may 2016 • vol. 15 no. 5 serving the seating & wheeled

May 2016 • Vol. 15 No. 5

mobilitymgmt.com

Serving the Seating & Wheeled Mobility Professional

0516mm_Cover1.indd 1 4/11/16 12:37 PM

adirides.com | stealthproducts.comMark Zupan

S O L I D B A C K U P.W H E N E V E R.W H E R E V E R.

ERGONOMICALLY DESIGNED for you and your lifestyle, our seating system eases the strain on your lower back and is ideal for long days of great activity...on the court and off.

ADI Ad Final.indd 1 12/8/15 9:05 AM

http://stealthproducts.com

“Since I have been using iLevel, it has been a lot easier for me

throughout my day. Whether I am in school or attending a concert or ceremony,

I can now see what is going on in front of me. My friends had to look down at me

in my other chair. iLevel works a lot better for me because I can now talk to my

friends and drive my chair at the same time at eye level.”

www.ilevel.rehab • (US) 866-800-2002 • (CAN) 888-570-1113

/quantumrehab @quantum_rehab

http://www.ilevel.rehab

4 mobilitymgmt.commay 2016 | mobilitymanagement

contents

Cover Story 16 Justify It: K0108 Code

Complex rehab technology’s miscellaneous HCPCS code covers a

wide range of products and can pose enormous challenges to ATPs

and funding specialists.

22 Profound Cognitive Impact: Embrace the PossibilitiesWhat should seating & wheeled mobility expectations be for clients

who present with significant cognitive involvement?

Mobility Management (ISSN 1558-6731) is published monthly by 1105 Media, Inc., 9201 Oakdale Avenue, Ste. 101, Chatsworth, CA 91311. Periodicals postage paid at Chatsworth, CA 91311-9998, and at additional mailing offices. Complimentary subscriptions are sent to quali-fying subscribers. Annual subscription rates payable in U.S. funds for non-qualified subscribers are: U.S. $119.00, International $189.00. Subscription inquiries, back issue requests, and address changes: Mail to: Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866, email [email protected] or call (847) 763-9688. POSTMASTER: Send address changes to Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866. Canada Publications Mail Agreement No: 40612608. Return Undeliverable Canadian Addresses to Circulation Dept. or XPO Returns: P.O. Box 201, Richmond Hill, ON L4B 4R5, Canada.

© Copyright 2016 by 1105 Media, Inc. All rights reserved. Printed in the U.S.A. Reproductions in whole or part prohibited except by written permission. Mail requests to “Permissions Editor,” c/o Mobility Management, 14901 Quorum Dr., Ste. 425, Dallas, TX 75254

The information in this magazine has not undergone any formal testing by 1105 Media, Inc. and is distributed without any warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry.

Corporate Headquarters: 1105 Media9201 Oakdale Ave. Ste 101 Chatsworth, CA 91311www.1105media.com

Media Kits: Direct your Media Kit requests to Lynda Brown, 972-687-6781 (phone), 972-687-6769 (fax), [email protected]

Reprints: For single article reprints (in minimum quantities of 250-500), e-prints, plaques and posters contact:PARS InternationalPhone: 212-221-9595E-mail: [email protected]/QuickQuote.asp

This publication’s subscriber list, as well as other lists from 1105 Media, Inc., is available for rental. For more information, please contact our list manager, Jane Long, Merit Direct. Phone: 913-685-1301; e-mail: [email protected]; Web: www.meritdirect.com/1105

mayvolume 15 • number 5

6 Editor’s Note

8 MMBeat

15 Clinically Speaking: Open Complex Rehab

27 Marketplace: Pediatric Mobility

29 Ad Index

30 Commentary: Innovation to Inspire

Boxe

s: Ind

igolot

os/iS

tock.c

om. W

areh

ouse:

RonF

ullHD

/iStoc

k.com

. Flow

er: Ip

opba

/iStoc

k.com

.

On the CoverOne code, so many products. Cover concept by Jim Stephenson. Cover layout by Dudley Wakamatsu.

May 2016 • Vol. 15 No. 5

mobilitymgmt.com


0516mm_Contents4.indd 4 4/11/16 10:40 AM

mailto:[email protected]

http://www.1105media.com



http://www.magreprints.com/QuickQuote.asp


http://www.meritdirect.com/1105

www f

http://www.amysystems.com


Editor Laurie Watanabe (949) 265-1573

Group Art Director Dudley Wakamatsu

Production Coordinator Charles Johnson

Director of Online Marlin Mowatt Product Development

Group Publisher Karen Cavallo (760) 610-0800

mobilitymgmt.com

Volume 15, No. 5

May 2016

REACHING THE STAFF

Staff may be reached via e-mail, telephone, fax, or mail. A list of editors and contact information is also available online at mobilitymgmt.com.

E-mail: To e-mail any member of the staff, please use the following form: [email protected]

Dallas Office (weekdays 8 a.m. - 5 p.m. CT) Telephone 972-687-6700; Fax 866-779-9095 14901 Quorum Drive, Suite 425, Dallas, TX 75254

Corporate Office (weekdays, 8:30 a.m.-5:30 p.m. PT) Telephone 818-814-5200; Fax 818-734-1522 9201 Oakdale Avenue, Suite 101, Chatsworth, CA 91311

Chief Executive Officer Rajeev Kapur

Chief Operating Officer Henry Allain

Chief Financial Officer Michael Rafter

Chief Technology Officer Erik A. Lindgren

Executive Vice President Michael J. Valenti

Executive Chairman Jeffrey S. Klein

SECURITY, SAFETY & HEALTH GROUP

President & Group Publisher Kevin O’Grady

Group Publisher Karen Cavallo

Group Circulation Director Margaret Perry

Group Marketing Director Susan May

Group Social Media Editor Matt Holden

editor’s note

Honor CodeOn my way back from March’s International Seating Symposium in Vancouver, B.C., I ran into a clinician at the airport. I don’t recall exactly how we got onto the subject of HCPCS codes — isn’t that what everyone talks about in airport terminals? — but she recalled that a client’s mobility system went literally overnight from perfect to pariah when the power wheelchair was reclassified from a Group 3 to a Group 4.

“The same wheelchair she’d used for years,” the clinician said of her client’s system. “It worked great for her. We had everything dialed in. And then one day her wheelchair went from being a great solution to no longer being funded. Just like that. She didn’t change, her needs didn’t change. Her condition didn’t change, the chair didn’t change. Just its code did.”

That sounds like a perfect example of when HCPCS codes become the tail wagging the dog. I think everyone agrees that with tens of thousands of products and components in complex rehab, maybe hundreds of thousands in durable medical equipment as a whole, there needs to be a way to organize them and streamline the medical justification and payment process. But HCPCS codes should be tools that help us to get things done, not the wrenches in the works.

In the case this clinician mentioned, her client was a long-time user who knew exactly what she wanted, and in previous years, after confirming everything in the evaluation, the seating & mobility team “re-ordered” her seating and wheelchair when replacement time came around. But suddenly, the system that had worked for years was no longer available. One day, the chair had a Group 3 code, and everything was fine. The next day, it was reclassified as a non-funded Group 4 chair, and the seating team had to scramble for a suitable replacement. Surely, the replacement system felt second best to the client who’d gotten used to driving and operating the same wheelchair for many years.

In this issue, we tackle another coding conundrum: the K0108 miscellaneous HCPCS code for complex rehab technology (CRT). This catch-all code covers an incredible range of products that have one thing (besides the CRT tag) in common: They don’t have narrower, more distinct codes of their own. And because they’re often handled rather arbi-trarily by funding sources, K0108 products can be very challenging to ATPs and funding specialists. So we gathered our own group of reimbursement and coding experts and asked them to share their experiences, advice and best practices when dealing with this crucial code.

We’ll also check on the status of that 2015 declaration by the Centers for Medicare & Medicaid Services (CMS) that the agency would eliminate the K0108 code and replace it with multiple new codes based on pricing…a decision that CMS walked back last fall without much explanation, just a few months before the new policy was to start.

There was no perfect solution for that client whose power chair suddenly became unobtainable, and codes and their accompanying allowables continue to be more whim-sical than anyone in CRT would like. So we know our cover story won’t entirely fix the unpredictability of K0108 reimbursement, but we do hope to leave you with a little better understanding of it, and maybe with a few tips you can start applying today to lessen the worst of the sting. l

Laurie Watanabe, [email protected]

@CRTeditor

0516mm_EditNote6.indd 6 4/11/16 11:07 AM



YOYO HI-LO BASESpecifically designed to support the Trekker seating base.

www.convaid.com888-Convaid (266-8243)

INTRODUCING

CARROT 3 BOOSTER SEAT AND KITThe Carrot Booster Seat provides room to grow. It can be purchased as a complete seat or you can buy the booster separately and attach it to your current Carrot 3 back.

http://www.convaid.com


mm beat

Chris Ritter Named ROHO Product Manager of AGILITY Backrest LineSeating specialist Chris Ritter has been named the product manager of global sales for ROHO Inc.’s AGILITY line of products.

In a March 16 news announcement, ROHO noted that the position was newly created, with the goal of “establishing focus and placing a senior, professional resource in a key area of growth for the company.”

The AGILITY line currently consists of the Max Contour, Mid Contour, Minimum Contour and Custom wheelchair backrest systems. But at last month’s International Seating Symposium in Vancouver, B.C., ROHO showed off its upcoming AGILITY Carbon — a carbon fiber backrest.

Ritter was previously ROHO’s senior director of global sales.

Not all of your seating & mobility clients can be elite wheelchair basketball players who bring home world champi-onship and Paralympic medals the way Paul Schulte has in his illustrious career.

But thanks to Invacare Corp., at least they can now go along for the ride when Schulte goes handcy-cling with friends on a sunny, blue-sky Florida day.

They can also accompany para-triathlete Charlie Mosbrook on a visit to the Cleveland Botanical Gardens and to the Cleveland Museum of Natural History, where he (and they) get up close and personal with dinosaurs.

