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.

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.

Repetative Strain Injury

This type of injury is becoming more and more prevalent in our society, from carpal tunnel syndrome to shoulder injuries suffered by a growing number of aging individuals in manual wheelchairs. It has always been the stance of medical professionals and insurance carriers to limit the ability of walking impaired to manual wheelchairs as their principle means of mobility. It makes sense that if you are walking impaired, that your calorie burn to intake ration is less, and using a manual wheelchair will help burn more calories, and help keep the user physically fit.

As these clients who were prescribed only manual wheelchairs for their mobility are aging, many are finding themselves having severe pain in the shoulders, which is being diagnosed as repetitive strain injuries. In addition to propelling their wheelchair throughout the day, within their homes, into the community and workplaces; medical professionals are realizing that the human shoulder has limited capacity for these functions.

The movements of pushing a wheelchair, compounded with independent transfers, and daily routines it generally too much for the human shoulder to handle.

It has always been my belief that there is a balance between manual and powered mobility for individuals who are confined to a wheelchair, and dependent for their mobility. From a mobility stance, having the ability to use manual mobility within the home and work place, as the chairs are smaller and more maneuverable is certainly an advantage. Manual wheelchair burn more calories, reducing the potential for excess weight gain; and increases strength allowing for independent transfers. Powered wheelchairs allow a user to travel across greater distances, which put users at risk for repetitive strain injuries.

Repetitive strain injuries can cost funding sources tens of thousands of dollars, not to mention loss of employment to the wheelchair user. This loss could be simply reduced by providing both a manual wheelchair, and powered system to long term users of mobility aids. It would make sense (and reduce costs) by providing this equipment to specific diagnosis; that generally develop these types of injuries.

A possible solution to save money and benefit the wheelchair population, would be to provide both types of equipment; and prompt an education program for potential injury groups to explain the benefits of using both types of equipment; thereby reducing medical care costs, and risk of obesity from inactivity.

This article was provided by Carey Britton, ATP/SMS, CRTS from Active Mobility Center, located in Pompano Beach, FL. He can be reached at 954-946-5793 or cbritton@wheelchairguys.com

Thinking Out Side the Box.

It amazes me how many times I hear clients tell me that their old equipment suppliers/providers told them NO it couldn’t be done. For many industries this may be the case, but for our industry, the custom seating and positioning industry; telling people NO, can mean the difference of independence, or the equipment not being used.

Of course our company says NO, when it liability or safety is a concern; but we offer our client’s the option to customize their equipment to the extent is makes their lives easier or more independent.

Our company advertises its ability to provide custom mobility and seating equipment. If we advertise this we must be able to deliver. Our company continues to offer off the shelf products when needed, offering molded seating systems, customized seating frames, tilt in space, recline, elevating seat, and standing options.

To further our out side of the box thinking, we have the ability to add, specialty lighting to equipment. Many of our clients are children and young adults who were robbed of the ability to own, customize and drive a car. We have been offering neon and other lighting packages to accessorize their rides. Kicking it up a notch, or octave is mounting stereo systems, amplifiers, and speaker systems to the chairs for the entertainment of themselves and their peers.

A new addition, has been adding rear view camera and display systems for clients who have difficulty seeing behind the chair. For may wheelchair users, there is a big blind spot behind their chairs. We have been offering a camera that mounts to the rear of the chair which is attached to a LCD screen on the front of the chair to enable clients to see what is behind them.

Our company still strives at providing systems that fit, and interact with it’s users. We challenge ourselves everyday in enabling our clients; maximizing their abilities!!!!

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

Is Medical Equipment too Expensive?

I have seen many posts lately on Face Book and in Blogs about the high prices for DME and Medical Equipment. I have seen comparisons to Sport Aid and other online pricing compared to the brick and mortar companies. 

As a tax payer, and after taking an Ethic course and discussing the outside perception of the costs of Medical Equipment; I understand the concerns.  It is hard to fathom that a powered wheelchair may cost as much as a car, that an ultra light weight wheelchair may cost $3000. 

That being said, have you seen how much a refrigerator, furniture or a racing bicycle may cost?  I have a friend that has a bicycle that costs $5K.  I understand that the racing bicycle may be considered a luxury and where a wheelchair is not; but there are a lot more bicycles sold yearly than the same custom wheelchairs. Bicycles do not have the same requirements and liabilities as do wheelchairs.

