2/10/2016
Building
Consensus
Or
How We All Get to the
Same Page
Weesie Walker, ATP/SMS
NRRTS Executive Director
2016 NRRTS Webinar Series
Learning Objectives
Not Exactly What We
Mean!
List 3 Barriers to Team Consensus
List 3 Consequences of Lack of Team Consensus
List 3 Strategies for Building Consensus
Consensus Definition
Our Job Description
Inform and Educate on Rehabilitation/Assistive
Technology and Its Application❋
General Agreement
Group solidarity in sentiment and belief
Synonyms: accord, concurrence, unison
Rehabilitation Technology Specialist, strives to
provide the consumer, family and funding source
with the most cost-effective options to meet the goals
and objectives specified※
Antonyms: conflict, disagreement
❋RESNA Code of Ethics
※NRRTS Standard of Practice
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2/10/2016
Overcome the
Challenges
Challenges
Unrealistic Goals/Expectations
Environmental Factors
Reimbursement Constraint
Approach the eval without a preconceived solution
Uninformed, misinformed, over-informed
Develop a Screening Method to Identify Need
Inexperience
Listen to the Client to determine the Goals
Be willing to compromise
Consider the environment of your Client
Case Study
Intake
Polio
Lives with her husband in wheelchair accessible
home
Her husband uses a power wheelchair
She drives an accessible van with lift
They rely on their son for some help
Laura
Goals
She has been a wheelchair user most of her life
Challenges
Replace her 10 year old power chair with exactly the
same chair
Replace her 10 year old power chair with exactly the
same chair
Remain Independent
Remain Independent
Continue Same Transfer Method
Continue Same Transfer Method
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Power Chair
Replacement
Transfer to Bed
Frames and Electronics are different
Transfer to the Toilet
Solutions
Close Enough?
Solutions
Extend seat pan and
cushion rearward to
decrease the gap
Even though she got
another Quickie Power
Chair, it was not exactly
the same frame
configuration
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Lessons Learned
Case Study
Understand the small detail that will become the
huge roadblock
Change is very difficult for longtime users who are
independent
Be clear on your capabilities
Be realistic
Kylie
Intake
Goals
Diagnosis Cerebral Palsy
Lives with her parents in an accessible home
Replace power chair with Standing PWC
Completed a Bachelor’s Degree
Easier Transfers
Seeking employment in an office setting
ADL’s more efficient
Longtime user of PWC with power tilt
Increase access to different environments
Dependent for transfers and most ADL’s
Mom is Primary Care Provider
Challenges
Workplace Eval
Funding (Getting two different State agencies to
work together!!)
Transition from Sit to Stand Positioning
Determining appropriateness of a Standing Chair
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Standing PWC
Lessons Learned
Listen to the client
Don’t have a preconceived idea of what will work
We learn something new everyday
Involvement by the whole team provides a better
outcome※
※RESNA Wheelchair Service Provision Guide
Case Study
Intake
SMA type I
Lives with parents in a wheelchair accessible home
Parents are care providers along with home health
nursing
Dependent on CPAP machine
Currently using dependent manual mobility
Non-verbal
Mary
Goals
Challenges
New mobility system
Evaluation took place at home
Powered wheelchair for Mary to drive
Positioning for function/vision to drive a power chair
System must accommodate all equipment
System must fit in current van
Treating therapist was not experienced with switch
assessment
Meet all Mary’s positioning needs
Goals kept changing
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Trialed many
different drive
options
Sitting at 160°
Seat to back angle
CPAP impairs line
of sight
Solution
Driving
Proximity Switch
Two direction driving
Did we Meet All the
Goals?
Lessons Learned
Determine the Goals
Write down the Goals
Re-visit the Goals
Document all your work
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Consequences
Barriers to Consensus
High Abandonment Rate❋
Unwillingness to compromise
Less Optimal Outcome
Unrealistic expectations
Unnecessary effort, time and resources (Frustration)
Preconceived Ideas
❋Kittel, DiMarco & Stewart,2002
Strategies for Building
Consensus
References
RESNA Wheelchair Service Provision Guide 2011
Identify/Prioritize the Client’s Goals❋
Look at the Whole Picture/Environment
Discuss Likes/Dislikes with the Current Mobility
System
Johan, & Shea, 2004, Scherer & Cushman, 2001
Kittel, DiMarco, & Stewart, 2002
NRRTS Standard of Practice
RESNA Code of Ethics
❋Johan, & Shea, 2004: Scherer & Cushman, 2001
Questions??
Weesie Walker
[email protected]
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