Complex Rehab Technology Training Then and Now

Meet Angie Kiger, clinical strategy and education manager for Sunrise Medical—a company that specializes in the development, design, manufacture and distribution of manual and powered wheelchairs, mobility scooters and both standard and customized seating and positioning systems. Key products are marketed in the United States under the brands Quickie (adult manual and power wheelchairs), Zippie (pediatric manual and power wheelchairs), Breezy (adult standard wheelchairs), JAY (wheelchair cushions, backs, and positioning supports), Whitmyer (head supports) and Switch-It (electronics and alternative drive controls).

Name: Angie Kiger, M.Ed., CTRS, ATP/SMS Home state: Virginia Fan of: All University of Virginia sports teams; Washington, D.C., sports teams, spending quality time with friends and family—and the beach Specialty: Trains clinicians, rehabilitation technology suppliers and caregivers on proper seating and mobility equipment

Question: What path did you take to get where you are today?

KIGER: While growing up in Lynchburg, Va., my siblings and I spent a great deal of time with our cousins. One of my older cousins has cerebral palsy and intellectual disabilities; however, we were never told to treat Susan any different. In middle school I began volunteering at a local day camp Susan attended, and continued to work at the camp through college. I knew early on my professional focus would include working with individuals with disabilities in some capacity. Initially, I was planning to major in special education, but transitioned to recreation therapy my freshman year.

After graduating from college, I began working full time as a recreation therapist at the HSC Pediatric Center (HSC) in Washington, DC. HSC is a transitional care and physical rehabilitation hospital for children 0–21 years of age. While at HSC, I had the opportunity to work with children of all ages with a wide range of diagnoses and disabilities, including cerebral palsy, traumatic brain injury, spinal cord injury, degenerative neuromuscular conditions, rare genetic disorders, chromosomal abnormalities, etc.

One of my passions was helping my clients engage in play and recreation activities, alongside their peers, through any means possible. That drive and creative spirit led me to be invited to join HSC’s Assistive Technology (AT) Team. HSC’s AT team was a multi-disciplinary group of therapists, which included occupational therapists, physical therapists, speech therapists and special educators.

In order to further my knowledge of Assistive Technology, I set my sights on taking the Assistive Technology Practitioner’s, now the Assistive Technology Professional’s (ATP) certification examination from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA).

After appealing to the RESNA board to have recreation therapy included as a qualifying degree to take the exam, I took and passed the ATP exam. (Side note, RESNA subsequently changed their requirement standards to include recreation therapy after my appeal.) My desire to further my education in AT continued leading me to earn a certificate in AT from California State University at Northridge and a master’s degree in education with a focus on Assistive Technology from George Mason University, all while working full time at HSC.

Training other professionals became an interest of mine, so I began speaking at professional conferences on the topic of AT. I also served as an adjunct instructor for a few semesters at George Mason University in their M.Ed. in AT program.

Since joining Sunrise, I have had the opportunity to train clinicians and rehabilitation technology suppliers all over the U.S. I have also taught in Canada several times and in Ireland. The experience has been fantastic and has taught me a great deal too. In addition to teaching, I have also written articles, blog posts, training documents and assisted with internal training. My focus externally has been not only on clinicians and rehabilitation technology suppliers, but also clinicians and caregivers.

Question: Who needs the education and training you offer?

KIGER: Anyone who is working with clients who utilize CRT should participate in the trainings. The technology is ever-changing, and the amount of research being done in our industry is increasing. Seating and mobility equipment has a tremendous impact on an individual’s health, function, independence and overall quality of life. Without proper seating and positioning, a client is at risk for a number of potentially serious health problems, including pressure injuries, joint contractures, respiratory issues, digestive complications, postural deformities, etc.

The wheelchair service provision process is a team process that may include professionals such as physical therapists, physical therapy assistants, occupational therapists, occupational therapy assistants, rehabilitation technology suppliers, physicians, etc. Each of the team members plays a vital role in evaluating the client, making equipment recommendations, setting up the equipment, and ensuring proper utilization of the equipment. The settings in which the clinicians who participate in the wheelchair service provision process may include inpatient hospitals, outpatient programs, schools, homecare and community day programs. Each state has specific guidelines for both occupational and physical therapies, but in most situations, classes on seating and wheeled mobility fit the criteria. Training is extremely important to ensure proper equipment is selected, utilized appropriately and maintained properly.

Question: What did you first know of training and education in this specialty, and what have you since learned?

KIGER: When I was first introduced to the world of complex rehabilitation technology, I had the opportunity to learn from very experienced clinicians and rehabilitation technology suppliers. Like most folks new to this industry, I learned a tremendous amount from hands-on experience in the clinical setting. The more exposure I gained to it in the clinical setting the increase in desire I had to receive formal education and to earn my ATP, so I sought out professional continuing education courses. Many new clinicians I meet report that they received very little exposure to complex rehabilitation technology and the wheelchair provision process while in school. Seating and mobility is considered by many to be a specialty within the clinical fields that require the clinicians to seek additional training post-formal education.

