OCT 1100H April 27, 2017 WHEELCHAIR SERVICE STEPS

Transcription

1 OCT 1100H April 27, 2017 WHEELCHAIR SERVICE STEPS

2 Introduction Speakers/Facilitators: Pearl Gryfe, MScOT, OT Reg. (Ont.), Assistive Technology Clinic Marlene Adams, OT Reg. (Ont.), UHN, Toronto Rehabilitation Institute, Lyndhurst Karen Hall, MScOT, OT Reg. (Ont.), Assistive Technology Clinic Jessica Comay, OT Reg. (Ont.), Assistive Technology Clinic Andree Gauthier, OT Reg. (Ont.), UHN, Toronto Rehabilitation Institute, Lyndhurst

3 Time Topic Format 9:10 9:20 Welcome and Introductions Pearl Gryfe Lecture Whole class Room 132 9:20-9:40 World Health Organizations Wheelchair Service Provision Step 1: Referral and appointment Marlene Adams 9:40 10:30 Step 2: Assessment overview and interview Karen Hall 10:30 10:45 Break 10:45 12:15 Step 2: Assessment practice session Hands on practice with facilitators 12:15 1:15 Lunch 1:15 3:00 Case Studies Hands on practice with facilitators and wheelchair users Steps 2, 3, 6 Bring all 3 forms 3:00 3:15 Break 3:15-3:45 Case Studies Groups present on learning highlights from each case 3:45-4:05 Step 4: Funding Jessica Comay 4:05 4:25 Step 5: Product preparation Step 7: User training Step 8: Maintenance, repairs and follow up Andree Gauthier 4:25 4:30 Closing remarks Pearl Gryfe 5 Groups Room Groups Rooms 132, 150, 428, 453, 750 Lecture Whole class Room 132

4 WHEELCHAIR SERVICE STEPS STEP 1: REFERRAL AND APPOINTMENT Marlene Adams, OT Reg. (Ont.), UHN, Toronto Rehabilitation Institute, Lyndhurst

5 RESOURCES

6 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product (wheelchair) preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up

7 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Screen When to refer Required information

8 Referral and Appointment

9 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Structured Thorough

10 ASSESSMENT International Classification of Function and our new assessment form 1. Body structure and function 2. Activities and participation 3. Environment and current device

11 The clinic on a cart ASSESSMENT

12 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Clinically appropriate options

13 PRESCRIPTION

14 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Know the criteria Explore other options

15 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Based on assessment Set up in advance

16 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Prescription meets need

17 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Prescription meets need

18 TRAINING

19 THE WHEELCHAIR PROVISION PROCESS 1. Referral and appointment 2. Assessment 3. Prescription 4. Funding and ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs and follow-up Prescription meets need

20 MAINTENANCE AND REPAIRS I Have a Problem With My Wheelchair Who Should I Call? Type of Wheelchair Manual Power Make/Model Date Received Vendor Rep + Phone # Service Department Phone # Prescribing Therapist Name : Phone number: RED FLAG CONTACT THERAPIST CONTACT VENDOR Redness on skin caused by your cushion/seating equipment - This is very important to address! Deterioration of your posture - Slouching - Sliding - Sitting balance Seating equipment causes a negative impact on function - Having difficulty performing everyday tasks Cushion and/or backrest are broken beyond repair or over 2 years old. Wheelchair is not worth repairing due to regular use and its age. Equipment maintenance and repairs needed - Brakes are loose - Flat tire - Squeaking - Dead batteries - Hazards/dangers **If you are receiving OW or ODSP benefits call your worker to request a repair requisition. They will require the name of the vendor. ODSP Worker Name + Phone # ** IF you have been discharged and no longer have a therapist you may need to be referred to a seating service by your family doctor.

21 MAINTENANCE AND REPAIRS RED FLAG CONTACT THERAPIST CONTACT VENDOR Redness on skin caused by your cushion/seating equipment - This is very important to address! Deterioration of your posture - Slouching - Sliding - Sitting balance Seating equipment causes a negative impact on function - Having difficulty performing everyday tasks Cushion and/or backrest are broken beyond repair or over 2 years old. Wheelchair is not worth repairing due to regular use and its age. Equipment maintenance and repairs needed - Brakes are loose - Flat tire - Squeaking - Dead batteries - Hazards/dangers

