Redefining What's Possible

Benefits of a Power Standing Wheelchair | EP 6 | Redefining What’s Possible

• Independent Living Specialists • Season 1 • Episode 6

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In this episode of the Redefining What's Possible podcast, host Sarah Uncle, Head of Clinical Education at ILS, is joined by Tilly Brook, Director of Clinical Services at Permobil Asia Pacific. Together, they explore the evolution, benefits, and clinical considerations of power standing wheelchairs. Tilly shares insights from her extensive international experience as an Occupational Therapist, highlighting how power standing technology has developed over time and the profound impact it can have on participation, health, and quality of life. The conversation delves into clinical reasoning frameworks, evidence-based benefits, and practical advice for therapists prescribing this advanced form of assistive technology. The episode concludes with inspiring real-world stories that showcase how standing wheelchairs can truly redefine independence. 

Clinical Resources https://www.permobil.com/en-au/clinical-resources

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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 the Head of Clinical Education for ILS and I trained as an Occupational Therapist. And today I am delighted to be joined by Tilly Brook. Let me introduce her to you. Tilly is an Occupational Therapist and she's the Director of Clinical Services for Permobil Asia Pacific. She is based in Australia. She started her career as an OT working in the community and in inpatient brain injury rehabilitation units in Sydney. After this time, she moved to Singapore where she worked at Cerebral Palsy Alliance School where she had the opportunity to work with individuals across the lifespan with a variety of seating and wheelchair goals. She further developed her skills and hands-on experience when she moved to Auckland, New Zealand and worked with the amazing team at Mobility Solutions. She moved back to Australia in 2019 and she worked as a clinician with those who had sustained catastrophic injuries later moving into clinical education. She joined Permobil and the clinical services team in 2021. She has loved wheelchairs ever since her senior rolled out the oldest iris you have ever seen and asked her to make it work for the next admission. She honestly believes that prescribing wheelchairs and seating is the best job in the world. And when we get it right, it has the most extraordinary impact on an individual's life. I 100 % agree with that. She enjoys nothing more than working closely with therapists, helping them work through difficulties and having those needed light bulb moments. When she's not working, you'll find Tilly traveling the world with her family, discovering and eating as much of the local food as she can. So a big warm welcome to Tilly to the podcast today. Thank you, Sarah, for having me. I'm really, really excited to be here today to talk all things Power Standing Chess. Yeah, and that's what we're going to do. And just, you know, reading out your bio, you have a wealth of experience and you are well-versed to be the person that we have this conversation with today around the benefits of power standing wheelchairs. So thank you for coming and sharing your expertise with us. So to get us started, can you give us a brief history on power standing wheelchairs in Australia? Yeah, look, when you threw out, like tell me about the history, was like, whoa, that's a really good question because I think when you come up in your career, it just kind of is around you. So was really interesting that I actually had a pause and went and had a bit of a dig as well. so I obviously, because I work for Permobil, so we're the manufacturer that makes Permobil power chairs and you know, other products as well. But so I was like, well, I'm curious from from a Permobil perspective, what's the history in Australia, because in my mind, they've just kind of always been there. And, you know, standing chairs, Permobil released their first standing power chair, I think it was in 1977. And what's really cool is I haven't seen the original one that was made, but I have seen one of the first power chairs that was designed Dr. Pair Ordon that's on show in Nashville, actually. So when you look at this chair, it's like bicycle wheels and almost like a tilt table attached to it. And that was kind of the original standing concept. A long time ago, 1977, that’s a long time ago. Yeah, yeah. before I was born. So I don't believe those chairs were here, but. I know that power standing has been in Australia for at least 20 years. And, you know, over those 20 years, technologies evolved just like all power wheelchairs. You know, when I reflect on, you know, the chairs I was prescribing 15 years ago and today they're very different. So power standing has evolved as well. So in the chairs that we know today, they really came to be what we know from about 2015. And this is where we're able to combine both the high-end power seat functions to get a good stand with the base of the chair that's going to allow the individual to get to where they go. So really, in Australia, power standing from a Permobil perspective has been around for a good 20 years. And there are some other manufacturers out there that I think