Problem Solvers

Creating Seating Success Stories

Providing seating solutions for young mobility patients involves a number of factors. What should providers consider?

For mobility providers, serving young patients ushers in a whole host of unique challenges and issues, especially when it comes to seating. Determining the right seating solution for young patients can be difficult, because of one simple, universal challenge: they’re still growing.

HME Business sat down with Magdalena Love, OTR, ATP to learn more about this tricky subject. A “go to” resource on the subject, Love currently works for Permobil as Clinical Education Specialist, is an Assistive Technology Professional, and is an active member of AOTA and RESNA.

Love has considerable mobility expertise. She received her Masters of Occupational Therapy from University of Florida. Following a specialty affiliation as a research assistant at the National Institute of Health (NIH), she worked as an OT in the New York School system and at an outpatient pediatric clinic. In 2011, she went on to hold an OT position at The Institute for Rehabilitation and Research (TIRR) in Houston, Texas on both the Brain Injury then the Spinal Cord Injury/Specialty Rehab team. Magdalena was actively involved in seating and mobility clinics during her career at TIRR.

Love provided some detailed answers to various questions providers might ponder when it comes seating for young mobility patients.

What are some of the common problems/risks facing young mobility patients when it comes to seating?

“One of the most difficult aspects of working with pediatric clients is providing a seating system that allows for growth and modularity, without adding dysfunction. This can be a delicate balance — as the hardware often necessary for growth can be heavy or cumbersome — decreasing the child’s functional access to their environment for the sake of future growth.

“Another common difficulty with working with pediatric clients is knowing the correct balance of positioning equipment for the child. Especially in earlier intervention clients, its important to provide the support necessary to operate the device and get a stable visual field, however over positioning may hinder the development of trunk balance and postural reactions.

“Additionally, ATPs face the challenge of balancing family dynamics and the “status quo” of mobility products. For instance, a young child may be a candidate for powered mobility to maximize his or her exploration of the environment. Instead of viewing this as a learning opportunity and a way for the child to achieve functional independent mobility, caregivers might see the device as a last resort — in other words, evidence of “giving up” on other therapy goals.”

What are some of the key ways to mitigate these problems/risks? Are there specific types of product solutions that are key in this regard?

“Get products that allow for growth and modularity. There needs to be a plan in place when ordering the mobility device, how much is the child expected to grow (and in what direction), as well as how both the positioning equipment can potentially support and/or hinder daily functioning. Both the TiLite Twist and Permobil power wheelchairs have a significant amount of growth built into the system to assist with these clients. For clients who are on the cusp of being able to operate a powered mobility device, I love the GoBabyGo modified toy cars (www.udgobabygo.com) for introducing mobility as a therapeutic modality or a toy rather than a medical device.”

What about staff expertise? What kind of experts should providers have on the team if they want to ensure they are taking good care of young patients?

“The type of staff needed includes ATPs that can manage the client and the family. The most successful ATPs can manage all the people involved in the mobility device (teacher, therapist, mom, bus driver, etc.). There are lots of people to make happy with pediatric clients. The ATPs should be okay with taking some extra time to ensure that both client and family are trained in the use of the mobility device (especially important when considering powered mobility with individuals who have cognitive limitations).”

What are some key issues when dealing with referral partners as well as parents in these situations?

“I imagine that the mobility provider is somewhat ‘in the middle’ in these scenarios — how can it ensure that partners are satisfied, parents are not only happy, but educated on the mobility solution, and that the patient is happy and enjoying the chair and seating solution?

“The answers are communication, realistic expectations, and sensitivity to the child’s disability (especially very young or medically fragile). These mobility devices are tools to use in daily life, not an indication that therapy goals are being discontinued.

“If a provider has not obtained all required documents or one of the documents is not valid, it should not deliver the product; otherwise, it will be at risk for recoupment in an audit. Visit cms.gov for more information.”

This article originally appeared in the February 2015 issue of HME Business.

About the Author

David Kopf is the Executive Editor of HME Business and DME Pharmacy magazine. Follow him on Twitter at @postacutenews.

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