Posts Tagged ‘Power Wheelchair’

A YOUNG BOY AND A WHEEL CHAIR

Wednesday, April 11th, 2012

Active American Mobility

Justice was sitting in his driveway on a rainy Monday morning waiting for the school bus to pick him up and start the new week. His normal sitting spot while awaiting the bus was at the end of his yard next to the curb of the cul-de-sac. Today was different. It had been a rainy morning and the ground was saturated. Instead of waiting on the covered porch Justice decided to await the bus while sitting at the end of the driveway on the concrete with his backpack strapped to his shoulders and a small umbrella to protect him from the rain.
His neighbors shared a common driveway between the two homes and, on this morning, Betty, the neighbor, had to leave for work early to make final preparations for an important presentation with the board of directors. Betty’s company was struggling financially and Betty was under increasing stress of getting transferred or, worse, potentially being downsized and laid off. Betty left the house in a rush, opened the door to her Cadillac and quickly started the engine and backed out of the driveway.
She took no notice of her surroundings with the exception that she checked her mirrors and saw nothing evident through the blur of the rain covered glass. The thought did not occur to her that the elementary school bus picked up the children on her cul-de-sac at about this time each morning. After backing out of the driveway, she quickly threw the transmission into gear and accelerated toward the intersection.
At the intersection, she heard some kids yelling and carrying on but took no particular notice. Besides, the work meeting and her company’s financial position were foremost on her thoughts. Just before reaching thirty miles per hour, two children jumped in front of her car waving frantically. Betty slammed on the brakes, stopped the car, and got out thinking “What are you kids doing?” Before she could speak, one child yelled “Justice is caught on the back of your car!” and she saw the other boy run to the passenger rear corner of her fender. Betty gasped in horror as she saw a young blond boy dangling from the fender of her Cadillac, apparently caught and dragged along by his backpack for somewhere between her home and the middle of the street.
Judy, Justice’s mother, asked around to her friend who worked for a local durable medical equipment company, to see if she could get some advice on wheelchairs. Judy indicated that her son had received third degree burns and had been at Children’s hospital for the past week receiving burn treatments for damage to legs and shoulder areas. Following an extended hospitalization, Judy met with the elementary school administration who instructed her that her child needed to begin attending classes immediately or he would be required to either [1] attend summer school or [2] repeat the forth grade next year. Judy felt that in no way was her son ready to attend classes. He struggled with walking and needed to keep his left leg elevated to reduce pain and swelling.
Even though the wheel chair provided to Judy’s son was simple in design, not customized, and did not necessarily fit perfectly, Judy was grateful for the prompt service and delivery of a wheel chair that would provide a solution for her son’s immediate need.

In consideration of this story, I think about how something as seemingly simple as prompt delivery and service to a family in need of a basic item both helped in reducing the stress that this mother was going through and solved an immediate need by providing a means for Justice to attend school while his leg healed over the next two weeks.
Now project a little further into this scenario: a person, loved one, who has had a debilitating accident or progressively debilitating disease and has lost most functioning in his or her arms and legs. The miracle of the previous story is that the child survived the accident and, even during the painful recovery, remained hopeful of a full recovery in a relatively short time. Many disabled persons are not entitled to such hope. Their lives remain forever complicated by their disability and reliance upon others for assistance. Those of us who work in the rehabilitation / mobility device industry must keep our paradigms intensely focused upon client outcomes. Consequently, what many of us frequently forget is that outcomes are very much dependent upon processes. A friendly, interactive face, promises kept, and client centered customer service go al long way toward making a person’s experience positive, no matter how difficult their situation. Positive outcomes are not mutually exclusive of a favorable process. Take the case of the young boy and the wheel chair. The medical device solved the physical problem of temporary mobility; however, I would contend that the value of the customer service remained equally as important so at least the stress could be reduced by knowing and trusting fully that their mobility needs were being met.
Here at Active American, we pride ourselves on taking every individual case personally, trying our best to empathize with the client and their story through customer service and communication. It is difficult enough to admit that you are currently in a situation in life that you have to depend on equipment for mobility or actually need help from others to get through whatever the situation might be… working with a company that offers great customer service we feel is an absolute must.

by Robert Barr, ATP

Medicare Power Mobility Documentation Requirements

Wednesday, October 19th, 2011

July 10, 2008
Power Mobility Documentation Requirements

A review of power mobility claims and ADMC requests submitted to Jurisdiction C shows continued uncertainty regarding the various assessment and evaluation documentation requirements. The following article reviews this information and includes a reference chart indicating the assessment and exam requirements for the various levels of power mobility.

