← 4D: Deep Dive into Degenerative Diseases - ANPT
4D: Deep Dive into Degenerative Diseases - ANPT
DD SIG Episode 60: AT/SWM SIG Collaboration: Seating for People with ALS
00:37:36
In this episode, created in collaboration with ANPT’s Assistive Technology and Wheeled Mobility (ATSWM) SIG, host Chris Buke is joined by AT/SWM SIG Chair Wendy Koesters and special guest Pam Glazener to discuss wheeled seating considerations for peopl...
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- [00:02]
A
Welcome to 4D deep dive into degenerative Diseases, gaining insights through casual and amusing clinical conversations. Welcome to 4D, a podcast brought to you by the ANPT Degenerative Diseases Special Interest Group and the Academy of Neurologic Physical Therapy. This podcast is intended for informational and educational purposes only and and is not a substitute for medical or rehabilitation diagnosis, advice, treatment, or clinical decision making. Patients and other members of the general public should always seek the advice of a qualified healthcare professional. Hello, I'm Chris Burke. I'm a physical therapist, and I serve as the chair of the DD sig. We are doing a special collaborative podcast today on seating with individuals with als, and we are joined by Wendy Kester of the Seating and Wheeled Mobility Special Interest Group. So welcome, Wendy.
- [01:01]
B
Thank you.
- [01:02]
A
In addition, we also have Pam Glaser, who is an occupational therapist and also an ATP, which is an assistive technology professional, as well as Wendy. And so, Pam, welcome to you.
- [01:15]
C
Thank you.
- [01:16]
A
So, can you briefly introduce yourself and comment how you got into seating and wheelchair mobility specialization?
- [01:22]
C
So.
- [01:22]
A
So, Wendy, let's start with you.
- [01:25]
B
Sure. I have always loved neurology, and doing inpatient rehab got a touch of seating, and when I transitioned to outpatient care, that started to just grow. And our clinic has become so large. And I am a unique therapist that I get to specialize in assistive technology. So we'll throw out the terms complex rehab technology. Pam and I both have specializations from a group called resna, but basically, we're wheelchair nerds and finding mobility solutions to help people keep their independence. I love my job, and I'm excited to share some opportunities with everyone.
- [02:02]
A
Great. All right, Pam, tell us about yourself.
- [02:06]
C
Well, I've been a therapist since 1991, and I have been at Houston Methodist for over 33 years. But about 29 years ago, I was introduced to the ALS clinic here and fell in love with it. And I have been working with ALS patients ever since I started doing chairs, probably about 20 years ago. It was not a service we offered at our clinic, and it was a loss for our patients, and so I just jumped feet first. And like Wendy said, I am a wheelchair nerd. I absolutely love it because it gives independence, and those of us who are
- [02:43]
A
not wheelchair nerds need people like you, because the technology and everything changes so fast that there's no way to keep on top of all of that. So welcome.
- [02:52]
B
And so, Pam, can you talk about the specialization that you have for seating the resna?
- [02:57]
C
Oh, I'm an ATP. I'd say three fourths of my Job is assistive technology work. If it's modifying the home, doing this, you know, working with the speech devices, the power chairs, that's what I do. You have to sit for a board examination and pass it to become an ATP. And you have to have a certain number of hours before you can apply to take that exam. Working with ATP clients.
- [03:27]
B
So this specialty certification for assistive technology practitioner is something that you, you sit for and then you renew too. So you have are required, just like your PT licensure to keep up with specific classes. Just, I mean, it's just like with traditional therapy that technology and clinical application is always changing. There's also one besides the assistive technology practitioner is the seating mobility specialist. So the ATP is one that clinicians like Pam and I get just because we're wheelchair nerds. Medicare requires it for suppliers to vend and help with the funding process of this complex power mobility. Medicare calls this type of advanced power mobility that we're talking about group three. It's just that it can take alternative drives. It has that specialty tracking, advanced suspension. And then we choose all of the seating components from there too.
- [04:31]
A
And so thinking about your perspective as an ATP, why is seating and wheeled mobility such a critical intervention for individuals with als?