As a Complex Rehab,  DME supplier and Board Member of NRRTS, I see the other side of the equation.  Generally Medical Equipment is funded through Insurance and all insurance companies follow Medicare guidelines. Unlike the Sport Aid type companies, we are forced to comply with all Federal, State, Local, Accreditation, and Insurance guidelines.  Unlike Sport Aid, we have to follow the clinical model and have to provide a report that builds a case for medical necessity, we have to chase all the paperwork, submit the request to funding, help with any appeals, order, assemble, deliver, fit and then submit the claim for billing; which can take up to one year to be reimbursed. 

Retail companies, advertise their products, take a deposit or the entire amount up front, and ship the equipment to the customer.  There is little cost and risk in this process. Catalog and On-line companies can be anywhere, allowing them to reduce costs, they do not have to have the insurance coverage, they do not need to be accredited, inspected, or follow the same standards as Insurance providers.

There are costs associated with playing the game. In retail, it is all about price and value. When providing equipment through insurance, you have to have a location that is certified, inspected, accredited, bonded and insured. The costs above the rent, staff, trucks, equipment, parts; etc. is the Professional and Liability Insurance ($10-$20K / year), Accreditation ($3-$5,000/year), Medicare and Medicaid Licensing ($1K/year), Bonding ($1K/year). There are regular audits by the insurance carriers, which cost much time, and expense in fulfilling the requirements and ensuring payment for services.

DME companies offer and provide knowledge, education, and their experience to improve the quality and successful outcomes. I am the first to agree that there are not enough safe guards in the DME world, which is why NRRTS is aggressively promoting trying to carve out Complex Rehab Equipment from DME.

There are studies that have been conducted, showing that in Complex Rehab that the net profit for most DME's are under 7% which is very low in comparing to other industries. This offers very little room for growth, pay increases to staff, or any additional benefits to workers. 

Competitive Bidding was introduced, reducing payments for many DME products. After the first year 33% of the winning providers went out of business as they could not afford to stay in business.
It is important to remember, that DME companies purchase the equipment they are providing, and help with all the insurance paperwork and do not receive any compensation until the equipment is delivered.  All of the labor costs from the intake, evaluation, quoting, requesting medical documentation, submission for approval, ordering, assembly, and ensuring there is a service staff to help with concerns is all funded through the sale of the product.  It is a semi-flawed system, however if insurance companies paid a lower rates, and considered labor hours for the entire process; the price of the equipment would be higher than it is now.

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

Active Mobility Center Knows the Power of Networking

People buy from people they trust, and they need to get to know you before they trust you.  This process makes it difficult for companies who depend on traditional advertising. 

If you have tried print, video, social marketing, networking, and exhibits, I am sure you will have found that networking and exhibits where you are face to face with people increase your odds in building a relationship of trust which will likely recruit more customers.

Many people do not know they are networking every day of their life.  They tell people what they like and what they don't like.  In business, advertising is expensive, and networking can dramatically help increase the number of people that you can explain why you are valuable.

If you have a clear message, and can back up what your promise you will create an amazing word of mouth business. 

This article was written by Carey Britton with Active Mobility Center. He can be reached at 954-946-5793 or at cbritton@wheelchairguys.com

Active Mobility Center says to Emb(race) Everyone

Emb(race) is an event put on by Stand Among Friends at FAU to support diversity.  Active Mobility Center was pleased to support the 4th annual race on February 23rd of 2014. Hundreds of people came out to support this all-inclusive family fun event that features a 5k & 10k walk/run and one mile family walk; all to enhance the lives of people with disabilities.

Their programs help them transition to greater independence; learn work, technology and social skills while emphasizing their talents, interests and education. We help them realize and achieve their career aspirations and widen their social opportunities--so they can experience a meaningful life, both personally and professionally.

Through a comprehensive employment program, state-of-the-art assistive technology program and lab, vocational evaluations and community outreach efforts, Stand Among Friends helps people regain their independence and dignity. Over 1,200 individuals have participated in our programs and we have placed over 500 individuals in active employment.

The Disabilities Center is located on the campus of the Florida Atlantic University in the Christine E. Lynn College of Nursing in Boca Raton, Florida. The Center, which is designated as a Center of Excellence in the State of Florida University system, coordinates research efforts to develop new approaches, products and services for people with all disabilities.

Thanks to all that came out ad supported this event. Carey Britton, seating and mobility specialist, can be reached at cbritton@wheelchairguys.com or 954-946-5793.

