Clinicians who prescribe seating and mobility equipment must be aware of their clients’ current and future needs. Clients with progressive conditions present unique challenges to assistive technology prescribers. By the time equipment is evaluated, funded, and delivered, a client’s functional status may have changed—requiring modifications and/or additions to a newly acquired system.

In the initial assessment and throughout the prescription process, it is important to ask questions that will identify the client’s long-term needs and develop strategies to provide systems that provide long-term benefits at a reasonable cost.

For HME providers, funding of assistive technology equipment continues to be difficult and time-consuming to procure from both the public and private sectors. Justification of medical necessity is paramount when requesting any seating and mobility system, and justification can be questioned, especially when requesting additional accessories. We as health care providers must therefore ensure that all potential requirements are considered before submitting funding requests.

Not only must we consider changes in function for clients with progressive conditions, but we also must be cognizant of changes in function and body position due to aging. Traditionally, conditions such as cerebral palsy, spina bifida, and spinal cord injury have not been considered inherently progressive. However, the effects of unbalanced muscle forces and elongated muscle fibers due to growth lead to changes in functional capabilities of these clients. Continued overuse of muscle groups can lead to changes in joint formation—reducing strength and range of motion.

Arthritis may also lead to pain and reduced movement and function. These issues must be considered in the development of assistive technology systems for clients. It is important to educate clients on expected changes in function (based on their condition) and to encourage use of equipment to maintain independence in positioning and mobility. Consider as many factors as possible when developing a system that allows a client to continue to function independently. These factors include:
            • age
            • growth (effects on muscular function)
            • potential for weight gain (due to effects of medications, increased inactivity)
            • changes in physical function (affecting driving ability, switch access, communication)
            • rate of disease progression
            • potential for skin breakdown
            • positioning requirements to maintain body position, balance, and     alignment
            • psychosocial issues (affecting acceptance of equipment)
            • aesthetics of equipment
            • cognitive status (affecting understanding of equipment usage and education/communication strategies)
            • cost of equipment and available funding
            • vocational and recreational activities
            • family roles and responsibilities
            • physical environment
            • transportation

Creativity is the key as we develop systems for our clients. Equipment should meet the client’s present needs, but should be flexible enough to allow changes or additions to meet future changing needs.

Goals for assistive technology systems should include modularity, versatility, and compatibility to interface with other accessories (ability to change setup of wheelchair frames, additions of seating and positioning equipment, additions of power positioning systems to wheelchair bases, and ability to interface drive systems with computers).

Timing is important in the implementation of equipment to ensure that prescriptions address prevention and not only current function. Use of multicomponent power seat functions allows for greater flexibility in client positioning and repositioning, promotion of body alignment, and independent function and comfort.

Choosing a system with modularity allows a client to add functions as necessary. Some clients may not be ready to accept, understand, or afford systems with multiple positioning functions (power tilt, power recline, power elevating legrests, seat elevation), but you should not limit the possibility of adding these features in the future. It is important to choose a system where these options can be installed individually at any point should they be required. It is also important that, in installing additional features, they do not impose changes to the original system (increasing seat height, changing overall dimensions of the wheelchair, making footrests difficult to swing away and remove, and distorting the look and aesthetics of the chair).

Not only is choosing a flexible system important, but also working with a creative team assists the client in understanding the process of equipment selection. This team includes therapists (occupational and/or physical), dealers, manufacturers, clients, family members, and caregivers. It is essential that the goals of each of these team members be identified and prioritized so that the end result is successful and everyone understands the reason for the choice of equipment.

Often a successful system is one that combines features from different products and manufacturers. We as therapists and dealer/providers must not be limited in our thinking to one particular product, but instead be creative in combining seating and mobility products in a way as to best meet the goals of our clients. We can challenge equipment manufacturers to develop or modify products to match our creative ideas. Dealers (where resources exist) can customize “off-the-shelf” products to meet specific client needs. Often this leads to new product development, which in turn will benefit future clients.

It is also important that a plan be developed for ordering, fitting, delivering, and educating the client on specific use of equipment once the funding is secured. Each of these roles must be identified and assigned to a specific member of the team at the time of assessment. Ongoing follow-up will determine the effectiveness of the equipment. Asking the right questions prior to ordering the equipment is ultimately the best way to promote communication and ensure successful outcomes for clients.

Kathryn Fisher, OT, ATS, is education manager for Therapy Supplies and Rental Ltd, Toronto. Fisher has presented at a variety of international conferences including the Canadian Seating and Mobility Conference, International Seating Symposium, Medtrade, and the Canadian Association of Occupational Therapists. She is a faculty member for the RESNA Fundamentals in Assistive Technology Course, and can be reached by email: kfisher@therapysupplies.com.