L16 Custom Mobility

Question 1

Complex Rehab Technology

Answer 1

Products and services including medically necessary, individually configured manual and power wheelchair systems, adaptive seating systems, alternative positioning systems, and other mobility devices that require skilled evaluation, appropriate configuration, custom fabrication, fitting, adjustment or programming.

Question 2

What happens with inappropriate
Complex Rehab Technology?

Answer 2

• Loss of mobility
• Loss of function
• Compromised positioning
• Increased health risks
• Increased health costs
• Decreased quality of life

Question 3

Wheelchair Selection

Answer 3

• Stroller
• Manual (Dependent or Propeller)
• Power Assist
• Power (Wheel configuration, Controls)

Question 4

Level of Propulsion

Answer 4

• Dependent Mobility
• Functional propulsion
• Independent/Active
  propulsion
• Power mobility

Question 5

Orientation in Space

Answer 5

Recline: Change of position in space with open seat to back angle (Fixed or dynamic)

Tilt: Change of position in space while
maintaining seat to back angle (Fixed or dynamic)

Question 6

Fore/Aft Rear Wheel Position

Answer 6

The rear wheels can be positioned either rearward or forward in relationship to the frame

Question 7

Frame Bucket or Squeeze

Answer 7

Standard seat to back angle
Closed seat to back angle

Question 8

Closed seat to back angle

Answer 8

*Might help increase UE and trunk
mobility and function
*Might help to secure pelvis in
position and reduce risk of sliding
into posterior pelvic tilt
*Might help manage tone and
spasticity

*Precautions:
- Need adequate hip flexion!
- Risk of hip flexion contractures
- Increased ischial pressure?
- Interference with transfers?

Question 9

Front Wheel Drive Pros

Answer 9

 More maneuverable than rear
wheel drive
 Climbs low obstacles
 Accesses tables and countertops
 Short overall length

Question 10

Front Wheel Drive Cons

Answer 10

Drives “backwards” as casters are in
the back (learning curve)

Question 11

Mid or Center Wheel Drive Pros

Answer 11

 More maneuverable than front or
rear wheel drive
 Good traction (client’s weight over
drive wheels)
 Very tight turning radius

Question 12

Mid or Center Wheel Drive Cons

Answer 12

• Depending on set-up, can rock front to back
• Can lift drive wheel off surface on some obstacles

Question 13

Rear Wheel Drive Pros

Answer 13

 Fair traction
 Holds straight line better than front or mid wheel
 Good for alternative drive controls

Question 14

Rear Wheel Drive Cons

Answer 14

-May be longer than other drive types
-Less maneuverable
-Have to compensate for front casters position

Question 15

Foam Cushion

Answer 15

Foam base alone provides stability but creates build-up of reaction pressure forces

Question 16

Foam Cushion Foam/Fluid Cushion

Answer 16

Addition of a fluid pad evens out the pressure distribution, which reduces build-up of reaction pressure forces

Question 17

Alternative Adaptive Equipment

Answer 17

• Standers
• Gait Trainers
• Bathing/Toileting Systems
• Specialty Beds/Cribs
• Car Seats