Observation Deck

Tailor-Made Mobility Services

Providing custom applications tied to various patient diagnoses.

• By Megan Kutch
• Aug 01, 2012

As we all know, it is extremely important to evaluate your client and provide the appropriate equipment to maintain and improve overall quality of life. Whether we are fitting a patient in a scooter, manual wheelchair, or power mobility device, we need to have a discussion with the client to determine how the equipment will be used throughout the day andwhat must be accomplished during activities of daily living.

We then determine the appropriate type of equipment that will work for our clients and also look at the accessories needed to meet their daily needs. Manufacturers of mobility equipment provide detailed order forms that will help the therapist and ATP put a chair together with all of the accessories that their clients will need. Your clients might have a progressive diagnosis or a unique need and the accessory you need is not listed on the order form. You will then need to think out-of-the-box and determine what type of custom application is needed.

Working as a Team

In our current economic climate, it would not make sense for a manufacturer to stock accessories that have only been requested on a limited basis. It is important to have knowledgeable individuals that can work with a therapist or ATP to meet their clients’ custom needs. The Custom Application Specialist can work with the therapist or ATP by listening to the specific needs of the client and offering suggestions that may have been done in the past. If it is a request that has never been done before, the therapist or ATP can send drawings with measurements of what they need done.

With the permission of the client, an ATP can also e-mail pictures of the clients existing power or manual mobility device for review. This helps them work together as a team to determine what works best for the client. When the custom design is completed, the Custom Application Specialist can then take a picture of it and send it to the therapist or ATP prior to shipping it in order to ensure it would meet the client’s need.

What Is Considered Custom?

Any accessory that is not listed on an order form can be considered a custom order. This can range from modifying a cushion for a pelvic obliquity to mounting a joystick to a foot platform, to adapting a chair for conjoined twins. One aspect that needs to be considered is the safety of the client who will be using the custom modification. Any modification has to be tested by a manufacturer’s lab to ensure that it will not put the client at risk.

Often the therapist or ATP will need to supply all of the client’s measurements along with his or her weight in order to gage if the modification will be a safety risk. If the request is something that has never been made before, the entire chair should be assembled as it would go out to the client and put through safety testing prior to shipping out to the provider.

Real Life Custom Applications

Dwarfism. An ATP requested that a 90-degree foot platform be added to his client’s power chair mounted 7 inches below his seat pan so that he would be able to climb into his seating system. The unit was assembled with the standard foot platform mounted to the base of the unit and a smaller foot platform that was cut down was mounted above it with a modified high mount bracket. This enabled the client to step onto the foot platforms while using the transfer handles on the armrests to pull himself into the seating system. Considerations taken in to account prior to agreeing to ship this modification included client height, weight, seating system, and type of power mobility base.

Manual wheelchair user (15 or more years). A client requested to transfer in and out of his chair through the back canes due to the inability to access his bathroom the way the chair was currently configured. A heavyduty zipper was installed on the right side of a sling back which allowed the sling back to be unzipped. Once unzipped, the sling back pulled back allowing the client to transfer out of his chair through the back versus a traditional side or front transfer. This modification gave the client the ability to increase his independence during his activities of daily living within his home environment.

Paraplegia. An ATP wanted his client to be able to weight shift independently in his power chair with a power recline back. The client required the back to have scapular cut-outs and a transfer bar mounted to the top of the back so that he could weight shift in his chair throughout the day.

Hypotonia and decreased gross and fine motor skills. A client was unable to drive his power wheelchair with a standard hand control due to decreased gross and fine motor skills. The solution for this client was to drill a hole through a hand pad coming off the armrest and mount a mini proportional joystick to a height adjustable bracket. This enabled the client to drive his power chair using either his finger or the palm of his hand to independently drive the chair.

There are many solutions that can be made to meet your clients’ specific need. Providers committed to helping their patients get these tailored solution must seek vendors that are equally committed to providing custom modifications to meet the unique needs within the rehab community.

This article originally appeared in the August 2012 issue of HME Business.