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

Trish Toole is an occupational therapist who works extensively in wheelchair seating and mobility, as well as 24/7 postural care. She is also the co-author of a chapter on the subject of 24/7 postural care management in the upcoming 2^nd edition of Seating and Wheeled Mobility: a clinical resource guide.

Trish was more than willing to share her thoughts on the value of Dynamic Backs in our ongoing efforts to achieve a reasonable funding amount for this component under the new CMS fee determination schedule.

Trish, can you share an example of how the Dynamic Back has benefited the clients you work with?

I work with a client who has repeatedly broken his wheelchair back, head, and foot supports with his constant and forceful movement. I recommended a Dynamic Back to prevent further damage to his equipment. However, I also recommended Dynamic Seating to help him with other issues that lead to movement.

Reducing Agitation. This client moves to cope with difficult situations. He has both cerebral palsy and autism, and certain situations and stimuli can cause agitation. Movement helps reduce this agitation. Common triggers include his sister’s high-pitched voice, the sound of Velcro, bright lights in his classroom, and hospital waiting rooms.

Reducing Pain. He also moves to cope with pain. He can only tolerate sitting in his static wheelchair for about 2 hours. He is non-verbal, and when something hurts, he hits himself as he cannot adequately express his needs and he is frustrated. He moves to try and shift his weight to alleviate discomfort.

Evaluation. The first time he tried a Dynamic Back, he was thoughtful and still. He then began gently rocking the back. He was happy and comfortable for the entire 2-hour evaluation after already insisting on getting out of his current, static wheelchair. Being in the room with five adults talking about him and what he needed would normally be agitating for him, yet he was content being able to move the Dynamic Back and Dynamic Footrests on the demo wheelchair. His parents were incredibly grateful that there was hope for him to use his wheelchair long enough for the family to leave the house together again.

Results:

After receiving his equipment, this young man was able to attend his younger sister’s pool party. Even though it was loud on the pool deck with a whole group of 8 year olds, he moved and rocked his chair happily and was able to stay the whole 2 hours. This was much better than his family expected, and they did not need to activate the exit plan- which meant that both parents got to attend the whole party. Now that is a win!