In the early 1960s, Marilyn Blom, the first occupational therapist employed at Faribault State Hospital, fabricated a seating harness for a 13-year-old boy with cerebral palsy. With that support, this young boy sat up for the first time in his life. Blom had no training in seating or positioning or orthotics, but she knew that this boy must be positioned properly to function optimally.
There were no seating and positioning clinics for children then and would not be for a decade and more. In 1974, U.S. District Judge Earl Larson ordered that each Cambridge resident who required a wheelchair must be provided one adapted to his size and personal positioning needs by July 1, 1975. He found, based on the evidence he heard in the Welsch case, that “such wheelchairs are helpful in preventing muscular contractures and assuring proper posture and positioning in order to enable the resident to relate to and received stimulation from his immediate surroundings.” By then, the habilitation technologies laboratory at Gillette Hospital had developed seating and positioning systems that served these important purposes.
The order that Larson gave in 1974 had to be repeated in the Welsch Consent Decree in 1980 and a negotiated settlement in 1987. The state’s volume purchase contracts for standard wheelchairs proved to be an impediment to providing appropriately adapted wheelchairs. Inadequate reimbursement rates under both Medicare and Medical Assistance prevented many persons from receiving the type of wheelchairs and seating and positioning systems they needed.
Many of these barriers to provision of appropriately adapted wheelchairs have been removed, but the current financial crises will likely prompt insurance companies and government agencies to try to reinstate them. To counter such efforts we must portray the harm done in the past and stress the harm that will happen in the future if people cannot sit safely to observe and to learn from the world around them.