Mobility is POWERful! An In-depth Overview of
Contents
1. able to drive straight for 200 feet without stopping avoid bumping into objects 90 of the time able to drive chair in all directions with no more than minimal verbal cues A device is recommended based on what is Known about the client s ability and what is known about his support network CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 98 Driver Education Recommended This client has at least one reliable access site He she is able to visually scan and attend to the environment while driving He she exhibits the motivation to move and explore the environment This client is able to follow basic 1 step commands i e on off or stop go This client also has a supportive team family caregivers teachers and therapists that willing to assist to with carryover of skills training CONFIDENTIAL AND PROPRIETARY Duplication or Distributior t Uplica Di n Prohibited STEPS ee 99 33 6 16 2014 e Training Exploration sessions are important Misguided recommendations often come from clients who did not complete proper training or did not have the opportunity to trial different equipment prior to ordering a system Devices that are too high level may not be supported at home at school and or abandoned all together STEPS Sessions are therapeutic and goal driven Throughout the process caregivers are given homework to do with the client at home to i2. Clinical Best Practices e Are there any related to seating and mobility e What would they be CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS 18 6 16 2014 Key Assessment Information Power Mobility CONFIDENTIAL AND PROPRIETARY Duplication or Distributior t ition Prohibited STEPS p Satthad Taio ry amp Gace Proprars 19 Prior to the evaluation Completion of an intake form by the client and or caregiver Information should include Funding Goals of the evaluation Brief case history Current level of function AT experience Contact other team members including assistive living outpatient and or school day treatment programs Arrange for loaner equipment i e power w c alternative controls etc as needed CONFIDENTIAL AND PROPRIETARY Duplication or Distributior tea 6 2014 20 During the evaluation Explain the purpose and process of the evaluation Review goals funding and case history Current medical status and level of function Evaluate status in current equipment as appropriate Screen cognitive visual and hearing status Complete a physical assessment and mat evaluation Environment assessment and transportation discussion Driving assessment CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited Uplica Prohibi STEPS oo Jasia Talery amp Sdacethes Propers 21 6 16 2014 Mat Evaluation CONFIDENTIAL AND PR
3. Meet current needs Have modularity to adapt to changing needs Equipment changes should be Economical and easy to do Cause least amount of disruption to client CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 35 Dynamic Seating e Who is appropriate for tilt recline seat elevator power elevating leg rests ELRS Consider the client s e Ability to change position shift weight e Postural stability e Physiological risks e Problems with homeostatic control e Mobility Related Activities of Daily Liy MRADLs needs e Environment demands CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS ve asia Tale ry amp Gdscethes Progrars 36 12 Clinical Justifications Tilt Provides for pressure redistribution Accommodates joint contracture s Maintains specific seated angles Adds no resulting shear forces Minimizes extensor spasticity STEPS Provides for position change Minimizes effects of gravity Provides increased trunk stability and head control Improves postural alignment Improves visual field fixed kyphosis Maintains access to specialty devices mounted on chair CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 37 Clinical Concerns Tilt Poor access to perineal area No change in hip or knee position Risk of contracture Discomfort with sensate clients CONFIDENTIAL AN
4. footplate touches the ground CONFIDENTIAL AND PROPRIETARY plication or Distribution Prohibited STEPS aaa 63 21 6 16 2014 Downhill Performance MWD e COG moves forward towards front casters e Reasonably good control COG position COG Q position 29 CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS Se Downhill Performance Potential Concern e Forward pitching on downhill slopes could be a problem e COG displacement Solution Front suspension acts as a dampener to reduce pitching CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 65 Clinical Benefits of Suspension e Reduces vibration and e Terrain Navigation jarring for School Pain reduction Work Postural control Community Spasticity reduction e Shopping Minimize sliding e Gravel T sitting tolerance e Sidewalks Weather elements CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS 7 66 22 Maneuverability vs Stability Problem with MWD historically Fixed front stabilizers can sacrifice obstacle climbing ability however Dynamic front stabilizers can affect stability and comfort of the ride Solution Base Suspension CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS 5 67 Stability e Stability is increased by Larger base of support Positioning the center of ma
5. CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS a 27 After the evaluation Review recommendations of equipment and or therapeutic as appropriate with the client and caregivers Pieces of the Power Puzzle Discuss the client s and or caregiver s responsibilities in the process and the next steps Ensure that the client and or caregiver are in agreement with the plan Review order and funding process including potential delivery timeframe for recommended equipment Provide contact information and an overview of the evaluation to the client and or caregiver 28 Sometimes shortcuts are taken with the evaluation Sometimes trial is not possible Sometimes we battle with the conflict between therapeutic perfection safety and function Sometimes we do not find out or understand their funding situation before the evaluation CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 29 Evaluation Seating amp Positioning Power base Electronics amp Programming Access gt Training 2 Uplica Di n Prohibited STEPS E Documentation amp Funding CONFIDENTIAL AND PROPRIETARY Duplication or Distributior t 30 6 16 2014 10 Seating and Positioning For each client consider e Size needed Potential for growth or weight change Potential for change in function Postural control and positioning needs Seat back
6. PROPRIETARY Duplication or Distribution Prohibited STEPS an 52 Both motors receive equal current Encoder sends more current to Encoder reads rev sec of each the right motor and the chair wheel and indicates that right runs straight again motor is turning more slowly Faster Same Speed CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 53 With amp Without Tracking FWD without FWD with tracking tracking technology technology Tracks straight while allowing users to I conquer slopes E l i thresholds obstacles AT ada BEEBE EBB BPP Bea 2an CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibit 6 2014 54 6 16 2014 18 oa gt 4 2 amp Oa Front casters affected by gravity directing front of chair down slope Rear casters Casters or affected by _ Stabilizers gravity directing Minimally affected l by gravity chair rear of chair traverses ina 6 16 2014 down slope straight line CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 STEPS 55 Grade Transition RWD Fixed anti tioper La can cause high centering QS the drive wheels Dynamic rear stabilizers allow drive wheel to stay on the ground CO emia ae Meme EA Ai steps 6 Grade Transition Fixed front stabilizers PoS can cause drive wheels to high center Dynamic front stabilizers allow drive wheels to stay on
7. speed torque Lower power overall chair power for safe use Programmable short cut buttons with decals Limit number of profiles CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibite Cognitive and Visual Impairments Pieces of the Power Puzzle Evaluation Simple joystick with intuitive torque Programmable short cut buttons with decals Lower speeds Decrease acceleration Increase deceleration Decrease overall chair power CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 86 Seating amp Positioning Power base e Electronics amp Programming gt Access gt Training 2 STEPS aii Documentation amp Funding CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibit 87 6 16 2014 29 Joystick Positioning amp Support Examples Standard Mount Midline Mount amp Tray STEPS Midline Mount Arm Trough Swing away mount CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 88 Alternative Joystick Handles STEPS Evaluation Kit Bodypoint Custom Handle handmade from splinting material CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 89 Specialty Controls Drive Station Switch lt Inc Mechanical Switches ASL Inc STEPS Head Array ASL Inc And MANY P l MORE Micro Pilot Switch lt Inc CONFIDENTIAL AND PROPRIETARY Duplication o
8. that can be implemented into the client s daily life therapy or school program Consider re evaluating the client in 6 months 1 year 6 2014 104 Not Appropriate for Power Mobility e The client states that he she refuses to utilize a power wheelchair e Other behaviors impede successful use of the device e Put him herself or others in danger CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibit steps ic 105 35 Seating e Drive wheel position Speed Obstacle climbing Battery range e Weightcapacity Seating options Captain Rehab Modular Need for power seating Now or in the future How many seat functions STEPS Electronics CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 5 Need for alternate controls Progressive condition What electronic customization is required Does PWC need to interface with other AT AAC Computer EADL s CONFIDENTIAL AND PROPRIETARY Duplication or Distributior tea 6 2014 107 CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 21 6 16 2014 36 Pieces of the Power Puzzle Evaluation Seating amp Positioning Power base Electronics amp Programming Access gt Training Documentation amp Funding STEPS e Whois the funding source e Whatis the client s medical history Diagnosis primary se
