Redefining What's Possible

How to plan and run Power Standing wheelchairs | EP 8 | Redefining What’s Possible

• Independent Living Specialists • Season 1 • Episode 8

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In this episode of Redefining What’s Possible, we explore practical strategies for planning and running successful trials for power standing wheelchairs. Joining host Sarah Uncle, Head of Clinical Education at ILS, is returning guest Tilly Brook, an occupational therapist and Director of Clinical Services at Permobil Asia Pacific.

Building on her previous discussion about the benefits of power standing wheelchairs, Tilly shares clear, practical guidance to help therapists approach assessments, structure trials effectively, and gather meaningful evidence to support clinical justification. Drawing on extensive experience across Australia, Singapore and New Zealand, she offers grounded insights to enhance confidence, streamline the process, and ultimately support better outcomes for clients.

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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'm joined again by Tilly Brook. Tilly just did an episode for us on the benefits of power standing wheelchairs. And if you haven't listened to that one yet, I recommend going back and listening to that one first before jumping onto this one and listening to this one. So this one is going to cover how to plan and run a successful trial for power standing wheelchairs. And we are so lucky to have Tilly back to speak with us again today. So in case you haven't met her before, let me give you a little brief introduction to Tilly. So she is an occupational therapist and she's the director of clinical services at Permobil Asia Pacific. She has experience as an OT across Australia, in Singapore and New Zealand. and she has specialised in seating and wheelchairs throughout her career. She's very passionate about the life-changing impact of good prescription, and she now supports therapists like yourself through education and clinical services. So welcome back to the podcast, Tilly. Thank you so much for having me back. I'm really excited to be back. It was such a great chat last time. Yeah, it was. And he have so much expertise when it comes to power standing wheelchairs. So thank you for coming back and supporting our therapists on planning and running successful trials with this type of AT, because it's more complex and we just want it to go well. So to kick, yeah, to kick us off, let's talk about the planning part of a successful trial and what needs to be considered and organised before we even start organising the trial itself. Really good question because we are seeing some therapists just, you know, they know they need a chair and they call up automatically for a trial. But there's a really important step that needs to happen before then. And that's, you know, our initial assessment or our reassessment if we know the person. Because, you know, that initial assessment is so crucial for collecting all of our all of the clinical information. personal information and really get to understand the person we're working with, understand who they are, what their goals are, where they want to go, and what their non-negotiables are as well. And when we collect the right information, it allows us to clinically reason and articulate what are our product parameters? What does the chair need to do? Where does it need to go and what elements are going to potentially enable the person we're working with to increase their participation and function and ultimately live their best life. this assessment might look a little bit different for each of us because we all have different ways of going about it. For me, I'm a really, really functional OT. So I'm going to sit down and Maybe say, yes, I'd love that cup of tea and assess someone functionally. How are they managing with their current piece of AT within their environment? What's working? What's not? And I'll chat it through with them. I saw you struggled here. How could we make it better for you? Or perhaps if there's a need to look at someone's cognition, I might be using the PRPP. or whatever is your go-to or is going to work with the individual you're working with, structure or assessment tool to help gather as much information to then really help us establish that level of function and the goals for that individual. Personally, I'm going to use the ICF model to... Why do you like the ICF Model? I really like it because it's client-centered. It's about the individual, their level of function, their life. It's really not diagnosis driven. So I think it works particularly well for us here in Australia under the NDIS, You know, rules of funding and that sort of thing too. And I think it enables us because you talked about last episode how in the US, like it's different, it's a medical model where we're here, it's quite different in the way that we sort of justify if someone needs what they need and why, yeah. Yeah, absolutely. I think, you know, as I think working within any funding model is frustrating. I've had similar issues in Singapore and New Zealand and whatnot. But what is so special about the NDIS is we get to focus on function and participation. And that's pretty cool. That's that's really special. But that's why we need to collect, you know, and understand the person we're working with really, really well, because they're the expert on themselves. So We really need to develop a great relationship and come together as a team. So, you know, when you're collecting that information, that initial assessment, make sure you're looking at that and understanding that person's life