Page 12 - Mobility Management, September/October 2021

ATP Series
Words Matter: The Language of CRT
push the pad back. That’s why hardware adjustability and rotation are critical when you’re looking at headrests in particular.
“People will say, ‘I just want a simple 10" pad.’ Okay, but I need to see the person and how they’re going to use it. Do they want more support when they’re tilted? ‘Oh, they hardly go back that far when they’re tilted.’ Okay, so they need it when they’re upright so they can just put their head back and get support because they’re never tilting? Or if they’re tilting, they’re not using it to the maximum that they should. So they’re using it just for minor adjustments [such as using tilt to reposition].”
Romero has also used adjustable head positioning and supports to help a client strengthen neck muscles. “It’s understanding the diagnosis — is there an ability to gain muscle strength back? What we used to do for people who were new [spinal cord] injuries, and you didn’t know how much they would gain back — [the physi- cians] would put them in a halo, and they were locked in. But as soon as they took them off the halo, we would create a curvature
of pads around them like a halo. They could fall forward, hit that pad, and start to come back in small increments. In that space, they were gaining muscle strength back, using their neck muscles.”
With head positioning, the challenge is explaining that
the familiar definition of headrest doesn’t apply to CRT. “Our funding system worded that in a way that you couldn’t make the
advancements that were important, like with hardware that’s adjustable or hardware that flips away, hardware that rotates and gets into unique angles for people who have already established a deformity that you’re going to have to work to support,” Romero said. “Or in younger people, to try to reposition them or setting boundaries so they don’t go beyond that. A headrest, how it’s defined in coding, it’s not to have fore and aft adjustment. But when you really need support, that’s when you get into systems that can support [the head] and almost cradle it in a way that allows you to completely relax. Not hang off of it, but actually will allow you to say that something is holding your head and cradling your head.
“I’ve seen people who drop their heads because of their posi- tioning. When you’re aligning your body and your head is too far forward, your head is going to want to drop.”
Manual Chair Conundrum: The K0009 Loss
One example of how much words matter — and how misinter- pretations can have dire results — was the elimination of the K0009 manual wheelchair code in 2013.
Deceptively simple in phrasing — Other manual wheelchair/base — the K0009 code included chairs that were crucially different than those in the K0005 (Ultralightweight wheelchair) code.
The Centers for Medicare & Medicaid Services (CMS)
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