9. AND PROPRIETARY Duplication or Distribution Prohibited STEPS i 77 Programming Electronic Customization e Programming considerations Use existing templates Develop and save your own templates e Assign shortcuts Common functions are easier to achieve e Program buttons and ports e Customize display menu e Interfacing with Augmentative Alternative Communication Devices or computers via Bluetooth e EADL functions built into wheelchair Access to the environment included through Infrared IR for TV DVD Blue ray player stereo etc CONFIDENTIAL AND PROPRIETARY Duplication or Distribut Prohibited STEPS ai 5 2014 78 6 16 2014 26 Type of Drive Input Device e Proportional joystick Variable speed and 360 of directional control More fine tuned control for course correction Requires more user coordination motor control e Non proportional switched Pre programmed speed no directional control Less fine tuned control for course correction Requires less user coordination motor control CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS 79 Mode of Driving Momentary chair only drives when user is actively operating the input device Turning is less controlled and less efficient when using switched systems Latched once input device is activated chair drives without further activation until stop command Right and left ar
10. D PROPRIETARY Duplication or Distribution Prohibited 6 2014 38 Lateral Tilt STEPS Designed to complement traditional positioning solutions Provides pressure reduction aids in transfers and assists in respiration swallowing and gastric emptying CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibit 6 2014 39 6 16 2014 13 6 16 2014 Clinical Justification Recline e Provides change in position amp body angles Provide relief for sensate clients e Allow for personal care while in chair Bladder management dressing Avoid additional transfers e Allow supine transfers CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS a 40 Clinical Justification Recline e Shifts and expands weight bearing surfaces e Decreases peak pressures e Provides different body angles S CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 41 Clinical Concerns Recline e Shear Forces During Recline e Pivot point of equipment does not match client s pivot point at hip e Extensor Spasticity Low pivot point of recline CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited S T EPS a 6 2014 asia Tabirg amp Edatera Pre 42 14 6 16 2014 Clinical Justification Tilt amp Recline e Tilt and recline together Maximum amount of pressure re distribution Maximum relief from gravity s force
11. OPRIETARY Duplication or Distribution Prohibited STEPS sn asita Tal vey Edatea Prepara 22 Measurements CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS sa avrg S Edatea Prepress 23 Measurements tse ei Jy ae CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS ve Basia Tal oyars 24 vry Shaten P 6 16 2014 Prior to getting your client Behind the Wheel Observe the client s movement patterns while in his her seating system and on a mat flat surface If the client has other AT devices i e communication devices tablet computer switches etc ask the client to demonstrate how he she uses the item s Set up the seating system so that the client is in most functional position for his her movements Identify activities or items that are highly motivating to the client Ensure that the client is positioned for function as opposed to perfection CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 25 Does the client have a progressive condition What type of postural support seating Is dynamic seating medically necessary Where will the chair be utilized How might the client operate the chair What other devices will the client be controlling through their wheelchair CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 26 Evaluate for Potential Not a Device ee
12. STEPS gr Sunrise Training amp Education Programs Mobility is POWERful An In depth Overview of Power Mobility Presented by Steve Boucher OTR L ATP amp Angie Kiger M Ed CTRS ATP SMS Clinical Education Specialist Sunrise Medical LLC MANUAL POWER ADULT PEDIATRICS SEATING GERIATRICS CONTROLS FUNDING A Seminar Content Disclosure e The authors and presenters of the Sunrise Training amp Education Programs STEPS are full time employees of Sunrise Medical e We do not intend to endorse any particular model brand of product or manufacturer CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS e2014 Sasiia Talery amp Gdacethat Propers 2 Course Objectives Upon completion of this course participants will be able to Articulate the steps required to complete a thorough power mobility evaluation List at least 2 differences in the performance of a rear wheel drive front wheel drive and mid wheel drive power wheelchair on uphill downhill and even surfaces State the 3 clinical justifications for each dynamic power seating functions including tilt recline elevating leg rests and seat elevate Define the difference between expandable and non expandable electronics Understand the critical components required in a clinical justification letter or evaluation when requesting funding for a power chair CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS
13. a Jatta Vasery Gjaco Propers 3 6 16 2014 6 16 2014 Housekeeping RESTROOMS es J Se WS G a G a MEN WOMEN Restrooms Breaks AUTHORIZED at A a A ur yJ PROV ED E R Handouts CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS ot 4 CEU Requirements IACET CEU CREDIT Must be paid in full Must sign in at the registration table Must provide last 4 of your SSN If you didn t provide it when you pre registered there will not be a certificate onsite You can still provide the last 4 of your SSN now on your evaluation certificate will be provided within 45 days Must complete the evaluation form and turn it in at the close of the seminar It is a requirement that to receive CEU credit you must attend the full course CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited steps s 5 30 mins Introduction to Power Mobility 45 mins Evaluation Process 45 mins Seating amp Positioning for Power Mobility 15 mins Break 45 mins Power Mobility Base Options 30 mins Hands on Activity 60 mins Lunch 75 mins Electronics amp Access 45 min Hands on Activity 15 mins Break 30 mins Training 30 mins Documentation and Funding 30 mins Group Activity 15 mins Questions amp Wrap up CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS ri attra anergy Sdscete Propers 6 6 16 2014 Words of Wisd
