Preparing for the initial clinical assessment
Planning the initial assessment in advance gives the clinician more time to:
- Consider whether any additional information is required
- Understand the needs of the client
- Anticipate the questions that the client may ask, and
- Determine questions to ask the client to assist in developing the client profile (this Module will cover some of these questions).
If a desired clinical outcome is known in advance it is important to consider the feasibility of these goals and to confirm whether they are reasonable, whether they need to be adjusted given the client’s specific situation, or whether further information is needed to determine the feasibility of this outcome.
As with any specific diagnosis there are key considerations that should be taken into account when determining what options are available for a client. These considerations will be covered in the sections below. Remember, individual clients may have unique circumstances which are not outlined below, but which may be critical in determining the best course of action for that client.
There may be a wide range of issues to be addressed as a part of the client’s clinical care.
- Why are you seeing the client? Ask the client why they have been referred, and what they hope to achieve
- Consider the client as an expert on their own wellbeing and needs. Establish what aspects of the seating and wheeled mobility system have worked or not worked for the client and why
- What are the referrer and other stakeholders expecting as an outcome?
- How will the equipment be funded?
Understanding your client and your client’s experience can help you present information at an appropriate level. A clinician should not be overly simplistic with a very experienced spinal client, nor assume that a recently discharged client will be familiar with terminology and available equipment.
It may be appropriate to involve other clinicians or specialists who have particular knowledge that will help ensure a positive outcome for the client.
- Does the client have needs that require input from other team members or consulting specialists?
- Consultation with a wound nurse specialist to assess pressure injuries
- Consultation with a physiotherapist to assess shoulder joint and transfer technique
- Consultation with a medical practitioner regarding medical management, for example, pain and spasm issues, or
- Consultation with a dietician regarding client's significant weight loss or gain.
Understanding the Local Context
Consider the specific factors that may indicate whether a community referral or home visit is required to assess the environment prior to seating intervention. For example:
- A client who currently uses a manual wheelchair and has requested a power wheelchair, which may influence environment and community access
- A client performs functional tasks in a specific environment based on the current wheeled mobility dimensions or specifications, for example, sliding transfer on/off bed or toilet, accessing a modified kitchen, computer set up at home or modified vehicles, or
- A client who has gained weight and requires a much wider wheelchair which may impede access around the home.
Consider the intended outcome of the initial assessment and decide what other reports, tools and trial equipment you may need for initial assessment, trials and intervention. For example:
- Different pressure care cushions or other equipment to consider or trial
- Brochures for different styles or manufacturers of wheelchairs to compare and contrast specific design features, or
- Resource documents provide information about specific issues, for example, travel considerations for clients with a spinal cord injury.
Other useful information to coordinate the initial assessment:
- Transfer skills or equipment and supports required
- Planned medical interventions precautions and contra-indications (e.g., autonomic dysreflexia, seizures, MRSA in wound)
- Transport requirements
- Directions to the client’s house or local treatment space, and
- Parking and access information.