have been around for a similar amount of time as well. So yeah, really, really interesting. You know, if I call myself a wheelchair nerd, but if you want to Google what those old power standing chairs look like, absolutely do that. They've come such a long way. Yeah, as wheelchairs have in general, like amazingly so. The technology now is mind blowing actually. And just to think where else we're going to go with things like AI moving ahead in the future, it's going to be really interesting to be part of this space. Yeah. I always joke that the unicorn wheelchair doesn't exist. You know, when you when you go out and you do an initial assessment with that end user and and then you hear, you know, I want a lightweight, portable, foldable wheelchair that can also stand and go off road. Like, OK, well, that for me is the unicorn wheelchair. doesn't exist. It doesn't exist yet. And you're absolutely right with how technology is just evolving. And there's some amazing product developers out there. So I'm curious what the next 20 years. and really excited what that's going to look like for our users. Yeah, it's good, it's all good. Okay, so with power standing wheelchairs, what would a typical client be like who would benefit from a power standing wheelchair? Yeah, look, you know, I kind of think everyone is a nice place to start. I clinically we should look at each wheelchair we're prescribing and go through the clinical reasoning process. You know, is this piece of equipment going to assist this individual to meet their goals? But I guess to be a little bit more specific than that. And in this kind of discussion, I'm going to put for those of us in Australia that work under the NDIS, I'm gonna put the funding model to the side because that shouldn't impact on our clinical reasoning. we think about the typical person that would benefit from a power wheelchair. I would really encourage you not automatically go to diagnosis, really look at the individual, their goals, their environment, what they're doing, what they're not doing. Because I think sometimes when we ask the question, what is that individual not doing, it often opens up a whole lot of other pieces of AT that could potentially help them achieve their goals. So for me, we think about it, and I would encourage you all to think about it, is the world is designed for those of us who can stand. Yeah, it is. You know, you think about your own home, your local community. You know, there's a bank teller. And I tell this story all the time. And this bank is lucky that it's never open when I'm there. But on the high street where I live, there's an ATM. And where you insert your card is really, really high up. So you actually need to be in a standing position to be able to access that specific ATM. So, you know, who's going to benefit from standing? potentially everyone, whether it's appropriate for everyone is another question. But the world is designed for standing. So I really encourage you to think about everyone you're working with, just pause and consider, is standing going to really assist this person achieve their goals? There's been so many studies that have also shown us, power standing can have a really positive impact on accessibility, on participation, on quality of life and that sort of thing. really anyone you're prescribing a wheelchair for, whether that be manual or power, just pause and consider. Okay. There's a whole lot of pros and cons to work through, but I'd really pause and consider. But you know, if we then kind of thinking about particular groups, you know, power standing can have a really positive impact. on those diagnosed with Duchenne Muscular Dystrophy. And we see a lot of power standing in this population and lots of young people having really great functional outcomes as well. I've seen and worked with some therapists who are prescribing standing for individuals with cerebral palsy to really increase their function and participation too. those with spinal cord injury, MS, and you know, said, the list goes on. So really, I'd encourage you to think about every individual you're working with, just pause and consider, could power standing assist them? And if it's no, that's okay too, it's just part of the clinical reasoning process. Yeah, it's really good Tilly. We've had a conversation in the past around how the world is sort of built for people who are standing. And there's one thing that you said that I've never forgotten and that's the butt effect. Do you want explain to the audience what the butt effect is? and when this is not my story, so I have a colleague, Arne, who’s now actually the head of our scientific and medical affairs global team. And Arne was telling us about this beautiful client he worked with when he was a sales rep many, years ago. And this lady had been a power wheelchair user for a good decade, quite a long time. And in his words, she knew what she wanted. She needed a new chair. And he's like, look, I've got a standing chair here. How about I just leave it with you? We don't need to prescribe stand, but use it to test out the base and some of the other power seat functions. And she agreed to that. She was grateful. And it was over Christmas and New Year. So he said, look, I'm on leave. I'll drop the chair off on the last day. And I'll come and pick it up the third or fourth of January when I come