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Serving the Seating & Mobility ProfessionalMarch 2011 • Vol. 10 No. 3
mobilitymgmt.com
EZ-ACCESS, TRIFOLD, SUITCASE, Advantage Series, Signature Series, and PATHWAY are registered trademarks of HPi. Text and images © 2007-2010 Homecare Products, Inc. All rights reserved. 5092M10 REV 12-10-10
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4 mobilitymgmt.com| March 2011 |
March
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 offi ces. Complimentary subscriptions are sent to qualifying subscribers. Annual subscription rates payable in U.S. funds for non-qualifi ed subscribers are: U.S. $119.00, International $189.00. Subscription inquiries, back issue requests, and address changes: Mail to: Mobility Management, 14901 Quorum Dr, Ste. 425, Dallas, TX 75254, email [email protected] or call (847)763-9688. POSTMASTER: Send address changes to Mobility Management, 14901 Quorum Dr, Ste. 425, Dallas, TX 75254. 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 2011 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 75254The 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
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On the Cover
It’s the 2011 — i.e., XI — installment of our Clash of the Titans ultralight-
weight series. Cover by Dudley
Wakamatsu.
12 Cover Feature
Clash of the Titans II: Folding vs. RigidTradition states that ultralightweight rigid chairs offer superior ride and lighter weights, while folding chairs are easier to transport and provide greater adjustability. Is the evolution of ultralights bringing these two design rivals closer together? Or is there still a clear-cut “winner”?
16 Consumer Power Chair ComparoCompare consumer power chairs head to head using our annual grid of specifi cations, sizes and photos. BONUS: Check out the Rehab Power Chair Comparo on page 36!
VOLUME 10 • NUMBER 3
What’s New Online: mobilitymgmt.comLooking for educational opportunities that don’t
break the bank or take you away from the offi ce? Visit
mobilitymgmt.com for the latest online educational
opportunities for complex rehab providers, occupa-
tional and physical therapists, mobility dealers and
DME suppliers. Live Webinars are designed with your
schedule — and budget — in mind. Don’t forget to
also check out our on-demand Webinar offerings!
06 Editor’s Note:Cookies crumble?
08 MMBeat
47 Marketplace:Wheelchair Parts & Accessories
46 CMS Update
49 Classifi eds/Ad Index
50 Funding Essentials
Page 19
Serving the Seating & Mobility ProfessionalMarch 2011 • Vol. 10 No. 3
mobilitymgmt.com
6 | March 2011 | mobilitymgmt.com
T here are two annual indicators that spring is right around the corner. One is the impending arrival of the International Seating Symposium (ISS), which is the impetus of our annual
Seating & Positioning Handbook in this issue (turn to page 19). The other is the arrival of Girl Scout cookies. David Kopf — editor of our sister publication, HME Business (hme-business.com), and an all-
around good guy — has two daughters in Girl Scouts and thus arrived at the offi ce this morning holding a cookie sign-up sheet. I nearly tackled him. After a couple of minutes of poring over the cookie roster and peppering Dave with questions — “What does ‘carmelized’ mean? Does that mean they taste like ginger snaps?” — I ordered one box each of classic shortbread, peanut butter patties, Lemonades, and chocolate-dipped Thanks-A-Lots.
At $4 per box, I owed David’s daughters $16.“Do I pay now or when the cookies are delivered?” I asked.Interestingly, turns out the Girl Scouts now give a Girl Scouts troop a higher profi t margin if
the girls’ parents pre-purchase the cookies, rather than taking orders. Accordingly, David and his wife had bought and paid for a large number of boxes of cookies, which I imagine are stacked to the ceiling in their home.
“You’ll get your cookies tomorrow,” he said. “Instant gratifi cation.”Before David arrived with his order form, I’d been writing a Medicare news story. That gave
me an idea:“Give me the four boxes tomorrow, and I’ll start eating them as soon as I get the boxes open.
But I’ll pay in installments. Like, one payment per month for 13 months.”“I already had to pay in full for the cookies,” David pointed out. “This is the Medicare way of doing things,” I countered. “I’ll give you my fi rst month’s
payment, and you hand over all my cookies.”“Oh, but you’ve chosen the fi rst-month purchase option,” Dave decided. “I’ll deliver the
cookies tomorrow, you pay, and you’ll own your cookies outright.”“I’d rather pay over 13 months, so if I accidentally drop a box before I fi nish paying you off
and some cookies break, you’ll replace them for free.”“Yeah, you’re buying your cookies outright. Thanks.”Accepting the fact that Girl Scout cookies are not capped rental items, I wrote Dave a check
for $16. As I handed my payment over, we discussed what Medicare’s elimination of the fi rst-month purchase option for standard power chairs and other DME reimbursement reductions are doing to the industry. Cumulative cuts over the past decade are resulting in reimbursement levels so low that eventually, it may be impossible for Medicare to fi nd enough equipment suppliers to meet benefi ciary demand.
Surely, the idea is not to “save” so much money that Medicare prices its benefi ciaries right out of high-quality, professional services and technology?
The motto of the Girl Scouts is Be Prepared. In this issue, our policy and funding experts (pages 44, 50) discuss the current state of mobility and complex rehab technology, just in time for kicking off the rehab show season. ISS and other venues always impress and inspire with their technological and research advances. I hope that Medicare and other payors understand that such advances do require everyone’s investment, and are prepared to do their part. ●
Laurie Watanabe, [email protected]
How the Cookie Crumbles? Editor Laurie Watanabe
(949) 265-1573 Editorial Fax (949) 265-1528
Art Director Dudley Wakamatsu Director, Jenny Hernandez-Asandas Print Production Production Coordinator Charles Johnson
Director of Online Marlin Mowatt Product Development
Group Publisher Karen Cavallo (760) 610-0800 National Sales Manager Caroline Stover (323) 605-4398 Classifi ed Sales Stan Pruitt (972) 687-6738 Sales Assistant Lynda Brown (972) 687-6710 Advertising Fax (866) 779-9095
HME MEDIA GROUP Group Publisher Karen Cavallo Corp. Circ. Mgr. Margaret Perry Circ./Mktg. Mgr. Irene Fincher
President & Neal Vitale Chief Executive Offi cer Senior Vice President & Richard Vitale Chief Financial Offi cer Executive Vice President Michael J. Valenti
Senior Vice President Abraham M. Langer Audience Development & Digital Media
Vice President, Christopher M. Coates Finance & Administration Vice President, Erik A. Lindgren Information Technology & Application Development Vice President, Carmel McDonagh Attendee Marketing Vice President, David F. Myers Event Operations
Chairman of the Board Jeffrey S. Klein
REACHING THE STAFFStaff 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] Offi ce (weekdays 8 a.m. - 5 p.m. CT)
Telephone 972-687-6700; Fax 866-779-9095
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Corporate Offi ce (weekdays, 8:30 a.m.-5:30 p.m. PT) Telephone 818-814-5200; Fax 818-734-1522
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mobilitymgmt.com
Volume 10, No. 3
MARCH 2011
Life is calling
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8 mobilitymgmt.com| March 2011 |
news
Invacare Corp. will be part of a new healthcare-focused facility
that will combine showrooms, tradeshow exhibit space and conference space in Cleveland.
Named the Cleveland Medical
Mart, the project is due to open in
2013. Ground-breaking ceremo-
nies took place in January.
The Medical Mart will include
permanent showrooms that
display healthcare technology
from a number of medical fi elds,
including cardiology, surgery,
obstetrics and gynecology,
imaging, healthcare IT, medical
devices and, of course, DME.
Due in part to the local concen-
tration of prominent health-
care organizations, including
the renowned Cleveland Clinic,
Medical Mart offi cials say
Cleveland is an ideal location for
“the world’s only facility targeted
specifi cally to the medical and
healthcare industries.”
Mal Mixon, Invacare’s chairman
of the board, said of the venture,
“Invacare is the global leader in
the home and long-term care
industries. We are proud to be
a healthcare company based in
Cleveland, Ohio, and there is no
better way to show our dedica-
tion to the city and the healthcare
industry than to give our support
to the Medical Mart.”
For more information on the
Cleveland Medical Mart, visit
clevelandmedicalmart.com. ●
Invacare Joins Cleveland Medical Mart Project
Paul Bergantino Named CEO as ATG Rehab Announces Major New InvestorPaul Bergantino has become the new CEO of ATG Rehab, as the
company announced that Audax Private Equity has become a
major new ATG Rehab investor.
A news release said ATG Rehab founders Chuck Wallace,
Mike Freedman, Tim Burfi eld and Bryan Cressey would
remain “signifi cant minority investors.” Bergantino, who has
been ATG Rehab’s president for the last fi ve years, replaces
Burfi eld as CEO.
The release described Audax as a “Boston-based investor
in middle market companies with a reputation for spurring
growth and creating value.”
ATG Rehab has 26 offi ces around the country and will retain
its corporate headquarters in Rocky Hill, Conn. ATG Rehab
provides complex rehab technology and services in 19 states.
Bergantino said of the news, “Audax Group shares ATG
Rehab’s vision of transforming the complex rehab industry.
Our plan is to continue to lead consolidation efforts within the
industry, expanding both our physical presence and focus on
providing excellent service and support to our customers.”
Burfi eld, who remains ATG’s chairman, said, “Over the
past 11 years, ATG Rehab has become the leading provider
of complex rehab equipment thanks to the dedication of our
associates and their focus on the needs of our customers. We
welcome Audax Group’s commitment to our company and
the industry. Paul’s promotion to CEO marks the culmina-
tion of a fi ve-year succession plan and is a tribute to his
outstanding leadership and contribution to our company. We,
along with ATG’s shareholders and management, are excited
to be co-investors with Audax Group and look forward to the
continued success of ATG Rehab.” ●
Artist renderings of the Cleveland Medical Mart show a vibrant environment where healthcare professionals, consumers and caregivers can come together to network. Images courtesy Cleveland Medical Mart.
10 mobilitymgmt.com| March 2011 |
news
Braun Vettes Raise More Money for Foundation
Consider it the ultimate example of regifting! In January, Ralph Braun, president/CEO of the Braun Corp.,
donated two classic 1981 Corvettes to be auctioned to benefi t the newly formed Ralph Braun Foundation, a non-profi t orga-nization that “supports fi nancially needy people with physical disabilities,” according to a Braun news release.
At auction, the Vettes brought in $100,000 — but this wasn’t the fi rst time they’d been sold for charity.
When the cars were fi rst auctioned last September, the winning bidder — BraunAbility dealer Bill Siebert — paid $300,000 for them, gave the money to the Foundation… and
then returned the cars so they could be sold again. ●
Attending Freedom Designs’ CEU seminar series this year comes with a bonus: an additional seminar presented by Altimate Medical.
Freedom Designs is offering seminars, with CEU certifi cation from the University of Pittsburgh, on a pair of topics.
Simply Seating, a one-day seminar, will review the overall seating process and will cover the pediatric, adult and geriatric populations. Topics include skeletal development and deterio-ration, structural deformities, motor and sensory development and deterioration, skin, and the benefi ts of early independent mobility related to neuroplasticity.
Seating: Bottom to Top is a two-day seminar covering the wheelchair seating process. The course will emphasize phys-ical assessment for musculoskeletal abnormalities and postural issues that impact function. A Freedom Designs description of the seminar said, “Normal and abnormal development will be discussed as well as strategies through wheelchair seating that can facilitate muscle strategies that will improve functional outcome.” Research on propulsion and reducing shoulder and wrist strain will also be discussed.
Missy Ball, MT, PT, ATP, Freedom Designs’ seating clinic
Freedom Designs, Altimate Medical Partner on Seminar Series
Robot Manufacturer: “Collision-Proof” Power Chairs Are PossibleWill accidents between power wheelchairs and the occasional doorjamb — or family dog — become things of the past?
GeckoSystems International Corp., based in Conyers, Ga., and maker of what it terms “mobile robot solutions for safety, security and service,” says its inventions enable “cost-effective retrofi tting of electric wheelchairs to be ‘collision proof.’”
According to a news release, the company is developing a retrofi t kit that “may be added to most joystick-operated electric wheelchairs. The wheelchair occupant would simply move the joystick in the direction they wish to go, and GeckoNav would automatically seek that desired direction while avoiding any and all obstacles, whether stationary or moving.”
GeckoNav is the company’s navigation software. The soft-ware operates based on input from GeckoImager, which uses a sensor fusion system to gather environmental information.
The cost of the system?Martin Spencer, GeckoSystems’ president/CEO, said, “We
expect the cost to the end-user, completely installed, to be only a few thousand dollars for this heightened level of safety for not only the occupant of the wheelchair, but also those persons around them.” Fans of artifi cial intelligence and its
potential applications can visit geckosystems.com. ●
consultant/education specialist, will present both of the seating seminars.
Seminar attendees will also be able to take part in Altimate Medical’s Don’t Just Sit There presentation, given by Andy Hicks, ATP, and Peter Wankelman, ATP. The course will cover “why children need frequent position changes, and how movement benefi ts their cognitive and physical development,” according to a news release. Metabolic Syndrome, how movement can help to maintain overall health into adulthood, and how to write successful letters of medical necessity for assistive technology will also be discussed.
