Building confidence around 'Behaviours of concern'

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Clinicians and therapists who work with wheelchair users will often encounter clients who demonstrate ‘behaviours of concern’.

This may involve rhythmic rocking, picking apart their wheelchair, biting themselves or others, general fussing and lashing out. Their wheelchair can take a battering as a result.

Many of these clients end up in the ‘too hard basket’ because clinicians lack confidence and knowledge about what solutions are available on the market, and how to tailor their assessment and intervention practices accordingly.

“It can be quite distressing as a therapist working with this population if you’re not confident in understanding why a person is presenting that way,” explains Lauren Hunter, Director of Clinical Services at Linds Rehab in Melbourne.

These issues will be addressed by Lauren during her upcoming seminar at the ATSNZ Disability Expo. Her topic ‘managing behaviours of concern through wheelchair interventions that allow for sensory expression and enhance participation’ is designed to help therapists look behind labels like ‘difficult’ or ‘destructive’.

“We have to marry the right style of assessment with the right equipment and the right ongoing intervention plan,” Lauren explains. “We have to look at the whole picture rather than accept a preconceived idea about what’s going on for the client.”

She says her seminar is designed to help therapists build confidence and discuss a certain type of client who they will often encounter. “It’s a large issue. Anybody who has an acquired brain injury can demonstrate behaviours of concern. Anybody who has developmental delay, intellectual disability or is non-verbal. They all have the ability to develop behaviours of concern because they’re trying to communicate. And sometimes, unfortunately that can lead to frustrations and result in them lashing out.

“It can either be a really rewarding experience when you put the right methods and practices in place for these wheelchair users. Or it can be an experience that is very daunting and can make you want to stay away from working with this type of population.”

Lauren’s seminar will touch on both the ideal assessment process and the actual wheelchair componentry available that can make a difference.

“A wheelchair, ultimately, becomes an extension of that person and an extension of their world. When they are needing sensory input or to use their environment to communicate, then the prescription and setup of the wheelchair become vital in making sure we’re getting their needs met. It’s also about making sure that we’re causing no harm to them or anybody else around them.”

Any movement is going to create some kind of force so it’s important to look at what elements of the wheelchair can capture that force, thus preventing injury.

“Reducing a pressure injury can be achieved through dynamic hardware and through absorbent material surfaces like foam or gel – so really looking at where we pad things out. But also just understanding that too much padding can take away function as well. Ultimately, we’re trying to get the balance right for that client because every client is going to look very different.”

Lauren’s 45 minute seminar will be held on day two (Thursday 2 November) of the ATSNZ Disability Expo at the Due Drop Events Centre in Manukau, starting at 8:45am.

“It’s a different topic but it does affect a large percentage of people that we work with within the wheelchair population. I’d love people to come and listen to what my experiences have taught me, what the latest research is saying, and the types of equipment and interventions that are available to start problem solving some of these client-centered issues.”

For more information or to register, visit ATSNZ 2023 (