These adventures are possible thanks to Invacare’s new virtual reality experiences, created to showcase the independent mobility and freedom offered by wheelchairs.

Schulte uses an Invacare Top End Force RX handcycle to race along the shores of Clearwater, Fla. Mosbrook uses a pair of power wheel-chairs — the ROVI X3 power chair with Motion Concepts Ultra Low Maxx power positioning, and the Invacare TDX SP2 power chair — on his adventures.

“We want everyone — providers, therapists, and most importantly, consumers, to experience what it’s like to be in an Invacare product,” said Maegan Hurtado, Invacare’s digital marketing manager. “We want people to be inspired and know that they truly can do anything they put their mind to.”

In his new role, Ritter will be training clinicians, educators and sales/business partners on current AGILITY products as well as lead introductions of future additions to the line, ROHO said. He’ll also be responsible for driving worldwide sales growth of the line and will act as “the voice of the customer regarding the design and performance of AGILITY products within ROHO’s product management system.”

Tom Borcherding, president of ROHO, said of the appointment, “Chris brings to the table a strong combination

of sales experience, product knowledge, leadership and tenacity. That combination of traits sets him apart and makes him uniquely qualified to take on this very important position.” l

Invacare’s Virtual Reality Takes Consumers Along for the Ride

The specially created footage makes it possible for virtual reality users to not only look straight ahead, but also to the sides, up and down — for example, just as if they were racing alongside Schulte.

The videos at invacare.com/VR can be viewed in the traditional method via laptop or computer. But the most robust experiences come when the films are viewed using a virtual reality headset, such as Google Cardboard’s. Consumers can load the virtual reality footage onto their smartphones via a YouTube app, then fit their smartphones into the viewer and enjoy the virtual reality experience. l

Chris Ritter

Invacare Corp. shot special footage to create virtual reality adventures from the perspectives of wheelchair users.

American wheelchair basketball legend Paul Schulte went handcycling in Florida with friends for Invacare virtual reality cameras.

Best virtual reality results come via a virtual reality headset, such as this cardboard version that Invacare distributed at this year’s International Seating Sympo-sium in Vancouver.

0516mm_MMBeat814.indd 8 4/11/16 2:40 PM

Conference: July 12-14, 2016

Pre-Conference Education Dates: July 10-11, 2016

Hyatt Regency Crystal City

Arlington, VA

Promoting Access to Assistive Technology

In partnership with NRRTS

Education I Advocacy I Networking

RESNA/NCART 2016

www.resna.org/conference2016

Early bird deadline: May 25

http://www.resna.org/conference2016


mm beat

A new study conducted on rats says hypovolemia – a signifi-cant loss in blood volume — combined with spinal cord injury caused poorer outcomes post injury.

The study, carried out by researchers at the University of Sao Paulo, Brazil, was recently published in the journal Spinal Cord.

Researchers subjected 20 rats to identical spinal cord injuries via surgery and contusion, then additionally drained blood from half of the rats to create a 20-percent lower blood volume. The rats were other-wise given identical care before and after surgery.

The loss of blood in half the rats was done to simulate the hemor-rhaging that sometimes occurs after a spinal cord injury.

Study: Blood Loss with SCI Leads to Poorer Outcomes

The rats were tested one, three, seven and 14 days after their proce-dures, specifically to determine how long they could maintain their positions on an inclined plane set at different angles. Rats that had gone through both spinal cord injury and hypovolemia afterward did not perform as well as rats that did not have blood drained. Rats that did not suffer hypovolemia also performed better in motor skills testing. Prior to the procedures, the rats had all performed similarly on the tests.

Researchers believe the poorer results in the hypovolemic group were caused by reduction of the oxygen supply in the injured area, which led to further damage to nerve cells versus cases of spinal cord injury without loss of blood volume. l

Bodypoint Hires New Product ManagerLaurie Gelb has been named product manager for Bodypoint, the manufacturer has announced.

Gelb’s responsibilities include helping to “maintain Bodypoint product alignment with user and therapist needs,” according to the news announcement.

Bodypoint added that Gelb is a veteran of the healthcare industry, having worked for more than 30 years in research, operations and marketing with companies in the health systems, biopharmaceuticals, medical devices and managed care fields.

Gelb has previously managed biomathematics at the M.D. Anderson Cancer Center in Texas, as well as helped to commercialize new

products at Sanofi, a pharmaceutical company.Nicole Muehlenhaus, Bodypoint’s director of global

sales and marketing, said of the hire, “Laurie’s experience translating insights into new products to improve the lives of patients runs deep and wide. We’re thrilled to benefit from that experience in this key position at Bodypoint.”

“My husband had ALS, so I know the importance of wheelchair user access to the unique positioning solutions that Bodypoint has spearheaded over the last 25 years,” Gelb said. “I look forward to supporting products that keep pace

with the innovations that we are seeing in mobility devices, and in other assistive technology that enables fuller lives.” l

Masitinib, a drug that’s already received “Or-phan Drug Designation” from the U.S. Food & Drug Administration (FDA), appeared to slow the progression of amyotrophic lateral sclerosis (ALS) in early results of a double-blind, phase 2/3 controlled trial, Medscape reported in April. The drug’s manufacturer, AB Science, specializes in developing tyrosine kinase inhibitors that it hopes will be able to treat cancers, chronic inflammatory diseases and neurological degenerative disorders. Masitinib has been available in the United States to treat cancerous tumors in dogs since 2010. The FDA grants Orphan Drug Designations to

drugs developed to treat, diagnose or prevent rare diseases. In some cases, the drugs’ manu-facturers are not expected to recover the costs of developing and producing the medications due to the relatively low number of patients who will use it… If you’re traveling in early summer to the No Barriers Summit (June 23-26) or the National Wheelchair Veterans Games (June 27-July 2), look for the team from GRIT Freedom Chair. This chair isn’t a medical device — so it’s not technically a wheelchair

— but it can offer off-road access on hills and beaches via its hand-lever propulsion system. For more info, visit gogrit.us. l

briefly…

GRIT Freedom Chair

Laurie Gelb

0516mm_MMBeat814.indd 10 4/11/16 2:40 PM

http://gogrit.us

http://easystand.com


mm beatmm beat

APTA CSM 2016 Sets Attendance Record in CaliforniaANAHEIM, Calif. — This was my first visit to the Combined Sections Meeting (CSM) of the American Physical Therapy Association (APTA), the organization’s annual signature event. It’s the conference that involves all 18 of APTA’s specialty sections and draws both practicing physical therapists and students who are the industry’s next generation.

This year’s event took place in Southern California, Feb. 17-20, and it set a new event attendance record. APTA said more than 11,300 profes-sionals took part, excluding the large hall of exhibitors representing segments ranging from sports rehabilitation to business management.

Seating & wheeled mobility is a small segment within the physical therapy realm, but complex rehab technology (CRT) manufacturer participation in the exhibit hall was more robust than I expected, particularly among pediatric manufacturers. Other mobility exhibitors included WHILL, the Japanese power mobility manufacturer whose Model A — technically, not considered a medical device — is already available. WHILL’s big announcement was that its Model M had just

been given Food & Drug Administration clearance to be labeled and sold as a power wheelchair in the United States.

One of my favorite aspects of APTA CSM was the huge presence

0516mm_MMBeat814.indd 12 4/11/16 2:40 PM

http://rowheels.com

mobilitymgmt.com 13 mobilitymanagement | may 2016

mm beat

Don’t just look

for a better job.

Look for a

better career.

Our Assistive Technology Professionals

help maximize our customers’

independence. Our ATP Development

Department helps our ATPs lead

better careers. With over 1,800

contracts in place, we have the most

payer contracts in the complex rehab

industry.

We provide extensive support for our

ATPs, letting them concentrate on

doing what they do best.

Put your career in motion at

numotion.com.

For CRT as a whole, that might be the best reason to participate in APTA CSM. A Quantum Rehab sales team was at the show with iLevel, the manufacturer’s new powered seat elevation system on the Q6 Edge 2.0 power base. In the booth, iLevel was indeed at eye level, attracting interested looks from attendees, including students who pointed and whispered to each other. I just could imagine what they were saying.

“Look! Have you ever seen anything like that before?” “I didn’t even know a wheelchair could to that!”Seating & mobility is indeed a narrow niche within physical

therapy, but educating a new generation of PTs — perhaps raising their

National Seating & Mobility chatted with current and future physical therapists.

Freedom Concepts is celebrating its 25th anniversary of making seating & mobility more fun and inclusive for kids with special needs and their families.

of physical therapy students, some of whom were getting their first in-person looks at what complex rehab has to offer. I took a late-day break in the Permobil booth, happily accepting an offer from Darren Hammond, MPT, CWS, senior director of The ROHO Institute, to take a seat on a ROHO cushion set onto a TiLite chair. As I sat, I listened to Darren explain Permobil’s F5 standing power chair functions to a pair of young women — PT students. They’d spent a few moments gazing at the upright F5 from just outside the booth’s perimeter before finally venturing closer.

“Is that a wheelchair?” one of them asked.

0516mm_MMBeat814.indd 13 4/11/16 2:40 PM

800.500.9150 numotion.com

http://numotion.com


mm beat

APTA CSM 2016

expectations of what seating and wheelchairs can and should accomplish — could resonate in years to come.

Next year’s Combined Sections meeting is in San Antonio, Feb. 15-18. l

— Photos & story by Laurie Watanabe

EasyStand’s new Zing MPS (Multi-Positional Stander) can take a child from full supine to prone position while the child remains in place — and without needing to change, turn or flip pads and footplates.

EasyStand’s optional hygienic covers for the Zing MPS are washable and available in six patterns, including the irresistible “Fancy Pants Elephants” choice.

