Posts Tagged ‘Wheelchair’

ADA and More: Limitations of ADA Law With Respect to the Home Environment

Wednesday, October 19th, 2011

By Adam Horton,
Home Access Division Manager
Active American Mobility
888-734-2207

The American’s with Disabilities Act (ADA) was passed July 26, 1991. It was created to prevent discrimination against individuals or groups that have disabilities, either mental or physical. While the ADA was passed to prevent discrimination against individuals in the workplace, public settings, buildings, restaurants, etc., it did not cover anything in the home environment. There are, however, guidelines that are put in place that in the event that a home is being built to ADA guidelines. The problem with this is that it is a mere guideline and not a requirement that can be enforced by code specifically for ADA.

The ADA guideline for a finished door opening is 32”. Most doors in a home are 24”-30”. Exterior doors do have to be wider with one exterior door a minimum of 36”. Other doors in the home are sometimes wide enough, but this is typically the master bedroom and master bathroom doors. A typical hallway is 36” wide, but should be 48” wide to meet ADA requirements. Also, most homes come with a concrete entry walk that joins to a porch with a step up to the porch and also a step into the home. ADA requirements call for a minimum of one no-step entrance into a home for ease of access for mobility equipment. Light switches and thermostats should be a minimum of 48”-54” from the floor and 40” if they are over a counter top. The list of changes goes on and on. The problem with all of this is none of it is required in a typical home setting. It is recommended but not required.

Most home builders will make the changes to a home to meet ADA standards, but it all comes at a cost. Builders will charge a fee most of the time they deviate from the original plan. However, these changes don’t cost much money at all, and if managed properly will only make the home more accessible and accommodating living area.

On a positive note, one organization is making a mark in becoming the “ADA” of the home environment. Accessible Home Improvement of America™ is a new organization that addresses the gaps for home owners that ADA leaves behind. AHIA™ consists of a nationwide network of independently owned and operated , certified providers and contractors dedicated to providing accessible home modifications and related services.

AHIA™ also offers the CEAC (Certified Environmental Access Consultant) credential. This credential brings professionalism and diversity to current businesses. The CEAC™ credential certifies that the consultant is a specialist in independent living strategies, universal design, barrier free access and design, assistive technology, retrofitting, home modifications, and medical remodeling.

Active American will be CEAC certified in the coming months and we look forward to supporting AHIA™

For more information contact Active American Home Access and Construction.

888-734-2207

Example Letter of Medical Neccessitty for Sleepsafe Bed and Wheelchair

Wednesday, October 19th, 2011

2 EXAMPLES of LETTER OF MEDICAL NECESSITY

The following example letter of medical necessity and advice are only intended to assist you in writing your own letter to aid in securing funding for medical equipment. It is in no way implied that if you use this example you will be granted funding for medical equipment. Our only intention is to share information that we have gathered in the past and used by other clients.

The funding agencies that would be in charge of compensation for such medical items, such as your insurance company or a private philanthropic organization, almost always demand a letter of medical necessity from a therapist (physical, occupational, or otherwise) or from a physician to prove your claim that your child’s medical equipment was necessary to his successful treatment. The claim or appeal will be likely be refused if you do not include a letter of medical necessity which includes a detailed explanation of the condition or disability that makes the equipment a necessity for your loved one.

It is possible that your particular physician may not fully be acquainted with the rules of your insurance company which will affect whether or not you are reimbursed for your child’s medical equipment. (Each insurance company or state may have slightly different rules.) To be on the safe side, educate yourself on the rules so that you can be a better advocate for your family. You should become familiar with the bare minimum of information that needs to be included in a letter of medical necessity. Otherwise, the letter may contain insufficient information, which may lead to the funding agency denying your claim.

The following is an example of a thorough and professional letter of medical necessity taken from Dr. Freeman Miller’s Cerebral Palsy: A Complete Guide for Care giving. If you prefer, you can take a copy of this letter to the physician who is writing your child’s letter of medical necessity, and ask that he or she adhere to the example letter below.

“To Whom It May Concern (or, better, to a specific employee of the funding agency):

John Smith is a 5-year-old male with a primary diagnosis of cerebral palsy. He was seen at the Seating Clinic at the John Doe Institute in Anywhere, USA, on June 23, 2007, for the prescription of a bed system to meet his resting needs.

