such drastic cuts.

My peers performed exceedingly well, and we were successful in preventing the cuts. In my presentation to the committee, I explained that these access-to-care issues would have a direct impact in the Houston market.

In the last two years, three major complex rehab providers in Houston closed their rehab doors. The result was a barrage of wheelchair users who suddenly found themselves with no place to have their equipment serviced. In some instances patients were turned away by rehab providers simply because they didn’t have the particular insurance contract held by the patient. In other cases providers simply could not physically add new service patients for fear of failing their own existing clients.

When we think of the term refugee, we think of war-torn third-world countries. The truth is a new form of refugee is emerging in many towns and cities throughout our country. These refugees are “healthcare refugees.” These are individuals who find themselves confined to bed with a broken wheelchair and no rehab provider to repair their equipment.

Fortunately in Houston, the situation has improved. Yet the healthcare refugee issue still looms like a gathering storm. If the gap between reimbursements and costs associated with wheelchair repairs continues, the volume of healthcare refugees will increase at an alarming rate.

So what to do in the interim? Many of our trade organizations and manufacturers continue to fight on Capitol Hill to repeal competitive bidding. If every reader of this article simply picked up the phone and called their representatives to support H.R. 3790, which certainly would be a great first step, it would make a significant and measurable difference. In our office at Active American Mobility, we ask our entire staff to call. We give them the time to do so during their workday. I would certainly encourage you to do so.

Coordinating a Service Program
While legislative efforts are happening, we still have businesses to run. Thus we must look at efficiencies within our own organizations.

Often when a client calls for a repair, the first person who answers the phone handles that repair until it is seen through. There is nothing wrong with this approach. When we formed our complex rehab division at Active American Mobility, this is exactly how we operated.

In the beginning this process worked quite well. But over time, we discovered that this process was becoming more difficult to manage, and the frequency of errors was on the rise.

Our management team decided to create a new position called a “service coordinator.” Once this position was created, service became much more manageable, and client satisfaction increased dramatically. Another positive impact of this decision was our other rehab admins working the pipeline for new equipment saw greater efficiencies in their respective roles.

The service coordinator now takes all calls for repair, schedules all of the service calls, and is the go-to person for all things service.

Warren Buffet once said, “It takes 20 years to build a reputation and five minutes to ruin it. If you think about that, you’ll do things differently.” I think everyone will agree that better service is good for the patient, the company, and the referral source.

A Checklist for Successful Service Departments
In interviewing several rehab providers for this article, I heard many creative and effective ideas on efficiency as it relates to service:

• Measure Gross Profit Margin and Net Margin on every repair. Set a tripwire that if a gross profit margin (GPM) drops below a set percentage, the employee must explore other means to increase the margin before submitting for a purchase order to obtain repair parts. (In our company that threshold is 35 percent.)

• For providers who do mobile repair, always encourage the client to come to your facility.

• Ensure that each technician’s vehicle is always properly stocked with items such as batteries to eliminate the need to make multiple repair calls.

• Have a person other than the service coordinator issue purchase orders. Checks and balances are a good thing.

• Train technicians to know how to do a home assessment on each call. They can then offer to do home safety assessments for the clients they visit. Bathroom equipment, ramps, etc., are often needed by the consumers you serve and are easy cash-sale items. Ensure that each tech has a few ramps, double hinges, etc.

• Management should enforce a culture where each employee understands that a 30-cent bolt for a repair client can end up costing you a million-dollar account.

• Create a formulary for commonly stocked items such as seat belts, headrests, etc. Buy them in bulk, and negotiate for a volume discount.

Henry Ford once said, “A business absolutely devoted to service will have only one worry about profits: They will be embarrassingly large.”

While we may not see embarrassingly large profits in our service departments, better service is good for the bottom line.

This article originally appeared in the September 2010 issue of Mobility Management.

We have all heard the phrase “they are non-compliant” in this field. When we hear this we assume the patient or client is not adhering to the instructions given to them by their healthcare professional, whether it is a physician, therapist, nurse, ATP or even a care provider. In the realm of seating and mobility it can usually mean they are not using the equipment that was prescribed and purchased for them to help correct or prevent possible seating and positioning deficits that have been recognized during a seating evaluation.