Rifton showed off its new Dynamic Pacer gait trainer. Highlights include easy height adjustability, new arm plat-forms, and the ability for the dynamic upper frame to be used on standard, utility and treadmill bases. An optional odometer in the front caster keeps track of feet (or meters) traveled.

ROHO’s Darren Hammond did triple duty in the Permobil/TiLite/ROHO booth, where Permobil’s F5 power base was on display.

0516mm_MMBeat814.indd 14 4/11/16 2:40 PM

http://www.diestco.com


clinically speaking

Making the Argument for “Open CRT”

Steve Mitchell, OTR/L, ATP, is an occupational therapist who works as a clinical specialist in seating/wheeled mobility & assistive technology for the Spinal Cord Injury & Disorders Service at the Cleveland Veterans Affairs (VA) Medical Center. He has more than 25 years of experience working with people who have neuro-logical conditions. The last 12 of those years have been devoted to providing custom mobility equipment to veterans living with spinal cord injury (SCI), multiple sclerosis, and amyotrophic lateral sclerosis (ALS).

Once his appointments for the day are done, Mitchell starts on his second passion, one deeply and personally connected to his first. He spends days prescribing seating & mobility to produce the best outcomes for his clients, but dedicates many evenings to developing systems he may one day prescribe.

He calls this goal “Open Complex Rehab Technology (CRT).” Mitchell hopes it’s the direction that future assistive technology will take to address the needs of the industry’s most complex clients.

The Role of Product Configuration “I work at one of the 24 VA regional SCI centers,” Mitchell says. “Most of my veterans have complex needs; their wheelchairs play a critical role in just about everything they do. We will follow each veteran for life.”

He adds that VA seating clinicians are often responsible for func-tions that are performed by the supplier/ATP in other settings.

“When seating clinicians in the private sector evaluate a client, what they are able to prescribe is frequently constrained by funding,” Mitchell explains. “Much of their time away from the client is used documenting the medical necessity of the equip-ment to ensure it will be reimbursed. When a veteran requires a complex rehab power chair, we are less constrained in what we can prescribe, but many of us must also assume responsibility for obtaining product specifications and configuring the product

without supplier ATP services.”Working so closely with products

has given Mitchell insight into how successful outcomes are created. He notes that they “require more than just a clinical understanding of the user and knowing which products are available. Knowing how to configure the product to effectively meet their needs is equally important. When I’m not working directly with veterans, I devote a significant amount of time identifying the most effective configurations for the needs of the populations I serve.”

Mitchell acknowledges that this has gained him a reputation “of being very product oriented for a therapist,” but he says, “At the end of the day, I am just a therapist trying to get the best outcome for the individual who uses a chair I prescribe. It’s truly an awesome respon-sibility, when you think about it.”

In 2008, the VA made ALS a service-connected condition, meaning that anyone diagnosed with ALS who served in the military became a poten-tial candidate to receive power mobility

from the VA. “Our SCI/D service formed an ALS clinic the next year, and we began seeing veterans with ALS in significant numbers,” Mitchell says.

But there were differences with ALS patients.“Our service delivery model was completely compressed, because

it wasn’t as if [ALS patients] were going to come in and see me to reevaluate their seating,” Mitchell says. “Actually, they’re here to see the doctor for some other reason. Or they’re people I hardly have the chance to evaluate — they’re in the doctor’s office because they have a lot of respiratory issues, or they’re newly diagnosed.”

Due to the severity of ALS, how quickly clients can progress, and how precise their positioning has to be, Mitchell found himself tweaking equipment for individual ALS clients.

“When I came up with workable solutions in the clinic, I didn’t want to do more work than I had to,” Mitchell says. “Instead of having to repeat the same thing, instead of having it done through our [supplier], I was having it done through the customs

In a self portrait, Steve Mitchell tests out one of his alternative drive control systems designed especially for clients with ALS.

continued on page 29

0516mm_ClinicallyAdIndex1529.indd 15 4/11/16 2:42 PM


Funding Series

What do battery wiring harnesses, front shroud assemblies and manual wheelchair crossbraces have in common?

That’s an easy question for a complex rehab technology (CRT) funding specialist: Those components are (or can be) coded K0108, the miscellaneous HCPCS code for CRT.

HCPCS codes are supposed to include products that are strictly defined and therefore similar in nature. The K0108 code, though, is anything but specific. It’s the default code for products that don’t fit into any of the others, and as a result, the code encompasses an array of components and systems that otherwise have little in common, besides being designed for wheelchair use.

Therein lies the challenge. Getting K0108 components funded in a timely manner can be an enormous task for ATPs and funding special-ists, which can cause ripple effects for the rest of the complex rehab team, including clinicians, caregivers, and seating & mobility clients.

K0108: A “Black Hole of Sorts”For all the infamy surrounding K0108, its actual definition is brief and simple.

Rita Stanley, VP of government relations for Sunrise Medical, said the official definition for K0108 is “Wheelchair component or acces-sory, not otherwise specified.”

But that seems to be the only simple and straightforward thing about the code.

Stanley continued, “You just stepped on one of the biggest landmines in the area of complex rehab. What is officially coded — and remains valid — by the Medicare contractor (PDAC) as K0108 is a minuscule list of items; a list of wheelchair accessories or replacement compo-nents that do not match an existing HCPCS code is quite extensive. The reason this code has generated so much attention is that it is a black hole of sorts. Manufacturers and suppliers often are at odds with Medicare and other payors regarding whether an item fits an existing code or not. There are numerous examples where a payor insists that the supplier use a specific code for billing, yet the descriptor for the code and the reimbursement for the code are incongruent with the item being provided. Stakeholders have tried numerous times to resolve these coding conflicts with little progress.”

From the perspective of a CRT provider’s funding department, an astonishing number of components, both commonly used and rarely used, can fall into the K0108 code.

Paul Komishock, general manager, Pride Mobility Products, said of the code, “From a practical standpoint, it refers to any part or product that doesn’t fit into an existing code. From a CRT standpoint, it could be anything from a replacement straw in a sip ’n’ puff to a combination head array/sip ’n’ puff alternate drive device.”

Jim Stephenson, rehab reimbursement & coding manager for Invacare Corp., offered real-world examples of K0108 products, noting that many spring from repair and replacement situations.

CRT’s Miscellaneous Code Can Be a Huge Funding ChallengeBy Laurie Watanabe

Justify It:

0516mm_K0108Feature1621.indd 16 4/11/16 4:11 PM


“For a standard elevating legrest, if you get those as a pair, it’s an E1010,” he said. “But if you have to replace one of them — one of them is a K0108. A joystick with an inte-grated controller, meaning the controller or the brains of the power chair are also in the joystick box, that box is a K0108. A display is K0108. If you’re replacing a van seat, it’s K0108. Shrouds are K0108; switches are K0108. So are axles, footboards, cylinders, hub locks. If somebody needs to replace the framework of an adjustable height arm, but the armpad is still usable, that arm assembly becomes K0108 because it’s not a complete code without the armpad.

“If you’re providing pieces and parts of a complete component, a lot of times if you’re just doing a partial piece of that component, that’s going to be a K0108.”

Common K0108 ProblemsStephenson added that another common K0108 situation arises when a seating & mobility team creates a hybrid system to meet the needs of a particular client. It’s not an unusual situation with alternative driving controls for power chairs: The ATP and the clinician will piece together a hybrid system by using components taken from two or more systems.

When the systems are taken apart and built into a new system, that’s a K0108 situation.

By definition, CRT clients have positioning and mobility needs that

are so complex that straight-out-of-the-box products may not be fully suitable. So the K0108 code is a commonly used one, and often it’s used multiple times per client.

Dan Fedor, compliance director for The VGM group, acknowledged that a claim for a complex wheelchair often includes multiple K0108 items. The biggest funding K0108

problem he hears from providers, Fedor said, is that the reimbursement rate for K0108 is terribly inconsistent. While the Centers for Medicare & Medicaid Services (CMS) is supposedly using gap-fill methodology to determine K0108 payment, gap filling itself is highly controversial due to the old age of the data being used, and the fact that much of today’s new technology can’t be accurately compared to the technology of decades ago.

“I’m starting to hear more and more about the pricing as far as what they’re allowing,” Fedor said of Medicare K0108 payments to providers. “Since it is a miscellaneous code, that’s one of the challenges for a provider. You’re putting out, let’s say, a $1,000 item. Based on history, [Medicare has] paid between 60 and 70 percent of the Manufacturer’s Suggested Retail Price (MSRP); they set the allowable at 60 to 70 percent of the MSRP. But that’s not a guarantee.”

Fedor related the ongoing case of a provider who received far less than that for a costly K0108 item he’d delivered to his client.

“A VGM member I was working with submitted [a claim for a

Go to www.mobilitymgmt.com/renew and use priority code MHR so you can keep pulling your issue of Mobility Management out of your mailbox each month.

May 2016 • Vol. 15 No. 5

mobilitymgmt.com


Tug-of-War was an Olympic event from 1900 to 1920 (and countries could enter more than one tug-of-war team each).

To keep receiving your free monthly editions of Mobility Management, you need to regularly renew your subscription.

Our auditing agency requires us to annually verify your information and confirm that you wish to continue receiving Mobility Management maga-zine. Please take a moment now to renew your subscription information.

They’re both True!


http://www.mobilitymgmt.com/renew


Funding Series

Justify It: K0108 Code

What Happened to CMS’s Proposed K0108 Changes?January 2016 was supposed to be the start of a new way for the Centers for Medicare & Medicaid Services (CMS) to handle miscellaneous complex rehab technology (CRT) and durable medical equipment (DME) codes.

K0108 (CRT) and E1399 (DME) miscellaneous HCPCS codes would be replaced by six new codes. Existing K0108 or E1399 items would be sorted into a new code based on whether they cost more or less than $150, and whether or not they were part of a repair situation.

