Clinical Corner

The focus of Clinical Corner for the past 2 months has been on outcomes and outcome measures.  The June 2019 article, Outcomes and Outcome Measures in Seating and Mobility: Current Practice, distinguished between outcomes and outcome measures and highlighted some of the results of a survey with therapists practicing in seating and mobility in Canada regarding their use of outcomes and outcome measures.  The July 2019 article, From Outcomes to Outcome Measures: Next Steps, reviewed the relevance of outcome measures and the key considerations when selecting outcome measures. Clinical Corner will continue the theme on outcome measures this month with a focus on specific outcome measures that can be used in seating and mobility.

Last month, Clinical Corner distinguished between outcomes and outcome measures and highlighted some of the results of a survey with therapists practicing in seating and mobility in Canada regarding the use of outcomes and outcome measures.  See Outcomes and Outcome Measures in Seating and Mobility: Current Practice to refer to that article.  This month, Clinical Corner will continue its focus on outcome measures with a look at key considerations when selecting outcome measures.

There is a subtle difference between outcomes and outcome measures in seating and mobility. Whereas outcomes may include subjective descriptions, outcome measures can be objective, quantifiable means of validating interventions. The results of an on-line survey suggest that many therapists involved in seating and mobility in Canada consider outcomes when working with clients. Some outcomes, such as pressure mapping, sitting tolerance and using SMART goals, allow for some aspect of measurement to occur. A future Clinical Corner article will provide additional details on outcome measures that help to provide objective quantification of outcomes such as those mentioned in this month’s article.

What are the similarities and differences between assessing an individual for a power mobility device versus a manual wheelchair? What is important to consider for a power wheelchair versus a manual wheelchair? Does it matter if an individual cannot drive effectively the first time they use a power wheelchair? These questions, and more, will be answered this month in Clinical Corner.

This month, Clinical Corner has reviewed the updated terminology used for pressure injuries and the staging of pressure injuries. In addition, the position statements of the NPUAP related to pressure injuries have been reviewed. More information on Pressure Injuries can be found on the NPUAP website.

Rigid frame wheelchairs offer some choice in the type of frame – from open frame to closed frame and from fully welded to models with fold-down back canes. Some models of rigid wheelchairs provide adjustability in the rear axle while others are fully fixed. Rigid frame wheelchairs promote efficiency of propulsion due to their light-weight design and minimization of moving parts, which allows for more efficient propulsion. A thorough assessment is required in order to match the needs of clients with the products that are available on the market for optimal fit, function and performance.

There is never going to be one model of wheelchair that is right for every client. Manufacturers recognize this and often provide several models of wheelchairs within a category to meet the various needs and demands of clients. This allows for optimizing both fit and function for a client through the selection of an appropriate model of wheelchair. How we choose between models of wheelchairs goes back to the assessment and then matching the goals of seating and mobility with the choices that are available.

Just as there are many factors that contribute to the risk for falls, there are many interventions to address the risks. A multi-disciplinary, multi-factorial approach is important to take for older adults who are identified at high risk for falls.

Many factors contribute to the risk of falls. Such factors include biological, behavioural, socio-economic and environmental. Next month, Clinical Corner will address strategies to reduce the risk of falls for older adults.

If you have been following my blog for a while, you may recall that in October I tend to write an anniversary article to celebrate another year with Sunrise Medical Canada. This month marks my 8^th year with Sunrise Medical! Since October also is Occupational Therapy month across Canada, I thought I would write a little on my experiences that led me to occupational therapy. I would also like to celebrate Occupational Therapy month by sharing a recorded webinar and by seeking input for a future webinar. More on that later in this article!

Are we all speaking the same language in seating and mobility? Have you heard a wheelchair cushion being called a “pillow” by someone who does not work in this field? Do you call a “wheel lock” a “brake” on a wheelchair or an arm support an “armrest”? Is a pelvic positioning belt the same as a pelvic belt for transportation of occupied wheelchairs? (The answer to this last question is no!) The language of seating and mobility is evolving and, in fact, becoming standardized. This month, Clinical Corner will address standardized terms in seating and mobility. We will look at why standardization in terms is important and review a sampling of common terms.

Creativity in knowledge translation helps to produce different resources that are available when and where the client needs them. Having information shared in multiple formats helps to reinforce learning, which bridges the knowledge to action gap, which is what knowledge translation is all about!

Standardized and non-standardized outcome measures in seating and mobility provide information that can be used to improve individual client results. In addition, with informed consent, the results of standardized outcome measures can be pooled to help to provide a body of evidence that helps to inform evidence-based practice in the area of seating and mobility.

The issue of restraints versus function versus postural supports is a large one! This month, Clinical Corner began to address the issue of restraints versus postural supports and personal assistance services devices. Future Clinical Corner articles will address issues such as how to minimize the use of devices that could be considered restraints on wheelchairs and when do we consider the effect of the device on an individual.

Clinical Corner first addressed electric mobility scooters in Scooters: The Essentials of What You Need to Know. With spring emerging in many parts of Canada after a long winter, and with summer just around the corner, it is a good time to revisit electric scooters as the promise of good weather often leads us to think about outdoor mobility.