Wheelchair content Flashcards

(53 cards)

1
Q

Players in wheelchair service delivery

A

client and family caregivers

therapist - PT or OT

physician

DME/CRT supply company
-CRT- complex rehab technology

supplier (CRTS with ATP and or SMS certification)
-CRTS: complex rehab tech supplier
-ATP: assistive tech professional (must be present on assessment according to medicare (or SMS))
-SMS- seating and mobility specialist

CRT technician - complex rehab technology

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2
Q

Types of certifications for assistive tech:

A

RESNA - Rehabilitation Engineering and Assistive Technology Society of North America offers two types
–ATP: assistive technology professional
–SMS: seating and mobility specialist

ATP VS SMS EXAM:
-The ATP exam is broad-based covering all major areas of assistive technology, the SMS exam is focused specifically on seating, positioning, and mobility.

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3
Q

Identification of wheelchair need

A

TYPES OF NEED:
-new wheelchair user: unable to walk safely and functionally in environments where they need to be mobile

-existing user: wheelchair no longer meets needs
–> due to change in condition, growth, or disrepair of equipment
–look at seated posture, skin breakdown, functional mobility

WHO CAN IDENTIFY NEED?
-client, family
-DME/CRT company
-physician
-other health prof, school staff
-treating PT or OT

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4
Q

Assessment for wheelchair

A

PERFORMED BY:
-PT or OT
–medical fucntional need
–primary problems identified
–seating and mobility objectives and goals
–POC

-supplier
–therapist and supplier together determine necessary features for patient’s goals –> match to tech
–make recommendations of tech

-physician (must be face to face)

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5
Q

Eval by PT or OT includes:

A

background

personal function

mobility function

physical assessment

-establish initial goals and POC for assessment process

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6
Q

Eval by CRTS or ATP, and therapist includes

A

seating simulation

special tests/product trials

final prescription/intervention plan

-go through the order form together if possible

-establish and document health concerns and functional impairments to provide a rationale for the recommended mobility device and accessories

-establish final POC for implementation and follow-up phase

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7
Q

Who is involved in finding auth/documentation?

A

PT or OT
supplier
physician
DME/CRT company

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8
Q

What is the order of least costly to most costly assistive devices according to Medicare?

A

Ambulation aids

Standard manual wheelchair w/ minimum adjustability

fully configurable MWC

power scooter

power wheelchair

** justify why less costly version does not meet person’s medical and functional needs

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9
Q

CMS documentation requirements for an assistive device

A

1.) Prescription and 7-element order
2.) Detailed product description
3.) Chart Notes of face-to-face exam by a physician
4.) Clinical documentation
–face-to-face exam form or report (physician or
therapist)
–specialty eval form or report (by therapist)
5.) Home assessment report

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10
Q

PHYSICIAN’S ROLE DOCUMENTATION

A

-face-to-face exam
-7 element order
-refer to a therapist for completion of F2F or specialty eval

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11
Q

SUPPLIER’S ROLE DOCUMENTATION

A

-tech assessment with a therapist if needed
-detailed product order
-home assessment report

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12
Q

PT/OT ROLE DOCUMENTATION

A

-specialty evaluation report or form

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13
Q

SUPPLY COMPANY’S ROLE DOCUMENTATION

A

puts together a full packet of ALL the documentation, and submits to the insurance company

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14
Q

What is the specialty evaluation performed by the physical therapist?

A

-typed or handwritten

-represents therapy eval and technology assessment t

-no one specific form is accepted

-must be hand-signed by YOU and hand-dated by you

-Report or Form must attest that you completed the form/did evaluation and that you have no financial relationship with the
supply company providing the wheelchair

** DME/CRT company or CRT supplier BEST source of info on what is needed from you as a therapist

THINGS TO DOCUMENT:
-findings from the eval
-results of simulation or product trials
-less costly alternatives and why they cannot address the client’s medical/functional needs
-address payers coverage criteria for the type of wheelchair and accessories recommended

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15
Q

Who is involved in the wheelchair implementation process?

