Hi - my name is Sharon Sutherland.
While I've had the privilege of working with many of you in some capacity during my clinical journey to date, I'd like to take a moment to share a bit about who I am and how I became so passionate about the world of postural care and mobility for those of you who might not know, or might be considering this as a possible career path for yourself. I’ve also realised that I have never really shared my story in full before. As I have elaborated on bits and pieces of my experiences with others throughout the years, I thought that this might be a nice opportunity to string it all together to highlight the possibilities that arise through non-traditional routes as a clinician.
A question that I’m often asked is - How did I find myself in this world of postural care and mobility?
It all started way back in the 80’s, where my professional journey as a physiotherapist began in Galway, Ireland (which happens to be one of my personal favourite places in the world!) after graduating from Trinity College Dublin with aspirations of being a sports physio - because let’s face it, most physios want to be sports physios. Sports were sexy - Seating, on the other hand….? I digress.
My focus areas at Merlin Park Hospital in Galway were orthopaedics and respiratory while working in an inpatient setting. I was so very lucky to work with a great team under the fantastic leadership and direction of Marian Clarke. At that time, I remember it all being about patient care. I don’t have much recall of spending hours on documentation, like we hear about and experience in many parts of the world today. Work was fun and there seemed to be great work-life balance as I remember it!
After some time and a few letters from my university friend Fidelma, I found myself with itchy feet. A search for new experiences and opportunities led me to Toronto, Canada, where I planned to work for a year (or so I thought!) at an outpatient clinic – my dream come true! At that time, many PTs and OTs sought opportunities to work outside of Ireland as jobs were not plentiful at home. The US, UK, Canada, and Australia were popular stops for us.
So off I went.
Just me, two suitcases, and a burning desire to continue progressing along the career path I thought I was destined for.
Fidelma and I found ourselves working in what one might say was a “less than ethical” clinic operation. I managed to untangle myself from this arrangement with the help of the Canadian physio board and moved to a more traditional hospital-based PT role at St Josephs hospital, again focusing on Orthopaedics as this was what felt like the best match for me professionally at the time. I could see results with my patients quickly and was learning so much from the orthopaedic surgeons who were such incredible advocates for PT.
This was an appealing point in my career, and soon I took an opportunity that presented itself to work in sports at a private clinic. I loved working with the patients in this setting. What I believe I enjoyed most was their personal desire and drive to “get better”, follow our exercise protocols, and get on with their lives in a better and more healthy way than before we met. Those were the “outcome measures,” so to speak, back then.
One day during my time at this private clinic, I met a young man seeking adjustments to his wheelchair to optimize performance. Well, let me tell you something – I had never been asked to do that before. If I’m being completely honest, I knew nothing about this. I was utterly stopped in my tracks.
At that time, I didn't even realize seating and mobility, or postural care, was a specialty within our field!
During our years of clinical education as physio students in the early 80’s, we spent a couple days rolling around Dublin in wheelchairs to help us appreciate and gain insight towards how wheelchair users were viewed in society and the barriers they faced when navigating familiar environments. Many clinicians have since shared that they had similar experiences in university, and few have expressed learning much about anything to do with postural care, skin integrity preservation, or wheelchair configuration. One might be able to argue that we were introduced to wheelchair skills through that exercise in Dublin, but that would be a stretch as there was no structure or discussion on motor learning, cueing, or promoting shoulder and wrist preservation.
It wasn't until meeting this young man in Toronto that I decided to find about more about what was involved with this ‘wheelchair stuff’. And who better to learn from than professionals who actually knew something. So out came the yellow pages (the old fashioned google!). That moment marked the start of a major learning curve and newfound passion for young Sharon Pratt (we’ll get to the marriage bit in the next post!). Little did I know that this decision would be a monumental turning point as the beginning of my clinical journey for life.
Learning about products was my first task. I spent time with Invacare Canada, Sunrise Medical Canada, Jay Medical , and ROHO, to name a few. All it took was a phone call - I would ring them up and share a bit about who I was, noting that I knew nothing and I needed help. They were over and beyond helpful – all we had to do was ask! I was so thankful for being welcomed during those early days –you know, those days where you’re not quite as confident as you’d like to be and ask a million questions because you want to know everything?!
I am forever thankful to Mike Regazzi who then was with a DME company called Hunts. Not only did he truly take me under his wing and teach me so very much about wheelchair and seating prescription as well as how to navigate the funding/reimbursement world in Ontario, but he helped immensely as I transitioned to begin my practice as a private practitioner offering home assessments in the greater Toronto area. Mike and I worked closely for many years and was always someone I looked forward to catching up with and reminiscing with as time passed when we would see each other at conferences, such as CSMC in Toronto and ISS in the US and Canada.
Mike wasn’t the only influential person I came to know and respect. I cherish my learning experiences from many other suppliers at the time, including David Harding, Mike Dorman and Ruth Anne Whicher, among others.
I feel like I couldn’t have accomplished what I did during the late 80’s and early 90’s without their guidance and coaching.
They kept me tuned in about new products as they came to market and provided valuable insight about all the nuances of funding and reimbursement. Meeting with Ruth Anne in Toronto for a day of assessments in nursing homes was always a highlight of my week! One my recommendations for new graduates, or clinicians just starting in the field of postural care, is to link with a brilliant mentor. Not only will this help with professional development and skill acquisition, but it will make the process a lot more enjoyable and less intimidating.
These experiences were all fantastic, and what I loved most about this time was working with the elderly and with the veterans in the community. I remember distinctly when the first “hemi “and then “superlow” wheelchairs came to fruition. For the elderly, those low seat to floor options opened up independent mobility and therefore made funding possible for the first time for so many in Ontario! It was an exciting and vibrant time for me in practice all over the greater Toronto area.