It is vital that clinicians who work with clients that utilize complex rehabilitation technology have a good understanding of areas such as how to evaluate a client for proper seating and mobility equipment, what options are available, and for determining if current equipment is appropriate for a client, the funding process, current technology on the market, the clinical application of pieces of equipment, proper configuration and set-up, etc.

Throughout my time working as a clinical educator, I have learned that there are major discrepancies in the level of knowledge of individuals who are tasked with recommending complex rehabilitation technology, resulting in really good and absolutely horrible client outcomes.

Question: How have Complex Rehab Technology needs in the homecare industry evolved?

KIGER: Across the country I am hearing more and more of homecare and community therapists being tasked with taking the lead on evaluating and recommending clients for complex rehabilitation technology. The reasons for this trend include decreased inpatient hospital stays, resulting in unclear understanding of how a client could progress in the rehabilitation process, so equipment recommendations are held until post-discharge. Clients are sent home in rental equipment and unable to get to an outpatient wheelchair clinic with a team of clinicians who specialize in seating and mobility. The clinicians are a vital piece of the wheelchair provision process, so they must have a good understanding of the process in order to make appropriate clinical recommendations.

Question: What are the hardest conversations you have with people?

KIGER: Helping a client and/or the caregiver understand the need for specific Complex Rehab Technology can be difficult because it may mean a whole new level of acceptance for whatever the medical condition is requiring the equipment, and/or the loss of function or independence. While I may know a specific piece of equipment is going to change the client’s life for the better in the long run (by decreasing the likelihood of joint contractures being developed, or allowing the client to be independent with mobility through the use of a power wheelchair), it is difficult to explain to the end user and caregiver that what I am recommending might not be at all what was expected, and it will likely require changes.

Clinicians and suppliers struggle with providing the best pieces of equipment for a client with the resources provided. Whether it be the time the professionals are allotted to complete the evaluation and required paperwork, or the time spent battling with a funding source just to get a piece of equipment approved, the sad reality is it is very common to hear of both clinicians and suppliers working during off/nonpaid hours to complete required documentation, or other steps in the process just ensure the client gets what is needed.

Discussions surrounding the topic of funding can also be very difficult. Some funding sources flat out deny a piece of equipment that could improve a client’s overall quality of life. In other situations the battle to get a piece of equipment funded that is supposed to be covered takes months. Funding is arguably the most difficult obstacle the client and his team face.

Question: Why is seating, and positioning training and education so important?

KIGER: In order to make the most medically appropriate recommendations for seating and wheeled mobility equipment, it is essential that the entire team working with the client have a complete understanding of the entire wheelchair service provision process from evaluation to delivery and set-up of the equipment. If not, the inappropriate equipment could be provided to the client that may cause more harm than good. Also being aware of the most up-to-date research is important.

[When it comes to] clinicians, there is not a great deal of formalized education included in the therapists’ curriculum, in areas such as the evaluations for equipment, making recommendations, proper fitting of equipment, medical necessity, etc. The vast majority of learning happens on the job or in continuing education classes.

Not only do clinicians need to have an understanding of the process, but they also need to be educated on the technology that is on the market and the clinical implication for use of the equipment.

For some clinicians who work at various sites or who are homecare therapists, attending product demonstrations from manufacturers can be difficult, so it is of even more importance that those therapists receive training.

[When it comes to CRT suppliers], similar to clinicians, rehabilitation technology suppliers need to be trained on the latest products and standards of practice to provide the proper equipment to the clients they serve. Participating in continuing education classes and product trainings help the suppliers stay up to date.

Credentialing and Certification for Rehabilitation Technology

Professional credentialing standards for a rehabilitation technology supplier can be obtained through the National Registry for Rehabilitation Technology Suppliers (nrrts.org). Rehabilitation technology suppliers who aspire to become Registered Complex Rehabilitation Technology Suppliers (RRTS) or Certified Complex Rehabilitation Technology Suppliers (CRTS) must complete the requirements outlined by NRRTS.

In order for a rehabilitation technology supplier to provide all types of complex rehabilitation technology, Medicare and many state Medicaid programs require the individual also hold the Assistive Technology Professional (ATP) certification from RESNA (resna.org). The ATP is intended to certify the individual who has successfully earned the credentials has the competence to evaluate, recommend and train individuals for all types of AT. It is important to note that professionals specializing in AT, besides rehabilitation technology suppliers, also earn this certification, including occupational therapists, physical therapists, recreation therapists, speech therapists, special educators, rehabilitation engineers, etc.