Powered Wheelchairs- Driving Options

Although the Wheelchair has not significantly changed over the past 10 years, the technology that allows them to operate has.  There is a saying in our company, if a person has any consistent independent movement and the desire, we will get them mobile. 

Even with all the negative pressures in the Medical industry, innovation is no longer limited by the big four wheelchair producers. There are many switch and electronic companies that lead the charge in offering more creative ways to drive powered mobility.  Additionally many universities have gotten involved and have been stretching the options....from using an Ipad, eyegaze and video game controllers to EEG, and Voice Control.

Traditionally the joystick has been used to operate a powered wheelchair. When users could not control a joystick, there was switch control and sip and puff.  Later head control using proximity switches and modified head joysticks.  Modifying a joystick to be mounted on a arm or footrest was common.  In the past decade, fiber optics, magitek, light touch joystick has been used. More recently game controllers (ie PS4 and Xbox) have been converted to allow individuals to drive their powered wheelchairs with these systems. Many of the new technologies that are emerging are adapters, and supports to hold current control devies.

In the past few years, we have seen the Wii balance board used as a input device for children who when lean, can control a powered wheelchair.  Although this is not yet in the market place it certainly offers a wider range of options for those who have limitations in access or those who do not understand movement through space.   We are seeing many universities experiment with EEG as when you communicate and think, the waves are consistent and can be converted into a signal in which to drive a powered wheelchair.  Speech communication has also been used to drive a powered wheelchair.   Most recently, a university has been piercing people's tongues using it as a way to drive a powered wheelchair.

Unfortunately most of these newer technologies have not yet become commercially available or even made it through FDA consideration.  All these technologies are exciting for people who have lost the ability to move independently.  It is truly exciting to see more and more options available which will allow more access and integration.

We are really excited to see people thinking outside the traditional box, and are  looking forward to these new technologies that will enable more people to drive and be independent.

This Article was written by Carey Britton, he can be reached at cbritton@wheelchairguys.com  or at 954-946-5793.

Is it Important to be Certified?

It can be an unconscious decision to entrust someone who is an authority in the field we need assistance from. Whether it is building a house, having a major renovation, having your automobile repaired, having a medical procedure; there is value and peace of mind knowing that your choice is certified and reputable.

You may find it surprising that when it comes to Seating and Mobility equipment; many insurances including local Medicaid's do not require any certification or licensing that the person recommending, and providing the equipment has no certification.  At the time I am writing this, only Medicare and a few Private Insurance carriers require at a minimum an A.T.P. certification.  The ATP (Assistive Technology Provider) is a RESNA certification that requires an individual have some basic experience in DME (Durable Medical Equipment), and who sits for a test.  This certification was established to set a minimum standard to ensure that the person who was involved with the equipment has some experience, and who is requires continuing education. 

As you can imagine, some individuals take this test to gain the minimum standards required by Medicare and never increase their skills as it is not a requirement. Is that enough? There are several people who have been in this industry for decades that have great experience; however when you are looking for an expert, how do you separate a veteran ATP versus one who passed the test last week?

If you are needing basic Seating and Mobility equipment then maybe a newbie can help, but if you are facing challenges; wouldn't you want someone who you can trust? 

The NRRTS organization felt that the ATP was a good starting point, but felt that Seating and Mobility is a specialty and felt there needed to be a higher standard.  NRRTS established the RRTS (Registered Rehab Technology Supplier) which you become after meeting their standards and are listed on a Registry.  After two years of being registered, with no complaints against you, you become a CRTS (Certified Rehab Technology Supplier).  The CRTS has been the gold standard when it comes to finding an expert Seating and Mobility Specialist. 

In the past few years, there is a new SMS certification. This Seating and Mobility Specialist Certification is tested on experience, and was created by RESNA.  This test requires years of experience as there is no manual, or book to read to pass the exam. 

I find it puzzling how if you want compression stockings, only a certified fitter can help you; however with a custom wheelchair with many insurances anyone can fit you for this equipment.  I am happy to see that it is changing, but in my eyes not soon enough. Many lobby that the reason more insurance carriers do not mandate these certifications are that they may not be enough ATPs around.

There was a time where every community had an amazing physician, or an amazing therapist who were the expert in Seating and Mobility; and where the equipment supplier only had to know about their product(s).  Today, with budget cuts, and increased productivity demands; the Physician and Therapist do not have the time or incentive to be the expert. They have higher demands and expectations on the Equipment Supplier for measurement, assessment and recommendation of equipment.