from the moment they wake up to the moment they go to bed and how, you know, over the night, it's really important to. We're looking at all aspects of their home, their local community, school, work. You know, where are you completing this assessment? Are you meeting them at the local soccer club? Are they spending three days a week there? Volunteering or how are they getting to work? really, you know, seek as much information as possible to be able to paint a really clear picture of the person you're working with. Yes, good advice. And do you recommend doing a MAT eval in there as well as part of that initial assessment? Yeah. Would that differ at all from when you're doing MAT eval for just a standard wheelchair versus a power standing wheelchair? No, I think completing a solid MAT assessment is really important for everyone. We need to understand what's possible in their range of movement and their body. Where can they sit and stand functionally? And where perhaps do they need a bit of support as well? So try not to overthink it. Remain client-focused, client-centered. And if you're not sure, ask for help. Reach out to... to your colleague who's an expert. There's plenty of people in the industry who will come along and give you a second pair of hands as well. So if you're not sure what that looks like, ask. There's also some really great free resources online. initially, these resources are still great today. The ACI network, they have all of them, all of the, I break down the MAT assessment with some really great learning resources and videos. We've got a whole stack of resources on our website too. So just ask if you're not sure. So yes, our MAT assessment is really, really essential as well as key measurements. Now I think both Permobil and ILS were equally to blame on our assessment forms. We have a body with like 20 different measuring points. Please don't spend time taking 20 measure points, you know, measuring body structures. Really, if you can get hip width, leg length, lower leg length, trunk height, chest width. If you can send those key measurements to your wheelchair supplier, I guarantee they will be doing backflips. You know, measurements for the sake of a trial, those key measurements will really help set up an important trial. you know, a successful trial, I should say. So yes, MAT assessment is really, really important part of that information gathering, getting those key measurements. And then, you know, not only gathering all this information, but sitting down with the person you're working with and their carers if they need to be there or their partners. And I always like to ask, what are your top three or four priorities of this chair? And then I want you to list them out in priorities because we don't have a unicorn wheelchair yet. I'm sure in 20 years time we will, but it's really easy to get sidetracked by all the bells and whistles and the number of chairs on the market. But if you can prioritise those non-negotiables, it helps you as the clinician, the user and the wheelchair supplier remain really focused on what's super, super important. I love that advice. Just the top three. Yeah, I think and then and put them in order and it just that focuses everybody. I think that is excellent advice. Well, hopefully you find it useful, but I think it's so easy to get, you my gosh, I can do this, I can do this. But if you're non-negotiables are non-negotiables, we don't want to lose focus of those things along the way. You know, what we're going to do after that assessment, I'm still not going to call up my wheelchair supplier yet. I'm going to really think about, well, here are my goals. Okay and this is what I need out of the chair and the seating to enable that person to achieve them. So for example it could be I have a non-negotiable of a really small turning circle. I've only got you know this many centimetres to to turn in. So then that non-negotiable is going to be you know you go the wheelchair supplier and say I need a chair that can do this. and that's really easy to help narrow it down. Or your goals might be that Mr. Brown has a goal of being able to plant seedlings in his raised garden bed. So then I need a chair that's going to go into an active reach position. Let’s have a chair that lets trial elevate and active reach to do that or query stand. I need a cushion that's going to... Mr. Brown also has reducible posterior pelvic tilt. So I need a cushion which has an issue or shelf. I might need to consider a pelvic belt and then posteriorly I need to block the PSIS at the backrest. You know there's lots of things to consider, but if you write down the goal or the problem, then we can write down the element of the equipment or the product parameter that's going to help overcome those barriers or achieve those goals. And by sharing that with the wheelchair supplier as well, it helps them understand and for you all to come together as a team to ultimately achieve the goals. So. Yeah. And you know, from our perspective, from someone who works for ILS, just to bring the right equipment out for the trials Yeah. yeah, because we can't bring five chairs. And I mean that from the logistically, but also you think of you like, you know And I mean that logistically, but also you think about So if we can get the trial down to two chairs, you know, maybe it is, you know, a front and a mid because we're not quite sure. which one will fit in or which one the user will prefer. Or maybe it's, you know, try and get it down to two cushions and two backrests. So by taking the time to do the clinical reasoning, work through those product parameters, it's really going to end up with a better trial. And also