WorkCompWire just published an insightful article on bariatric equipment by our Kevin Wallace, ATP, CRTS, Rehab Technology Specialist.
Not only does Kevin bring over 30 years of knowledge and patient care experience to the topic, but he brings a deep level of sensitivity and compassion.
The topic is a tricky one – equipping a claim for an obese injured worker. When Kevin started working with obese patients, bariatric beds, wheelchairs, and other equipment were so heavy and unsightly that injured workers refused to use chairs outside their homes or have people over to visit.
Fortunately, the industry gave bariatric equipment a makeover and the newer, cooler wheelchairs, beds and equipment help overcome embarrassment and isolation. The concept of inclusivity has finally reached this segment of the market.
Although she oversees all our rehabilitation services, our Executive Director of Rehab Technology Erin Zablocki has a special love for adaptive housing solutions for injured workers. So it comes as no surprise that she recently became licensed as a Minnesota Certified Accessibility Specialist.
Erin took a day-long class on the scoping and technical criteria of the Minnesota Accessibility Code and commercial building plan review and then sat for the exam. She has added AS to the long list of initials after her name. Erin was already a Certified Environmental Access Consultant (C.E.A.C.) and was one of the first five people in the country to earn the Master C.E.A.C. certification. Since she also holds the Executive Certificate in Home Modification (ECHM) and Certified DME Specialist (CDME) certifications, you can address her as Erin Zablocki, CDME, Master C.E.A.C., ECHM, AS.
ATF Medical strongly supports the professional development of our team members. Making the effort to earn certifications and licenses shows dedication to grow in their fields, and expand their expertise. And staying on top of the new products, technologies, and techniques empowers our specialists to provide the most appropriate mobility, accessibility, and rehab solutions to workers’ comp patients.
Give Erin a shout-out! Email her at ezablocki@atfmedical.com.
More than 7 million Americans live with chronic pressure injuries. There are no stats on how many of these are injured workers, but you can bet there are a lot.
Pressure injuries are dangerous. Without prompt and proper treatment, there’s a high chance of infection, hospitalization, and even amputation.
Wounds are hard to heal. Recovery is difficult even in a hospital setting. It’s especially hard in the uncontrolled environment of an injured worker’s home. The environment must be extremely clean and the injured worker needs proper hygiene and to eat a nutritious diet, plus they need to follow a pressure relieving program.
The Treatment Team
Treatment calls for a collaborative, multidisciplinary approach. There are physicians, surgeons, wound care nurses, wound care centers, wound care consultants, manufacturers, physical therapists, and occupational therapists, along with medical equipment and supply companies–to name a few. And these specialists need to talk to each other, sharing treatment plans and progress, so you also need care coordinators.
ABWM and other organizations provide wound care certification for some of these professions providers as well. You can compare the offerings here.
What Can You Do?
If you manage claims, take time to review those of injured workers who receive home health care, use wheelchairs extensively, are bedridden, or have other risk factors. Talk to case managers to see if patient-education reminders about nutrition or pressure relief techniques are in order. Should elevated seats or standing chairs be considered? If they have serious wounds, what can be done to improve hygiene and home cleanliness?
ATF Medical will help you find the right rehab technology for your particular injured worker. If you have a case that needs attention, please contact us at referrals@atfmedical.com.
Taking steps to foster healing or better–prevent–pressure injuries will save our injured workers from experiencing delayed recovery, tremendous pain, and dangerous complications – and save payers considerable time, worry, and money.
Also, whether you manage claims or not, please take time this month to thank the many providers involved in your patients’ wound care for their hard work.
Advances in complex rehab technology continue to redefine accessibility and independence for injured workers. And manufacturers continue to refine their offerings.
ATF Medical stays up to date on the latest, always monitoring new products, features and benefits so we can recommend the best fit for an injured worker. Our Manager of Complex Rehab David Bedard, ATP, C.H.A.M.P. recently checked out Permobil’s new M Corpus VS Power Chair and shared some thoughts.
This remarkable chair combines the maneuverability of mid-wheel drive with an anterior tilt feature, delivering new accessibility and functionality for injured workers.
“A lot of standing chairs have front-wheel drive and can’t turn in tight spaces,” Bedard said. “This new model features a mid-wheel drive, which cuts down on the chair’s footprint when turning.”