14. angle and contour Pelvic trunk or head positioning supports Skin protection material Need for dynamic positioning CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 STEPS Seating and Positioning Captain s Seat Dynamic Seating Modular and Rehab Seat CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 32 Appropriate client e Fits in standard seat sizes e Maintains optimal posture with Standard back height vi No positioning supports Minimal contour Minimal seat to back angle adjustment Does not require dynamic seating Needs comfortable seating Ability to independently complete weight shifts Prohibited 6 2014 33 CONFIDENTIAL AND PROPRIETARY Duplication or Distributio steps 6 16 2014 11 6 16 2014 Rehab Seat Appropriate client e Requires specific seat back size e Might require seat depth growth e To maintain posture requires Specific back height Positioning supports Specific seat or back contour Specific seat to back angle e Might require some dynamic seating CONFIDENTIAL AND PROPRIETARY plication or Distributio Duplica Di n Prohibited STEPS i astra amiy Shachi Propers 34 Modular and Adjustable Seating Clients can change in size function cognition and environment Changes due to progressive condition recovery aging and or medical intervention Appropriate system should
15. condary etc Surgeries previous and upcoming Medications past present future e What equipment has the patient had Not just wheelchairs When was it received why does it no longer meet their needs medical primary Who funded the equipment CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited State Medicaid Programs Private Insurance Medicare Worker s Compensation Veterans Affairs How does secondary insurance work Willit matter to you Others CONFIDENTIAL AND PROPRIETARY Duplication or Distributior t Uplica Di n Prohibited STEPS een 111 6 16 2014 37 Simplify Your time is limited As you go through your evaluation keep in mind that at the same time you are also creating your documentation Think about climbing a ladder to justify the equipment selected Tie your thought process and selections to what will be down on paper CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibite Preparation e Think about Who will review the letter or request for funding What is this person s medical background Do they have an understanding of the Durable Medical Equipment DME world that we live in every day Remember The reviewer only knows your patient by what is on paper It is your job to tell the detailed story e Make a game plan to keep it simple CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Proh
16. e still momentary Allows course corrections Allows control of the arc of turn CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS i 80 Electronics Programming High Spasticity Considerations e Decrease acceleration Increase deceleration Decrease sensitivity Smoothes out commands Expand neutral zone Accommodate excess movements Turn joystick into switch joystick CONFIDENTIAL AND PROPRIETARY plication or Distribut Prohibited Du atior ion Prohib steps 6 2014 81 6 16 2014 2 6 16 2014 Electronics Programming Athetoid Considerations Provide stability Decrease acceleration Increase deceleration Expand neutral zone Accommodate excess movements Turn joystick into switch joystick Decrease sensitivity Specific Directional Weakness and or General Weakness Active orientation Reduce joystick throw Increase sensitivity Increase acceleration Program for Auto Mode Jacks for mode buttons CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 83 Geriatrics Slower speeds Decrease acceleration Decrease overall chair power Decrease sensitivity Reduce joystick throw Reduce torque depending on environment CONFIDENTIAL AND PROPRIETARY plication or Distribution Prohibited STEPS Sa 84 28 Electronics Programming Pediatrics Decrease sensitivity Decrease high speed torque Increase low
17. ibited e Gather your evidence Write a detailed initial evaluation Create data logs to track distance success and level of independence Take pictures and or videos of the initiation evaluation and the graduation day from Driver s Education class Write an addendum to the original report Write a letter of medical necessity LMN and include reasons why the device is medically necessary be sure to get the client s physician to sign the letter CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited S T E pod S T 6 2014 114 6 16 2014 38 6 16 2014 Suppliers The 7 Elements The order for mobility equipment must contain all of the following 7 Elements 1 Beneficiary Name 2 Description of the item ordered can be specific with mfr name or general power wheelchair 3 Date of face to face evaluation with MD 4 Pertinent diagnosis conditions relating to the need for the equipment ordered 5 Length of need Lo 6 Physician printed name and signature J K 7 Date of physician signature STEPS Documentation e Is your evaluation completed electronically or hand written e Letter of medical necessity e Template or not e Important documentation reminders Your clients are individuals Proof read Contradictions CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 116 Final Questions to Ask Yourselves Does the client a
