Last month's Clinical Corner article was about the role of the therapist assistant in wheelchair provision. Many occupational therapists and physiotherapists from across Canada contacted me via email to provide feedback on their use of therapist assistants in seating and mobility, in response to my request for information. Drawing from the information provided, the article focused on the various tasks that are assigned to rehabilitation assistants throughout the steps of wheelchair provision, from referral to discharge. The article included the different clinical environments in which a therapist assistant may work in wheelchair provision, from acute care, to inpatient rehabilitation, to long-term care/complex continuing care, to community care, to seating clinics, and how the role may differ depending upon the clinical setting. If you missed that article, see The Role of the OTA/PTA in Wheelchair Provision: Part One. Like Part One, the terms occupational therapist assistant/physiotherapist assistant (OTA/PTA), therapist assistant, and rehabilitation assistant will be used interchangeably in this article.
In Part One, I mentioned that I started to notice themes emerging when I read the emails from therapists. I read numerous comments that related to communication, collaboration, and knowledge base. Let's look at each of these themes more closely.
Communication is an important element in the provision of wheelchairs, no matter the clinical setting. When looking at the role of therapist assistants in wheelchair provision in long-term care settings, being the contact person and relaying communication from the client, family and nursing staff to the therapist upon his or her next visit is one of the duties when a therapist is employed part-time in a facility. One therapist termed this as the therapist assistant acting as a "messenger".
Another therapist wrote about the communication that occurs between the client and the rehabilitation assistant. In some settings, the therapist assistant is involved with multiple aspect of the treatment plan, as assigned by an occupational therapist and/or physiotherapist, and therefore spends more time with the client than the therapist who is overseeing the treatment program. It was noted that sometimes the rehabilitation assistant can get the "real" feedback from the client on the wheelchair trial. Perhaps the client is uncomfortable sharing negative feedback about the seating and wheelchair with the therapist, but are more willing to share their honest opinion with the OTA/PTA as they spend more time with the therapist assistant.
In the article "Occupational therapist assistants: Enabling well-being in community power mobility users", the authors, Gillespie and Engel, stated that "there may be a decreased perceived authority differential between the client and the OTA compared to the occupational therapist, and this can foster a good therapeutic relationship." 1, p. 9. The decreased perceived authority differential may be another reason why a client may be more willing to give the "real" feedback on the wheelchair trial to an OTA/PTA, rather than an occupational therapist or physiotherapist.
Other therapists wrote about the methods of communication between the therapist and therapist assistant. Methods and frequency of communication will vary depending upon the practice setting. For example, in the community, communication on client progress occurs through documentation in the client record and through voicemail and email updates to the supervising therapist, when face-to-face communications may be more difficult to plan. An innovative practice described in the literature is the use of iPads to communicate within a large hospital setting. 2 This allows for immediate communication between the therapist and therapist assistant, using the texting feature to share information and even using the video conferencing feature to problem-solve issues, such as equipment needs, in real time.
When describing the role of the therapist assistant in wheelchair provision, some therapists described the rehabilitation assistant as being a collaborator in the process. For example, in acute care, the therapist and therapist assistant may select a wheelchair together from amongst available equipment pool choices if there were difficulties with the original piece of equipment provided from the equipment pool. Some therapists reported that in the absence of an OTA or PTA in the community, the vendor/technician becomes the person for collaboration on equipment selection and assistance with making adjustments to the wheelchairs. Due to the complexity of some seating and mobility systems, having someone with whom to bounce ideas can be beneficial.
Collaborative relationships between therapists and therapist assistants have also been described in the literature. Collaboration between the occupational therapist and OTA, in which both skills and knowledge were combined, enabled enhanced service delivery 1, which benefits the client. "OTAs provide another pair of eyes and hands to assist the occupational therapist to recognize concerns and promote engagement in occupation. The relationship between occupational therapist and OTA is more than the assignment of a task. It requires trust, understanding, an exchange of ideas and working together to provide the best care for the client." 3, p. 20
Many therapists who emailed me about the role of OTAs/PTAs in wheelchair provision commented on the knowledge or skill required of the therapist assistant to work in the area of seating and mobility. When a lack of skill was observed, there was less willingness on the part of the therapist to assign any tasks related to seating and mobility to the assistant. Orientation and mentoring by experienced therapist assistants, on-the-job training, and on-going education in seating and mobility through attendance at in-services, workshops and conferences were considered important to gain the knowledge and skill required to work in this area. It was noted that when a therapist assistant develops the necessary expertise to work in seating and mobility, greater efficiencies can result. For example, in some inpatient rehabilitation settings, it is more efficient to have one rehabilitation assistant be responsible for the seating and wheelchair pool and setting up wheelchairs for inpatients, rather than having several assistants share the responsibility. The expertise gained by the individual having primary responsibility allows for greater efficiencies to be realized.
A therapist wrote not only about the knowledge required to work in the area of seating and mobility, but also about the attitude and motivation that is needed. Someone with a great attitude and willingness to learn is an asset to the team.
Therapist assistants play an important role in wheelchair provision. The knowledge required for the role will vary depending upon the clinical setting in which the therapist and therapist assistant work. For example, some rehabilitation assistants will gain expertise in seating and mobility to allow for greater efficiencies in service delivery. Collaboration between therapists and therapist assistants also allow for enhanced service delivery when knowledge and skills are shared for the benefit of clients. No matter the setting, communication between the client, therapist and therapist assistant are important in achieving the goals of wheelchair provision.
Once again, my thanks go out to the many therapists who contributed to this article by providing feedback on how they work with therapist assistants in their practice relating to wheelchair provision and to the therapist who suggested I write about this topic!
- Gillespie, H., & Engel, L. (2015, March/April). Occupational therapist assistants: Enabling well-being in community power mobility users. Occupational Therapy Now, 17(2), 8-10.
- Feenstra, C., & Grouchy, N. (2015, March/April). Communication: From low tech to high tech. Occupational Therapy Now, 17(2), 15.
- McCready-Wirth, A., Hepting, C., Ng, W., Haney, C., Bratkoski, L., & MacAusland-Berg, D. (2015, March/April). On the road together: Community occupational therapists and occupational therapist assistants working to provide the best care. Occupational Therapy Now, 17(2), 19-20.
- Canadian Association of Occupational Therapists. (2009). Practice profile for support personnel in occupational therapy (2009). Retrieved from https://www.caot.ca.
- College of Occupational Therapists of Ontario. (2011). Standards for the supervision of support personnel. Retrieved from http://www.coto.org.
- College of Occupational Therapists of Ontario and College of Physiotherapists of Ontario. (n.d.). Support personnel E-learning module. Retrieved from http://www.coto.org