The seminar tour will be stopping in Philadelphia in March and in Louisville, Ky., and Orange Beach, Ala., in April. For additional seminar dates and venues throughout the summer and fall, or for more registration information, visit freedomde-signs.com or talk to your Freedom Designs representative. ●
| March 2011 |mobilitymgmt.com 11
news
Seating & positioning products from The Comfort Company are now featured on LMNBuilder, a tool that helps clinicians to write letters of medical necessity at lmnbuilder.com. Among the offerings are the Adjuster
and Vector seat cushions with Vicair air cells, the Acta Back Deep and the Elements Back… Uplift
Technologies has won an Arthritis Foundation Ease-of-Use Commendation, given to products that pass a series of Foundation tests. The Commendation was awarded to Uplift’s portable, electric lifting seats, Risedale Lifting Seat Chair, and Commode Assist self-powered lifting commode chair… Here’s something for DME suppliers and complex rehab technology providers to consider when working with clients who have dementia: A recent study has shown that such patients had trouble understanding their discharge instructions when leaving emergency rooms. The study, published in Annals of Emergency Medicine, “found that elderly patients with cognitive impairment could not accurately explain why they were in the emergency department,” said lead study author Jin H. Han, M.D.,
MSc, Vanderbilt University. “Furthermore, those patients with cognitive impairment had decreased comprehension of their discharge instructions, which may negatively impact patient safety.” The study also noted that emergency room physicians don’t routinely screen for dementia and delirium, which means ER personnel may not be aware that patients have those conditions and may not treat them accordingly. “Elderly emergency patients with cognitive impair-ment are at a higher risk for miscommunicating their needs and misunderstanding the discharge care plan,” Han said. “This affects our ability to adequately provide quality care for these vulnerable patients.” The study results said delirium and dementia occur in 25 percent of older emergency room patients… Congratulations to Kurt Landsberger, CEO and founder of Maddak, Inc., who recently celebrated his 90th birthday. Landsberger, who celebrated the occasion with his family, still works three days a week and travels regularly between New Jersey and Florida. Maddak manufactures a range of aids to daily living for seniors and people with disabilities… Gary Nowitz, director of sales in North America for Ergolet, announced that the company is now an approved supplier for the U.S. Government Services Administration (GSA). Ergolet manufac-tures overhead patient lifts, sit-to-stand aids and mobile lifts for use in private homes as well as healthcare facilities. ●
Briefl y…
The Adjuster cushion with Vicair technology is one of many Comfort Company products now featured at LMNBuilder.
Freedom. Independence. Mobility. The FreeWheel is a durable lightweight third wheel that quickly and easily clamps to the footrest of a rigid-frame wheelchair, raising
the front casters, making it easier and safer to roll over and through curbs, dirt trails, snow,
and uneven sidewalks. WWW.GOFREEWHEEL.COM
Dealer Inquires Welcome 208-571-2051
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See us at ISS
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12 | March 2011 | mobilitymgmt.com
Last year in our discussion on ultralight-weight manual chairs, it was aluminum vs. titanium. This year, we turn the
spotlight on design. Historically, ultralight frame designs have been divided into two categories: rigid or folding. And historically, each type of design has been credited with being “better” than the other type in certain situations.
But given advances in technology, we wondered: Are these assumptions still true? Were they ever? And are the two designs now more alike than they are different?
We asked experts on ultralightweight design and manufacturing — several of whom are also ultralightweight chair users — to weigh in:• Josh Anderson, VP of marketing, TiLite• Jim Black, marketing manager, Top End• Brent Hatch, director of product manage-
ment/adult manual, and Christy Shimono, senior product manager, Sunrise Medical
• Rick Hayden, VP of North American sales, Colours Wheelchair
• Doug Munsey, president, Ki Mobility
Assumption #1: Folding Chairs Are More Easily Transported than RigidsTraditionally, this is assumed to be the biggest benefi t of a folding chair: that a crossbrace enabling the chair to fold verti-cally makes a folding chair easier to trans-port than a rigid chair, which has a main frame that cannot be collapsed.
For Superior Ride, Transportability & Adjustability, Does One Design Prevail?
Multiple experts noted that a clarifi cation of “folding” is needed.
Josh Anderson points out some of today’s rigid chairs have folding backs, “and you even have folding backs on folding chairs.”
This story categorizes chairs based on whether or not the frame folds — though the fact that some rigid chairs now have folding backs speaks to the overall design evolution of all ultralightweight chairs.
Says Jim Black: “In the old days, when the folding chair was designed, it was designed to put into a car to transport it. It was an easier way to put it into a trunk. But a typical user today is probably more effi cient in their prod-ucts and more apt to put their products in their cars themselves or have somebody who can put the chair in the car. So transportation isn’t as big an issue as it was 20 years ago.”
Black adds that changes to rigid chair design — including that folding back — have made rigid chairs much more transportable.
Anderson says, “I think the advent of the quick-release axle was a huge turning point, because now you can pull the rear wheels off
(a rigid chair). A lot of times today, you can fold the back down, and (a rigid) chair is more compact than a folding chair.”
Christy Shimono says the assumption that folding chairs were automatically more trans-portable may have been fl awed, anyway.
“Way back in the day, (we’d say) this is a folding chair, and this one doesn’t fold, and it really made people say, ‘Oh, I can’t have that.’ I think that was a poor analogy, because both (designs) are portable in their own way.”
Shimono also suggests that clinical consid-erations are crucial to the transportability discussion.
“It really comes down to clinical,” she says. “You might think this person (is appro-priate for) a folding chair, but then you fi nd out they don’t have the upper-body strength to fold and pull the entire product in (to the car). They might be better off breaking the frame down, taking the wheels off and putting it in. You might have somebody with Guillain-Barre — they’re very active, but their hand function is really limited, and they might not be able to pull that wheel off. So I
By Laurie Watanabe
| March 2011 |mobilitymgmt.com 13
always like to be very cautious.”Our experts’ consensus: While folding
chairs have traditionally won hearts and minds on the transportability issue, that assumption is outdated.
“The folding frame will consist of an X brace and often a footrest that swings away and can be removed,” says Rick Hayden. “So to transport, you remove the footrest and fold the frame. A rigid frame is a solid, one-piece frame that to transport, you remove the rear wheels and fold down the back if necessary. In a nutshell, rigid frames have reached the point where they are as convenient or more convenient to transport than a folding frame.”He also points out that there’s an overall weight savings with rigid chairs vs. folding chairs: “Rigid frame wheelchairs are lighter in weight due to fewer bolt-on parts.”
And that “lifting weight” — the weight of the chair as it’s being lifted in and out of the car — is important, Black says. “Weight is a very small component to the whole thing, but yes — lifting weight is going to be an issue. Generally when people fold chairs up to put
them in the car, they leave the wheels on. So the lifting weight is increased.”
In contrast, users of rigid chairs typically take the wheels off their chairs before putting them into the car. That means that in addi-tion to the rigid chair weighing less to begin with, the lifting weight of the frame is further reduced because the wheels are off.
Assumption #2: Folding Chairs Offer Greater Adjustability & FlexibilityRigid frames, by their very nature, are typi-cally custom built for a particular user. Folding chairs are modular — as Black describes, “You have a front frame section, a rear frame section and generally, a crossbrace.” Modular pieces are offered in a range of sizes, typi-cally in 1" increments, while rigid chairs can provide more customized fi ts — which can result in smaller footprints.
Anderson is 6'9" and uses a rigid chair without a folding back. “Using myself as an example, if you have somebody who’s very big, you can use a rigid chair and put that
rigid chair into a very compact spot,” he says.In that way, customized rigid chairs can be
considered more fl exible in sizing, since they can more exactly fi t their users. In comparison, a folding chair user may have to accept a chair that’s a little bigger than he needs it to be.
On the other hand, folding chairs can be more adjustable when it comes to options and accessories, says Doug Munsey.
“There are many, many more options avail-able for a folding chair,” he notes. “There’s more things you can do with them: more armrest options available, more caster options available, more foot positions. On a rigid chair, it’s welded custom; it is what it is. So the frame can’t be modular, it can’t be changed. You can change what their seat dump is, their positioning. But you can’t change the width of the frame.”
That can be a critical consideration espe-cially among new ultralight users.
“Spinal cord-injured people in partic-ular tend to lose weight over their fi rst year, because they’re not doing activities so well,” Munsey says. “They may have been 180 lbs.
14 | March 2011 | mobilitymgmt.com
a folding chair’ just doesn’t exist anymore. It doesn’t apply.”
Assumption #3: Rigid Chairs Provide a Better RideRigid chairs may be improving in areas such as adjustability and transportability, but their main claim to fame has always been the ride.
Much of that claim is simple physics based on the design of a rigid frame.
“A rigid frame design is more energy effi -cient due to fewer moving frame compo-nents,” Hayden says.
“A rigid chair is just that — it’s more rigid,” Anderson says. “The transfer of energy is more effi cient because with a folding chair, you have that crossbrace, technically. I say ‘technically’ because some folding chairs use different types of crossbrace mechanisms. But typically with a rigid chair, it’s more rigid so it’s more effi cient to propel. There’s a better transfer of energy. They’re more effi cient to propel because you don’t have all the fl exing of the different components.”
That means that when a user pushes a rigid chair, more of that energy is translated into propulsion, versus a folding chair, in which some of the energy is lost.
With a folding chair, Shimono says, “because you need to collapse that chair, one way or another you’re going to have things that are absorbing some of the energy that you put into the push.”
That leads to a bigger question: Physics-wise, folding chairs are going to surrender more energy than a typical high-quality rigid chair because folding chairs have more moving parts. But is there a big enough differ-ence in the ride for the average user to really notice? Or are users’ ride preferences based on other factors?
Yes…and yes, our experts said.Asked if people truly notice ride differences
between rigid and folding frames, Munsey said, “I think they do. I also think people get used to whatever it is they’re sitting in. They acclimate to it, so it becomes less of an issue. If you get sneakers, you may not be buying the very best sneakers, but you feel pretty
good in them. Then you go try a really great pair of sneakers, and you feel, ‘Whoa, these are great.’ But two weeks later, you don’t necessarily feel it any more. You acclimate to whatever it is that you’re using.”
Anderson started using a wheelchair as a young teenager, when he says, “The level of technology was not nearly where it is today.” He had two chairs, a rigid and a folding. He started out in the folding chair and used it for a few weeks. After that, he started using his rigid chair. “I never went back into the folding chair,” he says, adding that even when trav-eling overseas, he uses his everyday rigid chair.
Black used a folding chair for a year, then switched to a rigid chair. “The ride of a folding chair, to me, never felt good,” he says. “It never felt right to me.”
He acknowledges friends who prefer folding chairs, “but for me, it’s more cumber-some,” he says. “That’s a preference at that point. I think everybody should be in rigid. That’s not the case, but I’m just being honest. It’s what I believe.”
Hatch agrees that personal preference — and personal comfort zones — play a huge role in which type of chair an individual consumer uses.
“Once you become comfortable, once your life’s routines are set up around that — you now have a folding chair with a swing-away hanger, and you access the bathroom, the toilet, and you’ve done that for 15 or 20 years — those things all play into your deci-sion-making.”
Conclusion #1: Fit Is CriticalSo if some of the most commonly held assumptions about folding and rigid frames are actually untrue given technological advances, can we draw new assumptions for ultralightweight designs?
Apparently so. And the top opinion of our experts is that — assuming that clinicians and complex rehab providers are working with high-quality folding and rigid chairs — the fi t of the chair is ultimately the most important factor in determining success or failure.
“The fi rst thing you need to do is have the
when they were injured — a year later, they could be 150 lbs., and could continue to lose weight. They’re going to need a smaller chair.”
“There are things that a folding chair has that not every rigid chair has, like swing-away hangers,” Shimono says. “For the most part, you’re more limited in accessories on a rigid chair.”
“Seating accessories have historically been built around and designed for folders,” Munsey says, noting that such accessories typically accommodate 1" tubing, which is what folding chairs commonly use. “Rigid chairs, the custom-welded nature of it, allows for a more individual fi t, a more exacting fi t. Not that it’s exact, but it’s closer. Folding chairs are modular so you’re limited to, for K0005s, 1" increments in a variety of dimen-sions, not just width and depth. People don’t come in 1" increments, but the chairs do.”
Says Brent Hatch about the common belief that folding chairs are more adjustable, “I think traditionally, that’s a pretty true state-ment — that you see development around folding chairs in the positioning and the amount of adjustability. But I think you can fi nd that for the most part, there’s a good amount of adjustability in the rigid chairs out there, too.”
Shimono agrees: “I certainly think there’s a lot of change happening with new injuries, certainly in the fi rst six months to a year, maybe even longer. Historically at times, a folding chair would give you the modularity to change frame length or depth. But we shouldn’t cate-gorically say there isn’t a lot of adjustability to rigid chairs. It goes back to what may be changing in the user. Certainly a lot of rigid chairs out there can adapt to changes.”