18. lities Need to show proficiency in all driving skills right away Be completely unable to ambulate or propel manually Need to be a certain age CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS pa atika Talerg amp Gjaceiai Propers 11 Power To whom amp where WHOM WHERE e Individuals with diagnoses that may Work include School Spinal Cord Injury SCI Community mobility Cerebral Palsy CP Vecatianal use Muscular Dystrophy MD Traumatic Brain Injury TBI Multiple Sclerosis MS Amyotrophic Lateral Sclerosis ALS Clients of all ages pediatrics to geriatrics Long term manual wheelchair users STEPS Pediatrics and Power Children develop thru exploration stimulation Children without physical impairments begin mobility at 12 mo Give children with disabilities the same opportunities Introduction to power mobility as young as 12 18 months Time and practice to learn and make mistakes Appropriate supervision Marginal ambulation or manual propulsion Risk of stress damage to muscles joints Requires energy and endurance Reduces energy available for other activities CONFIDENTIAL AND PROPRIETARY Duplication or Distributio Di n Prohibited STEPS F Satthad Talery amp Gdscethe Proprars 13 Geriatrics and Power Is anyone ever too old to utilize power Maintain independent mobility Maximize function Provide energ
19. ls function determine parts Prescribe for today with tomorrow in mind User friendly Keep It Simple Ensure correct use Maximize chance of funding Adjustability Programmability CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS os Jasia Wakery Gjat ehai Propers 73 e Non Expandable e Expandable CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 74 Non Expandable Expandable Joystick only e Specialty Controls lt 2 actuators Multiple Drive Input Devices Simple to use Multi actuator Systems Basic programming options Multiple Drive Profiles Useful for client with non EADL Interfacing progressive condition Enhanced programming options CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited S T E ct S 6 2014 Jasia Walery amp Gjate Proprans 75 25 Electronics Programming e One of the most important things you can do for any power chair user e Inappropriate programming can cause Inability to control the chair Unsafe operation of the chair Inability to learn to drive Lack of confidence in the equipment Refusal to use the equipment Inefficient driving Inability to access all environments CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS ese 76 Programming Speeds Tremor dampening Acceleration vs Deceleration Torque Sensitivity Dead band Throw Active Orientation CONFIDENTIAL
20. ncrease success Suggestions to school teams and outpatient therapists are also made Members of the patient s therapy team are invited to come and observe CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 101 Get the entire team involved Scavenger hunts Create real life scenarios Red Light Green Light Play hide and seek Use familiar images attached to the switches when teaching directions Drive in a variety of settings on various types of terrain Create game tapes video sessions to review with the clients and caregivers CONFIDENTIAL AND PROPRIETARY plication or Distribution Prohibited STEPS ae 102 34 6 16 2014 Not right now The client doesn t exhibit comprehension of cause effect He she does not have a reliable access site This client may have positioning issues preventing successful access at the time of the evaluation Further medical evaluations or interventions may be necessary i e Suspected visual impairment Other behaviors impede successful use of the device i e self stimulatory or violent behaviors CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibite Medical consultations Seating and positioning Computer software programs to practice cause effect and switch skills Activities that can be done at home to encourage learning of skills needed for driving Offer to contact the client s team to brainstorm skills
21. nd or caregiver have a clear understanding of the plan Have specified that the recommended equipment is in fact the minimal equipment essential to this client Have demonstrated how ruled out lesser level equipment Is the equipment that am recommending in fact the least costly alternative Do have all of the information needed for funding Has my documentation left the reader with a clear picture of the consequences to the client in the absence of having the recommended equipment CONFIDENTIAL AND PROPRIETARY plication or Distribution Pro t steps aii 117 39 Course Objectives Upon completion of this course participants will be able to Articulate the steps required to complete a thorough power mobility evaluation List at least 2 differences in the performance of a rear wheel drive front wheel drive and mid wheel drive power wheelchair on uphill downhill and even surfaces State the 3 clinical justifications for each dynamic power seating functions including tilt recline elevating leg rests and seat elevate Define the difference between expandable and non expandable electronics Understand the critical components required in a clinical justification letter or evaluation when requesting funding for a power chair CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS sn Sasiia Talery amp Gdscethas Proprats 118 CONFIDENTIAL AND PROPRIETARY Duplication or Distribu
