Pediatric neuro Wheelchairs/seating/equipment

DME vs HME

DME - durable medical equipment with a purpose of meeting an objective (example: walker gets kid to bathroom)

HME - home medical equipment (more stationary equipment such as an oxygen tank)

What is ATP

PTs and OTs can get this certificate by taking an exam through RESNA (assistive technology professional)

What purpose does the national coalition for assistive rehab tech (NCART) serve?

advocates to promote and protect access to complex rehab technology for patients

what did the Medicare reform act do for assistive devices

allowed for medical equipment to be paid for

examples of home modifications

ramps, door widening, overhead track lifts, vehicle modifications, bathroom modifications, stair lifts

what is an ICF/DD

An intermediate care facility for individuals with intellectual disabilities

How does equipment coverage work under medicare

- As a general rule, do not cover W/C in LTC

• Device needed for meal prep, toileting, bathing/hygiene, dressing or transferring

• Can rent or purchase devices

• Prior authorization is needed

• Only pay for 3 in 1 commode as far as bathroom device

How does equipment coverage work under medicaid

- Will purchase DME for clients living at home or in supported living

• Require physician prescription and wheeled mobility form from a PT or OT

• Prior authorization is needed

• Will provide W/C to those in SNF if they require custom seating

how does equipment coverage work under a prvate insurance

- follow medicare guidelines

- pay at 80-20%

- private insurance is primary, then Medicaid

What is the BCMH

- bureau for children with medical handicaps

- we as PTs can help families get their children onto this

- allows extra funding for those under 21

- good for families who do not qualify for Medicaid

National Rehab act of 1973

the original ADA act

What did the American with disability act of 1990 help with:

- Wider doors

o Curb cut outs

o Universal design (e.g. pedestal style sinks to allow W/C access, lever style door handles)

o 12:1 ramp ratio

o Moved children with disabilities from specialty schools and integrated into their home school

IDEA

- Individuals with disabilities education act

- current legislation

- school specific

things to consider when selecting a wheelchair

- Client profile (disability, date of onset, prognosis, size and weight)

o Client needs (activities, context of use, preferences, transportation, reliability, durability, cost)

o Physical and sensory skills (ROM, motor control, strength, vision, perception)

o Functional skills (transfers, ability to propel-manual or power)

o Cultural/ belief systems

o Family expectations

o ID developmental delays

Important W/C measurements to take

- hip width

- hip to shoulder

- hip to knee bilaterally

- knee to foot

- can also do chest width and depth, hip to axilla, elbow to hip, elbow to hand, shoulder width

W/C and seating all starts with what

the Pelvis!

things to consider:

- pelvic position is key

- consider abnormal tone

- look at spinal deformities

- contractures

- are deformities fixed or flexible

- is it going to be comfortable?

- history/risk of ulcers?

- positioning for function

- what is their line of vision

- do they wear orthotics?

manual wheelchair frames

- standard

- standard hemi

- lightweight

- heavy duty

- manual tilt

why is axle positioning important

- wheel behind axle makes the chair quicker and easier to use

- easier to pop a wheelie

- can shift angle of back and seat for better line of vision when appropriate

mid-wheel drive power wheelchair pros

- great indoor maneuverability

- tight turns

front wheel drive power wheelchair pros

- good turning radius

- better on uneven grounds

rear wheel drive power wheelchair pros

- larger turn radius (can also be a con)

- good on uneven surfaces

power wheelchair options

- power tilt/tilt in space

- power recline

- power elevating leg rests

- power elevating seats

scooters

- not as practical as wheelchairs

- medicare pays for them

what is the best cushion type to avoid skin breakdown

- air is the best

- don't want to over inflate

- want to be emersed into cushion

gait trainers

- encourage MOBILITY and exploration of environment w/ device

- can be used as a bridge to promote independence while learning the movement

- also strategy for strengthening and getting WB

- can be forward or rear facing

- considerations for child growth

- Rifton gait trainer is very common, but there are others on the market

standers and dynamic standers

- supportive device that holds child upright in WB

- helps improve bone density especially helps promote hip health!

- many go into supine and prone too

- many allow legs to be in abduction

can we appeal denials if a patient needs a device, but it wasn't approved?

Yes and we should!

are power wheelchair batteries replaced by insurances or out of pocket?

- replaced annually by most insurances

what does a wheelie bar do

- stops you from falling backwards while still being able to pop a wheelie

what is head array

allows the wheelchair to be driven with head movements

alternative ways to drive a wheelchair

- head array

- joysticks

- sip-n-puff

-eye gaze

- finger movement

- etc.

what is a java cushion

- seat with a cutout in the middle for the sacrum

what is a roho cushion

- air filled cushion

- good for pressure relief

- high maintenance

- air can be inserted into entire cushion or can be divided into halves/quarters

- high profile or low profile options

P-pod purpose

- for proper sitting alignment outside of wheelchair

mobility evaluation forms

- letter of medical necessity: used for Medicare and commercial insurance

- certificate of medical necessity: required for Medicaid

Mobility equipment process

1. Mobility evaluation: DME, Therapist and family meet to discuss needs and decide on equipment

2. paperwork collection: therapist completes LMN or CMN, doctor signs in agreement

3. submission to insurance for prior authorization:

- approval

- partial or line-item denial

- full denial (DME and family can decide to appeal the decision or take to an independent hearing)

4. order/assemble/deliver equipment after approval