That announcement came in the summer of 2015. Then in October, CMS issued an update: “We appreciate the comments received on the proposed coding changes… and will continue to consider the issue further. The changes described… will not take effect on Jan. 1, 2016. Additional information will be provided on the status of these coding changes in the future.”

What Happened & WhyThe CMS statement was very brief and offered no details into what appeared to be an abrupt about-face in plans.

Behind the scenes, industry organizations and at least several CRT manufacturers took a deeper look at what the new six codes could mean based on their own K0108 product lists. They then presented that information to CMS.

In essence, said Jim Stephenson, rehab reimbursement & coding manager for Invacare Corp., CMS’s proposal of six new codes was an attempt to streamline the reimbursement and processing workflow for a very large, disparate group of products.

“Instead of having to manually review and manually price K0108, now they would have a specific code with a specific fee schedule to where if this particular product falls within this price range, this is how much it’s getting paid, regardless [of what the product was],” Stephenson said.

So a previously coded K0108 product that cost less than $150 would be reimbursed at a set amount, and a K0108 item that cost more than $150 would be reimbursed at a second set amount. But what sounded like a cut-and-dried formula proved more complicated when actual products were plugged in.

Stephenson pointed out that K0108 items varied widely not only in cost, but also in how often the items were used. Some K0108 items were routinely included in mobility system claims, while other K0108 items were only rarely used by ATPs.

“Once [CMS] started getting feedback from the industry, they came to realize they were going to be paying more money for most things because there weren’t as many high-end K0108 items as what they had thought,” Stephenson said. CMS had expected to save money on high-cost K0108 items by plugging them into a formula that would require

CMS to pay far less than the agency previously had. In reality, though, CRT manufacturers pointed out that those high-priced items were not used very often.

And those less expensive K0108 items? Under the new formula, CMS would have paid much more than it had before — and doing so frequently, since those lesser-cost items were frequently used.

“Up to $150 was getting paid one way, over $150 would get paid another way,” Stephenson said. “So if you sent in a claim for a [K0108-

coded] bag of screws that cost a dollar, the allowable for that particular code was going to be [approximately] $86.

[Providers] were going to make out like a bandit. “There were going to very few times where those items

over $150 were going to be billed. When they were, there weren’t going to be so many of them that providers would lose

enough to offset the amounts they were being paid for the lower-end items.”

Stephenson said Invacare analyzed its list of K0108 components and concluded that CMS’s proposal would inadvertently end up being very expensive to the agency and its beneficiaries. Only a handful of Invacare’s many hundreds of items would have fallen under the more expensive new code, and the few items that did were relatively rarely used. The vast majority of K0108 items would shift into the new under-$150 code, and thus be reimbursed at a much higher rate than what Medicare was currently paying.

Was there any thought of letting CMS go ahead with the policy anyway? Apparently, industry organizations and manufacturers who crunched the numbers thought of beneficiaries and the industry’s ongoing relationship with CMS when deciding to take the high road.

“We have to be good stewards on our end if we expect them to give us anything in the future,” Stephenson said.

As far as what’s next for the 2015 proposal, Stephenson said he hadn’t heard any news at press time.

Paul Komishock, general manager of government affairs for Quantum Rehab, said he hasn’t heard further conversation on last year’s proposal, or a replacement one.

“There has not been any further discussion on revising the miscel-laneous codes,” he said. “One of the issues with these proposed codes was that there would be a standard fee set for a miscellaneous wheel-chair accessory. As the industry correctly pointed out, this would have inflated payments for very inexpensive items and reduced payments for very expensive items. When such a broad range of items are covered in a miscellaneous code, it’s very difficult to standardize pricing.”

That suggests that though the processes surrounding it are imper-fect, K0108 will remain in the CMS funding equation…for now. l

product that cost] $1,197 MSRP, a miscellaneous K0108. Medicare came back with an allowable of $8.31. We know that’s an error; they probably thought [the MSRP] was $11 instead of $1,197. But this is the challenge. The provider and I called Medicare directly to see if they would just readjust it, and they said it has to go to redetermination. That takes 60 days for

something that is an obvious error.”Fedor added that providers’ options in that situation are

limited. “I’ve had providers ask me: ‘I’m getting paid 50 or 60

percent of MSRP, can I appeal that?’ You can, but I’ve never seen anyone win that.”



Customized Ergonomics,PremiumMaterials

Featuring theFreestyle™ Backrest, 7000 Series aerospace aluminum,and our highest level of customization.

8 0 0 . 3 3 3 . 4 0 0 0 w w w. S u n r i s e M e d i c a l . c o m

Watch 7R Video

7777RRRR

New Mobility Ad.qxp_Layout 1 4/11/16 6:11 PM Page 1

And even if a provider decides to appeal, the burden of work falls on the providership’s staff. Not to mention that the clock continues to run: Equipment has been delivered, but no reasonable payment has been received.

“We obviously know that $8 on a $1,000 item was a miscalculation,” Fedor said. “But they wouldn’t fix it right then and there, wouldn’t let it go through a reopening because it wasn’t an error on modifiers or something like that. So they said it has to go to redetermination.

“They deliver the product, they file the claim assuming they can get 60 to 70 percent of MSRP off this $1,000 item, and they got the $8. And that was the allowed amount: [Medicare] paid 80 percent of the $8. It’s 60 days, probably, before they get this fixed; they deserve another $700 on this. So $700 out for 60 days on one line item, and then their time to have to do that.”

While Fedor acknowledged this had happened to one provider, he’s heard from enough of them to detect a K0108 payment trend.

“We’ve noticed over the past two years that the allowed amount on K0108 has been decreasing,” he said. “It used to be about 80 percent of MSRP, and now on average we’re seeing 60 percent of MSRP.”

The uncertainty of not knowing how much they’ll be paid — combined with how frequently K0108 codes are included on claims — makes it very difficult for providers to efficiently run their businesses.

“You’re rolling the dice; you don’t know how much you’re going to get,” Fedor said.

What’s a K0108 Alternative?Since the current K0108 payment rate is unpre-dictable — and, according to conversations Fedor has had with providers, also dropping as a whole — what would be a good alternative?

Creating more codes to at least reduce the number of K0108 items might seem like a good idea. Practically speaking, though, it’s another story.

“With CRT there are a wide variety of items that do not have a code assigned to them that still provide important clinical benefits,” Komishock said. “K0108s also cover any item that doesn’t have a code that’s used on a wheelchair. So while a K0108 might be used for a combination sip ’n’ puff/head array, it can also be used for a replace-ment screw.

“From a payor standpoint, a miscellaneous code is difficult to automate for payment, since it can apply to so many different items. At the same time it allows the payors to accurately assess what an

item is and what it does. The existence of an actual code is by no means a guarantee that it will be an accurate representation of what is actually being provided. Any code description that contains the words ‘any type’ can sometimes too broadly define

an item, and limit any real variations that may actually exist among products in a particular code.”

Stephenson affirmed that just adding codes isn’t a solution.“There’s just such a vast amount of different things that generating

or publishing a code specifically for every single item out there is impossible,” he explained. “It’s fairly common stuff a lot of times, but

0516mm_K0108Feature1621.indd 19 4/12/16 9:42 AM

http://www.SunriseMedical.com


you can’t build a code for these 5/8" screws and this bag of 1" bolts. You would have such a ridiculous number of codes, and I think it would just be too much to police. Anything that’s custom is almost always K0108.”

Fedor pointed out the problems offered by another type of CMS-related payment referred to as “cost-plus.”

“Medicare might come up next with what Medicaid’s doing, and say, ‘Miscellaneous codes are cost-plus. Show me your acquisition costs, and we’ll give you a percentage above that.’ I don’t think the industry would want that. When you do cost-plus, it depends on the plus. Some of the Medicaids are cost plus 10 percent, which isn’t good.”

One of the many questions about a cost-plus system would be whether Medicare would calculate a “plus” amount that would accu-rately take into account all the work that went into the product listed on the claim form. What about systems or components that had to be altered to meet a particular client’s needs? Or created from scratch because of the complexity of a client’s posture or limited ability to reach and control a switch?

On the positive side, Fedor said, with a cost-plus system, providers would at least know what they would be getting paid.

“Let’s say Medicare comes out with a cost-plus 30 [percent],” he said. “Then as a provider, you could plan. You could say, ‘My cost is $1,000, so I know exactly what I’m getting.’ You can make an educated decision and say, ‘It’s cost-plus 30, and I can do this job.’ Just like the fee schedule: You know what the fee schedule is, so you can decide: ‘Can I put a headrest on the chair or not?’ Can I accept this miscellaneous code knowing I’m going to make 30 percent?”

Clearly, the current system — in which payments are so inconsistent that providers are being paid different amounts for supplying exactly the same K0108 item — is flawed. But so is the idea of adding dozens of new codes, or opting for a “cost-plus” model. Is there any other choice?

“Miscellaneous and otherwise not specified codes are necessary for items with very small utilization, which often is the case for CRT items,” Stanley said. “However, the issues and challenges associated with this type of code are significant for all stakeholders, including payors.

“I support a transparent and predictable process for obtaining defined codes for items to reflect technological difference, and differences in clinical application. This allows appropriate pricing and coverage policies to be developed. When utilization is too small to justify unique HCPCS codes, I support segmenting the miscellaneous codes into smaller buckets to allow better tracking of utilization. The angst at this point regarding obtaining new HCPCS codes is prob-lems associated with capped rental and the gap-filling process used to develop payment. Inadequate reimbursement for items is creating real barriers to access generally, but is nearly eliminating innovation and the ability to introduce new products that improve the lives of people living with disabilities.”

K0108 Best PracticesCurrent K0108 payment practices are clearly not ideal, but there are still ways to improve your chances in the miscellaneous code environment.

“When billing with K0108, it’s important to tell the funding source

A K0108 Case StudyConceivably, the complex rehab technology niche has tens of thousands of systems, components and hardware items that fall under the K0108 code, either on their own or when part of a modular repair situation. How can so many products lack a code of their own and therefore default to the miscellaneous K0108?

