Putting On Your Rehab Shoes

Take your shoes off for me, please. No really, take them off. Now put them on again, but this time on the wrong feet. You probably haven’t felt this sensation since you were a small child, right? Can you do me a favor and keep your shoes on the wrong feet while you read through this article?

Imagine yourself as an aspiring track star working toward a gold medal performance in the 100 meter sprint event at the Olympics this summer and it’s time to purchase new shoes. You walk into your favorite department store, head right to the shoe department, try a few shoes, walk up and down the aisle a couple of times, and purchase the shoes that are comfortable and on sale.

You hit the track for practice with your new shoes and by the end of the workout you realize that your feet hurt in new places, the shoes seem really heavy and sluggish, and is that a blister forming on your third toe? That’s new. Maybe those shoes weren’t the best choice after all? It’s time to get some professional advice.

Accompanied by your coach, you walk confidently into a running shoe specialty store and are greeted by a smiling sales person who interviews you extensively about your activities, history, and plans for using the shoes. Your feet are measured. You are questioned about your running style, gait, and performance issues that you are hoping the shoes may help correct. Your coach interjects a question and answer every now and then to help you give the salesperson the best answers to the questions. The salesperson even asks you what you dislike about your current shoes that you want to change, as well as what features you like about your current shoes that you want to make sure is present in your next pair of shoes.

At the end of the interview, the salesperson reviews an extensive assortment of shoes and narrows down the selection to three that are brought to you to try on. As you try on the different shoes, the salesperson explains that all shoes have pros and cons, but the goal is to find the shoe that is as close to perfect as possible. The salesperson points out the benefits of each of the shoes as related to your goals. The salesperson also points out that one shoe is a little heavier, the second shoe is a little stiffer, and the third tends to run a little narrow.

Armed with all the information as well as a chance to take a short run in each shoe outside the store and on a treadmill, you and your coach are able to choose the right pair of shoes to meet your training goals.

Your next practice with your new shoes is a success. Your feet feel great after a short break-in period and you notice less fatigue allowing you to work out longer and harder and thus improve your times as you prepare for the Olympics.

Lets come back to you now. How are the shoes you are wearing now feeling on your feet? Even sitting down, they have probably become a little uncomfortable. But they meet the basic definition and function of a shoe, right? They protect your feet from the elements and sharp objects and they provide some level of support. But they just aren’t right are they? Worn this way, these are not the shoes you would want to spend an entire day on your feet in are they?

What’s the difference between the department store shoe experience and the specialty running shoe store experience? The professional attention and guidance found in the specialty running shoe store was the key to successfully finding the right shoes to meet your training goals.

In the rehab wheelchair world, one of the professionals a wheelchair user needs to work with for the optimal outcome is an Assistive Technology Professional (ATP). Just like working with a well trained shoe salesperson, an ATP will interview each user about their needs and goals, take measurements, and when possible consult with a ‘coach’ or caregiver to make sure that each question is answered as clearly as possible. Only then can the myriad of choices be narrowed down to a small selection that can be discussed and trialed before settling on the best mobility solution.

Let’s switch those shoes back to normal now. Doesn’t that feel better? Like a comfortable old shoe. A wheelchair should be just as supportive, comfortable, and close fitting as a good pair of shoes. Just as a well chosen shoe can help meet training goals, a well chosen wheelchair can help meet progress goals, activity of daily living achievements, and independence goals.

Mal Mixon represents HME Industry on Fox News

Mal Mixon, Chairman of the Board and CEO of Invacare was part of a panel on Fox & Friends this morning. Gretchen Carlson of Fox questioned Mal and two other panel members about the current health care bill proposal and President Obama's handling of other initiatives including job growth.

Mal has an obvious stake in the health care bill that may or may not still be alive now that Scott Brown won the Senate seat in Massachusetts. If the bill passes, Invacare will be one of the many health care manufacturing companies that will face an extra tax to help pay for the plan. According to Mal, the Invacare portion of the bill will be in the neighborhood of $12 million dollars annually. "That is more than my R&D budget and US profits alone," said Mixon.

As the largest employer in Lorain county, Ohio Mal and many of his employees worked hard to invite President Obama to visit Invacare and discuss other ways to handle the same issues. The President has decided not to make the trip, but Mal briefly spoke about the plan he would have proposed during the visit. Mal's plan would eliminate the manufacturing tax and replace it with tax credits. Based on company performance, the tax credits would be used for the sole purpose of hiring new employees to allow companies to expand, creating new jobs and paying more income taxes based on profits.

Mixon has led Invacare since 1979 when he and a group of Cleveland based investors bought the company from then parent Johnson & Johnson. He serves on the boards of several Cleveland area corporations and civic organizations, including chairmanship of the world-renowned Cleveland Clinic. Mixon is highly regarded in the Cleveland business community and has been recognized nationally for his entrepreneurial skill and leadership. He received his education, BA and MBA from Harvard, and served four years in the Marine Corps prior to launching his business career.

Cash For Clunkers

Are you following the raging debate going on about the Cash for Clunkers program? Have you figured out how this applies to Rehab?

Cash for Clunkers was set up to allow people to receive $4500.00 from the government towards buying a car with higher fuel efficiency. The program was set up with an initial 1 billion dollars but that money was burned through in the first week. Many critics have started to ask, "If the Government can't run a rebate program, how can they run a health care system?"

What the pundits don't realize is that the Cash for Clunkers program already has a number of similarities to the Medicare program:

1. 136 page manual used to detail the plan in simple, easy terms
2. Car dealerships have to determine if a customers vehicle qualifies or not
3. Car dealerships have to pay the rebate immediately and wait for reimbursement from the government later.
4. Cash for Clunkers requires digital filing
5. There are already stories of abuse of the system.