back from work. And she was really known to him. So he had no concerns leaving the chair. And he said he turned up in the new year to collect the chair. And she flat out refused to give the chair back. So it required some negotiating. And he's like, OK, well, tell me. And she said, for the very first time, she was at their New Year's party that happened every year and she was up in stand and she said, the first time I was able to look at people's faces instead of their butts and in her words was, I lost the butt effect, which I think is so true. I said, I could choose where I wanted to go, I could choose who I wanted to speak to, but she said, most importantly, I could choose who I wanted to avoid. Like we've all been in those positions, right? Where you are at a party and you see someone you go, I don't want to talk to you today for whatever reason. And so, you know, she said this chair helped me lose the butt effect. And I think that just summarizes how cool is standing. It's, you know, it's more than just for communication and that sort of thing. is really about enabling someone to live their life. And I think we take that butt effect for granted. I'm a massive introvert, so I totally get wanting to avoid people or on the opposite seeking out those genuine conversations as well. yeah, so the butt effect, it couldn't be more true. Yeah, it really is a thing. yeah. It summarises participation in life to a T, I think. Yeah, agreed. So, okay, we've just touched on some benefits to standing, but I want to go a bit deeper with that and talk about more of what the benefits are and the supporting evidence around that. And I understand that the answer to that question is a very long, very long one. Yeah. So maybe to, if you could break it into categories and maybe help us have that holistic view of the positive impacts that power standing wheelchairs have. for the end user. absolutely. And look, I'm going to give a shout out to my scientific and medical affairs and wider global clinical team at Permobil. Because in 2023, we published our second white paper on the benefits of power standing. So I would really, really encourage you that if you want to have a deep dive into the evidence, then download the white paper. It is absolutely free to do it. Grab it, download it, save it to your computer. Look, it's not a light read, I'm not going to lie, but it's really, really beneficial and written in a really functional way as well. if you want to find out more, do that. Where would they find that, if they wanted to download it. yeah, sorry. If you go to the Permobil website, there's a clinical services tab. So you can click on the clinical services tab. and then just scroll down and you'll see all of the standing resources there as well. But the white paper is definitely there for you to download. Yeah, that's wonderful. I've had a read of it. It's such a good resource, very comprehensive. Yeah. on it later. Absolutely. But look, and I think your question is really good. Like, you know, how can you categorise it? How can you explain it? you know, for those of us working within the NDIS, this is where I would really encourage you to. I love and Permobil are really, really big advocates for using the ICF model. So the International Classification of Function, it's a really great way of structuring, you know, collecting all of the information you might need to on the person you're working with to help formalise and organise your clinical reasoning. And what the authors for the white paper actually did was they organised all the evidence within each ICF category. So I really like that because say if I'm working with an individual of goals around bladder function, perhaps I can go straight to that part of the white paper, read it and then be able to quickly and easily apply it to the person I'm working with and their goals. So I would use the ICF. If you don't know about it, just Google it. You know, there's some fantastic free information available on the web. But I like structuring it this way because that's how I do my clinical reasoning and structure my initial assessment that I complete. I really like thinking about the body functions and structures side of things. So this is where I'm going to think about pressure redistribution, improvements in bladder and bowel health. managing tone, managing spasticity, bone density, and that sort of thing. So I really think about those more medical side of things, those physical side of things. And because in the US, their funding model is based more around the health model as opposed to functional, there's a stack of evidence available. Okay. you know there is some really high level studies to support the use of power standing in more of that medical clinical side of things. So you know some of the things we do know is standing provides you know the best pressure redistribution for someone. So you know if someone has a history or is trying to assist in healing and that sort of thing standing might work for them. So you know look into that as an option. There's some quite good evidence around bladder, bowel and digestion improvements to bladder, bowel and digestion there for individuals. You know a lot of those to me, because when you stand up, you're opening up the life box, right? So everything can function so much better in a stand than when you're sitting and that