Our seating service story: A synopsis spanning the Tasman (A brief history of the wheelchair-seating service sector in Australia & New Zealand) Author: Rachael Schmidt (OT/PhD student, Deakin University) Abstract: Poster History provides perspective, especially in the cut and thrust of providing best practice services. There is scant historical data pertaining to seating service development in Australia. This poster attempts to map the history of the wheelchair and seating service industry that was evident in New Zealand and Australia, over the past 200 years. The history is informed by personal memories provided by many ARATA members from New Zealand and Australia, who have long professional histories of working in wheelchair and seating prescription and supply. The personal recollections were shared electronically in response to the author’s request for a historical perspective, to assist an investigation into specialised seating servicing in Australia. Key contributors were invited to review relevant sections to corroborate of the historical story. Summary The historical story was presented as an interactive poster at the 2012 ARATA 2012 Conference in Sydney. The following paper provides historical background of the development of the seating-wheelchair industry in Australia and New Zealand, as recalled by many key contributors. A list of known seating services currently operating at August 2012 is also listed. Acknowledgements to PhD Supervisors: Professor Karen Stagnitti, Dr Genèvieve Pépin & Yvonne Duncan 1 Historical background from 1983-2012 New Zealand (NZ): As early as 1893, the New Zealand Thompson brothers started manufacturing wheelchairs in Auckland, North Island. A second Christchurch manufacturer, Betsone group began producing the ‘Chairmobile’ in response to a poliomyelitis epidemic in 1960s, in the South Island. The Hospital Wheelchair and Seating Service, in Auckland was the first seating clinic in Australasia in 1961 and included a centralised technical wheelchair service (WhitcombeShingler, 2006). The NZ Cripple Children’s Society was the first non-government agency to ‘address wheelchair and seating needs’ of children (affected by the polio epidemic) by lobbying for government funding for wheelchairs. Sonny Riordan, an occupational therapist employed by the NZ Cripple Children’s Society (1963-68) pioneered supportive seating systems (replacing vinyl slung seating). Working with a volunteer, Riordan designed and made individual high-density foam-plastic seating systems that provided a 90 degree hip angle for controlling extensor tone. The seats could be lifted out the wheelchair to be used as a car seat and on the floor (Whitcombe-Shingler). Since 1995, all New Zealand therapists seeking wheelchair funding must be registered nationally as an accredited assessor (Whitcombe-Shingler, 2006). Prior to the 2000s, access to disability funding, consumer-related decision making and even selection of the only NZ made wheelchairs were tightly controlled. This changed with the introduction of the Public Health and Disability Act in 2000 which was aimed at a more inclusive society. As a result seating services became client-centred, consumer decision making was empowered with education and wheelchair selection (and funding) was based on needs and not just limited to locally made wheelchairs (Whitcombe-Shingler). Currently Enable NZ provides national equipment and home modifications funding (Enable NZ, 2012). Enable NZ funds seating services and provides wheelchair-seating (A. Nicholls, 2 p.c. 28th November 2011) and night time positioning solutions (T. Maginnity, 1 st June, 2012). Enable NZ has an active assistive technology refurbishment program that can accelerate provision of wheelchair-seating products to its recipients (Browning, 2012). Wheelchair services, funding and selection are informed by client-centred approach (Howard-Brown, 2010), are needs-based (Nicholls) and wait times for refurbished wheelchairs are timely (Maginnity). More complex wheelchair provision may extend the delivery time if not available from the refurbishment inventory. All Enable NZ funded wheelchair assessment and seating prescription is undertaken formally, (on a medical referral) by accredited EMS ‘assessors’ who are credentialed under Equipment and Modification Service (EMS) Accreditation Framework (Howard-Brown, 2010). Enable NZ also funds the national training program aligned to the accreditation of EMS assessors (Enable NZ). Operating for approximately ten years, the Equipment and Modification Service (EMS) Accreditation Framework has recently been updated in 