Here’s a look at a current K0108-coded product: Comfort Company’s Comfort Foot.

What It IsStacey Mullis, OTR, ATP, director of education, described Comfort Foot as “a lower-extremity positioner that promotes alignment of lower extremities when weakness, abnormal tone, or contractures are present; provides pressure distribution to decrease risk of wounds; accommo-dates contractures at the knee or ankle and can prevent progression of abnormal postures; is adjustable in length to decrease tone and minimize excessive pressure on the ball of the foot that can increase tone or trigger unwanted reflexes.” Mullis added that Comfort Foot can be ordered in different configurations to match a client’s specific needs.

Why It’s Under the K0108 CodeWhat makes this lower-extremity product “miscellaneous”?

“Our Comfort Foot has this code,” Mullis said, “because there are no

HCPCS code descriptors that accurately reflect the description and function of the product. The most ‘similar’ codes are for a calf pad or heel loop, which do not reflect the positioning and skin protec-tion capabilities of the Comfort Foot.”

How to Justify ItDespite the range of disparate prod-ucts that fall under the K0108 code, the process for medically justifying the Comfort Foot resembles that of more specifically coded products.

“The most important thing to remember when justifying this code,” Mullis said, “is to describe in detail why the product is necessary and why a lesser option or omitting the product will be detrimental to the client. In the case of our Comfort Foot, I would recommend to the ther-apist to describe the physical presentation of the client and how the Comfort Foot will do any of the following: protect skin integrity, prevent wounds by increasing pressure distribution, accommodate foot/ankle contractures, prevent lower-extremity contractures by promoting alignment.” l

Funding Series

Justify It: K0108 Code

Comfort Company’s K0108-coded Comfort Foot.



exactly what the item is,” Komishock said. “For Medicare, any time a K0108 is billed, it should include the manufac-turer name, the model/part number (if one exists), and the MSRP, if it exists. In cases where it does not, that should be indicated. Many denials are due to either missing infor-mation about what the item is, or clinical documentation on how the item is benefiting a particular beneficiary. Remember that when a payor sees this code, it could be an almost infinite number of items. The more they know about what it is and what it does, the better the informed decision they can make about it.”

Stephenson said the current claims structure makes it challenging to document as thoroughly as providers should.

“There are a lot of things that fall under K0108, so it’s possible to have five or six K0108s on one chair,” he said. “When [providers] go to bill it, they get 80 characters to summarize five or six K0108s. And you have to provide manufacturer and model number, justification. Eighty charac-ters doesn’t go very far. In fact, 80 characters very rarely covers one.

“K0108 in my opinion should be able to be filed on paper just because filing electronically is unfair. They just don’t provide enough space to input all the information that’s necessary in order to bill a K0108.”

Stephenson suggests that providers abbreviate judiciously on claims.“If you’re billing multiple miscellaneous accessories, each should be

billed on a separate claim line,” he said. “If you have five items that are K0108, you can’t just do one line of K0108 with a quantity of five. Each one has to be its own separate line item. They allow you to use abbre-viations; the only thing is you can’t abbreviate model numbers. Brand names can be abbreviated using the first five letters.”

There is additional information involved when the K0108 is part of a repair. “Not only do you have to identify what the K0108 is, but you have to describe the piece of equipment that’s being repaired, what the HCPCS code is for the item that’s being repaired, the date that the piece of equipment was originally purchased on top of the K0108,” Stephenson said. “You can abbreviate: If you’re replacing an armpad, you can do RPL K0019 BBR, which stands for Broken Beyond Repair. RPL stands for replace, and K0019 is the code for HCPCS. So you can abbreviate it down to a pretty small amount, but still — 80 characters doesn’t go very far.”

Since providers frequently are asked to provide additional documen-tation for K0108s — in part because of the small amount of space on the claim form — Stephenson recommends using a bullet-point format.

“When providers document for K0108, they should make sure to document by bullet points and reference it back to the claim,” he said. “Let’s say they have a claim and it’s five lines of K0108s. In their documentation, they may want to say, ‘Claim line 1: what it is, model number and the reason why it needed to be repaired.’ Then next bullet, ‘Claim line number 2 is K0108 for…’ and keep it separated so that it’s easy to follow and understand as opposed to just providing one big narrative. Bite-sized chunks are a lot easier to digest for a review staff.

“There’s a lot of times where people get denied, and they go back and review their documentation and they say, ‘I don’t say how they missed this; it’s right here at the bottom of this paragraph!’ [Reviewing claims]

is a production-based job; they have to review so many claims an hour. So they’ll get into speed-reader mode where they’ll read the first sentence of every paragraph all the way through the document and say, ‘Okay, I got the general idea of what they’re saying.’ But if you said

anything of great importance at the bottom of a paragraph at the end of the report, you’ve just increased the likelihood that it’s going to get overlooked. You want to make their jobs as easy as possible.”

“There are two very important aspects of documentation regarding K0108,” Stanley said. “The first, and maybe the most challenging, is to explain clearly why the item does not fit a defined HCPCS code. The second step is the medical justification. If the product is needed for a repair or replacement, it is important to explain why it is necessary. If it is a new item, clinicians need to follow best practice in terms of the clin-ical justification. It is important to include information such as Has the person used this item successfully in the past? Or is it needed because what was used in the past no longer meets the person’s needs? And why?

“Documentation is a lot like showing your work regarding an answer to a mathematical equation. Claim reviewers are not allowed to use inference. They must only use the information provided to reach a decision. So it is important to write complete sentences that paint the strongest picture of the person and their medical needs.”

The Future of Miscellaneous CodesStephenson’s final word on K0108 claims concerns the very under-standable temptation to write them off if Medicare denies them or asks for more documentation.

“My advice is don’t ever just give in,” he said. “When you give in, it kind of sets a precedent for Medicare: ‘Well, everybody is walking away from this $5.51 item.’ Next thing you know, it’s not going to be covered. In your next chair you’re going to have about 10 of those $5.51 parts to where it adds up, and it’s now $55 instead of $5. How many of those are you going to let slide?”

That said, he understands that providers need to make daily deci-sions about which claims are worth investing more time in.

“If you fight to the end of the earth for a $5.51 item, you’re probably going to spend $100 in human resources and supplies and paper,” he admitted. “By the time you print out 10 copies of something, you’re pretty close to $5. You have to weigh it out. The dollars and cents to chase that money is going to cost you more than what you’re going to get back, so that’s a good business decision to say, ‘It’s not worth my time and effort. With my $15-an-hour billing person, I’m going to chase something that’s worth $500 instead of something that’s $5.’ You chase the big-ticket items first.”

But pursuing what’s owed you on a K0108 has one up side: More of the work rests with the provider rather than, for example, the prescribing physician. “There are no face-to-face rules,” Stephenson said. “Providers can document the reasons for these things. There’s no prescription required for replacement items. It’s an easier process for K0108 from that perspective, just because providers can do most of the work themselves. You have a little more control.” l



It was a minor thing, a detail that would probably have gone unnoticed in most other situations. Lee Ann Hoffman, OT, MSc, was on a seating & wheeled mobility team that was working with an adult client named Alan, who had sustained a traumatic brain injury and been bed bound for many years. Hoffman and the team, including Alan and his sister, were working toward the goal of getting him out of bed and into a wheelchair.

Alan, Hoffman said, was in a “low-level consciousness” state. This made it challenging for his rehabilitation team to accurately assess what move-

ments Alan could intentionally make.Then one day, a staff member carried a cup of coffee into the room where the team and Alan were working.

“[Alan] voluntarily turned his head towards the coffee,” Hoffman recalled. Alan, she added, “was unable to take

liquids due to a compromised swallow,” but his sister told everyone that he used to enjoy coffee.

“Bingo!” Hoffman said. Alan’s seemingly small act of turning his head toward the aroma of coffee was “a movement we were later going to capitalize on, and what followed was the implementation of a switch.”

Such can be the challenge of working with seating & mobility clients with profound cognitive deficits. Many clients are nonverbal, and even those who can speak or communicate via an augmentative communications device could be significantly limited in what they can say directly. Their positioning challenges may be complex, as are their medical conditions.

Ipopb

a/iSt

ock.c

om


Optimizing Seating & Mobility Choices for Clients with Profound Cognitive DeficitsBy Laurie Watanabe

ATP Series

0516mm_ProfoundCognitiveImpact2226.indd 22 4/11/16 1:21 PM


But these clients can still have a lot to say to the clinician or ATP who takes the time to listen and knows what to look for.

Who Is the Cognitively Impacted Client?The significant cognitive impairments that these clients present with may have been present at birth or diagnosed soon thereafter, as is the case with cerebral palsy. In other cases, clients developed and grew typically, then sustained brain injuries or cerebrovascular accidents later in life, as older children, teens or adults.

Lois Brown, MPT, ATP/SMS, channel manager of mobility & seating for Invacare Australia, points out that even though clients with serious cognitive involvement may have similar outward presentations, there are so many possible reasons for their symptoms.

For example, she said, “You can be fully cognitively intact and not be verbal, like a Locked-In patient. You can have someone who has good cognition, but can’t communicate.”

Due to stroke or other injuries to their brains, patients with Locked-In Syndrome retain full cognition, but are typically paralyzed except for eye movement, and therefore are nonverbal.

“So you still have a problem, because you have to be able to find a way for them to communicate,” Brown said. “When I first started as a brain-injury therapist, I had a Locked-In client, and she just cried and cried. If you looked at her, you’d think she’s just sad. She’s crying. But actually, she had more of a frontal release, where the crying was inappropriate. She cried at everything, even when she was happy. Some stroke patients do this.”

Other clients, Brown said, have mild to moderate cognitive impair-ments and may be limited in how well they can directly communicate with the seating & mobility team.

And therein lies perhaps the greatest challenge when working with cognitively impaired clients.