life box is all squashed and all the organs are squashed when you're sitting for those long periods of time. Yeah, that makes sense to me. yeah, and I liken it to when you travel long haul at the back of the bus, right? When you're in economy and you head over to Europe or the US and you just feel so gross because your digestive system is just, you know, smooshed together essentially. So what really interests me is, you know, in interviews you hear with people and in the evidence is that people are self-reporting, you know, decreasing UTIs, improve just bladder and bowel function. And from a... you know, young boys being and men being able to stand to urinate as well. You know, from a participation perspective is huge as well. And the dignity of independent toileting. Oh Absolutely. just to be like everybody else. Yeah. Yeah. not having to do a transfer onto another surface or onto the toilet or that sort of thing as well. So, you know, we also know around range of motion and bone density and that sort of thing. But it's also shown it's not super high evidence. I only say that because there's not a lot of research, but it's shown that standing has quite a good impact on mental health as well. Yeah, yeah. You know, it'd be really, really great to see more, more evidence in this space. But but for me, when you hear about quality of life and that sort of thing, it kind of makes sense to those sort of things. But on the flip side, when I completed a few interviews with some end users around standing, especially younger people in school, They said, look, I do feel a little bit self-conscious. So sometimes I choose not to stand. And sometimes it takes too long to get into stand. So by the time I get up there, the conversation's moved on or the opportunity is moved on. So, you know, there are things we need to consider as well. that, were they children who are more introverted and just, I guess the attention, cause it's pretty cool when you watch a power standing wheelchair go from sit to stand, that's pretty cool. So I could imagine a lot of attention would be on them simply because of the machine itself doing what it's doing and how cool that looks. Yeah. We see it as cool, but you know, they're just a kid. They want to be seen for who they are and you know, not the wheelchair. So I, on the flip side, I can totally appreciate that feedback and you know, I just want to be a kid. You know, I want to be me. I don't want to be the kid in the chair. I just want to be me. So, you know, that's, you know, something to consider too that. If you're reviewing a piece of AT, especially with young people, they're not using it, try and find out why. Often there's a real genuine reason, and that's something we, just because we're not the ones experiencing it, doesn't mean we shouldn't be empathetic and see if there's anything that we can help by overcoming those barriers too. Yeah, absolutely. Really important. Yeah, it definitely is. So I guess coming back, so I guess we have those clinical kind of physical medical things. And then the next box on the ICF is activities. So activities of daily living, communication and that sort of thing. And we know from the evidence, right? We know that standing increases functional reach. It's shown to absolutely increase participation in activities of daily living. and also facilitates communication as well. Let's go back to the world is made for standing. I've got that bank teller, then think about the local pub. Bars are there to stand up and order your drink. Bakeries, getting over counters. Local ice cream shop, I was there with my kids the other day. Same thing, right? We need to be able to stand to... to communicate, to reach for the ice cream, to even look at all the ice cream flavors at the back. So really think about standing and enabling that in the home, into the fridge instead of just accessing the front of the fridge or accessing the dryer, all those sort of things. So I could talk forever. Yeah, there's so many benefits. Yeah. Yeah, yeah. And then, you know, obviously, face to face communication as well. Even just think from a professional point of view, you know, we greet people standing. When we're presenting, we might want to stand up, you know, getting around the office, being able just to do all that and standing because the world is made for those of us who stand. So, yeah, it really does from an activities perspective really really increased participation. And this is why it's so important. What I love about the ICF is because we're relating it back to the individual, you can really reflect on well, what are the goals? You know, what is a person currently doing? And what are they not doing as well? Because that's where we could potentially see if standings going to enable that. Yeah, and that's really good advice to think of it that way too. When you're putting together the goals and asking the right questions to uncover the goals. Yeah, what things do they want to be able to do that they can't because they actually can't get up into a stand. Yeah, absolutely. I always like to, you when you're doing an initial assessment, you know, I always like to look at the photos in someone's house, in the room that we're in and say, when was the last time you went fishing or tell me about this? And often that's when you'll start to uncover what are the things that they