2010. The updated EMS competency program simplified the skill level needed to assist EMS prescription from a three layer to two levels of assessor classification. EMS accreditation is linked to a Ministry of Health (MoH) contracted and subsidized Seating to Go training program (Primrose & Howard-Brown, 2011). The Wheeled Mobility and Postural Management Competency Framework (WM&PM) recognises two levels of assessment related to the assessor’s clinical experience, consumer complexity and cost of the wheelchair-seating technologies in relation to consumer need (E. Gooder, personal communication (p.c) 14th March 2012). The two levels are described as Level 1: The EMS assessor at this level is able to prescribe for ‘non-complex’ prescriptions. A non-complex category of wheelchair, postural and lying equipment prescription describes standard off-the-shelf wheelchairs designed for a non-complex consumer needs e.g. A basic manual or powered wheelchair requiring no additional customisation. 3 Level 2: The EMS assessor of this level is able to prescribe for complex prescriptions. Level 2 category recognizes an advanced skill required to assess the complex postural and mobility needs and to prescribe appropriate wheelchair-seating systems, and lying systems required for an individual who requires more advanced mobility and day and night-time daily postural needs (Maginnity, p.c. 1st June 2012). The Wheeled Mobility and Postural Management Competency Framework is augmented by an assessor training program, operated by Seating to Go. The Seating to Go workshops cover posture assessment, seating prescription, manual and powered wheelchair prescription and night-time postural intervention and technology solutions. EMS assessors can attend the Seating to Go training workshops as many times as they feel is necessary. (Maginnity, p.c. 1st June 2012). NZ Seating Services currently operating Enable NZ-Wheelchair Service is based in Lower Hutt (North Island). Funded by the Ministry of Health (MoH) Enable NZ-Wheelchair Service is a comprehensive service to support EMS assessors and their consumers (aged ≤ 65 years) when seeking postural, positioning and wheelchair technology solutions (Enable New Zealand 2012). Enable NZ-Wheelchair Service, coordinated by an expert wheelchair-seating assessor, supports EMS prescribers with advice on product parameters and appropriate technology options. Access to Enable’s comprehensive re-issue store and technical services enhances the seating service outcome with the consumer taking home a fitted wheelchair-system (new or re-issued) for a one week trial. If successful the funding application is activated and the consumer retains the wheelchair system. Enable NZ covers the lower and central part of the North Island via an outreach service program, excepting Gisborne and New Plymouth environs (EMC assessors can phone for support). Enable services the South Island with outreach clinics (Enable NZ, 2012). Auckland DHB Mobility Solutions, based at Rehab Plus in Pt Chevalier, Auckland is a MoH contracted service for complex wheelchairs & seating needs based in Auckland (Auckland DHB Mobility Solutions, 2012) Wheelchair Solutions is a MoH funded disability service that operates a support wheelchair service for EMS prescribers in addition to a comprehensive seating service, Seating to Go. There is a Seating to Go service in Hamilton, Tauranga and Rotorua covering Bay of Plenty, Coromandel Peninsula, Rotorua areas (Seating to Go, 2012). 4 Seating to Go is a specialised wheelchair and seating service, and postural management assessment service. Seating to Go provides both an ACC assessment service for consumers under the no-fault injury scheme and a consultation service for EMS prescribers (Level 1 & 2) providing MoH services to consumers within wheelchair, postural and night time technological solution. Seat to Go is contracted by the MoH as an accredited wheelchair, seating and postural training program and is linked to accreditation of the EMS assessors (Seating to Go, 2012). ACCESS Clinic in Auckland operated by Accessable (MoH funded disability support service) to support EMS assessors where needed (clinical specialist and technician) and supports clients who are not sufficiently complex to be seen by Mobility Solutions. ACCESS Clinic is the Auckland/Northland equivalent of Enable NZ and provides equipment for consumers covered by ACC (New Zealand Government, 2012). Wheelchair & Seating Services are based within the local district health boards in Christchurch and Dunedin and can access Enable Wheelchair Service for more complex prescriptions, as