Expert Tips for Adult Power Wheelchair Prescription | Ep 2 | Redefining What’s Possible Podcast

Join host Sarah Uncle and Amy Bjornson as they dive into the guiding principles of power wheelchair prescription, breaking down the roles of therapists, suppliers, and manufacturers. They discuss the assessment process, emphasising the importance of understanding client needs and environmental factors. This episode highlights common pitfalls in wheelchair prescription and provides practical advice for therapists to achieve the best outcomes. Amy also shares insights into MAT assessment and the crucial role of collaboration in supporting clients with complex needs.

Takeaways

• The triangle of power wheelchair prescription involves therapists, suppliers, and manufacturers.
• Client-centered care is crucial in the wheelchair prescription process.
• Assessing client needs requires asking the right questions and listening actively.
• Compromises are often necessary in wheelchair prescriptions; prioritize needs effectively.
• Understanding the MET assessment is vital for accurate client evaluations.
• Common pitfalls include not considering transportation and fitting needs for power wheelchairs.
• Effective communication with clients and caregivers is essential for successful outcomes.
• Trialing the right wheelchair options is key to meeting client needs.
• Therapists should feel confident in their assessment skills, regardless of their background.
• Assistive technology can significantly enhance a client's independence and quality of life.

Chapters

• 0:00 Introduction to Assistive Technology and Power Wheelchair Prescription
• 3:05 The Triangle of Power Wheelchair Prescription
• 6:08 Assessment Process: Investigative Reporting for Client Needs
• 8:59 Choosing the Right Power Wheelchair for Clients
• 11:51 Understanding MAT Assessments and Therapist Confidence
• 15:07 Common Pitfalls in Power Wheelchair Prescription
• 17:56 Key Takeaways for Successful Wheelchair Prescription
• 20:48 Real-Life Impact of Assistive Technology on Clients

Transcript

0:02

Welcome to Redefining What's Possible, your guide to Assistive Technology in Australia. Join us as we explore practical applications of AT featuring expert interviews and the latest industry insights to enhance your professional development and to improve client outcomes. Welcome to this episode of the Redefining What's Possible podcast. I'm your host, Sarah Uncle. I'm a clinical educator from ILS, and I trained as an Occupational Therapist. And today I'm joined by Amy Bjornson. Amy is the Asia Pacific Clinical Director from Sunrise Medical. She trained in the US as a Physical Therapist and she's had over 25 years experience working with clients, both adult and pediatric, with neurological conditions. And she's specialized in spinal cord injury and in the evaluation and provision of assistive technology for clients who have physical challenges. Currently, she works to develop training programs both internationally and nationally. And if you've ever been to one of her training programs, you know what an engaging and dynamic presenter she is. So we are privileged to have her here today and to learn from her. So welcome to the podcast Amy.- Ah, thanks very much. Glad to be here.- It's great to have you here. So our theme of the podcast today is we want to glean from you your expertise and your knowledge around the guiding principles for power wheelchair prescription with a focus on our adult clients. And it's gonna be wonderful to learn from you. So to help us kick off, I just wanted to talk about the team involved in power wheelchair prescription and sort of knowing whose role is what, when it comes to the therapist's role and the supplier's role and the manufacturer's role, when we're looking at the assessment and then the provision of power wheelchairs Yeah. I think of this as a bit of a triangle. So each end of that triangle is a, is a person or a group of people. So on one end they're the therapists obviously, and they're gonna be the client and the, and the caregiver's expert. Their job is to really figure out what that client needs, what environments they're working in. And then on the other edge of the triangle, you have a manufacturer. So we make the products hopefully that they're reliable, they're durable, they're easy enough to use. And then the last point on that triangle is gonna be the supplier network. Now they're the product experts. They are going to, you know, generally they have bunch of different manufacturers products. And so they need to be the expert and tell the client, the caregivers what the best aspects of this particular product are and what maybe the considerations are for the, for another competing product. They're gonna be the ones that are gonna put together a package of the product that suits the needs of that, of that client. So, you know, if we're in our, our triangle here, we have to remember that we're all working for the person, the group of people in the middle. Yeah. The client themselves and everybody that they interact with- Clients. Yeah, absolutely.