Volume 11, Issue 3 FALL 2009 MS Clinical Messenger Tips to Obtaining Mobility Devices Kerri Morgan, MSOT OTR/L ATP Instructor of Occupational Therapy and Neurology Washington University School of Medicine Sue Tucker, MSOT OTR/L ATP Clinical Specialist Program in Occupational Therapy Washington University School of Medicine Gateway Area Chapter Clinical Advisory Committee Committee Chair Barbara Green, M.D. St. John’s Mercy Medical Center West County MS Center Committee Members Elissa Held Bradford, PT St. John’s Sports & Therapy Mary DuParri, M.A., LPC Private Practice Gerard Erker, PhD SSM Rehab St. Mary’s Health Center Penny James OTR/L, MS Veteran’s Administration Medical Center Michelle Keating RN, OCN MSCN St. John’s Mercy Mecical Center Robert Naismith, M.D Barnes-Jewish Hospital John L. Trotter MS Center Barry Singer, M.D. Missouri Baptist Medical Center Florian Thomas, M.D. Saint Louis University Health Sciences Center Beverly, diagnosed in 2001 Approximately 6.8 million (3.51%) of the general population ages 18 and older not living in a nursing home setting use an assistive device for mobility [(1), (2)]. Mobility devices can enhance the ability of a person with a disability to engage in major life activities by increasing the level of independent action, reducing the time spent in activities of daily liv- ing, and providing more choices of activities and greater satisfaction in participating in activities. Although mobility devices can have a positive impact, the devices can be difficult to acquire due to problems associated with obtaining the appropriate and optimal fit of reliable, affordable and durable mobility devices. The system for obtaining a mobility device has many steps and can be difficult to navigate. Below are steps and resourc- es for acquiring a mobility device. Evaluation – Wheelchair vs. Scooter During the evaluation a decision needs to be made on what type of mo- bility device is appropriate (e.g., manual wheelchair, power wheelchair, and scooter). Each type of device has positives and negatives and the challenge is selecting the device that may be the most effective in the activities and environments the person is going to experience daily. For instance, manual wheelchairs are the lightest weight and therefore most likely the easiest to transport. However, the person that will be using the wheelchair needs to have enough strength and endurance to propel the manual wheelchair or have assistance to push them. Power wheelchairs require more consideration for transportation needs because they are heavy and difficult to break down into smaller pieces for transport, but a power wheelchair can allow a person to have independent mobility in environments that are accessible. Scooters are a good option when the device is only needed to cover the distance to and from certain places rather than using it as a full-time de- vice. Some scooters can come apart into pieces for transport. However, scooters may not be appropriate if someone has very specific seating and postural needs. No matter what device is selected, proper fitting of the device and training in device-use must be part of the process.
Transcript
Volume 11, Issue 3 FALL 2009
MS Clinical MessengerTips to Obtaining Mobility Devices
Kerri Morgan, MSOT OTR/L ATP Instructor of Occupational
Therapy and Neurology Washington University
School of Medicine
Sue Tucker, MSOT OTR/L ATPClinical Specialist
Program in Occupational TherapyWashington University
School of Medicine
Gateway Area ChapterClinical Advisory
Committee
Committee ChairBarbara Green, M.D.
St. John’s Mercy Medical CenterWest County MS Center
Committee MembersElissa Held Bradford, PT
St. John’s Sports & Therapy
Mary DuParri, M.A., LPCPrivate Practice
Gerard Erker, PhDSSM Rehab
St. Mary’s Health Center
Penny James OTR/L, MSVeteran’s Administration
Medical Center
Michelle Keating RN, OCN MSCNSt. John’s Mercy Mecical Center
Robert Naismith, M.DBarnes-Jewish Hospital
John L. Trotter MS Center
Barry Singer, M.D.Missouri Baptist Medical Center
Florian Thomas, M.D.Saint Louis University
Health Sciences Center Beverly, diagnosed in 2001
Approximately 6.8 million (3.51%) of the general population ages 18 and older not living in a nursing home setting use an assistive device for mobility [(1), (2)]. Mobility devices can enhance the ability of a person with a disability to engage in major life activities by increasing the level of independent action, reducing the time spent in activities of daily liv-ing, and providing more choices of activities and greater satisfaction in participating in activities. Although mobility devices can have a positive impact, the devices can be difficult to acquire due to problems associated with obtaining the appropriate and optimal fit of reliable, affordable and durable mobility devices. The system for obtaining a mobility device has many steps and can be difficult to navigate. Below are steps and resourc-es for acquiring a mobility device.
