Wheelchair Seating Clinic

Case Study: Wheelchair Seating Clinic

The outpatient department of a rehabilitation center offers a monthly wheelchair seating clinic to evaluate seating needs for patients and community members. Team members meet with patients and caregivers to determine optimal seating recommendations based on individual needs. The team includes a physician, the equipment vendor, a social worker, and a physical therapist.

Tom Hargrave is 26 years old, and 1 year past a motorcycle accident in which he sustained multiple injuries, including a severe head injury. He requires a custom wheelchair for mobility. The physician provides a brief medical history and opens the discussion asking for recommendations from the team. In discussing potential recommendations, the vendor suggests a particular wheelchair with modular inserts for postural alignment. The physical therapist and the family report the need for removable arm and leg rests. As the conversation continues, the physician notices that the social worker has not spoken and specifically asks for his input regarding insurance coverage for medical equipment. Before finalizing the prescription, the physician asks the team if there is anything else they should consider. After a pause, the caregiver mentions the new communication device that Tom has been working with in speech therapy. The team modifies earlier suggestions so that the wheelchair includes a lap tray to accommodate the communication system as well.

Discussion Questions

1. Why was it important to have interprofessional collaboration for this situation? What would likely happen if patient-care decisions were made “in a silo”?
2. Suggest other members of the team that should be involved in decision making for the wheelchair seating clinic. Provide a rationale for your answer.
3. Identify leadership practices demonstrated by the physician in this case that supported collaboration and team effectiveness. Suggest additional strategies or behaviors to enhance the interactions. Refer to Chapters 13 and 14.
4. Refer to Chapter 13 to explore how perceptions of hierarchy and empowerment could have influenced the team meetings described in this case.

1. Importance of Interprofessional Collaboration: Interprofessional collaboration was crucial because each team member brought a unique perspective and expertise. If decisions were made in isolation (“in a silo”), the outcome might not consider all aspects of the patient’s needs. For instance, the physician might focus solely on medical requirements, neglecting the input of other professionals like the social worker, leading to gaps in the patient’s care plan.
2. Additional Team Members for Decision Making: Occupational therapists and speech-language pathologists would be valuable additions to the team. Occupational therapists specialize in activities of daily living, including wheelchair mobility and function, while speech-language pathologists could provide insights into communication device integration. Including these professionals ensures a comprehensive approach to address all aspects of Tom’s needs.
3. Leadership Practices Demonstrated and Strategies to Enhance Interactions: The physician demonstrated inclusivity by actively seeking input from each team member, acknowledging the social worker’s expertise on insurance coverage, and ensuring the final recommendations accounted for the communication device. To enhance interactions further, the physician could implement regular team meetings where all members can voice concerns, encourage open dialogue, and foster an environment where every opinion is valued equally.
4. Perceptions of Hierarchy and Empowerment: The team meetings might have been influenced by perceptions of hierarchy, where certain members, like the physician, might be perceived as having more decision-making power. Empowerment could have positively impacted the discussions by encouraging all team members, regardless of their roles, to contribute ideas and suggestions freely. Encouraging a flat hierarchy where each professional’s expertise is respected and valued could enhance team dynamics.

In summary, interprofessional collaboration, inclusive decision-making, and fostering a culture of equality among team members are crucial in providing comprehensive care and ensuring that individual patient needs are met effectively in situations like the wheelchair seating clinic.