Power mobility Flashcards
(87 cards)
1
Q
What is a Letter of Medical Necessity?
A
A written statement by a healthcare provider.
Used to justify the need for a medical service, treatment, equipment, or medication.
2
Q
Letter of Medical Necessity
Required by:
A
Insurance companies
Government programs (e.g., Medicare, Medicaid)
Employers
Helps secure coverage approval for services or items not automatically included in a standard benefits plan.
3
Q
When is the Letter Needed?
A
To request insurance coverage for: Specialized treatments, surgical procedures, or medications not typically covered.
To obtain durable medical equipment (DME)
To justify therapy services
To appeal denied insurance claims
4
Q
Building Blocks of the Letter:
A
Patient Information
Provider Information
Diagnosis & Condition
Recommended Treatment/Service
Medical Justification
Alternative Treatments
Supporting Documentation
5
Q
Patient Information:
A
Full name, DOB, relevant medical history
6
Q
Provider Information:
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Name, credentials (e.g., DPT, MD), and contact info of the clinician writing the letter
7
Q
Diagnosis & Condition:
A
Concise summary of the medical issue and why intervention is required
8
Q
Recommended Treatment/Service:
A
What exactly is being requested (e.g., manual wheelchair, physical therapy 2x/week)
9
Q
Medical Justification:
A
Evidence-based rationale for how the service improves health, function, or quality of life
10
Q
Alternative Treatments:
A
Why other options are inappropriate, insufficient, or have failed
11
Q
Supporting Documentation:
A
Clinical notes, test results, or outcome measures backing up the request
12
Q
6 Key Components of an LMN (Device-Focused)
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Disability Description
Assistive Technology/Device Description
Medical Need
Other Alternatives Not Appropriate (WHY?)
Ability to Use the Device/Technology
Community Standard
13
Q
Detailed History:
A
Medical, functional, and therapeutic history related to the need.
14
Q
Client & Environmental Factors:
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Barriers and supports in the home, school, or community.
15
Q
Social/Living Situation:
A
Who helps them? Is a caregiver available for transfers, set-up, or transport?
16
Q
Mobility Equipment:
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Current device vs. needed device—what’s insufficient and what’s recommended.
17
Q
Pain:
A
Document how mobility impacts or alleviates pain.
18
Q
Posture/Seating Needs:
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Any pelvic obliquity, scoliosis, or pressure sore risks?
19
Q
Neuromuscular Function:
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Weakness, spasticity, or ataxia that limits safe ambulation.
20
Q
Functional Mobility:
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Gait deficits, fall history, or inability to walk sufficient distances.
20
Q
Sensation:
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Loss of protective sensation, especially in seating surfaces.
21
Q
Self-Care Status:
A
How mobility limitations impact dressing, bathing, toileting, etc.
22
Q
Who Writes the LMN ?
A
Primary Author: Medical Provider (e.g., PT, OT, physician)
Collaboration with DME Provider (Durable Medical Equipment supplier)
23
Q
Primary Author: Medical Provider (e.g., PT, OT, physician)
A
Completes the comprehensive evaluation.
Understands the client’s physical, functional, and environmental needs.
Justifies each specific equipment recommendation based on clinical findings.
24
Collaboration with DME Provider (Durable Medical Equipment supplier):
Ensures equipment options are available and justified in terms of coverage criteria.
Helps compare “same or similar” devices for medical justification.
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DME Role:
Provides updated forms, educates all involved on coverage and documentation.
Obtains physician signature (for legal approval) and submits the full package to insurance.
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MRADLs =
Movement Related Activities of Daily Living
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Coverage is limited to devices used in the home —
meaning the equipment must directly support basic daily activities essential for independent living
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Covered MRADLs:
Toileting
Dressing
Grooming
Bathing
Feeding
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When justifying a wheelchair or assistive device, you must link the patient’s needs to one or more of these MRADLs —
especially emphasizing how the device will enable them to safely and independently complete these activities in their home environment
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Key Questions to Address in a LMN:
What prevents the client from performing MRADLs?
Is participation in MRADLs unsafe or potentially harmful?
Does it require excessive time or energy?
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What prevents the client from performing MRADLs?
Is it poor endurance, balance deficits, pain, weakness, unsafe transfers?
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Is participation in MRADLs unsafe or potentially harmful?
For example, are they at risk of falls, pressure injuries, or cardiovascular stress?
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Does it require excessive time or energy?
Even if the client can perform the task, is it so fatiguing or inefficient that it limits independence?
34
_____ = the first and most foundational component of a Letter of Medical Necessity (LMN)
Disability Description
35
Disability Description:
Diagnosis: The specific medical condition (e.g., multiple sclerosis, spinal cord injury).
Prognosis: Expected progression—will the condition remain stable, worsen, or fluctuate?
Disability: A functional description of how the condition limits mobility-related activities of daily living (MRADLs) like toileting, dressing, or feeding.