The Equipment Supplier is now suffering from the same budget cuts, and now have a reduced menu of services which depend on the funding source. These insurance pressures are forcing providers to provide what is minimally necessary to maintain a level of profit for the company to ensure their doors can stay open. 

At the end of the day you have to decide who will help you, who will recommend equipment equipment that will affect your life.  The equipment supplier has to make a profit for survival; however your equipment supplier must have your best interests in mind.   The certification(s) are a layer of protection for the consumer, not only for the knowledge and ongoing education.

Not unlike another Medical Professional there is a board that they are accountable for and where their licenses or certifications can be taken away and where it will affect their ability to work. 

This Article was written by Carey J. Britton, ATP/SMS, CRTS with Active Mobility Center. He can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com. Find us on Facebook.

Father’s Day, a Day to Appreciate Dad.

I am sitting here reflecting on My Dad who I lost a year after He and I started South Florida Mobility Inc. D/B/A Active Mobility Center in 1992.  My Dad was an electrician by Trade, and was able to teach me a lot about mechanical and electrical equipment., which I use every day.  I was lucky to have a Dad and Family that gave me the opportunity to succeed and find my passion in helping others maximize their abilities. It was my Dad who found a Medical Equipment business for sale, when I was dismayed about medical school. 

On this Father’s Day, spend some time reflecting on how your Dad has made you better, and appreciate what you have. 

Happy Father’s Day from Active Mobility Center. 

Tilt in Space has almost replaced Recline on Manual Wheelchairs.

Before tilt-in-space wheelchairs, reclining wheelchairs were dominant when a person was a high risk for pressure sores and needed to change their position in the chair during the course of the day. The drawback of reclining wheelchairs is that when reclining the backrest, it causes a sliding effect on the user. The back shears against the users pelvis and against their back. This can cause sores on the back and pelvis if the user's skin is susceptible. Additionally recliners can cause a client to slide down and out of the wheelchair creating positioning and functional issues.

Since the introduction of the Tilt-in-Space wheelchair; recliners have taken the back seat. The only time recliners are prescribed over tilts is when a client needs to recline for feeding, issues with blood pressure, hip limitation, daily activity or severe deformity.

Tilt-in-Space takes a person sitting upright and tilts the whole seat frame back. This allows for the pressures on the buttocks to be redistributed to the back of the user. The tilt-in-space also allows for correct posture throughout the entire range of tilt in space. The tilt with the assistance of gravity helps force a users back, and hips to the rear of the wheelchair helping maintained midline posture. With tilt there is no shear effect since the user's body never changes position against the support surfaces of the wheelchair.

There are chairs now that offer both tilt and recline that can offering maximum benefits.

This article was written by Carey J. Britton, ATP/SMS, CRTS for Active Mobility Center.  Any questions or comments, call (954) 946-5793 or email cbritton@wheelchariguys.com .

We Still Need your Help to Make a Change in CRT- HR 942

I am sitting here on the first day of June, thinking of how far we have come in our quest to change Complex Rehab Technology.  CRT is a relatively new term, which covers custom configured equipment including ultra light weight wheelchairs, powered mobility and seating and positioning equipment. 

It is mostly understood that, CRT is not a order and drop equipment, and requires skilled staff to help with the evaluation and assessment, the gathering and submission of paperwork to insurance funding, the ordering, assembly, delivery and fitting of this specialty equipment. 

Unfortunately our industry has not done enough to police itself and has a black eye, as it is lumped in with DME.  Every month you can see in the news DME suppliers investigated for fraud and abuse.  It is unfortunate that instead of CMS doing a better job screening their suppliers, they have placed higher and higher requirements which are negatively affecting the beneficiaries. What CMS/Medicare does, is adopted by all other insurance carriers.

I am excited to tell you at this moment we have 130 House Co-signers and 15 Senators who have Co-Signed on to this Legislation. This is a great start but we need more to make this legislation to be important enough for Congress to move on this.

None of us know if/when we may need these products and services; and there is a real concern that if things do not change, then this industry will certainly change; and possibly disappear.

A friend of mine reminded me that, Orthotics and Prosthetics went through this Journey several years ago, and it took them over a decade to be recognized and have their products/services separated from basic DME and are understood that it takes a special group of people to take care of those with special needs.

Take a moment to sign on to the petition to separate CRT. If you want to be move involved please contact me and I can put you in touch with several groups who are leading the charge to change CRT.

This Article was written by Carey Britton, ATP/SMS, CRTS for Active Mobility Center. He can be reached for comment at (954) 946-5793 or at cbritton@wheelchairguys.com.