Even more innovative is its anterior tilt feature, which enables the seating system to move into a 45-degree anterior tilt. Typically, power wheelchairs come with a posterior tilt function.
“The forward tilt is fairly new,” Bedard explained. “Permobil calls this ActiveReachTM because it allows patients to tilt forward and reach in front of themselves. “This way they can do more activities of daily living, help their kids get ready for school, or use a keyboard. This feature will enable some people to return to work.”
In previous blogs and Linked In posts, we have discussed the many ways standing chairs increase functionality and accessibility. Using one, an injured worker can stand at a stove of standard height, cook their own meals and reach for something from a top shelf.
Healthwise, the standing position empowers the body to work as designed. Standing is good for circulation, bone density, muscle strength, and it helps reduce atrophy. Standing chairs also improve bladder and bowel management because they put people in position to allow gravity to void fluids from the body. This helps prevent urinary tract infections (UTIs). In addition, standing chairs provide one of the best pressure release techniques, helping patients avoid painful pressure injuries (wounds.)
“In fact, standing chairs help people live longer and healthier,” Bedard said.
They also provide all kinds of mental health benefits. Being more productive, being able to look people in the eyes during conversations, and being able to work again are huge. Standing chairs make it easier for injured workers to get out into the world and interact with people. They can stand at a counter to pay for something and more easily reach items on grocery store shelves. or at work and engage with friends. In short, they facilitate confidence and independence.
ATF Medical analyzes the complex rehab technology and adaptive housing options when recommending and developing a cost-effective solution for an injured worker. Standing chairs, for example, can avoid the need for extensive home modifications. There’s no need to lower kitchen cabinets, build pull-out drawers, and install special stoves and other appliances. The new M Corpus VS with its smaller turning radius opens access to tight spaces without major remodels and increases functionality.
ATF Medical focuses on the person’s condition and likely progress when developing a solution for an injured worker. This chair won’t work for everyone, but it will literally change the lives of some.
Why don’t you review your book of claims and let us help you decide which injured workers would benefit from these new features? If you have questions or just want to know more, please contact David Bedard at dbedard@atfmedical.com.
ATF Medical is in growth mode! Our newest addition to the team is Abbi Akstulewicz, who has just started as our Director of Payer Partnerships. This is a new position, and she reports to Brendan Swift, working to enhance, grow and establish new relationships with our payer partners, nationally.
Abbi has a strong background in workers’ compensation care coordination, complex care and catastrophic claims management. While studying nursing, she gained hands-on experience with a local home care company where she provided care to adults with special needs and disabilities.
“I have a real passion for helping people that are struggling with paraplegia and tetraplegia,” she said.
Most recently Abbi served CorLife as Supervisor Claims Specialist, Workers’ Compensation, developing and executing strategic plans to achieve favorable carrier and patient outcomes on catastrophic claims.
Earlier this month, Abbi had the honor of serving on a panel, “Catastrophic Case Management in a Post COVID-19 World” at the Insurance Rehabilitation Synergy Group (IRSG) conference in Dallas, TX.
She graduated from Rasmussen College in Green Bay with a degree in nursing and a goal of going into case management. In 2019, she was hired by CorLife as a Workers’ Comp Claims Specialist.
Abbi lives in Shawano, Wisconsin (about 35 miles from Green Bay) near where she was born and raised.
Her family all live nearby and she cohabits with Finn (the dog pictured with her above) and her cat Boots. She comes from an outdoorsy family and enjoys hiking, fishing and hunting. And she’s also a foodie, who likes to cook and try new food when she’s traveling.
Zorybel Bernabe is the latest member of the ATF Medical family. She recently joined as Rehab Coordinator 1, Rehab Technology
Zorybel works closely with Jaymi Saunders on ATF Medical’s mobility team to ensure workers’ comp patients receive appropriate wheelchairs and other equipment along with equipment repairs. She enjoys communicating with claims representatives of third-party administrators and carriers and is passionate about building relationships with our patients.
“I’m so glad to be in a position where I can work directly with them,” she said. “It’s so rewarding when someone regains mobility after a wheelchair repair. You know you have really helped them.”
Speaking of wheelchair repairs … she has coordinated several in her first weeks with ATF Medical. “It’s given me more knowledge of the equipment, parts, pieces, manufacturers, and product lifespan,” Zorybel said.