Evaluation – Wheelchair vs. ScooterDuring the evaluation a decision needs to be made on what type of mo-bility device is appropriate (e.g., manual wheelchair, power wheelchair, and scooter). Each type of device has positives and negatives and the challenge is selecting the device that may be the most effective in the activities and environments the person is going to experience daily. For instance, manual wheelchairs are the lightest weight and therefore most likely the easiest to transport. However, the person that will be using the wheelchair needs to have enough strength and endurance to propel the manual wheelchair or have assistance to push them. Power wheelchairs require more consideration for transportation needs because they are heavy and difficult to break down into smaller pieces for transport, but a power wheelchair can allow a person to have independent mobility in environments that are accessible. Scooters are a good option when the device is only needed to cover the distance to and from certain places rather than using it as a full-time de-vice. Some scooters can come apart into pieces for transport. However, scooters may not be appropriate if someone has very specific seating and postural needs. No matter what device is selected, proper fitting of the device and training in device-use must be part of the process.
Michael, diagnosed in 2004
Wheelchair seating clinics are often good places for a person to visit when pursuing an order for mobility equipment as these locations have knowl-edgeable therapists and demonstration equip-ment. Wheelchair seating clinics are a part of many rehabilitation hospital outpatient therapy depart-ments and may also be present at community based service organizations (such as the Enabling Mobility Center, St. Louis, MO, 314-298-4202). Some clinicians are certified as Assistive Technol-ogy Professionals (ATP) through the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). ATPs that are certified with RESNA have demonstrated a knowledge spe-cific to the provision of assistive technology and have passed testing to demonstrate their knowledge and are required to demonstrate continuing education hours for recertification. The RESNA website (www.resna.org) can be used to locate ATPs. Rehabilitation Technology suppliers also can be credentialed through RESNA and the National Registry of Rehabilitation Technology Suppliers (NRRTS).
Patient ExpectationsThe individual and family members may have different expectations than the health professional regarding what a mobility device will allow them to do. An interview should be conducted during the evaluation and assessment process to understand an individual’s expectations. Individuals may not think about accessibil-ity issues, such as home access (e.g., can the scooter fit through the doorway, is there a ramp), transportation access (e.g., how will the power wheelchair get transported for community outings), or the possibility that their disease may progress and the device they want may not be appropriate in the future.
Documentation & ReimbursementIf an individual with MS is acquiring a new mobility device and is seeking reimbursement from a third-party payer for the equipment, a physician prescription is required. Typically, the prescription can include a gener-al description of what is recommended (i.e. “new wheelchair”). Once a prescription is written, an evaluation of the person for the appropriate device is helpful and may be required, depending on the funding source. This evaluation process is most effective when a team is involved. The team may include the consumer, a family member, a rehabilitation technology supplier (sometimes referred to as a vendor or durable medical equipment dealer) and a healthcare professional (such as an occupational or physical therapist). The con-sumer and family member are responsible for providing information about what activities the device will be used for and where the device will be used. The rehabilitation technology supplier knows the features and characteristics of wheelchairs, scooters and cushions and is responsible for ordering the new device. The healthcare professional is responsible for taking measurements (e.g., seat width), assessing strengths, weak-nesses and postural needs and selecting the appropriate device.
Once a device is selected, a letter of medical necessity or justification needs to be written and submitted to the third-party payer. The letter is either written by the therapist, an experienced rehabilitation technology supplier or the physician. The letter explains the medical necessity for the recommended device and why certain features are important. The letter of medical necessity or justification represents why the person needs the device and is what the insurance company uses to decide if they will pay for the device. Therefore, the letter needs to clearly describe the person, the recommended device and the medical necessity of the device.
Chris, diagnosed in 1993
Reimbursement for mobility devices varies by insurance com-pany (i.e. Medicare, Medicaid or private insurance). Typically, insurance companies will pay for a new mobility device every five years, therefore the client and healthcare professional must plan ahead when ordering a mobility device. Some insurance companies will cap what they will pay for durable medical equipment which includes wheelchairs, while others will pay a certain percentage, and others will not cover du-rable medical equipment. Medicare will usually reimburse 80 percent of the cost of a mobility device as long as the medical necessity of the device is documented. Insurance companies will also provide reimbursement if there has been a signifi-cant medical status change such as weight gain or loss of 30 pounds or more or an additional diagnosis that impacts activi-ties of daily living and mobility.
Funding OptionsOccasionally funding for mobility devices may be denied or clients may not have funding. In these cases other resources such as local loan closets or reutilized equipment programs may be appropriate. Disability specific organizations often maintain a loan closet of wheelchairs and other medical equipment:
Local independent living centers - Paraquad, Inc., St. Louis, •Mo (314-289-4200) and Delta Center, St. Charles County (636-926-8761), have reutilized medical equipment pro-grams that provide used medical equipment that has been sanitized and refurbished for no cost or low cost. Center of Independent Living Center (ILC) in your commu-•nity, see website: http://www.ilru.org/ à Directory of ILC.Show Me Loans program through the Missouri Assistive •Technology Advisory Council (800-647-8557). Qualified candidates may borrow up to $10,000 for the purchase of assistive technology at low interest rates. National MS Society Website – www.nmss.org • g Living with MS g Mobility & Accessibility
In summary, finding an appropriate device can be a multi-step process and is most effective when a team approach is utilized and appropriate resources are utilized.