it means you've got so much more evidence to assist in your report writing at the end. You you've got your hypothesis essentially. which then you're going to take through to the trial and then to your report writing as well. And my next question for you was around structuring the trial for success. And this kind of leads into that because all that assessment is gonna then help you then have a plan for the actual trial itself. So can you give any more tips around structuring the actual trial? Yeah, so my first tip is to remain absolutely user focused. Okay, I think particularly in, when we're talking about power standing trials. If the individual we're working with is quite anxious, then for me, the initial goal is going to be, let's focus on the stand first and really enable that individual to feel supported and set up and confident in getting into that stand. Okay, so, you know, if there is anxiety and worry about the stand, focus on the sit to stand or the supine to stand. and just do it slowly. Okay. Is it quite common to have people feeling quite anxious coming up into a stand when they haven't stood for a long time? Yeah. they haven't stood in a long time, it can absolutely be a little bit scary and a little bit overwhelming. But I think that's quite normal. If you're doing something new for the first time, I'm sure you get butterflies, I know I do. So be aware of any kind of slow points we might need to have, but make sure you really communicate that with your wheelchair supplier. Yeah. Okay, because then they're only gonna come in with one chair, they're gonna come in a lot slower maybe, or, you know, we're gonna work that through together. So be really mindful if we need to take that into consideration. But, you know, from there, really think about the trial. So, you know, most wheelchair reps will come out anywhere between 90 minutes and two hours. Okay, so. It's a long time, but it's not at the same time, you know, if we're doing hoist transfers and all of those things. So my first advice to you is get there early and make sure that, you know, the user and the carer are set up ready to go. Have they had their meds? You know, where does their bowel regime fit into it? Do we need to schedule the trial in and around those sort of things? So yeah, yeah. And then, you know, be ready. to rock and roll essentially. And then, you know, when we get the person into the chair, you as a therapist need to be really clear about, well, what evidence am I gathering today? Okay, so what do I need to, first of all, make sure this is gonna work for the person. And then if we think it's gonna work, you know, how are we gonna gather that information? So for me, you know, I think about three or four functional tasks. that we need to do. So we need to make sure we're justifying stand and each of the power seat functions in addition to the base of the chair. So I break it down in that way. So from a power seat function perspective, particularly standing, you know, let's use cooking a simple meal in the kitchen perhaps. What I'm going to do is I'm going to have permission to take a couple of photos along the way. But I'm going to have my user, first of all, try and complete the task in their normal seated position in the chair. I'm going to say, Mr. Brown can complete 10 % of the task, 20 % with this much assistance, and the rest he's unable to complete without maximal assistance. And then from there, I'm going to get him to go into elevate and say, hey, Mr. Brown, complete the same task in elevate. I'm going to observe and then report how independent is he or maybe he's fatiguing quite quickly in that position. And then I'm going to keep stepping up. Then I'm going to go into active reach. So maybe 35 degrees of active reach, which is kind of like a half stance. So similar to what's behind me. So. Mr. Brown in active reach is able to complete maybe 70 % of the task or is reporting a fatigue or whatever. And then I'm going to get him to go into a full stand and complete the task. So we're really able to demonstrate that reasonable and necessary, that impact of function and participation as well. And working out what doesn’t work too the same time. Yeah. we have had times though where active reach is actually enough to increase function and participation that, you know we’ve gone through this process and we haven’t actually needed to prescribe stands. We've actually been able to prescribe, you know, more of a reasonable power seek function from you know, from a cost perspective because someone's been able to do everything that they've wanted to do. So, it’s a great outcome. Yeah. And that's what clinical reasoning is, right? So, you know, I go through this, you know, this, this way of assessing the three or four key, key tasks, functional tasks or goals for the individual. Because, you know, as maths teachers say, show you're working out. How did you get to stand? You know, the funding funding body wants to know, okay, well, are you prescribing standards because it's nice to have, or is it actually the power seat function that is going to enable this individual to participate and do what they want to do? Tilly, that's such good advice, really clear. And I've actually seen that Permobil has a form that you can actually follow follow these steps that you're talking about to show you're working out like you just explained. And do you want let everyone know where they can get hold of that? Because I think that's a really useful tool. Yeah. So I think we call it the power standing trial form, I think. And you can access it on the clinical services drop down menu on the Permobil Australia website. So you'll click on that and then just scroll