Anderson says the notion of a lack of adjust-ability in rigid chairs is simply outdated. “If you go back to the initial Everest & Jennings rigid chairs, they had zero adjustability. I think that’s where a lot of that mentality comes from: ‘I can’t put a new user into that because it doesn’t have the adjustability.’ There’s still this misconception that a folding chair has more adjustability. That whole aspect of ‘If I want to have a fully adjustable chair, I need to go with
| March 2011 |mobilitymgmt.com 15
right fi t,” Anderson says. “Because every-thing else doesn’t matter if you don’t. I don’t think we can say enough about the fi t of the chair because that is really just absolutely critical, whether you’re talking about a rigid or folding chair.”
He defi nes that “right fi t” as including “getting that rear wheel in the right position, getting that caster in the right spot, having the footrest wide enough that your legs get in easily, but don’t fl op around. All of these things make such a difference. The stability of the individual is based off of that fi t of the chair.”
“Along with the understanding of the rigid and folding mechanisms and how that may or may not put more rolling resistance in the chair, the setup is also key,” Hatch says. The selection of the right wheels, the center of gravity — all of those things are highly impor-tant to optimize the ride. And both, if they’re missed — whether it’s folding or rigid, it doesn’t help the user either way. We hear a lot of our sales force, our clinicians, our ATPs talking about selecting the right caster, the position of the caster, the rear wheel setup to help customize that performance.”
“As with most things in our industry, the key is the prescription,” Munsey says. “It’s the seating team getting people what they need and making sure that not only do the dimensions fi t the person, but that the chair fi ts the environment and the circumstances that they have to live in. It’s the seating team that is still the key.”
Conclusion #2: Ditch the Stereotypes About Who Could Benefi t from Rigid ChairsYes, some users who could choose a rigid chair prefer folding chairs instead.
“I see them all the time,” Anderson says. “And that’s just fi ne.”
What’s not fi ne, our experts noted, is that too many consumers currently aren’t given the option of choosing a rigid chair — or in some cases, even an ultralight chair.
Black references as an example “a CVA client, somebody with a stroke, and they have a typical K0004 wheelchair that’s generally
folding — almost 100 percent (of the time). And they set the person in the chair, and they’re just sitting in it — they’re not building the chair around the user, it’s a modular product.
“To create effi ciency for that elderly client who’s had a stroke, you need to make (the chair) more effi cient. A rigid chair would be a better solution; to have a wheel to move fore and aft would be a better solution for them. But the way our outdated Medicare system is, you’ll never see that in this world. You’ll never see them in a more effi cient product, where they need to be. It’s hard to set up a folding chair to be as effi cient for them and their life-style. A lot more people will be more effi cient in a rigid frame.”
Asked if he’d like to see more geriatric clients given the opportunity to use rigid chairs, Black replies, “Bariatric, geriatric, pedi-atric — absolutely, 100 percent. It’s all about building a chair around the person. You’re not going to buy a bike that’s too big for your kid. You’re going to buy a bike that fi ts them for safety reasons, for health and wellness. It’s effi ciency. We’re the only industry that puts in all these other parameters: growth, you have to have this product for fi ve years. What about the user? How do you make him more effi cient? How do you stop him from having a repetitive injury? How do you stop that from happening? It all stems from the fi t of that product, if it’s rigid or folding. But if you do it right the fi rst time, you should be OK.”
In talking about how rigid chairs can answer a wide range of client needs, Hayden notes the example of a client named Pete, a wheelchair athlete with arthrogryposis: “Pete has little to no hip, knee or ankle fl exion. Therefore to play competitive wheelchair basketball would be unheard of in a folding frame design. With a rigid frame design, the chair could be modifi ed enough to accommo-date his sitting posture to allow Pete access to the sport he loves to play. Pete has played competitive wheelchair basketball all over the world and coaches the sport as well.”
Hayden adds, “From a performance stand-point, the rigid design has always been supe-
rior due to the increased energy effi ciency and custom frame confi gurations.” Those are benefi ts, multiple experts agree, that deserve to be made available to more clients.
Conclusion #3: Technological Advances Are Improving Both Folding & Rigid DesignsPerhaps the best news of all is that technolog-ical advances — in design, engineering and manufacturing materials — are benefi ting both types of ultralight frames.
Says Shimono, “What we can do to lighten the chairs up can only benefi t those in folding chairs as well as rigid chairs. Being able to look at different styles or ways to fold the chair, different styles of crossbraces, different things like that: We learn from one and trans-late to the other.”
Hatch says, “I would agree with that. There will be changes in technology, but we strongly believe that the product and the clin-ical adapting of the product, whether it’s rigid or folding, meets our standards and what our users are asking for, so at the end of the day, if someone says, ‘I’m going to go folding,’ I support that 100 percent, if they’ve talked to their clinician, and that’s what’s best for them… I don’t foresee a point in the short future that we’re selling only one style of chair.”
Munsey agrees that among high-quality ultralight chairs, rigid and folding designs are improving to the point where they are becoming more and more alike.
“There’s more creativity coming out for non-traditional crossbraces that would lock out and be even more effi cient,” he points out. “There are new ways to do folding chairs that would be effi cient. Folding chairs are getting better.
“Ten to 15 years ago, rigid chair users were 20- to 30-year-old spinal cord-injured people who didn’t use (armrests) and didn’t need any accessories other than the frame and wheels. Today, more and more people are using those chairs and demanding more accessories, features and options. Rigid chairs have been expanding what you can do with them. So (the designs) are meeting in the middle.” ●
16 | March 2011 | mobilitymgmt.com
Power wheelchairs are listed in alphabetical order by manufac-turer names. Manufacturers were asked to report data, HCPCS
codes and specifi cations for their chairs. When the category was not applicable or when information was not reported or available, “N/A” is listed.• Seat widths and depths are separated by a slash. Overall chair
width and length are separated by a slash.• “Disassembles/folds” indicates whether or not the power chair
disassembles or folds for easy transportability.• “Top speed” is the chair’s top speed in miles per hour when
moving forward.• ”Positioning" refers to the available degrees of tilt and recline, and
inches of available seat elevation, if applicable to that model of power chair.
• “Target user” describes one or more examples of the manufac-turer’s intended users, such as “senior with strength or stamina issues.” Other applications may also apply.Data is listed as reported by the manufacturers. This comparo
features as many makes and models as space permitted; some entries were edited to meet space requirements. For complete statistics, please consult the manufacturers using the Source List on page 18.
For a comparison of complex rehab power chairs, please turn to the Rehab Power Chair Comparo starting on 36.
How to Read This Comparo
HCP
CS C
odes
Dri
ve
Confi
gur
atio
nW
eigh
t Ca
paci
tySe
at W
idth
s/D
epth
sCh
air
Wid
th/
Leng
thTo
p Sp
eed
Elec
tron
ics
Disa
ssem
bles
?Ba
tter
ies
Posi
tion
ing
Opt
ions
Targ
et U
ser
Seat
Typ
e
K082
3Fr
ont-w
heel
dr
ive
300
lbs.
Capt
ain'
s18
", 2
0"/1
6",
18"
24"/
40"
3.5
mph
PG V
R2
50-a
mp
2 22
AH3"
of s
eat
heig
ht
adju
stm
ent
Entr
y-le
vel m
obili
ty u
ser.
Yes
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
rM
anuf
actu
rer/
Mod
el
Golden Technologies
Alan
te D
X
| March 2011 |mobilitymgmt.com 17
Pron
to M
41
Boss
4.5
Jazz
y Se
lect
Elit
e
HCP
CS C
odes
Dri
ve
Confi
gur
atio
nW
eigh
t Ca
paci
tySe
at W
idth
s/D
epth
sCh
air
Wid
th/
Leng
thTo
p Sp
eed
Elec
tron
ics
Disa
ssem
bles
?Ba
tter
ies
Posi
tion
ing
Opt
ions
Targ
et U
ser
Seat
Typ
e
Min
i P14
K082
3Re
ar-w
heel
dr
ive
250
lbs.
Buck
et s
eat
18"/
16"
22.4
"/35
.8"
3 m
phP&
G V
R22
12V,
22
-am
pN
/AN
/AYe
s
P4F
Rum
ba S
F
K082
3Fr
ont-w
heel
dr
ive
300
lbs.
Capt
ain'
s18
", 2
0"/1
8"24
"/41
.8"
4.5
mph
VSI 5
0-am
p12
V 35
-am
pN
/A
Neu
ropa
thy,
ede
ma,
up
per-b
ody
wea
knes
s &
ambu
latin
g di
ffi cu
lty,
seve
re a
rthr
itis,
de
gene
rativ
e jo
int d
iseas
e,
spin
al a
rthr
itis,
bul
ging
disc
No
K082
2,K0
823
Cent
er-w
heel
dr
ive
300
lbs.
Fold
-dow
n,
sem
i-rec
line
offi c
e st
yle,
va
n
Fold
-dow
n:
18"/
17";
se
mi-r
eclin
e:
16-2
0"/1
6-18
";
van:
16-
20"/
16-2
0"
24"/
34"
5 m
phN
/A2
U1
batt
erie
sN
/AG
eria
tric
(art
hriti
s, C
OPD
, et
c.)
N/A
N/A
Mid
i-driv
e45
0 lb
s.
Cap
tain
's;
solid
bot
tom
; ad
vanc
ed
baria
tric
seat
ing
is av
aila
ble
18-2
8"/1
8-24
"25
.5"/
44"
5 m
phM
odul
ar2
Gro
up 2
4
5.4°
tilt
(Com
-For
-Bac
k se
at),
50°
for
adm
iral s
eat
Indo
ors/
outd
oors
use
rYe
s
K082
2,
K082
3Fr
ont-w
heel
dr
ive
300
lbs.
Capt
ain'
s or
so
lid s
eat p
an18
", 2
0"/
18",
20"
22.7
5"/3
4.37
5"
with
out f
ront
rig
ging
s4
mph
PG G
C3U
-1N
/AG
eria
tric,
indo
or u
ser
No
Trac About
IRV
2000
K001
4Tr
ack
350+
lbs.
Man
ual-
recli
ne
leat
her
capt
ain'
s
21"/
21"
(cus
tom
sizi
ng
avai
labl
e)
27"/
49.5
" in
clud
ing
foot
rest
3.5
mph
Penn
y &
Gile
s 12
0A R
-Net
2 G
roup
24
AG
M
stan
dard
(G
roup
27
AG
M
avai
labl
e)
Recli
ne a
nd
elev
atio
n av
aila
ble
thro
ugh
spec
ial-
orde
r sea
ting
Cons
umer
s w
ho n
eed
a ch
air a
nd w
ant t
o tra
vel o
ff pa
vem
ent a
s w
ell
No
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
r •
Co
nsu
me
rPower Chair Comparo 2011
Man
ufac
ture
r/M
odel
IMC-Heartway IMC-Heartway Invacare Corp. PaceSaver Pride Mobility
18 | March 2011 | mobilitymgmt.com
manufacturers’ source list
Golden Technologies401 Bridge St.Old Forge, PA 18518(800) 624-6374goldentech.com
Heartway Medical Products13050 Metro Parkway, Bay 5Fort Myers, FL 33966(866) 464-9779imc-heartway.com
Invacare Corp.One Invacare WayElyria, OH 44035(800) 333-6900invacare.com
PaceSaver/Leisure-LiftBurke, Inc.1800 Merriam LaneKansas City, KS 66106(800) 255-0285pacesaver.com
Pride Mobility Products182 Susquehanna Ave.Exeter, PA 18643(800) 800-8586pridemobility.com
Trac AboutP.O. Box 502Newton, KS 67114(316) 283-5660tracabout.com
Power Chair Comparo 2011Welcome to a demanding career that
you will absolutely love.
Potential is a relative word. From the clients we work with, to the people that work with us, whose to say where we can’t go.
lling career of putting lives in motion and w ant t o s ee h ow f ar a U nited t eam c an g o, contact us a t [email protected].
You’ll measure compensation in a whole new way.
See us at ISS Booth #129
EZ-ACCESS, TRIFOLD, SUITCASE, Advantage Series, Signature Series, and PATHWAY are registered trademarks of HPi. Text and images © 2007-2011 Homecare Products, Inc. All rights reserved. 5097M11 REV 01-31-11
Ramps for use at home or on the go. With over 60 ramps to choose from, EZ-ACCESS has a ramp for every lifestyle need. To contact an EZ-ACCESS dealer near you, call customer service at 1-800-451-1903.
RUBBER THRESHOLD:for doorways & raised landings
THRESHOLD: for doorways & raised landings
Ramps for use at hom
PATHWAY LITE: for ultra strong & secure home access
on the go With over 60
TRIFOLD Advantage Series:for vehicle & travel
SUITCASE Signature Series: portable ramp for home & travel
MODULAR:for safe & secure home access
mobilitymgmt.com | March 2011 |21
Ever since I was a little girl, Sleeping Beauty has been my
favorite Disney fi lm. The princess is beautiful, the prince is
charming, and in the time it takes them to waltz through a
single song, they’ve fallen in “I-would-walk-through-a-wall-of-
thorns-for-you!” love.
That’s not my favorite part.
I love the end of the fi lm, when the prince on his noble steed
gallops madly toward the castle, seemingly just moments from
kissing his sleeping beauty. In a last-ditch effort to keep the love-
birds apart, the wicked fairy blocks the prince’s path by trans-
forming into an immense black-and-purple dragon that breathes
green (!) fi re.