required. (E. Gooder, personal communication 14 th March 2012). Australian seating service commenced in 1960s in NSW. In the absence of documented history pertaining to Australian seating services, the following is a brief history gathered via oral histories and personal recollections collected from the ARATA members and friends. During the writing of this synopsis the author invited relevant contributors to member check pertinent sections of this historical compilation, via email. The historical background has been presented within each state (or territory) and is followed by a list of known seating services currently operating (as at August 2012). Any seating service providing a select service for medically or organisationally linked clientele is identified with an *. New South Wales (NSW): The first Australian seating service was probably operating in the mid 1960s within the Spastic Centre of New South Wales, Allambie Heights in Sydney. By 1967 The Spastic Centre (TSC) was operating an internal technical training and employment program and 5 proudly announced this program was manufacturing two hundred ‘electric wheelchairs’ (TSC, 2010). In New South Wales (NSW), Rehab Engineers Bill Fisher and Robert Bingham employed by Royal Sydney Hospital, inner Sydney, set up a seating service in approximately 1980-2. This seating service that was transferred to Prince of Wales Hospital after the Royal Sydney Hospital closed (L. Walker, personal communication, 14th October 2010). Currently the NSW Spinal Seating Services (NSWSSCIS) operates two seating services catering for adults living with spinal cord injury (NSWSSCIS, 2010). One is located at Prince of Wales Randwick campus, known as The Seating Service at the Prince of Wales (POWH) services an aligned inpatient cohort and rural south eastern Sydney and the Illawarra Area Health zone (NSW Spinal Seating Services). The second service, the Assistive Technology & Seating service (AT&S) is located at Royal Rehabilitation Centre, recently relocated to Gladesville, servicing adults living with spinal cord injury, with medical links to Royal North Shore Hospital or Royal Rehabilitation Centre Sydney and rural NSW not covered by POWH Seating Service. Both services offer rural clinics addressing posture and pressure care and wheelchair mobility technology for consumers living with spinal cord injury and each work closely with local health care services (NSW SSCIS) in rural New South Wales. The Agency for Clinical Innovation (ACI) State Spinal Cord Injury Service was established in 2010 and maintains a comprehensive educational web-site (modules, videos & workshop program) to support the clinical development of health professionals working with spinal cord injury. The ACI Spinal Seating Professional Development website provides ten self-directed learning modules to build prescribing clinician’s skill and confidence in spinal seating and wheelchair prescription and practice (ACI, 2012). In outer Sydney, Parramatta, the Northcott Equipment Service (NES) commenced as an internal customised seating service for consumers of the Northcott Disability Services (1992). 6 By 1995, under the leadership of occupational therapist Sandra Vassallo and in partnership with occupational therapist Penny Knudson and Barbara Cooke (orthotists) and technicians, the NES customised seating service became the first Australian seating service to operate under a cost recovery model providing services to all consumers requiring customised wheelchair seating system (P. Knudson, p.c. 8th August 2012). Below are the current seating services operating in NSW (with approx. starting date): Assistive Technology & Seating (AT&S) *, Royal Rehabilitation Centre, Sydney, initially at Ryde and recently relocated to Gladesville providing metro-based and remote services to medically linked consumers in NSW & ACT (1982-84?). POWH Seating Service*, Sydney providing metro-based and remote services to medically linked consumers in NSW & ACT (1982-84). TASC*- Cerebral Palsy Alliance, Allambie Heights Sydney operates a technology and a seating-wheelchair consultative service for primary therapist and their consumers living with Cerebral Palsy (1962). Northcott customised seating service, Parramatta (1992). Northcott customised seating service provides a prescription & technical consultative service for all consumers requiring high-end wheelchair-seating solutions. Megalong Positioning Service (MPS). Established in 2001, MPS is a social enterprise under the governance of Greystanes Disability Services (a 57 year old charity) in the Blue Mountains, New South Wales’ (Megalong, 