Page 7 - Mobility Management, June/July 2020

show that most people don’t use all the tilt they’ve been prescribed. We have to look at why aren’t they using it? Is it just non-compliance? Is it someone who doesn’t want to be tilted that much? Is it someone who can’t, because professionally or school wise or just personally, they can’t spend 15 minutes an hour looking at the ceiling?”
The news that some consumers don’t use the full range of tilt on their chairs has resulted in some funding sources — notably, the Centers for Medicare & Medicaid Services — deciding that larger ranges of tilt aren’t necessarily needed and wouldn’t be as readily reimbursed. Peterson believes the rationale was “Well, people don’t use it, so we don’t need it.’ It’s kind of a slippery slope. Because I think you do need a certain amount of tilt in a well-pre- scribed, well-fitted, complete system for someone who really has pressure concerns. Twenty degrees of tilt is
not going to do it. You have to have at least 40° to 45°,
or 30° in conjunction with recline. And that’s where your clinician and your multi-disciplinary team to look at the whole picture is so important.”
That being said, Peterson added, “For some people, 20° of tilt is fantastic. It might give them the visual field,
the balance, the stability that they need, or comfort. From a manufacturing standpoint, it also opens up possibilities for cost reduction; it opens up possibilities
for reducing the complexities for a chair. A lot of times,
if you’re only using 20° to 25° of tilt, you don’t need CG shift. You don’t need that big, sliding, 45° tilt mechanism. You can simplify a chair. It does have a cascading effect on the design of a chair.”
It gets dangerous, though, for funding sources to believe that lower ranges of tilt will work for everyone. “What concerns me,” Peterson said, “is that some people take advantage of a lower cost, and then we compro- mise the code for the people who really need that 45° of tilt for respiration, pressure reduction, etc.”
Tilt’s New Directions
Tilt no longer just means tilting backward. Anterior and lateral tilt have given seating clinicians and providers more positioning options to choose from.
“What I’ve found in my experience,” Peterson explained, “is that anterior tilt is used a lot for transfers and environmental access. We have a lot of people
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