The prince charges, falls from his horse, runs forward and
with his sword clouts the dragon on the snout. But the monster
shakes it off. Our prince might as well have whacked the dragon
with a letter opener.
That’s how I felt when working on the cover story for this 2011
Seating & Positioning Handbook. I’d heard the word dystonia
in so many other clinical interviews with therapists and rehab
technology suppliers that I thought it would be superb for this
special section.
I was excited – sort of my waltz-in-the-woods stage – until I
started talking to experts on dystonia. This neurologically based,
involuntary-movement disorder is a dragon-sized topic that can
present in so many different ways and with seemingly endless
variations. And here I am, attacking it with a laptop.
This story cannot be the fi nal word on dystonia. But I hope
it serves as a good foundation for seating & mobility special-
ists. My humble thanks to the experts who fueled this month’s
discussion by generously sharing their experiences and
research.
In Sleeping Beauty, the prince defeats the dragon, of course,
thanks to very timely magical intervention. Seating & mobility
assessments aren’t fairy tales, but here’s hoping that under-
standing more about dystonia will lead to happier endings for
clients and their families.
— Laurie Watanabe
table of contents
New Products
Cover Story
The Challenges of DystoniaUnderstanding the Causes, the Impacts &
the Possible Interventions
Rehab Power Chair ComparoComparing & Sizing Up Power Wheelchairs for
the Complex Rehab Market
Clinically Speaking: Clinical
Development for Rehab Providers
By Jay Brislin, MSPT
Clinically Speaking: Listening to
Non-Verbal Clients
By Lois Brown, MPT, ATP
Policy Perspectives: What 2011
Holds for Complex Rehab Providers
By Seth Johnson
22 26
36
41
43
44
mobilitymgmt.com22 | March 2011 |
Bounder Plus Off-Road PackageOff-Road package for the Bounder Plus H-Frame power chair in-
cludes 14" x 5.4" low-pressure
pneumatic tires to provide
a smooth ride. Aggressive,
knobby tire design provides
excellent traction over loose
terrain, mud or snow.
21st Century Scientifi c
(800) 448-3680
wheelchairs.com
Airpulse PKPowered, alternating-pressure
wheelchair cushion system is
designed to help heal and prevent
pressure ulcers for end-users at
high risk. New optional equipment
includes a Moisture Control Unit to
help keep skin cool and dry.
Aquila Corp.
(866) 782-9658
aquilacorp.com
Little WavePediatric manual chair is now available in the
XP edition, which gives the chair ad-
ditional growth opportunities over
time. Enhancements include the
5th Wheel for more aggressive
rear-wheel positioning.
Ki Mobility
(800) 981-1540
kimobility.com
Stimulite Tension-Adjustable BackFor folding and rigid wheelchairs,
the back features Stimulite hon-
eycomb to circulate air, evaporate
moisture and equalize pressure
for comfort and stability. Adjust-
able Velcro straps accommodates
kyphosis or posterior pelvic tilt.
Supracor
(800) 787-7226
supracor.com
SparkDesigned to be used with
clinically prescribed seating,
the Spark promotes portability
and increases usable depth.
Frame structure is made of
1" tubing without interference
from crossbraces or backrest
support bars. Growth capabili-
ties are built into the frame.
Ki Mobility
(800) 981-1540
kimobility.com
new products
M300New mid-wheel-drive power chair features an
IntelliLink System with solid-steel struts that
connects wheels and 8" casters for greater
stability and a smooth ride. Flat-free tires with
gel inserts help to absorb shock. The M300
boasts climbing capabilities of 3" forward and
2" in reverse.
Permobil
(800) 736-0925
permobil.com
JAY ZipNew cushion designed
especially for kids uses
anthropometric data — hip
breadth, child weight and is-
chial tuberostiy spacing — and
provides skin protection and position-
ing in a comfortable, effective and convenient
cushion. With X-static, silver-impregnated fabric
outer cover that inhibits bacterial growth.
Sunrise Medical
(800) 333-4000
sunrisemedical.com
Push-Button BucklesLine of buckles offers a range of features asked for
by therapists, caregivers and users,
including light weight, durability, low
profi les, button-size options and
ability to be easily cleaned. Patented
construction allows for removal of
buckle cover.
Bodypoint
(800) 547-5716
bodypoint.com
Invacare Corporation and Motion Concepts have come
together to create the strongest and most clinically effective seating
and positioning line in the industry with the Invacare® Matrx®
Seating Series. With the combined efforts of both companies, you
can expect improved product design, accelerated product introduction,
component interchangeability, single invoicing and greater ease in
sales and technical support.
For more information visit www.invacare.com/matrx or call 1.800.333.6900.
Joining ForcesInvacare® Matrx® Seating Series
©2011 Invacare Corporation. All rights reserved. Trademarks are identified by the symbols ™ , sm and ®. All trademarks are owned by or licensed to Invacare Corporation unless otherwise noted.
See us at ISS, Booth #211
mobilitymgmt.com24 | March 2011 |
Get Ready. Get Set.
Grow… See our new
pediatric chairs!
Gotta ride it!To learn more, visit www.kimobility.comCall 800-981-1540 for an authorized supplier near you.
Little Wave
Visit us at booth #101.
new products
Crossfi re T7AThe new Top End Crossfi re T7A boasts
a weight reduction of 25 percent,
thanks not only to the use of special
7005 aluminum to reduce wall thick-
ness, but also thanks to an effort to
minimize high-stress concentrations
throughout the chair while improving
strength.
JetStream Pro Back Full-height back weighs only
ounces more than standard
upholstery, but is designed to
maximize performance of any
mobility base. Recommended
for users who want to minimize chair weight or may have potential
for shoulder or back pain or require postural support.
The ROHO Group
(800) 851-3449
therohogroup.com
FreeWheel AttachmentA durable, lightweight
third wheel that easily
clamps to the footrest of rigid-frame manual chairs, FreeWheel
lifts the front casters to enable users to navigate tough terrain,
from uneven sidewalks to dirt trails or grass. Stores on the perch
on the back of the chair when not in use.
FreeWheel
(208) 571-2051
gofreewheel.com
Sahara HP7RTFour-pole, high-power motors and tilt-in-space abilities
combine to create a high-performance chair that
accommodates rehab seating. With a 450-lb.
weight capacity; 18", 20", 22" seat
sizing; a 7.5-mph top speed and full
suspension.
IMC-Heartway
(866) 464-9779
imc-heartway.com
Invacare Corp.
(800) 333-6900
invacare.com
mobilitymgmt.com | March 2011 |25
800.547.5716
Optional covers to suit every user
BMM035_1.2011 rev.2
The new Bodypoint Push-Button Buckle offers solutions that therapists, care givers and users have requested for years:
It’s time to switch to a buckle designed for wheelchair users
Light Weight Durable Button Size Options Easy to Clean Low Profile
Ever wonder
what your belt was
designed for?
new products
Synergy Spectrum Air CushionWith a 4" multi-cell air insert and Quantum Rehab’s Sil-air silicone
foam base, the Synergy Spectrum air
cushion was created to deliver stabil-
ity and positioning abilities in an air
cushion. Maximal airfl ow and
moisture protection also
provide skin protection
and comfort.
Quantum Rehab
(866) 800-2002
quantumrehab.com
Starlock 5"This new cushion features a taller, 5" air cell height to pro-
vide greater fl exibility to address asymmetri-
cal needs of the user. Air cells provide
deeper immersion and create
an environment of enhanced
positioning and stability.
Star Cushion Products
(888) 277-7827
starcushion.com
EasyStand BantamSelf-propelled mobile option gives kids the
independence to explore their environment
while in a standing position. Children who
can propel a manual chair can also propel
the Bantam. Fits kids from 28" to 54" tall
who weigh up to 100 lbs.
Altimate Medical
(800) 342-8968
easystand.com
Galaxy CushionMulti-celled air technology and
an anatomical shape combine
in this seat cushion, which
won Medtrade’s 2008 Merit
Award. Positioning benefi ts include built-in
trochanter shelves, adductors, pommel and voided relief areas for
coccyx and perineum.
Star Cushion Products
(888) 277-7827
starcushion.com
See us at ISS Booth #100
mobilitymgmt.com26 | March 2011 |
Involuntary-movement disorder. That’s a very
simplistic description of dystonia, a condition that is anything but simple to
understand, treat and work with from a seating & mobility perspective.
Seating & mobility clinicians and complex rehab technology providers see
many clients with dystonia — and yet, those clients’ dystonia can present in
a number of ways and can be impacted by a number of other factors…not all
of which are currently understood.
Even for healthcare professionals who specialize in working with move-
ment disorders, dystonia can be a highly challenging and even baffl ing condi-
tion that constantly tests their ability to observe and respond effectively.
Defi ning Dystonia
It seems nothing about dystonia is very simple, including its defi nition.
Jessica Feeley — the editor and special projects coordinator for the
Dystonia Medical Research Foundation — explains dystonia via a metaphor.
“I once heard our scientifi c director — Mahlon DeLong at Emory
(University) — use the analogy that you could say dystonia is almost similar
to fever,” Feeley says. “There are lots of different conditions or disorders that
can involve fever. Sometimes it’s a primary symptom of what’s going on, and
sometimes it’s one of many symptoms.
“The pathologies are completely different, but I thought (the fever analogy)
was interesting, to help frame the different forms that dystonia can take, the
different disorders that it can piggyback — because it can be pretty confusing.”
Let’s start at the beginning.
Though dystonia affects various voluntary muscle groups, it is neurologi-
cally, not orthopedically, based.
Feeley says, “The signaling in the nervous system that normally instructs
movement and what muscles contract when others relax in order to coordinate
voluntary movement — the signaling is just chaotic. It’s considered a circuitry
disorder. The electrical system of the brain is what’s not working properly.”
Dystonia comes in many, many forms, but one of the major ways to cate-
gorize it is whether the condition initially presented in childhood or adulthood.
When the condition appears early in life — from childhood through the
mid 20s — it’s typically referred to as an early-onset form. In those cases,
Feeley says dystonia is more likely to be a generalized form, “which means
it’s going to affect the limbs, the torso, the neck — and it’s going to affect
several big muscle groups at once.”
Dystonia that starts appearing in adults typically “will stay relatively isolated
to a particular body part,” Feeley says. “Sometimes the neck or the shoulders,
sometimes just the eyes, sometimes the hand, sometimes the vocal cords.
Sometimes you get little clusters of dystonia, so someone who has symptoms in
their neck will also experience it in their jaw and in their eyes.”
Dystonia that appears in adults and is relatively isolated is referred to as a
focal form of the condition.
“These are usually referred to as primary dystonias, where there doesn’t
seem to be anything else neurological going on,” Feeley says. “Many are
presumed to have some sort of genetic component. You can contrast that
primary category with secondary dystonia, in which case you see dystonia as
the result of a stroke or a head injury or exposure to certain medications or
toxins.”
Secondary forms of dystonia — in which dystonia presumably can be
defi nitively traced to a traumatic injury or event — can, obviously, happen at
any age.
Despite its neurological roots, the effects of dystonia can require interven-
tions on multiple fronts.
For instance, while dystonia doesn’t directly affect muscles required for
breathing, respiration can certainly be impacted.
Feeley explains, “In some cases — because of the way the musculature
can be involved, whether it’s laryngeal muscles or sometimes if the torso
is twisted or not aligned properly — diffi culty breathing can defi nitely be a
side effect of dystonia. It’s more a side effect than a characteristic symptom,
The Challenges of DystoniaBy Laurie Watanabe
mobilitymgmt.com | March 2011 |27
Understanding a Neurologically Based
Condition with Unique & Wide-Ranging
Presentations
more sort of how the mechanics of dystonia get in the way of some of these
processes.”
She notes that a diagnosis of dystonia involves “a lot of moving parts.”
Therefore, the Dystonia Medical Research Foundation understands the need
for an interdisciplinary reaction.
“Sometimes there are orthopedic needs,” she says as an example.
“Because dystonia affects people in such different ways, there isn’t neces-
sarily a catch-all specialty. We advise people that in terms of diagnosis and
treating the actual dystonia, a movement-disorder specialist is really the best
trained to identify that. But someone who has the dystonia primarily in their
eyelids may see an ophthalmologist. So there are different branches, and
people are going to have different needs.”
Far-Reaching, But Not Degenerative
One important note on a dystonia prognosis: While there is no cure, there are
a number of therapies and treatments; Feeley references “a whole host of
oral medications that are helpful in some cases. There’s typically a lot of trial
and error in terms of fi nding the drug or the cocktail of drugs that’s going to
work. Botulinum toxin injections really revolutionized dystonia treatments in
the ’90s, and they’re used primarily to treat those focal, isolated dystonias.”
Brain surgery has also had some success, and today’s use of deep-brain
stimulation — implanting electrodes that use pacemaker batteries into the
brain — works by stimulating areas of the brain thought to be associated
with dystonia, rather than actually destroying brain tissue.
One of the most hopeful aspects of dystonia, Feeley says, is that the
condition causes no degeneration of brain tissue. While dystonia can be a
symptom of degenerative diseases, such as Parkinson’s and Huntington’s,
the dystonia itself is not considered degenerative.