down and there's a whole lot of power standing resources. And that's free to download. know, download it, use it at the top, we have, what's the goal? And then we prompt you, know, current AT We start at elevate, then we do active reach, and then we do stand. Because I think at a trial, things can move so quickly. It's really nice as the clinician to have that prompt to be like, yes, I've done elevate. I forgot to do active reach. Let's go back and do active reach for working on the car or in the workplace or at church or whatever that might be. Because it's so easy to miss things. A trial happens and moves so quickly. So, you know, think about those three or four tasks and be prepared as much as you can. You know, have the toothbrush ready to go. You know, if we're going out into the community, what shop are we going into or, you know, what supermarket are we going into? You know, really, really pre-plan that as much as you can because it's going to mean a much more smoother trial and also you're going to be able to see functionally the impact that power seat function is having for that individual. I know we said before, yeah two hours sounds like a long time. It's not when you're doing all of that. You need to have it really well planned. You're right. absolutely, absolutely. And it is really important that we're justifying each power seat function. So even if we are prescribing a power standing chair, we need to justify tilt, recline, VS legs, elevate, active reach, and then stand as well. So we've got so much evidence that we need to, not just evidence, we need to assess first and foremost and then collect. the right evidence to be able to use. When you say collect evidence, are you talking about photos? Yeah, a couple, I don't think we need thousands of photos in our report, but sometimes a photo saves a thousand words. And, know, in our report writing, we do need to be quite succinct, you know, to say, just break task analysis. That's, you know, go back to uni days. And it's something I think as OTs we just do automatically anyway. Yep. Yeah, we get trained that way but we just need to be able to break down that task to show where the difficulty is and how the piece of AT is overcoming that barrier. Yeah, it's good. So in all your time working as an OT, have you ever been on a power standing wheelchair trial that did not go well, did not go to plan and what, it's like, what can you, what did you learn from that? And what, you know, what could we learn from that sort of experience too? look, it's not one of mine, but it is a recent story I have heard. Not a story, a therapist called me up for some help actually. She's like, oh, the trial was really successful, but I don't have anything really to show for it. Like what have I missed here? So she called me with a, I know it's right, but I've missed something, help me out. And we were talking about the trial and she was talking through how beautiful it was. how the end user had stood and hugged and kissed his wife in standing for the first time in 15 years and how beautiful it was. And I could tell, you I was even getting emotional listening to this therapist. And I said, it's beautiful. And I said, okay, well, that's fantastic. What else did you do on the trial? I said, oh, well, you know, we drove around a little bit and you could almost see her going, oh, Oh, I know what I've missed. So, you know, everybody even even the supplier kind of said, yeah, it was just so beautiful that we all kind of missed the big picture. You know, we all got caught up in the emotion on the day and how special it was and how life-changing that moment was and how important that was and I don't think anybody really wanted to bring them back to the real world. So you know, in the end they actually ended up hiring a chair for a couple of weeks for an extended trial for this individual and over that couple of weeks, the therapist worked really closely with the end user and broke down, you what are the goals of standing and how are we going to collect and justify power standing for you? You know, to just really focus on the big picture side of things. So, you know, that wasn't a bad trial at all, but it was just one where everyone focused on the gosh, how beautiful is that, right? I know that is so beautiful. Yeah. So there was no blame and everyone just kind of went, ah, but it is really important that as the clinician, we're focusing on, you know, the clinical process, assessing, making sure this piece of AT is the right piece of AT, why it is, and then collecting that evidence to, for the clinical justification side of things. And, you know, I know I've been talking a lot about the power seat functions. Don't forget about the base. We still need to clinically reason and assess, is this a front wheel drive or is this a mid wheel drive? And why? Why do we need this? And we also still need to justify for standing, why power standing chair? Why not a manual chair or a power standing chair and a tilt table? Yeah. So, you know, there's a number of elements we really need to consider in this process. And I think, you know, from a funder's perspective, it's a fair question. Yeah because these are expensive pieces of AT So I don't disagree as to, you know, being questioned about it, but it's really important that we go through the clinical reasoning process, assess, come together as a multidisciplinary team. You know, the physio might be able to provide a number of reasons as to why a power standing chair would be better over a tilt table. If I can have one less piece of equipment in my house, I would be ecstatic as well. If I don't need a tilt table, happy days. yeah, lots and lots to consider. So