Making the Most of LanguageCommunicating with the client directly is most likely the best way to determine if, for instance, a seating intervention is causing pain or other discomfort. Certainly, discussing potential solutions and brain-storming around any obstacles is critical to seating & mobility success.

Direct, comprehensive conversations won’t be possible with all seating & mobility clients, but Brown said there are ways to make the most of what these clients are able to say.

“If the client has mild cognitive impact, address the client with ques-tions with the family and caregiver present to verify or add additional pertinent details that affect seating/mobility needs,” she advised. “Ask closed-ended, yes/no questions, and verify that you’re understanding their yes/no answers.” Though Brown acknowledged that these clients “are not going to be the historian that gives you everything you need,” she pointed out that they can definitely contribute, especially if team members phrase questions optimally.

“Are you comfortable? Yes or no?” Brown said as an example. “Do you have pain anywhere? Yes or no?”

Some clients aren’t able to directly speak, but can communicate

well via some other means. Brown said it’s important to tap into those abilities from the very start of the evaluation process.

“If somebody shows up to a wheelchair assessment and they’re not verbal, the first question is Is there an established method or system of communication?” Brown said. “Is there eye-blink? Is it consistent? Is it accurate? Or is it using thumb-up/thumb-down? Do they actually have an iPad with communication software, or do they have an actual communication device?”

If the client does have a communications device, Brown wants the family or caregiver to bring it to the seating evaluation — and it’s important to state that fact up front.

“I can’t tell you how many times I would be in the clinic, and the family would show up and bring everything but the communication device,” she said. “They would say, ‘Oh, it was just one more thing to bring along, we didn’t think you needed it. We’re here.’

“I’d say, ‘It’s great that you’re here, because we do have questions for you, and we do want to confirm the information that the client shares with us. But we want to talk to the client directly as much as possible, right?’ They didn’t always see the value in bringing that device or seeing the importance of the individual having that voice.”

If there is no established communication system, Brown said it’s worth trying to create one if the medical team believes the client would be capable of using it.

Remember the Locked-In client who wept uncontrollably? That involuntary behavior, Brown noted, incorrectly suggested the woman had little higher cognitive function. But the rehab team set out to give her every chance to disprove that outward notion.

“Nobody had set up any communication with her; they just thought there wasn’t anything going on [cognitively], and she was just crying,” Brown said. “We ended up putting a flashlight on a baseball cap, put the baseball cap on her head, gave her an ABC letter board, and she started typing out to her husband where the safe and the important papers were in the house because she was convinced she was going to die before she could tell him.”

Observing Nonverbal CluesOf course, the even greater challenge comes when the client is not reliably communicative in any way.

“But if they’re nonverbal, you at least have to find that out,” Brown said. “If they’re cognitively intact, there’s more likely to be an estab-lished system of communication. If they’re nonverbal, but there’s mild cognitive impairment — that’s really hard to figure out. The most important thing is to not assume someone cannot participate.”

In these situations — when the client is not able to directly give input into what he or she is feeling, thinking, experiencing or desiring — the importance of input from family and caregivers becomes even more important, says Hoffman.

“The answer to the majority of questions can be answered by including the family and the caregivers who assist an individual with profound cognitive deficit,” she said. “I usually refer to the family and the caregivers as the true experts. They know the individual like no one else.”




Families and caregivers who spend hours every day with the client have usually learned the nuances of their behaviors, facial expressions and body language.

“I have asked the family: You say, ‘Blink once for yes, two for no.’ Sometimes the client blinks and blinks and blinks, and you’re not sure that they even understood your directions to have an established communication. The family is going to know best. If you’re really good at what you do, you lean on the people who spend the most time with that individual and know their communications system. Sometimes the aide knows better than the family because they spend more time with them, and they can identify when it really is a yes and really is a no. I think it’s making sure that you have the primary caregiver or the primary family member who spends the most time with that individual at the evaluation or at the assessment.”

Brown has also monitored clients’ physical conditions while trying different seating systems and looked for clues in how their bodies responded.

“You could even go so far as to look at blood pressure and heart rate, because I’ve done that,” she said. “If you have somebody who begins to profusely sweat, you could have somebody who’s having an episode of autonomic dysreflexia from what you’re doing. You could be putting them where they’re getting pressure behind the knee as you’re trying this new system, or maybe they’re sitting in a way that’s been causing them to have that reaction. Is it autonomic dysreflexia, or are we actually giving

them a painful stimuli to where the body is reacting to that?”Brown recalled working with a client who was so medically vulner-

able that her group home administrators insisted she keep a pulse oximeter on her finger as Brown was doing the seating evaluation.

“Someone had plaster-casted her,” Brown said of the client. “She was molded from the top of her head to the back of her knees in a shell. They took a mold of her body and made a shell and strapped it to an upright manual wheelchair. She was almost lying down in recline with a really open hip angle in this chair.”

Brown and the seating team brought in a tilt-in-space manual chair to try. “We didn’t open the back as far, because after we got her out of the mold, she literally bent forward at the hips. She had certainly more of a neutral pelvis and trunk angle, an upright trunk.”

All this time, the pulse oximeter stayed on the woman’s finger as staffers from the group home watched. Brown and the rehab team had been told to call 911 if the woman’s vital signs dropped to dangerous levels.

“So we put her in the [wheelchair], and in no more than a minute, her pulse ox was going up,” Brown said. “When you’re upright, your diaphragm actually has excursion and increased inhalation, and that increases oxygenation through the lungs and through the body.”

The aide, Brown recalled, was astonished and sputtered that this client’s oxygen saturation had previously only registered in the 80s. But sitting in a wheelchair without her cast on and in a more closed back

Embrace the Possibilities

No Assumptions: The Lesson of the Green HandbagWhen clients have profound cognitive involvement, it can be tempting to skip some steps during the “getting to know you” interview or the seating & mobility assessment. Why waste the time of the rehab team, the client, caregivers and aides when it’s “obvious” that so many assistive technology interventions won’t apply?

Given the limited time allowed for assessments, taking shortcuts might seem like common sense. But skipping steps might also deprive you of critical information about the client, or might deprive the client of interventions that could make an enormous difference in health or quality of life.

Lee Ann Hoffman, OT, MSc, got confirmation of that while working with an adult client named Alan, who’d been confined to bed in a state of low consciousness for many years following a brain injury.

“We were unsure of Alan’s vision, as there had been no formal assess-ment carried out in over 20 years,” Hoffman said. “His sister reported that he used to wear glasses.”

When Hoffman was running late one day for an appointment with Alan, she got a peek into his visual acuity.

“I came rushing into the room where Alan was,” Hoffman recalled. “The rest of the team had been trying to see if Alan would turn his head — no success. I hurried up to Alan to greet him and apologize for being

late. He turned his head and looked at my OT green handbag!”Alan subsequently received an adapted visual assessment, “and has a smart new pair of glasses, all the better to see me

with,” Hoffman said. That sort of improved ability could give a rehab team another tool as they make equip-ment decisions.

The moral of that incident? “Too often, we are quick to make snap assessments and fast-track assumptions of the ‘outcome,’ based on the fact that the individual may not be able to formally communicate verbally in the method we all seem to take for granted at times,” Hoffman said. “Almost ‘expecting less’ of the individual.

It happens, for whatever reason, based on time, financial resources or just lack of understanding the individual, their function, activity and participation levels in the context of their own personal and environmental settings. Your best tool here as part of the seating & mobility team is observation. Observe the individual in their environ-ment and record your findings. Ask team members to do the same.

“Creativity can go a long way to understanding the individual and aspects of their function, with the assistance of their family and care-givers to help determine and explore preferences for the appropriate equipment provision. That can have such a significant impact on the individual’s routine and ability to participate, with assistance in activities of daily living and wheeled mobility.” l

digiba

be/iS

tock.c

om

ATP Series




angle, the woman’s oxygen saturation rose into the 90s.“If I could have filmed the look on the aide’s face,” Brown remem-

bered. “I said, ‘Well, we just sat her up.’ Just watching vitals could be a great way to assess someone.”

Getting to Know Your ClientHoffman believes another key to a successful seating & mobility outcome is learning as much as possible about your clients. That includes the ones who may no longer be able to speak well for themselves.

“It’s my mission to learn as much as I can about the individual,” she said. “They are a person, after all. As clinicians and therapists, it must be our goal to create opportunities at every meeting and appointment to get to know, understand and appreciate the individual. This means not just the formal evaluation and assessment stage. I am referring to every single opportunity you get, as formal or as informal as the opportunity which presents itself.”

For Hoffman, every interaction with the client is a chance to add to the collective information that the rehab team might be able to draw on later. “I make a point of talking with families and caregivers. It may look like small talk, chit-chat — okay, some of it is, as I am genuinely interested in people. [But] this curiosity is what drives me to find out more about the individual. Often the person with profound cognitive

disability was a ‘fully functioning person’ with likes and dislikes, hopes, wishes and aspirations. No different, just because of a diagnosis of profound cognitive disability.”

To the outsider, this sort of conversation may seem casual. But Hoffman said she uses these discussions to gather information that could help her during the seating & mobility evaluation.

“I ask those who know the person best questions like ‘What makes William happy, sad, angry? How do I know if William is unwell, anxious, in pain?’”

Hoffman also asks about the client’s typical behavior so she can distinguish it from new responses during the evaluation.

“It is vital to find out what routine the individual has at home,” she said. “When is medication time, when is meal time, when do they take a nap? This can give you clues into what to expect when working with individuals with profound cognitive disabilities who have difficulty with communication. Non-verbal [cues] are a huge clue when working with individuals with profound cognitive disabilities. I am always on the lookout for any little flicker of nonverbal [behavior], and then I will ask the family and caregivers to be the interpreters: What does that face mean? Does this face mean she is comfortable? Does this face mean he is hungry, as we are nearly at meal time?