“In theory,” Feeley says, “if you can reteach the brain to (use) different loops
and different circuits, (dystonia) is reversible. In the vast, vast majority of cases,
it’s not life threatening, and it’s not going to shorten your lifespan.”
Nor is dystonia likely to become widespread if it’s the focal, adult-onset form.
“The younger you are when you develop symptoms, the more likely it is to
spread,” Feeley says. “So typically, around age 9, a kid will start limping or
have problems with handwriting. And within a number of years, that dystonia
will spread typically to the limbs, the torso, all these major muscle groups.”
The focal dystonias, Feeley says, typically do not spread, though there is
a period of time after initial onset during which more muscle groups could
become affected.
As an adult-onset example, she says, “You’ll wake up and you’ll feel like
you slept on your neck wrong. And then over a period of weeks, you look in a
mirror, and you realize your head has tilted to the right. There’s sort of a window
of about three years in which the symptoms may get worse, and sometimes
you do have symptoms spreading to adjacent parts of the body, but still staying
relatively focused. If it starts in the neck, possibly (the dystonia will spread to)
the jaw and the face, the eyes. It’s also not that uncommon for people to have
symptoms in the neck and a hand.
“But for example, if you’re an adult and it starts in your neck or your face,
chances are it’s not going to go into your legs.”
The Seating & Mobility Challenges
While not all patients with dystonia need mobility technology, those who do
can present unique sets of symptoms for seating & mobility specialists.
Jay Doherty, OTR, ATP, is Quantum Rehab’s clinical education manager,
but has an extensive history of working with children with cerebral palsy
and dystonia.
Because children with dystonia are likely to be affected in multiple muscle
groups, Doherty says, “That makes seating even tougher — seating as well
as access to mobility because there are multiple locations in the body that are
being affected.”
While dystonia is neurologically based, Doherty explains how orthopedic
changes can also occur: “You’ve got muscles that normally we can control
the contracture over, but in those individuals (with dystonia), these muscles
involuntarily contract on them. So you can have actual orthopedic changes
happen over time because those muscles are contracting and moving the
body in ways that the person otherwise might not normally move.”
As an example, Doherty says, “If you think of somebody whose arm is
mobilitymgmt.com28 | March 2011 |
affected, and they go into extension and their fi st clenches, and they’re
constantly going into that position — there’s going to be a change in that
arm over time in some cases. Not all, but in some cases. There are folks
where their trunks are impacted, so you may have some asymmetry in the
trunk that appears over time because of the postures they take on because
of the dystonia.”
Those asymmetries can present positioning and seating challenges,
but Doherty points out that a client’s ability to adapt may cause additional
challenges.
“These folks learn to use their bodies, much like folks with other diag-
noses,” he says. “They learn to use their bodies in certain ways. So if we
position them in such a way that we restrict their movement, we now restrict
their function also in some cases.
“You have to weigh the pros and cons of the seating system and how can
we best provide function for that individual as well as good positioning.”
Understanding the Basis of Tone
Theresa Plummer, Ph.D., MSOT, OTR, ATP, is a faculty member of the school
of occupational therapy at Belmont University in Nashville, Tenn. Plummer says
that when she teaches on this topic, she begins with an introduction on tone.
“I actually start explaining to people what tone is, because what I fi nd
with both therapists and suppliers is their understanding is tone is an active
movement, when in fact tone is only assessed passively,” Plummer says.
“You may have heard people say, ‘I can break the tone.’ Well, you can’t break
tone, because tone is a passive state. And so learning what tone is and what
contributes to tone helps us in terms of the seating and positioning. Because
if somebody is hypotonic, meaning they have really low tone, it means their
joints are unstable. So if you’re asking for a lot of movement around an
unstable joint, the person’s never going to have refi ned function.”
For clients with hypertonicity, Plummer says, “You need to allow for move-
ment of the joint around the joint capsule itself, and that’s what helps to infl u-
ence the tone so that the tone can be managed.”
Understanding the neurological basis of tone and dystonia, Plummer says,
is crucial to successful seating & mobility outcomes.
“In the seating and positioning world for the most part, tone is greatly
infl uenced by proprioception, which is the receptive ability around the joint,
and by sensory systems, so if you don’t allow for good weight bearing through
the joint, it’s diffi cult to manage tone. And for seating in particular there are
mechanoreceptors, which are very, very specifi c proprioceptors — recep-
tors in the hip capsule. So if a person in a sitting position has their shoulders
behind their hips, those proprioceptors really can’t be fi red.”
Plummer says that seating & mobility interventions frequently come from
an orthopedic perspective. “The pelvis has to be level,” she says as an
example. But with neurologically based conditions, “really the point is you
have to have a neurological understanding of them rather than orthopedic.
That’s why you can infl uence it, because it’s neurological as opposed to
orthopedic. So restricting movement is not what you want to do with some-
body with dystonia.”
A Neurological Approach
Plummer’s approach to dystonia, she says, is “I really look at their sensory
systems in terms of my evaluation to see what provides them with best
posture and typically weight-bearing posture. So that rather than the knee
being extended, the knee should be a little bit fl exed so they can have weight-
bearing through their feet. It’s the weight-bearing that helps facilitate proprio-
ception in the joints. It’s the information that the proprioceptors send to the
brain that tell the brain, ‘Oh, you’d better relax a little bit down there.’
“If you have a child with dystonia and you put on ankle huggers, the
sensory input — the feeling of the ankle huggers — makes the ankles even
more uncontrolled or the movements more involuntary because (the child’s)
sensory system doesn’t know what to do with that information. So I typi-
cally would use a shoe holder that tells the body where it’s supposed to be
rather than restricts the movement. So you guide the movement, because it
is movement driven. Guide the movement rather than restrict the movement.
You need to infl uence what’s going on in the brain.”
Plummer also says that it can be possible to use those classic dystonic
movements in a functional way.
“When you see it from a posture perspective, you see a child writhing
around, and you think, ‘Oh, I need to restrain them, I need to tie them down,
I need to stop that movement,’” she says. “When in fact, oftentimes if you do
that, you restrict their function. They may have involuntary movement, but
they can still use that movement to manage their posture, to manage their
activities, to navigate a power chair.
“It’s not always the same with every client. Some kids with dystonia also
have hypertonicity, so their muscles are more rigid, and you may have another
child with dystonia that has no increased tone. Particularly with voluntary
movements, the minute they try to move, the body goes into all these distorted
patterns and positions. So that doesn’t mean you don’t allow them to move, it
means you channel that movement into functional movement.”
Because trying to execute a voluntary movement can trigger involuntary
movement in people with dystonia, Plummer says she is mindful of asking a
child to try to move too much while learning to drive a power chair.
“In that case, if I’m trying to teach a child to use a power device, I’m not
Dystonia Resources & InformationThe Dystonia Medical Research Foundation (dystonia-foun-
dation.org) funds research on the disorder, promotes aware-
ness of dystonia and its impact, and provides support and
resources for people who have dystonia and their families.
Coming up this summer, the Foundation will be presenting
the John H. Menkes Children & Family Dystonia Symposium,
Aug. 19-21, in Chicago. The meeting is described as an event
“for families affected by dystonia with a special focus on chil-
dren, teens, and young adults.” For more information, e-mail
[email protected], or call (800) 377-DYST.
The Challenges of Dystonia
mobilitymgmt.com30 | March 2011 |
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mobilitymgmt.com32 | March 2011 |
going to start with a joystick that requires too much movement,” she says.
“I might start with a switch where they can just slide their hand forward with
their hand on the switch and make the chair move. Then once they have
some movement, it’s the movement around space that helps their visual and
vestibular systems to start taking in all this information.”
For very young children, dystonia presents an additional challenge — one
that can have a life-long impact on their development.
Plummer has intensively studied how posture impacts the vision and
therefore the development of very young children.
“There’s a pretty signifi cant relationship between posture and vision,”
Plummer says. “And with dystonia, because the child doesn’t have a stable
posture, a static posture — and because children develop their vision after
their posture — oftentimes kids with dystonia don’t have normal ocular
motor control.”
Plummer says her specialty practice is the relationship between vision and
posture, which is a signifi cant consideration for children with dystonia.
“Kids with dystonia who don’t have a stable base of
support don’t have proximal control, meaning control of
their trunk,” she explains. “They can’t gain control of their
head and neck. And if they can’t gain control of their head
and neck, they cannot gain control of their oculomotor
muscles. We gain control proximal to distal —the trunk
being proximal, the eyes being distal — and so in kids who
are constantly moving around, their eyes do not develop
what’s called visual fi xation, meaning the ability to look at
something for a period of 10 seconds.”
That lack of visual fi xation, Plummer says, means “it’s
really diffi cult for these kids to learn anything. So they
appear to have more cognitive involvement than they
might, just because it’s diffi cult for them to learn from their
environment.”
As an analogy, Plummer suggests imagining how
diffi cult it would be to read a document that’s printed in
small type while riding a roller coaster at the same time.
Because the roller coaster is jostling you so much, you’d
continually lose your place while reading. So how much of
the document could you read and learn?
That’s what it’s like for young children with dystonia,
Plummer says: “They’re constantly in motion, so for them
to be able to see anything is really diffi cult.
“Structurally, there’s nothing wrong with their eyes;
functionally, there is. They can see, it’s not like they don’t
have acuity. But their oculomotor system doesn’t work
together, because you have to have a stable base of
support.”
While adding a head positioning system to a child’s
power chair might seem an easy solution, Plummer says
fi nding the right balance between support and movement
can be tricky.
“You want to allow a little bit of movement, and you
cannot restrict their ability to turn their head from left to
right,” she says. “You cannot restrain the head in any way,
but you still need to provide some base of support so their
visual systems can develop as well.
“Our visual system actually feeds our vestibular
system; the vestibular system tells us where our heads
should be in space. Any child who doesn’t have stable
trunk posture is not developing normal vision. That’s
The Challenges of Dystonia
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why we struggle so much with head control with the pediatric population.
A normally developing child at two months of age can start to extend their
head and neck, and as they do that, their eyes can visually fi xate. If you
don’t have posture, if you don’t have postural control, your eyes never get
to that point. So almost all kids with impaired posture have impaired vision.”
Achieving Balance
Just as fi nding a proper balance between head support and freedom of
movement is important, Doherty says the need to fi nd a similar balance
applies to the rest of the seating & mobility system.
That can involve signifi cant observation periods to learn, for example, how
a client with dystonia typically moves.
While clients who move frequently may not be at a particularly high risk for
classic skin breakdown caused by pressure, Doherty says shearing could be
an issue. He recommends learning the client’s skin integrity history, “as well
as watching how the person sits, how they move. You have to look at how
they’re moving, the surfaces they’re on, what they are in contact with — and
you still want to inspect their skin thoroughly and look for areas that may have
some redness or may be susceptible to developing a sore over time.”
Because dystonia also has a sensory component, observation periods
should also include learning what sorts of sensations exacerbate the involun-
tary movements or cause discomfort.
“They do have sensory impairment,” Plummer says of kids with dystonia.
“They might really dislike the touch of neoprene, for instance. One child may
be more sensitive to that, where another child may be sensitive to the touch
of vinyl-like products. Some like deep pressure; other kids don’t like deep
pressure at all. Understanding what calms the person or centers the person
in terms of posture is also helpful.”
Stress and fatigue have been known to worsen episodes of dystonia; says
Jessica Feeley, “We hear from people that when they’re in a stressful situa-
tion, usually the most inconvenient public situations, their symptoms will get
worse. Stress management is also a huge part of the daily maintenance —
learning relaxation.”
Despite the broad numbers of people affected by dystonia, Feeley calls
the disorder “very individual — even individuals who have the ‘same type’ of
dystonia may have symptoms that don’t resemble each other very much at all.”
That’s a truth that seating & mobility professionals who work with these
client know all too well.
“It’s a huge, broad disorder,” Doherty says. “It’s going to be very different
from person to person.” ●
The Challenges of Dystonia
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T hese power wheelchairs have been identifi ed by their manufacturers as com-
plex rehab models. Power chairs are listed in alphabetical order by manu-facturer name.
Manufacturers were asked to report data and specifi cations for their chairs.
When the category was not applicable or when information was not reported or
available, “N/A” is listed.
“RESNA rating” refers to the chair’s RESNA dynamic stability rating.
Seat widths and depths are separated by a slash. Overall chair width and
length are separated by a slash.
“Top speed” is the chair’s top speed in miles per hour when moving forward.
“Transit option” indicates whether or not the power chair is equipped for
transport in an automotive vehicle while the user is seated in the chair.
“Disassembles/folds” indicates whether or not the power chair disassembles
or folds for easy transportability.
Tilt and recline positioning ranges are listed in degrees.
Data is listed as reported by the manufacturers. This comparo features as
many makes and models as space permitted; some entries were edited to meet
space requirements. For complete statistics, please consult the manufacturers
using the Source List at the end of this page.
For a comparison of consumer power chairs, please turn to the Consumer
Power Chair Comparo starting on 16.