wish they were still able to do or do more easily or more frequently. Because, you know, we have the potential to really help someone live their best life. And I genuinely mean that. So standing is just one way of being able to potentially do that for someone. Yeah, right? It's not many people get to do that in their jobs, that's for sure. So the next, then I also look at participation. So going across the ICF, we've got... activities that we go across to participation. So that's going to look different for everyone again. So think outside the home. We've got the home, we might have work, we might have school. What's going on in their local community? Are they going to church? Are they going to the soccer club? Wheelchair trials don't just have to take place in someone's home. Where are they spending their most time? Are they singing in a choir? Are they wanting to stand up at church? You know, what's really, really important. And this is one of the great things about working under the NDIS is that, you know, the goals are around function and participation as well. Whereas like in the US, it's all medical model. So, you know, there's, ups and downs. and cons to both ways of thinking and both focuses, yeah. absolutely, absolutely. And then, you know, that next part of the ICF, we can look at personal factors and environment as well. So, you know, do make sure you're looking at that evidence and the quality of the evidence and how that can be applied to that individual. And then finally, we've got quality of life, which which really encircles everything. So. I know on trials and things we can just be like, bang, bang, bang, I need to demonstrate X, Y, and Z. But if you are doing a longer trial or you're doing a replacement, really think about how are you going to measure quality of life? Or what statements are you going to use? Or how creative can you be to really encapsulate the impact that power standing can potentially have on an individual's quality of life? Yeah, it's good. And I think we might get you back for another episode actually to talk through planning and running a successful trial, Power Standing Wheelchairs. Because I think it's something, yeah, I think that'll be really helpful for the audience just to support them in understanding how to plan that well, how to run it well, how to report well. Yeah. and how long is a piece of string, right? But I'd be more than happy to, you know, to offer my perspective on that where I can. Yeah, well, let's do that. Let's do that as another episode. Sounds great. So is there any clients that a power setting wheelchair would not be suitable for? Yes, they're fantastic, but they're not for everyone. I think it's important to consider it as part of your clinical reasoning process, but it isn't for everyone. I guess my old boss actually, Rachel, I really love the way she summarized this to me one day. And she's a physio. And she's like, look, there's precautions and there's contraindications. And I really like the way she spoke about that because I think power standings can feel really scary. And you know, I think, you know, when we don't prepare, and sometimes in the past, people haven't prepared and maybe something, you someone's got scared or something's happened. But if we prepare, it's okay. So some of the precautions, so some of the things we need to be aware about clinically, and we might want to draw in our colleagues. If we're an OT, you might want to draw in the physio you're working with or the exercise physiologist or their main doctor. We need to be aware of that individual's blood pressure. What's it doing? Is it high? Is it low? Because I'm not sure if you, as a new grad, you are a student, you ever did your placement on the orthopaedic ward, right? And you went and you stood Mrs. Smith for the first time after. two days in bed and she had a drop of blood pressure and you caught her on the way down the floor. So same thing, if someone hasn't stood for ages, we need to be mindful of what's going on. Are they gonna have a drop in blood pressure when we stand them the first time? So not a contraindication, just something we need to be aware of, speak to the treating team and how are we gonna manage it? Are we gonna stand them from a sick to stand or more of a supine to stand? Or are we just gonna go halfway up today? and see how it goes. We also need to be aware around weight bearing status. Okay, so are they safe to stand from a bone density perspective and a weight bearing status? So, you know, how I think about it is when was the last time they stood? If they're standing regularly, then it's something we probably just need to have a quick chat with the physio. But if they haven't stood in many, many years, it might be worth having a chat. to their treating team to see how at risk are they of their bones being osteoporotic. We can do a bone density test, but all that is going to tell us is where their bones are in terms of risk of osteoporosis and that sort of thing. And then we have to use our clinical reasoning to determine, well, is this person safe? And then... Even if their medical team says, they're at really high risk of fracture, there's still dignity of risk. So just like you and I make choices every day to maybe cross the road, not at the lights or that sort of thing, the individuals we're working with can absolutely make