Face-to-Face Exam

What is It?

The face-to-face examination is a statutory requirement for all power mobility devices (PMD). This exam consists of two separate elements, an in-person visit to the physician for the purpose of requesting a PMD, and a comprehensive medical examination.

Who Can Perform It?

The treating physician must conduct the in-person visit. The comprehensive medical evaluation may be performed by the physician or may be referred to a licensed/certified medical professional (LCMP), such as a physical therapist or occupational therapist, who has experience and training in mobility evaluations to perform part of the exam. If the treating physician has referred the medical examination to a LCMP, the physician must review the findings after receiving the LCMP’s report. In addition the physician must document their acceptance of this report in writing and sign and date the entry.

REMINDER: If the report of an LCMP examination is to be considered as part of the face-to-face examination, there must be a signed and dated attestation by the supplier that the LCMP has no financial relationship with the supplier.

How Should the Findings be Reported?

The in-person element of the face-to-face exam should be documented in a detailed narrative note in the physician’s chart in the format that they use for other entries and clearly indicate that a major reason for the visit was a mobility examination. The comprehensive medical examination may be documented either:

In the physician’s narrative record, if they performed the entire exam; or,

By including the report of the LCMP exam in the office record if the exam was referred.

A supplier generated form must not be used to document either the treating physician’s or LCMP’s exam since a supplier generated form is not a considered to be a part of the medical record.

REMINDER: The supplier must receive a written report of the face-to-face exam within 45 days after its completion and prior to delivery of the wheelchair.

Specialty Exam

What is It?

The specialty evaluation is a written report providing a detailed explanation of why a particular power wheelchair base and each specific option or accessory is needed to address the patient’s mobility limitation.

A specialty exam is a mandatory requirement prior to dispensing a Group 2 Single Power Option or Multiple Options PWC, any Group 3, 4 or 5 PWC, or a push-rim activated power assist device.

Who Can Perform It?

The specialty exam must be performed by a licensed/certified medical professional, such as a PT or OT, or physician who has specific training and experience in rehabilitation wheelchair evaluations. The person performing this exam may, but is not required to be, a RESNA-certified ATP.

REMINDER: The PT, OT, or physician performing the specialty exam may have no financial relationship with the supplier.

How Should the Findings be Reported?

The policy does not prescribe a specific format for reporting the specialty exam findings. However, the report should be in the office or facility’s usual medical record form; it should not be on a supplier-generated form.

Home Assessment

What Is It?

All levels of PMD require that an onsite evaluation of the patient’s home be performed prior to or at the time of delivery. The person conducting this assessment should verify and document, in a written report, that the patient’s typical environment supports the use of a PMD.

Who Can Perform It?

The home assessment can be performed by the supplier (or supplier’s employee) or a practitioner (physician, physician’s employee or LCMP, etc.).

How Should the Findings be Reported?

The policy does not specify a particular format or form to use. The policy, however, does state that the assessments and measurements should include physical layout of the home, doorway width, doorway thresholds and surfaces the device will have to move over.

ATS/ATP In-person Appraisal

What Is It?

As of April 1, 2008, suppliers providing certain wheelchairs as described in the PMD LCD must employ a RESNA credentialed professional and this person must have direct in-person involvement in the wheelchair selection process. For an in-depth review of this requirement, please refer to the recently published article, Power Mobility Devices, FAQ – ATS/ATP Requirements.

Who Can Perform It?