Rehab Power Chair Comparo 2011
Ma
nu
factu
rer/
Mod
el
RE
SN
AR
ati
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HC
PC
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od
es
Dri
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on
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ea
t W
idth
s/
Dep
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air
Wid
th/
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ics
Sea
t-to
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or
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es
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ing
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on
s
Reh
ab •
Reh
ab
• R
eh
ab
• R
eh
ab •
Reh
ab •
Reh
ab •
Reh
ab •
Reh
ab •
Reh
ab •
Reh
ab •
Reh
ab •
Reh
ab •
Reh
ab
Innovation In Motion
X8
Ex
trem
e
N/A
N/A
4-w
heel
drive
40
0 lb
s.16
-24"/
16-2
0"
28
"/4
5.2
5"
6.2
mph
Dyn
amic
DX
219
" (2
0"
with
full
pow
er)
2 G
roup
24
LA
/AG
MYe
s5
0°
tilt,
150
° re
clin
e
12"
seat
ele
vatio
n,
pow
er e
leva
ting
legr
ests
IMC-Heartway
All
ure
HP
6R
T
10°
K0
83
8M
id-w
heel
driv
e3
50
lbs.
18",
20
", 2
2"/
18",
20
", 2
2"
24.5
"/4
6"
5 m
phV
SI
50
-am
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-am
pN
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N/A
manufacturers’ source listHeartway Medical Products13050 Metro Parkway,
Bay 5
Fort Myers, FL 33966
(866) 464-9779
imc-heartway.com
Innovation In Motion201 Growth Parkway
Angola, IN 46703
(800) 327-0681
mobility-usa.com
Invacare Corp.One Invacare Way
Elyria, OH 44035
(800) 333-6900
invacare.com
Permobil300 Duke Drive
Lebanon, TN 37090
(800) 736-0925
permobil.com
Quantum Rehab182 Susquehanna Ave.
Exeter, PA 18643
(866) 800-2002
quantumrehab.com
Sunrise Mobility2842 Business Park
Fresno, CA 93727
(800) 333-4000
sunrisemedical.com
How to Read This Comparo
Toll Free Tel: 1.888.433.6818 � Toll Free Fax: 1.888.433.6834 � www.motionconcepts.com
See us at ISS, Booth #217
38 | March 2011 | mobilitymgmt.com
Ma
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ati
ng
HC
PC
S C
od
es
Dri
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nfi
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Weig
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Ca
pa
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Reh
ab •
Reh
ab •
Reh
ab •
Reh
ab •
Reh
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Reh
ab •
Reh
ab •
Reh
ab •
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ab
Permobil
C5
00
Co
rpu
s
9°
K0
88
4Fr
ont-
whe
el
driv
e3
00
lbs.
17",
19
", 2
1"/
16-2
2"
24.2
5-
28
.5"/
43
"
(34.5
"
tran
spor
t
leng
th)
5.5
mph
(6.5
mph
optio
nal)
R-n
et19
.5"
2 G
roup
24
Yes
45°
tilt,
17
5°
recl
ine
8"
seat
ele
vatio
n,
pow
er e
leva
ting
legr
ests
Invacare Corp.
FD
X
N/A
K0
84
8Fr
ont-
whe
el
driv
e3
00
lbs.
12-2
2"/
12-2
2"
24"/
43
"
5 m
ph
(6
.8 m
ph
with
hig
h-
spee
d
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or
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n)
MK
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Tilt
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vate
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Permobil
C30
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s 3G
9°
K0
84
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K0
85
6,
K0
86
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Fron
t-w
heel
driv
e3
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17",
19
",
21"
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14",
15",
16
",
17",
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", 1
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20
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e
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42
.5"
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udes
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ph
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mph
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-
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d
vers
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34
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° til
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vatio
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ing/
artic
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Invacare Corp.
N/A
K0
84
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K0
84
9,
K0
85
6
Cen
ter-
whe
el
driv
e3
00
lbs.
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35"
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5"
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Permobil
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codi
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Mid
-whe
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driv
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lbs.
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19
",
21"
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3"/
14",
15",
16
",
17",
18
", 1
9",
20
", 2
1",
22
"
24"
(bas
e
wid
th)/
41"
(with
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6 m
ph
(7.5
mph
high
-
spee
d
vers
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R-n
et 1
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anda
ble)
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roup
34
Yes
(IS
O
717
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50
° til
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seat
ele
vatio
n,
170
° el
evat
ing/
artic
ulat
ing
legr
ests
M30
0 C
orpu
s 3G
Quantum Rehab
N/A
K0
84
8,
K0
84
9,
K0
85
6,
K0
85
7,
K0
86
1
Mid
-Whe
el 6
30
0 lb
s.
10-2
2"/
10-2
2"
(Syn
ergy
sea
t);
14-2
2"/
14-2
2"
(TR
U-B
alan
ce
Pow
er
Pos
ition
ing)
24"/
35
.5"
Sta
ndar
d
up t
o 5
mph
;
optio
nal
up t
o 6
mph
Q-L
ogic
Drive
Con
trol
Sys
tem
As
low
as
17.1
25"
with
TR
U-B
alan
ce
pow
er t
ilt &
recl
ine
2 1
2-v
olt,
deep
-cyc
le
NF-
22
Com
ing
soon
Up
to 5
5°
tilt,
95
-16
8°
recl
ine
10"
seat
ele
vatio
n
with
TR
U-B
alan
ce
lift
& t
ilt; po
wer
fron
t rigg
ings
;
wid
e ra
nge
of p
ositi
onin
g
com
pone
nts
Q6
Ed
ge
Power Chair Comparo 2011
TM
CUSHIONSTAR
Feel the Difference
First in the development of complete CELL LOCK technology, Star offers you the 5” StarLock Cushion. This is our premier wheelchair cushion offering you the ultimate in aggressive positioning, unparalleled stability and the highest level of therapeutic prevention and treatment of pressure ulcers.
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Phone: 618-539-7070www.starcushion.com
The Galaxy is a cushion that combines multi-cellular air technology with a patented, contouring design, fitting the anatomical form. These detailed, contouring features, offer several benefits to aid in the patients’ stability and posture, while greatly enhancing a true therapeutic advantage.
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40 | March 2011 | mobilitymgmt.com
Quantum Rehab
Q6000Z
/6400Z
N/A
Q6
00
0Z:
K0
84
8.
K0
84
9,
K0
85
6,
K0
85
7, K
08
61;
Q6
40
0Z:
K0
86
8,
K0
86
9,
K0
87
7, K
08
84
Mid
-Whe
el 6
30
0 lb
s.
Syn
ergy
sea
t:
10-2
4"/
10-2
4";
TR
U-B
alan
ce
Pow
er
Pos
ition
ing:
14-2
4"/
14-2
4"
25
.87
5"/
36
"
6 m
ph
(sta
ndar
d,
Q6
00
0Z
);
8 m
ph
(sta
ndar
d,
Q6
40
0Z
)
Q-L
ogic
Drive
Con
trol
Sys
tem
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low
as
17"
(TR
U-B
alan
ce
pow
er t
ilt &
recl
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supe
r-lo
w)
2 1
2V
deep
-cyc
le
NF-
22,
Gro
up 2
4 o
r
Gro
up 3
4
Yes
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to 5
5°
tilt;
95
-16
8°
recl
ine
10"
seat
ele
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with
TR
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alan
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& t
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fron
t rigg
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;
wid
e ra
nge
of p
ositi
onin
g
com
pone
nts
Sunrise Medical
Qu
ick
ie P
uls
e 6
Pas
sed
max
.
10°
angl
e
K0
84
8
(Pul
se 6
BC
);
K0
85
6
(Pul
se 6
SC
)
Mid
-whe
el
driv
e3
00
lbs.
16-2
0"/
16-2
0"
24"/
33
.9"
with
out
foot
rest
s
6 m
phV
R-2
or
R-n
et
BC
: 15
.5",
16.5
", 1
7.5",
18.5
", 1
9.5
";
SC
: 17
", 1
8",
19",
20
", 2
1"
22
NF
Yes
50
° til
t (S
C)
Long
late
ral t
high
supp
orts
and
knee
add
ucto
rs
can
be u
sed
Sunrise Medical
Qui
ckie
Rhy
thm
Pas
sed
max
.
10°
angl
e
K0
84
8
(Rhy
thm
BC
),
K0
85
6
(Rhy
thm
SC
),
K0
86
1
(Rhy
thm
MP
C)
Mid
-whe
el
driv
e3
00
lbs.
12-2
4"/
12-2
2"
25
.5"/
39
"6
.5 m
phR
-net
17-2
0"
(all
mod
els)
Gro
up 2
4,
22
NF
Yes
50
° til
t an
d/
or r
eclin
e
Long
late
ral t
high
supp
orts
can
be
adde
d an
d kn
ee
addu
ctor
s ca
n be
used
Power Chair Comparo 2011
Engineered to be the mostadvanced seating system to helpheal and prevent pressure sores.
Alternate cells inflate anddeflate automatically to thedesired pressure on anadjustable-timed cycle.
• Custom made for maximum effectiveness• Demo program offered for customer trial
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HCPCS E2609
Ma
nu
factu
rer/
Mod
el
RE
SN
AR
ati
ng
HC
PC
S C
od
es
Dri
ve
Co
nfi
gu
rati
on
Weig
ht
Ca
pa
cit
yS
ea
t W
idth
s/
Dep
ths
Ch
air
Wid
th/
Len
gth
Top
S
peed
Ele
ctr
on
ics
Sea
t-to
-Flo
or
Heig
ht
Ba
tteri
es
Tra
nsi
tO
pti
on
?T
ilt/
Recli
ne
Po
siti
on
ing
O
pti
on
s
See us at ISS Booth #117
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mobilitymgmt.com | March 2011 |41
It’s a diffi cult task for rehab providers to keep their busi-
nesses running effi ciently and effectively in our ever-
changing industry. Medicare changes and funding cuts
certainly present a challenge to keeping businesses thriving
while providing clients with the most appropriate equipment
based on their needs.
Effective clinical development is an essential ingredient to
achieving these goals.
It is critical to develop and enact a clear clinical develop-
ment strategy. This includes:
• Cultivating new clinical relationships.
• Maximizing resources at your disposal.
• Proactively creating diversity.
• Developing an infrastructure to support and maintain your
overarching goal.
Thirty percent of full-service, complex rehab business is
generated from rehab facilities, and your clinical develop-
ment strategy must target gaining business in this area.
However, gaining referrals from facilities on a regular basis is
not something that happens overnight. Becoming a regular
supplier within a facility requires strong product and clinical
knowledge; the ability to develop relationships with the
decision-makers and rehab team at the facility; and most
importantly, sharing the ultimate goal of meeting the needs
of each client.
So, how do we maximize the development of clinical
referral sources and create strong business partnerships to
serve the rehab client population?
The key to gaining referrals through facilities is to establish
mindshare. You want to be at the forefront of the minds of
clinicians when they need to provide their clients with rehab
seating & mobility equipment.
Research Builds the GroundworkThe fi rst step in clinical development and establishing a
strong relationship with a rehab facility is to know the facility
background, the clients it services, the facility’s goals, and all
of the people involved in the client rehabilitation process.
Become familiar with the facility’s client base, and be sure
to have knowledge of the clients’ diagnoses and rehabilitation
needs for those diagnoses. It is important that clinicians are
able to discuss, in detail, a client’s needs with you. This will
continue to build the clinician’s trust in you for future referrals.
clinically speaking
Clinical Development for Rehab Providers: Effective Methods & Diversity in Approach
By Jay Brislin, Pride Mobility Products
Communication Is KeyIn order to build and maintain
strong clinical relationships,
it is important to determine
what that particular facility’s
clinicians focus most on and
provide the services tailored
for that. Every facility can be
different based on specifi c
client population, specialized
units, main products they
spec, inpatient, outpatient, etc.
Many facilities have multiple
units within the same location
that have different specialties
and focuses. For example,
it is important to focus the
majority of your in-services
and communication on topics that your audience wants to
hear and that are prevalent to their daily interaction with
their specifi c client population. Discuss updates on products
that the clinicians are already familiar with, and provide
training on products that the clinicians would use more
frequently. Having vast knowledge of rehab product offerings
will continue to increase your value within a facility.
Deliver Service & DemosTop-notch service is another key to creating a strong pres-
ence within a facility. Prompt follow-through, consistent
exposure, high responsiveness, excellent listening skills,
and regularly scheduled in-services will continue to help
gain and maintain clinician trust and comfort level with you.
Another piece of this equation is to ensure that each facility
Be sure to have knowledge of the clients’ diagnoses and rehabilitation needs for those diagnoses
Jay Brislin, MSPT, is the director
of Quantum Product & Clinical
Development for Pride Mobility
Products Corp., Exeter, Pa. Jay can
be reached via e-mail at jbrislin@
pridemobility.com or by calling (800)
800-8586.
mobilitymgmt.com42 | March 2011 |
you service has access to demo products. You must ensure
that the demo products being used for each facility fi ts with
their needs and is also the product that the clinicians have
requested. This is where it is very important to communicate
demo product needs to your manufacturer representatives.
But it doesn’t stop at just having demo product available.
The demos being used for the facility must be in good
working condition and have the options and accessories
that the facility requires. Demo products should be evalu-
ated on a regular basis to ensure they are still relevant to
the facility’s needs.