Having worked with Orchid Medical, an ancillary medical management company in workers’ compensation, before, during, and after its acquisition by Sedgwick, she brought a good understanding of home health care and workers’ comp to the position. Most recently, she was a Provider Relations Representative. In that role, she built and maintained relationships with healthcare providers, ensuring that they were contracted, credentialed, compliant, and that they provided cost-effective, high-quality care. Earlier she served Orchid as a Senior Complex Care Coordinator, arranging for injured workers to receive appropriate medical services and products.
She honed her care coordination skills in a previous position with Senior Helpers in Orlando, Florida. As Team Scheduler and Coordinator, Zorybel coordinated staff and worked with family members of dementia patients to meet their care needs.
Now she’s working on the solutions provider side, focused on complex rehab technology. And she likes it. “My supervisor Jaymi has given me the best tools and resources and clearly described the different type of referrals and how to do the job,” she said.
Fluent in Spanish as well as English, Zorybel grew up in Orlando, Florida where still lives. She earned her BS in Biomedical Science from Orlando’s Advent Health University.
When not working, she will continue her travels to different Florida cities to sample different types of ethnic food. Asian cuisine is her current favorite.
She has also decided that this is the year to do things that are outside her comfort zone. Any suggestions?
Please welcome Zorybel to the team by emailing zbernabe@atfmedical.com and if you’re in the Orlando area, think about joining her on one of those food adventures.
ATF Medical is genuinely excited about our new occupational therapist, Melissa M. Smith, OTR/L, ECHM, CHAMP, CAPS.
Melissa has dedicated her OT career to helping injured people obtain home environments that are safe, and accessible, and facilitate mobility. We sat down with her to learn why she became an OT and what led her into an adaptive housing practice.
What can you tell us about occupational therapy?
Occupational therapy takes a unique, holistic approach to working with people. We look at the health conditions—whether they come from an injury or progressive condition—and how their conditions impact them, how it affects their daily lives–what they like to do and what they need to do to take care of themselves. Then we address the deficits they’re experiencing because of the condition. In the case of a back injury, for example, we might modify a job task, so the employee doesn’t repeatedly pick up heavy objects, teach good body mechanics, or recommend a long-handled sponge so the injured worker doesn’t have to bend over to reach their feet. We take a broad view of how the injury affects them.
You seem to have a strong interest in construction, did you ever work in the construction field?
No! Well, I was always been interested in design and function and how it affects a person’s happiness and independence. I thought about being an interior designer, but my interest in occupational therapy was stronger. Keeping people in their home is very important to me because “home” is so much more than a house.
Where did you go to college?
My occupational therapy degree is from the University of Puget Sound in Tacoma, Washington. I also have a bachelor’s in psychology from the University of Iowa. Later I took courses to learn more about building in construction, architecture, and interior design at Portland Community College.
Tell us about your early career.
I worked in acute care hospitals in Denver and Portland for several years. I was also a Traveling OT. Like traveling nurses, we work in one location for three months, then move to another. I worked in nine locations, including two stints in Portland. I worked in inpatient rehab, home health, and nursing facilities. I also worked two summers at a camp in Newport, Rhode Island called Shake-A-Leg. We provided occupational therapy for one group of young campers with developmental disabilities and another group of adults who have spinal cord injuries. In addition to general rehab, we adapted different sports, sailing, swimming, tennis…all kinds of sports and that was a lot of fun.
You traveled so much and saw so many cities; why did you decide to settle in Portland?
My cousin and aunt live here and when I was a Traveling OT, I lived in Portland for two, separate three-month stints and just fell in love with the city and area. There are so many cute neighborhoods, with beautiful landscaping and old homes. It’s just a lush, green and very cozy city and the people are very friendly. Plus, it’s ideally situated, just 1.5 hour’s drive to ski resorts in one direction and 1.5 hours to the ocean on the other side. It’s an unbeatable area.
How did you transition from traditional OT to being a clinical specialist on the home environment side?
I read an article in OT Practice Magazine about OTs working in home modifications and thought, “This is perfect for me!” Being a home mod OT merges my medical and interior design interests. Home Mod OTs help people who have experienced disability function better in their own space by making a personalized fit for them.