This process must be performed by either a RESNA-certified Assistive Technology Supplier (ATS) or Assistive Technology Practitioner (ATP) who specializes in wheelchairs and is employed by the supplier.

NOTE: The requirement for the supplier to employ a RESNA-certified professional and for this person to have direct, in-person involvement in the wheelchair selection process is not waived if the specialty exam is performed by an ATP. The person performing the specialty exam cannot work for the supplier and the person involved in the ATS/ATP in-person appraisal must have a financial relationship with the supplier. Therefore, one individual cannot meet both requirements.

How Should the Findings be Reported?

There must be evidence in the supplier’s file of direct in-person interaction with the patient by the ATS/ATP in the wheelchair selection process. The documentation must be complete and detailed enough so a third party would be able to understand the nature of the ATS/ATP involvement and to show that the standard was met. Just “signing off” on a form completed by another individual would not adequately document direct, in-person involvement. Also, merely signing a statement such as, “I am a RESNA-certified professional specializing in wheelchairs and had direct, in-person involvement in the wheelchair selection for this patient” does not sufficiently verify that this policy requirement was met. Finally, a home assessment completed by a supplier-employed ATS/ATP would not meet the requirement unless the documentation showed how the ATS/ATP applied the assessments and measurements to the wheelchair selection process.

REFERENCE CHART: PMD EVALUATION/ASSESSMENT REQUIREMENTS

PMD Group HCPCS Code Range Face-to-Face Exam Specialty Exam Home Evaluation ATS/ATP In-person Appraisal

Group 1 POV K0800-K0802 Yes No Yes No

Group 2 POV K0806-K0808 Yes No Yes No

Group 1 PWC K0813-K0816 Yes No Yes No

Group 2 PWC – NPO K0820-K0829 Yes No Yes No

Group 2 PWC – SPO K0835-K0840 Yes Yes Yes Yes

Group 2 PWC – MPO K0841-K0843 Yes Yes Yes Yes

Group 3 PWC – NPO K0848-K0855 Yes Yes Yes Yes

Group 3 PWC – SPO K0856-K0860 Yes Yes Yes Yes

Group 3 PWC – MPO K0861-K0864 Yes Yes Yes Yes

Group 4 PWC K0868-K0886 Yes Yes Yes Yes

Group 5 PWC K0890-K0891 Yes Yes Yes Yes

Abbreviation Key PMD = Power Mobility Device

POV = Power Operated

Vehicle

PWC = Power Wheelchair MPO = Multiple Power Options

NPO = No Power Options

SPO = Single Power Option

Refer to the Power Mobility Devices LCD for additional information on coverage and documentation requirements.

An ISO 9001:2008 certified company

Custom Molded Seating Systems: Pros and Cons

Wednesday, October 19th, 2011

by Mike Duenas, ATP,
Active American Mobility and Medical Supply

Pressure ulcers (Decubitus) can be some of the most serious problems associated with clients using wheeled mobility for long periods of time. A seating system for many clients can be as basic as a foam back & seat. Some higher involved clients need to have a “Custom Molded” system to fit their actual body shape and size. This seating system if manufactured & produced properly can help many clients achieve the proper seating and posture they need while using their mobility equipment. This seating system will also help prevent the medical costs of hospitalization due to the possible development of a decubitus ulcer. Many clients that need this seating have no way to shift their body weight to allow pressure relief on any given area at a time. Pressure points can vary from person to person however; most areas are the in relation to the pelvis, spine, shoulders, back & head. Trying to eliminating or minimize the pressure (points) over these body surface areas is the goal. A custom molded system can provide the maximum amount of body surface support. The weight distribution helps prevents occurrences of decubiti. It will also increase comfort, and supports the client by distributing their weight over the broadest possible area.