- Mm. I actually think that can give peace of mind to the therapist to know they don't need to know all the products. Yeah,- Yeah. As they get more experienced, I think they tend to know more and more about the products and they have particular ones that have seemed to work well in the past. But if you're newer, you really are expected to be the client expert. And then the supplier is meant to be the product expert and then the manufacturer, you know, we're working with all of these different people to make sure that we're building the products that, that are useful and required.- Yeah. - We're all in this together. It's a big soup. And when we're working together, I think the outcomes are much more successful.- Yeah. And that's the goal, right? We just want really good outcomes for our clients, particularly those who require a power wheelchair.'cause they're more likely to be more complex clients.- Sure. Yeah. And we probably expect a power wheelchair to last three, five, even longer years. So you think about how somebody's condition might change, how their environment might change. You need to future proof that as much as you can when we're dealing with power wheelchairs.- Yeah, absolutely. So I've heard you educate before around the assessment process for power wheelchairs and I've heard you talk about it being a little bit like you're an investigative reporter. So what kind of information do you wanna obtain in that assessment process, which will hopefully lead to a really great outcome in the end for the client?- Yeah, sometimes when I'm joking, I think clients feel like this is doing their taxes in Greek, they don't wanna do their taxes, they don't know tax law and they certainly don't know Greek. So think of it from that point of view that the clients are coming in, you know, just not aware of everything that might be available to, to suit their needs or to, to meet their functional goals. So making sure that you're asking the, the "W" questions, What do they wanna do? Where do they wanna do it? I know this isn't a W at the beginning, but How do they wanna do it? Like how are they gonna interface with this power wheelchair? Make a make a problem list? What are they currently not able to do? What are they struggling with in their life? And then maybe make a needs list. What do they need to do? How does it need to function? And then that list, you're gonna need to prioritise, especially with power chairs. Number one goal might be in contradiction to number 10 goal. And you know, it's hard to get everything in one, in just one chair. So if we all of a sudden have that that needs list, we can prioritise it and make sure that we're really meeting their goals, their needs the majority of the time. I have a couple sayings that if you've heard me speak before, I probably say it at least once every session. What's most important, most of the time? We're going to make compromises when we're doing wheelchair prescriptions, whether it's power or manual. So we need to make sure we're hitting the nail on the head for those issues that are of most importance to the client. What's most important to this client and their caregivers most of the time. I think that will get you on the pathway to a successful prescription.- That's such good advice.'cause there will have to be- Compromises. There are compromises. Yeah. And you wanna make sure that you're making the compromises in the appropriate places. Right? Yeah. The, the best tool for the job. Right. You know, if I'm washing windows, I'm gonna make sure that I've got a squeegee, I'm not gonna have a hammer. And I think sometimes power wheelchairs can be the hammer when really the, the client just needed a squeegee or vice versa, right? Yeah. But you're only gonna find that out if you do a proper assessment.- Yeah. And have those important conversations. Yeah.- And you know, maybe that's, did I actually answer the question? How do we have those conversations? You wanna ask open-ended questions and then listen and look around, get all the clues that the environment is giving you. Not only from just the client, but all those people around them, their family members, their teacher, their carers. Again, that goes down to the investigative reporter. What's going on in this environment, how do they function? What do they do? What does, you know, a day look like in the life of this client?- Yeah. The other important part is, you know, their, their world really might have shrunk. They didn't have good function, they haven't been able to go outside. So all of a sudden what they do on a daily basis is, is very different than what they could do. So don't, don't forget to ask about potentially what could they, what would they like to do if they had the right piece of Assistive Technology?- Yeah. And dream a bit about- What And dream a bit.- Yeah, exactly.- But you can't dream too big. Yeah. Because then you have too big of a priority list. So- Yeah, that's- True. Yeah.