Knowing & Valuing the Needs of ClientsThe final piece to establishing long-term and successful
partnerships with rehab facilities is having excellent inter-
action skills with not only the clinicians and rehab team
within the facility, but with the clients themselves.
Clinical Development for Rehab Providers: Effective Methods & Diversity in Approach
clinically speaking
Clients in a rehab facility who are in need of rehab mobility
equipment usually have a large number of unanswered ques-
tions, in addition to stress, uncertainty, and concern about the
state of their future function and mobility. It is imperative that
when applicable, clients are fully engaged with the clinical
team in the decisions being made about their mobility.
We must remember that the client is part of the clinical
team and must have direct input in the products they receive.
The client needs to have clinical trials and training on any of
the products they may be receiving to ensure an adequate
level of comfort.
A client’s independence and quality of life with their
mobility products is always maximized when they have
played a role in the decision-making and goal settings
throughout the entire process. Successful outcomes are
always increased when clients understand the goals and feel
their personal needs are being addressed. ●
(ROHO®. Jay®.Two trusted brands. One effective cushion.)
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© 2011 ROHO, Inc.
WHAT’S INSIDEIT’S THAT COUNTS.
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This exclusive ROHO design hydrostatically loads both the ischial tuberosities and greater trochanters. It provides control over lower extremity and pelvic alignment, without sacrificing shape-matching ability.
Get the inside story on this breakthrough product at http://hybrid-elite.therohogroup.com
See us at ISS Booth #610
mobilitymgmt.com | March 2011 |43
When I arrived in the ICU hospital room, I found Lili, my
best friend of 33 years, with a vent tube in place that
precluded her from speaking.
This did not mean she wasn’t able to communicate.
Lili lost her battle with cancer in September 2010, but stead-
fast in her life as a teacher and camp director, she continued to
teach us until the end.
With eyes wide open, giving a thumbs-up, she signaled her
determination. With her fi nger pointing to the tube in her throat,
she clearly stated she had important things to say to her husband
and children, to me and to the teachers at her school.
“When are they removing the tube?” she wrote, using the
paint program on my iPad. “I have a meeting at the school at
11 o’clock.”
As doctors and nurses began the “merry-go-round” of coming
in and out of her room, the questions began.
“How is she feeling today? Does she need more medicine?” And thus we answered over and over, “I don’t know. You will
have to ask her.”
As evaluations continued, one remained lacking: what type of
communication system would be used to ensure Lili continued
to have a “voice” in her own care. As a PT who has worked
with persons with disabilities for 19 years, it was diffi cult for me
to accept the lack of awareness and assumptions being made
about her ability to think and communicate.
Can You Hear Me Now?Everyone wants to be heard; it’s human nature. Regardless of the
patient’s diagnosis or the type of professional treating that client
— PT, OT, speech or RTS/ATP — direct communication with the
patient is the most powerful tool in assessing and addressing a
patient’s needs. Anyone working with the patient should address
the individual as if they could communicate, whether it be to
encourage facial expressions, mouthing words, eye blinks,
thumbs-up/down or a more sophisticated communication method.
But I have had patients come to my clinic for a wheelchair
evaluation with a communication mount on the wheelchair
frame… and no sign of the device. The common response from
the family: “We didn’t know we needed to bring that for the
wheelchair evaluation.”
Without that device, it was extremely diffi cult to hear from
that patient regarding what their goals were and their feedback
on the equipment being trialed.
With some patients, by virtue of their diagnoses, we do not
know the cognitive status or their communication ability. But we
still owe it to the patient to remove the ladder of inference and
clinically speaking
Giving a Crucial Voice to Non-Verbal Clients
By Lois Brown, Invacare Corp.
assumptions, and give everyone
the benefi t of the doubt. That
means making direct eye
contact, asking them about their
care, and adopting the belief
“Able until proven unable.”
Many healthcare profes-
sionals I work with, especially in
the home, will tell you that most
times there is no established,
consistent communications
method among family and team
members. At a minimum, we
can begin by asking what the
agreed-upon communications
system is for this individual. In a
hospital setting, the care team can post a sign above the hospital
bed that indicates that method. Simple, yet impactful!
A Matter of InterpretationThere are times when the family can best interpret what the
patient is trying to say, and therefore the strategy is to wait for
that interpretation so the patient is included in the process.
Utilizing closed-end questions (yes/no) versus open-ended
ones during the patient evaluation can yield important informa-
tion. Remember, communication strategies can range from a
magnetic MagnaDoodle drawing board to a paint or communi-
cations device application on an iPad or iPhone, to a simple yes/
no, thumbs-up/down or a letterboard with a headlamp.
Another aspect of communication is establishing a method to
ensure learning and carry-over. For those prescribing and fi tting
wheelchairs, it is important to document the patient’s ability
to safely and successfully operate the mobility device being
prescribed. With a communication issue, it will be important to
determine how the person is best able to learn.
For instance, do they learn better by listening, watching,
writing or a combination of methods? Asking them to perform
specifi c mobility tests and observing outcomes may be the only
way to determine their skills and satisfaction with the device.
Another important recommendation is to refer the patient to a
speech therapist, who can determine the best long-term commu-
nication strategy.
It took Lili’s husband and me to ensure she had a voice: an
iPad, a MagnaDoodle, and later, a pen and paper that ultimately
allowed her to be an active participant in her care. Please do
your part to ensure everyone’s voice can be heard. ●
Lois Brown, MPT, ATP, is the clinical
education specialist for Invacare
Corp. and a frequent presenter
at educational conferences and
tradeshows.
44 mobilitymgmt.com| March 2011 |
The complex rehab industry is starting 2011 in a much different legislative envi-
ronment than it began 2010. The historic elections last November have
ushered in a new Republican majority and leadership in the House, along with a slimmer majority in the Senate for the Democrats. The most noticeable change in the Senate from a healthcare perspective is the ascen-sion of Sen. Orrin Hatch (R-Utah) to the top Republican position on the Senate Finance Committee. He is replacing Sen. Charles Grassley (R-Iowa), who was known for having a close working relationship with Chairman Max Baucus (D-Mont).
Sen. Hatch is quite knowledgeable on many industry issues, has been a supporter in the past and will play a key role on this important committee as we look to advance industry initiatives.
While this year will certainly be fi lled with challenges on many fronts, the complex rehab industry in particular appears to be much better posi-tioned than other larger industry segments. Still, it is important to evaluate the opportunities and threats for the complex rehab industry this year and identify what actions will be necessary in order to ensure the industry moves forward in 2011.
Separate Benefi t for Complex Rehab TechnologyHopefully by now you are familiar with the proactive separate benefi t initia-tive for complex rehab technology, which is in the early stages of develop-ment. The overarching goal is to improve and protect access to complex rehab technology for individuals with signifi cant disabilities and medical conditions. The anticipated outcomes from this effort include:• Clearer and more consistent coverage policies.• Tighter provider standards to promote better clinical outcomes and
consumer protection.
• Recognition of depth and cost of products and clinical services.• Future payment stability to ensure continued access.• An improved model for Medicaid and other payors to follow.
Those supporting this initiative and actively participating on the steering committee include NCART, the American Association for Homecare (AAHomecare), NRRTS and RESNA, along with other clinician and consumer group stakeholders within the complex rehab community.
The CELA conference that occurred in Washington, D.C., in February was focused on building more awareness of complex rehab technology and legislative support for the soon-to-be introduced legislation that will craft the framework for the complex rehab technology separate benefi t. In addition, there are task forces under the steering committee focused on development of regulatory proposals relative to coding, coverage, payment and standards for complex rehab technology providers under the separate benefi t. Stay tuned for signifi cant updates and “calls to action” in order to advance this initiative as we move through the year.
Competitive BiddingThe good news for complex rehab is that all Group 3 power wheelchairs were exempt from future rounds of competitive bidding.
The area of concern focuses largely on the inclusion of Group 2 complex rehab (power seating options codes) and related accessories that were included, and the threat that the Round 2 product categories (yet to be released as of the writing of this article) could include other types of product categories of concern to complex rehab providers that were not included in Round 1 of the competitive bidding program.
The industry has an opportunity to continue working with both CMS and Congress to secure a removal of the Group 2 codes categorized as complex rehab by Medicare policy prior to the CMS announcement of product cate-gories to be included in Round 2 of the program. The announcement of the product categories, ZIP codes and other pertinent information regarding the start in the process for beginning Round 2 is expected early this year, so timing is of the essence for these efforts.
In addition, DME industry efforts will once again be focused on stopping the program and/or slowing down the timeframe for beginning the Round 2 bidding process, scheduled to begin early this year according to CMS’ published timeframe. It is important to note that the healthcare reform bill passed last year not only expanded the footprint for Round 2 from 79 to 100 areas, but it also requires the Secretary to either expand the competi-tive bidding program or apply the competitively bid rates nationally by the year 2016.
So what can be done to stop or slow the expansion of competitive bidding? AAHomecare and other state and national associations are extremely focused on collecting the negative outcomes occurring in the nine Round 1 areas in order to demonstrate the magnitude of the problems associated with the competitive bidding program. This is necessary in order to secure some relief this year. If you, your customers, caregivers or referral
Legislative Landscape for Complex Rehab in 2011
By Seth Johnson, Pride Mobility Products Corp.
Look for Medicare fraud prevention and enforcement to be a hot-button topic in the 112th Congress
Seth Johnson is the VP of
Government Affairs for Pride
Mobility Products Corp., Exeter,
Pa. He can be reached via e-mail
at [email protected] or
by calling (800) 800-8586.
| March 2011 |mobilitymgmt.com 45
sources are aware of negative outcomes or have problems, complaints or concerns related to the Round 1 rebid of the “competitive” bidding program, you are encouraged to report these problems to AAHomecare via their Web site (aahomecare.org) or by calling their hotline at (888) 990-0499. Waste, Fraud & AbuseControlling erroneous and inappropriate spending in the Medicare program has been a focus for many members of the House and Senate. In the 111th Congress there was a signifi cant number of ideas brought to the table, numerous bills introduced and several legislative hearings held to ferret out the best way to strengthen anti-fraud measures that never made it into healthcare reform law.
Look for Medicare fraud prevention and enforcement to be a hot-button topic in the 112th Congress, as the wave of baby boomers begins turning 65 and ages into the program this year. While complex rehab has not been a specifi c target for this type of legislation, changes to how providers participate in federally funded programs (Medicare and Medicaid) in the future will likely impact complex rehab providers as well.
Medicaid IssuesAgain this year, Medicaid issues will remain a signifi cant concern for
many in the complex rehab industry. Medicaid is a signifi cant payor for complex rehab technology, and in light of the increasing fi nancial pres-sures from the states, the industry will likely see continued activities to reduce coverage and reimbursement.
In light of this growing issue, last fall NCART convened a National Medicaid Summit. The meeting included strong representation from providers, manufacturers and state association leaders interested in a common goal: protecting coverage and payment for complex rehab technology.
The summit provided a good foundation and set of resources to assist those interested in getting more involved in the Medicaid battles in their states. I encourage anyone concerned about Medicaid issues in their state or simply interested in getting more involved in advocating for complex rehab technology at the state level to go to ncart.us/medicaid. The list of arbitrary proposed state budget cuts impacting complex rehab is growing. Get involved in being a part of the solution today.
Clearly it is going to be another busy year, ripe with opportunities to further advance positive outcomes for the complex rehab industry. If the industry continues to build on the signifi cant educational and lobbying efforts with policymakers, legislators, consumer and clinician groups, and other stakeholders over the past few years, I am confi dent 2011 will be a positive year for the complex rehab industry. ●
Designed for casual riding and commuting, the Kwick Trax is the ideal
tire whether you're at home relaxing or riding around the city enjoying
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This tire uses the new R2C compound that blends the best attributes of traction, speed and durability. A Grippy (60 shore-A durometer) compound featured on the shoulder for cornering assurance and paired with a fast rolling (68 shore-A durometer) center compound for straight-line speed.
Kenda Konstrictor K1051
KendaKwick Trax
K1053
Commuter TiresHi-Performance/Sport Tires
46 mobilitymgmt.com| March 2011 |
Legislative & Policy News, Education & Resources
DME MACs Announce New Directions for Upgrade Modifi ersThe DME MACs have issued instructions for providers who want
to use upgrade modifi ers to resubmit claims that were previously
denied for “least costly alternative” reasons.
According to a bulletin issued by CIGNA Government Services,
the Jurisdiction C DME MAC: “For certain items that were previously
subject to LCA (least costly alternative), suppliers will now receive a
‘not reasonable and necessary’ denial.”
If the claim regarded items previously subject to the LCA rule,
CIGNA said, “Suppliers have the option of resubmitting the claim
using the upgrade modifi ers and the code for the covered medically
necessary item rather than exercising the option of Appeals.”
As an example, CIGNA used a claim for a fully electric hospital
bed (HCPCS code E0265): “A supplier submits a claim after Feb. 4,
2011 for code E0265, and the claim is denied as not reasonable and
necessary. That claim may be resubmitted with code E0265 and the
appropriate modifi ers on Line 1 and code E0260 and the appro-
priate modifi ers on Line 2. Resubmitting the claim in this fashion will
not result in a confl ict with the original code E0265 claim and subse-
quent duplicate claim denial.”