When a Therapist and or ATP looks at providing a custom molded seating system for a client, they should be thinking of how having the clients upper body bear some of the overall body weight. Properly created and positioned trunk laterals & appropriately angled back supports will allow for a desired level of contact, support, and weight distribution. It’s really all about the best contouring & seating surface that can be made. A custom-molded seat may be produced in the same manner as the back cushion. In most cases you will create both the seat & back during the same evaluation. With today’s technology, a shape capturing system can make this process very easy and will help you create and make adjustments to the seating surface electronically at the same time, before you save the file. There are quite a few (manufactures) choices when deciding on custom molding. There are also a number of pros and cons associated with any of the molded systems that need to be considered.

“Pros” of creating and using a custom molded system are:
1. A properly molded seating system will increase comfort and postural support for your client.
2. Molded systems can help prevent decubiti “pressure wounds”.
3. Can help functional ability for the client’s body stability while reaching and or working with both upper and lower extremities.
4. Help prevent additional skeletal deformities while the client uses the system.

“Cons” of using a custom molded system are as follows:

1. Once molded, most systems, depending on the type of materials, are hard or next to impossible to make changes once they are produced.
2. Client is most likely set in a “Fixed” seat to back angle. Reclining type wheelchair frames do not work well because the molded seating & exact fit to client’s body shape.
3. If these molded seating systems are not done properly, it can actual cause more issues with pressure points against the client’s body and or other deformity issues can develop.

Manufacturers / Types
The quickest and easiest custom mold to fabricate is a “Mold-in-place” type mold. These types of systems require a seat and or back cushion that will allow you to remove and or install foam pieces into them first. The form pieces may be of several different types of density & thicknesses. Once you have created a very close fit with the form you can then insert a plastic bag that will serve as“Void” filler. You will take to chemicals that once mixed together will soon become a liquid foam that when poured into the plastic bag, it too will began to set-up and maintain its shape. You will need a very large and open area to produce this system and to help with the small amount if any, of extra product that will possibly fall to the floor. Basically once you pour the foam, you have to place the client on top of the cushion to allow the foam to set and capture their shape. Once it has set, cut any extra produce off and close the cushion cover. These systems are for both seat & back cushions however, they might only provide mild to moderate control for your clients. If your client is more heavily involved and needs more postural control, you might need the next system mentioned.

Another system uses molding bags that when a client is placed upon them and a vacuum removes all the air within, the client shape is captured. Think of two “bean bag” chairs you would sit on, both bags mold to your body form. Then while removing the air and shaping as you do, the bags become very firm. It’s basically a temporary mock-up mold of the intended seating system. Once the molding process is completed, a plaster cast (oldest method) or an electronic digitized file (newest meathod) is then sent to the manufacturing company. It in turn uses the plaster cast or digitized file to produce the finished foam seating system. This type of system allows for great freedom in design while providing good contouring. Also, the cover of this type of seating system is smooth, completely seam-free, and moisture-proof. This eliminates hot spots created by seams and other breaks in the seating system cover, and protects the integrity of the underlying foam. These same systems can also be created with air holes that allow liquids to move away from the clients skin. It also helps cooling and body temperature.

Whichever system you use, understand that you should have the proper training and certificates necessary to provide your clients with the best healthcare products and services they deserve.

http://www.invacare.com/cgi-bin/imhqprd/inv_catalog/prod_cat.jsp?s=0&catOID=-536885209

http://www.ottobock.com/cps/rde/xchg/ob_us_en/hs.xsl/18039.html?id=18121

Michael s. Duenas / ATP
Active American Mobility
13003 Murphy Rd, G1
Stafford, Texas 77477
281-495-4400
mduenas@aamobility.com

TIRR Hospital Houston Offer Many Treatment Modalities

Wednesday, October 19th, 2011

Specialized Treatment Modalities

TIRR Memorial Hermann has numerous specialized treatment modalities. These specialized programs are offered for both inpatients and outpatients. Links to more information are also provided.

•Ambulation
•Wheelchair Seating and Mobility Program
•Enhanced Therapies
•Spasticity Management

Ambulation

1. GAITRite: Changes in a person’s gait pattern can lead to an increased risk for accidental falls and fall-related injuries. A normal gait pattern helps to prevent injury and maintain independence. The GAITRite system records timing and distance parameters on a portable electronic walkway connected to a computer.