really go in with a plan. And if your trial doesn't go right, it's OK. If something happens and it goes left field, just have a chat with the supplier, have a chat with the user. You guys are a team. There's evidence that shows when the user, OT and supplier and manufacturer even more so come together and work as a team, you get really, really great outcomes. yeah, and the fact that there's evidence there to support it as well. So pause, communicate, reflect. If you need to organize another trial, organise another trial. If you need to look at hiring a chair for a couple of weeks too, look at that option too. So yeah, there's lots we need to look at, but the more prepared you are, the better the outcome. Yeah, absolutely. Really, really good advice. Okay, let's talk about report writing. So you've had an amazing assessment, you've planned the trial, let's just say it's gone really smoothly, and now you're up to the point where you're writing the report. What tips have you got? Take one step at a time. Absolutely. Look, the number one piece of advice is do that really good initial assessment first and document along the way, on this next piece of advice, I'm going to say do as I say and not as I do And often that, you know, specifically if we're looking at NDIS reports, that first part of the report, part one, that can pretty well be written. you know, before your assessment as well. So I think that can help with that clinical reasoning process. Have you collected all of the information you need? Have you got a really good hypothesis? What are your goals? So, you know, make sure you've done that really, really good assessment because that really does help the process. really good initial assessment. You've planned your trials. okay and you've collected as much information as you can along the way. Then when you're writing the report, be clear try not to waffle okay because I imagine that people reading our reports have a lot of reports to get to and I think about I did debating at high school I'll throw it out there, I did debating I'm not sure if you did Sarah I think we all had to do it in primary school and I think I didn't do it in high school but definitely did it in primary school. I've voluntarily put myself forward for high school. And in a way, I personally, you you might be listening to this going oh my gosh, Tilly, seriously, what are you on? But I think about, I think about AT Reports as a bit of a debate. You know, part one, introductory speaker. You know, this is Mr. Brown, this is who he is as a person, this is his family life, this is where he lives. This is what he does. And these are his goals. And these are the current barriers he's having, whether it's with his current AT or perhaps we're prescribing a wheelchair for the first time. Then the second part is we're adding to that argument, that debating argument. We're looking at Mr. Brown's level of functioning, perhaps where his difficulties are. We might be talking through some standardised outcome measures as well. We're really painting that picture. And at this point, we're really starting to think about and throw out there, well, this particular wheelchair could help to overcome these barriers or enable Mr. Brown to achieve his goals and increase his function and participation. Because by the time we get to part three, this is the section where we're talking about the chair. So we're going to be breaking down each element of the chair. and really demonstrating why not only the chair, but each element of the chair is reasonable and necessary and going to enable Mr. Brown to achieve his goals. So, you know, if we're talking about the power seat functions, I'm going to break down tilt, you know, functionally, why is tilt going to help Mr. Brown? When is he going to use it? Then I'm going to be adding tilt, sorry, recline and legs. talking through all those functional elements. And then from there, I'm going to talk through what we're going to use elevate for. And if elevate is all we need, fantastic. But if it's not, talk through where elevate's going to work and then where it's still not working. And then we're to build up to there from active reach. How is active reach going to enable Mr. Brown to increase his function? If it is, participation, or if it's not. And then stand, you know, what is this standing feature going to do that all the other power seat functions can't do? Okay, why is it reasonable and necessary? And, you know, let's show the report reviewer how Mr. Brown is going to increase his participation and function. And potentially, is it also going to reduce care of burden informal care, or even formal care? So Do you have to be careful around that one though when you potentially, you know, if they're worried about their care hours. Yeah. you know, and that's a discussion we all have to have as a team as well. You know, if this element of AT is going to reduce formal care, does everybody want it? You know, does the user want that? Do their carers want that? Or what is most reasonable and necessary from the funder’s perspective as well? So there's lots we need to take into consideration and really make sure you're working as a team and ultimately coming back. those goals and working within the rules and regulations of the funding body as well. What I love about the advice you just gave is that structure and that showing you're working out. it is just, it is like a debate. I like that analogy. It works for this. But that structure and then the person kind of goes along the journey with you and it follows how you structured the trial. So it's, it all flows together, which is why the planning right at the beginning is so important all the