Running Out of the Gate

2014 is here, and things are not slowing down.  Active is looking at the industry as the glass is half full, and where there is great opportunity.  We are seeing many national companies buying up local companies and intimidating the local providers like Walmart.  Insurance is changing, and we are now learning the affects of Obama Care.  There is constant pressure to change, and the staff at Active are embracing this not to ensure survival but to become better.

Over the next few months, our customers and partners will see some major changes. Our office is having some renovations to increase it's display space, increase the retail and accessories available to our customers.  We are improving our inventory management system. A face lift on our website will be completed by February to offer a more friendly site to navigate and access the information.  An event calendar will be added and will show local and regional activies, and events to allow the community more involvement.  You will see a higher level of community visability and involvement. More interaction between our customers and business partners to help us become more valuable to the community and remove any inefficiences. Last but not Least, we will be adding more FUN.  We understand that the Medical Equipment business can be sterile and we want to improve the experience not only for our customers but also for our staff.

We realize change is occuring with or without us, and understand that we need to be ahead of the curve to ensure that we are here for our customers, partners and health care professionals.  We also know that what we do is very personal and that our customer wants a company who listens, who cares, who is local, and who will be there to support and educate them.

Thank you for your continued support. We understand that there is a choice for Medical Equipment and know we have to continue to earn your business and referrals.  Please continue to send in comments or suggestions on how we can continue to improve to be your number 1 choice.

This article was written by Carey J. Britton, ATP/SMS, CRTS from Active Mobility Center. Active Mobility Center, located in Pompano Beach, Florida provides and supports; seating, mobility and specialty rehab equipment.  Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .

What's More Important Wheelchair Brand or Wheelchair Configuration?

The Wheelchair Frame or the Wheelchair Configuration?

It is important to understand that when you are using a wheelchair, scooter or powered wheelchair; the seating and frame configuration is more critical than the brand of chair that you own/buy.  As an expert in the industry, I find most consumers coming to me with questions on which brand; Quickie, Invacare, Colours, Permobil or Tilite wheelchairs and which is the best.  If you had asked me a few years ago, I may have had a preference, however today through innovative new technology there are only subtle differences.

The wheelchair frame is important, however the configuration of the frame and the seating is much more critical to the function and well being of the user.  As I am sure you will agree, many wheelchair users posture is less than perfect in their wheelchair; even if the chair brand is a good one.  You can have the best of equipment but if it isn't configured properly it is only contributing to the problems you are facing.

How Can I Improve My Posture & Function? 

/As a professional, when I am asked this question, I suggest they see their physician or their physical/occupational therapist.
Their medical professionals may have insight on why they sit the way that they do. It is good practice for any wheelchair user to use a team of people to help solve these issues. 

Assuming their physician clears the user with no physical limitations, we can work to improve posture and positioning.  This may require only an adjustment; or it could require new seating and positioning equipment or an entirely new device.

The goal is aways to start at the pelvis. The human pelvis is where everything is attached, and requires the greatest attention in sitting. The goal is to place the pelvis in as close to neutral position as possible. Of course for some individuals having the pelvis anteriorally tilted or posteriorally tilted will be necessary. A stable pelvis is the route of function, which equates to mobility and quality of life. The seating supports are also very critical in the positioning and stabilization of the pelvis.

The position of the lower extremities (legs/feet) are important to consider, as they are tied to the pelvis and require support and positioning.  The angles at the feet/ankles,  the angles at the knee and the angle of the hips are very important for positioning as well as for function and mobility.

What DO I  Need to Know ?

If you are are a wheelchair user, you need to understand that how you are positioned in your wheelchair frame, the orientation, and the seating supports will improve your posture, improve your stability, improve your function and improve your health.  Failure to consider this early, when he body is flexible can result in contracture and deformity that can increase life complications. 

Who Can Help Me?

There is a seating and mobility specialist in nearly every community. This may be a physician, therapist or RESNA or NRRTS. These organizations maintain a list of practicing experts who can assist you with all your equipment needs. You should find and align yourself with a team who can monitor and make recommendations as your body changes or when you are confronted with an obstacle.

This article was written by Carey J. Britton, ATP/SMS, CRTS to offer general but important information on wheelchair configuration and seating.  Carey is the resident Seating and Mobility Specialist for Active Mobility Center. He can be reached at cbritton@wheelchairguys.com or (800) 326-4463.

Is a Wheelchair is a Medical Failure ?

I was appalled when I first heard that a Wheelchair is a Medical Failure. Apparently in the Medical Model, it is taught that when resorting to long term use of wheelchairs and other mobility devices, that you have given up.

