Chris' Blog: Evaluations

Understanding

Thu, 10 Apr 2008 13:41:39 GMT

I had the chance yesterday to spend time with a customer who has MS and one who suufers with a recent spinal cord injury. The customer with MS was diagnosised approximately 17 years ago and started using a power wheelchair 7 years ago. She is currently using a Pride 1113 and has taken excellent care of the chair and has had very little issues with the chair. What I find hard to understand, is know that MS is a progressive disease, why would someone put her in a basic chair that will not meet her needs longer term. She has purchased cushions because the van seat caused her severe pain from day one, the joystick doesn't swingaway, the foot plateform wasn't adjusted right and the armrest do not provide the upper extremity support she requires. Why not put her in a base with a pressure relieving cushion, a positioning back and a base that could be easily modified as her conditions changed?

I am not saying that her base can't be modified but running powered seat functions through the joystick are not an option, putting a tilt on would be a challenge and it get high centered everywhere. She can't go up her back ramp without getting high centered, she is unable to get on her interior wheelchair stair lift without getting high centered so her independence is diminished.

Stop and think about what you are doing and what you would do for yourself. I can promise you that the person that sold them that chair would not have put themselves in that chair if they had MS or any other type of progressive disease. Love your customer just as you love yourself and if you don't love yourself that much, find another line of work.

Our industry needs positive things to come out about it. We hear all the negative stuff but what about the life changes that we assist with in this industry. Tell your stories and tell them loud. We need more positive stories to come out so we can show that there are more good guys and gals in this industry than bad.

Chris

Listen

Thu, 03 Apr 2008 01:05:04 GMT

When you are performing a mat eval or just measuring a customer while they are sitting in a chair, if you listen to what their posture is telling you, you will learn alot. Some folks just go in pull out their tape measure and note pads, write down a bunch of numbers and walk out of a customers home without ever laying hands on the customer. I use a tape measure and many other tools, but my hands have ears. As I run my hand down a customers back, I understand what is going on with their spinal alignment. While up close and checking their pelvic positioning, i listen to their breathing especially if they have a lung condition, cardiac condition or scoliosis.

As I hold on to their pelvis while checking for proper midline pelvic alignment, I notice their shoulder and trunk position. Can they hold a midline alignment independently, do they lean to one side or the other, are their shoulders rounded, how much of their back os touching the back of the chair and so on. While checking their lower extremity hip and knee flexion and extension, what is the position of their ankles. When sitting do they sit in a severe posterior pelvic tilt,anterior tilt, frog legged, abducted or adducted and what is their head position. As I am doing all this I am making mental notes and my hands are moving them into a midline alignment if possible and my hands are listening for increased heart rate, increased or decreased breathing and stomach rumbling. What are you doing?

I was recently in an eval at a physicians office, the customer had multiple medical conditions that required complaex rehab power wheelchair. This customer had diagnosis of multiple CVA's, MS, seizures, frequent falls with injury, severe weakness in the trunk, inability to maintain midline posture without maximum supports, mild kyphosis scoliosis and weak neck muscles. She had been evaluated by another local provider but physician told customer that she want her evaluated by me. When I arrived at the office, I walked into the exam room and was introduced to customer and her family. I explained to them how I conduct an eval and what I was doing at each step. I made my recommendations and the physician agreed and we then talked with the customer and family as to the what equipment, why the equipment and the process in getting the equipment.

After that conversation the daugther gave me the paperwork from the other provider. They had recommended a basic consumer power base with a captain seat and said that when they came to her home the only measurements they took was seat depth, seat width and door measurements. She said other than the eval that this physician had given her, I had probably performed the most detailed eval that her motherhad had in 2 years.

My advice is this, listen with your hands, your eyes, your ears and your heart. When recommending equipment ask yourself this, is this the equipment I would put my wife, my child, my mother, father or brother in? If you answer no, don't do it. If it's over your head, refer it to someone who is qualified to do it. Remember this, just because the person has achieved the ATS status means that they are an ATS. Be a professional, build relationships with your physicians, therapist, customers and know your limits. Don't do it just because you can.

I went to a home today and visited with a family as to what their daugther needed. She looked so uncomfortable and was hanging on the arm rest. The first thing I did was to move the armrest and ask why they had armrest on her chair? Their response, don't you have to have them on the chair? My response, can she use them with her upper extremity contractures? No, so why have them on their because thay can't be adjusted low enough and she is hanging on them. After removing the armrest, this young lady relaxed, she smile, her lung function increased, she started talking and her shoulders came into a neutral alignment. We are going to make a few more modifications but over all the other provider had done a wonderful job with the chair. The family had nothing but high regards for the other provider and so do I, the other provider had just reached his maximum capabilities. Know yours, ask for help, its not your body you will do long term damage to.

Chris

Think Outside The Box

Mon, 03 Mar 2008 17:17:34 GMT

Well my newsletter and website are coming along. In the first article of the newsletter I will be discussing evaluation and how we become settled in if you will to our jobs and forget to look at each customer individually. There are times we become so over burdened with business that we don't do a complete evaluation, our paperwork get behind and it takes for every to get a customer the equipment the need. I am as guilty of this as the next person. I have to remind myself daily that just because the person I am evaluating has the same DX as the last person I seen doesn't mean they need the same equipment, the same cushion, back and headrest. Each person is created differently and needs to be evaluated as such.

In April I will be presenting at the Missouri Assistive technology conference and will be presenting on Wound Prevention and Increased Seating Tolerance. As I have been sitting and preparing my presentation, this has come to the forefront," We are not doing our customers justice when we hurry". We need to step back and ensure we are gathering the information we need to properly make suggestions rather than just using the same chair for each customer. I know we all have our favorite bases and cushions but we need to ensure each customer gets what is in their best interest not our best interest.

I recently wrote a comment about "The Machine" meaning the consumer power companies that advertise. The companies that advertise that are ensure each customer recieves the proper equipment is providing a valued service. I recieve calls from consumer power sales reps that refer customer to me because they know a consumer power chair is not in the best interest of the customer. When they fax me their evaluation notes they are sometimes more detailed than what we as rehab professional get. I reviewed one the other day and was amazed at the detail of information. They had measured door openings, ramp degree's, customer measurements, diagnosis and transportation concerns.

We can all sit and make comments about the machine and how they are hurting our industry but they do a better job than we do sometimes. Those of us that have taken and passed the RESNA exam sometimes put our selves up on a shelf and think that just because we have the "ATS" status that we are somehow better than those providing consumer power bases. Individuals requiring consumer power bases makes up a larger portion of our market than rehab chairs. We all need to work together to ensure customer are getting what they need. If they need a rehab type chair and you are only qualified to sell consumer power refer that customer to a rehab dealer and vice versa. Our industry has a black eye and we are the reason. The only way to change that is for us to all work together and stop having CMS make these rules and funding cuts. If a customer only needs a consumer power base than that is what you sell them, if the need a rehab product than sell them a rehab product. Don't up sell just because you can, that is killing our industry.

I'm sure I will get hammered for expressing this view point but it won't be the first time and damn sure won't be the last.

Chris