- [04:42]
C
The importance of wheelchairs, especially power wheelchairs, cannot go understated with the ALS population. We have to protect their muscles so much and fall prevention, their respiratory system, it's also intertwined to treat them holistically. You almost have to get them power mobility to have an impact on their life in a positive way once they get to the point of unsafe mobility.
- [05:08]
A
Okay, thanks.
- [05:09]
C
Yeah, you're welcome.
- [05:10]
B
And when do you feel that that referral to be assessed for mobility tools should be started?
- [05:19]
C
I tell people because I get this question actually from my patients and families when they have fallen, if they've noticed symptoms progress because of the fall, if their respiratory status is to where they cannot do an activity outside the home or inside the home independently without multiple breaks, they should probably start considering power mobility. And if they're, of course, if their legs are weak, if they can't walk, I tell people, if you're homebound because of your disease and your mobility, we need to discuss hour and I never, I hardly ever do manual wheelchairs for my people.
- [06:03]
A
That was going to be my next question. Right. Because Medicare oftentimes will only approve one chair, and I would guess it would be smarter to go with the more expensive. Is that correct?
- [06:12]
C
Yes. And actually, I tell my people never to push a manual chair. I don't even want them propelling it with their legs. I want them to save their muscles and their strength. And so I always recommend power. And we work really hard on finding a way to get the mobile into the community with the power. We have a lot of resources, so we can really adapt homes through some of our organizations.
- [06:38]
A
And so when you're thinking of prescribing a wheelchair, how much do you look into the future and how patients might progress with what accessories you're going to order for the chair?
- [06:49]
C
That's one of our challenges. You have to doing this for so many years. I can almost get my crystal ball out and look back to the year before and sort of see the progression rate. But you only can order what the patient needs at the time. So it is a challenge for the seating specialists. I say we always try to start with joysticks because then you can learn the chair. It's easier. Lots of programming availability in the joystick, lots of mounts. But when I order a chair with a joystick, I usually order it with tracking. So when it's time to progress on to our advanced alternative drive controls, we already have tracking on the chair. So I try to prepare the chair for any changes that may come, if that makes sense.
- [07:37]
A
Yeah, absolutely.
- [07:39]
B
So tracking just like a supplemental part to the chair from a programming perspective, that makes the chair keep a straight path. Once you're using an alternative drive outside of a joystick, I mean, a joystick is just simpler. You can control your speeds, you can get into positioning, you can look at lights, all these things in one spot versus when you go to the alternative drive, it just opens up a whole window of complexity. And. And Pam, I found if we can get people who are still walking but have fears of their endurance or of falling and they. They use it kind of intermittently, that confidence builds and it's not so stressful. So we really tell people, you know, if you have anxieties of being mobile within your home, definitely with leaving your home, let's start now.
- [08:30]
C
I sooner is better than later. I would rather them have it and use it minimally than not have it when they need it. Absolutely. I start early also.
- [08:43]
A
And I would imagine that if you're using a power chair, you would need appropriate transportation.
- [08:47]
B
Right.
- [08:48]
A
Is that a concern when you're deciding when you're going to order it, that they have a van with a lift or something like that?
- [08:55]
C
Not everybody will get a van. Some people will use medical transportation. I tell my people get in contact with their yellow cab service, they're all independently Owned here. Find your favorite driver and get their card and then you just call your personal yellow cab driver when it's time to go someplace. I do have a lot of people who get vans. We have a really good system. There's a chat network and they buy those vans from other customers, other clients, and it's just a recycling of the vans. But I also have some people who never get a van also. They still get into their vehicles and they just get a foldable manual chair or they get the lightweight power foldable chairs that Team Gleason provides for us. Now they loan them out. So we do have a lot of people get those for community. The big chair needs to be used at home. That's what insurance is paying it for. We have to justify it in the home.
- [09:59]
A
And thinking about the home, like, what measurements do you have to be sure of in regards to doorways or barriers, you know, that you need to be aware of?
- [10:09]
C
Yeah. So the base of all power chairs are 24 inches or less. And then the top is measured to your size. Because it's rare for me to have a chair more than 26 and a half inches in width, so any 30 inch door will be fine. So I asked them to measure all their doors because I don't go into the homes. I asked them to send me measurements for their steps. And I have organizations that will provide ramps for us, which is really nice. So we ask mostly for the steps, thresholds and door widths. And then the bathroom's a whole nother beast in itself.