2012). MPS provides an expert assessment and technology solutions that addresses complex postural and 24 hour positioning advice and services. Wheelchair Seating Consultancy service, Western Health NSW LHD, is located in Bathurst. Sarah McBurney (occupational therapist) provides a consultancy service to develop the work capacity of the occupational therapy (OT) in Bathurst, Orange, Cowra, Forbes, Parkes and Dubbo and environs. McBurney worked (with technician Jim McWhinnie) for twelve years in the Bathurst Seating Clinic until its closure in 2010. In her current NSW Health funded position, McBurney, as a seating consultant supports primary therapists (OTs in their consumers’ home environments) through their complex wheelchair and seating prescription processes (S. McBurney, p.c. 10th August 2012). Queensland (Qld) 7 The first Queensland seating service, ETS Mobility, was operating at the Spastic Welfare League in New Farm, Brisbane, around 1979 (P. Slattery, p.c. 14th October 2101). ETS Mobility has been rebadged as Mylestones Mobility and is part of the Qld Cerebral Palsy League commercial arm of Mylestones Employment services, located in Geebung. Mylestones Mobility offers both consultative services to primary therapists prescribing for Medical Aids Subsidy Scheme (MASS) listed wheelchairs and seating solutions. The current team is coordinated by physiotherapist Rae Parker who has access to a technical-therapy team on an as-needed basis (R. Parker, p.c. 23rd April, 2102). At a similar time (1979), a second wheelchair seating service commenced within the Royal Brisbane Children’s Hospital, Herston under the leadership of Biomechanical Engineer Dr Gil Logan in collaboration with acting medical superintendent Simon Latham and Dr Paul Hopkins (Rehab Specialist). The original seating service commenced initially as a twelve case project (P. Slattery, p.c. 24th April, 2012). Still located within the Royal Brisbane Women’s Hospital (RBWH) Herston campus, the RBWH Rehabilitation Engineering Centre continues to customize personal wheelchair, seating and controls using ‘engineering principles and skills and knowledge of health science to create effective technology solutions to assist people’ (RBWH, 2010) experiencing pressure, postural and wheeled mobility needs for specified Brisbane regions and select remotely located Queenslanders. Long servicing Rehab Engineer Peter Slattery coordinates an engineering team and co-opts RBWH therapy services on an as-needed basis. In 1992, Rehabilitation Technology Service (RTS) – was commenced by Cootharinga Society of North Queensland in Townsville under the directorship of Dr Lloyd Walker initially working with children (L. Walker: p.c. 2nd May 2012). ‘Cootharinga’ RTS continues to operate from Townsville with a regional mobile Cootharinga team servicing regional Queensland around and including Cairns and Mackay (Cootharinga, 2012). Originally Cootharinga was 8 established in 1951 (as the North Queensland Society for Crippled Children) to address care, education and training for children who contracted poliomyelitis (Cootharinga North Queensland Ability First, 2012). Today Cootharinga’s RTS services a diverse cohort, of all ages who require repairs and modifications to wheelchair seating and associated mobility technology. The RTS team provide a mobile assessment service from Cairns to Mackay and environs in between (Rehabilitation Technology Service, 2010). In 1933 The Queensland Society for Crippled Children was caring for children affected by polio epidemic. As occurrence receded the organisation expanded to cater for children living with a range of disorders and eventually became MontroseAccess. MontroseAccess wheelchair service was established to provide a multidisciplinary clinic approach to support therapists and address timely seating- wheelchair prescription for children and their families. Physiotherapist Helen Posselt has been identified as the probable instigator of the original dedicated seating clinic based at Corinda. The Corinda based clinic was specifically designed to provide centralised services for a large number of consumer families and to support inexperienced therapist within an experienced team. The current physiotherapist coordinator reports that: ‘Each appointment is ... attended by the client, their parent or carer, and their MotnroseAccess therapist (most commonly physiotherapist, but sometimes occupational therapist), as well as me and the equipment supplier. We mostly use off-the-shelf products ... although some of the suppliers ... custom make ... backrests, armrests with incorporated leg supports to control abduction, and ... customised push handles to achieve adequate [attendant] handle height. We use a variety of off-the-shelf backrests, cushions, lateral supports, armrests, headrests, footplate configurations and the like. For those clients who require fully customised seating, our therapists refer them to the Rehabilitation Engineering Clinic based at the Royal Children's Hospital’. (S. Fifoot, p.c. 27th August 2012). A second seating clinic operates at the Gold Coast and a multi-disciplinary team provides an outreach service to Queenslanders living with neuromuscular conditions. 