A

PT and OT
supplier
technician
DME/CRT company

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16
Q

The implementation process for wheelchair

A

shape capture for custom contoured seating -> PT has a role in making sure the client is sitting in an optimal resting alignment during shape capture and optimal postural alignment

Order equipment (supply company)

Equipment set-up (technician)

Fittings/delivery
-a person must be seated
-fit is checked and numerous adjustments made
-may need more sessions for fitting before delivery
-check to make sure all features are specified and all objectives met

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17
Q

Training for implementation

A

Training of consumer and/or caregiver in proper positioning as well as operation care and maintenance of equipment –> (can be done by PT/OT, supplier and/or technician)

-transfer or WC training by PT or OT

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18
Q

Follow-up process for wheelchair fitting

A

Adjustments and modifications
-change device properties, need an original evaluating team
-PT or supplier

Repairs and Maintenance
-not altering device properties, does not require clinical judgment
-technician performs

Reassessment
-assess whether objectives are being met so equipment can be modified or adjusted to reflect progress or changing status of individual
-done by PT/OT or supplier

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19
Q

Billing for wheelchair fitting process

A

Assessment Phase: 2-3 sessions

Tech Assessment
-additional sessions required to complete wheelchair assessment or if billed with initial PT eval need to apply 59 modifier

Follow-up phase: 1-3 sessions
-fittings, delivery, and training
-97542 wheelchair management
-97535 self-care/home management

-we write POC to cover assessment and follow-up phases of service delivery
-must update POC for initial visit cause there is a 2-3 month delay before follow-up phase
-home modifications are often not covered by insurance
-Medicare does not cover a backup device

