Wheelchair content Flashcards
Players in wheelchair service delivery
client and family caregivers
therapist - PT or OT
physician
DME/CRT supply company
-CRT- complex rehab technology
supplier (CRTS with ATP and or SMS certification)
-CRTS: complex rehab tech supplier
-ATP: assistive tech professional (must be present on assessment according to medicare (or SMS))
-SMS- seating and mobility specialist
CRT technician - complex rehab technology
Types of certifications for assistive tech:
RESNA - Rehabilitation Engineering and Assistive Technology Society of North America offers two types
–ATP: assistive technology professional
–SMS: seating and mobility specialist
ATP VS SMS EXAM:
-The ATP exam is broad-based covering all major areas of assistive technology, the SMS exam is focused specifically on seating, positioning, and mobility.
Identification of wheelchair need
TYPES OF NEED:
-new wheelchair user: unable to walk safely and functionally in environments where they need to be mobile
-existing user: wheelchair no longer meets needs
–> due to change in condition, growth, or disrepair of equipment
–look at seated posture, skin breakdown, functional mobility
WHO CAN IDENTIFY NEED?
-client, family
-DME/CRT company
-physician
-other health prof, school staff
-treating PT or OT
Assessment for wheelchair
PERFORMED BY:
-PT or OT
–medical fucntional need
–primary problems identified
–seating and mobility objectives and goals
–POC
-supplier
–therapist and supplier together determine necessary features for patient’s goals –> match to tech
–make recommendations of tech
-physician (must be face to face)
Eval by PT or OT includes:
background
personal function
mobility function
physical assessment
-establish initial goals and POC for assessment process
Eval by CRTS or ATP, and therapist includes
seating simulation
special tests/product trials
final prescription/intervention plan
-go through the order form together if possible
-establish and document health concerns and functional impairments to provide a rationale for the recommended mobility device and accessories
-establish final POC for implementation and follow-up phase
Who is involved in finding auth/documentation?
PT or OT
supplier
physician
DME/CRT company
What is the order of least costly to most costly assistive devices according to Medicare?
Ambulation aids
Standard manual wheelchair w/ minimum adjustability
fully configurable MWC
power scooter
power wheelchair
** justify why less costly version does not meet person’s medical and functional needs
CMS documentation requirements for an assistive device
1.) Prescription and 7-element order
2.) Detailed product description
3.) Chart Notes of face-to-face exam by a physician
4.) Clinical documentation
–face-to-face exam form or report (physician or
therapist)
–specialty eval form or report (by therapist)
5.) Home assessment report
PHYSICIAN’S ROLE DOCUMENTATION
-face-to-face exam
-7 element order
-refer to a therapist for completion of F2F or specialty eval
SUPPLIER’S ROLE DOCUMENTATION
-tech assessment with a therapist if needed
-detailed product order
-home assessment report
PT/OT ROLE DOCUMENTATION
-specialty evaluation report or form
SUPPLY COMPANY’S ROLE DOCUMENTATION
puts together a full packet of ALL the documentation, and submits to the insurance company
What is the specialty evaluation performed by the physical therapist?
-typed or handwritten
-represents therapy eval and technology assessment t
-no one specific form is accepted
-must be hand-signed by YOU and hand-dated by you
-Report or Form must attest that you completed the form/did evaluation and that you have no financial relationship with the
supply company providing the wheelchair
** DME/CRT company or CRT supplier BEST source of info on what is needed from you as a therapist
THINGS TO DOCUMENT:
-findings from the eval
-results of simulation or product trials
-less costly alternatives and why they cannot address the client’s medical/functional needs
-address payers coverage criteria for the type of wheelchair and accessories recommended
Who is involved in the wheelchair implementation process?
PT and OT
supplier
technician
DME/CRT company
The implementation process for wheelchair
shape capture for custom contoured seating -> PT has a role in making sure the client is sitting in an optimal resting alignment during shape capture and optimal postural alignment
Order equipment (supply company)
Equipment set-up (technician)
Fittings/delivery
-a person must be seated
-fit is checked and numerous adjustments made
-may need more sessions for fitting before delivery
-check to make sure all features are specified and all objectives met
Training for implementation
Training of consumer and/or caregiver in proper positioning as well as operation care and maintenance of equipment –> (can be done by PT/OT, supplier and/or technician)
-transfer or WC training by PT or OT
Follow-up process for wheelchair fitting
Adjustments and modifications
-change device properties, need an original evaluating team
-PT or supplier
Repairs and Maintenance
-not altering device properties, does not require clinical judgment
-technician performs
Reassessment
-assess whether objectives are being met so equipment can be modified or adjusted to reflect progress or changing status of individual
-done by PT/OT or supplier
Billing for wheelchair fitting process
Assessment Phase: 2-3 sessions
Tech Assessment
-additional sessions required to complete wheelchair assessment or if billed with initial PT eval need to apply 59 modifier
Follow-up phase: 1-3 sessions
-fittings, delivery, and training
-97542 wheelchair management
-97535 self-care/home management
-we write POC to cover assessment and follow-up phases of service delivery
-must update POC for initial visit cause there is a 2-3 month delay before follow-up phase
-home modifications are often not covered by insurance
-Medicare does not cover a backup device
Body segment angle for hip flexion and extension joint motion
thigh-to-trunk angle
Body segment angle knee flexion and extension
thigh to lower leg angle
Body segment angle for ankle DF (PF) motion
lower leg-to-foot angle
Seating angle for hip flexion
seat-to-back support angle
Seating angle for knee extension
seat to lower leg support angle
Seating angle for ankle DF
lower leg support/foot support angle
What joints are assessed in a supine mat assessment
pelvis and spine flexibility
hip flexion
knee extension with hips flexed
ankle dorsiflexion
pelvis flexibility assessment
palpate ASIS and PSIS
determine flexibility by trying to move pelvis manually towards neutral position
Hip flexion assessment
Hip flexion angle = 180 - thigh to trunk angle
supine, knees flexed
place hand under pelvis to feel iliac crests and lumbar space
monitor lumbar flattening/posterior rotation with hip flexion
in most ppl at end of hip flexion range the pelvis will posteriorly rotate
Knee extension with hips flexed assessment/hamstring length assessment
Knee flexion angle= 180-thigh to lower leg angle
-hips flexed to end comfortable range or 90 degrees if no limitation
-make sure the pelvis and lumbar spine are in the client’s neutral position
-keep one hand under the lumbar/sacral area as you extend the knee slowly until you feel pelvis posteriorly tilt or the lumbar spine flatten
Ankle dorsiflexion assessment
Ankle dorsiflexion angle= 90- lower leg to foot angle
-assess in supine
-hips and knees flexed to the angle determined in prior procedures
-stabilize thigh and lower leg with one hand just below the knee
-move foot into dorsiflexion
Other body measurements that are taken during wheelchair assessment
buttock/thigh depth
shoulder height
elbow height
lower leg length
hip width
What is the ADA?
