The Secret Life of Mobility Providers
Understanding Your Mobility Equipment Fitting
- By Elisha Bury
- Apr 01, 2012
The diagram outlines common measurements taken during a standard mobility equipment evaluation. Some situations might require additional measurements such as chest depth, redundant tissue extension, forearm length and hand length as well as measurements for lateral placement and any discrepancies in overall positioning, says Marshal Decker, ATP, RRTS, the branch manager of Active American Mobility in Dallas, Texas. Source: Active American Mobility
Think of your new mobility equipment as an Armani suit. It needs to fit you like a glove, be made with the finest materials and make you look good as you're moving across a room.
If you were shopping for something this exquisite, you wouldn't trust an off-the-rack model. You would go straight to a tailor who would take the right measurements and make adjustments so that the suit moves with you and becomes an extension of you.
Your mobility equipment provider is the tailor for your new mobility equipment. To give you the most independence and maximize your health, your local mobility provider will take measurements beyond your wildest imagination and ask you questions that might seem inconsequential. But like any good tailor, there is a method to this madness. Here are the answers to your burning questions about what your mobility provider is doing to fit you with the perfect mobility system. What Are All of These Measurements For?
Custom fits don't happen by accident. Mobility providers must diligently measure a client's entire body to get it right. And minimizing mistakes requires great attention to detail.
"Like a carpenter, measure twice, cut once," says Joe C. Hill III, ATP, CRTS, of Piedmont Medical Supply in Hickory, NC.
The figure shows the standard measurements needed for mobility fittings. But in some cases, more measurements might be needed. Marshal Decker, ATP, RRTS, the branch manager of Active American Mobility in Dallas, Texas, says additional measurements might include chest depth, redundant tissue extension, forearm length, hand length, lateral placement and any discrepancies in overall positioning.
Even if those measurements might not be needed, Hill says he takes additional measurements, such as head and ankle diameter and foot separation, anyway because he never knows when a certain piece of equipment is going to require a specific measurement. He says it's better to get the measurement up front than to have to go back to the client multiple times.
But the measuring doesn't stop with the client. The equipment also has to fit home, work and school environments or it won't be functional, says Decker.
Hill says there are some measurements of the environment that are a must, such as door and hallway widths with 90-degree turns. "Sure the doorway is wide enough, but factor in the turn into a bathroom and you’re in trouble if the chair is too long no matter the door width going straight in," he says. "All things must be considered. Will the joystick allow getting up to the dining table? Will their legs pass underneath? I can do this all day; you can never get enough measurements." Why All the Questions?
The evaluation might seem like a cocktail party, without the cocktails, at first. That's your provider getting to know you. And although you might be wondering why all this small talk is necessary, your provider needs full disclosure to ensure that your equipment matches up with your lifestyle.
"My method is to get to know the client, family [and] caregiver so that I can better understand their unique needs," explains Hill. "Everyone has their individual needs and goals; it’s important to listen so that I may grasp their physical, environmental and mobility requirements."
Providers will ask what you hope the equipment will help you accomplish and what your daily routine is. They might also ask you to describe your home and provide dimensions of chairs, beds, counters, tables and doorways. You will also be asked to talk about how you transfer from one surface to another.
"I get as much information as possible so that I solve problems not create them," says Hill.
In addition, expect to discuss your diagnosis and previous medical conditions because those conditions impact what equipment is recommended, says Decker.
"You can never ask too many questions when doing an evaluation," he says. "Any information can be useful in the selection of the best possible seating system or wheelchair for an individual." Why Can't I Just Take My Wheelchair Home Today?
Because a mobility system is custom fitted, taking a wheelchair home the day the prescription is given is not possible.
"The clients that we evaluate rely on these wheelchairs for their independence, and for some of these people, this is the only independence they may have," says Decker. "There are so many different things that we have to address when selecting the best possible equipment, and some of these could be crucial components that could be left out if someone were to just show up and get a wheelchair."
Multiple steps must be completed to ensure the best possible fit.
First, providers have to assess your needs in an evaluation that includes the entire team—client, provider, therapists, doctors and caregivers.
"A mat evaluation conducted by a therapist is also a crucial part of the evaluation process," explains Decker. "The purpose of the mat evaluation is to figure out what the most functional positioning for the client is going to be so you can then transform that into the recommended seating system. You will also take measurements of the client in this part of the process."