We were lucky then to have a program called the Assistive Devices Program (ADP) a division of the Ontario Ministry of Health. Funding from the ministry of health had just been made available for seating and mobility equipment for those over the age of 21 in Ontario and who were independent with their mobility, meaning people were finally able to get the equipment they needed to function and integrate into society with some financial assistance. Being part of that movement was incredible. Clinicians who prescribed seating, wheelchairs and ambulatory aids for individuals who qualified for this financial assistance had to be authorized to do so and were known as ADP Authorizers. This meant documentation was to be completed following coverage criteria and pretty strict guidelines for both the person and the equipment. Everything was subject to audit, ensuring adherence to policy and fraud mitigation. I was an authorizer for this ADP program and found myself doing part-time projects at the time when products were being assigned to generic categories, as opposed to line items/individual product listings.
This lead to a huge learning curve for me.
I needed to delve into each wheelchair and seating product available in the Ontario market with an eye for component detail, marketing and literature detail, and true clinical understanding. All while continuing with my much enjoyed private practice work.
As a consequence of working on these projects and my part time work with ADP, I had the opportunity to work full time with the Ministry of Health as Senior Project Coordinator for ADP seating and mobility categories.
Not in my wildest dreams did I ever imagine myself in this position!
Talk about jumping over the table from being in a role where I was defending my assessment, conclusions & recommendations and asking for the funding on behalf of my clients, to writing the policy for coverage criteria for individuals and the equipment while also reviewing all the requests from the field for funding. Contrary to what you might be thinking - I absolutely loved it! Even though most of my colleagues didn’t understand how I could say I loved that job, I truly and honestly did, and to this day I find myself benefiting from the knowledge and skills gained through that role.
From learning about government policy from the inside out and liaising on a daily basis with the manufacturers, suppliers and clinicians, not to mention occasionally fielding the calls from not-so-happy applicants - I was thriving in this new professional role. And it was about to get even better.
There was the assumption to some degree that OTs and PTs who were authorizers knew about seating and mobility and knew how to do the assessment and complete the government forms with confidence. What I quickly realized was that for clinicians, suppliers (vendors),manufacturers and consumers to understand what was needed by me and my colleagues at ADP to make informed decisions regarding the approval or rejection of claims for funding, we needed to be better at information sharing and education!
And there it began…… my first true public speaking ever! There was a need, and I was in a position to address it. As I started doing presentations on behalf of ADP, teaching clinicians how to do the assessment (where needed) and how to complete the Authorization forms correctly, I continued to learn and my passion for seating and mobility continued to grow.
I was a nervous wreck every time I did a presentation, just as I still am to this day!
While this may not seem like the traditional clinical route into seating/postural care, the experiences I had during those years added so much to the way I practice as a clinician and educator today.
The most significant takeaways for me from this step in my life journey were :
The importance of the hands on assessment from a clinical perspective.
This is where our understanding of the facts about body structure comes from. It’s hard to define what the basic and essential needs of the person are if we haven’t completed a thorough hands on assessment… there’s a lot going on under those clothes!
The importance of thinking about product solutions in terms of essential “generic” features.
For example, based upon the recorded findings and measurements from the assessment, “this person needs a cushion that will allow him to sink in or immerse enough to get his trochanters loaded yet not have his ischial tuberosities bottom out. He also needs to have his windswept femurs and lower legs/feet supported while maintaining a neutral pelvis. His cushion cover must help manage moisture without negatively impacting immersion”.
This is more useful information that ties directly into the assessment findings than simply listing a product name. The essential features would then be trialed via appropriately selected products. This process also provides a check and balance opportunity.
The importance of clear, effective and meaningful communication.
There is immense value in knowing, understanding and being able to communicate effectively about and within the coverage criteria for whatever reimbursement structure you are working within.
Several years after I began presenting, I met a gentleman by the name of Rick Jay. He was the owner of Jay Medical at the time, which was based in Boulder, Colorado, USA. I was introduced to the Jay philosophy, and when I think about this period in my career, some of the Jay clinicians such as Joan Padgett and Jane Fontaine come to my mind straight away! One could only admire the way this company and its leader, Rick, truly believed in clinical education as well as the clinicians’ views and values relative to seating and positioning at that time. Rick was a fantastic leader.
A decision was made. After a few visits to Colorado and some wise advice from my colleague and friend Michel Papillion (“but Sharon, you have to go – its US $$$$ after all”), relocating was inevitable. On Saint Patrick’s Day, 1996, myself and husband #1 ( who I met in Toronto and married in 1989!) along with my precious daughter #1 (who was then just turning 2) moved to Boulder, CO. What was meant to be one year working in Toronto at an outpatient clinic turned into 10 years living in Toronto working in a field I didn’t even know existed. Funny how life happens, isn’t it?
The next phase of my career and life journey began as I started my new role as the clinical educator for Jay Medical.
From orthopedics to sports, home health to govenment - my path has not been that of a “typical” physio by any means. I hope by sharing these experiences, new clinicians who are just starting their careers can see how flexible our roles as physios can be.
Thank you for reading this far…and I hope you’ll continue to read about my story in the next post (My American Dream: New Job, New Name, New Brain Injury) about what I learned during my time in the US and how I came to be Sharon Sutherland after being known so well as Sharon Pratt.
I’d love to hear about your first experience in Postural Care! What was your education like in school? How did you start patient care? Who were your mentors, and what were the most valuable pieces of information, or clinical pearls, that you learned from them?
Leave a comment below!!