Why do clients need an Occupational Therapist to assist with equipment prescription?

Time and again, I am required to assist new clients to acquire new replacement AT due to having been “sold” an incorrect and/or ill-fitting piece of AT.

Not all disability/medical suppliers are created equal!

Some have very experienced and knowledgeable staff and others…don’t.

Occupational Therapists are “functional” specialists.

We are trained to consider what is suitable for our clients now, to have a level of knowledge about what their prognosis looks like, and to be able to choose assistive technology that will be suitable and/or adaptable for our clients over the long-term, with consideration to anticipated deterioration or improvement in condition, and potential changes to living and care circumstances.

Some things that need to be considered for successful AT prescription are listed below:

  • Pressure area care
  • Type of fabric/stretch
  • Correct seat depth to reduce shearing
  • Structural material (foam, gel, air)
  • Immersion/Envelopment
  • Ability to transfer off cushions and/or mattresses
  • Adequate thigh and lower limb support for effective distribution of pressure
  • Modification/Adaptability
  • Growth of a child
  • Postural deformities
  • Changing mode of transfers with deterioration
  • Onset of incontinence
  • Adjustable seat height, depth, back rest, height of armrest and/or footrests
  • Swing away armrests and/or footrests for effective transfers
  • Incontinence
  • Type of material
  • Hygiene, ability to clean
  • Maintaining skin integrity
  • Cognition
  • Ability to successfully use assistive technology
  • AT suited to cognitive level
  • Ongoing ability to use prescribed assistive technology if deterioration is expected
  • Manual Handling
  • Method of transfers (current and future) e.g. step around, stand & pivot, slide board, hoist
  • Type of transfer e.g. independent/dependent, side or front access required
  • Postural Support Required
  • Does the client have fixed or flexible postural abnormalities?
  • Are lateral support required
  • Is extra seat support required to align the pelvis?
  • Does the client require tilt in space?
  • Mobile Shower Commodes
  • Type of seat required for pressure area care
  • Type of seat required for carer access (front, side or back access)
  • Is tilt in space required
  • Is postural support required (lateral supports, thigh guides, calf guides)
  • Is the seat height adjustable?
  • Does the client require swing back armrests and/or footrests?
  • Can the mobile shower commode fit over the current toilet?
  • Is there adequate clearance for tilt in space to be used
  • Environment
  • Is there adequate circulation space for the assistive technology to be used
  • Where will the assistive technology be stored?
  • Who is responsible for maintaining the assistive technology?

Please note that by no means is this an exhaustive list. I have not even considered wheelchair prescription in this list as it can be a very complex process that addresses all of the above and more. It is just to give an idea about the Occupational Therapist method of thinking and all of the things we are considering for our clients in order to achieve a successful prescription of Assistive Technologies. In relation to acquiring Complex Assistive Technologies under NDIS funding, we also must be able to provide clinical reasoning and justification that level 3 and 4 AT is a long-term (3-5 years) solution for participants.

Written by Occupational Therapist Casey Morrison

Casey graduated from the University of the Sunshine Coast with a Bachelor degree in Occupational Therapy (Honours). She is passionate about community care and enabling people to remain in their own homes for as long as possible, whilst maintaining safety and independence. A strong focus on safe mobility, reducing falls risks and home modifications enable Casey to help her clients reach this goal. Casey has a keen interest in pressure injury prevention, fatigue management, dementia, brain injury, and cognition rehabilitation. Casey studied Occupational Therapy as a mature aged student after running a successful business as a Personal Training and Massage Therapist. She prides herself on her holistic approach to healthcare which focuses on psychosocial wellness and collaboration with all care providers to ensure the best possible outcomes for her clients.