How many times have we spent countless hours’ even days on configuring a specialized wheelchair and custom seating components for a patient only to return after a period of time to witness that individual using a pillow or rolled up towel in the place of lateral supports or a cushion? How many times do you go over a proper “pressure program” with the patient in conjunction with the recommendations of their therapist while sitting with them in the clinic only to find out they developed a pressure ulcer 6 months after receiving their “customized tilt-in-space” wheelchair? After almost 20 years in this industry I have rarely had the opportunity to actually come across a situation where I have met somebody that has truly embraced the instruction and direction they received and adhered to it for an extended amount of time and reaped the benefits of that “compliance.”

For privacy reasons, I will refer to this patient as John. I met John thru a referral from a home healthcare agency. I was told John was a 62 year old with a C-6 spinal cord injury he suffered when he was 20 years old in 1968. I was asked to see him about possible cushion recommendations as well as a power wheelchair replacement. Of course, I assumed the worst case scenario being he had been injured so long ago and had lived with this devastating injury for so long. I called and set up an appointment to go and see John. Surprisingly he answered the phone himself and was a very personable, upbeat individual!

When I arrived at John’s house I noticed an accessible van in the driveway with ramps going to the front entry. I assumed there would be a care provider answering the door, wrong! John answered the door while using a manual wheelchair! I went in and we sat in the living room and began to talk about his needs. I was absolutely amazed at this individual as he began to tell me his story and really his life since his injury.

When he was injured 42 years ago, he was in a rehab facility for almost 10 months. While he was there he told me the clinicians could not stress enough the importance of the things they were teaching him. He said he met several people there that had suffered injuries like him, but were back there because of complications that had arisen such as pressure sores, severe scoliosis, contractures etc. He told me that he decided then and there that he would not be like those people and that he would learn and implement everything that he was instructed to do to deal with his devastating injury.

In the 42 years since his injury, John had never had a pressure sore, his spine had a very, very slight curvature, and he had very minimal contractures of a few digits on his hands. His posture was impeccable and he had very little muscle atrophy in his extremities! I was extremely impressed to say the least! I had to know what he was doing. This was a man who had been completely paralyzed for over 40 years from the neck down except for some “gross” upper extremity movements! I also wanted to see what equipment he had been using and what if anything he needed from me that he obviously just couldn’t live without!

John had embraced everything and anything he had been taught at the rehab facility he was in so long ago. He explained to me that even though he was very uncomfortable with the seating and positioning he was prescribed so long ago he trusted what he was told and that it was what was right for him. He trusted the instructions and exercises he was given by his therapists and clinicians and formatted a regime he has stuck with for over 40 years! From movement and isometric exercises to complete bladder and bowel programs, he learned them and stuck to them no matter how mundane and tedious. He had only one other visit to a rehab facility that he could remember, and that was for a custom manual wheelchair he was still using because he had actually regained so much strength in his arms he wanted to be able to self propel himself. He actually had not used his power wheelchair in so long he wasn’t sure he wanted to go back to it! By the way, it was a belt driven E&J Marathon that still looked like it came right out of the box! All of John’s equipment was over 15 years old! But, all of it had been regularly maintained and was in absolutely new condition!

While we were talking, John continually lifted himself up with his forearms to relieve pressure from sitting. I asked him about it and he told me it was so common to him now he actually never realized he was doing it! He explained it was just so automatic now as well as his hand, arm and leg stretching he would do while we were talking that he actually apologized! I told him I was so impressed with him and that I had never met anybody like him that had actually been so “compliant” for so many years without just giving up to boredom or depression and that he was in such great physical shape his injury not withstanding!
He told me that it was very hard in the beginning to stay “compliant” with everything he had been taught and prescribed, especially the seating on his wheelchair because it did “feel” uncomfortable. But, he said he was so glad his therapists, clinicians and wheelchair supplier so long ago drilled into his head to stick to it and be “compliant” and he could still has a fulfilling, productive life. John did just that. He worked a job and retired after almost 30 years, he became self sufficient but most of all he was “compliant” with what he was taught and implemented those ideals which has kept him extremely healthy both mentally and physically for over 40 years after suffering a devastating injury. Needless to say, I did not change a thing for John, nor did I make some outlandish suggestion about a new power or manual wheelchair. I did supply a new cushion cover for him, as his original had finally worn out!

I believe the moral or point of this story would be that even though we specify and supply specific types of equipment to individuals for their specific needs, we need to emphasize why we are doing it and most importantly that it is for their benefit and how important it is that they utilize it for their health and well being.

Robert Spitzmesser ATP
Active American Mobility
San Antonio TX