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20
Q

Body segment angle for hip flexion and extension joint motion

A

thigh-to-trunk angle

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21
Q

Body segment angle knee flexion and extension

A

thigh to lower leg angle

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22
Q

Body segment angle for ankle DF (PF) motion

A

lower leg-to-foot angle

23
Q

Seating angle for hip flexion

A

seat-to-back support angle

24
Q

Seating angle for knee extension

A

seat to lower leg support angle

25
Seating angle for ankle DF
lower leg support/foot support angle
26
What joints are assessed in a supine mat assessment
pelvis and spine flexibility hip flexion knee extension with hips flexed ankle dorsiflexion
27
pelvis flexibility assessment
palpate ASIS and PSIS determine flexibility by trying to move pelvis manually towards neutral position
28
Hip flexion assessment
Hip flexion angle = 180 - thigh to trunk angle supine, knees flexed place hand under pelvis to feel iliac crests and lumbar space monitor lumbar flattening/posterior rotation with hip flexion in most ppl at end of hip flexion range the pelvis will posteriorly rotate
29
Knee extension with hips flexed assessment/hamstring length assessment
Knee flexion angle= 180-thigh to lower leg angle -hips flexed to end comfortable range or 90 degrees if no limitation -make sure the pelvis and lumbar spine are in the client's neutral position -keep one hand under the lumbar/sacral area as you extend the knee slowly until you feel pelvis posteriorly tilt or the lumbar spine flatten
30
Ankle dorsiflexion assessment
Ankle dorsiflexion angle= 90- lower leg to foot angle -assess in supine -hips and knees flexed to the angle determined in prior procedures -stabilize thigh and lower leg with one hand just below the knee -move foot into dorsiflexion
31
Other body measurements that are taken during wheelchair assessment
buttock/thigh depth shoulder height elbow height lower leg length hip width
32
What is the ADA?
The Americans with Disabilities Act (ADA) became law in 1990. The ADA is a civil rights law that prohibits discrimination against individuals with disabilities in all areas of public life, including jobs, schools, transportation, and all public and private places that are open to the general public
33
What are the 4 titles of the Americans with Disabilities Act?
Employment -regulated by the Equal Employment Opportunity Commission Public Service -regulated by the secretary of transportation Public Accommodations -regulated by the attorney general Tele-communications -regulated by the Federal Communications Commission
34
Bathroom requirements
42 inch minimum grab bar on side of wall 36 min grab bar on back of wall behind toilet
35
Home specifications * MEMORIZE
Sidewalk width- 36" Door width- 32 min-36" preferred Hall width - 32-40" preferred (36" in the middle) Threshold height absent or up to 0.5" Door handles 36" max from floor, lever type Ramp 36-48" wide, no more than 1" rise for each foot of length **ramps longer than 30 feet will need a landing area
36
What is the min height needed for knee clearance in a kitchen?
29"
37
What is the needed length for safety grab bars in a bathroom for wheelchair user?
24-30" long
38
Group 1 and 2 mobility assistive equipment
basic power wheelchairs
39
Group 3 and 4 mobility assistive equipment
complex power wheelchair
40
What are the three main types of power mobility devices?
scooter basic power wheelchair complex power wheelchair
41
What kinds of chronic med conditions would indicate need for group 1 or 2 power mobility devices?
-circulatory conditions -cardiac conditions -pulmonary -ortho
42
What kinds of medical conditions would indicate the need for group 3 or 4 mobility devices?
neurological conditions myopathies congenital skeletal deformities
43
Scooters appropriate for
-good head/trunk control -can use UEs to control tiller -can get in and out of seat safely -travel longer distances CON -the turning radius may limit mobility or independence
44
Group 1 basic power wheelchairs
-for limited, intermittent use (< 2 hrs/day) -no headrest -5 mile range -3 mph speed -6" incline -20 mm obstacle climb -300 lbs max weight
45
Group 2 basic power wheelchair
-for continuous use (>2 hrs/day) -headrest may be included -single and multiple power options -up to 600 lbs -7 mile range -3 mph speed -6" incline -40 mm obstacle climb
46
Group 3 complex power whelchairs
-for active users with continuous use needs -sling/solid seat or captain's chair -single or multiple power options -up to 600 lbs -12 mile range -4.5 mph -7.5" incline -60 mm obstacle climb -suspension for comfort and skin protection
47
Group 4 complex power wheelchairs
* very hard to get funded * ask specific questions to justify *for highly active users with continuous use needs and need to encounter non-accommodated terrain *have added capabilities that are not needed for use in the home by some payers (Medicare) -sling/solid seat or captain's chair -single or multiple power options -up to 600 lbs -16 mile range -6mph speed -9" incline -75 mm obstacle climb
48
Alternative drive controls
any drive control device other than a standard joystick -programming, mounting, or shape of device is different
49
Types of drive controls
PROPORTIONAL CONTROLS -more efficient due to the decreased number of inputs required -intuitive -provides control of speed and 360 degrees of control -stop by returning device to center or letting go -more you push faster you go -motor control needed for graded movements DIGITAL/SWITCH CONTROLS -all-or-nothing response -each direction= diff switch -speed changes require mode changes
50
Types of proportional controls
standard joystick joystick with modifications alternative joysticks --> require less force to move
51
Types of switch input controls
3- 5 switch inputs -3 switch:forward, left, right, reverse pneumatic inputs/combo systems (sip and puff) -forward: hard puff -right: soft puff -left: soft sip -reverse: hard sip 2 switch inputs 1 switch input -quite inefficient -when the correct option is highlighted, the user activates the switch and holds it as long as they want to go in that direction w -to stop the chair the switch is released TYPES: -mechanical -pneumatic -proximity (usually embedded in headset) -fiber optic (tiny movements)
52
Momentary vs latch for pneumatic control programming
Momentary -output only when input being applied Latch -output maintained when input given until opposite or stop command provided -promotes independent and efficient control of the wheelchair using sip and puff controls
53
Lined 2 switch driving
allows individuals with 2 access points the increased efficiency and ease of using of 3-switch system