- [10:48]
B
Typically bathroom doorways are so much narrower.
- [10:51]
C
Yeah, they're usually 24 inches. I, I tell people, take the door off the hinges, that gives them two more inches. Right. Take the door frame off the frame off the door, and that may give them another inch or two. But she's right, the door are usually to the bathroom, 24 inches.
- [11:09]
B
And kind of some simple things within the home too, that can be super. Lifesavers are just on Amazon for like $40 is a rubber threshold ramp. So even within the home, if there are large transitions, those can be hard to like hit straight on. So just that little ease of that small ramp can be huge. In Ohio, our group is called ALS United and they give money towards smart home technology. So even like power door openers and things like that can be super helpful for within the home as well. So really good referrals if your area has opportunities for occupational therapists, rehab engineers, looking outside of just how you operate the chair, but how you can operate your home as well, from whatever Your access point is of your power wheelchair.
- [12:00]
C
The ALS association, they've started doing virtual assessments with our folks. So they'll actually do a virtual home assessment and send them an entire detailed modification list. And then the clients reach out to us asking if we have any funding for any of it. So there's a lot of resources out there now. And I don't know if y' all are aware, I think this is nationwide. The MDA now has a DME grant program. It's $1,000 a year for a patient that they can give $1,000 towards DME and they can apply annually. So that's new this year.
- [12:39]
A
I was just going to say, the more information that you could share with us, we could post it in our notes for our listeners to have as well.
- [12:45]
B
Yeah, so that would be wonderful, because for als, thankfully, there are so many resources that they can tap into. Some that we've touched upon so far, and these are regionally throughout the U.S. in Ohio, we have ALS United and certain courses, we have ALS association or alsa. And Pam, you mentioned that. We talked about Team Gleason, and then just there's lots of community resources that will tap people into loan closets that are maybe like church or community based in that way. MDA is not one that I've typically given ALS clients to. Have you directed individuals with ALS to utilize mda?
- [13:28]
C
I have actually quite a few. They help sponsor our ALS clinic along with alsa. They both do it. I referred to them a lot to the Brigance Brigade in Maryland. They've helped modify homes for us and given money towards that. The Les Turner foundation is another good one.
- [13:49]
A
So would you say that a lot of individuals need to go to outside sources for funding, that private insurance or Medicare is going to cover all their needs?
- [13:58]
C
Insurance doesn't cover anything. One in the bathroom also. Nothing with the vans. Nothing really on the outside. No ramps. They only do the walking devices, wheelchairs, speech devices, pulmonary stuff. They don't provide anything else. You have to use your outside organizations,
- [14:16]
B
and that can just be so overwhelming. So starting these conversations early and making sure that they have access to these is great. I don't work in our Alsace Clinic, but I definitely have a pulse on everybody there. And we really talk a lot collaboratively between us to make sure that they're getting that information because, you know, they can only take so much in at a time. So it's just kind of that checklist of Are you aware of these opportunities can be very helpful to hear from a multitude of places.
- [14:49]
C
I get Emails and phone calls every day from people saying, this is starting to look a little different. What should I do? And so we always make sure the solutions in place and. And we have time to find a solution before they need to depend on it. So we're very blessed in that way.
- [15:06]
A
I would think that getting into an ALS clinic would be the ideal situation.
- [15:10]
C
Right.
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A
But what if a patient doesn't have access, like, it's not nearby? What would your recommendations be in regards for seating?
- [15:19]
C
There is an online team where they do everything virtually. Our doctors always say their medicine is us. It's the ancillary services is their medicine for this disease. So if they can't get into a clinic, at least go one time, get established, get the therapist names, and then you're in. You can always reach out for help.
- [15:45]
B
And we have individuals, too, that depending on when they were diagnosed or how rapidly they're progressing, sometimes going through insurance for equipment is not the best CH choice. And so I will give advice to, you know, Ohio, in my region, the ALS United of this would be the ideal loaner power tool for use. And they'll get set up in that way.
- [16:12]
C
Us too.