that choice too. I understand that my bone density might be on the low side, but I understand the risks and I'd like to try. Okay, so. actually, ultimately most likely help improve bone density. Yeah, yes. But I know that, yeah, I'm not over all the details of that one, Sarah. So I think let's be mindful of that. does, I know the earlier we get people to stand, the more of a positive impact it has. But I'd have to check the studies on like, if someone hasn't stood for 10 years, what's the impact it's going to have? So. I'd like to research that too, just to have a good understanding to see. Because knowing that stain does benefit bone mineral density, then if someone has low bone mineral densities, that's something that will actually be therapeutic as time goes on. But yeah, you're right. We need to evidence and have a look to see what the evidence says. Yeah. definitely the sooner you can have someone standing post spinal cord injury, it's shown to have a really positive effect. But I personally haven't read the studies if it's like 10 years or 15 years since they last stood. What's the impact? I'm not sure on that one, I'm afraid. And then with weight-based status as well, think about all of their lower limbs in terms of contractures. We need to make sure that individual has the appropriate range at their hips, knees, ankles, and feet as well. So it's really, really important to do a MAT assessment. And if I'm doing standing, I'm getting the physio in. Multidisciplinary practice is really, important. And in complex wheelchairs, even if that's a standing or not a standing chair, working as a team is essential. So if you're not sure, Speak to the physio, do a joint assessment together, get them there at the time of trial as well, just to make sure, you know, we're setting ourselves up for success. Yeah, good advice. Yeah, and the other thing we need to think about is standing provides the best pressure relief, but if somebody has a pressure injury on their sacrum or ITs or heels, we just have to be aware, like the way our chairs are particularly designed with anti-shear plates and that sort of thing, we are minimising risk, but we just need to be careful of the cushion the person is on. If someone's on a super contoured cushion, that cushion could be rubbing up against their skin when they go into stands. So again, it's a precaution. It's something we need to just be aware about as well and monitor. And then we have the contraindication. So when am I definitely not going to stand someone? First of all, if they have like an active fracture or, yep, or they're... their medical team set up so they cannot stand for whatever reason, whether that's due to really, really low bone density, the active fracture, or if someone doesn't have those two feet to stand on because of contractures or limited range, I'm really not going to stand them. I might look at maybe other ways of being able to do that using alternative pieces of AT. And each power chair, this is something we don't think about. you know this is more of a kind of we might rely on the reps to think about but ask a question if you're working with someone who has really short stature or a young person there's a there's a minimum lower leg length so from the the base of their foot to behind their knee that that person will need to have because we can only shorten that foot plate that lower leg length to a certain point because the chair needs to be at a, you know, all the actuators have to move and that sort of thing as well. So ask the question, each chair is gonna be different for each manufacturer. But yeah, really ask that question as well. Yeah, okay. Good advice. So... Yeah. When you're worried, is this person suitable? Really, work as a multidisciplinary team. Use your clinical reasoning as well. And don't forget about the individual you're working with. They're an expert on themselves. They know what their body can and can't do. And they also get to choose that dignity of risk. Yeah. It's important, right? Yep. Being as client-centered as possible. Yeah. Even with risk. and, that's what we document for, right? Mm-hmm. There are waivers available if you're really worried, you can write your own, but ultimately, there's that dignity of risk. Yeah, yeah, I like that. Okay, I have a sort of more product specific type of question for you. Just around the fact that when it comes to a power standing wheelchair, you have the choice between a front or mid wheel options. So I just wanted to get your thoughts around like how do you choose or decide between those two options? Yeah, look, first and foremost, just as I would any power wheelchair. So there's no right or wrong. I think historically front wheels have been given a really bad rep along the way. But front wheels are fantastic options. So for me, I always go with what are the non-negotiables I have to work with first, because we can't do anything about non-negotiables. Do I have as a you know as a therapist do I have a really really small turning circle inside the house that I can't change. If that turning circle is my non-negotiable then I might need to go for a mid-wheel because it it has that smaller turning circle the base is a little bit smaller than the front wheel drive. So that that might be my absolutely non-negotiable. Other reasons I might be considering a mid-wheel drive is it can