New Wheelchair Clinic

I was happy to see a project finally beginning after a year of discussion with Nova South Eastern University. I had met with Adrienne Lauer, OT and professor with Nova to discuss a need in our community. There are several clinics for children to educate and monitor seating, mobility and posture; however there is little access for adults. In my over 20 years of service in the community, we continue to see and hear issues with access, and issues with satisfaction.  After a few discussions, the goal was to create a clinic at Nova to not only provide these needed services, but also create a place that may bring new clinicians and technicians together to ensure access and exertise for future generations.

With a bump in the road at Nova for space to hold this clinic, we had approached the Broward Center for  Independent Living to be a site for this seating/mobility clinic.  After some discussion and planning; and with the help of the CIL, we introduced the clinic on August 30th, 2013.  

Our Launch was successful bringing in people with canes, walkers, wheelchairs, and powered mobility equipment. The concept was well received, with several people making appointments for the next clinic, and several others wanting to tell their friends and families about this valuable service.

This new concept is still in it's infancy, and will be guided by the community for it's direction.  Several members of the audience indicated that when they received their equipment, they didn't know what they needed and left it up to the therapist and equipment company. They were anxious to learn more and to be able to advocate for themselves.

The intent of this clinic is to reach people in the community who do not know where to go for help with their mobility and seating needs.

This article is written by Carey J. Britton, seating and mobility specialist with Active Mobility Center. He can be reached at (954) 946-5793 or cbritton@wheelchairguys.com

Walker & Wheelchair Combo

For years we have consulted customers for four wheeled walkers and companion wheelchairs. For individuals who limited ambulation and nee the support from a walker and fatigues needing a seat, the four wheeled walker has been a great solution. For long distances, these walker users, have sat on the seat and had a caregiver push them which is not safe; but for many transporting a walker and wheelchair is not practical.

Now mobility challenged individuals have another choice, a 4 wheeled walker, with seat that converts to a companion wheelchairs.

 

 

 

This article was provided by Carey J. Britton, Seating and Mobility Specialist for Active Mobility Center and can be contacted at (954) 946-5793 or cbritton@wheelchairguys.com . 



Lift Chairs are not One Size Fit's All

We were fortunate to have Ruth Scheman with Active Mobility Center provide an educational in-service for our staff on Lift Chairs.  I have been involved in DME, Seating and Positioning and I learned a lot from Ruth. 

What is a Lift Chair?

Lift chairs were designed to allow people to power recline the chair, but more importantly to power raise the chair up where the user's legs are unflexed to make standing easier.  These chairs are very helpful for anyone who has some difficulty standing from a sitting position.  Over the years, these chairs have evolved from a 2-position chair that offers limited recline, a 3 position chair, that offers full recline and now a infinite position chair which is the best for individuals who want to reduce lower extremity swelling. The most trusted manufacturers of Lift chairs are Pride Mobility and Golden Technologies.

These chairs come in a variety of colors and fabrics. Once only offered in vinyl or fabric are now offered in leather, and a wide selection of vinyl and fabrics.

Which Chair is Right for You?

There is an art in matching a person's needs/wants into the most appropriate equipment. These chairs come in petite to extra large sizes. There are different pad options that provide support/stability to different body styles which affect support/stability and comfort. There are removable arm styles, different hand controls, optional heat/massage, incontinent coverings, trays and overlays.

Does Insurance Pay for these chairs?

Generally Insurance only considers funding for the power mechanism of the chairs, and not the furniture. There are medical necessity requirements where the individual must ambulate to some point independently to quality for this equipment.

Conclusion

Lift Chairs make a huge difference in the lives of people with mobility challenges. It can provide a sitting and sleeping surface; and a place to reduce swelling and provide comfort. These chairs  are categorized by how much they recline. These chairs have many options and interested people will get the best results by consulting with a lift chair specialist.  Learning and Understanding  all the options will insure your satisfaction of your choice.

This Article was written by Carey J. Britton, Seating Specialist for Active Mobility Center. He can be reached at (954) 946-5793 or cbritton@wheelchairguys.com . 