- [16:14]
B
And Medicare just recently extended the telehealth benefits. And so there is a time and a place that that can be helpful, too. There are times where we have the supplier in the home, and I'm working from the clinic to kind of give advice and suggestions.
- [16:31]
C
Yes, we talk to home health quite a bit, but I'm sort of picky about the wheelchairs. I want to make sure you only get one every five years. You have to make sure it's done properly and that you get everything you need in that chair, which can be a challenge.
- [16:46]
B
Sure. And so, Pam, when you think about when you're prescribing equipment and you're prescribing it with how they present for you at that time, you know, based on their presentation. What would you say for someone who's more bulbar onset?
- [17:02]
C
My bulbar onsets are usually respiratory compromised, so usually they only need a joystick. I will say I see a trend of bulbar onsets having more upper extremity deficits. Also, their legs tend to be the last thing to go, but I still usually start with the joystick with them. It's more for energy conservation, respiratory compromise. Our pulmonologist orders off their ventilators. When they have AVAPs, there's a boom that they could have. That's a mouthpiece, and it's for breakthrough breathing. So we put that on the back of their chair. So they just have to put their mouth on the device and it triggers their bipaps and they can get the rescue breaths. And then they don't have to wear their mask when they're in their chair. It's sort of nice.
- [17:51]
B
Yeah. And the pulmonary devices can be partnered with the power supply of the power chair. It's not the easiest thing to do, but it can be done. And that can be really give people confidence to leave the home more often. I have done. It's not often, but there are joysticks that you can do through your foot. For people who have good foot control, you kind of have to be able to stand doing wide base and come up from there. So pretty powerful in the hips. But there is definitely a time and a place there, too.
- [18:26]
C
There is a new foot control. I just saw it at my last conference I went to. And it's almost like a pedal. You push it down like a gas pedal to go forward, and it tilts left and right for right and left and then back. It's interesting. I used. And you're right, it takes lower extremity strength, but if it prevents a fall, it helps the respiratory status. And they're safe.
- [18:51]
A
So they're driving with their foot. Interesting.
- [18:55]
C
I had a gentleman type a whole book with his toes.
- [18:57]
A
Wow.
- [18:58]
C
And he was. He crossed his legs, and his joystick was mounted high at his toes, and he drove with his toes. He drove like 15 years like that. Wow.
- [19:07]
B
Wow.
- [19:08]
A
So going back to the loaner chairs, Right. Like, if you're getting from a loaner closet, how hard is it to take someone else's power chair and modify it to meet the needs of your client?
- [19:20]
C
Unfortunately, we get a lot of them returned. It is a terminal disease. A lot of people ask me how. I've done it for almost 30 years, and because I get close to my people, I've known them for years, and if I can make an impact on their lives and have them live their life to the fullest, it's worth every single second I spend with them. And that's sort of how I take it. It should bother me, but I know that they've lived a good life, if that makes sense. So when they turn their equipment back in, it's almost like giving back to someone else. And they know that, and we can make an impact positively on someone else. So I take it as a good thing. Right.
- [20:04]
A
And then to. How hard is it to adapt it for the new person taking the chair?
- [20:09]
C
We do not. At least I don't do specialty Alternative drive controls on loaner chairs. If someone needs alternative drives, we want to do it ourselves. So someone's following them and educating them and we're trialing things. The only kind of loaner chairs we give out at our clinic are joystick program joysticks. That may be different across the US but that's how we do it.
- [20:36]
A
And can you just go into a little bit more for our listeners? Like, what are examples of alternative drive?
- [20:41]
C
Alternative drives, My three most common are putting switches at their head for right and left and forward, usually at their knee to where they can just press on it and they go forward. I do do some chin drives. It's rare, but I have a few people doing it. They're very good at it. Where you put the joystick at the chin or lip. And then a very popular one is eye gaze. We've gotten a lot of people driving with their eyes now, and you can jump from joystick to eye gaze. So when they fatigue, they can just go to their eyes and drive through their speech devices.
- [21:17]
A
Can you explain that a little further, how they use their eyes?
- [21:20]
C
Most of them get speech devices that they type and they speak with their eyes through their speech generated device. So there's a program now called Tiltability Drive that we can download onto their speech devices.