“Individuals with profound cognitive ability know what their routines are. I don’t know how or why, but they just do. They know

ThevoSleepingStar

ThevoTwist

RECARO Monza Nova Reha

EASySEASyS Modular Swifty

RECARO Performance Sport

tRide tRide+ High/Low base

EASyS+ High/Low base

Visit www.thomashilfen.us

· 309 South Cloverdale Street · Unit B 12 · Seattle WA 98108 · E-Mail: [email protected] · Phone: 866 870 2122 (toll free) · Fax: 866 870 0801 (toll free)


http://www.thomashilfen.us


when you get them out of their chair and place them on the mat for an evaluation that it is not bed time — and ‘Why are you putting me in lying down position when it is 11 a.m.?’ is the sense I often get from nonverbals. I chuckle to myself when families and caregivers usually confirm, ‘Yes, Angela is usually in her chair and we are going for country walks this time of day.’”

Hoffman added, “So it is everyone’s job in the seating team to make sure they have a good understanding of how things are done at home or the individual’s primary place of residence, where they feel safe, comfortable and familiar with their surroundings.”

Preserving & Optimizing IndependenceWhat should the goals be for a client with profound cognitive deficits? Should those goals be any different versus those of a client without those deficits?

Brown indicated she doesn’t automatically disqualify clients with significant cognitive impact from the same seating & mobility goals she has for other clients. As an example, she described a former client with cerebral palsy.

“She had mild mental retardation, and she was an older adult, around 55,” Brown said. “She came in for a wheelchair assessment, and [her aide and the wheelchair provider] said, ‘We just need another [dependent] manual wheelchair. She’s in a group home.’”

The woman, Brown said, was capable of basic speech.“She said hi. I said, ‘How are you?’ and she said, ‘Good, good.’ Not

much, but she does verbalize. The group home aide was there, and the RTS. I had this instinct, and I pulled over a basic power wheelchair and said, ‘Guys, will you just indulge me for a minute?’ I put her in the chair, and she could drive it. She could do stop/start, and she could turn. Was she 100 percent? No, but she’s in a group home, supervised, all the time, and could drive to her bedroom, to the kitchen, or take herself from the kitchen to her bedroom when she felt like it.”

Brown felt that independence was absolutely worth preserving and encouraging.

“To me, it makes all the difference in the world for that person to be able to have any level of independence. If you haven’t really looked at all the options, you could easily make an assumption that would have negated or limited someone’s abilities when they very easily could have had more independence. It could be easy to overlook it.”

Brown recalled another client who was also in a dependent manual tilt-in-space chair. “I said, ‘What about power with tilt? I think he has the cognition to do it.’ And they said, ‘We understand that, but right now, he’s on a behavior plan at the brain injury long-term care facility, and we would be concerned about his erratic behavior and being a danger to others. We’re asking you right now not to introduce power.’ Even though he had more physical mobility capabilities to drive the chair, it didn’t fit with his behavior and his behavioral plan. So it can go either way.”

Even for clients in these situations, however, Brown is a proponent of considering autonomy as much as possible. For example, a client who is unable to safely drive a power chair might still be able to control

powered seating options independently.“Behaviorally, it might help him to feel like he has some control over

what he does and how he sits,” Brown said. “Maybe he’s just so frus-trated. [Operating powered seating] would give him the ability to get in and out of tilt and recline, almost a rocking, calming [motion]. You can put the power chair in no-drive and only give him the tilt/recline access, or access to the communication device.”

Brown acknowledged that acquiring funding for a power chair that the client can’t drive himself can be difficult. But she pointed out that it’s worth checking for alternative sources — such as a private trust fund or funds earmarked for that client at the group home — if it would mean the client could control some of the chair’s functions, such as weight shifting for pressure relief and comfort.

“Think about an ALS client: They’re advancing, and their precision with driving is decreasing,” she said. “So let’s leave them with powered seating. They’re going to sleep in their chairs now, at the end of their lives, and they should still be able to hit a button for calling someone or their communications device. So give them access to those.

“I think that’s important. You’re maintaining whatever level of independence, no matter how small we think it is. It can be very big and important to that individual.”

Celebrating Quality of LifeUltimately, no seating & mobility system will completely compensate for the clinical complexity of profound cognitive impairment. But there is still much that can be achieved by the seating & mobility team willing to push boundaries and push through expectations.

“On the topic of stimulation,” Hoffman said. “if we continue to include and involve individuals with profound cognitive disabilities in tasks which require their activity and participation, who is to say that one day a dendrite won’t sprout, a synapse won’t be made, a connection won’t be made, or a window of opportunity won’t be available? I am always on the lookout for ways to meaningfully include the individual in all aspects of their lives.”

Hoffman also pointed back to the main goals of all seating & mobility interventions, regardless of a client’s physical or cognitive condition.

“The main emphasis of any seating & mobility intervention is three-fold: comfort, function and preventing secondary complications. All seating & mobility goals must align with promoting function — and here, I am referring not just to physical function, but also to internal function, such as respiration.”

Hoffman insisted that clients with profound cognitive deficits are clients first — and therefore not so different than clients who have cognition completely intact.

“We are all inherently different,” she said. “Those unique things that make us us are still important when working with individuals with profound cognitive disabilities. Don’t dismiss them.

“Quality of life is so individual, and specific to each person. Quality of life is the ultimate aim of any intervention and rehabilitation. Who are we to decide about ‘quality’ of life?” l

Embrace the Possibilities

ATP Series




pediatric mobility marketplace

4-Switch ArrayFour proximity sensors enable the driver to operate a power wheelchair by covering the corre-sponding forward, reverse, left or right sensor. This Atom proximity array can be used as a wireless switch interface for computer access or communication devices. The system is usually mounted in the ASL 601 Full Lap Tray Driving Platform or in an ASL 619 Eclipse Tray, though it can be used with no tray. Sensors can be positioned anywhere inside the tray.

Adaptive Switch Laboratories(800) 626-8698asl-inc.com

PinnipedThis free-standing commode is designed to be easy to maintain and can be used at home or at school to help promote a child’s efforts at learning successful toileting skills and independence. The Pinniped comes in red or blue frames and features a height-ad-justable, snap-on seat, adjustable hook & loop chest strap, molded plastic armrests, non-skid rubber foot tips, a 7.5-quart removable commode bucket, and a metal handle and cover.

Drive DeVilbiss Healthcare(877) 224-0946drivemedical.com

AllTrackP SeriesThe Alltrack P series pediatric configuration can be used on the Alltrack mid-wheel or R Hybrid power base to create just the right mobility system for active kids whose adventures take place indoors and outside. The interactive, six-wheel suspension plus seat suspension enhance the power chair’s stability, mobility and comfort. A wide range of powered seating options, including customized ones, is available.

Amysystems(888) 453-0311amysystems.com

Chill-Out ChairFreedom Concepts’ Chill-Out Chair has long offered comfort-able, upright, independent seating via a deep-V foam design that hugs and “cocoons” kids to eliminate the needs for straps or restraints. Now, the appealing Chill-Out Chair has a new array of options, including an All-Terrain Wheel Kit so the chair can be taken on gravel roads or outdoor trails, and Sunbrella fabrics that stand up to family camping trips and lounging on patios.

Freedom Concepts(800) 661-9915freedomconcepts.com

Spirit APSThis pediatric car seat offers swing-away trunk and hip supports like those found in complex seating and wheelchair systems to provide optimal posi-tioning for kids with diagnoses that include positioning needs, such as cerebral palsy or scoliosis. The Spirit APS fits kids weighing from 25 to 130 lbs. and measuring up to 66" in height.

Columbia Medical(800) 454-6612columbiamedical.com

Little Wave ClikWith width/depth growth of 8" to 16", this chair promotes inde-pendence for kids. Index System tubing has dimples to optimize adjustment and eliminate guesswork. The Little Wave Clik promotes proper positioning and wheel access, so you’re one “click” away from a just-right fit. The dynamic fifth wheel allows you to adjust range and spring rate to match your rider’s abilities. With a 12.5-lb. transport weight and 165-lb. weight capacity.

Ki Mobility(800) 981-1540kimobility.com

TrekkerThe lightweight, compact Trekker can take kids around in style while supporting their positioning needs. The Trekker offers adjustable tilt from -5° to 45°, 170° of recline, plus “functional” and “rest” positions to match whatever activity is happening at the moment. Trekker’s seating can be forward facing (so the child can look out at the world) or rear facing (to look at the caregiver). A WC19 transport option is available.

Convaid(310) 618-0111convaid.com

TRAKA lightweight, easily foldable, dependent wheelchair, TRAK offers 45° of tilt in space and 30° of hip-angle adjustment, plus easy adjustment of handlebar, back height, seat depth and knee angle. The RESPOND seating system can be contoured to fit each child; options include trunk supports, therapeutic tray, curva-ture configuration, hip guides and a positioning wedge kit.

Leggero(844) 503-KIDSleggero.us

0516mm_PedsMarket2728.indd 27 4/11/16 12:24 PM


pediatric mobility marketplace

HeadpodThe concept behind this dynamic head support is to begin to position the child’s head in the neutral point of balance over their base of support, either sitting or standing, while allowing free head rotation and forward movement to strengthen head control over time. The ladder strap over the head is adjustable to allow movement within the plane of strength.

Pacific Rehab(888) 222-9040pacificrehabinc.com

Stimulite ContouredThe Stimulite Contoured Pediatric Cushion has a soft top layer fused to a firmer bottom layer of honeycomb for positioning and comfort. Adductors, abductors and an ischial dish position the child, while soft honeycomb cells keep him/her in place. The cushion is available in sizes 10x10", 12x12" and 14x14", and it’s natu-rally antimicrobial and machine washable.

Supracor(800) 787-7226supracor.com

Q6 Edge 2.0 iLevelNow kids can be at eye level with their peers, thanks to the Q6 Edge 2.0 power base and pediatric iLevel technology that provides complex rehab seating and power mobility. The system can include tilt, recline and a power articu-lating foot platform, plus iLevel seat elevation of up to 10" of lift while driving at up to 3.5 mph to keep up with pals. In 12x12" seat sizes and up.

