Attitude is everything

I was recently fortunate enough to have the opportunity of attending and presenting at the 24th International Seating Symposium in Vancouver, B.C., Canada. For anyone interested in wheelchairs and seating, this is one of the premium world events in this field. Among a sea of positives, the most positive was a strong sense of collaboration and willingness to collaborate, between users themselves, manufacturers, clinicians and academics — it was a truly multidisciplinary experience. The presentations I attended have undergone a paradigm shift, away from predominantly evaluating the effect of the wheelchair or seating system on body functions and structures, towards a shared vision of enhancing activity and participation of the user as the primary goal of provision of wheelchairs and seating. Reid et al. (2002) stated ‘The prescription of wheeled seated mobility devices for clients with mobility impairment is a growing area in occupational therapy practice. The goal is to enhance client participation in occupation through technical intervention’. I find this a very useful justification for an intervention that is an underpinning for successful occupational engagement. In a later article, the same authors investigated the occupations of survivors of stroke who use wheelchairs, and found that wheelchairs were a significant enabler of community participation, but created difficulties such as increasing dependence on others and limiting how far a user could travel as an enabler of community participation among the participants. However, the wheelchair's use also created problems, such as limiting destinations and creating increased dependence on others (Barker, Reid, et al., 2006). This illustrates a theme that the technical intervention of working with the client for the best solution is extremely complex. Wheelchairs and seating provide a dual role; as a piece of equipment to help the individual with impairments of their body structure and function, but equally as an enabler of occupation. As an occupational therapist, I am more comfortable with the second, but need to work within the constraints of the first. This is particularly applicable when working with clients with complex needs; often the client is the person who requires the piece of equipment, but his or her family and carers will need to utilise the system. We need to understand the effect of wheelchairs and seating on the user and their carer in order to maximise health, enable activity and promote participation of users and their families (McDonald, 2008). The increase in the number of research-driven papers was a further positive outcome of the conference. While there remains a lack of quality studies related to the impact of wheeled mobility, seating and positioning (Reid et al., 2002), there was evidence of high quality research programs underway at present, often motivated by improving the activity and participation of the person who uses wheelchairs and special seating. One such plenary session was titled ‘Mobility of older persons in residential care’ (Miller, 2008), and outlined work that has been performed so far regarding increasing the resources for this client group in order to improve seating outcomes, in particular, socialisation and participation opportunities for people inside and outside their residential care home. The author further expanded into themes and proposals for larger studies which will influence national and international policy in this area. This illustrates the purpose of high quality research in this area; to highlight issues, discuss and propose solutions that can be applied in the practice setting to improve the quality of life and participation of our clients. The final two sessions of the conference were for me the most thought-provoking and inspiring. The first presentation was titled ‘Darius goes west: working as a team to provide a one of a kind wheelchair’ (http://www.dariusgoeswest.com/) and was the story of a young group of friends who took a 15-year-old boy who had never left his home town (and had Duchenne's muscular dystrophy) on a trip from his home in Athens, Georgia, to Los Angeles and back, in the hope of convincing MTV to ‘Pimp his ride’ (jazz up his powered wheelchair). The trip took in Las Vegas, swimming in the sea for the first time and the Grand Canyon, and on Darius’ return, a new powered wheelchair which is so ‘pimped’ it has to be seen to be believed! The final presentation was by Kelly Smith (http://www.wheel-power.com/), who won the silver medal in the marathon at the Paralympics in Athens, Greece (the gold was won by Australia's Kurt Fearnley). Kelly went through his journey, from his rock-climbing accident that caused his spinal injury, to giving up his commercial pilot's licence and becoming an air traffic controller, modifying his own kayak and competing in international wheelchair racing. Both of these presentations illustrated the need to focus on abilities rather than disabilities, and made me reflect that, as occupational therapy practitioners, we are often constrained — by the institutions we work for, our own professional and personal boundaries and by funding issues. But if we can look into our professional underpinnings, and work out the important issues for our clients, we can assist in them achieving true participation, rather than the socially constructed outcomes that we are bound by. Easier said than done, but in the words of Kelly Smith ‘Attitude is everything’.

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