9 Current Qld seating services (with approximate starting date) are identified below: RBWH Rehabilitation Engineering Centre, Royal Brisbane and Women's Hospital (1979-8) provides engineering solutions to southern Queenslanders. Cootharinga RTS (Rehabilitation Technology Services) - Cootharinga Society of North Queensland, Townsville (1992) to North Queensland between Cairns and Mackay regional environments (inclusively). Mylestones Mobility*-Cerebral Palsy League, Geebung, Brisbane provides a unique service model providing a combination of expert consultation to local equipment prescribers, plus individual prescription and (MASS funded) wheelchair and seating equipment to assist people living at home (R. Parker, p.c. 23rd April 2012) (initially as ETS in 1979- relocating as Mylestones Mobility 2010). Montrose Access*, Corinda, Brisbane is the clinic base for the multidisciplinary therapy team with wheelchair technician access. Montrose Access also provides an outreach consultative service at the Gold Coast to support local therapists providing services to children with severe and complex needs, often neuromuscular conditions (Montrose, 2010). Princess Alexandra Hospital spinal posture & pressure management clinic* for medically linked consumers living with spinal injuries in Queensland. Western Australia (WA) Around 1978, the Royal Perth Hospital, commenced the first hospital-based seating service in Australia, known as Rehab Technology Services (RTU) (ARATA, 2007). RTU team of therapists, engineers and technicians is coordinated by Rehab Engineer Robert Bingham. RTU is located at Royal Perth Hospital, Shenton Park Campus and is a state funded provider of specialised wheelchair-seating systems for medically linked patients and consumers living with neurological disorders. In Western Australia, around 1987, the Rocky Bay Technical and Equipment Services was operational in Mosman Park and relocating later to Cockburn Central premises in Perth as Posture Tech (2012). The current Posture Tech team of therapy, rehab engineering and technical specialists is coordinated by physiotherapist Cheryl Lockwood. Posture Tech 10 provides a comprehensive consultative service to primary therapists, including assessment, prescription and training and technical services for modification and manufacture of seating solutions. The current WA seating services are: CP Tech, The Centre for Cerebral Palsy* (in Coolbinia, 1980) provides clinical and technical services to consumers with Cerebral Palsy in WA. Rehab Technology Unit RTU*, Royal Perth Hospital, Shenton Park, provides a consultative service to support hospital, rehabilitation and community-based therapists and consumers living with spinal injuries and multiple neurological disorders. Posture Tech-Rocky Bay, Perth provides a consultative clinical and technical support service to primary therapists and their consumers living with disabilities requiring highend postural and mobility solutions. [Community Resource & Consultancy Team: a WA country AT consultancy service to support rural allied health prescribers involved in complex wheelchair-seating] Australian Capital Territory (ACT) In the mid 1990s, medical specialist Dr Ralph Farnbach and physiotherapist Zaieka Annon are credited with initiating the Specialised Wheelchair and Posture Seating Service (SWAPS) initially within the Canberra hospital (P. Knudson, p.c., 8th August 2012). Around 2004-5 SWAPS moved from the hospital to a community centre in Woden as part of the Aged Care and Rehabilitation Team and finally SWAPS settled into their current spacious communitybased location in Kambah. Current coordinator is occupational therapist Harold Brown. Current ACT seating services: SWAPS in Canberra. SWAPS is a HACC funded service providing an assessment and consultative service to assist primary therapists and their consumers with the prescription of customised wheelchairs and specialised seating systems (including customising and fitting for individual needs) (RACC Services, 2012). Northern