Quantum Rehab(866) 800-2002quantumrehab.com

Recaro Monza Nova 2The Recaro Monza Nova 2 Reha booster seat offers supportive positioning for kids with special needs. It features adjustable lateral supports, a full-range positioning harness and a unique swivel base accessory for safe and convenient transfers. Other accessories include a tray, footrest, seat-depth extender and seat wedge for 15° additional recline.

Thomashilfen North America(866) 870-2122thomashilfen.us

Java Decaf BackThe pediatric Decaf back can be flexed specifically to support the unique contours of a growing child’s body without losing seat depth, and with accurate support contact through the pelvis, lumbar and thoracic spine. It’s available in permanent or quick-release configurations. Patented FlexLoc hardware allows the Decaf to be adjusted in multiple axes for optimal contact with the trunk for comfort and support. Fits chairs 10-15" wide.

Ride Designs(866) 781-1633ridedesigns.com

TWISTThis growable, rigid ultra-lightweight chair encourages exploration while providing a safe environment to learn new skills. The TWIST offers 2" of seat width growth plus 3" of seat depth growth, and requires no parts or growth kits. A 1" aluminum frame design makes for easy installation of seating components. A center-mounted push handle option allows Mom and Dad to lend a hand when needed. TWIST has a 165-lb. weight capacity.

TiLite(800) 545-2266tilite.com

I-Drive 4.0I-Drive’s newest hardware and software release includes built-in Bluetooth for seamless program-ming and future connectivity. Smart ports recognize when something is plugged in, which enables easy troubleshooting. A real-time user interface facilitates improved driving efficiency and a more effective learning curve thanks to smooth, intuitive controls. I-Drive’s latest release is designed to offer endless possibil-ities in configuration.

Stealth Products(800) 965-9229stealthproducts.com

JUNIOR Cushions & BacksThe JUNIOR line of seat cushions and back supports was designed especially for active kids, using anthropometric data to develop lightweight, streamlined seating solutions. The lineup includes a 10x10" seat cushion, plus 10" back supports (for 9-11" chairs) in mid or deep configurations and with pediatric-specific VariLock hard-ware. All use VARILITE Air-Foam Floatation.

VARILITE(800) 827-4548varilite.com

0516mm_PedsMarket2728.indd 28 4/11/16 12:24 PM


clinically speaking

Making the Argument for “Open CRT”department of the manufacturer.”

Technology needs vary from client to client, he adds, including whether a patient will eventually need respiratory equipment to be accommodated on the wheelchair. But so many of those needs can’t be predicted when a power chair is first being configured.

That’s where Mitchell’s “Open CRT” strategy comes into play. It can be described succinctly via a single word: Modularity.

Holding Onto Old RulesModularity would embrace the probability that the best answer for any particular ALS patient could be a hybrid power wheelchair system.

One example: “There are elbow stops that I developed that allow us to work with normal armpads, but if we need to do arm troughs, we can pull the inserts off the armpads and put those on there,” Mitchell says. “On one hand, I’m a clinician. On the other, I’m a product person. What I try to do is interface the equipment with the person’s need.”

Creating a successful interface, Mitchell adds, can require adopting new ways of thinking for everyone involved: clinician, ATP and CRT manufacturer.

“What seems to be happening a lot these days is we’re holding

onto old rules, and we’re not really looking at what’s best for this population’s needs,” Mitchell says. For instance, while tradition may dictate a head array for late-stage ALS clients, “What I’m finding is if I can get a joystick in the right place, most of our guys are going to be able to use that joystick the rest of the way.”

Preserving function and quality of life is personal to Mitchell, who sustained a spinal cord injury at 17.

“It was the first three weeks after my injury, and I had sensation, but it was abnormal sensation, and I was sitting in just a regular wheelchair in the hospital,” Mitchell said. “I remember being totally miserable and helpless. To think about these guys at the end of their lives — their chairs by and large are sitting to the side because they stopped being driven some time ago. [These clients are] sitting in a hospital bed on their sacrum, uncomfortable and unable to move. Where I think power mobility can play a super important role is if you can give them the ability to control their positioning in their chair, and tilt and reposition, that’s going to be 100 percent more comfortable than the alternative —in a bed, unable to move. I just can’t imagine my last days being that.”

And Mitchell says that’s why Open CRT is needed.

Coming up in Part 2: What Open CRT looks like, and the obstacles in its way. l

continued from page 15

ad index

Group Publisher Karen Cavallo(760) 610-0800

Sales Assistant Lynda Brown(972) 687-6710

Advertising Fax (866) 779-9095

advertisers’ indexAmerican Association for Homecare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Amysystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Convaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Diestco Mfg. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

EasyStand/Altimate Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Numotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Permobil/TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Pride Mobility Products/Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

RESNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Rowheels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Stealth Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Sunrise Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Thomashilfen North America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

Company Name Page #

0516mm_ClinicallyAdIndex1529.indd 29 4/11/16 2:42 PM


commentary

Rehab Power Chairs Must Advance to Become More Confidence Inspiring

If we are to have a candid conversation about how rehab power chairs serve those whose lives rely on them, we can’t merely acknowledge the medical benefits, but also how power chairs must meet the emotional and social aspects of the user — that is, serve as confidence-inspiring solutions toward the entirety of one’s life pursuits.

In the evolution of power chairs, as an industry, we first rightfully focused on evolving products to meet medical needs decades ago, and it profoundly enhanced lives. Rehab power chairs subsequently have dramatically improved in so many areas, including seating and positioning, maneuverability, frontal stability, electronics and alternative drive controls. However, our consumer research indicates that more must be done in evolving rehab power chairs. Users appreciate the

medical benefits and essential mobility offered by rehab power chairs, but remain disappointed by remaining limitations. Users are perplexed about why so many features that could be built into their power chairs to increase daily functionality and quality of life aren’t funded by reimbursement.

Even more disheartening, our consumer research shows that as difficult as disability can be, the “medical model” power chair expe-rience can make it worse, where based on restrictive designs, users feel less secure in their lives. Many feel left out of social situations because they’re not at conversational height. Some feel insecure to venture out alone out of fear of power chair reliability and battery range issues. Others feel vulnerable at night, navigating their power chairs without lights. And many feel embarrassed because cumbersome, non-intuitive drive systems cause them to hit walls and doorways. What consumers tell us is that everyday experi-ences — trying to meet friends for dinner among high-top tables, navigating a dark parking lot, or even maneuvering in their own homes — can be “demoralizing” experiences.

What our consumer research ultimately shows, however, is that we must break this cycle limiting the lives of those we serve. With the past behind us and lessons learned — as an industry, through progressive perspective, technological innovation, and dignified

funding policy — we need to shift rehab power chairs from limiting to confidence inspiring.

What we’re witnessing with user after user is that with every incremental socially aware advancement that we make in rehab power chair technology, they express how profoundly it improves their lives — independence increases, social inclusion expands and confidence climbs. “You wouldn’t think including lights on a power chair is a big deal, but when I’m trying to negotiate sidewalks at night coming home from the bus stop, it’s so much safer, and I feel more confident in my independence,” a user told us.

Of course, building in rightful features that address the entire spectrum of one’s well-being — from the medical to those that create greater independence and remove social limitations — can add cost. However, the industry is seeing successes in overcoming the cost challenges through both educating funding sources and striving to design and manufacture these features to be affordable. For example, by demonstrating during the funding submission process that power-adjustable seat height can increase the user’s safety during transfers and decrease in-home care by allowing independent cooking and such, funding sources are realizing the vital nature of the technology to the beneficiary. Simultaneously, some manufacturers are striving to reduce the cost of confi-dence-inspiring technologies like power seat elevation and lighting so that it’s accessible to all. And additional clinical research studies are being performed and presented to further demon-strate to private and governmental funding sources that a small investment toward providing the right technologies dramatically improves the physical, emotional and social well-being of users. In all, we need to continue uniting as an industry in furthering these fundamental approaches. We must work to truly show the value of confidence-inspiring rehab power chairs, where everyone under-stands the ethical importance of funding and delivering technolo-gies that liberate the entirety of users’ lives.

As rehab power chair professionals, we must recognize that the perspective of users is our guiding light. The late Steve Jobs said, “What’s important is that you have a faith in people… and if you give them tools, they’ll do wonderful things with them.” When it comes to rehab power chair technology, let’s provide those we serve with tools that empower all aspects of their lives. By deliv-ering power mobility solutions that not only meet medical needs, but also social and emotional needs, we’re then giving power chair users the fullest scope of well-being. And with that confidence-in-spiring technology, they can then best advocate for themselves and their peers, including toward ensuring funding for such rightful technologies — and everyone wins in that process.

By Scott Meuser and Mark E. Smith

What consumers tell us is that everyday experiences can be “demoralizing” experiences

Scott Meuser

Scott Meuser is chairman/CEO of Pride Mobility Products. Mark E. Smith is a life-long complex rehab power chair user and general manager of public relations for Pride Mobility Products and Quantum Rehab. l

Mark E. Smith

0516mm_Commentary30.indd 30 4/11/16 10:36 AM

2016

washington legislative conference

join hMe leaders froM around the country at the preMier advocacy event for the hoMe Medical equipMent sector.

aahoMecare will provide issue education and related Materials, and will also schedule appointMents for you on capitol hill.

washington court hotel May 25

12 noon – lunch & keynote address

1:00-5:00 pM – issue education & congressional speakers

6:00 pM – pac fundraising reception

May 269:30 aM-4:30 pM – capitol hill Meetings

May 25 - 26, 2016 | washington, dc

visit aahoMecare.org/wlc for More details

http://aahomecare.org/wlc

S E R I E S 2

http://www.tilite.com

may 2016 • vol. 15 no. 5 serving the seating & wheeled

Documents