CIGNA emphasized that the resubmission instructions “apply
only to items previously subject to LCA payment policy that
now receive not reasonable and necessary denials. Other items
receiving reasonable and necessary denials must follow the usual
redeterminations process.” ●
Briefl y…An update of the Jurisdiction B National Government Services
(NGS) Medical Policy Center page makes it possible for
providers to now search for active local coverage determinations
(LCDs) and related policy articles (PAs). But the LCD and PA
search function works only on the Medical Policy Center page,
not for the general site — and draft and old LCDs/articles won’t
appear on the Medical Policy Center page. ●
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| March 2011 |mobilitymgmt.com 47
Easy-Wash Covers• Easy-Wash seat covers fi t EasyStand’s
Bantam pediatric stander to protect against spills and accidents.
• Tek Stretch material can be quickly wiped clean or laundered.
• Available for planar and contoured seat options.
Altimate Medical(800) 342-8968easystand.com
Konstrictor K1051• “Snakeskin” pattern provides added
grip while turning.
• R2C compound gives better grip in corners and faster straight-line speed.
• A grippy compound on the shoulder provides cornering assurance, while a fast-rolling center compound was cre-ated for straight-line speed.
Kenda USA(866) 536-3287kendatire.com
Soft Headrest 430H2• Modular design accommodates indi-
viduals who require more positioning capability along with superior comfort.
• Three layers of non-latex, multi-density foam cushion are at all contact points.
• Contour can be customized via orthotic foam positioning wedges that can be cut and positioned in headrest.
Otto Bock(800) 328-4058ottobockus.com
Matrx Elite Deep Back• Offers 6" of contour depth and pro-
vides lateral trunk support within the wheelchair.
• “Easy set” hardware is installed and adjusted in minutes with user seated in the chair.
• In sizes 14-20" wide and 12", 16", 18" and 20" high; 300-lb. weight capacity.
Invacare Corp.(800) 333-6900invacare.com
Vent Trays• Articulating tray features top tray for
portable ventilators up to 14.5" wide by 15.5" deep.
• Compact tray mounts directly to the back of the seat for LTV-style vents.
• Available on many Q6 power chairs with Synergy Seating and TRU-Balance power positioning systems.
Quantum Rehab(866) 800-2002quantumrehab.com
Wheelchair Parts & Accessories
Positioning Belts• Pediatric line includes a Two-Piece and
a Double Adjustable auto-style belt.
• Belts are 1" wide by 48" long and feature push-button, auto-style buckles and durable polypropylene webbing.
• Neoprene belt pads are designed to overlap at the buckle for optimal comfort.
Healthwares(800) 492-7371healthwares.com
48 mobilitymgmt.com| March 2011 |
Tuffwheels• Diameters range from 4" to 24".
• Numerous hub and tire options are available.
• SKYWAY also offers tires to fi t many mobility applications.
SKYWAY(800) 332-3357skywaywheels.com
Carbon Core WX2.5• Combines strength and durability in a
lightweight package.
• Available in 24" and 25" sizes.
• 20-spoke, continuous carbon fi ber.
• Rim is made of heat-treated, 6061 T6 aluminum with a proprietary double-walled design.
Topolino Technology(203) 778-4711topolinotech.com/wheelchair
Icon Back System• Delivers innovation, versatility and
comfort to users who need more sup-port than sling upholstery offers.
• Provides fast installation, excellent adjustability and simple, lightweight performance.
• In four styles for chairs 12-24" wide.
VARILITE(800) 827-4548varilite.com
Whitmyer Biomechanix• Head supports and accessories address
a range of user needs, from basic sup-port to multiple-point control.
• A variety of pad shapes/sizes fi t the single, two-pad or three-pad systems.
• Compatible with the AES and JAY Confi gureFit custom seating systems.
Sunrise Medical(800) 333-4000sunrisemedical.com
Multi-Axis Headrest• Fully adjustable solid-back chair and
wheelchair head support system is height, depth and angle adjustable.
• Pivots on a ball for rotation and can be placed off center.
• Includes a mounting clamp, fastener package for plywood back and posi-tioning stop collar.
Wenzelite Re/hab(877) 224-0946drivemedical.com
Sport Light Extreme• Rim is a double-walled, custom alumi-
num design; hub is custom designed and CNC machined.
• Spoke design was created to be extremely durable for less truing and spoke replacement required.
• Spokes are PBO fi ber, 4mm diameter, in 18 or 24 count.
Spinergy(303) 823-6299spinergy.com
Wheelchair Parts & Accessories
| March 2011 |mobilitymgmt.com 49
Group Publisher Karen Cavallo(760) 610-0800
Nat’l Sales Manager Caroline Stover(323) 605-4398
Classifi ed Sales Rep Stan Pruitt(972) 687-6738
Sales Assistant Lynda Brown(972) 687-6710
Advertising Fax (866) 779-9095
Company Name Page #
Wheelchair Parts & AccessoriesAltimate Medical . . . . . . . . . . . . . . . . . . . . . . . .47
Healthwares . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Invacare Corp.. . . . . . . . . . . . . . . . . . . . . . . . . . .47
Kenda USA.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Otto Bock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . .47
SKYWAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Spinergy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Sunrise Medical. . . . . . . . . . . . . . . . . . . . . . . . . 48
Topolino Technology. . . . . . . . . . . . . . . . . . . . . 48
VARILITE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Wenzelite Re/hab.. . . . . . . . . . . . . . . . . . . . . . . 48
Jim Black, Invacare Top End
Pat Boardman, Active American Mobility
Ann Eubank, Users First Alliance
Rick Graver, Medtech Services
Rita Hostak, Sunrise Medical
Julie Jackson, Invacare Corp.
Mark Leita, The SCOOTER Store
Amy Morgan, Permobil
Kevin Phillips, The Ability Center
Julie Piriano, Pride Mobility Products/Quantum Rehab
Mark Smith, Wheelchairjunkie.com
Stephanie Tanguay, Motion Concepts
Cody Verrett, ATG Rehab
Company Name Page #
Aquila Corp. . . . . . . . . . . . . . . . . . . . . . . . . . . . .40ATG Rehab. . . . . . . . . . . . . . . . . . . . . . . . . . . . .34Blue Chip Medical Products. . . . . . . . . . . . . . . . .35Bodypoint. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Colours Wheelchair. . . . . . . . . . . . . . . . . . . . . . .32 Comfort Company, The. . . . . . . . . . . . . . . . . . . .33 EZ-ACCESS. . . . . . . . . . . . . . . . . . . . . . . . . . . . .20Gerber Chair Mates. . . . . . . . . . . . . . . . . . . . . . .46 Healthwares. . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Invacare Corp.. . . . . . . . . . . . . . . . . . . . . . . . . . .23 Kenda USA. . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Ki Mobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24Motion Concepts. . . . . . . . . . . . . . . . . . . . . . . . .37 Open Sesame. . . . . . . . . . . . . . . . . . . . . . . . . . .46 Pride Mobility Products/
Quantum Rehab. . . . . . . . . . . . . . . . . . . . .29The ROHO Group. . . . . . . . . . . . . . . . . . . . . . . . .42Star Cushion. . . . . . . . . . . . . . . . . . . . . . . . . . . .39Sunrise Medical. . . . . . . . . . . . . . . . . . . . . . . . . .31Symmetric Designs. . . . . . . . . . . . . . . . . . . . . . . .40 Three Rivers Holdings . . . . . . . . . . . . . . . . . . . . .30
Company Name Page #
EZ-ACCESS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Free Wheel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 IMC-Heartway. . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Ki Mobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49 Permobil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52Pride Mobility Products/Quantum Rehab. . . . . . . . . . . . . . . . . . . . . . . . . .3SKYLINK Group. . . . . . . . . . . . . . . . . . . . . . . . . .49Stealth Products. . . . . . . . . . . . . . . . . . . . . . . . .51 TiLite. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Trac About. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 United Seating & Mobility.. . . . . . . . . . . . . . . . . .18VARILITE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
mob
ility management
editorial advisory board
editorial advisory board
2011 Editorial Advisory Board
50 mobilitymgmt.com| March 2011 |
On Jan. 1, Medicare’s fi rst-month purchase option for standard power
wheelchairs was eliminated, and those chairs became capped rental items. The new policy has been the mobility industry’s hottest topic this year, according to funding expert Jim Stephenson. As the fi rst weeks of the new year drew to a close, Mobility Management asked how providers were responding to this big change in business. — Ed.
Q: What impact has the elimina-tion of the fi rst-month purchase option for standard power had on providers?Jim Stephenson: It’s a big deal because it changes cashfl ow. In order to maintain the same cashfl ow, people essen-tially have to sell seven chairs for every one (that they sold in the past). Providers are not going to go from selling 10 chairs a month to 70 chairs a month.
It’s caused some folks to really change the way that they do business. Some are
looking at “I can still do a scooter as an up-front purchase, so maybe I can qualify them for a scooter and not get into the whole power wheel-chair rental.” There are providers who are trying to fi gure out how to bump customers up to Group 3 power chairs, which also are not rentals.
Some providers are buying used equipment, they’re not doing power wheelchairs at all, or they’re only doing a few, to where they’re not on the hook for so much money.
Q: Providers are buying used power chairs?A: I hear about it regularly. They’re going to fl ea markets, they’re putting ads in newspapers: “We’ll buy your old wheelchair.”
I understand the reason why; it’s all about getting the equipment for the least amount of money. But what I think a lot of people are short-sighted on is that they have no idea what they’re buying if they buy a used chair on craigslist or eBay or they’re getting it at a garage sale. Who knows what’s wrong with it? When they put the chair out there, sure — it’s not costing them much. But they’re on the hook for repairs for 13 months. So if they replace one joystick, they’ve spent about as much as they would have spent for a brand-new chair with a warranty. If one major component goes bad in 13 months, they might as well have bought a new chair.
These providers are playing the risk game: Maybe it will last 13 months. But how do you know what you’re getting? If I were a businessperson, I would have concerns about that. I don’t know what somebody’s done to that chair; it could have sat out in the rain!
From the equipment perspective, if a provider puts out a used chair, and the benefi ciary stays in that chair for 13 months, the chair becomes the benefi ciary’s. Technically, it’s the same as if you or I went to a car dealer-
ship and bought a used car and paid a brand-new price for it. There’s no difference in price between a used piece of equipment and a new piece of equipment. For the benefi ciary, they’re paying the same 20-percent co-pay for a used chair that they would pay for a brand-new one.
I’ve heard some providers say, “We’ll put the used chair out for the 13 months, and if it comes to the point where the end-user takes ownership of it, we’ll give them a new chair then.” And then the provider will take the used chair back and put it in the rental fl eet again, so they’ll only provide a benefi -ciary with a new chair at the end of 13 months. I’m not sure that makes sense.
Q: What else are you hearing about the fi rst-month purchase option elimination?A: The questions I’ve been getting are about the billing of it: How do I bill it as a rental, and what modifi ers do I use? Those questions are coming just because standard power chairs have been a purchase for so long.
There’s nothing signifi cant about how you bill a power wheelchair as a rental in comparison to how you would bill a standard manual wheelchair or a hospital bed as a rental. There are no unusual rules as far as power wheelchairs are concerned that are any signifi cant difference from any other capped rentals that people have been billing.
Q: What other funding issues are providers talking about in 2011’s fi rst quarter?A: Audits are a big deal because people get hit coming and going. They’ve got RAC audits, pre-payment audits, post-payment audits — everywhere they turn, there’s an audit lurking. There are some people who have been run out of business based on audits, because their money’s been held up so much or they’ve had to pay back more than they could bear.
The best way to prepare for one is to make sure you have your docu-mentation in order. That seems to be the biggest thing people are getting dinged on. People out there by and large are doing the best they can to gather up all the information they can. But then, rather than continue to argue with physicians about “I need this” or “I need that,” they decide to take their chances. Then they miss a key piece of information, and they end up having to pay back or don’t get paid in the fi rst place.
Q: So, collect documentation as if you expect to be audited?A: Absolutely. These are Medicare contractors. They’re paid based on how much money they recover. They’re going to try to fi nd every last penny they can possibly pull out of an audit.
A lot of people get those audit results, and they just pay the money back. What they don’t realize is there’s a fairly signifi cant percentage of times that the results get turned over when somebody fi ghts them. Statistically, what they’re having to pay back in an audit is probably not what they would truly owe if they were to fi ght to keep the money that they’ve been paid.
I’ve seen enough audit results get turned over that it’s something I always mention. Don’t just accept the audit results. Review them. If you review the chart and you think, “Oh, yeah, they got me on this one,” then by all means, leave it at that. But if you can’t fi gure out why they said what they said, then fi ght it. Don’t let it go. ●
Providers Confront the End of the 1st-Month Purchase Option
Jim Stephenson, CMC, is the rehab
reimbursement & coding manager
at Invacare Corp. He has worked
in healthcare reimbursement for
more than 17 years and has experi-
ence working with federal, state
and private insurance payors. He is
currently a member of the Advisory
Committee for Regions C and D.
Q&A with Jim Stephenson, Invacare Corp.
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