way through. absolutely. And when therapists and I talk around, oh, this is where I'm having a difficulty, when we're talking through the process, I go, “Oh I missed that”. In that discussion, it can be, oh, I knew I missed something. So it's OK. If you've missed something, we can go back. You can have another trial if you need it. But we only have so many hours to work in as well. Which is or may or may not be best practice, but if we can work with the hours that are in the plan, planning, problem solving and collecting the right information at the time of trial sets us up for a solid report. what advice do you give if the report does get knocked back? what's your advice then? Take a breath, it's okay. It happens. Try not to take it personally, I think. I think we all put in so many hours that it is heartbreaking when we get a report knocked back. Hours and hours have gone into that. But I would say, actually take one step before you submit your report, get someone to review it as well. Yeah, that’s good advice. I know that I read what I want to read if I've been writing something for a really, really long time. I hand it over to someone and can you take a red pen to this for me, please? So, you know, give it to someone in your team, you know, keep it confidential. You can give it to them, de-identified and have a colleague lovingly tear it apart. And I mean that in the nicest possible way, because they'll be able to find gaps. So before, you know, before you do submit it, do get feedback from someone as well. But if you are knocked back, it's okay. Okay. You know, it's disappointing. But we can go back with more evidence. You know, if they've asked a couple of key questions, provide that evidence if you're really confident. And if you're not, phone a friend. You know, talk to your mentor, talk to your supervisor, talk to your colleague, you know, talk to the rep who was on site or, you know, reach out to the manufacturer and say what have I missed here? Is there... What other evidence can I provide? Or ask the question, did I overprescribe? Is this a fair question that is being asked by the funding body? What have I missed? Have I overprescribed? And often we don't, but I think sometimes asking the question is a nice double check. But use the community around you. Work with the user to collect any additional evidence you might need. and go back to the funding body in a really succinct way. Okay? Again, have a supervisor or a mentor or, you know, even one of us, if we're available, we'll happily give you some, support you need, if we can do that. You know, and there's support within this community of AT providers. You know, all of the suppliers and manufacturers, we want ultimately the best outcome for each user. And I mean that. It's just not a throwaway line. So, you know, it's such a great community that wants really good outcomes. So you're not alone. You know, reach out to Sarah as well. There's so many of us in the industry who are always happy to help. And I think that comes out every time I do a podcast episode, that's what comes out, we're all in it for the same reason. We all want great outcomes for the person at end of the day who's gonna be using the AT. Yep. I think we're all wheelchair nerds. And I say that in a really nice, I say it in a really positive way. You know, my friend and colleague in the US, she hosts wheelchair nerds. And every time I listen to that podcast, it makes me smile because it's a whole group of like-minded people who just want really great outcomes for every single user. doesn't matter what product they're in. Everyone wants great outcomes. So don't hesitate to reach out. right? We're a big team. It's good, I like that. I like that, really such great advice, Tilly. Okay, so we've talked a lot and we brought out a lot of really important points from this conversation. Top three, top three points for running successful trials. What would they be? Be prepared and complete a really great initial assessment. Be clear and organised on your trial. Okay, so, you know, for you and the user together to be like, right, this is what we're doing. You know, let's be prepared for those two hours and get as much, you know, let's do the assessment, make sure it's right, and then gather the evidence. And ask for help, ask questions. You know, if you don't know the product, you know, speak to your, your rep and say, who, who can I find out more about this product? If you're on the road and you don't have time, can you connect me with the manufacturer? I need to understand what is special about this product and why I'm scripting this over a different chair. You know, we do need to potentially trial other chairs, but Sometimes we can consider them. If you can outline why perhaps this chair over my shoulder over a non-standing chair or a different chair, manufacturer's chair, understanding the features of each chair is really important to help within that clinical reasoning process. Because they are not cheap pieces of AT. And even if we are prescribing a low-cost piece of AT, we still need to make sure it's the best piece of equipment for that individual. And it's okay to not know everything. You can't actually, as an OT, you can't know everything. no. And I learn something every day still about wheelchairs and seating. And I've been doing this for a while. So I love learning every day. So yeah, ask, ask a question. There's no silly question out there. And there's plenty of people who will happily sit down and chat away with you while you're driving home from an appointment or wherever you may be. Yeah, very valuable advice, thank you. Okay, we're to our final closing question. So I asked you this on the