be more intuitive initially to drive. So, you know, if that person you're working with has been in a mid-wheel drive for 10 years, they might really just want to stay in a mid-wheel drive. It's easier. It's easier also for an attendant to control a mid-wheel drive. So, you know, if their carer or partner or parents are doing a lot of the driving, mid-wheel drives can can be easier as an attendant than a front wheel drive to control. But front wheel drives, they actually do amazing 90 degree turns. So they do really tight turns really, really well. And because we don't have those front casters in front of us, you can get really, really close to benches, to store counters. You're a lot closer for interactions and functional tasks and that sort of thing. I might also be more inclined to prescribe a front wheel over a mid wheel if someone's really active out in the community. Because, know, front wheels were right over that drive wheel when we're in the community as well. So they're really good climbers. You know, they can get over gutters a lot easier, you know, go over a bit of gravel and that sort of thing. So, you know, if maybe suspension is something we're really looking at. or vibration impacts and that sort of thing. A middle drive has to go over everything three times. So if we're going say over a lip in the front door, we've got the front casters, the drive wheel, and then the rear casters, whereas the front wheel drive, we only have to go over it twice. So that vibration can on some individuals cause some issues. So think about that as well. And you know, from a product perspective, you know, there's obviously differences in how each chair is made, but with the Permobil chairs, the front wheel drive, you can stand to 80 degrees, whereas the mid wheel, it's 70 degrees. And that's, yeah, and that's from a stability perspective. But interestingly, you know, when the mid wheel chair at Permobil came out, said, well, why only 70? They said, well, for stability, but they said the only... The reason they were really happy to produce a chair with only 70 degrees is what they found when they looked at all of the Connect data. So our chairs can provide information on how often someone's standing and at what degrees. They were able to see that most people weren't standing all the way up anyway. And that 70 was that degree of stand that most people were standing to. So that kind of, you know. the engineers and product designers, so no, it's functional. This is how people are using it. So yeah, I thought that was really, really interesting. Yeah, I've been in a power standing wheelchair and when you get to the 70 degree, like you feel like you're almost into a full stand. And when you actually come up, like it feels like you're almost too far forward when you come up past 80 degrees. So it's, yeah, it makes sense that it probably feels quite comfortable to be at 70 degrees. Yeah. functional too. You know, I'm always a bit of a skeptic. I'm like, no, I'm getting in it. I'm giving it a go. And that's the best way. So I would really, really encourage you as therapists, if you don't know what it feels like, if you haven't had the opportunity, you know, before your trial, ask the rep, hey, can you meet me 10 minutes earlier? Do you have time to do that so I can get in the chair, experience it, drive it, you know, go up? the paths that you're going to do on the trial, you know, getting that stand position. Because I think it makes you a better clinician as well. It makes you also understand how that chair is going to move and work and that sort of thing too. Yeah, that's really good advice, Tilly. I like that. Yeah, get hands on. we said at the same time. Okay, we've covered a lot of information today. So to kind of sum up, like if you had to pick three sort of top takeaways for the therapists that have been listening today, to keep in mind when they're bringing up power standing wheelchairs with clients that they can see would probably benefit from. a standing wheelchair, what would those top three things be? I think the first one would be, it's not for everyone and that's okay. So I think as a therapist, you might be anxious on either side. might be, my gosh, if I bring up stand and I can't justify it, how am gonna have that conversation? But equally, if you don't bring it up, we might be missing out on a whole lot of opportunities of participation and function and quality of life. It can be scary to bring it up, bring it up and have that discussion around that we could try it. may not be right, but it could also be right. So be brave and have the conversation if you're worried. The second thing would be, although there are all of these great positives, those clinical medical aspects to standing that I spoke around, pressure distribution. you know, bladder and bowel health, bone density, that sort of thing. It's really important that, you know, under NDIS for those working in Australia, we're really making sure we're following the funding rules and guidelines around function and participation and that the AT we're prescribing is reasonable and necessary. So really think about, you know, is it a nice thing to have? you know, really stay goal function participation focused and you'll you know, you'll be prescribing the right piece of equipment if if you keep that mindset. Because, know, ultimately standing