Wii Wheelchair Gives Mobility to Disabled Infants

• Cerebral Palsy
• Multiple Sclerosis
• Muscular Dystrophy
• Paralysis Cures
• Spinal Cord Injury
• Traumatic Brain Injury

Technology is amazing; this has been used in NY as a creative game that teaches mobility challenged children how to safely drive a powered motorized device (PMD). This information was shared to me from a local therapist in South Florida as we were talking about emerging technology for children and adults with mobility challenges.

 

A team of researchers, in 2009 developed the prototype of a motorized wheelchair in order to provide “safe powered mobility to infants with physical disabilities who are less than two years of age.” IC Tots on Bots is a collaborative research project among the departments of Computer Science, Occupational Therapy and Physical Therapy at Ithaca College in New York.

The balance board has responsive pressure sensors in each of its four corners and built in Bluetooth capabilities. They are using a commercial Bluetooth adapter and WiiYourself! C++ library to access balance board data within our robotics software. Their software compares the values of the four pressure sensors to determine which, if any, direction the infant is leaning. When a sustained lean is detected, the robot begins to move in that direction. When the child reaches out for an item, he or she leans in the direction of the item and moves towards it. We believe this will be the most intuitive method for a young child to learn to use.

Because each child moves differently from any other, the researchers are working on creating parameter files that are tailored to the individual. In addition, the Pioneer 3 robotic platform uses sonar to keep from bumping into objects, which helps keep babies safe from collisions. For ultimate peace of mind, there is also a remote-control joystick that provides wireless parental override.

                                 

 

It is great when people think outside the box and apply different technologies to create new solutions that may improve people's lives.  This should be a great tool in schoos and therapy centers to help children to move through space, increase development and improve independence.

 

This device was not found currently available in a recent search.

 

Carey Britton, Seating and Mobility Specialist for Active Mobility Center can be reached at (954) 946-5793 or cbritton@wheelchairguys.com

 

What is a Seating and Mobility Specialist?

Most people are unaware of how important seating is, especially when you are confined to a mobility device.  For years companies outside the medical equipment industry have been studying chairs, and standing. In the business world, there are studies that show loss of productivity, as well as work related injuries from sitting too long, or in chairs that are not ergonomically correct.   If so many studies have been documented on ambulatory individuals; wouldn't it be true that wheelchair users are much higher risk?

Traditionally the Seating Specialist was a physiatrist, physical or occupational therapist; however with changes in funding, reductions in reimbursements and the changing equipment/technology, this role is being done by the equipment supplier.

Now called a Seating and Mobility Specialist, this position is  a very important one. They sit at the same table as the physician and clinical therapists when discussing and offering suggestions on seating and mobility equipment based on the patients physical and environmental needs.  They know how insurance and funding work, and can help you navigate through this process. They are a resource, helping make recommendations to other medical equipment services.

The Seating and Mobility Specialist (SMS), is a certification that requires continuing education to maintain the credentials. This ensure that have the skills and most current trends and knowledge. 

For anyone who needs seating and mobility equipment, it is important to discuss your needs, goals and expectations with one of these professionals to ensure your satisfaction and ensure life quality.

This article was written by Carey J. Britton, seating and mobility specialist for Active Mobility Center. He can be reached at (954) 946-5793 or cbritton@wheelchairguys.com

Change can be Hard, not being able to help is even harder........

I met a women the other day, where I was asked by their therapist to see if we could make some suggestions to improve the way she sits. This patient suffered from Quadriplegia and was currently in a new powered wheelchair. The therapist was concerned that the company who recently provided this new powered wheelchair did a poor job due to the appearance of her posture.

This patient was sitting slid forward in a posterior pelvic tilt, with a significant rounded back posture (khyphosis). This is a typical position for anyone post SCI who was not initially provided structured seating.   She was being held in the chair by her seat belt.  She had to hook her arms around the back canes (push handles) to stabilize her posture.

On inspection, it was concluded her ROHO cushion was over inflated, and her back support provided only support to her scapula with a huge gap between her pelvis and lower back support. Patient complains about sitting pain, and the therapist is deeply concerned that her posture will only progress and that it is destructive and will lead to significant health complications.  She also stated the company who provided the chair had to provide more foam to the back support since it was provided.

I asked the woman, who has been using a powered wheelchair for over thirty years, what her concerns were. She said discomfort, and in-stability.