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_____ , the second key part of a Letter of Medical Necessity (LMN)
Assistive Technology (AT) Description
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Assistive Technology (AT) Description:
Detailed Description: Include features, dimensions, and functions—especially for custom or newer devices (e.g., “tilt-in-space manual wheelchair with adjustable headrest and lateral trunk supports”).
Use Common Language: Write clearly so non-clinical reviewers (like insurance reps) can understand.
Avoid Acronyms: Don’t assume abbreviations are familiar (e.g., write “power wheelchair” instead of “PWC”).
Explain Equipment Issues: If replacing an old device, document its limitations, wear, or how it's no longer meeting patient needs.
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Third key section of a Letter of Medical Necessity (LMN): ____
Medical Need for Assistive Technology (AT)
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Medical Need for Assistive Technology (AT):
Link each device to a functional or medical outcome
ex) “Tilt-in-space wheelchair: Enables pressure relief to reduce risk of ischial pressure ulcers in a patient with limited independent repositioning.”
Use clear, direct medical language that ties impairments (e.g., pressure injury risk, poor trunk control) to the equipment benefits.
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Alternatives Not Appropriate
This section justifies why less expensive or more commonly covered options are insufficient for your patient
Why the recommended device is better
Identify missing features in alternatives
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User’s Ability to Use Technology =
supports the claim that the client is capable of operating the requested assistive technology (AT), especially if it is advanced (e.g., power wheelchair, electronic device)
Evidence of user competence
Trial documentation
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Evidence of user competence:
→ Document motor control, cognition, and safety awareness.
Example: “The client demonstrated safe and effective use of the joystick during a 30-minute trial of the power wheelchair.”
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Trial documentation:
→ Note the exact model used and outcome of the trial.
Example: “During the trial with a tilt-in-space power chair, the client independently navigated within the home and performed MRADLs with minimal redirection.”
44
Community Standard:
addresses whether the requested assistive technology (AT) aligns with accepted clinical norms
Evidence that the device is widely accepted
Reference to clinical practice guidelines
Justification that it’s not experimental or excessive
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Medicare Requirements for Wheelchair Justification:
Device Hierarchy (Least to Most Complex)
The person "has not expressed an unwillingness to use the recommended device"
The device is medically necessary for completing MRADLs ("Mobility-Related Activities of Daily Living") in the home
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Medicare requires documentation that less complex, less costly alternatives are not sufficient:
Cane or walker? Y/N
Standard wheelchair? Y/N
Lightweight wheelchair? Y/N
High strength lightweight wheelchair? Y/N
*Optimally-configured manual wheelchair? Y/N
*Scooter? Y/N
*Power wheelchair? Y/N
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how to justify a power wheelchair by ruling out a manual wheelchair:
Trial with an “optimally-configured manual wheelchair”
Collect Objective Data During the Trial
Assess Environmental Barriers
Consider Caregiver Availability
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Trial with an “optimally-configured manual wheelchair”:
→ You must document that the patient attempted use of the best-suited manual wheelchair first.
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Collect Objective Data During the Trial:
Include metrics like:
Time and distance traveled
Heart rate, blood pressure, pulse oximetry
Perceived exertion or fatigue levels
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Assess Environmental Barriers:
Evaluate the patient’s ability to navigate:
Smooth vs carpeted floors
Ramps, door sills, thresholds
Turns in narrow hallways, etc.
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Consider Caregiver Availability:
Does the patient lack a caregiver to push the manual wheelchair safely and consistently?
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Categories of Seating & Positioning Needs:
Balance & postural control
Neutral sitting posture
Postural supports needed
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Seating & Positioning Needs:
Balance & postural control
basic = Good balance; sits hands-free
intermediate = Fair balance & trunk control
complex = Poor sitting balance
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Seating & Positioning Needs:
Neutral sitting posture
basic = Achieves posture without support
intermediate = Achieves posture with some support
complex = Unable to achieve posture without full support
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Seating & Positioning Needs:
Postural supports needed
basic = No supports needed
intermediate = Needs postural supports
complex = Requires custom postural supports
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Key Points Supporting Power-Assisted Manual Chairs:
Manual add-on drive systems
Condition changes, injuries, or aging
Energy conservation
Risk reduction
Progressive conditions
Contextual limitations
Cost considerations
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Manual add-on drive systems:
These provide motorized assistance without fully transitioning to a power chair
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Condition changes, injuries, or aging:
A patient who previously used a manual chair may no longer have the strength or endurance required
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Energy conservation:
Helps users preserve energy for daily activities, critical in conditions like MS or post-stroke fatigue
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Risk reduction:
May lower the likelihood of overuse injuries (e.g., rotator cuff tears)
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Progressive conditions:
Serves as a transitional option before moving to full power mobility
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Contextual limitations:
Power chairs may not be feasible due to space, caregiver support, or personal preference
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Cost considerations:
Some add-ons can actually exceed the cost of a full power wheelchair — important for insurance justification
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three types of power add-ons for manual wheelchair:
Hand Rim-Activated Power-Assist System
Power Unit Add-On
Manual Wheelchair Converted to Power
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Hand Rim-Activated Power-Assist System
Motors are integrated into the hubs of special wheels.