- Yeah. That's true. That's good advice. And when you've sort of had those conversations and you're starting to think about, okay, what wheelchair am I gonna take out for trial for this client? Is there any further questioning you want to go to so that you're taking out the right wheelchair, power wheelchair? Because, you know, we don't wanna waste people's time. I know we all wanna do the right thing, but the team that we're working with and with the client and their families and there's so much to choose from. So what kind of questions do you ask to whittle it down and I guess know what to take out, or at least what to take out- For a client to try? Yep, yep. And that's very much how I approach this. I'm thinking about knocking out power wheelchairs that aren't appropriate. Right. Okay. And so then you whittle it down to maybe two, the most three chairs that are gonna meet the, the majority of those priorities that you've established. You know, that's tricky. I, I think the T's are very important. Transportation. Yeah. How is this gonna be transported? How are they expecting it to be transported? Do they expect to be sitting in the unit as they're on public transportation, in their own van transfers? How are they gonna get in and out of the system? How are they going to interface with this chair? Are they gonna drive it? Is a carer gonna drive it? Maybe sometimes during the end of the day they need someone else to, to drive that chair. And then the last T, I guess is terrain. Where do they wanna go? What kind of distances, what kind of terrain? And then I think to myself, what's the narrowest thing they have to get in between? What's the shortest thing they have to get underneath? What's the shortest thing they have to get inside? And then how often do they have to do that? That's the trick. You know, you can have a client that has the smallest house and well I've got really narrow doorways, but then they've got a really steep hill and a huge curb to get into their, to their driveway. Right. How often do they come in across these obstacles, whether they be maneuverability obstacles or you know, big curbs or inclines declines outside. Yeah, yeah. Think about how they use the chair, where they use the chair, how are they gonna interface with it? What does a day, what does a day look like?- Yes. It's simple, but it's really important to be holistic like that, isn't it? And think about all those different factors. Yeah.- And I, I don't know that it's simple. I think it's really complicated, you know, and I think about all the methods of transportation I use in all the different kinds of footwear that I use.- Yeah. - You know, I sometimes ride my bike to work, I take the train, I drive a car when I need to carry stuff, I take a van, I take public transportation. Right. Whereas these people for the next five years, maybe longer, they get one mobility device and it has to work across environments. It has to work across different activities. So there are going to be compromises. But I think the whole idea of the assessment, the conversation that you have with people is that both yourself as a clinician and as a client, you're gonna be happy with the compromises and the decisions that you've made. You know, I think clinicians and suppliers both, we enable people to make good decisions about what wheelchair is gonna work for them. Yeah. Right. And how do we do that? By giving them information, knocking out the ones that they don't need to be bothered with. And then, you know, coming to that trial with two or three chairs that are most likely to, to meet that needs list and then they, they can trial it out and you know, some people like pink better. You know, it can be as easy as how it looks or, you know, or the decision maker can be, you know, how it drove around the corner or how it tilted or how they a access the tilt. But when we drill down to those, you know, top two or top three choices that are gonna best suit the established problem list, I think that's, where we're in the best shape.- Yeah. That's really good. Really good advice. Amy, you've been educating in this space of assessment for wheelchair prescription for a while. When it comes to the physios and the OTs that you have been educating, what kind of level of confidence do you feel like most of us have with the MAT assessment and the MAT assessment skills? We need to do that Well,- Hmm. With the MATs in particular, I think a lot of therapists are scared or intimidated by the, the MAT assessment. But that's, you know, you need to figure out what the client's body can do and what it can't do.- Yeah.- Right. You need to understand where the body wants to be. You wanna think about what the, their postural tendencies are. And I really think the simplest way to do that is via some sort of MAT assessment. And I'll be the first person to say that, hey, if it's a, a person that you know well, you've been treating them for a while or it's pretty simple, right? They're, they don't have a lot of tone, maybe just a paraplegia or you know, something where they're just not all that involved in their trunk and, and maybe upper limbs, you could get away with just doing a sitting assessment. Right, I think you have enough idea of how they move around in space. Same thing goes for maybe a aged care client that they're still ambulating. You can see their ranges of motion as they move around. That doesn't require a full on supine mat assessment.- Yeah. - Okay. As long as you know what the the hip range of motion is, what the knee range of motion is, maybe even ankle range of motion is, and how that body moves through space. I think you can get enough information from sort of a sitting postural evaluation.