- [21:31]
A
Gotcha.
- [21:32]
C
So they just look at an arrow and it goes in that direction. They don't work well outside. So in the sun.
- [21:38]
B
Yeah, it tracks your pupils. There's a. It has to be a certain distance, a height. Their family members or caregivers need to be a little bit techy because you definitely have some things you need to update with time. You have to recalibrate. But yes, for people with cataracts, it's challenging outdoors in the bright sunlight, very challenging. But it can really open a whole new world. And they're looking at the screen and the screen is kind of showing some of the periphery as well. So it's wonderful.
- [22:12]
A
Yeah. That's amazing.
- [22:13]
C
A great technology insurance pays for it. If they have a speech device. If they don't have a speech device, then we have to get creative and find them one on loan.
- [22:25]
A
Okay.
- [22:26]
B
There are times where we get it first before speech, but that's not typical. If somebody is progressing to that extent, they typically are already having challenging with their breath, support for breathing and have gone that route. But these specialty of driving with a little tiny joystick that takes such a small degree of force. Driving with your eyes, driving with your foot, driving through switches. These require such customization and. And that's where specialists like Pam and I really need to get involved. So, Pam, what are some things for comfort, stability, pulmonary support? What are some of those accessories that you might suggest as well?
- [23:10]
C
Years ago, they would say ALS never had wound issues. I have patients with wounds now. They get sacral wounds. I'd say 15, 20 years ago. I had none with wounds.
- [23:24]
A
And why is that, do you think? Because people are living longer or.
- [23:27]
C
And so I asked our chief neurologist what he thought, and he doesn't know if the skin. Something changed in the disease. And the skin is different for our folks if they don't have that protective mechanism anymore. But I. We get some wounds. So I put a lot of people on air cushions. They like them. I prefer the Quattro select because we can put the air where we want it, fix any obliquity with the hips out of alignment. We can put a shelf so they don't slide out. I really do like that cushion. The back is not usually an issue, but I do have people who lose so much weight, I have to do the agility back that has Rojo cells in it to protect the vertebrae because we get wounds on the vertebrae if they have kyphosis. So those are two of my go to cushions. We do a lot of the rounded headrest for a little bit of lateral support, but I have a lot of people with neck weakness, so I end up doing a full, like the elan headrest and stuff like that that really have lateral support with frontal head straps. I do those also respiratory wise. Everybody gets bag hooks to hang their ventilator on the back of their chair. I don't do vet trays,
- [24:44]
A
and that's actually some of those products that you're talking about. And pressure relief is a good segue. So let's say a patient who has ALS goes back to their physical therapist. Any tips now that they have this new chair that you would give them on pressure relief or driving or maintenance?
- [25:00]
C
Education on how to blow the ROHO cushion up is always welcomed. We educate, educate. I do video facetime with people teaching them how to pressure relief. How often, how much, how many degrees does that require in tilt and recline? If we can get recline, all those things cannot be taught enough.
- [25:21]
A
Yeah.
- [25:21]
B
Yep. And I think important parts with those air cushions and even competitors other than the Roho, they have warranties. And so it's really important that the families are aware of when those warranties expire, because the warranty means that they're nervous about the air, that they can get it replaced. Probably Within a week or two. But if it's out of warranty, they have to go all the way through the funding process, which is going to be at least a month, if not two. Not to mention the time it takes to see that referring physician therapist.
- [25:52]
C
Right.
- [25:54]
B
And from a pressure relief perspective, Resna has white papers that would suggest tilting 40 degrees, adding 10 to 20 degrees of recline in every 20 minutes for two minutes. But there's some new research that's coming saying for people who are super thin, have had wounds or diabetic, you know, smokers like other comorbidities that potentially they should be doing this more frequently or for longer periods of time. I think my take home message is, you know, your wife is not sitting still ever look at how many times she shifted and moved. You can't do that as often. So you've got to build this into your day. And maybe that's a Google timer or, you know, something going off on your, your Alexa. So using technology to be that reminder as well. And people just don't give enough credit to how much weight they've lost.
- [26:47]
C
Exactly. And that's part of the disease. Right. It increases the metabolism in these people. So weight loss is expected. You can eat the same amount of calories, but they're still going to lose weight. And I have people who sleep in their chairs. They never leave their chairs 24, 7.