When discussing the cushion, she said she had inflated the cushion as when it was delivered the cushion was too unstable and she added air to make it more stable. We discussed that the cushion for its therapeutic value needed to be less inflated she said that was not a possibility. We discussed that a different cushion may have been more appropriate, but she had always used a ROHO, and nobody asked her those questions. her insurance only covers a one cushion every five years.  When we discussed the back support, I offered that a back that was more contoured, possibly even molded would improve her stability and posture. She said that if she had a back that was more confining it would affect her ability to move and she was not willing at this time to compromise.

After several minutes of listening and learning what her needs were, and more importantly what she was unwilling to compromise over; it was obvious that there was little we could do to improve the situation.  She is an adult and can make her own informed decisions. At this time her function outweighs any physical complications that will result in the future from sitting in a destructive manor.

I offered her some information, and suggested she watch her postural progression and remember that there are other options if and when she is open to trying them. As a Seating and Mobility Specialist, I was disappointed that I could not help; however understand that I am not in her body, and understand that it is ultimately her decision.

Carey Britton, is the seating and mobility specialist forActive Mobility Center. He can be reached at 954-946-5793 or at cbritton@wheelchairguys.com .  

How Does Your Supplier Measure Up ?

In Most industries, Service is a promise, something that cannot be seen but certainly can be measured. In the Medical Equipment Industry, Service is very visible; from the representative answering the phone, to the consultant taking the time to listen and learn, to the service technician who maintains and repairs your equipment.

 

Listening is key in providing specialty services; getting to know the client, their needs, wants and expectations can mean the difference between function and dependence. In a time where everyone is trying to manage evey minute and every dollar; it is always refreshing when the staff takes the time to say hello, to ensure everything is going well, and to see how to improve the company.

 

It is important to review the entire picture, including: physical dimensions, pressure, posture, environmental needs, caregiver needs and the expectations of the medical professionals on the case.  Failure to do this, will reduce the satisfaction and outcomes customers deserve.

 

Hiring a Coach can be very helpful, from experience we have seen where getting an outside view of how we operate; and more important how we can get better.

 

The standard in the industry is being certified by RESNA and NRRTS, as both Assistive and Certified Rehab Technology Suppliers. These certifications, in addition to being accredited ensure that you and your patients are receiving a higher level of professionalism, quality, expertise, and dedication to our customers.

Belonging to a group also helps with education access. VGM/USREHAB and MEDGroup offer access to resources to help the company provide exceptional service and support.

Staff  must be able to effectively work with therapists, customers, caregivers and physicians to brain storm , and design cost effective strategies (products) to help increase function, and reduce the incidence of skin ulcers and deformity.

Active Mobility Center has over 20 years of experience offering seating and positioning equipment for a dynamic and diverse population.  We practice what we believe and are committed to maximize the abilities of our customers.  Carey Britton can be reached at (954) 946-5793 or cbritton@wheelchairguys.com .

The Vast Array of Wheelchair Tires

Joe Navarro, Service Technician with Active Mobility, presented to the staff today an in-depth look at Wheelchair Tires. Joe explained that wheelchair tires are different than bicycle tires as they are non-marking for in-door use. Tires come in a wide variety of sizes, and have different purposes.

Rear Tires range in size from 12” to 26”, and Casters range from 3” to 9” in diameter.  The rear wheel sizes affect the seat to floor heights and reach to the wheel by the wheelchair user.  The rear tires are offered in Pneumatic, Flat Free, or Polyurethane (Poly).  The Pneumatic are always the softest ride, and through research show that are the easiest on the shoulders.  Many uses do not want to have to check and inflate tires so they choose Flat free or Poly.  Flat Free uses the same pneumatic tires, where the inner tubes are removed and are replaced with plastic inserts.  Polyurethane tires are lighter than the Flat Free Inserts and are a little softer ride.

The width of the rear tires also come in different sizes from 1” to 2.25”.  The narrower tires reduce the rolling resistance so the are much easier to start moving and keep moving; whereas the wider tires work better over unstable and softer surfaces (grass /sand). 