1. Russell, J.N., Hendershot, G.E., LaClere, F., Howie, J., & Adler, M. (1997). Trends and differential use of assistive technology devices: united states, 1994. Advance Data 292, 1-10.
2. Kaye, H., Kang, T., & LaPlante, M. (2000). Mobility device use in the United States. Disability Statistics Report, (14). Washing-ton D.C.: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.
National MS Society website:www.nmss.org. g Living with MS g Mobility & Accessibility g Affording Stairlifts, Ramps & Wheelchairs
ABLEDATA g www.abledata.com.Product listings, manufacturer informa-tion, consumer guides and fact sheets, and Equipment Resale Resource Center. ABLEDATA also posts a consumer guide to wheelchair selection.
www.wheelchair.net/. Fact sheets, product descriptions, and links to wheelchair sites.Spinal Network: The Total Wheelchair
Resource Book. Available through New Mobility (www.newmobility.com).
Upcoming Chapter Events and ProgramsBike MS: Express Scripts Gateway Getaway Ride 2009: Columbia, MO September 12-13For the past 25 years, Gateway Area cyclists have been strapping on their helmets and hopping on their bikes to move towards a world free of multiple sclerosis. As a result of their dedication, great strides have been made in the diagnosis and treatment of MS. This is why we ride and this is why we are celebrating our 25th anniversary of pedaling for a cure. Nearly 3,000 cyclists and 700 volunteers will converge on the Boone County Fairgrounds in Columbia, MO for Bike MS this year.
Midwest Teleconference Series, September 14, October 12, November 9, December 14 Every second Monday of the month MS specialists provide up-to-date information on a variety of topics during free, one-hour teleconferences. Upcoming topics include: Beyond the Basics - Alternative and Complementary Therapies for MS with speaker Rock Heyman, MD, University of Pittsburgh on September 14; Intimacy and MS - Answers to the Questions You Always Wanted to Know but Were too Afraid to Ask with speaker Heather Raznick, MSW, LCSW, Clinical Sex Therapist, Licensed Psychotherapist on October 12; Fitness MS - Eathing Healthy and Staying Fit Through the Holidays with speaker Tony Maslan, CSCS on November 9 and Oral Medication Update with speaker Dr. Robert Naismith, John L. Trotter MS Center on December 14. All teleconferences are from 7-8 p.m.
Walk MS, September 19, September 26, September 27 Join us at one of our fall community walks. Walk MS in Washington, MO is Saturday, September 19 at Lions Lake in Bernie E. Hillermann Park with registration at 10 a.m. and a start time of 11 a.m. The Bootheel Area Walk will be Saturday, September 26 at West City Park in Dexter, MO with registration at 4 p.m. and the walk starting at 5 p.m. Walk MS in Mt. Vernon, IL will have registration at 10:30 a.m. and a start time of 11 a.m. on Saturday September 26 in Veterans Memorial Park. The inaugural Walk MS in the historic district of Ste. Genevieve, MO will be Sunday, September 27 and will begin at Lions Club Park with registration at noon and a start time of 1 p.m.
John L. Trotter Research Program in St. Louis: September 24 Dr. Bruce Trapp, Chairman, Neurosciences, Cleveland Clinic will be the featured speaker at the Sheraton Westport Hotel - Lakeside Chalet,191 Westport Plaza, St. Louis, MO 63146. The learning objectives are to: discover how repair and regeneration of nerves hold promise for preventing permanent damage and restoration of function, learn how nervous system repair research has the potential to stop and possibly reverse disease progression resulting in improved quality of life for people with MS and to learn what researchers are discovering about the body’s natural repair process to restore myelin and preserving neurological functions - findings that can ultimately be applied to people with MS.
Family Weekend at Touch of Nature Carbondale, IL: October 16-18Family Weekend in Columbia, MO, is a great way for people with MS and their families to get away in the beautiful setting of Touch of Nature just outside of Carbondale, IL. Fully accessible activities include: hayrides, arts and crafts, horseback and pony rides, pontoon boat rides, nature hikes and much more.
The Heuga Center For MS JUMPSTART Program: St. Louis, MO November 7This is a free, one-day introduction to The Heuga Center’s wellness philosophy for people living with MS and their carepartners. Presentations and workshops include: Eat Well, Prepare Easily, Be Well, Utilizing Wii for your Exercising Pleasure and Support Partner Concerns Interactive Discussion. Register by contacting Ron Wheeler at 1-800-367-3101 ext. 1277 or [email protected].
Registration and more information:Call 1-800-344-4867 or 314-781-9020 or go to www.gatewaymssociety.org.