- Okay. - Yeah. But when we're in more complex postures with lots of tone, spasticity, abnormal reflexes, variations, abnormal postures, and you don't know why. Yeah. That supine assessment is, is really imperative because it's the easiest, it's the simplest, it's the safest, it's the most effective way to get that information. Yeah. Now, you know, how do you do that? Well, you know, best would be in some sort of firm mat space. Second would be coming into like a supplier's showroom or maybe a clinical center in some sort of high low firm mat space. Next best would be their bed. Okay. Or even, Hey, can I come early in the morning? And when you're getting dressed, your care is getting you dressed, can I just come and see how that happens? That's gonna give you a lot of information about their range of motion and how that body moves through space.- Yeah, that's good advice.- But you need to understand however you do it, you need to understand what the ranges of motion are and how that body, you know, moves or doesn't move through space and what influences those postures.- Yeah. - So, you know, this is my standard joke when I go to the dentist, I just assume they're gonna have all the gear to properly assess my teeth, even the ones way back in the molars. Yeah. So this is a profession I think we really need to treat it the same.- Yeah.- Okay. But I'm not saying that we need to do a full on MAT assessment with all of our clients. 'cause we don't,- Yeah.- We can get information other ways. We wanna be effective, efficient so that we can have successful trials and prescriptions. Really.- Yeah. That's good. And I know you've trained as a Physical Therapist, do you see a difference between how confident Physiotherapists are getting their hands onto clients and doing a MAT assessment versus Occupational Therapists?- I think physios probably spend more time in body dynamics and body mechanics.- Yeah. - So out of the gates we're probably just a little bit more comfortable moving bodies around, but OTs can learn it just as, as well. We all, we all start from ground zero.- Yeah.- So we can learn it. We all come from different perspectives and I think we can work together Physios and OTs.- Yeah, absolutely. Team effort.- Team effort, team effort.- And at the end of the day, we, you know, we want success when we are prescribing power wheelchairs. Yeah. But things can go wrong. So I wanted to ask you, you know, what are some of the common things that can go wrong and what can we do to avoid those common things that can go wrong? So at the end of the day, the end user doesn't end up with a seating system or a power wheelchair that isn't actually working for them.- Yeah. I'd rather talk about how to avoid things that don't work. And I think that always goes back to the assessment. Yeah. Know what ranges of motions are, know what body shape asymmetries, what's happening with the client, what might be reducible, what might not be reducible. Remember that, especially with the power chair, the more complex they are, people are sitting six hours, eight hours - longer. They have to be comfortable.- Yeah.- Right. Thankfully we've come a long way and we're now talking about 24 hour postural care. So maybe I can let a little bit of asymmetry be in their wheelchair and I can try and undo it when they're lying down or out of the chair. So, you know, at the end of the day, we need this power wheelchair, for example, today to meet their functional goals. Yeah. And be comfortable. So in terms of posture, range of motion, if you don't do anything else, just know the ranges of motion. And then in terms of sort of the right tool for the job, I guess that would be not investigating enough how this thing is being used, where it's going to be used, what are the top, you know, three things, four things they have to have this chair do and make sure you're dead on on those. So really it all goes back to your assessment and making sure that, that, you know, how this device is going to be used and, you know, even broader maybe how it can be used to, to broaden their life and allow them to be more independent and, and be more active.- Yeah. That's good. Going back to being an investigative reporter, again, like really it's all back at the beginning. It's asking the right open-ended questions, getting the right information from the client and from their caregivers and family members to make sure we've got those goals and we put them into hierarchy and that do that needs assessment and then make good decisions from there.- But somehow we also need to be efficient in this process. You know, we don't want just knowledge for knowledge sake about the client in the wheelchair prescription process. So make sure you know, you're asking questions that are targeted, that you're listening to the answer, that you're probing a little bit deeper. The more experience you have, the easier it is, the more you can deduce from what you see. But you know, sort of again, look and ask and listen and, and then maybe look again just to make sure you're getting the, the information that's appropriate for this assessment process without a hundred page reports. Yeah. And five hour assessments. Right.- Yeah.- Targeted. It's not- Necessary.- Yeah. Yeah.- So to round off our conversation, if there were three key takeaways that you would like therapists to remember from our conversation today, what would they be?