Page 18 - Mobility Management, February 2019
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                                 ATP Series
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 Clients with CVA Are Often Older. Does Age Impact Their Options?
By Laurie Watanabe
Last summer, Mobility Management published a series on the Function- al Mobility Assessment (FMA), a 10-question survey for people who use wheelchairs. The FMA was de- veloped by a team at the University of Pittsburgh; U.S. Rehab has the worldwide rights to commercialize and collect data with the FMA.
The survey has approximately 40 diagnoses to choose from. The most commonly reported diagnosis was stroke/cerebrovascular accident (CVA), chosen by 17.53 percent of respondents.
In practical terms, that means seating and mobility teams work with a lot of stroke clients. But for many stroke clients, seating and mobility intervention is a standard, attendant-propelled manual wheelchair without much ability to be fine-tuned, let alone be self propelled. Why are so many stroke patients using less functional equipment?
Anatomy of a Stroke
The Centers for Disease Control CDC) says two-thirds of people who have a stroke are 65 or
older, according to 2009 statistics. In comparison, the average age for a newly injured spinal cord injury patient is 42 years, according to 2016 statistics from the National Spinal Cord Injury Statistical Center. That’s much older than the average age of a newly injured patient (29 years) in the 1970s, but still decades younger than most stroke patients.
Is a subtle form of ageism at work with stroke patients when it comes to acquiring optimal seating and mobility equipment?
The Process & the Policies
Why, for instance, are many stroke clients not given the opportu- nity to self propel in an ultralightweight wheelchair?
Debbie Pucci, PT, MPT, is a Clinical Specialist at Ki Mobility.
“As a clinician who continues to work in a seating clinic, I don’t feel that there’s less consideration of the ability for [stroke patients] to self propel,” she said. “However, Medicare coverage for equipment in many cases has limited the options available for individuals due to the in-the-home clause that Medicare has. That clause really limits the definition of what Medicare deems medically necessary for those individuals.”
To qualify for a wheelchair purchased by Medicare, a benefi- ciary needs to meet the medical necessity guidelines laid out by Medicare: “There has to be some mobility limitation that signifi- cantly impairs their ability to participate in one or more mobili- ty-related activities of daily living,” Pucci said, such as toileting, feeding or dressing in the home. “That’s the first criteria. Then you have to say that beneficiary’s limitations cannot be shown to be resolvable through the use of an assistive device such as a cane or walker. You have to go down that road to get them to qualify for any manual wheelchair. To qualify for what we consider

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