Cath Lab Digest

Picture this scenario; you have a patient who has been paraplegic as a result of an injury 8 years ago, did just fine for the first 5 or so years and then began to have issues with skin breakdown. The ulcers were minor at first, and then the patient presented with an eschar that ended up being a Stage 4 ischial pressure ulcer. Attempts over several months were made to heal to no avail. The decision was made to proceed with a reconstructive flap, which was done—and the patient spent the required time on bed rest. The ulcer is eventually determined healed, and the patient is ready to proceed with a sitting program again. He has a sports type of wheelchair, which he has used since his injury. The patient has his cushion, which he wants to return to using but you have concerns that this was the same system used prior when he broke down. To learn how to handle this situation, the author interviewed Stephanie Tanguay OTR/L, ATP an employee of Motion Concepts, Tonawanda, N.Y.

Dot Weir (DW): Tell me about yourself.
Stephanie Tanguay (ST): I’ve been an occupational therapist since the mid 80’s. I trained at Eastern Michigan University, and for the first 13 years I worked at a freestanding rehab center, The Rehabilitation Institute of Michigan, which is part of the Detroit Medical Center. I then spent 7 years working as a RTS (a rehabilitation technology supplier), so on the equipment provision side of things. For the past five and a half years I have been working for Motion Concepts, a company based out of the greater Toronto area with US distribution and customer service out of Tonawanda, N.Y.
Our company creates an extensive range of power positioning systems such as tilt and recline seat systems for pressure redistribution and elevating seat features to enhance functional access to various height areas of the environment. We also manufacture a line of seating products, which are designed to meet the positioning and pressure distribution needs of a wide range of consumers. I specifically work with the MaTRx line of seating and back products and accessories that can complement almost any mobility system, power or manual. In the role of Clinical Education Specialist I travel the entire U.S. and parts of Canada meeting with clinicians and providers to educate them about our product line.

DW: How did you develop such an interest in the specialty of seating?
ST: In my first job I had the unique opportunity as an occupational therapist to rotate to different units, which were very specialized for brain injury, neurology, stroke, spinal cord injury (SCI), even a rheumatology unit, as well as a general physical medicine and rehab unit, which included orthopedics. An interesting aspect of how the program ran was that in the SCI unit, the Physical Therapists (PT’s) were responsible for the prescription of manual chairs and the Occupational Therapists (OT’s) were responsible for the prescription of powered chairs. It wasn’t an “un-crossable” line though and over time, we became more collaborative with both disciplines working more closely together. When I rotated to SCI unit, they didn’t have a seating clinic so I went to my supervisor with the anticipation of being mentored in how to properly prescribe power wheelchairs. Instead, I was told to just call a DME Dealer, and that they would tell me what the patient needed. At that time, there wasn’t a lot of info available regarding the different chairs and seat surfaces in terms of the various features and comparing and contrasting between them. There didn’t seem to be a process, and I thought that I, as the therapist for the patient, should be the one deciding what features would best meet the patients’ needs. That was more than 20 years ago. Now there are a number of very excellent providers available, which we’ll also talk about, but it is still so important for the OT’s and PT’s to be involved to be able to really match the specific needs of the patient with the features needed in a chair. It’s important to know the hand function, the ability to transfer and type of arm rests that will be needed, for example if the arm comes off, lifts, latches, locks, etc. The needs will be different for someone with limited trunk balance as another example, or special difficulties with their feet requiring specialized lower extremity supports. A lot of the challenge is created by the billing guidelines for Medicare patients (which can also effect reimbursement from other funding and insurance). There are complicated issues for evaluation time lines, documentation and diagnosis qualification criteria.