The system assists with each propulsion, reducing strain on the user.
Removable, so the chair remains foldable and transportable.
Good for users with limited upper extremity strength or endurance.
65
Power Unit Add-On
Mounted to the back of any manual wheelchair.
Provides powered propulsion to assist with mobility.
Useful for hilly terrain, fatigue management, or when push-assist is needed intermittently.
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Manual Wheelchair Converted to Power
Full conversion: wheels are replaced, and a battery + joystick control system is added.
Allows for powered operation while keeping the manual frame structure.
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Decision-Making Factors:
specifically Power-Operated Vehicles (POVs) like scooters
Cognition: User must understand and safely operate the device.
Functional independence: Can they transfer on/off, navigate, and manage daily tasks?
Inability to use a manual wheelchair: Due to fatigue, coordination, or upper extremity limitations.
Risk of overuse injuries: Especially in shoulders and wrists.
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POV Scooter Characteristics:
3- or 4-wheel configurations
Controlled by a tiller (steering column)
Requires upper extremity strength and endurance
Large turning radius (less ideal for tight indoor spaces)
Supportive seat, but often with:
Limited seat depth and height
Poor compatibility with tables
Risk of tipping
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POV Scooter
Clinical Notes:
Cannot be driven up to a table—requires dismounting or rotating seat.
May not meet Medicare criteria for in-home use.
Consider long-term appropriateness, especially with progressive conditions.
70
Power Wheelchairs
Categorized by:
Frame style: Rigid vs. folding
Seating system: Modular, custom, tilt/recline
Drive-wheel configuration: Front-, mid-, or rear-wheel drive
Performance: Terrain capability, responsiveness, range
Power seat options: Tilt, recline, seat elevate, leg elevate
Electronic capability: Programmable controls, Bluetooth, etc.
Input options: Joystick, sip-and-puff, head array, switch control
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Power Wheelchairs
Design Factors:
Environment
Performance Features
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Environment:
Indoor: tight turning radius, compact
Outdoor: rugged tires, suspension
Combo: hybrid designs for mixed use
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Performance Features:
Weight capacity
Stability and durability
Obstacle climbing
Range (battery life)
Speed
74
Client-Centered Matching:
Clinical, physical, and personal needs must match both capacity and environmental demands.
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Frame Type:
Integrated system: All-in-one design
Power base: Modular system allowing interchangeable seating
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Wheelbase Configuration:
Front-wheel drive (A): Good outdoor traction; wider turning
Mid-wheel drive (B): Tightest turning radius; best for indoor use
Rear-wheel drive (C): Fastest, smoothest ride; requires more space
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Power Feature Placement:
Location and accessibility of electronics, motors, controllers, and input devices (e.g., joystick, head array)
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Front-Wheel Drive (A)
Moderate turning radius
Good outdoors, curb climbing
Less stable at higher speeds
Mixed environments
May fishtail during fast turns
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Mid-Wheel Drive (B)
Tightest turning radius
Fair – best on flat surfaces
High stability (6 wheels on ground)
Best for indoor use
Most intuitive turning, may get stuck outdoors
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Rear-Wheel Drive (C)
Widest turning radius
Best for speed and slopes
High stability at higher speeds
Outdoor use and long distances
Larger turning radius, tracks straight well
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Power for Positioning:
features
Tilt: Shifts seat angle without changing hip/knee angles. Aids pressure relief, posture, and trunk control.
Recline: Opens the seat-to-back angle; helpful for rest, catheterization, and dressing.
Elevate legs: Reduces edema, improves circulation.
Elevate seat/chair: Facilitates transfers, enhances social engagement and access to environments.
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Power for Positioning:
operation methods
Switch access: For users with limited UE function.
Joystick: Standard for most users.
Track pad or Head control: For users with high-level spinal cord injury or severe motor impairments.
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Power Seat Elevation – Key Purposes
Access Higher Surfaces and Controls Easier = Facilitates reaching kitchen counters, shelves, light switches, and other elevated areas in the home/workplace.
Social Participation = Allows the user to be at eye level with peers during conversations and interactions, supporting psychosocial well-being.
Improved Transfers = Aligns seat height with transfer surfaces (e.g., bed, toilet, car), reducing caregiver burden and risk of falls.
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Power for Positioning:
Clinical Justification
Weight shifting to reduce pressure sores
Assistance with transfers
Improved functional posture and positioning
Used independently or by a caregiver
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Power Standing Wheelchair – Key Benefits
Weight Offloading = Enables the user to assume a standing posture intermittently throughout the day to relieve pressure on the ischial tuberosities and sacrum, reducing risk for pressure injuries.
Access to Higher Surfaces = Facilitates participation in MRADLs such as cooking, grooming, and accessing shelving—tasks otherwise limited by seated height.
