Guest blog post by Bob Vogel
Ironically, the best-known wheelchair user these days doesn’t even use a wheelchair. Non-disabled actor Kevin McHale plays Artie Abrams, a 16-year-old high school student in a glee club who became a paraplegic in a car crash at age eight. Each week over eight-million TV viewers tune in and watch Artie on the hit TV show Glee on FOX Broadcasting Network. Hiring a non-disabled actor to play Artie has stirred up a lot of controversy in the disability community. The huge TV audience, along with the controversy prompted New Mobility Magazine to name Artie as their Person of the Year.
What bothers me about Artie’s character is, it appears that (at least for the first two seasons) the TV show didn’t bother hire a consultant (a physical therapist, occupational therapist or paraplegic) to create an accurate portrayal of a paraplegic. This is glaringly apparent by Artie’s ridiculous seating and positioning. The promotional photos of Artie — including the ones in New Mobility — are typical of Artie’s seating for the first two seasons, lower body contorted to the right, and his right leg is jammed against frame of the chair. Most of his weight is shifted onto his right side — right ischium — and he is sitting on a foam cushion. Apparently the folks involved with Glee thought this made Artie “look” paralyzed.
I took a small unofficial poll of wheelchair users and therapists and asked them what they thought of Artie’s seating and positioning, most quickly noticed that his seating was poor, and was an inaccurate portrayal of the way an average paraplegic sits.
“If an actual para sat like that he would quickly end up with multiple pressure ulcers that would likely land him in the hospital for months and cost $100,000,” Delia Freeny an occupational therapist registered/licensed (OTR/L) and an assistive technology professional (ATP) says. “Proper seating and positioning are preventative — it helps prevent pressure ulcers and orthopedic problems. Spending the time and money to get the proper equipment for each wheelchair user is inexpensive compared to the serious medical problems and huge hospital bills the wrong equipment will cause.”
Like it or not, television and media define much of our reality. The way Artie has been portrayed teaches the general public — including policy makers that decide on equipment funding — that a contorted seating position and sitting with all of your weight on one ischium on a foam cushion is the norm. We never see what would really happen with this kind of seating, a lengthy and expensive hospital stay with life threatening pressure ulcers.
Unfortunately, failure to see the importance of proper seating and positioning is not limited to TV shows. Although some progress has been made, it seems the people who create Medicare policy have also failed to see how crucial proper seating and positioning is. They’ve failed to see the difference between standard durable medical equipment (DME) like a wheelchair or foam cushion you can purchase at a drug store, and complex rehab equipment — a cushion, wheelchair etc., specifically fitted by a rehab team and prescribed by a physician to address the seating requirements of a specific individual. New Mobility provides an in depth explanation of complex rehab vs. standard durable medical equipment here.
This why it is important for each of us to continue calling, emailing and writing our senators and legislators, elected officials that work for us, and tell them we do not want complex rehab equipment included in competitive bidding. The continuous efforts of everyone so far have mattered because on December 27, 2011, CMS officially announced that cushion codes E2622–E2625 have been removed from the competitive bidding program! To find out how to contact your senators and legislators are see, “A Step-by-Step Guide to Contacting U.S. Representatives and Senators.”
Back in the TV world of Glee, after enduring two seasons of poor seating and positioning, Artie’s seating improved in season three. He is sitting straighter, his legs are no longer contorted to the right and his right leg is no longer pressed against the frame. It also appears he is sitting on some type of complex rehab cushion that addresses his seating needs, rather than the foam cushion. I imagine this change came about because folks at Glee either hired a consultant, or took heed of criticisms — including mine — about Artie’s seating. Either way — good for them!
In my imagination, one of two story lines transpired in Artie’s TV world to change his seating.
In my first storyline, Artie ends up in the hospital with massive pressure ulcers on his right calf and his right ischium. He develops osteomyelitis in his right ischium and almost dies. The kids at McKinley High School hold a constant vigil for Artie during the weeks he is in intensive care on strong antibiotics to kill the infection. He manages to beat the infection and undergoes surgical skin flaps to repair the wounds and spends another three months in the hospital to recover.
Once healed, Artie’s physician refers him to a much-needed evaluation at a seating and positioning clinic. At the clinic, Artie’s wheelchair and cushion requirements are evaluated by a team including a physical or occupational therapist, as well as an ATP and a physical medicine and rehab (PM&R) physician. After the evaluation, his PM&R physician carefully writes a prescription for his new equipment needs making sure to write the exact manufacturer, brand and size, of each piece of equipment to ensure he gets exactly what is prescribed. Because of Artie’s hospitalization, the physician is sure to write “to prevent re-hospitalization” on the prescription — key words that quickly get his equipment requests authorized and delivered. Artie is now sitting straighter and enjoys a successful season three.
In my less dramatic, but much more hopeful storyline, Artie notices a red area on his right ischium and right calf during his daily skin check. His parents make an immediate appointment with his primary care physician — she looks at the red areas and writes a referral to the seating and positioning clinic (described in the previous paragraph). Artie gets a full seating evaluation and a prescription for the proper equipment. Over the summer he does extra weight shifts, and extra skin checks until his new equipment arrives. When his new equipment arrives, his seating is improved, he has no more red “hot spots” and enjoys a successful season three.
Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group.