22 FOLLOW-UP Initial Follow-up Scheduled Follow-up As Needed

23 FOLLOW-UP

24 THE SEATING TEAM Distributer Sales Rep The Resource Source Manufacturer Clinical expert

25 The most important part of my rehab was my wheelchair. independence comfort good health

26 HOW TO FIND IT < knowledge-center < position papers and service provision guides

27 HOW TO FIND IT m.ca/eng/index.phpa.org <

28 HOW TO FIND IT data/as sets/pdf_file/0003/167286/guidelines-on- Wheelchair-Prescription.pdf

29 HOW TO FIND IT Free online module: video, forms, prompts Google: Spinal Seating Professional Development

30 HOW TO FIND IT < resources <wheelchair seating

31 HOW TO FIND IT ssure_ulcers_best_practice_guideline_final_web4.p df

32 HOW TO FIND IT Appendix of the Canadian Best Practice Guidelines for the Prevention and Management of Pressure Ulcers in People with Spinal Cord Injuries OR

33 HOW TO FIND IT ogy/wheelchairguidelines

34 WHEELCHAIR SERVICE STEPS STEP 2: ASSESSMENT Karen Hall, MScOT, OT Reg. (Ont.), Assistive Technology Clinic

35 Assessment Thorough assessment helps to: choose the most appropriate wheelchair determine postural support needed decide what training and support is required Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

36 Assessment Assessment is carried out in 2 parts INTERVIEW PHYSICAL ASSESSMENT THOROUGH ASSESSMENT Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

37 Interview Good communication skills are essential! be respectful address the wheelchair user directly explain why you are asking certain questions questions do not need to follow an exact order determine how the wheelchair user communicates if communication is not possible ensure caregiver is present identify signs of pain Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

38 Interview Why did you come to the assessment today? Goal: I would like to be more comfortable in my wheelchair. What should your wheelchair help you do? Goal: I would like to be able to transfer safely and independently in and out of my wheelchair. Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

39 Interview Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

40 Interview Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

41 Interview Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

42 Physical assessment Physical assessment includes: identifying the presence and/or risk of pressure sores identifying the method of mobility finding out how the wheelchair user sits/posture taking measurements Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

43 Physical assessment Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

44 Physical assessment To be able to move with as much independence as possible is a basic human right Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

45 Physical assessment Considerations for power mobility How will the wheelchair user control the wheelchair? hand/arm, head/neck, mouth, foot, other motor points Diagnosis/disease progression Cognition Vision Environment ADL

46 Physical Assessment - Posture Determine how much postural support needed by: observing sitting posture without support doing a pelvis and hip posture screen simulating the support needed with hands taking measurements Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

47 Posture Record posture to: remember findings after Ax track changes over time Record by: describing in words drawing a picture taking photographs Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

48 Posture Flexible posture provide support to maintain neutral Flexible part way to neutral posture provide support to achieve as close to neutral as is comfortable and functional Fixed posture provide support to accommodate Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

49 Posture Curves of the spine cervical Thoracic Lumbar Pelvis landmarks Ischial tuberosities (ITs) Anterior superior iliac spine (ASIS) Posterior superior iliac spine (PSIS) Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

50 Posture sagittal view trunk upright back following natural curves ear, shoulders and hips in line hips bent to 90 knees bent to 90 ankles bent to 90 feet supported Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

51 Posture frontal view pelvis level shoulders level legs in line or slightly abducted head midline and balanced over the body Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

52 Posture transverse view pelvis level shoulders level hips, knees and ankles in line or slightly abducted head midline and balanced over the shoulders Image from ISO Wheelchair seating Part 1: Vocabulary, reference axis convention and measures for body segments, posture and postural support surfaces

53 Posture Does a change in the posture of the pelvis affect the rest of the body? What happens to posture when the pelvis is in: anterior tilt? posterior tilt? lateral tilt/pelvic obliquity? rotation? Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

54 Posture The posture of the pelvis will always affect the rest of the body Always begin postural assessment with the pelvis When providing postural support, support the pelvis first Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

55 Posture Sagittal plane Frontal plane Transverse plane Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

56 Sitting posture without support To understand postural tendencies To demonstrate a range of different sitting postures To find the most upright posture that can be safely and comfortably achieved without losing function Always ensure the wheelchair user is safe and their feet are supported Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

57 Sitting posture without support Describe posture - sagittal plane anterior, neutral or posterior pelvic tilt lordosis, neutral trunk or kyphosis head/neck neutral, in flexion or extension shoulders forward, neutral or back thigh to trunk angle Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

