Recently, a therapist provided a suggestion to me to write a Clinical Corner article on the role of the therapist assistant in wheelchair provision, from referral to discharge. What a great topic! Having worked in a number of different clinical settings prior to joining Sunrise Medical, my personal experience has been that the role of the therapist assistant with respect to wheelchair provision varies depending upon the practice setting and the size of the institution or agency in which one works. In order to fully address the topic, I sought feedback from therapists working in different practice settings and provinces and conducted a literature search on therapist assistants and wheelchairs. For the purposes of this article, the terms occupational therapist assistant/physiotherapist assistant (OTA/PTA), therapist assistant, rehabilitation assistant and rehab assistant will be used interchangeably.
In reviewing the emails I received from occupational therapists and physiotherapists on the topic of rehab assistants in relation to wheelchairs, I started to notice common themes. Many community therapists replied to me that they do not work with rehabilitation assistants, but wish that there was the opportunity to do so. Therapists working in seating clinics that do not employ therapist assistants also expressed their desire to have the support of a therapist assistant. I will write more on the other themes I noticed, such as communication, collaboration and knowledge base, and how these themes relate to the existing literature in this area in part two of this article, which will be posted next month.
The majority of the responses I received to my request for information were from therapists who work with therapist assistants and the emails described the various roles that the OTA/PTA takes on in relation to wheelchairs. The therapists represented the full range of work environments, from acute care, to in-patient rehab, to seating clinics, to community care, to long-term care and complex continuing care.
Let's look at how therapist assistants provide support to occupational therapists and physiotherapist in wheelchair provision.
Depending upon the clinical setting, a therapist assistant may be assigned some administrative duties. In a seating clinic, the rehab assistant may be responsible for booking appointments, which includes scheduling the therapist, client, vendor and any other required individuals at a time that is convenient for all. The rehab assistant may order charts and obtain other background information required by the therapist for the assessment. After the completion of the assessment, the therapist assistant may contact the vendor to request equipment for trial, as specified by the therapist.
In long-term care, some facilities may contract or employ therapists on a part-time basis, ranging from a specified number of hours weekly or monthly, depending upon the size of the facility. These same facilities may employ rehab assistants on a full-time basis. In this type of situation, the therapist assistant may be responsible for initiating a referral to a therapist for a seating and mobility assessment when it is noted that a client requires a mobility device so that the therapist is aware of this upon the next visit. Likewise, the therapist assistant may be the point of contact for family members and other staff regarding mobility devices between the scheduled visits of the therapist and may notify the therapist when an assessment or intervention is needed.
Whether in acute care, long-term care, inpatient rehabilitation or seating clinic, rehabilitation assistants provide much assistance for seating and mobility assessments. In seating clinics, an OTA/PTA prepares the clinic prior to each appointment and cleans it between appointments. In addition, the therapist assistant may assist with modular shape captures at a seating clinic. In long-term care, the therapist assistant may be able to provide the therapist with relevant background information regarding the client, such as usual method of propulsion, transfers, and postural history. In settings where the therapist visits the facility weekly or monthly, having the rehab assistant involved in the assessment allows the assistant to be part of the process and to be informed of the requirements as the assistant tends to be the liaison between the client/family, vendor and therapist.
In all settings, a rehabilitation assistant may assist when a second person is required. For example, an OTA/PTA may assist with transfers or the use of a mechanical or ceiling lift; may help to support an individual with poor sitting balance or unpredictable tone during the assessment; and may take required photos. For individuals who are on isolation or infection precautions, the rehab assistant can act as the "clean" person during the assessment, being the scribe and note-taker for the therapist.
Equipment Provision and Trial
The clinical setting influences the type and amount of involvement of a therapist assistant in equipment provision. In some settings, such as inpatient settings and some long-term care/complex continuing care settings, the facility has an equipment pool of wheelchairs, cushions and back supports. Sometimes, a therapist assistant provides a temporary wheelchair until the therapist returns to the facility to conduct an assessment to prescribe a more permanent seating and mobility system for a client, such as in long-term care. In some settings, such as acute-care, inpatient rehab, and complex continuing care, the therapist assistant sets up a wheelchair with seating and accessories, such as a lap tray, from equipment pool choices, as specified by the therapist. Adjustments to the set-up are made by the assistant, as directed by the therapist.
When equipment is being trialed for prescription purposes, the setting and the province (i.e., availability of equipment through funding programs) influences the responsibilities of the rehab assistant. At a seating clinic, the therapist assistant may be responsible for installing seating components onto a mobility base or making adjustments to a wheelchair to set it up for trial and/or fittings. The assistant may pre-wrap equipment, if required for infection control precautions.
