Michelle L. Lange, OTR/L, ABDA, ATP/SMS
I have had the privilege to know Missy for a number of years. Melissa “Missy” Tally, PT, MPT, ATP, is the Physical Therapy Coordinator at Perlman Center, part of the Cincinnati Children’s Hospital Medical Center. She graciously took time out of her busy schedule to talk with me about Dynamic Seating.
Missy, how did you get into this field?
Missy has been at Perlman Center for 21 years and has worked specifically in wheelchair seating and mobility for about 15 years. Like many seating and mobility clinics, their program used to provide a multi-disciplinary evaluation that lasted 2-3 hours, several times a week. Now, the center’s multiple clinics focus on 24 hour positioning, birth through adult, and see about 50 clients in a week! Looking at positioning over 24 hours encompasses interventions from wheelchair seating systems, mobility bases, sleep positioning, bathing equipment, adaptive car seats, adapted beds, and even home modifications.
Missy developed an initial interest in all the Perlman Center equipment while providing therapies to the clients there. Then, a therapist left and referrals went up – and Missy began working with wheelchair seating and mobility. She learned from both peers and suppliers. Perlman Center tends to see clients over a long period of time, allowing for follow-up over many years.
Missy eventually became involved in funding and advocacy. As Perlman Center sees such a large volume of clients, they tend to see trends in denials quickly. She works closely with manufacturers and suppliers to address any funding issues. Over 90% of what is recommended through their center is approved!
When did you start using Dynamic Seating and what led you to this intervention?
Years ago, Missy was working with several clients with dystonia who needed more than a standard static wheelchair. She and her team started exploring Dynamic Seating options. For some clients, movement led to an exacerbation of destructive movement patterns, but for others, the Dynamic Seating stabilized the client and improved function. Perlman Center also began to explore movement for younger kids who were rocking.
Do you use Dynamic Seating with your clients now? How is this intervention meeting your client’s needs?
Missy continues to use Dynamic Seating with clients who have increased tone, movement disorders (such as dystonia), and particularly clients who have a dual diagnosis of cerebral palsy and autism. She has found that Dynamic Seating gives proprioceptive feedback which reduces agitation and other behavioral issues. In her experience, Dynamic Seating has led to client increased function and decreased maladaptive behaviors, as well as less medication to address these behaviors.
“Dynamic Seating has led to client increased function and decreased maladaptive behaviors, as well as less medication to address these behaviors.”
Missy and I had an interesting conversation about dystonia and ‘active stability.’ Missy, being a wheelchair seating expert, knows that proximal stability facilitates distal control and mobility. People with movement disorders, such as dystonia, need movement for comfort and stability while still actively weightbearing through the pelvis. Static or passive stability typically involves using primary and secondary supports to keep the pelvis as immobile as possible. ‘Active stability’ is the stability found from proprioceptive input, such as pushing against the resistance of dynamic components while maintaining contact with the seating system surfaces – which is exactly what Dynamic Seating provides.
“Active stability is the stability found from proprioceptive input, such as pushing against the resistance of dynamic components while maintaining contact with the seating system surfaces – which is exactly what Dynamic Seating provides.”
Are you running into any funding challenges?
Missy and the staff at Perlman Center have been successful in obtaining funding for Dynamic Seating, though sometimes an appeal has been required. She credits their documentation including the necessary information to obtain successful funding approvals.
What improvements do you think are needed in this area?
Missy would like to see a Dynamic Back that folds down, particularly for the pediatric population. However, she likes what is available, particularly the amount of wheelchair frames which are compatible with Dynamic components.
In Missy’s own words, “I feel the mat evaluation is critical in the recommendation for Dynamic Seating. Understanding the client’s movement patterns, including origin of tone, strength of movement and reaction to stability, helps to achieve the best outcome for the client using Dynamic Seating components.”