58 Sitting posture without support Describe posture - frontal plane neutral, right or left pelvic obliquity neutral trunk or scoliosis head/neck neutral, in right or left side flexion shoulder height neutral or asymmetric Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

59 Sitting posture without support Describe posture - transverse plane neutral, right or left forward pelvic rotation neutral or trunk rotation head/neck neutral, in right or left rotation lower extremities neutral or windswept Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

60 Pelvis and hip posture screen Sitting posture is influenced by what is happening with the pelvis and hips Screening helps understand how problems around the pelvis or hips affect the wheelchair user s sitting posture Supine Ax reduces the impact of gravity allowing further Ax Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

61 Pelvis posture screen w/c user lies supine, knees slightly bent assistant holds lower ribs assessor holds the pelvis with thumbs on ASIS assessor tries to align the pelvis if not level assistant reports if the trunk moves - there may be restricted movement record how close to neutral Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

62 Hip posture screen assistant holds the pelvis assessor moves the leg to neutral sitting posture assistant reports if the pelvis moves assessor feels how freely the hip moves repeat on the other side record with a goniometer Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

63 Recording the pelvis and hip posture screen

64 Pelvis and hip posture screen If the pelvis or hip cannot reach neutral, temporary support may be needed to: help with stability and balance facilitate completion of Ax assess the rest of the posture accommodate for the unlevel pelvis or hips Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

65 Hand simulation Your hands provide the support that will be provided by the wheelchair and postural supports Always start at the pelvis Then the rest of the body trunk head and neck hips and thighs lower legs arms Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

66 Recording the hand simulation

67 Taking measurements Body measurements relate to the size of the wheelchair and postural supports To take accurate measurements: use a firm tape measure use calipers to increase the accuracy in posture identified as the most upright, comfortable and functional Content from World Health Organization Wheelchair Service Training Package Reference Manual for Participants Intermediate Level, 2013

68 Taking measurements ISO Standardized Measures for Seating Supports and Seated Posture Standardized measures are important for: improving communication reducing inefficiencies reporting outcomes justifying cost doing research Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

69 Taking measurements ISO defines a global coordinate system for quantifying measures of the person and their seating support surfaces Measures of the person Relative body segment angles Linear body measures Measures of the seating support surface Relative support surface angles Linear support surface measures Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

70 Relative body segment angles Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

71 Thigh to trunk angle Landmarks used: lateral hip center point ~ greater trochanter (center of rotation) lateral femoral condyle lateral lower neck point Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

72 Thigh to lower leg angle Landmarks used: lateral femoral condyle (center of rotation) lateral hip center point ~ greater trochanter lateral malleolus Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

73 Lower leg to foot angle Landmarks used: lateral femoral condyle lateral malleolus later heel point (center of rotation) lateral toe point Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

74 Relative support surface angles SEAT TO LOWER LEG SUPPORT ANGLE LOWER LEG SUPPORT/FOOT SUPPORT ANGLE Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

75 Linear body measures Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

76 Linear support surface measures Content from A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces, 2013

77 QUESTIONS?

78 Step 2: Assessment Practice Session Meet in Room 750, 10:45 12:15 Break out into 5 Groups Study Group 1 and 2 = Group 1 Study Group 3 and 4 = Group 2 Study Group 5 and 6 = Group 3 Study Group 7 and 8 = Group 4 Study Group 9 and 10 = Group 5 Bring STEP 2 ASSESSMENT FORM we will be using pages 4 and 5 for the hands on practice session

79 Group 1 Room 132 Group 2 Room 150 Group 3 Room 428 Group 4 Room 453 Group 5 Room 750 Case Studies 1:15 3:00 Bring all 3 forms (ASSESSMENT, PRESCRIPTION, FITTING) 3:00 3:15 Break Meet back in Room 132, 3:15-4:30

80 WHEELCHAIR SERVICE STEPS Step 4: Funding Jessica Comay B.Sc.(OT), OT Reg. (Ont.) Assistive Technology Clinic

81 Step 4: Funding Considerations for funding needs to begin at the initial assessment Only when the wheelchair and PSD s have been prescribed can the cost be accurately estimated Funding organizations vary across regions

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83 Step 4: Funding Considerations for funding needs to begin at the initial assessment Only when the wheelchair and PSD s have been prescribed can the cost be accurately estimated Funding organizations vary across regions

84 Funding Overview in Ontario Assistive Devices Program (ADP) Private Insurance Disease Specific Agencies Community Agencies

