Taking a Second Look

In September of 2015, I wrote an article for Clinical Corner, entitled "Best Practices in Seating and Mobility Assessments". As outlined in that article, the following concepts were found to be necessary for best practices in seating and mobility assessments: experience, hands-on techniques, skills, technology, resources, self-directed learning, follow-up, and consumer relationships.¹ The article expanded on each of the concepts. This month, let's take a second look at some of the best practices in seating and mobility assessments, specifically technology and resources. Let's also consider why we should take a second look at products and technology.

As outlined in the above article, having an understanding of the technology available is part of best practices for occupational therapists and physical therapists conducting seating and mobility evaluations. This means understanding the strengths and weaknesses of various technologies and products and, in turn, understanding how the technologies and products are applied clinically.¹ Without this understanding, the seating and mobility system that has been prescribed for an individual may not meet the needs of the client, and in some cases, may even cause harm.¹ For example, a low profile cushion may be selected in order to achieve a low seat to floor height for transfers, without taking into account the potential effect of the cushion's profile on pressure management capabilities for an individual at high risk for skin breakdown.

It is also important to understand existing evidence and clinical practice guidelines. We may have an understanding of products and technologies, but we must pair it with knowledge of research evidence. For example, clinical guidelines exist on pressure injury prevention and outline the duration and frequency of recommended weight shifting. Any cushion has the potential to fail if effective weight shifting is not completed on a consistent basis. If that is the case, can it be considered a failure of the cushion if a pressure injury occurs without consistent, effective weight shifting or is it a failure of other factors? (For more information on weight shifting and pressure management, see the following Clinical Corner articles: Weight Shifting and Pressure Management 2.0 and The Evidence on Tilt, Recline and Elevating Leg Supports.)

In terms of understanding technology, it is important to remain up-to-date and know about new technologies and advancements, while also understanding the application of "old" technologies.¹ The "latest" technology may not be what is best clinically for an individual client, which is why it is important to not forget about "tried and true" products. Often a manufacturer brings new products to market but continues to support older products because the older products continue to meet the needs and desires of consumers. If an individual has had a very good experience with a particular product in the past, they may simply want that same product prescribed again.

Sometimes when I have been in the Sunrise Medical booth at trade shows or conferences, visitors to the booth will ask "What is new?" or say "Show me what is new". This is not a criticism of the therapists or vendors who come to our booth and ask this question. I understand that time is limited and people are trying to make effective use of their time, but let's not forget that it is best practice to also understand older technologies.

Why take a second look at products of which we may have some knowledge? One reason is to provide a refresher on some of the important details about a product that we might not readily remember. We may have been told the information in the past and when we hear it again it "rings a bell" but it is not a point that we would have been able to recall had we not had the reinforcement to our learning. In terms of knowledge translation, it is known that information must be repeated multiple times and in multiple formats. The same concept applies when learning about products. We will not be able to retain all of the relevant information if we do not have some repetition. Even if we work with certain products frequently, we may not be aware of different details and possibilities, particularly when working with products that have some complexity.

Another reason to take a second look at products with which we may have some familiarity is that products often undergo enhancements or improvements, some of which may be invisible to the naked eye. "Older" products get updated to foster continuous improvement. For example, a wheelchair model that has "been around" for decades has updates to it that may make it worthwhile to investigate the changes and ask about the clinical implications. The chair may maintain its original name but may have undergone numerous enhancements over the years. Another example of "invisible" improvements would be increasing the internal thickness of tubing on a wheelchair at certain points to provide enhanced strength, while decreasing the thickness at other points where the additional thickness is not required, resulting in overall increased strength to the wheelchair, while reducing weight. Other changes that might not be so readily visible are enhancements to suspension on a power wheelchair that may affect the ride for the individual driving the wheelchair. This would not be apparent when looking at the wheelchair or when seeing the wheelchair drive on flat surfaces. Taking a second look at products allows us to be informed of any changes to the product in order to remain informed and up-to-date.

We may also want to take a second look at products that we think we know if there has been a shift in the client population with whom we work. For example, clinicians working in the community continue to tell me about the increased complexity of the clients with whom they are now working. If we are unsure of the stability of a client's condition, we might want to think about using a wheelchair that has a modular frame, rather than a box frame, so that we can shrink or grow the frame of the wheelchair if needed in the future, or change the front or rear frame of the wheelchair to support any progression or deterioration in client condition. We may need a reminder on how to accommodate anticipated changes. (Refer to the following Clinical Corner article: Manual Wheelchair Prescription: Beginning with the Future in Mind for more information.)

Let's think about adult learning theory. One of the pillars of adult learning theory is that adults want to learn information that is relevant and timely. Perhaps instead of asking "What is new?" at a trade show, which may yield answers that are not relevant to your practice, think of describing your typical client population and ask what products may be most appropriate for that client population or ask for more specifics about a particular product you see, such as a power chair, cushion, specialty control, or ramps and think about how each may apply to current or past clients. It is essential that we employ best practice in terms of understanding "old", "new", and "updated" technology and think how the technology in products can be applied clinically.

Another concept in best practices in seating and mobility assessments that we will address this month is that of resources. In order to remain up-to-date on all of the available products and any associated enhancements or improvements, there are multiple resources.¹ Vendors have knowledge of a wide range of products available. Manufacturers' representatives have in-depth knowledge of their product lines and access to internal resources should more information be required. Do not be afraid to use all resources available to become as knowledgeable as possible regarding seating and mobility products – new, old, and updated – that are available so that you can have a clear understanding of how the products are designed to work so that this can be matched with the clinical needs of clients.

References

1. Isaacson, M. (2011). Best practices by occupational and physical therapists performing seating and mobility evaluations. Assistive Technology, 23, 13 – 21.