can change someone's life. It really can for the right person. You know, if standing is right for that person you're working with, it can absolutely change their life. So ask the question, trial it. Be really open that it may or may not work, but if it works, you're going to make such a positive impact. Yeah, it's gonna be a very good day at work. Yeah. And what's your third? You got a third thing? Reach out for help would be my third. Because I think prescribing AT can be so overwhelming, right? And there's so many new products all the time. Reach out to help. There's some great informal and formal networks out there. Pick up the phone to your product specialist and say, where should I go? I'm thinking about this. Can you point me in the right direction? Call the clinical team. You know, within Permobil or whoever, a mentor or supervisor, ask questions and ask for help because what I love about this industry is people genuinely want to help you get it right. And if it's not right, most people actually say you've tried, it's probably not going to work. Why don't we look at something else instead? So ask for help. Use the community, use the network. Yeah, that's really good advice. And I like what you said earlier around that multidisciplinary team and relying on your team around you. Cause we need each other when it comes to prescribing particularly more complex products like what we're talking about today. Yeah, absolutely. Pick up the phone and just have those chats. You know, always say talk at someone. Do your clinical reasoning. You know, unfortunately, I think with the rollout at NDIS, we lost all of those hubs that we used to all work in and we used to able to spin our chairs around. So just, you know, find out when, you know, your colleagues on the road and just call each other. Make use of that travel time and pick each other's brains. yeah, very good advice. Thank you, Tilly. Okay, I've one final closing question for you. And we ask this at the end of every episode. So can you describe a moment when assistive technology significantly changed a client's life and how has that impacted you? For me, I worked with this beautiful young lady in Singapore actually. She had diagnosis of cerebral palsy and she would have been, I think about 16 when I met her. And she was in an attendant propelled, like off the shelf manual wheelchair. She had a functional transfer, like a standing pivot transfer and she was able to stand holding onto things. I knew this is a young girl who, about to, you her life was really about to start, it was really about to start and her mum was so, so supportive. But there was absolutely no funding, no funding. So doesn't matter where you are in the world, right? Funding is always the barrier. And her mum and this lovely young lady and I, worked together and she was really open to trying a power wheelchair. Threw it out there thinking, it'll be, you know, they won't want it. But they were all really open to the idea. They hadn't considered it before. And looking at her face when we trialed this power wheelchair, like you could just see her whole universe had opened up. She's like, can I take this home on the train? Like without even going further than the classroom. She's like, can I take it home, you know, for the weekend or take it on the train? And, you know, it took us months and months and eventually we've We persevered and we found some funding and the family contributed too. But that young lady, she's so independent. She's able to be the young lady that she is. She's not reliant on other people to push her around. And she pops up on my social media every so often and just her smile every day. Just like, know what? That hard work, that advocating, that... not taking no as an answer, right? Like I knew clinically this was the right piece of AT and I was not going to give up. So yeah, that still makes me feel really warm inside. And now I look at her and I go, she so needs a new chair. You know, that was, you know, eight years ago now. And I'm like, that chair is, I know how far she takes it. And I think, oh, I need to get back to Singapore. prescribe her a new chair over the next couple of years or connect her, but suggest she goes back to her local therapist and starts the process again. So yeah, that for me, yeah, working with her and her family to enable her to live her life was pretty special. so good. Oh, I love it. And I love the way that that just gave her independence right at that age when you just want to be independent. 16, you need to be if you can, and she could. She just needed the right piece of AT. Yeah. And was it perfect? No. Would I have wanted to prescribe her an even better chair? Absolutely. But the chair she got was really good and it enabled her to do everything she wanted to do. So yeah, it still makes me feel good. a feel good story. love it. Tilly, thank you so much for coming on the podcast today, sharing all your expertise. It's been very, very helpful, insightful and supportive for our clinicians. So thank you so much. I think we will get you back for another episode to have a talk through running successful trials and planning successful trials for power standing wheelchairs. So you'll be back again soon. And I want to say thank you. And thank you so much for listening today and we will catch you in the next episode. Bye. Bye everyone.