last episode, so I'm gonna ask you to think of a different example this time. So can you describe a moment when assistive technology significantly changed a client's life and how has this impacted you? Yeah. A couple of years ago, I was asked to come in just to provide a different perspective on an assessment. My local sales rep had called and said, look, when you're in town, I'd love you to come out and the therapist would really value your thoughts as well. So they had a youngish gentleman probably in his mid 30s who he'd had a spinal cord injury and had intense pain, know, like life altering pain and really limited his participation and was spending, you know, 90 % of his time in bed to the point that he'd developed significant contractures in the hips and knees and feet. And, you know, the rep had said to me, look, he's because of his pain, he He really doesn't want to engage with too many people, but he's open to, he knows he needs a wheelchair to get out of the house. And it was, the therapist was really great, younger therapist, but understood, you know, that I really need some support in this case. So we went out and this person were, they were in their bed and he provided consent. He said, look, I'm in a lot of pain, so I just want this done as fast as possible. So I explained to him, said, look, we need to do a quick MAT eval. I did not do a full MAT evaluation. I knew clinically it was not appropriate. And I explained to him that ideally I'd like to get him in a seated position to see if he could sit on the edge of his bed and a couple of key measurements. And I just wanted to understand how his body moved or didn't move. And he said really clearly, I can, if you're fast, I can do this. And he spoke with his carer and he said, look, I'm going to do some pain management. So we stepped out for about 20 minutes and we left him with his wonderful carer and they managed that. And, you know, I was trying to just build a bit of rapport and he said, I know what you're doing, but I just, don't need you to do that today. I just need you to do this. So absolutely cool. Got it. Get in and out. So we did a really brief MAT assessment. I was able to, you know, also review, you know, I was able to have a conversation. I wasn't worried about driving a pouch or anything like that. And it was just a real quick teamwork. We got in, we took some measurements. And then he, you know, that trust was built really quickly because Beacuse you listened to him Yeah, yeah He's like, this is, you know, this is what I'm happy to do. You know, the other therapist had lots of that other information about where he was going in the community and that sort of thing. But we needed to make sure we could set up a chair successfully for the trial, you know getting those basic measurements because he was in so much pain It was essential that it was going to fit him like a glove first time because, you know, he said, if this doesn't work, I'm not doing it again. You know, right. No pressure But I must say, what? What made it a success was the therapist reaching out for help. The local sales rep actually reached out to the Permobil rep. And I think because the Permobil rep and myself were so far removed and it was, this is just the one job we're doing. We built the trust. We were really clear about what we were doing and weren't doing and what we were there for. He engaged and was not engaged is the wrong word, but you know, we came together as a team. We listened to him. We were really user focused, you know, everything was only ever done with consent and engagement. And, you know, next time we came back, we set up the chair beautifully. The local rep had those measurements, you know, perfect. And we were able to get him out of bed. He, he took that trial chair outside into the sun for the first time in so long. So. You know, for me, this is not always perfect, but it was a really, really good reminder about being really user focused, listening to them and they're an expert on themselves, right? You know, he could stand. knew how much he didn't have a lot of time that he could actually engage with people in his bedroom, you know, moving his body around and the pain he was in. He knew he didn't have very long. He couldn't give you a lot of time. Yeah. you know, that sometimes it's really nice to just, you know, be reminded that everybody is an individual and no matter what, you know, the barriers are or how tricky it might be, if we remain user focused and work as a team, we can get really, really great outcomes. And that therapist wrote a splendid report. They did such a great job and it was approved first time as well. So it was really, really great teamwork. Yeah. Yeah, teamwork and yep client focused. Love it. And the user is an expert on themselves. I can't say that enough. yeah. Well, Tilly, you are a wealth of knowledge and expertise and you make things so clear and you break things down in a way my brain really likes. So I'm sure that everyone, I'm sure everyone listening to this has enjoyed it too. So thank you for your support and your help when it comes to running successful trials and report writing as well. It's been really valuable. Thank you for your time. Well, you're welcome. And look, if you've got a question, ask honestly, where everybody is here to absolutely support you. you know, I'm going to plug my team. We have such a wealth of knowledge in the Permobil Clinical Services team. So please reach out to them and myself. We're always happy to support and have a wheelchair nerd chat any day of the week. Yeah, make everybody happy. Thank you so much for joining us on the podcast today and we'll catch you in the next episode. Bye. Bye.