85 Assistive Devices Program (ADP) ADP pays 75% of the cost of a mobility device Who qualifies: an Ontario resident have a valid Ontario health card have a disability requiring the equipment for six months or longer NOT income dependent

86 Assistive Devices Program (ADP) What is Covered? manual wheelchairs power wheelchairs power scooters power add-ons positioning devices forearm-crutches wheeled walkers for adults pediatric walkers, standers and strollers

87 Assistive Devices Program (ADP) How many devices are covered per person? One device per person every 5 years Exception: Type 2 indoor wheeled walker can also be obtained when applying for a wheelchair Seating and positioning components have a 2 year replacement period

88 Assistive Devices Program (ADP) How much is covered? ADP will pay 75% of the ADP price for mobility device and positioning components The client must pay the remaining 25% of the cost

89 Assistive Devices Program (ADP) ADP covers 100% of the cost, if the client receives financial support from one of these programs: Ontario Works (OW) Ontario Disability Support Program (ODSP) Assistance for Children with Severe Disabilities (ACSD)

90 Assistive Devices Program (ADP) Replacement of mobility device before 5 years: Change in medical condition and/or functional ability Change in body size the mobility aid is worn out, and cannot be repaired at a reasonable cost ADP does not cover costs for devices lost or damaged through misuse or neglect

91 Assistive Devices Program (ADP) 3 steps to apply for funding: Assessment by OT or PT registered with the ADP Find an ADP authorized vendor Fill out the application form with the help of the occupational therapist or physiotherapist

92 Assistive Devices Program (ADP) Who does not qualify: Workplace Safety and Insurance Board (WSIB) receiving financial support from the for the same mobility aid Veterans Affairs Canada - Group A veteran receiving financial support from Veterans Affairs Canada for the same mobility aid

93 Not eligible for ADP: WSIB Workers Safety and Insurance Board (WSIB) 100% of the cost of mobility devices recommended by a WSIB authorized OT or PT All equipment needs to be approved by a WSIB case coordinator before purchase

94 Not eligible for ADP: Veterans Affairs Canada Group A clients are those clients who are eligible to receive health care benefits under the Veterans Health Care Regulations that are directly related to their pensioned disability (condition) as there condition was attributable to, or was incurred during special duty service)

95 Secondary Funding Motor Vehicle Accident HCAI Cover the 25% client balance May cover 100% of the cost of the devices not covered by ADP Extended Health Care Benefits All benefits are different Client needs to check funding benefits

96 Secondary Funding MS Society Muscular Dystrophy Association of Canada ALS Society

97 Secondary Funding March of Dimes Canada Income dependent Will cover part of the 25% client balance Will cover the cost of repairs Easter Seals (<18 years old) Hardship Fund Toronto only Income dependent

98 Secondary Funding Community Agencies: Rotary Club Lions Club Kiwanis Ceridian Cares

99 Step 4: Funding Summary Consideration of funding of the wheelchair and PSD s needs to start at the initial assessment Eligibility for ADP and other government programs Funding sources/options are region specific Be aware of the funding sources in the areas where you work

100 WHEELCHAIR SERVICE STEPS STEP 5: Product Preparation STEP 7: User Training STEP 8: Maintenance, Repairs, Follow up Andree Gauthier, OT Reg. (Ont.), UHN, Toronto Rehabilitation Institute, Lyndhurst

101 STEP 5: PRODUCT PREPARATION W/C set up Seating Installation Safe & Ready Check Work in Partnership with tech & rep. Review Prescription order

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103 STEP 6: FITTING W/C width and depth Posture check Pressure check Fit while in motion Use w/c fitting checklist

104 STEP 7: USER TRAINING The 6 important teaching components: 1. Wheelchair handling 2. Transfers 3. Wheelchair mobility 4. Prevention of pressure injuries 5. Basic care of wheelchair & cushion at home 6. What to do if there is a problem

105 STEP 7: USER TRAINING Go through the w/c users training checklist: WHO and Dalhousie w/c skills training program. program.ca/eng/index.php

106 STEP 7: USER TRAINING Great resource: ca/eng/index.php

107 STEP 8: MAINTENANCE, REPAIR & FOLLOW UP Home Maintenance: 1. Clean w/c and supports 2. Pump tires 3. Tighten loose nuts/bolts 4. Tighten spokes 5. Regular checks

108 STEP 8 CON T: FOLLOW UP 1. Check that the w/c is in good working order 2. Opportunity for more training 3. Adjustments/modifications 4. W/c follow up form

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110 Thank you!