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Don’t Jump to a Solution Without Knowing What the Problem is! Part 3: the Clinicians

Don’t Jump to a Solution Without Knowing What the Problem is! Part 3: the Clinicians

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

In Part 1 of this Blog series, we discussed the Client and Caregivers and how they can help identify the Problem that needs a Solution. Nobody knows the Problem like the Client and Caregivers. In Part 2, we discussed the Supplier and how their knowledge of CRT equipment and the reimbursement process can help identify the best Solution. Part 3 presents the Clinician and their unique role on the team in determining optimal Solutions.

The Clinician

Clinicians can connect the dots between the Client and Caregiver’s identified Problem and the equipment and reimbursement knowledge of the Supplier

Clinicians on the Seating and Mobility team may include Occupational and/or Physical Therapists. The Clinician brings unique knowledge of range of motion, muscle tone, orthopedic challenges, and, most importantly, function. Clinicians are also trained in clinical observations, task/activity analysis, clinical reasoning, and problem-solving. In wheelchair seating and mobility, it is essential to correctly analyze the client’s posture and to determine the ‘whys’ of that posture in order to determine the best Solution. Clinicians also provide evaluation documentation used to justify the recommended equipment which is submitted with other materials by the Supplier to obtain funding approval.

Clinicians can connect the dots between the Client and Caregiver’s identified Problem and the equipment and reimbursement knowledge of the Supplier.

An Example

seating dynamics blog evaluating problems

Pivot Point is too low

I was seeing a young man using Dynamic Footrests, though he was not activating these well. He was exerting force against the footplates, yet I noticed that his overall active extension was not reduced. In watching his movements within the wheelchair, I noticed that the pivot point of the Dynamic Footrests was significantly lower than the pivot point of his knees, impacting the ability of this dynamic component to absorb his forces.

Once this was corrected (using a High Pivot receiver), this young man could readily activate the Dynamic Footrests and his overall active extension was greatly reduced. This required clinical observations, task/activity analysis, and trying to remember High School Geometry!

Jumping to a Solution

I remember speaking with a Clinician who told me that they had tried over 20 cushions with a client and still hadn’t come up with a solution. When I asked her what the Mat Examination had revealed, she stated that she didn’t have time to do that. Time is short, productivity demands are high, but skipping vital areas of the assessment will either result in more time on the back-end (like trying 20 cushions) and/or poor outcomes. We need to complete a thorough assessment to determine all the Problems and the causes behind them in order to determine, with the Team, optimal Solutions.

I hope this short series has reminded all of us, Clients and Caregivers, Suppliers, and Clinicians, to not Jump to Solutions. Rushing to the finish line doesn’t always win the race. Let’s work together for the best outcomes.

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