To learn more about it, I took some certification programs–ECHM, CAPS, CHAMP—and some architecture, interior design, and construction at Portland Community College. I even got my residential contractor license from the Oregon Construction Contractors Board. And I did a lot of independent reading.
And you started working for Kaiser Permanente Home Care Services in 2012?
Yes, I conducted evaluation and treatment sessions, and generated goals and plans of care. I got into the assessment of home environments and recommended medical equipment to promote independence and better accessibility of the home.
By then, you knew you had found your passion?
I did and I started a company, LiveAble LLC, that assessed and modified homes and recommended medical, rehab and mobility equipment. We consulted on remodeling projects to make sure the accessibility and safety goals were achieved. Our patients ranged from young children to adults who wanted to age in place, and we served quite a few injured workers. LiveAble had a contract with the State of Oregon to provide environmental modification consulting services for Department of Human Services clients, including aging adults and people with developmental disabilities.
You’ve worked with so many different types of payer groups. What do you like about workers’ compensation?
Workers’ comp is generally willing to provide people the things they need—rehab technology, remodels, medical equipment—compared to Medicare which doesn’t usually provide home modifications or complex equipment. Because my recommendations are accepted and the changes get implemented, I can see how they improve workers’ lives. I feel I can make a real difference.
I know you haven’t been here long, but what are your first impressions about ATF Medical?
I got such a warm welcome from everyone – this seems like a company that people end up staying in because the culture is welcoming warm and positive. People celebrate others’ wins. It’s very collaborative – and organized!
Melissa Smith, OTR/L and Harriet rest after a hike.
Is there anything you’d like to share about your personal life?
I’ve lived in Portland for 15 years and have been married for 10. We like to travel, ski, and cook together. My husband teaches technology to middle school students, and we have a dog, Harriett, who is our baby.
I love to design and decorate. My first project was designing a closet through Ikea in a 483-square-foot studio. It took a lot of thinking and planning. In a home that small the closet needs to be very functional!
But my biggest hobby is tennis and I’m on several Portland teams. I’m very competitive in sports and tennis is great exercise and a lot of fun.
Help us welcome Melissa welcome! Email her at msmith@atfmedical.com.
Steven Killius (left) receives his first wheelchair after incurring a spinal cord injury at work. ATF Medical’s David Bedard (right) customized the chair, which is a manual with a power assist.
Our Manager, Complex Rehab Technology, David Bedard, ATP, CHAMP gets excited when he gets to customize a workers’ comp patient’s first wheelchair. “You want the patient to have a positive experience so you need to get it as close to perfect as possible,” he said.
Recently he customized a manual chair for Steven Killius, an injured worker who suffered a spinal cord injury during a motor vehicle accident. ATF Medical received the referral while Steven was treating at Brooks Rehabilitation in Jacksonville, Florida. David met with Steven and collaborated with his physical therapist, Erica Walling, to create this mobility solution.
“Brooks has a great neurological program. The physicians are very good about prescribing assistive technology, and the clinic has a wide variety of chairs for the patients to try out,” David said.
Steven, who is in his mid-40s, is a paraplegic with good upper extremity function and his team decided on a Permobil TiLite with its SmartDrive Power Assist that extends the length of a push. The user can push once and the chair continues to glide, sometimes twice as far.
“The amount of power you give it determines how far it will roll or how quickly it can climb a hill,” David explained. “Power assists reduce the number of pushes, preventing wear and tear on shoulders, wrists, and elbows.” With them, users can more easily traverse a large area, such as a warehouse the size of a football field.
This model features a wearable, a watch that can control the chair. The injured worker can hang their wrists on the side of the chair instead of pushing the on and off switch.
Another customization is the Invacare Matrx positioning back. Its carbon fiber shell is lightweight and durable. Because this injured worker has good torso control, the chair has a low back to allow him to reach behind himself to grab a water bottle or phone.
Steven was grateful for the power assist and wearable. “This technology will make a big difference for me when I’m using the chair to navigate day-to-day routines,” he said. “And it will help save my shoulders.”
Because he will probably spend 10-15 hours a day in the chair, selecting the right cushion was vital. The team chose a hybrid combination of air cells and high-density, positioning foam made by Roho. The air cells in the rear allow users to immerse themselves in the material, which disperses pressure over the greatest possible area. This helps with pressure release so patients can maintain skin health and avoid pressure injuries. The front of the cushion, composed of a higher density memory foam, carves out a place to cradle his legs to maintain natural, neutral sitting positions and sitting balance.