At a long-term care facility, a therapist may or may not be present when new equipment arrives for a client, depending upon scheduling. If the therapist is not present, the therapist assistant and vendor may set up the client with the new equipment until the therapist's next visit, when adjustments can be made/arranged. If both the therapist and therapist assistant are present when the new equipment arrives, the therapist may assign follow up to the rehab assistant for recommended changes that can be made by the vendor without the presence of the therapist. The assistant, because she/he has been part of the initial fitting and understands the rationale, can follow up with the vendor as the go-between for the therapist and vendor when the therapist works only part-time at a facility. Particularly when a therapist does not work full-time at a centre, the rehab assistant has a vital role in reporting back to the therapist how the wheelchair trial is progressing for the client with information on issues such as comfort, posture, or sliding. The OTA/PTA also has a role in communicating with the client's family on behalf of the therapist and with following up with the vendor on requested adjustments.
In the community, therapist assistants also may be assigned to follow up with straightforward changes made by a vendor at the request of the therapist.
Pressure mapping is another area where rehab assistants provide assistance. Therapist assistants set up the pressure mapping system in preparation for appointments when pressure mapping will be used to evaluate seating. This occurs in seating clinics. In addition, therapists working in home care in some Northern Ontario communities have access to pressure mapping, with the OTA/PTA providing assistance and some expertise in using the equipment and software.
Therapist assistants provide much support in the area of mobility training. Whether it is in acute care, inpatient rehab, long-term care/complex continuing care or seating clinic, rehab assistants often are assigned mobility training with clients. From basic wheelchair safety and mobility in acute care or long-term care to manual wheelchair skills in inpatient rehab to power mobility training over several visits in the community, rehab assistants play a role in assisting clients to learn the required skills and in reporting back to the therapist on client progress. Checklists may be used to ensure all areas of training are covered; for example, accessing transportation in the community. Training may have to be provided in how to remove/fold some wheelchair components for a transfer. Therapist assistants also may provide training to clients in areas such as cushion maintenance (e.g., how to check inflation of an air cushion) and wheelchair maintenance (e.g., how and when to charge batteries on a power wheelchair). In addition, therapist assistants provide informal training. For example, assistants may provide clients with safety reminders regarding wheelchair use when the therapist is not on-site and will advise the therapist of any safety concerns noted when the therapist is not present in the facility.
Whether in the community or at a seating clinic, a rehab assistant may assist in completing sections of funding applications. Depending upon the province and the funding agency requirements, a therapist assistant may call for price quotes on equipment. The rehab assistant may be assigned administrative duties and be responsible for submitting/faxing completed paperwork to funders or other agencies.
Equipment Maintenance/Inventory Management
Depending upon the size and type of facility, OTAs/PTAs may be responsible for seating and mobility equipment and related inventory management. In larger facilities, this role becomes specialized, with one person assuming primary responsibility and gaining expertise in this area. Often, the job title reflects this expertise, such as "wheelchair technician".
Therapist assistants are responsible for organizing equipment pools, cleaning and disinfecting equipment, and performing basic repairs. Therapist assistants also may be responsible for charging power wheelchairs and performing maintenance checks on equipment being returned to the equipment pool. Rehab assistants may follow up to ensure the return of borrowed equipment pool items. In some long-term care facilities, therapist assistants are responsible for submitting funding requests for vendors to complete more complex repairs.
The role of the therapist assistant in wheelchair provision is vast. Depending upon the clinical environment in which a therapist works, the therapist assistant can be assigned many different responsibilities. Rehab assistants can support therapists by completing administrative and clerical duties. OTAs/PTAs can assist during the assessment, by providing another set of hands for safety or for documentation purposes. Therapist assistants have a large role to play in equipment provision and set-up, in addition to client training with mobility devices and transfers. Rehab assistants also tend to become responsible for maintaining equipment pools and managing inventory. Therapist assistants have a role to play to assist therapists and clients in all of the steps of wheelchair provision, from assessment through to discharge, and from acute care to long-term care and every setting in-between.
My thanks go out to the many therapists who contributed to this article by providing feedback on whether or not they have the support of therapist assistants in their practice and the role that the therapist assistant takes in wheelchair provision in their work environments. Many thanks also go to the therapist who suggested I write about this topic!
Part two of this article, which will be posted next month, will address themes emerging from the feedback provided by therapists for this article. Themes, such as communication, collaboration and knowledge base, will be explored.