Measure Twice, Cut Once

As a young boy, my father instilled in me a very simple concept that has been a saving grace too many times to list. This concept has many different applications, including CRT. The concept is to measure twice before creating/recommending a complete CRT mobility device to ensure accuracy and thorough thought.  In CRT, the multidisciplinary team takes anatomical and physical measurements for the recommendation of the seating system during their wheelchair assessment.  A properly recommended mobility device also requires independence to use this device in the home, as well as any additional environments of anticipated use. The question that comes to mind is, “Why do we need two sets of measurements?”

  1. Let’s break down the reasoning behind both sets of measurements.The anatomical or evaluation measurements are meant to document the physical abilities, limitations and uniquities that each of our clients possess. 
  2. The home assessment measurements are put in place to ensure a proper match of equipment to the individual’s environmental needs. The recommended equipment should easily maneuver throughout the home and allow for increased function and independence in the completion of MRADLs. The home assessment guidance supplied by CMS is as follows:

Prior to or at the time of delivery of a POV or PWC, the supplier or practitioner must perform an on-site evaluation of the beneficiary’s home to verify that the beneficiary can adequately maneuver the device that is provided considering physical layout, doorway width, doorway thresholds, and surfaces. There must be a written report of this evaluation available on request.

Within the home assessment guidance supplied, it states that the home assessment can be completed for documentation purposes during or prior to the time of delivery. This means that there are patients receiving CRT equipment that may not have been trialed in their home until after the equipment had been purchased and assembled at delivery. What happens if we discover the slope of the ramp is too steep for the equipment to safely navigate? What if the carpeting is too thick for the individual to be independent in propulsion? What happens if doorways in the home do not allow access to necessary rooms in his or her residence? What happens if the client is unable to gain access to all required customary locations to complete their MRADLs (Mobility Related Activities of Daily Living), such as toileting, feeding, dressing, grooming and bathing?  

I can speak to any of the above happening on a regular basis throughout the industry. It’s nearly impossible to comprehend how a client intends to use his or her equipment unless you are there to witness the environments, see what limitations can be overcome by a change in recommendation to some or all physical components that were originally recommended at the mobility evaluation. This is the reason that you must always measure twice and cut once. This allows you to focus on the client’s goals, hopes and dreams and come up with the best equipment to meet his or her physical and functional needs as well as life and functional goals.  Would you have a new kitchen installed in your home by a contractor that has never been there to understand the layout and talk you through the available options?  I think not.

J.B. Radabaugh, CTRS, ATP/SMS
Clinical Education Manager, Eastern U.S.
Quantum Rehab

About J.B. Radabaugh: J.B. is a recreational therapist, ATP/SMS and the Clinical Education Manager for Quantum Rehab in the Eastern U.S. In his spare time, J.B. enjoys watching his two daughters grow, backpacking, camping and fly fishing.

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