Its rigid, titanium frame is durable and energy efficient. Carbon fiber Spinergy wheels cut the chair’s weight. “Removing as much metal as possible keeps the chair as light as possible, making transfers easier,” David added.
David and the Brooks’ team took care to think through the patient’s needs and customize a manual chair to help him keep exercising as much as he can. Since he was very active before the injury, he will likely want to test his physical limits in the chair.
David demonstrated the chair’s features when he went to Brooks to deliver and fit the chair.
“But I encouraged him to use it as is, first, then add the power assist features gradually,” he said. “Patients already receive so many instructions when they go home from rehab, we don’t want to overwhelm with the tech.”
Complex rehab technology (CRT) can make someone’s life better if the configuration is right – at least as close to perfect the first time. ATF Medical’s specialists pay attention to the details to set patients up for success. Next time you have a claim requiring CRT, mobility products, or home modifications, email us at referrals@ATFMedical.com. We’re dedicated to helping injured workers regain their independence, mobility, and functionality.
OTs are frequently associated with helping individuals redevelop and maintain the ability to perform activities of daily living, such as dressing, eating, and grooming. They do that … and much more.
You’ll find OTs practicing in nearly every realm of medicine, including mental health and sleep assessment. Their overarching role is to help people regain strength and functionality after an illness or injury. One thing that makes OTs unique is their ability to look at a situation holistically – which helps deliver the best outcomes.
In workers’ compensation, these highly skilled and highly educated clinicians are valuable members of an injured worker’s care team. Within workers’ compensation, OTs have several different areas of practice, including adaptive housing/home modifications.
A home modification OT’s goal is to maximize a worker’s independence and safety in their home. An assessment of the person and environment is conducted with a focus on what activities the IW is having difficulty performing in the home and what physical barriers the home presents. Then the OT will then develop a plan for a better “person-environment fit.”
This plan may include a scope of work, floorplan drawings, recommendations for structural modifications, medical equipment, complex rehab technology, and/or assistive technologies. Common projects include planning for home entrances, emergency egresses, along with bathroom and kitchen accessibility.
OTs that specialize in work rehabilitation concentrate on the worker in their vocational role. This OT conducts Functional Capacity Evaluations (FCEs) that determine an employee’s work capacity and barriers to performance and writes a customized rehab plan to foster recovery. This may include work conditioning, strengthening, worksite ergonomics, worksite modifications, or task modifications – all with the goal of facilitating the worker’s return to work.
April is the month to recognize the value OTs bring, so thank the OT on your claim for their expertise and service. Tagging them on social media is one way to show appreciation.
March is the month the Brain Injury Association of America has selected to bring awareness to brain injuries. The organization’s tagline #MoreThanMyBrainInjury reminds us that someone with a brain injury is a person first. This message aligns perfectly with ATF Medical’s consistent patient-centric approach. We wrap ourselves and resources around all our injured employees, including those who have suffered a brain injury.
What are brain injuries?
There are two overarching types of brain injuries: traumatic and acquired. Acquired or non-traumatic brain injuries occur when the brain is altered by internal factors. A lack of oxygen, exposure to toxins, pressure from tumors, and strokes are a few examples of the acquired types.
If an external force, such as being hit in the head, a fall, explosion, a gunshot wound, or vehicular accident causes the brain injury, it’s a traumatic brain injury (TBI). These impact injuries can be open (penetrating) or closed.
About brain injuries in workers’ comp
Approximately 20% of work-related injuries of work-related injuries involve a TBI, according to the Centers for Disease Control and Prevention. Severity ranges from mild concussion to severe brain injury, and TBIs are typically associated with high medical costs and long-term disability.
The industries most likely to incur brain injury claims are construction, transportation, and agriculture. And the claims tend to be expensive. The National Council on Compensation Insurance (NCCI) put the average cost of a claim involving a TBI at $84,000 in 2017. Medical inflation has pushed that number higher in the past five years.
About the impact on the injured worker
A brain injury cuts to the core of a person. It affects who the injured worker is—how they think, act, and feel. Symptoms vary greatly from person to person, and no two brain injuries are exactly alike.