It is not surprising then, that the community perspective is that a person in a wheelchair is lame, an invalid, or handicapped....all negatively describing a person's DISABILITIES. This is also why that Prosthetics are much more acceptable, even when they are not as functional.

It may come at a surprise, but mobility equipment is provided not for mobility or independence but to reduce the medical costs associated with an individual stuck in bed. It is clear that a bed bound individual will cost the Health care system more than what it costs to get them out of bed.  Cushioning and Positioning is not for the comfort of a wheelchair user, but to reduce injury, reduce skin breakdown and to reduce contracture and deformity.  We look at this equipment to increase function, independence and quality of life, but the funding sources (all based on Medicare's policy) does not.

Therapy services for individuals with long term mobility challenging conditions are limited. It seems that the Medical Model if there is not documented gain in function then therapy services are not needed. After spending over 20 years in this industry, the question should be without therapy services how much loss will occur. 

Medicare who creates Medical and Equipment Standards, approves equipment based on use within the home and has little flexibility about looking at equipment for recreation and vocation. 

In my 20+ year career, I have seen huge change.  I am concerned with the changing policies that more equipment users need to voice their challenges and their victories.  Not unlike the Women's Rights Movement, where women didn't have a voice, and where they were stuck in the home; equipment users deserve the same. 

If this article has moved you, I encourage you to look at www.usersfirst.org, or www.ncart.us and get involved, share your story, and be heard.  You can reach Carey Britton, Seating and Mobility Specialist at Active Mobility Center at 954-946-5793 or cbritton@wheelchairguys.com .

Krabat Jockey Plus

This new product to the US is a Hi-Lo base that provides kids with balanced, contoured support and lets them interact with the world- at whatever level they'd like, where every they like.. The angle-adjustable sadldle seat abducts the hips and puts the pelvis into a neutral position, encouraging an active seating position. The upper body is aslo well supported with high backrest, adjustable lumbar support, and adjustable side supports.

Saddle seats offer a dynamic, balanced position and are expecially well suited for children with tight or spastic hip adductor muscles.

Features/Benefits

* It makes it easy for kids to interact with teh world and get a handle on new skills

* For Kids between 2-7 and up to 132 lbs

* Folds down and fits into carrying bag for easy transport

* All major joints in the lower extermities become centered. This promotes natural muscle tone and length, and helps to rpevent muscle contractures, hip pain and subluxations.

* Dynamic postural control allows child to move freely.

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

Active Mobility Previews CinemAbility.



Carey and Jenni

I was lucky enough to be invited to the screening of CinemAbility on 10/19/2013 at the Muvico at Pompano Beach. CinemAbility is a documentary of Disability on the Silver Screen from the the early silent films  through the present day.  Jenni Gold, Director created an amazing journey with viewer, with a star studded cast. Our local celebrity Danny Murphy had several parts helping to show the importance of using actors with disabilities in TV and in the Movies to help bring more awareness  and realism.  Jenni explained that few movie writers give much thought to the disabled community when writing their screen plays; there is a push to bring more awareness to writers toward inclusion.


This Documentary will be traveling the US over the next few months, it is a must see.  It is being considered for an Award in the Documentary Category- Tell your friends, and family.

 

For anyone in South Florida, there will be another screening (part of the Ft. Lauderdale Film Festival) on November 2nd.

 

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



Danny and Carey

Quickie QM710 Power Wheelchair- Product Review

Scott Sweeney, representative from Sunrise Medical was in the office to provide an update on the Quickie QM710, Mid Drive Powered Wheelchair.  The QM710 has been marketed with Spider Track technology, where the chair has an aggressive suspension allowing it to traverse rougher terrain; including 4" curbs. Additionally the suspension dampens the ride reducing the seating displacement of the rider.  In the past year, we have seen several satisfied wheelchair users who have decided on this product to meet their needs.

New Improvements:
* New Lower Seat to Floor Height Available (16 1/2")
* Power Legrest Extension to allow standing on the footrest for transfers
* Black Wheel Option
* 12" Seat Elevator, scissor mount, and can drive at reduced speed when elevated

The QM710 is a good option for patients to consider when choosing a mid wheel drive system. 

Any comments can be directed to: Carey Britton, Seating and Mobility Specialist for Active Mobility Center. He can be reached at 954-946-5793 or cbritton@wheelchairguys.com.

