Page 10 - Mobility Management, September/October 2021

ATP Series
Words Matter: The Language of CRT
because the head, which is looking for support, will find it.
I’m not saying the pelvis isn’t important, because it’s extremely important. What I’m saying is when I first look into a room, I might not be able to see the [client’s] pelvis because of a lot of things [blocking] that view. But I can see the head, and it starts to tell me what that individual could be suffering from. And there’s a high probability of where the pelvis will be based on that [head’s] positioning.”
Head support can be challenging because the need for it can change over time... even throughout the day. “I remember a child who was sitting perfectly,” Romero said of one clinic visit he made. “It was the rules you see in textbooks on sitting — that 90-90-90. It was perfect. But this kid had severe tone, so he’d go into an ATNR [Asymmetrical Tonic Neck Reflex]. He’d be sitting perfectly, but a sound would trigger him, he’d go into ATNR, gravity would take over his head, and now he’s leaning on the side of his chair. He couldn’t get back into a stable position.
“If you would’ve seen him when we walked in — he was seated perfectly and holding his head up perfectly. But as soon as he went into this tone, his head hooked around the side of the headrest and stayed there. Some people will get into a different position like this and don’t have the ability or knowledge to
get back into a good position. That different position will seem
nice, but what happens is they start extending muscles, and the cervical region starts to get affected.”
Which is where headrests come in. E0955 is the HCPCS code for Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each. But, Romero said, this kind of component isn’t necessarily designed to handle the positioning and support needs that CRT clients often have.
“A headrest is a term in transportation,” he said. “You need it because if your wheelchair goes into a vehicle, you need to have something behind you. You need just an up-and-down type of pad, really. That’s what our cars have, on two rods most of the time. Eventually, the back of my head is going to be aligned with my back, and that pad should stop [the head] from continuing to go backwards. That’s what a headrest is going to do. It doesn’t have to be removable. We used to call it a pad on a stick.”
That’s entirely different from what CRT wheelchair users need. Said Romero, “We had conversations with coding: You realize that an E0955 is just a pad on a stick. It has no adjustments at all. So if
I’m putting somebody in a tilt chair, and gravity is taking over: Because of the thickness of the pad and because they don’t have the ability to push it back a bit, their head might be in an awkward position [compared] to where their back is aligned. [The head] is ahead of their back because of where the pad is, because I couldn’t
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