As a patient walks across the walkway, the system inputs data into the computer to document walking patterns, including both step time and step length. This captures abnormal walking patterns persons have adopted to compensate for muscle weakness, pain or limb shortening.

Patients using assistive devices and ambulatory aides such as crutches, walkers or canes, use these during their gait analysis. Therapists can use this data to assist with interventions and treatment designed to improve balance and gait. The data also helps to show progress.

2. Locomotion Training: Locomotion therapy supported by an automated gait orthosis on a robotic treadmill has established itself as an effective intervention for improving over-ground walking function impaired by neurological diseases and injuries.

Patients with neurological movement disorders are benefiting from intensive robotic rehabilitation therapy delivered at TIRR Outpatient Services Center at Kirby Glen, using the Lokomat®, the world’s first driven gait orthosis. The Lokomat assists walking movements of gait-impaired patients and is used to improve mobility in individuals following stroke, spinal cord injury, traumatic brain injury, multiple sclerosis or other neurological diseases and injuries.

The Lokomat is the first in Houston, the second in Texas, one of 30 in the United States and one of 100 in the entire world. It was provided for use at TIRR by a grant from the Medallion Foundation.

3. NeuroRecovery Network: TIRR is one of seven specialized member centers of the Christopher and Dana Reeve Foundation (CDRF) NeuroRecovery Network. The CDRF has launched the NeuroRecovery Network grant program to provide support for the translation of basic science and applied research into intensive, activity-based rehabilitation treatments.

It will also support the establishment of specialized centers to provide standardized care based on current scientific and clinical evidence. The program is funded by a joint agreement between the CDRF and the Centers for Disease Control and Prevention.

The therapy regimen includes highly specialized treatment strategies while using a body weight support system to optimize sensory cues to facilitate recovery of the nervous system. This treatment is provided daily during two-hour sessions and includes an hour of treatment on a treadmill followed by overground treatment time to increase carryover of the therapy session. Learn more about the NeuroRecovery Network.

Specialized Treatment Modalities

Wheelchair Seating and Mobility Program
The Wheelchair Seating and Mobility Program at TIRR provides assessments for inpatients and outpatients requiring the use of wheeled mobility in their home, work and community environments. The program enables the patient to try a wide variety of manual and power wheelchairs, seating and positioning accessories and environmental challenges. This allows the patient to trial the device and make accurate and informed decisions based on its performance.

The Seating and Mobility Program is designed to:

•Maximize independence and safety in the home and community
•Improve posture and function in the wheelchair
•Prevent secondary medical, orthopedic and skin problems caused by improper seating
•Provide demonstration equipment, simulation of the seating system and diagnostic tools, such as pressure mapping, to optimize comfort and function
With so many products in the market to choose from, information on the latest technology can be overwhelming.

TIRR keeps abreast of new and innovative technologies and monitors federal guidelines in the area of seating and mobility. We also work closely with local, certified and credentialed durable medical equipment providers and manufacturer representatives to provide comprehensive, patient-focused options.

For more information or to schedule an assessment, call 713-797-7386.

Specialized seating and mobility assessments include the projects below.

SMARTWheel® assessment – The SmartWheel is a clinical tool that assists clinicians with:

•Wheelchair Selection and Set-Up: The SmartWheel quantifies patient ease or difficulty in propelling different chairs or chair set-ups.
•Propulsion (momentum/propel) Training: Real-time visual feedback assists wheelchair users to reduce force and repetitive stress on their arms by using longer, less frequent strokes.
How a person propels a wheelchair is analyzed by a TIRR therapist specially qualified to perform the assessment by measuring every push on the hand rim. The SmartWheel then puts the data into easy-to-use automated summary reports to give clinicians better data to help manual wheelchair users improve quality of life.