Standing with Standers.....Training at Active Mobility Center

Benay Britton and Joe Navarro

This week, Benay Britton, from Active Mobility Center presented on Standing Equipment for people with mobility impairments.  Benay led the presentation saying that anyone not independently standing, and who has a mobility challenge needs to be standing. 

Benay clearly noted that anyone requesting a Standing device needs to be cleared by their physician and issued a prescription for standing.  Many people have skeletal and tendon/ligament limitations that may be aggravated or injured.

She went on to say that there are many benefits of standing from

• Builds Cardiovascular Endurance
• Improves Respiration
• Normalizes Bowel Function
• Improves Urinary Drainage
• Improves Motor Function
• Reduces the Risk of Pressure Sores
• Decreases Abnormal Muscle Tone
• Increases Circulation
• Maximizes Weight Bearing on Long Bones
• Increases Bone Density
• Increases Range of Motion

All of these helps reduces the negative affects of sitting in a wheelchair, scooter, powered wheelchair or bed.

There are many types of standing devices and they come in pediatric through adult sizes. The main types of standers are Prone, Supine, Upright and Sit to Standers. These systems come in manual or powered operation. The Prone/Supine standers come in fixed angle standers or tilt table standers. The fixed angle systems are generally for small children that are easy to transfer and where a specific angle is desired by the physician/clinician.  In many cases, it takes time to achieve more upright standing, and where an adjustable table stander is used in either prone or supine. These larger tilt tables allow the caregiver to be loaded on a flat table and then adjusted to the angle of standing tolerated or prescribed.

As the user becomes heavier and taller, transferring can be more difficult and using a table type stander. Additionally these tables for adults become very large and the user's environment may not accommodate the footprint. 

The Sit to Stand systems offer a smaller footprint, and allow for easier transfers for larger users.The

sit to stand systems can be used from sitting through standing and can be operated by the user themselves.  There are emerging studies that show increased benefits to bone density going from sit to stand. The drawback to the sit to standers is that they place force through the knees to achieve standing, and where the user needs to be able to tolerate this pressure

There are several manual and powered wheelchair standers that are commercially available. For many people standing affects their vocation, their ability to cook, access the home and interact with people.  Many times the need to stand cannot wait until one transfers into a separate standing device. 

What's Required from Insurance for Funding?

Like all Medical Equipment, a Prescription from a physician, explaining the need for standing, and most insurances now require a clinician to perform a specialty evaluation. The clinician may be a physiatrist (physical medicine doctor), a physical or occupational therapist.  These clinicians will perform a functional assessment which will determine whether a stander is medically necessary, and which type/orientation is most appropriate.  Many times it can require trialing equipment to determine what is most appropriate. Today, an ATP (Assistive Technology Provider), or SMS (Seating and Mobility Specialist) can help make recommendations once the user has been cleared for standing.

Who Funds Standers?

Technically any insurance should if medically necessity is established; however Benay explained that Medicare is very difficult to achieve approval. She explained that Medicaid, Vocational Rehabilitation, Worker's Compensation and most Private Insurances do approve these items.  Benay further explained that many insurances look at Standers and Gait Trainers as same or similar equipment, so when discussing options with one's physician and clinician; ensuring the most appropriate equipment is being provided.  Typically like all DME, there is a five year life expectancy on this equipment by the insurance provider.

This article was written by Carey Britton, Seating and Mobility Specialist for Active Mobility Center, and Complex Rehab and Assistive Technology Provider in South Florida. Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .

Special Needs Grocery Cart

Did you know there are grocery carts made for special needs children? I was recently made aware that a family who founded Parent Solution Group, LLC where they struggled with taking their child shopping to the grocery store. This is a regular problem I hear from families I work with and this could really help with everyday life.  Trying to push and navigate with  a wheelchair/stroller and grocery cart is challenging to impossible, making families make arrangements to make a  trip to the store.

A local South Florida Publix is testing a special needs shopping cart at 1180 Royal Palm Beach Blvd. Store #362 on the corner of Okeechobee Blvd.. The phone # is 561-790-4802. They are... using Caroline's Carts, which enables you to put a larger disabled child into a special seat on the front of the cart. You can see the cart at their website http://www.carolinescart.com/. Please tell your friends an families know about this important test, if we don't prove a need, then obviously they won't put them in other stores! See the store manager and ask for one in your home store.

 

This article was provided by Carey J. Britton, Seating and Mobility Specialist, for Active Mobility Center and 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 . 



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 .  

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.