- [27:06]
A
Why is that? They're most comfortable there.
- [27:08]
C
It's the best pressure relief because we've given them independence. If they're in bed, they can't move. Especially the softer the bed, the worse it is. And the families are being woken up all night long because they can't breathe in the chair. They hit a button or their switch or they activate their eye gaze and they can independently reposition. And they just say they sleep better in their chairs.
- [27:34]
B
Newer updates in the last 10 years too, has been something called memory seating. So almost all of the manufacturers have this too. And again, takes nerds like Pam and I to set this up. But with access, they can go to a designated pressure relief spot where that headrest supports them just right where it's best for their skin. And we're going to need to change that over time based on their pulmonary status.
- [27:58]
A
So it's like getting into your car and hitting the button that sets your, your seat to the position that's best for you.
- [28:04]
C
Exactly, yeah. But the more pulmonary, respiratory wise, they get worse, the less they can tolerate tilt and the less they can recline. And so it does have to be kept updated
- [28:18]
B
Another really common ones too is, you know, it's not uncommon for me to have someone who's 6 foot 3. And so then getting into that adapted van or a transport vehicle that might need to be a memory spot. We've set it up for access to get to, you know, their, their bar height, to be social with their family at dinner time, a transfer setup position. So those are all opportunities from memory seating.
- [28:44]
C
Yeah. One of the big wins this year is getting the seat elevator approved by Medicare. That's been huge this year.
- [28:52]
A
And you recommend that a lot. The seat elevator.
- [28:54]
C
Almost all of my people get seat. In fact, yeah, everybody gets a seat elevator because it does make a huge difference here, even in the society and the community. One of our folks came back and told us. They went Houston Rodeo is like huge. Okay, we're Texas. And he's always gone every year. And he's. But he said, I'm looking at butts. I just going through the crowd, that's all I see are people behind the Wranglers. And so we got at the seat elevator. He said, you know, people looked me in the eye, they parted ways when I came through the crowd. He's like, this was like a game changer. So even social aspect, the seat elevator is very, very valuable for their personal being.
- [29:37]
A
Any other standard features that across the board you almost always order on your
- [29:41]
C
power Chairs, seat elevation. Plus it comes with the 10 degree incline for free. So it helps them stand up and transfer. Still power legs, almost all of them get swelling because of immobility, always tilt. And I try really hard to get recline. And as Wendy probably knows, the only two things get reclined is intermittent catheterization and spasticity. If you don't have one of those two, you can't get recline. It will be denied. They don't care about respiratory status, anything. And it's. It's gotten hard. I get denials
- [30:20]
B
sometimes. If I comment on their motor fasciculations that like muscle twitch, that will be something. But I always like to use research articles in my documentation and I'll use the one from resin of the white paper of the benefit of combining power tilt and power recline. And I'll fight for that.
- [30:38]
C
Oh, I do. Yeah.
- [30:41]
B
And we, we had a conversation at Grand Rounds about AI recently and how denials. We can see things that are going through AI and they're looking for certain buzzwords. So we just have to be smart as we move forward too and find ways to use technology advances to not let that consistent denial Move forward. And so we are just trying to keep our pulse on that with suppliers. The way that our clinicians are documenting and just learning from denials and trying not to slow down the process for our individuals.
- [31:17]
C
I use the client's name a lot because it's personalization. In anything you're trying to get through insurance, you have to make it very personal. And I describe very detail about that individual.
- [31:29]
A
You have to justify every single thing you're putting on that chair.
- [31:32]
C
Right? Every single thing. And then you have to rule everything out. So if I want eye gaze, I have to rule out joystick switches, foot controls, sip and puff, which I would never put on an ALS patient. And chin control, you have to do. There's a pecking order, and you have to say why. None of them work.
- [31:50]
B
We're just evolving as we go. And. But personalization is the key. Rule out, less expensive, rule in why. And the big factors are, it's not just how you see them. In the clinic at 9am what is your function like at 9pm?
- [32:06]
C
Correct.
- [32:06]
B
So really fatigue, pain, joint protection, caregiver support, because this is a team.