The SmartWheel is for people with good hand function and has the following benefits:

•Eliminates pushing on the tire
•Gives a better grip for better performance with every push
•Eases pain in hands and wrists
•Provides greater control when braking
•Retrofits to your existing wheels
TIRR is one of 60 sites in the United States and the only site in Texas to have the SmartWheel clinical tool. It is offered on an inpatient and outpatient basis.

Enhanced Therapies

Animal-Assisted Therapy
TIRR utilizes Caring Critters, a nonprofit, all-volunteer, Houston-area organization. Caring Critters enhances the lives of TIRR patients by providing them opportunities for interaction with animals in a positive, nurturing environment.

Music Therapy
A music therapist’s role is to address the cognitive, speech/language, physical, and psychosocial needs of a patient, using Neurologic Music Therapy techniques. Music therapy is often requested to co-treat with other therapies, such as physical or speech therapy, and to facilitate functional movements and/or cognitive and speech behaviors.

•When co-treating with a physical therapist, music therapy may provide rhythmic stimulation to normalize a patient’s gait cadence, velocity and stride length.
•Music therapists address verbal expression in co-treating with speech therapists.
Music therapists also use song writing and lyric analysis activities to help address coping and adjusting issues. In addition, music is extremely helpful as a mnemonic cue in orientation and learning strategies for memory deficits.

Music Therapy is neurologically based and backed by more than 10 years of research at TIRR. Music therapists at TIRR:

•Hold a bachelor’s degree in music therapy
•Have passed the National Board Certification Exam for Music Therapists
•Are trained and certified in Neurologic Music Therapy (NMT)
Therapeutic Pool
The inpatient therapy pool offers aquatic therapy for patients with orthopedic and neurological disorders who experience symptoms such as pain, weakness, weight bearing restrictions after surgery, swelling, and/or changes in muscle tone. This therapy combines traditional exercise with the water’s buoyancy to enhance and accelerate the rehabilitation process. The pool is kept at a therapeutic 92 degrees and is accessible by stairs or chair lift.

Therapeutic Recreation
Therapeutic recreation specialists use recreational modalities and experiences to:

•Improve functional abilities in therapy
•Provide education and training in recreational skills and attitudes for healthy recreation participation
•Promote social interaction and healthy living through group and community recreational and leisure experiences
Therapeutic recreation therapists at TIRR have the training and unique ability to combine a group of people with a wide range of disabilities and functional levels who share a common interest or focus. Therapeutic recreation:

•Promotes social interaction and appropriate recreational participation
•Encourages creativity
•Helps with coping and adjustment while the patient works on enhancing functional abilities
TIRR therapeutic recreational therapists have four-year degrees and national certification training.

Spasticity Management

Spasticity is a form of muscle overactivity which can result in contractures, abnormal postures, and pain and stiffness in the muscles of the body due to damage to the central nervous system. Spasticity can result from traumatic brain injury, stroke, cerebral palsy, multiple sclerosis, spinal cord injury and other diseases associated with the brain.

Spasticity frequently impairs one’s mobility, positioning, comfort, care and ability to perform activities of daily living. Commonly used management strategies for spasticity include oral medications, intrathecal baclofen, orthopedic procedures, bracing and splinting, and medications which are injected directly into the muscle. Successful management of spasticity in patients with central nervous system disorders requires the expertise of a well-integrated team of clinicians.

Traditional therapeutic approaches, such as muscle stretching, positioning and movement exercises, are basic components of a management program.

Research has proven the value of new treatment options in maximizing the benefits of therapy. These options include:

•Medications that are injected directly into the spastic muscle, such as phenol and botulinum toxin (Botox®), are used in conjunction with casting, splinting and orthotic management.
•The intrathecal baclofen pump, a mechanical device, is surgically implanted and delivers medication directly into the brain and spinal cord. This treatment targets the lower limbs and can affect the upper limbs as well. The pump is the first new treatment for spasticity of cerebral origin approved by the FDA since 1981. Patients who could potentially benefit from the pump undergo a trial to assess their response to the therapy. If there is a favorable response during the trial, patients are admitted for surgical implantation of the pump.
Oral medications may be beneficial for some patients, particularly those individuals with spinal cord injury.