- I'm gonna sound like a broken record. You know, sort of assess, know your client, what can the body do, what can it not do? What are they expecting out of this wheelchair? You know, are you gonna go to the doctors? Well, what does that look like? How does it get transported? The number of power wheelchairs that I see fail because they're not transport ready or they don't fit in the van. Just crazy. That should be one of the first, first questions you ask. Hey, where's this chair gonna go? How are you gonna transport it? So what did I say? You know, assess.- Yeah.- Ask those important questions. Create a problem list. I guess maybe that's, that's how I'll say it. You know, assess, do your assessment, gather those bits of information, then have that conversation about how, where, when this chair's gonna be used, who's gonna be driving it. Make that priority list. And then you might need, based on, you know, all those conversations, you might need to re-prioritise, oh boy, we, we thought purple colour was the most important thing, but really I need to have a 460 seat to floor height because how we get in and out of this thing or on and off the toilet, that's just imperative. Yeah. It's, or, or whatever that, that imperative item is.- Yeah. That's so good, Amy. So I've got one last question to ask you when we ask this of all our podcast guests. So the question is, can you describe a moment when Assistive Technology significantly changed a client's life and how it inspired you to think differently about your work?- Oh, every day, every client, you know, I, I'm continually amazed at how well our bodies work - that we can treat them the way we do and ask them to do all these things and they continue to work. And then I'm also amazed at when you have a spinal injury, how that doesn't only affect, you know, the motor systems, it also affects, you know, sensory items and, and how all the endocrine systems work and it's all, we're all inter wired. It's, it's crazy. I guess I, if I have to come up with a person, you know, sort of recently, I saw a gentleman with MS and he'd been living with MS for probably 30 plus years and had lived long time managing, you know, he's aging with a disability and all of a sudden, he's in a power chair. All of a sudden it's getting to the point where he can't manage the input device, the joystick. And they've made lots of modifications over the last couple years. And you know, it's sort of, if something happens during the day when he's alone, his family goes to work, he's stuck. There's no way he can get back to that joystick. But, you know, as all people with power wheelchairs, there's a lot of asks of this chair. He has a very steep driveway. He has one of those awful irrigation, you know, humpty dumps that get them into the driveway. He has space issues in the home and he, he doesn't wanna lose his joystick, I think is, is the biggest thing. So yeah, we're looking at alternate devices, you know, can we do a head array? Can we do a sip and puff? Can we do a chin control? He's got some range of motion limitations at his head. So he's a perfect example where it's the electronics, it's the input device as well as the capacity of the wheelchair that we need to put together. So the first appointment that we had with him, we knocked out all the things we didn't wanna try and now we're down to two bases and we're gonna try a chin control and maybe a sip and puff. And I haven't done a sip and puff in a long time, but based on the information that we gathered from him that that looked like that was gonna be the most successful things to trial. I guess if I have one more comment for the therapist, you are gathering the information and knocking out products that you don't wanna try. You know, at this point you're not buying anything, you are just getting really good packet of information together to give to the supplier so that then you can try it on and oop, I didn't, I didn't understand that wi thing was gonna be that important. Oop, I didn't know that that armrest was gonna be, you know, something that was gonna trip us up. This is just the process to get us to trial. Okay. And if we're lucky, boom, we are right on the money. Probably more likely like, oh, we didn't really understand that. So we'll need to make a couple tweaks. Okay. That takes some of the pressure off, I think. Yeah. You're only gathering the information to figure out what you wanna try.- Yeah. Then give it a go and then try and give it a go try- Again. Yep. And hopefully, you know, you do it pretty quickly, pretty efficiently because you've gotten all that backstory to start.- Yeah. And that's- The key. That's the goal anyway.- Yeah. That's the key. And hopefully with that client you just spoke about, hopefully you'll have a good solution.- Yep. - Fingers crossed. To remain. as independent as possible. Yeah. Fingers crossed.- Yep.- Amy, thank you so much for your time today and for coming. And its pleasure sharing your expertise. I just love the way you take quite complicated clinical decision making and you make it so much more easy to understand and applicable to our everyday therapy world that we live in. So I really appreciate your time today. Thank you. And thank you so much for tuning in and we will see you in the next episode. Bye.