High Pressure Tires are used on the many of the ultra-light and sports products. These allow inflation of 90-110 lbs, and offer significantly less effort for self propulsion.  These tires tend to wear faster, but allow for greater performance. These tires have tubes that are either Presta or Shrader valves, which may require a special pump adapter to fill.  Additionally there are tubes that are thicker, called thorn resistant, which offer greater protection from punctures.

Caster Tires, the smaller front wheels, are offered in 3” (rollerblades) to 9” .  Many of these have tires that are molded to the hub and require the entire caster to be replaced, where as others allow replacement tires in both polyurethane or pneumatic.

Although the presentation was dedicated to rear wheels, wheel locks were discussed as they are affected by the tire types.  Many times as wheels wear the wheel locks no longer grip the tires and require adjustment. Additionally some wheel locks perform better on pneumatic tires over solid types.

Scooters, powered operated vehicles, also use both pneumatic and solid tires. The same holds true with these products where air/pneumatic tires last longer in wear, but are susceptible in getting a flat tire and require regular maintenance. Solid tires wear faster than pneumatics however for many the compromise to not becoming stranded outweigh the softer ride and longer times between tire changes.

Joe provided a thorough presentation of tires, and made everyone realize how confusing it can be for a wheelchair user and their caregivers. It is a good thing that Joe is at Active to help advise and service the equipment. Joe can be reached at service@wheelchairguys.com. 

This article was written by Carey Britton, Seating and Mobility Specialist, at Active Mobility Center and can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com.

University of Miami

In reviewing the week, I was reflecting on an In-Service given at the University of Miami rehab department this past Wednesday. In-Service programs are a great way to share information and to become a resource for Rehab departments; where the ultimate goal is to help improve the lives of people with mobility impairments.

This in service was focused on seating and positioning. Although we discussed several types of equipment and what funding sources are paying for; if the patient is not seated properly you can have the best equipment and not have the best outcomes.

The value of a Seating and Mobility Specialist seemed to be the biggest take away at this weeks inservice. Although the group knew about an A.T.P. certification, they were not aware of the effort it took to receive and keep this. Additionally they were unaware that there were advanced certifications such as the S.M.S. (Seating and Mobility Specialist) and C.R.T.S. (Certified Rehab Technology Supplier).  They were happy to hear that there is so much behind the scenes efforts to improve the standards and access led by the industry.

I was happy to see that their Seating and Mobility team had asked where they could learn more as they want to get better. I provided them with industry events like Medtrade, and the International Seating Symposium as well as suggested they become friends of NRRTS where they could join webinars with the leading speakers in the seating/mobility industry.

Sure, my initial reason for presenting to University of Miami was to promote the services of Active Mobility Center; but knowing that I was helping increase awareness, increase knowledge and provide resources to our community....I was reminded that Iam helping make our community better.

This blog was written by Carey Britton, Seating and Mobility Specialist for Active Mobility Center.  I can be reached at (954) 946-5793 or cbritton@wheelchairguys.com

Don't Eat the Marshmallow...Yet!

 I was fortunate to be invited to the Big Breakfast in Ft. Lauderdale this week to see and hear Dr. Joachim de Possada who is  speaker and author.  His famous book "Don't Eat the Marshmallow" has sold millions of copies world wide. What sounds like a funny title has deep meaning and consequences.

Back in the 50's, a study was conducted with children where they were sat a in a room, given a marshmallow and told if they waited until the reviewer came back they got two marshmallows.  The outcome of this study was that only 1 out of 3 didn't eat the marshmallow.  Later it was investigated that these same 1 out of 3 were more successful, they had better pay, better grades and an overall better life. 

Dr. Possada

There is a payoff in learning self discipline, patience; and to delay self gratification. Joachim had further studied this in other counties, and found that free/open societies had the same results where as with communist or severely under developed counties were 1 out of 10 who didn't eat the marshmallow. 

Dr. Possada went on to say that you can go through the pain of discipline now, or suffer through life with the pain of regret. He explained that when talking with people towards their life's end, that 1 out of 3 people were content and happy with the life they led. 2 out of 3 felt regret that they didn't do something. The same 2 out of 3 had less family and friends come and visit them.

My take away with this was that we all need to be patient, work on our self disciplines, and be grateful. Although there is lots of knowledge in the world, the one that applies the knowledge is more successful. We need to be memorable and spend time with those we love; after the money and fame is over we are left with friends and family.

