Posts Tagged ‘wheelchair design’

Planning for ‘Growability’ in Pediatric Seating & Mobility

Wednesday, October 19th, 2011

Among the most difficult tasks for assistive technology professionals is to assess a client today and then accurately predict what equipment that client will need a year, two years or even five years from now. And making those estimates can be even more difficult when the client in question is an infant, child or adolescent with a disability.

Nevertheless, funding sources typically expect pediatric seating & mobility to fit and serve a child for several years, which puts pressure on the rehab team to choose technology that will be appropriate today as well as tomorrow.

This kind of prediction isn’t an exact science, of course, but here are some factors to consider when putting together a “growable” pediatric system.

Independent or Dependent Mobility?

For some of your pediatric clients, independent mobility won’t be possible. But for many others, especially the youngest ones, selfpropelling or independent driving will be possible — if not immediately, then eventually. Therefore, one of the crucial first questions facing parents and the seating & mobility team is whether to pursue a manual or a power chair that the child will operate himself, or a stroller-type of chair that will be pushed by a caregiver.

Parents who are still working to understand a disability diagnosis may find it difficult to accept a wheelchair recommendation or may fear that using a wheelchair could discourage the child from learning to walk. In other instances, the family home, environment or lifestyle may preclude independent mobility under the present circumstances.

On the other hand, multiple studies have indicated there are many social, emotional and cognitive benefits to providing independent mobility at as early an age as possible — even if the child does eventually walk independently.

Some studies have shown that as with language acquisition, there is an optimum “window” for a child to learn to move independently, and that window corresponds with the age that infants naturally begin to crawl, stand and walk.

Research seems to indicate that giving young children with disabilities the same opportunity to explore can have a powerful effect later in life.

Building in Growability

Whether the child will be self-propelling, independently driving or using a caregiver-operated mobility device, building growth potential into the seating & mobility system is imperative.

That generally means being able to accommodate increased seat widths and depths, which can also lead to adjusting the location of the seat on the base, changing seat-to-floor heights and needing a longer frame as well.

While many seating & wheelchair manufacturers offer “growth kits” — with some offering the first one free of charge — it’s also important that those growth kits or other parts needed to grow the systems are readily available when you need them. Therefore, it’s wise to work with vendors who can deliver the parts or kits in a timely manner…since growing kids wait for no one!

Once you’ve made the seating or mobility system growable, make sure the entire team — parents, clinicians, techs and other provider staff working with the family — understand all the adjustments that are possible and how to implement them. After all, growth kits are at their best when they’re fully used.

The Importance of Adjustability

In pediatric seating & mobility, adjustability is key. For instance, with young and/or small clients who will be self-propelling, consider wheelchairs capable of switching between standard and reverse configurations. Your littlest self-propellers can start out with the drive wheels (i.e., the rear wheels) moved to the front, where the wheels and pushrims can be more easily reached, grasped and pushed.

Once the child grows taller, the drive wheels can be moved to the standard rear position for conventional self-propelling. Another area where adjustability could help: upholstery. If it’s a viable option for your young client, adjustable-tension back upholstery could “grow” the width of that initial wheelchair back without having to actually swap backs.

For families seeking growability and adjustability of function as well as sizing, some pediatric seating & positioning systems are capable of detaching and reattaching to manual or power bases as needed. That flexibility can be helpful for transportation or if the child needs the seating system to function in multiple environments.

Some manufacturers also make seating & positioning systems that can be swapped among different wheeled and nonwheeled activity bases, such as those used for schoolroom use, feeding or grooming.

Working with children who have disabilities will always include some potential element of surprise when it comes to anticipating growth. Depending on their medical conditions, family histories and individual biology, some children will grow taller but not much wider.

Others will grow wider before they grow much taller, and some children will grow both taller and wider. Creating optimal seating & mobility systems, therefore, requires careful planning beforehand, with all members of the team communicating effectively to understand the child’s goals and to tackle growth-related challenges before they come up…as well as along the way.

A Balanced Look at Seating and Positioning

Wednesday, October 19th, 2011

Pride Mobility’s Julie Polin and Mike McCarthy discuss the needs of wheelchair users, emphasizing the need for a clear understanding of the need. Their article, reprinted here, first appeared in Mobility Magazine.

Providers and clinicians share the same ultimate goal of ensuring that a client’s needs are fully met in the most complete and efficient means possible.