The car dealerships are only one week into the program and they are starting to wonder if they will ever get the money they have paid out to their customers reimbursed by the Government. Does that sound like the requirement to provide a custom ordered complex rehab power chair to a customer and then hope that the reimbursement will be forthcoming in a timely manner? Will an already struggling auto industry be able to survive the cash flow problems that this stimulus package creates?

If this issue is being leveraged to show the negatives of the new health care program, will DME industry leaders be able to use the same issue to show the flaws in the current system?

Business Lessons from Piracy

The world has demonized the image of the pirate but maybe we should learn a couple of lessons from those 'scurvy dogs.'

Pirates held the utmost contempt for anything that diluted the focus of the mission at hand. Pirates were focused on one thing and one thing only; bringing home treasure. Everything they did revolved around that one goal.

The pirate ship was run as a democracy with each member of the crew given a vote. The leader or captain was elected at the beginning of the voyage but didn't always come home commanding that same authority. If the crew was not satisfied with the results produced by the elected leader or had lost trust and confidence in the methods employed, a new leader could be elected. The deposed leader had the choice to walk away gracefully or fight the entire crew. Clearly, maintaining a good relationship with the crew and supporting them attaining their goals was not only a priority but also a survival technique.

Since booty was the goal, everything was built or designed to gather in that booty. Ships of that time were built to contain ballast in the hull that changed the characteristics of how the ship sailed. The ballast was usually composed of rocks or some other dead weight. While the ballast was important to sailing, it was less important than the booty. If the haul exceeded the weight capacity of the ship, the ballast was quickly traded to increase carrying capacity. In some extreme cases, a strategic decision was made to pitch cannons overboard to allow for more treasure. There were no sacred cows or cries of "but we always sail with dead weight in the hull." There was only focus on gathering treasure and getting it home no matter how creative the solution had to be.

Once the treasure was gathered in, the celebrations began. Guns were fired, mead was drunk, backs were slapped and cries of "Huzzah!" filled the air immediately after the work was done. In addition to their share of the treasure, pirates receive instant gratification and reward that binds the team together and creates legends that can be referred to as motivational stories for years to come.

You don't have to rape and pillage villages to be a corporate or an entrepreneurial pirate. You have to be focused, take care of your team, and celebrate every accomplishment.

Are you ready to wear an eye patch to your next business meeting?

Stable, Not Static [CELA]

Dynamic Seating to Improve Movement and Function Presenter:
Allen Siekman, Siekman Consulting

The pelvis was designed for standing and movement, it was not designed for sitting.

Dynamic Seating allows or enhances controlled natural movement patterns while providing stability.

Natural reaching patterns include pelvis and upper trunk movement. Restricting pelvic and trunk movement restricts functionality.

Standard shoulder harness usually does not allow torso movement, limits push range, strength, and reach for daily activities.

45 degree belts limit anterior tilt and limit range of motion. 60 to 70 degree belts allow for greater pelvis range of motion. 90 degree belts use the legs to hold the pelvis and allows increased pelvis range of motion. It is also possible to lean forward and do a pressure relief while using a 90 degree pelvic belt.

A leg harness (like the one from BodyPoint) allows pelvis and torso movement while holding the legs down and back.

A product like the HipGrip from BodyPoint is built to be a dynamic device that supports dynamic movement.

Although there are specialized options available, there is a lot of dynamic seating that can be done using traditional belts set up at the correct angles.

Image from: http://www.urz2.com/avivaw/images/drawing/pelvis_lateral.jpg

Powered Mobility Training for Children with Comples Needs [CELA]

Presenter:
Karen Kangas, OTR/L, Seating and Positioning Specialist in private practice, Shamokin, PA

Children are not small adults!
One of the reasons that children are not usually considered for powered mobility is because we view them within the paradigm of adults. Adults all ready know how to be mobile and move within space. Children may not have learned what it feels like to move in space they are still experiencing mobility.

For successful use of a powered mobility system, these three issues must be resolved:

1. Seating for task performance
2. Powerchair is programmed adequately
3. head first, hands free operation

Training should take place within the child's home or pre-school in an environment that is familiar.

We can not place adult standards of practice on children. Children will not demonstrate judgement or safety as these come with maturity and experience. The adults are responsible for these.

There is no doubt that independent mobility is critical for development, and that without it, delays in cognitive, emotional, social, and motor development are evident.

Image from: http://www.dragonmobility.com/as.php

Looking Back [CELA]

Lessons for the Future

Presenter:
Hymie Pogir, Vice President of Product Planning, National Seating and Mobility

This morning's session is a look back at the history of the rehab industry hoping to identify exactly where things went wrong and how to fix our future.

A call for educating people on exactly what we do. We shouldn't be the "wheelchair providers." We should be viewed as the people that are product experts, help people get jobs, provide functionality, help sick children.

Is the NRRTS Code of Ethics inconvenient or is it only being used when it is convenient? If adherence is inconvenient, we should change the code. If the changes are inappropriate, insist on adherence to the Code AS IS.

Mass marketing has made a positive impact on the industry. There is very little if any stigma to the usage of a powerchair. Mass marketing has expanded the market and increased the knowledge of the consumers. What should set rehab dealers apart from mass marketers is the process that the company uses.

As an industry, we do not unite together to fight the problems that come from payors and legislation. There is no unified organization, there is only a series of small and larger businesses that have to aggresively take a stand to save the industry.

All politics is local. We can not rely on someone else to do the work. We need to do the work and we need to involve the consumers. Consumer's stories are worth much more than the impact we can make on lawmakers.