The Americans with Disabilities Act (ADA) became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public
What are the 4 titles of the Americans with Disabilities Act?
Employment
-regulated by the Equal Employment Opportunity Commission
Public Service
-regulated by the secretary of transportation
Public Accommodations
-regulated by the attorney general
Tele-communications
-regulated by the Federal Communications Commission
Bathroom requirements
42 inch minimum grab bar on side of wall
36 min grab bar on back of wall behind toilet
Home specifications * MEMORIZE
Sidewalk width- 36”
Door width- 32 min-36” preferred
Hall width - 32-40” preferred (36” in the middle)
Threshold height absent or up to 0.5”
Door handles 36” max from floor, lever type
Ramp 36-48” wide, no more than 1” rise for each foot of length
**ramps longer than 30 feet will need a landing area
What is the min height needed for knee clearance in a kitchen?
29”
What is the needed length for safety grab bars in a bathroom for wheelchair user?
24-30” long
Group 1 and 2 mobility assistive equipment
basic power wheelchairs
Group 3 and 4 mobility assistive equipment
complex power wheelchair
What are the three main types of power mobility devices?
scooter
basic power wheelchair
complex power wheelchair
What kinds of chronic med conditions would indicate need for group 1 or 2 power mobility devices?
-circulatory conditions
-cardiac conditions
-pulmonary
-ortho
What kinds of medical conditions would indicate the need for group 3 or 4 mobility devices?
neurological conditions
myopathies
congenital skeletal deformities
Scooters appropriate for
-good head/trunk control
-can use UEs to control tiller
-can get in and out of seat safely
-travel longer distances
CON
-the turning radius may limit mobility or independence
Group 1 basic power wheelchairs
-for limited, intermittent use (< 2 hrs/day)
-no headrest
-5 mile range
-3 mph speed
-6” incline
-20 mm obstacle climb
-300 lbs max weight
Group 2 basic power wheelchair
-for continuous use (>2 hrs/day)
-headrest may be included
-single and multiple power options
-up to 600 lbs
-7 mile range
-3 mph speed
-6” incline
-40 mm obstacle climb
Group 3 complex power whelchairs
-for active users with continuous use needs
-sling/solid seat or captain’s chair
-single or multiple power options
-up to 600 lbs
-12 mile range
-4.5 mph
-7.5” incline
-60 mm obstacle climb
-suspension for comfort and skin protection
Group 4 complex power wheelchairs
- very hard to get funded
- ask specific questions to justify
*for highly active users with continuous use needs and need to encounter non-accommodated terrain
*have added capabilities that are not needed for use in the home by some payers (Medicare)
-sling/solid seat or captain’s chair
-single or multiple power options
-up to 600 lbs
-16 mile range
-6mph speed
-9” incline
-75 mm obstacle climb
Alternative drive controls
any drive control device other than a standard joystick
-programming, mounting, or shape of device is different
Types of drive controls
PROPORTIONAL CONTROLS
-more efficient due to the decreased number of inputs required
-intuitive
-provides control of speed and 360 degrees of control
-stop by returning device to center or letting go
-more you push faster you go
-motor control needed for graded movements
DIGITAL/SWITCH CONTROLS
-all-or-nothing response
-each direction= diff switch
-speed changes require mode changes
Types of proportional controls
standard joystick
joystick with modifications
alternative joysticks –> require less force to move
Types of switch input controls
3- 5 switch inputs
-3 switch:forward, left, right, reverse
pneumatic inputs/combo systems (sip and puff)
-forward: hard puff
-right: soft puff
-left: soft sip
-reverse: hard sip
2 switch inputs
1 switch input
-quite inefficient
-when the correct option is highlighted, the user activates the switch and holds it as long as they want to go in that direction w
-to stop the chair the switch is released
TYPES:
-mechanical
-pneumatic
-proximity (usually embedded in headset)
-fiber optic (tiny movements)
Momentary vs latch for pneumatic control programming
Momentary
-output only when input being applied
Latch
-output maintained when input given until opposite or stop command provided
-promotes independent and efficient control of the wheelchair using sip and puff controls
Lined 2 switch driving
allows individuals with 2 access points the increased efficiency and ease of using of 3-switch system