Territory (NT) 11 The original Northern Territory SEAT Clinic probably originated around 1983 by paediatric physiotherapist Ann Lind and machinist Chris Ogle working in the Royal Darwin Hospital basement. In 1989, Lind and seating technician John Bellman and later Trevor Gilford were operating the SEAT Clinic-Darwin which provided an outreach service to remote Northern Territory and as far south as Alice Springs until Lind retired in 1992 ( L. Marshall, p.c. 7th August 2012). According to present coordinator occupational therapist Lisa Marshall the SEAT Clinic-Darwin provide a consultation service with a strong education role for primary therapists and their consumers living with complex neuro-muscular disorders, both located in Darwin and in the remote north of Northern Territory. In 1994, the SEAT Clinic in Alice Springs was opened. Due to difficulties experienced in recruiting permanent allied health practitioner-coordinator, backup assistance was accessed from Seat Clinic-Darwin between 1995-6, according to The Alice Springs News (1998). Orthotists Ian Mortimer, when employed by Regency Park (now NovitaTech) recalled providing visiting specialist expertise to the Alice Spring seating service during times of allied health vacancies in 1990s (I. Mortimer, p.c. 20th August 2012). Additional assistance was again provided by NovitaTech during the 2000s with scheduled visits by occupational therapist Andrew Condon before he became service coordinator of the SEAT Clinic-Alice Springs. Condon was the Alice Springs service coordinator for three year until June 2012 (A. Condon, p.c. July 2012). Current NT seating services: SEAT Clinic-Darwin (1989, officially opened 1992), based in Darwin and provides remote services north east and west of Darwin and south regions not covered by the Alice Springs clinic (L. Marshall, p.c. 2012). SEAT Clinic-Alice Springs based in Alice Springs. This service provides a consultative service to Alice and outlaying lands and communities from the three aligned state including communities north to and including Tennant Creek (A. Congdon, p.c. 2012). 12 South Australia In South Australia, the current NovitaTech (formally Regency Park Rehabilitation Engineering seating and technology service) was the second Australian seating service to commence around 1976-8 in Adelaide (L. Walker, p.c. 14th October 2010) as part of the Cripple Children’s Association. NovitaTech’s team consists of rehabilitation engineers, orthotics and experienced technicians (10-≤18 service years) that co-opt Novita Therapy Services as needed (A. Rose, p.c. 16th January 2012) to customise mobility and seating solutions for people with complex wheeled mobility and postural needs in South Australia (NovitaTech, 2009). Rehab Engineer Andrew Rose is the current service coordinator. Current SA seating services: NovitaTech, Novita Regency Park, Adelaide (1976-78). DCSI Wheelchair & Seating Clinic* (2009) based at Woodville Park, provides clinical and technical seating and wheelchair assessment and manufactured solutions. Fortnightly clinics at Gilles Plains & Highgate Park, Adelaide. Hampstead Rehabilitation Centre: SASCIS seating clinic* provides posture and pressure consultation to medical linked consumers living with spinal cord injuries in South Australia and Northern Territory. Tasmania (TAS) The Special Seating Clinic within Royal Hobart Hospital commenced in 1989 (Schuringa & McGarth, 2004) operated by a small multi-disciplinary team and outsourced expertise from Regency Park (I. Mortimer, p.c. 20th August 2012). In 1998, the Royal Hobart Seating Clinic and the Prosthetic and Orthotics (P&O) departments amalgamated with the Repatriation Prosthetic Limb Centre to relocate to its current location adjacent to the Repatriation Centre, Davey Street, Hobart. The Orthotic and Prosthetic Services Tasmania (OPST) provides a combination of orthotics, prosthetics and specialised seating services (J. Schuringa: p.c. 19 th 13 December 2011). According to the current physiotherapist Joyce Schuringa, the current OPST service model was greatly influenced by the vision of the then visiting orthotists Mortimer. As a Regency Park (now NovitaTech) orthotists, Mortimer provided a visiting clinical service to the Royal Hobart Hospital seating service in the 1990s, before the current OPST amalgamated with the P&Os and relocated to Davey Street. Current TAS seating service: OPST, is located in Hobart. ‘The Special Seating Clinic is a team and facility within Orthotic Prosthetic Services Tasmania, which provides a service for people who have complex disabilities and require specialised