Some patients may be candidates for orthopedic surgeries to correct deformities resulting from spasticity or to augment the effects of other anti-spasticity treatments.

Referrals
Patients or families interested in spasticity management for inpatients and outpatients may call 713.797.5942 or toll-free 1.800.44.REHAB (73422).

SCI/Quadriplegia C7; Osteoarthritis; Sample Letter of Medical Neccessity for Quantum Power Chair and Seating

Wednesday, October 19th, 2011

Date:

To: Medicare

Re: ———————-
DOB: 00-00-0000
HICN: ———————

Diagnosis/Problems: SCI/Quadriplegia C7; Osteoarthritis

Subject: prescription for power wheelchair and seating equipment

To Whom It may Concern,

——————— is a 45 year old male patient of mine who suffered a C7 level spinal cord injury secondary to a MVA over 30 years ago. As a result he is quadriplegic, unable to ambulate, and dependent upon a wheelchair for mobility. Without a wheelchair he would be bed and/or room confined. Currently, he is using a manual wheelchair that was loaned to him by a friend. It is a lightweight frame but is significant disrepair. —————- is having increasing difficulty with propelling any type of manual wheelchair up/down ramps or across unfinished/uneven surfaces secondary to debilitation of shoulder function and loss of strength/endurance as a result of multiple decades of manual wheelchair propulsion.

————- lives in a rural setting in a mobile home that requires him to traverse rough/unfinished terrain daily and to be able to manage propelling himself up/down a 30-40 foot ramp daily to enter/exit his home. He lives on a farm with other family members living in homes that are adjacent to his so he must propel himself in/out of his home several times a day. ————— is reporting increasing shoulder and back pain with manual wheelchair propulsion within his home and on level surfaces as well. He reports taking 40mg of Vicodin per day for pain. He recently severed the skin on several fingers of his right hand and is unable to propel himself up/down his ramp secondary to pain in his hand. It is recommended that he be provided a power wheelchair that will meet his functional mobility needs and support his daily independence.

Due to the nature of his diagnosis, the following postural abnormalities and physical problems will need to be addressed in his wheelchair and seating equipment:

1) Moderate right pelvic obliquity(fixed) with secondary right scoliotic curvature of spine resulting in increased risks for skin breakdown on right IT’s/buttocks and/or increased risks for development of fixed contractures in spine/trunk.

2) Mild kyphotic curvature/deformity in upper thoracic spine.

3) Fair bilateral shoulder strength with poor bilateral wrist extension/flexion, MCP and IP flexion/extension impaired bilaterally. Poor endurance with available upper extremity movement(s).
Page 2/——————

4) Moderate to High risk for skin breakdown secondary to constant sitting, inability to perform adequate pressure relief in current equipment, loss of sensation below mid level of back, and a history of pressure breakdown(10 years ago).

In order to provide for safe supported sitting, facilitate independent functional mobility, accommodate for postural/physical abnormalities and reduce risks for secondary complications such as skin breakdown, the following equipment is recommended and is considered medically necessary:

1) Quantum 600 power wheelchair base with Tru-Balance power seat tilt is recommended to facilitate independent functional mobility and to provide for independent weight-shifting/pressure relief to reduce risks for skin breakdown. A PG 70 amp joystick with thru controller operation of drive/seat functions is recommended; 14 inch flat-free tires are needed since —————- cannot independently maintain tire pressure/repair flats; 50 amp gel batteries are required for drive/seat function power; Solution cushion is recommended for needed pressure relief when not tilted to reduce risks for skin breakdown; high mount foot platform to facilitate foot support when in tilted positions; solid curved seat back with Stealth head support to reduce risks for hyper-extension injuries/fatigue when in tilted postures; 2-post flip back arm supports with desk length pads;

Thank you for your consideration in this matter.

Sincerely,

———————————, MD
UPIN:

This copy is provided by Active American Mobility and Medical Supply. No restrictions on distribution. For more information contact us.
Contact Patrick Boardman 281-495-4400

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