Page 29 - Mobility Management, October 2018

Setting Up for Success
Continued from page 19
height that I can get in and out independently. It’s within 3",
and that’s good enough. If you’ve got balance [difficulties] and you’re having to move up 6" to 7" into your chair from another [surface], it’s much more difficult. You’re having to accommodate that distance and control your balance.”
Ergonomics: Bring on the Options
While options such as ergonomic handrims and power-assist systems aren’t designed specifically and exclusively for use by clients with quadriplegia, using them can give this population a very helpful technological boost.
Power-assist devices are often considered for self-propellers who experience shoulder or arm pain. Davis said, “I don’t neces- sarily think of it only for someone who is aging.” But she did point out a reimbursement challenge: “One of the limitations of our funding structure is that Medicare requires that the person has been using [an optimally configured self-propelled] manual wheelchair at least a year before they can be considered for a power add-on — whereas they could be considered for a tradi- tional power chair right from the get-go. So that’s something that our funding structure limits: You can’t consider [power assist] as your first power mobility option.”
Davis said that policy doesn’t extend to some other payors, such as Veterans Affairs, “and Medicaid can be more open. It’s just that when insurance payors decide they’re going to follow suit with Medicare, you have more of a struggle. Medicaid has a federally mandated community-access component to their rules, so you have a much easier chance to argue [power assist] for someone who has Medicaid only.”
Aftermarket performance products can also make propulsion more effective. Consider tire choice, for instance.
“I like to use a high-pressure tire, like the Marathon tire, because it has reduced rolling resistance,” Ramage said. “That really makes a difference versus using a solid insert or something that doesn’t roll as easily. A solid insert can absorb a lot of energy in propulsion. I try to make it as easy to propel as possible.”
“As a wheelchair user,” Anderson said, “you’ve got to take
care of your equipment. Keep it clean, keep your wheel locks adjusted. Inflate your tires. The biggest thing you can do is keep your tires inflated. Pneumatic tires are proven to ride smoother than solid tires. Even the best solid tire doesn’t roll nearly as well as a pneumatic.”
“Wheel size has a lot to do with it, too,” Black said. “Obviously, a smaller wheel, like a 24" wheel, is easier to get rotating. A wheel that is lighter on the outside is easier to get rotating. Those things are important to somebody with that type of disability [quadriplegia].”
Clients on a Roll
Every client with quadriplegia is different, even if their injuries appear similar on paper. Davis said that’s one of the reasons she
has learned so much from her clients.
“I’ve been a therapist for over 30 years,” she noted, “and most
of us that have been around that long didn’t learn a whole lot about this in school. If we did learn wheelchair setup in school, we’ve come to understand that what we learned was mostly wrong. Such as, ‘Add an inch to each side of the hip.’ Most of the time, it’s wrong to add in a lot of space. You may have to rethink
The closer you can get the chair’s center of mass to the user’s center of mass, the more successes you’re going to have — Jim Black
what you learned it in school. So, learn from your expert users.” Davis also advocates for the right intervention, right away: an
optimized seating and mobility system from the very start. “You want to get them into a good seating clinic right from
the get-go so their posture is optimized,” she explained. “It’s
a lot harder if, over quite a long period of time, somebody has already learned their trunk balance, with their postural stability in a severe posterior tilt. It’s harder to get them out of it and try to change their posture later on down the line. I would want to offer [manual mobility] first and get them configured correctly so they’re set up to do that optimally, then continue to be able to offer that choice of manual versus power.” m
advertisers’ index
Company Name Page # Amylior (dba: Amysystems) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Merits Health Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Motion Composites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 PaceSaver/Leisure-Lift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31 Permobil/TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 PrideMobilityProducts/QuantumRehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Shoprider . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Softwheel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Stealth Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SunriseMedical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Symmetric Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Thomashilfen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ATP Series
MobilityMgmt.com
MOBILITY MANAGEMENT | OCTOBER 2018 29