seating and/or wheelchairs’ (DHHS, 2012). Victoria The Victorian specialised seating service was flourishing in the 1980s with the Customised Seating Service, sited within St Nicolas Hospital and the Posture & Pressure Care clinic at the Austin Hospital. The Customised Seating Service was initiated by physiotherapist Mary Vaughan, Dr John Woodhouse and James Dean, in 1982. The Customised Seating Service introduced shape conforming seating for 30 bed-ridden adult residents at the St. Nicholas Hospital (J. Dean, p.c. 14th October 2010). Evolution from institutional care to an inclusive social model inspired the team to manufacture postural supports to sit-out-bed adults with complex postural needs. Informed by innovations from the Chailey Heritage School UK, Vaughan and Woodhouse introduced a range of innovative robust, body moulding technologies including plaster casting, vacuum bean bagging and hexalite seat shapes (re-mouldable thermoplastics) and the Matrix seating system capable of supporting complex postures (D. Blenkinsop, p.c. 10th August 2012). Initially funded by the School Commission, the Customised Seating Service was transferred to Kew Cottages, in 1986 on St Nicholas Hospital closure (B. Contoyannis, 14 p.c. 2010). Eventually this seating service was amalgamated into the (then) Spastic Society of Victoria's TREC workshop and Vaughan & Woodhouse retired 1991 & 1991 respectively. During 1990s TREC continued to explore moulded seating technologies, including the Seating Assessment Unit (also known as Queensland Back), lining hexalite shells with a closed cell foam ‘evazote’ and mounting seating on tilt in space repositioning technology for added postural comfort. In 2004, TREC was closed by (the rebadged) SCOPE as it redirected its focus to core services (D. Blenkinsop, p.c. 10th August 2012). Some of the above seating technology passed to competitors Jack Sibbings (Sibbings Wheelchairs) and Mobility Plus (D. Blenkinsop). James Dean recalls originally establishing his company Technical Solutions in 1985 to manufacture support frames for the Matrix seating systems used by the Customised Seating Service Dean, p.c. 5th August, 2012). From this early seating focus, James Dean and his Technical Solutions team have now become better known as leaders in the design and manufacture of electronic assistive technologies for adapting toys, computers, augmentative communicative devices and age related monitoring systems (Technical Solutions, 2012). In 1982, the Posture, Pressure & Seating (PP&S) clinic was being coordinated by physiotherapist Yvonne Duncan, including nursing, medical and orthotic staff working within spinal cord injury unit, Austin Hospital. PP&S currently operates under the Victorian Spinal Cord Injury Services to seating & pressure care services for medically linked inpatients & consumers living in the community via the SPORRT team (Y. Duncan, p.c. 8th August 2012). The P&PC clinic team consists of a spinal nurse and physiotherapist Liz Clements as coordinator (L. Clements, p.c. 9th May 2012). The contribution of the RehabTech team under Rehab Engineer Dr Bill Contoyannis’ leadership requires recognition for the wheelchair related research and the development of 15 industry standards over several decades. The Monash University based RehabTech team has generated quality technical advice, engineering expertise (R&D and industry standards) and product analysis (testing) specific to the Australian wheelchair and seating sector. In 2002-3, Yooralla Society of Victoria gained pilot funding for the Seating Advisory Service (SAS). The SAS provided a consultancy service (coordinated by the author) for communitybased therapists. Without ongoing funding SAS ceased operation and Victorians have not had access to a specialised seating service since. In the response, a small group of seating practitioners and suppliers, facilitated by Ron Smelter, met regularly to stay current with rapidly evolving wheelchair technology during the 2000s. In the past decade a strong vendorbased technical & assessment skill has progressively deepened to meet the consumer & prescriber demand in Victoria. The vendor strength in expertise is considered unique to Victoria and could be as a consequence of the lack of a centre of seating service excellence. In May 2012, Royal Melbourne Health secured pilot funding to operate a small seating service. Although there is not much detail to hand, it is understood this seating service will provide for a select number of cases (≤20). Current Victorian seating services: Royal Melbourne Health*: Pilot seating service project (2012) Austin