- [32:15]
A
As we wrap up the podcast, Wendy, is there anything else that you think our listeners would benefit from knowing?
- [32:21]
B
I think my main points, Pam, that you have really honed in is that, yes, this can be overwhelming the technology, but find someone who, even if you live in a more. More rural area, can you have a mentor or someone that you can tap into? So for PTs out there, the seating and world mobility SIG, we will help you find those people. Don't hesitate. And I'm just so excited that we're having this cross collaboration because we all find our specialty in our niche. And why not reach out to those who have that specialization in another area? It's really, really rewarding to be that person that someone who's having their worst day over and over can come to you and get some advice. And maybe we don't know every tool out there, but, Pam, I bet people are coming to you and asking for this is my issue. Who should I talk to? And so when you build that relationship, it's. It's wonderful they do.
- [33:22]
C
And I have therapists that call me a lot from all over the US Just for ALS advice, wheelchair advice, how to document. So my door is always open.
- [33:33]
B
I saw Pam speak at the International Seating Symposium. So if any of you out there, if this is touching and, you know, an interest of yours, that's a wonderful conference. It's every other year currently in Pittsburgh, and you just. The networking and the classes that you can tap into are. Are fabulous. And so that is a resource and opportunity that you may not be aware of to really kind of learn and,
- [33:59]
C
and hone in more in all the new technology. That's where they display all the new tools and all the new chairs and all the new upgrades is at iss.
- [34:10]
B
And then RESNA is that group that Pam and I have specializations through. And they also just have a lot of educational material and support documentation.
- [34:23]
A
Well, I've learned a lot just listening to the two of you. I could sit back and just listen to both of you. All right, so we have a tradition here on the DDC podcast that we end all our podcast with a question that's not related to the topic. And we probably. Pam, we probably didn't tell you this, but we want to know, what do you do for fun that's not like PT or OT related?
- [34:48]
C
Oh, my. I go to the beach and I read books and my favorite time is the winter because no one's there. Or I go down to the Caribbean and I go scuba diving. That's right, too.
- [35:03]
A
Those are good, too. Yeah. And Wendy, how about you?
- [35:08]
B
I have four children, a husband and a dog, so I love quiet. So if I can have a moment of silence, I eat that up. But I. I love being outside. So maybe not today when it's one degree here in Columbus, Ohio. But yeah, silence and exercise, I would say those are my things.
- [35:32]
A
So we want to thank both of our guests today, both Wendy and Pam, for joining us. And I can't tell you how much that I learned, and I'm sure that our listeners were really going to benefit from this podcast.
- [35:44]
B
Yeah. I really appreciate your time.
- [35:46]
C
Thank you for having me.
- [35:50]
A
Although several brands and products were mentioned in this podcast, we would like to emphasize that we do not endorse any of these products. 4D is produced by the AMPT Degenerative Diseases Special Interest Group. Our podcast team includes Fun Pageant, Sarah Zahler, Ken Vanako, Aisha Sonani, Madison Catalano, and I am Chris Burke. Subscribe to our newsletter on the AMPT website neuropt.org or check us out on Facebook and please share this episode with a friend or colleague. Special thanks to Jimmy McKay of the PT Pinecast for providing music. The views, opinions and positions expressed in this podcast are those of the individual creators. The Academy of Neurologic Physical Therapy and its collaborators disclaim any liability to any party for any loss or damage by errors or admissions in this publication. That'll be a blooper.
- [36:41]
C
That would be my blooper.
- [36:44]
A
Unless you live in New York City, and then you might find that some of the bathroom doorways could be, like, 19, 20 inches.
- [36:52]
C
That's just crazy. Wow. Everything.
- [36:57]
B
You know, I heard
- [37:00]
C
all her doors are, like, 36 inches. 30 inches.
- [37:07]
A
You might be sorry you said that.
- [37:14]
C
It is a word. Once you get into it, it's like a bottomless pit, a black hole. You just get sucked in. And there's so much information. It's so much fun.
- [37:26]
A
Chris is staying on for the boring stuff. Okay. Yeah. I'm just saying. On for the goodbye. But you guys. Goodbye.
- [37:34]
C
Bye.