When it comes to a client’s seating and positioning needs, it is necessary that all parties involved have a clear understanding of how this is best accomplished.

Understanding the Need

A complete wheelchair evaluation is necessary to address what an individual requires from his or her seating system, which may include cushions, backrests, headrests and trunk, arm and leg supports.

Only through a thorough seating evaluation can the client’s needs be understood. While the evaluation is the clinician’s key area of focus, providers, as product experts, should take an active role on the evaluation team.

A stable and comfortable position in an appropriate wheelchair is critical to the patient’s comfort, health, productivity and independence. Individualized seating and positioning systems can enhance breathing capacities, prevent skin breakdown, minimize pain and greatly improve overall functional abilities of an individual.

The factors that determine what seating components are going to work best for the client are numerous, but on a general level, are similar to those of other rehab equipment.

The patient’s level of injury, his or her capability, body type and activities of daily living must all be factored in, so this information should be gathered during the initial evaluation process

Know What Is Available

Seating requirements vary from a simple out-of-the-box solution to a highly complex, custom-built power positioning system.

Staying up to date on the latest equipment available and the reimbursement rules that govern its provision is a full-time job in itself. Providers must work diligently to educate themselves and their referral sources on the ever-growing number of seating solutions available.

Numerous educational opportunities can be found within the industry. By investing in education, providers can serve as a valuable resource to the clinician. Clinicians should therefore make time to meet with providers by scheduling in-services.

Providers are an excellent source of information on the options available to meet the client’s needs. Listen to what they have to say regarding the products they carry and why they are best suited to meeting your patient’s needs.

Providers should engage clinicians for feedback when reviewing the benefits of a product they would like to provide. Chances are the clinician has experience working with the product or a similar item and can offer an informed opinion.

Clinicians will also be able to estimate how many of their patients use the product, giving providers an idea of its demand and potential applications. Clinicians should remain realistic in their expectations. Understand the reimbursement and economic reality for each client. If you are recommending equipment that cannot be funded, then the patients’ needs are not going to be met.

Providers should create a system that takes the guesswork out of the reimbursement process. Develop an easy tool for your staff and referral sources to match International Statistical Classification of Diseases, Ninth Revision codes (ICD-9 codes) with the local coverage determinations (LCD) and match the demo equipment available to this tool.

When providers and clinicians work together to stay up to date, they are capable of giving the client access to the broadest range of equipment available.

Efficiency Is Essential

Patients and clinicians depend on providers to deliver seating solutions accurately and quickly. To stay competitive, providers must take steps to ensure that efficiency is a paramount part of their business operations.

To ensure efficiency, providers should evaluate their purchasing history and identify trends regarding the seating products they provide. A clear picture of the most commonly supplied products should emerge. Efficiency can be improved by purchasing your most popular products in quantity.

Providers should partner with a high-quality manufacturer that can provide many solutions to diminish the need to order from multiple vendors. Again, this can dramatically reduce overhead, reduce product lead time and shrink the margin of error.

Product reliability is an essential ingredient to ensuring the satisfaction of the patient, clinician and provider. Replacing or repairing a seating system leads to downtime for the patient, frustration for the clinician and quickly drives up provider costs.

If you select a manufacturer who produces and stands behind high-quality products, there will be fewer service calls.

Think Long-Term

Providers must work with clinicians to keep the patient’s future needs in mind. Will the back you provided easily integrate with the positioning components they may need in the future? A commitment should be made to carry products and parts your customers may eventually need or that will serve their changing needs.

Choose products that can be easily modified to prevent having to purchase additional items. Identify which products work best with the other equipment you are providing.

Compatibility is key. Offer cushions and other seating products that work with all of the chairs you provide. This keeps both patient and provider costs and down and makes future adjustment fast and easy. Ensure customizations are provided in a timely and cost-effective manner. It is important to consumers that their customizations are performed accurately and as quickly as possible.

Partner with a manufacturer that can quickly and reliably deliver custom seating sizes, and if necessary, can help fabricate unique components to reduce time and cost. Clinicians should educate providers on the progression of a client’s need. If a patient’s ability is likely to improve or decline, a plan that encompasses these changes should be discussed with the provider.

When providers and clinicians work closely together to meet seating and positioning needs, a great outcome is easily attainable. The needs and goals of each simply need to be understood and addressed.

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