Patients with brain damage can have functional issues, such as physical weakness and a lack of coordination in the limbs. Visual impairment can be a symptom, and a brain injury can affect mobility and limit a person’s independence.
Cognitive effects, including confusion, memory loss, poor organizational skills, and poor reasoning skills can affect these injured workers. They tend to have trouble sleeping and suffer from fatigue.
They can be emotional, given to tears, and unable to control their anger. There can be a lack of impulse control. Many patients are depressed, anxious, and feel vulnerable and isolated. (Feelings of isolation are likely more prevalent with injured workers than other patients because they suddenly lose contact with most of their colleagues along with the sense of purpose working provides.)
When patients with brain injuries head home
Injured workers with serious TBIs spend time in a hospital and a post-acute care rehab center. These facilities are highly structured and keep patients busy most of the time. Returning home after living in such a regimented environment can be disconcerting. Suddenly, the injured person has to figure out how to live, while dealing with the loss of some routine capabilities.
Naturally, the home must be adapted to provide a safe and accessible environment. Ramps, roll-in showers, and door widening are typical home modifications. At the same time, rehab equipment is placed. These could include ceiling lifts, hospital beds, special mattresses, door openers, and wheelchairs.
Payers need to determine what modifications and rehab technology a particular worker needs and not let the contractor or equipment providers go on autopilot. Clinically focused specialists, like occupational therapists, Certified Environmental Access Consultants, Assistive Technology Professionals, and those holding the Executive Certificate in Home Modification should collaborate with contractors to design an appropriate plan.
The end product needs to accommodate the size and weight of equipment while fostering mobility, independence, and functionality for a specific injured employee with specific symptoms and needs.
Communication among specialists, with the payer’s claim representatives, and especially the injured employee and their family are essential ingredients to delivering clinically appropriate solutions. The injured employee’s journey to recovery – or acceptance of their condition – is arduous enough. They and their families do not need the stress and frustration that comes with receiving equipment they can’t use or not knowing when the construction crew will come or the powerchair will arrive.
Paying attention to the family
Family dynamics is a major psychosocial barrier to recovery. And adjusting to a new reality, and in some cases, a new personality, is hard on everyone, especially family members living in the home.
Dealing with the patient’s mood swings, depression, and anger drain reserves, The day-to-day duties and constant vigilance wear down the most diligent caregivers. And divorce rates among seriously injured employees are high.
The severity of the injury and the status of recovery dictate when and if an employee can return to work after a brain injury. Some workers return to their previous positions with no problem and others can resume their roles with help from assistive technology and ergonomic adaptions and/or reduced responsibilities.
In other cases, flexible, hybrid, work-from-home, or part-time schedules are appropriate. Transferring to a different position in the organization or receiving vocational rehabilitation and seeking a different job are other routes to explore.
Employers and employees should have frank, empathetic, and open discussions about the person’s abilities and stamina and the workplace environment as they select the best option.
Summary
Living with a brain injury calls for a wide range of resources and strategies. The people who manage their claims and providers who care for them need to be empathetic. And they need to advocate for the best home and work environment possible.
ATF Medical’s specialists and other staff members do just that as they simultaneously contain costs by avoiding unnecessary expenses and waste.
Healthwise, the standing position empowers the body to work as designed. Standing is good for circulation, bone density, muscle strength, and it helps reduce atrophy. Standing chairs also improve bladder and bowel management because they put people in position to allow gravity to void fluids from the body. This helps prevent urinary tract infections (UTIs). In addition, standing chairs provide one of the best pressure release techniques, helping patients avoid painful pressure injuries (wounds.)
I worked in inpatient rehab, home health, and nursing facilities. I also worked two summers at a camp in Newport, Rhode Island called Shake-A-Leg. We provided occupational therapy for one group of young campers with developmental disabilities and another group of adults who have spinal cord injuries. In addition to general rehab, we adapted different sports, sailing, swimming, tennis…all kinds of sports and that was a lot of fun.
Because this injured worker has good torso control, the chair has a low back to allow him to reach behind himself to grab a water bottle or phone.
The front of the cushion, composed of a higher density memory foam, carves out a place to cradle his legs to maintain natural, neutral sitting positions and sitting balance.
