Building the Ideal Team for CRT Evaluations

The odds are high that at some point in your youth, you participated in a team-oriented activity such as a sports team, musical group, theater production, academic competition team, etc. Back in the mid-1990s I was a proud member of the Heritage High School girls' basketball team and the Big Orange Marching Machine (aka the marching band). Before you make any judgments as to how many cool points I had in high school, it is important to note that our marching band was one of the largest in the area with hundreds of members, some highly decorated. We traveled all over the country for competitions, and there were numerous "popular" kids in the band. Also, did I mention I was an athlete, too? But I digress.

The reality is that teamwork is a concept we are introduced to as children and which continues to be an essential part of not only our personal lives, but also our professional careers. The world of complex rehabilitation technology (CRT) is no exception. When it comes to evaluating, recommending, and obtaining the proper seating system and wheeled mobility device for a client, it is vital and in some cases required that a multidisciplinary team approach be utilized.

The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) published the Wheelchair Service Provision Guide in 2011. One of the first sections of the guide mentions the importance of working with qualified professionals, which includes both therapists and rehabilitation technology suppliers, because of the unique expertise and skill sets the different disciplines bring to the table. In the United States, Medicare's Local Determination Coverage (LCD) policies for manual wheelchairs, power wheelchairs, and wheelchair seating require that the beneficiary be evaluated by a licensed/certified medical professional such as a physical therapist (PT), occupational therapist (OT), or a physician with training and experience in rehabilitation wheelchair evaluations. The LCD policies state that the wheelchair is provided by a rehabilitation technology supplier that has a RESNA-certified Assistive Technology Professional (ATP) directly involved in the equipment selection process.

Early in my career I had the opportunity to work in a facility that fostered the multidisciplinary team approach. I believe our approach not only improved patient outcomes, but it also developed each individual on the team into a more well-rounded professional. In 2000 as a newly graduated Recreation Therapist I was recruited by members of our Assistive Technology (AT) team to join the hospital's team. Our team included PTs, OT, speech language pathologists (SLP), a recreation therapist, special educators, and a physiatrist. As we continued to build the program, other professionals such as rehabilitation technology suppliers, manufacturer representatives (CRT & communication device companies), community therapists, vision specialists, and audiologists all became members of our extended team. Please note that every client we saw did not warrant including everyone's input, but the value added by reaching out for insight into a specific client's needs was immeasurable.

Based on the guidelines and policies mentioned earlier, it is considered best practice for the CRT provision team to include an occupational and/or physical therapist and rehabilitation technology supplier who is certified as an ATP by RESNA. However, as you are developing the group of individuals to make up your team, I'd like to challenge you to think outside the box in terms of who you have sitting on the bench poised to assist because you never know who may be able to provide you with game-changing information. For example, an SLP might be able to show you the safest position for the client to be seated in for eating to decrease the chance of aspiration. A recreation therapist may provide insight into what adaptation the client needs to his or her wheelchair in order to engage in a favorite leisure activity. Or a vision specialist might provide you with strategies for teaching a child with a cortical visual impairment how to drive a power wheelchair.

I will always be thankful to my coworkers who invited me to join the AT Team and their belief in my skill set. While working as a member of our team I became the first recreation therapist permitted to sit for the ATP exam, earned two graduate-level certificates and a M.Ed. in AT, developed a power mobility training curriculum, became manager of that AT program, and helped to provide independence to hundreds of clients. Teamwork absolutely makes the dream work!

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Always remember at the end of the day, your client is your number one priority!
- Angie

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