I have worked as a learning disabilities (LD) occupational therapist (OT) in a community multidisciplinary team for 11 years. Taking the lead role in assessments for specialist seating, and contributing to assessments for wheelchairs has always been part of this OT role. Over the past three years, I have had the opportunity to work on the provision of a specialist assessment and treatment process for service users who have complex postural needs.
In 2013, the LD lead physiotherapist and I were funded to attend the Oxford Centre for Enablement course Management of Physical Disability 24-7 (MPD 24-7). The aim was to enable members of the OT and physiotherapy teams to develop a clinic for individuals with complex postural needs. The overall vision was for Rotherham to eventually have its own clinical pathway for adults with body asymmetry and postural management problems. I returned from the training with a renewed sense of optimism for clients living with extremely difficult physical and psychological problems due to inadequate support in sitting and lying. The approach to posture management, and its potential to change lives through stabilising the body in relation to its supporting surfaces throughout a 24-hour cycle, was something of a revelation to me (Hanson, 2010).
Work on this vision stalled in 2014 due to pressures on the service. The performance of the physiotherapy and OT teams was under scrutiny. At that time, the value of using the MPD 24-7 assessment was questioned and became a contentious issue within the health trust. I partnered up with a fellow OT and together, in 2015, we presented a case to the clinical director of our trust. We used a case study to illustrate the strength of the 24-hour approach, along with a cost benefit analysis. We referenced the work of Sir Jonathan Michael’s 2008 Healthcare for all: report of the independent inquiry into access to healthcare for people with learning disabilities, and Raising our sights: services for adults with profound intellectual and multiple disabilities (Mansell, 2010). We used these as a platform to highlight gaps in our trust’s service provision.
I am delighted to report that, two years down the line, the vision of having a clinical pathway for the management of complex postural problems in the Rotherham learning disability service is finally becoming a reality. I believe one of the winning arguments was the potential this approach has to reduce the number of re-referrals long term, by getting it right from the first assessment. My colleagues and I have been able to prove that our work is achieving positive changes in the lives of the people we work with. As our confidence and skills have grown, we have adapted MPD 24-7 to make it work in our community setting, and have also designed our own risk assessment screening tool for using sleep systems.
Attending the PMG Conference 2017 provided me with the opportunity to meet and listen to some truly inspirational people. Being able to talk to some of the original members of PMG about their experiences, and to many other delegates, gave me a renewed sense of optimism that there is a huge amount of respect for OTs in this field.
I found the work of Caroline Desjardins and Susanne Ziegler in their presentation Exploring seating solutions for children with complex physical disabilities - less is more very relevant to my own area of practice. Their discussion about how they are using MPD 24-7, and developing their own programme, raised questions for me about outcome measures. We have our own quantitative outcome measures in the recording of range of movement (ROM) data taken during the assessment process. This presentation led me to consider how we record qualitative data about the user (client and carer) experience. We currently collect this as a narrative in our clinical records but, on reflection, I can see the benefit of using a questionnaire to evaluate posture, comfort, activities of daily living, lifestyle, environment and manual handling. [Photograph of the presentation by Caroline Desjardins (far right) and Suzanne Zeigler (at the podium); PMG committee member, Paul Dryer, chairing. Photography courtesy of Suzie Hunt].
I have taken the lead in setting up our special interest group in postural management because we were relatively isolated using the MPD 24-7 assessment, and felt that we could benefit from peer supervision by other experienced professionals using this approach, and developing a network where experience and knowledge could be shared. Prior to the conference, I was looking forward to expanding my network of clinical expertise although, at the same time, the thought of being surrounded by people at the top of their game, the innovators, the researchers, and the hugely experienced, was slightly disconcerting! However, those fears were far outweighed by learning about a huge variety of innovative practice originating in the UK and beyond from speakers and delegates in the fields of clinical science, neurosurgery, orthopaedics, rehabilitation engineering, and other healthcare professions. Discussing our work in Rotherham with practitioners from all over the country has provided me with a new perspective that we are offering something very specialist, and have come a long way in developing our own expertise.
The equipment exhibition was also valuable for me, opening my eyes to a vast array of seating solutions and postural positioning equipment that I didn’t know existed! I have tended to stick with the same manufacturers because I feel confident and familiar with their products, but now have a new bank of knowledge about products that I can use to make sure I get the very best solution for my service users (within budget of course). Trying out the equipment and discussing some of my current challenges, relative to what the equipment could or couldn’t offer, was extremely useful. It's possible to overlook a piece of equipment online, and significant design features can be missed due to time constraints.
I left the conference with a renewed sense of excitement about the possibilities for our service, and for my own professional development. What is hugely significant for me is that I now feel that I am part of something much bigger. I recently attended Posture Care Train the Trainer which is an independently accredited course, and the next step for us is to train managers of residential homes and the care staff. We have learnt that without continued training on why (and not just how) we use postural care equipment, management programmes are not sustainable. The overall aim for our service now is to become proactive in identifying needs, and providing sustainable solutions for all adults who live with complex postural challenges.
Hansen, E. (2010). Postural Management 24/7 - What is That? Posture & Mobility, Vol 27:1, 2010
Hill & Goldsmith (2010). Biomechanics and prevention of body shape distortion. Tizard Learning Disability Review Vol (5), Issue (2)
Mansell, J. (2010). Raising our sights: services for adults with profound intellectual and multiple disabilities. Tizard Centre, University of Kent
Michael, J. (2008). Healthcare for all: report of the independent inquiry into access to healthcare for people with learning disabilities. Department of Health.