Efforts to fabricate kid-size wheelchair seating-and-positioning systems invariably go smoother and are far more apt to turn a profit when you, the referring therapist, and others take pains to communicate adequately every step of the way. “You should be continually striving for good communication because, in the long run, it will be the least expensive way for you to do your job—and the way that will deliver the most satisfaction for the wheelchair user, the family, and the referral source,” says Sandy L. Cormier, ATP, CRTS, owner of Rehab In Motion, based in San Antonio, Tex, with offices in Laredo and the Rio Grande Valley.

Sandy L. Cormier, ATP, CRTS, (back row left) and Laura Duran, PT, (back right) stress that communication should also extend to pediatric wheelchair users (if they are old enough and sufficiently cognizant).

Without good communication, it is entirely too easy to incorrectly spec out a system, warns Lauren E. Rosen, MPT, ATP, program coordinator of the Motion Analysis Center at St Joseph’s Children’s Hospital in Tampa, Fla. “It might be that an important detail gets overlooked, and you end up with a less-than-optimal seating-and-positioning system. But it would not have been overlooked had the equipment vendor and the therapist been talking to one another.”

Troubling to Rosen is the fact that many therapists can blithely spec out pediatric wheelchairs—running up tabs as high as $30,000 in the process—without possessing any significant knowledge of the products involved. For that reason, she suggests, equipment dealers should educate therapists about the features, benefits, indications, and costs of the various items before starting the selection process. “A therapist ought to know which kind of back, cushion, and armrest is the right one to order for this client versus that client,” Rosen asserts.

Cormier long ago adopted that same opinion. Thus, today, she periodically sponsors seminars for referring therapists to educate them on the latest strategies and techniques for better seating and positioning. While such info impartation can be delivered by a qualified HME spokesman or vendor representative, it is more effective when the presenter is a fellow therapist, says Cormier. “No matter who gives the presentation, it can’t amount to a product-driven sales pitch,” she notes. “That just won’t go over with therapists. The presentation must be function-driven—and that’s why it’s usually best to have a therapist deliver it.”

Cormier also pays to send at least a handful of her regularly referring therapists to the big annual MedTrade show. “They need to see the equipment. Exposure to all the options prevents tunnel vision. It makes them more receptive to looking at new ways of helping these children,” she says.

Spread The Words
Good communication can’t be limited to discourse between just you and the therapist. To be truly effective, it must extend also to the wheelchair user (assuming he or she is old enough and sufficiently cognizant to offer input) and to the parents or guardians of that child.

“Often, little Johnny goes to school one day and comes home in a completely new chair—a total surprise to mom,” Rosen reports. “And, of course, since mom wasn’t consulted, no useful input was obtained from her about Johnny’s habits and needs. The result many times is a chair that does not work right for Johnny’s unique circumstances.

“The first thing I ask a family when they come to me for a wheelchair evaluation is whether they currently have a wheelchair. If they do, I ask them to tell me what they like and dislike about it. There’s nothing worse than removing from a chair some product or configuration they really loved,” adds Rosen. “If I don’t ask that question, there’s a chance I might remove or leave off what they like simply because I do not have a preference for it. The same is true of things I might prefer but that they hate.”

During this same conversation, Rosen also asks for the name of the vendor that supplied the chair—and for some indication of whether they are happy with that company. “Depending on their funding source, the family may have a choice of vendor,” she says. “I want to know if they’re happy with that vendor because, if they’re not and they have a choice, I like to give them the opportunity to switch to a different vendor. I do this because I never like dealing with families angry at their wheelchair vendor.”

Once Rosen knows which equipment dealer will be used, she contacts that outfit to arrange an evaluation session. “I don’t perform evaluations separate of the vendor,” she insists. “Having the vendor present allows for a good give-and-take. For example, once I had requested a particular headrest for a client. But it turned out the headrest was having frequent in-field breakdowns, and I was unaware of that. Because the vendor was right there with me when I made that request, he was able to alert me to this problem and recommend that we look at an alternative. That prevented me from wasting time and effort.”

From left: Sandy L. Cormier, ATP, CRTS, John Michael Balli (3 years old), Jennifer Lively, OT, and Rose S. Bazan, PT, show John how to use his power chair.

In setting up any pediatric wheelchair evaluation session, Rosen recognizes a certain amount of phone tag between herself and the HME dealer will be inevitable. But the more elusive the supplier’s contact person, the more points that company loses with her. “The vendors I like to work with give me a variety of ways to catch them—direct line, cell phone, fax, email. And they’re very good about returning my calls right away,” she says.

Available Dollars
Cormier, meanwhile, believes that, prior to the evaluation session, the job of the HME dealer should be to determine from the funding source how much money will be available for piecing together the seating-and-positioning system. “By knowing the funding limitations, we’re in a better position to say yes, this is do-able; or, no, this is not,” she says. “The worst thing you can do is offer something only to find out after the fact that there’s no way to get it funded.”

On funding, it is Rosen’s view that one should never take no for an answer. Tenacity is required to shake money loose from tight-fisted funding sources. “Their systems are set up to discourage you from appealing,” she says of payors. “If they deny your claim, they hope you’ll just go away. I’ve learned to keep after them.”

Although Rosen knows the products, she nonetheless occasionally needs the HME dealer to supply information about them so that she can craft a reasonably bulletproofed letter of medical necessity. Typically, she’ll ask for this input when she determines that a detailed technical explanation of some advanced feature or component of the seating-and-positioning system will strengthen her written justifications to the payor.

A Matter of Interpretation
To foster good communication, it is nice if everyone who can offer input is physically present in the room where the evaluation will be conducted. But, in this era of email and video cell phones, is having all hands on deck really necessary? You bet, Cormier contends. “Not everyone,” she says, “has access to videoconferencing and other high-tech communications devices.” Especially not families lower down the socioeconomic ladder.

A characteristic of many poorer families is lack of proficiency with the English language, and that can amount to a serious barrier to good communications. To overcome that, Cormier attends meetings with an interpreter at her side whenever parents speak only a foreign tongue.

Interestingly, even in cases where English is spoken fluently by the family, interpretation of sorts may still prove necessary if the nomenclatures used by the providers are alien to the ears of the unschooled. Here, Cormier reaches across the divide by asking one clarifying question after another until she is sure the family understands what is being discussed. She also studies the family’s body language to detect when someone is still in the dark but too embarrassed to confess it.

The goal of good communication also should apply to your dealings with equipment manufacturers. Their friendship can be crucial—and good communication will help. In one instance, Cormier’s friendships with manufacturer representatives enabled a child denied funding to nevertheless obtain an expensive power wheelchair and seating-and-positioning system. The reps organized a charity golf tournament on behalf of the child and proceeds went to pay for the chair and modifications.

“There’s the sense here that these children are not a burden but a privilege,” Cormier says. “They’re really looked at as a gift from God.”

Rich Smith is a contributing writer for Dealer/Provider.