John presents with the following: generally decreased tone in upper and lower extremities, and fair head and trunk control. He is dependent in transfers and mobility. He is cognitively severely delayed. He is incontinent in bowel/bladder. He has frequent respiratory complications and is subject to bronchitis and pneumonia, and he receives chest therapy. He occasionally aspirates, he has increased skin sensitivity, and he has seizures, but they’re generally under control with his medication. He must have safe sleeping environment to eliminate the danger of falls and entrapment with appropriate positioning to provide safety and support, and to facilitate safe sleeping, breathing and feeding.

His current bed is a ___________ that is three years old. It no longer meets his bedding needs because he has outgrown it, and it poses safety concerns because_____________________.

The goals for John’s sleeping and resting is to provide a safe sleeping environment where falls and entrapment no longer pose a threat for harm and to foster a comfortable rest, maintain posture, provide comfort, and enhance function. Upon evaluation, _____________________ has recommended that the following equipment be prescribed for John:

(Be very specific in the bed model, size, and specific safety features)

the following example is for a wheel chair…rewrite this section to detail all of the specific features of the recommended bed system….for example…the Sleep Safe 2 Plus model is prescribed because it offers 22 inches of safety rail height protection above the mattress, eliminating the risk of a fall when he is in a sitting position. The “plus” model frame is prescribed because he is dependant on tube feedings and his head must be elevated during this time….etc)

The ____________________(is prescribed because it is a manual wheelchair for total positioning, and because he is dependent in mobility. The tilt is needed because he is hypotonic in head and trunk. He also has difficulty breathing, and it will help aid in feeding. It will help with low endurance and pressure relief, and it will control seizure reaction. The adjustable height arms are needed to support tray at right height, for upper body support and balance, and for ease of transfers. The I-back will bring side supports close to trunk, but insert will fit the full width of the wheelchair. The laterals will encourage midline trunk position, compensate for lack of trunk control, provide safety, and contour around trunk for better control. The chest harness is needed for safety in transport by providing anterior support, preventing forward flexion, and retracting shoulders. The headrest is needed for poor head control due to low tone, active flexion of head, posterior lateral support, safety in transfers, and to facilitate breathing. The clear tray is needed for functional surface for schoolwork, stimulation, upper arm and trunk support, inability to access tables, computer, and a base for augmentative communication devices. The shoe holders are needed to control increased extension or spasms in lower extremities, excessive internal rotation, and to prevent aggressive behavior for safety. The anti-tippers are needed for safety.

Should you have any questions regarding these recommendations, please do not hesitate to call me at (555) 555-5555. We hope that you will be able to accommodate these needs in an expedient manner. Thank you for your cooperation and assistance in this manner.

Sincerely,

John Doe

Be sure to take note of when your child’s letter was sent to the funding agency, and if three or four weeks pass without word from them, you might want to call the agency to inquire about the status of your claim. Always keep a record of when you call and with whom you speak to, and always try to remain calm and collected when dealing with the insurance company. If, however, you are unable to obtain a straightforward response as to when your claim will be processed, do not hesitate to enlist the help of your physician.

Motion Concepts Wheelchair Back HCPC Codes

Wednesday, October 19th, 2011

Manufacturer Product Name Model Number HCPCS Code Effective Date End Date Comments

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1516 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1517 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1518 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1519 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1520 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1521 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1616 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1617 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1618 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1619 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1620 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1621 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1716 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1717 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1718 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1719 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1720 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1721 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1816 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1817 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1818 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1819 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1820 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1821 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1916 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1917 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1918 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1919 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1920 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT1921 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT2016 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT2017 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX FLO-TECH FT2018 K0734 9/21/2006

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1415-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1417-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1616-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1618-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1620-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1816-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1818-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA1820-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA2016-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA2018-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA2020-V E2607 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA2218-V E2608 1/1/2005

MOTION CONCEPTS, INC. MATRX-V CUSHION MA2220-V E2608 1/1/2005

MOTION CONCEPTS, INC. MATRX-V HEAVY DUTY CUSHION MAWWDD-V E2607 OR E2608 5/4/2006

WHEELCHAIR LOWER BODY POSITIONING

Wednesday, October 19th, 2011

by Jeff McDaniel, ATP
Active American Mobility

Ideal wheelchair posture enforces neutral body alignment. The head is balanced over the spine, and the spine is balanced over the pelvis. The shoulders should align slightly behind the pelvis. Poor positioning causes skin irritation, loss of mobility, and breathing difficulties. A wheelchair evaluation team should perform a wheelchair evaluation for each individual’s unique ability and needs. A comfortable wheelchair position is vital for health and productivity. Along with providing mobility, a wheelchair should provide function, comfort, stability, safety, skin protection, and postural control. It goes without saying that matching the users needs to the best wheelchair is extremely important to meeting these goals. However, it is equally important to provide the accessories that work in conjunction with the wheelchair to provide the most positive outcome as possible. In order to achieve these goals, one aspect that must be considered is lower body/extremity positioning. Wheelchair users can profoundly affect the stability of their wheelchairs, a factor that should be considered in wheelchair design and in the process of wheelchair selection and training.

