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Wheel Knowledge

Reprinted from PN November 2017

Selecting and obtaining the most appropriate wheelchair to meet your needs requires plenty of research and expertise.

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There’s a plethora of wheelchairs from which to choose these days. But it doesn’t matter who made it, or how well constructed or modern it is, if you’re not comfortable and healthy in it. Using an ill-fitting wheelchair can cause pain, poor posture and even serious health issues such as pressure sores. Inadequate assessments, faulty measurements and poor wheelchair selection can also limit your independence. Veterans with spinal-cord injury and disease (SCI/D) can work through the Department of Veterans Affairs (VA) to take care of all their wheelchair needs in one place. Meanwhile, others with SCI/D generally need to work with multiple people and places. These tips for selecting, fitting and maintaining a wheelchair will help specialists better assist you, and they’ll also enhance everyone’s mobility, comfort, posture, health and safety.  

Find A Clinic

There are physical and occupational therapists who specialize in seating and mobility, applying advanced knowledge in assistive technology, durable medical equipment and complex rehabilitation equipment. Many of these therapists are certified as assistive technology professionals (ATPs) by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). These specialized therapists, together with ATPs from durable medical equipment (DME) companies, conduct seating and mobility clinics. At the seating clinic, the therapist, working with a DME representative, will perform a comprehensive evaluation of functional abilities and mobility limitations. They work as a team with the client and family members to understand physical, functional and environmental needs.

Suggested equipment can be demonstrated and tried at the clinic, in the home or workplace. Measurements will be taken to ensure a proper fit. A written assessment will be generated describing the physical and functional limitations and providing a detailed description of the medically necessary equipment. This seating assessment, along with documentation from a physician, will be submitted to a health insurance provider to obtain funding for the prescribed equipment. Usually, a physician’s order for a seating and mobility clinic is needed to obtain insurance coverage for the seating clinic evaluation. Your neurologist, physiatrist or primary care physician may know of a seating clinic in your area. You can also use the RESNA website (resna.org) to identify ATPs in the area who can recommend a seating clinic. In addition, veterans may use seating and mobility clinics that are offered at VA facilities. Using a seating clinic is the gold standard for ensuring appropriate equipment and high-quality follow-up services for the equipment. 

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Try It Out

You wouldn’t buy a car without taking it for a test spin. So why not give a potential new wheelchair a spin? DME vendors have demonstration models they can bring out to homes for a trial. Try using the equipment in your home and at work. Practice with the equipment when transferring into your car or accessing your van. See how the equipment interfaces with your tables and desks. Sit on a wheelchair cushion before ordering it, and make sure to try any seating system components, such as a positioning back. If a vendor can’t provide something for you to test at home, try calling the manufacturer directly to assist in obtaining trial equipment.  

Map It

Obtain a pressure-mapping cushion to determine which seat cushion is best for you. Objective measurements of pressure distribution and areas of maximum pressure are seen through pressure mapping. Wheelchair cushions have different levels of performance. Some only provide comfort, while others provide positioning. The best cushions provide pressure distribution and skin protection. Medicare guidelines distinguish three levels of wheelchair cushions based on diagnosis and history of pressure ulcers. Make sure you’re prescribed the highest available level that meets your needs. Most seating clinics can provide pressure-mapping evaluations.

Don’t Buy It Online

Selecting a wheelchair isn’t the time to take chances by going with an unknown vendor or seller because they’re offering you the “deal of a lifetime.” Work with only reputable DME vendors and never order a wheelchair online or over the phone. One of the biggest mistakes someone can make in this situation is thinking that he or she can purchase a wheelchair online or over the phone that will meet his or her needs and fit correctly. Reputable DME vendors have ATPs on staff who participate in seating and mobility clinics, evaluate your home and workplace and properly fit the equipment. The vendor should also have a billing specialist on staff to help you navigate the complex insurance coverage system. They’ll also have a service department to assist in maintaining your wheelchair for years. Medicare, Medicaid and most insurance companies will cover only one wheelchair every five years. If you order a wheelchair online or over the phone from a distant company and it’s ill-fitting or not really right for your needs, you could be stuck with it for five years.


Get It Checked

After the new wheelchair and seating system is obtained, check out the equipment at the seating and mobility clinic. Be sure the wheelchair vendor is present, as well as the physical or occupational therapist who performed the initial assessment. The therapist and DME vendor can make adjustments to ensure a proper fit and make sure the wheelchair and seating systems are appropriate.

Train In It

Rolling down a smooth, wide hallway is pretty easy for most wheelchair users. But what about dealing with sidewalks without curb cuts or uneven surfaces? Training from outpatient physical and occupational therapy clinics specializing in neurologic rehab is invaluable. Clinics and professionals can help manual and power wheelchair users develop the skills needed to be fully independent.  Ask a physician to write an order for wheelchair mobility training and have a qualified therapist provide training in home, community, transportation and workplace accessibility.

Stay Informed

Keeping up to date on the latest wheelchairs and seating systems helps ensure you have the most appropriate equipment and the greatest possible independence. Abilities Expos (abilitiesexpo.com) are held yearly across the country and feature the latest equipment and also include various workshops of interest to wheelchair users. 

Recognize Changes

Wheelchairs and seating systems will need to be adjusted as your needs and functional abilities change. Your first wheelchair may have been a manual wheelchair. But years later, powered mobility may be more appropriate, preserving shoulders, elbows and wrists for activities of daily living, instead of using them for home and community mobility. There’s a growing trend to move to power-assist mobility for manual wheelchairs or power wheelchair mobility earlier to prevent arm dysfunction. Having a yearly or bi-yearly assessment from a qualified seating and mobility therapist will help determine when different equipment would be beneficial.

Know Your Coverage

Become an expert in knowing what equipment is covered by your insurance company. Read the fine print before switching to a different insurance carrier. Be aware of what level of equipment you’re qualified to have, and keep track of when you’re eligible for updated equipment. Know how to appeal if the insurance company denies a claim. A billing specialist at a DME company can assist in insurance coverage questions. Medicare has a competitive bidding program that limits choice of a DME vendor for certain types of wheelchairs. Complex rehab equipment, which includes ultra-lightweight wheelchairs and custom power mobility wheelchairs, aren’t in the competitive bidding system, allowing a Medicare beneficiary to use any reputable company. 

Service Your Wheelchair

Get to know the service department wherever you buy your wheelchair. Develop a maintenance schedule and regularly maintain your wheelchair, just as you would a vehicle. Regular cleaning of your wheelchair is important for the long-term upkeep of the chair. Insurance companies will cover service and replacement parts. Take advantage of this benefit to ensure long, safe use of your wheelchair.

Karen Whitesell, PT, DPT, NCS, ATP, is a physical therapist at George Washington University Hospital in Washington, D.C., and an adjunct professor at Marymount University in Arlington, Va.

 

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