Next, home evaluations might be scheduled to ensure the mobility equipment can be used in the home.
Sometimes seating clinics or trial fittings that allow clients to test out equipment and pressure mapping might be necessary.
"The ability to demo many different cushions and chair bases is great," Hill says. "We all perceive pressure and comfort differently."
Hill uses two seating clinics associated with hospitals that have a collection of manual wheelchairs, power wheelchairs, backs and cushions. One of his clinics also has a pressure mapping system so that when a client sits on a particular cushion, hot spots created by the cushion are shown.
"Trials and demo equipment can be very useful, especially for those who are going into a chair for their first time or for someone who will be using a head array, sip-and-puff system [or] chin drive system," says Decker.
After the information is collected, the provider processes that information and selects the different components of the equipment, Decker explains.
Finally, the mobility system is completed, and last-minute adjustments are made for proper positioning. If you are being fitted for power mobility equipment, you might also need training on how to operate the equipment.
With all of these steps, and depending on the complexity of the equipment and diagnosis, you might have to go back to see the provider two to four times or even more than that for a proper fitting.
"Additionally, the process of going through insurance can be daunting, and evaluation to delivery times can range from a few weeks to a few months," says Decker. "This is in part due to the many elements that have to occur sequentially to get funding and ultimately order, build and deliver the chair. Often one custom chair can have six or seven different manufacturer components." How Can I Make the Evaluation Process Easier?
Although mobility providers ask smart questions and take all of the proper measurements, the best thing clients can do to make the process smoother is to tell all.
"Sometimes I think that clients end up holding back a lot of useful information because they don’t see the relevance," says Decker. "A lot of times this information can unlock a lot of unanswered questions and make the selection process a lot easier."
"There are no stupid questions or statements," Hill says. "I have to ask over and over to tell me something. So many are intimidated by what they perceive as authority figures. I love the ones that are my friends that helped me help them."
So, ask that burning question. Ask how much the equipment costs and if the wheelchair comes in bubblegum pink. And don't be afraid to speak up if you need your equipment to solve a problem, even if that problem seems minor to you.
Remember, your mobility provider wants to help you, and your feedback might mean the difference between a so-so mobility system and one that meets all of your needs.
Credentials You Need to Know
ATP: Assistive Technology Professional certification means that a provider has demonstrated competence in analyzing the needs of people with disabilities, assisting in the selection of appropriate assistive technology and providing training in the use of selected devices. To become certified, a provider must take and pass a 200-question exam.
CRTS: Certified Rehabilitation Technology Supplier certification means that an RRTS has passed the ATP exam and is a National Registry of Rehabilitation Technology Suppliers (NRRTS) member in good standing. NRRTS is a professional association supporting individuals who provide complex rehab wheelchairs and seating and positioning systems.
RRTS: A Registered Rehabilitation Technology Supplier is a member of NRRTS. The credential shows that the provider has demonstrated work experience, received recommendations from professional associates, adheres to a stringent code of ethics and commits to ongoing continuing education.
Important Considerations for Equipment Choices
What exactly does your mobility provider consider when selecting equipment among the endless choices in today's market? Choosing the right equipment for mobility clients is like putting together pieces of a puzzle, says Marshal Decker, ATP, RRTS, the branch manager of Active American Mobility in Dallas, Texas. Here are a few of the questions he asks to help him decide:
- Will the equipment be under duress? If so, Decker recommends equipment that withstands daily use and abuse because the mobility system often has to last for five years or longer.
- Can the client or caregiver perform adjustments and routine maintenance? If not, equipment that won’t require any maintenance or upkeep is necessary.
- Can the client effectively shift his weight? Is the client at high risk for skin breakdown? A tilt-in-space wheelchair helps the caregiver reposition the client throughout the day.
- Does the client have limited or no range of motion or fatigue? With manual wheelchairs, adjustable rear axles are sometimes necessary to ensure effective and efficiently propelling.
- What is the cognitive ability of the client? The provider will need to ensure that clients operating power wheelchairs can do so safely.
- What type of transportation does the client use? Whether traveling by car, minivan or public transit, mode of transportation can be a deciding factor regarding which equipment is chosen.
Elisha Bury is the editor of The Mobility Project. She can be reached at firstname.lastname@example.org.