Pelvic Positioning
Many physical conditions cause an uneven pelvis, and a proper evaluation will identify the cause. Tight hamstrings and limited hip flexion causes posterior tendencies. Additionally, improper wheelchair seat depth, improper back angles, and improperly adjusted footrests can cause this tendency as well. An anteriorly tilted pelvis may result from loose hamstrings and weakened stomach muscles. A pelvic rotation and obliquity can result from uneven muscle tone, contractures, and a poor seating system. There are many types of solutions to correct and/or accommodate an uneven pelvis. One simple solution is a properly fitted and adjusted pelvic positioning belt. Both forward and backward pelvic tilt can be corrected to a certain extent with a properly positioned belt. Two point, four point, or harness belts assist positioning. For wheelchair users that present with hip extensor tone, sub-asis bars may need to be considered. Padded leg harnesses should be considered with active wheelchair users that require pelvic positioning as they allow for pelvic positioning without sacrificing pelvic mobility.

Lower Extremity
The ideal positioning of lower extremities should:
· Provide 25% loading of the legs at the feet
· Provide functional knee angle positioning within range of motion limitations
· Provide functional angle alignment within range of motion limitations
· Provide slight hip abduction within range of motion limitations

Hip adductors provide lateral support at the hips or knees. They come in numerous shapes and sizes but should not apply so much pressure that skin integrity would be compromised. It is extremely important to consider transfers when selecting hip/knee adductors; a side transfer will require removal of the pad while transferring. An abductor provides abduction of the hips and knees. These also come in various sizes and mounting options. An abductor mounts between the legs at the front of the wheelchair and again, transfers should be taken into consideration when selecting the hardware. Foot positioning must consider the range of motion at the knees. I personally feel that the footrests should be as close to 90 degrees whenever possible. This promotes stability and reach. A simple exercise is to place your feet under your chair and reach forward like you are grabbing something in front of you. Then try the same thing with your feet out in front of you. You should notice a great deal more of stability and reach when your feet are under you versus when they are in front of you. However, wheelchair configurations for adults often times to not allow for 90 degree legrests due to caster interference, so be sure and verify caster clearance when recommending this option. Angle adjustable footrests are also needed if there is an ankle range of motion limitation. Shoe holders can be attached to the footrests to restrict movement of the feet for individuals that either have no lower extremity movement or control. However, keep in mind that this option will restrict any functional movements the individual may have. Padded footboxes often times are a more effective alternative as they do allow for functional movement while providing a safe and protective foot support. Ankle huggers are also a good option, as they do not restrain the feet as much as a shoe holder. However, it is important to verify good skin integrity as they do cause sheering and pressure above the ankle.

To view these options, please see the following manufacturers. They all offer different types of options and accessories that may help wheelchair users “keep their feet on the ground” or their footplate at least.

www.bodypoint.com
www.millersadaptive.com
www.therafin.com

To schedule an evaluation or consultation with Jeff please call 281-495-4400.

Active American Open House & Grand Opening- Lake Jackson

Tuesday, September 6th, 2011

Lake Jackson Texas- Active American Mobility and Medical Supply is pleased to announce the grand opening of our new location at 103 Circle Way in Lake Jackson. The event will be Friday, March 26th from 9am-5pm with free BBQ from 11-2.
Come check out the new state of the art showroom and see the latest products that we offer. There will of course be a sale so take advantage of the reduced prices offered this one day only.
While you are on site be sure to check out the new Accessible Bathroom display featuring a roll-in shower and other products and services provided by our new Home Access and Construction Division. Adam Horton, Division Manager, will be on hand to answer any questions you may have.
We will also have members of our Complex Rehab team available to answer questions and demonstrate complex rehab seating and wheelchairs.
Bring your loved ones and friends and come celebrate with us. We look forward to seeing you there!
For questions email pboardman@aamobility.com
Or call 979-297-3155

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