Health: Spinal Posture & Pressure Care Clinic* (P&PCC) (1982), clinics held at Heidelberg and Kew* as part of Victorian Spinal Cord Injury Services. (Calvary Health Care Bethlehem Hospital operates a multidisciplinary service specialising in progressive neurological disorders. The Bethlehem team has a holistic approach to the management of neurological disorders that also involves the prescription and provision of wheelchair-seating solutions and modified or alternative controls for operating wheelchair systems (P. Smith personal communication, 28th August 2012).) (ISIS Primary Care has commenced a small in-house community based clinic (with supplier support) for assisting complex wheelchair and seating prescriptions, in 16 Melbourne. According to occupational therapist Alison Schneider, each consumer is assigned an occupational therapist with the assistance of another for the physical assessment and trial of equipment. This clinic approach has resulted in a more confident justification for wheelchair customisation (A. Schneider p.c. 16th August, 2012). Young Adult Transition Clinics* located at Southern Health, St Vincent, Bendigo Health and Melbourne Health. The young adult transition clinics provide specialist medical and allied health services for young adults with complex disabilities transitioning from adolescence to adulthood, including wheelchair-seating prescription. (The Royal Children’s Hospital Melbourne, 2010; Fahey, Shannon, Blackburn & Mackenzie, 2002). In summary: New Zealand operates under a national Enable NZ disability funding system that ensures all New Zealanders, who have postural and mobility needs have access to appropriately prescribed wheelchairs-seating systems. Enable NZ ensures a quality assessment process, via an accreditation of qualified EMS assessors linked with a nationally endorsed training program and national program of seating service access and provision. In Australia, wheelchair and seating technology is funded by individual Australian state-bystate funding schemes operating independent protocols of assessment, provision and funding policies, ranging from subsidised/consumer contribution to needs-basis. The Australian seating services sector is fragmented as each service is operated and funded by a range of private, state health/disability and non-government organizations. Commencing June 2013, the National Disability Insurance Scheme (NDIS) will be implemented in Australia. The NDIS is a national funding program in which the consumer will have access to and manage their own care package to purchase their disability related support services, assistive technologies and resources. It is anticipated that the introduction of NDIS, as a national funding program will overrule all current state run funding schemes and any existing (albeit fragmented) quality control protocols that may monitor assessment and provision of wheelchair-seating systems. A new model of quality control is required 17 urgently. The New Zealand Wheeled Mobility and Postural Management Competency Framework is one working model of assessment quality control at a national level. A national program of accreditation of seating prescribers was highlighted as an issue of high priority by delegates at the ARATA 2012 Conference. The national approach of accreditation should be aligned with a national approach to training and quality assurance protocols for both seating services/clinics and wheelchair service provision currently operating in Australia. References: ACI NSW Agency for Clinical Innovation (2012). Spinal Seating Professional Development. Retrieved from: http://www.aci.health.nsw.gov.au/networks/spinal-seating Auckland DHB Mobility Solutions (2012). Retrieved from: http://www.healthpoint.co.nz/specialists/allied-health/auckland-dhb-mobility-solutions/ Browning, H. (2012). Refurbish, re-issue & rejoice. Conference paper ARATA 2012 National Conference-Bridging the AT Gap, Sydney 21-23rd August 2012. Cootharinga North Queensland Ability First, (2012). Rehabilitation Technology Service. Retrieved from: http://cootharinga.org.au/services/rehabilitation-technology-service/ Cootharinga North Queensland Ability First, (2012). Our History. Retrieved from: http://cootharinga.org.au/about-us/our-history/ DHHS, 2012. Royal Hobart Hospital. Orthotic and Prosthetic Service. Retrieved from: http://www.dhhs.tas.gov.au/service_information/services_files/RHH/treatments_and_servic es/orthotic_and_prosthetic_service Enable NZ, (2012). About us. Retrieved from: http://www.enable.co.nz/about-us Enable New Zealand (2102). 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