Thank you to Chris Roehm, who organizes the Big Breakfast and provides great speakers to improve our business community.  Carey Britton, seating and mobility specialist,  writes for Active Mobility Center. He can be reached a 954-946-5793 or cbritton@wheelchairguys.com

It's Time to Advocate for the Future Access of Complex Rehab Equipment

Demand your Rights, Get out and Live !

For years, the DME (Durable Medical Equipment) and HME industries have given away too much in the attempt to best service our customers.  Our industry is comprised of caring individuals who want to make a difference in the lives of patient's we serve. What drives us is that we know at the end of each day, we made an impact, and improved the lives of the people we touched.

The DME and HME industries were created to help reduce the costs of Health Care. Research shows that getting a patient home from the hospital they heal and recover faster. Having a system where equipment and services are provided to the home reduces costly Hospital and Nursing Home Care. The DME industry is 1% of the Healthcare Budget, and saves a lot of money.

In the past few years, the pressures of insurance reductions, fraud and abuse, and increasing equipment costs have affective the way we conduct our service delivery.  What started out as a noble profession of helping, has become a business of becoming efficient.

Caring for our customers, we created networks and groups to lobby the state and federal governments trying to avoid further reduction in access to wheelchairs, scooters, powered wheelchairs, standers, gait trainers and seating and mobility equipment.

What happens at CMS/Medicare is adopted by all other insurance carriers; so those who don't care what happens with Medicare are fooling themselves. Many of our customers cannot speak, many fear that if they complain and lobby that they could lose more than they already have, and others don't know how. Many providers have continued to give away services and equipment and now are no longer able to.  We have failed to educate our customers, and now we are caught in an insurance system who isn't paying and customer's who are angry that they can't get what they used to.

Suppliers and Manufacturer's have commited time and resources to this battle; however since these groups profit from the provision of this equipment their voices are not heard as loudly as when it comes from the customers and beneficiaries of these insurances. Beneficaries will need to Advocate or Accept reduced access to quality equipment and services.

In the past few years, Medicare has instituted competitive bidding, where they forced providers to issue their lowest bid in order to stay in business. The first round of bidding caused hundreds of companies to go under, and 33% of the winning bidders closed within the first year.  This program is being launched nationwide this year, and will certainly cause havock on beneficaries.  As you may have seen the Scooter Store was raided and closed (for now), and all of their customers are stranded. Since they were investigated for fraud, providers are concerned. If a provider repairs and submits a claim for one of these customers, and that customer's paperwork is investigated and found that the Scooter Store did not complete their paperwork properly, that the funds for the chair and all services can be recooped by Medicare.

CMS/Medicare in the past two years had created a system where private companies are auditing providers in hopes to find missing or incomplete documentation so they can recoop money back to Medicare. These companies (bounty hunters) receive money based on this recoopment.  Generally these recoopments are not because the customer/beneficiary didn't need the equimpent, not because they didn't get the equipment; but because their was a T-not crossed or an I not dotted.

Major insurance companies are following Medicare's programs, and it is affecting everyone needing durable medical equipment (DME).  Many DME companies have stopped accepting Medicare as a payment sources as the risk of audits are too great.

There is still time to improve access to this life enhancing equipment.  There are several groups looking for your and your voice to send a message that will affect the future of Medical Equipiment. I encourage you to research these groups and commit to sending emails and making calls to help reduce the future pressure. We cannot afford to lose more companies with the baby boomer population retiring and who will need access to these services. With the pressures from Insurance, the risks are too great for any new companies to invest in the infrastructure of a company to provide these services.

Important Pending Legislation

HR-942- House Bill to Separate Complex Rehab Technlogy Equipmentt from DME, an important step in ensuring Access
S-948- Senate companion bill to separate Compex Rehab from DME

HR-1717- Bill to Stop Competitive Bidding


Get involved:
NRRTS- National Registry of Rehab Technlogy Suppliers
NCART- National Coalition for Assistive and Rehab Technlogy
USREHAB- a Division of VGM
Users First- Voice of Consumers using Equipment

Any questions or comments can be directed to Carey Britton with Active Mobility Center, located in Pompano Beach, Florida.