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Craig staffers innovate to help rural physician make safer deliveries

March 15, 2019

Dr. Mike Welch had a bit of a problem.

Because of his paraplegia and lack of muscle control in his trunk, the medical resident was having trouble getting into a good position to deliver babies. He had been bracing himself on the bed with one hand and delivering from the side, with a nurse’s assistance. It was a workable solution, but he knew there had to be a better way.

Enter the problem-solvers: Craig’s Outpatient Program and Rehabilitation Engineering department.

Mike is currently a medical resident with North Colorado Family Medicine’s Wray Rural Training Program. He is spending his first 15 months training in Greeley, Colorado, and will move to a rural practice in Wray, Colorado, for the remainder of his residency training.

“I knew that when I moved into the rural setting, I would be participating in many more deliveries without as much support,” he says. “I wanted to have a good solution for handling this.”

The leaders of Mike’s residency program reached out to Craig for advice. The Outpatient Program invited Mike to come in for an evaluation, and he spent a day and a half meeting with a team including physical therapist Jenny Hladun and occupational therapist Donna Rainford.

After examining the situation and discussing options ranging from harnesses to corsets, the therapists took Mike to see Dave Birkle, one of Craig’s rehabilitation engineers.

Craig’s donor-funded Rehabilitation Engineering department is managed by two full-time engineers and a handful of dedicated volunteers, who work in conjunction with all clinical departments and physicians to design, develop, modify, and apply rehabilitative and assistive technology, providing customized solutions to meet patient needs.

Denver7 recently did a story on Dr. Welch as part of their "Empowering Lives: Stories from Our Colorado" series.

The Outpatient Program team originally approached Dave about creating a chest-strap clamp that would attach to the back of Mike’s wheelchair.

After trying various options, they realized that a strap would cause Mike’s back to bow when he was leaning forward, taking away his arm leverage.

Dave then had the idea of creating a chest support that would attach to a lap tray mount —something he makes for many patients. After some trial and error and adjustments, they decided on a simple T-bar wrapped in pipe insulation that attaches to a board under Mike’s wheelchair seat. This center-mount chest support allows Mike to lean forward with his arms over the bar, giving him total support but complete freedom to move his arms.

“It was a very simple solution,” says Dave. “The secret to smart engineering is to keep it simple and make it robust.”

To ensure that the solution would really work, Jenny and Donna put Mike to the test. They borrowed a procedure suite from Craig’s Urology Clinic and a simulation mannequin from Craig’s Nursing Education department. They wrapped a newborn-size weight with plastic and coated it with lubricant to allow Mike to practice a “delivery” with his new device.

“We wanted to make sure that we were sending Mike back to his program with a solution that would help, and we wanted to let his program director know we had evaluated the device in as close to a real-life scenario as possible,” says Jenny.

Jenny says that this type of interdisciplinary treatment approach is not seen in most other facilities. “We aren’t reimbursed by insurance companies for co-treatments, but Craig knows that we need to work together and share our perspectives for the good of patients like Mike.”

Mike has already found an additional use for the support — as an aid to help him hold his trombone while he plays. He envisions it being useful for other medical procedures, including gynecological exams and trauma response. Other Craig patients have seen it and have imagined uses ranging from photography and hunting to welding.

“This is one of the reasons people work at Craig, seeing something like this happen,” says Dave. “The difference it makes for people is priceless, and you can’t buy feedback like that.”