22. om e Continuous effort not strength or intelligence is the key to unlocking your potential Winston Churchill e Being able to drive a power chair has opened up a world for our son that experts always told us we could only dream of We will NEVER get tired of chasing him Parent T CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited Di n Prohi STEPS Jasia Wale ry Gdscetiat Preprensa 7 Pieces of the Power Puzzle Seating Power Base Funding Access Dynamic positioning Electronics amp Programming CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited Evaluation 6 2014 8 Who is appropriate for power Pediatrics Geriatrics Long Term Manual Chair Propellers Uplica Di n Prohibited STEPS Basita Talery amp Sdacetha Propers 9 6 16 2014 Understanding power mobility myths Providing power mobility will Cause a decrease in independence or function Will encourage a person to become lazy Prevent a client from ever walking or propelling manually Eliminate the use of the end user s manual wheelchair which is how they currently exercise CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS er Sasiia Talery amp Gdscethas Proprats 10 Is client appropriate for power To be appropriate for power client does not Need to show a certain set of motor skills Need a certain set of cognitive abi
23. p Positioning Power base Electronics amp Programming Access Training Documentation amp Funding CONFIDENTIAL AND PROPRIETARY Duplication or Distributior tea 6 2014 95 Be an investigator REMEMBER You are evaluating for potential not a device Discuss potential barriers to successful implementation with the family i e accessibility of home and or transportation Check with the school team and family to find out their familiarity and level of comfort with power mobility Interview the parents about their TRUE feelings about the device and if they ll use it with the client Will they be willing to come for sessions to learn to use the device CONFIDENTIAL AND PROPRIETARY Duplication or Distributior t plication is n Prohibited STEPS ms Jasia Takery amp Giscethe Proprars 96 32 6 16 2014 Which path to take Order a wheelchair immediately Driver s Education Program aka power mobility training Recommend skills to practice at home and or school to further develop the foundation needed for driving a power mobility system Not appropriate for power mobility CONFIDENTIAL AND PROPRIETARY plication or Distribution Prohibit Duplica Prohibited STEPS ae 97 Ready to roll This client will demonstrate clear comprehension of the task and cause effect relationships He she is able to able to stop and go on command within 2 seconds of verbal cue 90 of the time
24. r Distribution Prohibited 6 2014 90 6 16 2014 30 Additional Considerations e Environment Home Work School Work stations desks Maneuverability in spaces Entry and exit of settings Community Terrain City vs Rural CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibit 6 2014 91 e Lifestyle Leisure activities Support network Travel e Transportation Drive automobile independently from power wheelchair Personal family vehicle Facility commercial vehicle Public transportation CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibitea 6 2014 92 Need for additional medical equipment i e ventilator feeding pump IV pump etc Weight capacity need for heavy duty or bariatric options Growth capabilities Desire need for high speed motors Attendant control and push options Transfer status Seat to floor height User preference CONFIDENTIAL AND PROPRIETARY Duplication or Distributior t Uplica Di n Prohibited STEPS ae 93 6 16 2014 31 6 16 2014 Unable to use a power wheelchair POWER ASSIST SYSTEMS Individuals with limited upper extremity strength Individuals with compromised respiratory systems Individuals not ready for a power mobility device Environment reasons Psychological reasons CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 2 STEPS Pieces of the Power Puzzle Evaluation Seating am
25. ronics amp Programming Access Training Documentation amp Funding CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 47 Drive Wheel Base Options Front Wheel Drive FWD Rear Wheel Drive RWD Mid Wheel Drive MWD CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS eao Jasia Talery amp Ejacetiai Propers 48 16 6 16 2014 How Does Turning Radius Differ Printed with permission from lan Denison G F Strong Rehab Centre CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS 49 Direction of travel Printed with permission from lan Denison G F Strong Rehab Centre STEPS Obstacle Climbing Is the axle of the front wheel caster higher than the obstacle o amp FWD might have greater ability to climb obstacles compared to RWD or MWD RWD and MWD used raised and or dynamic stabilizers for assist CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 5 2014 STEPS 51 17 Tracking e RWD Mass over drive wheels increases with acceleration Directional stability increases exponentially as speed of chair increases e MWD Can be directionally stable or unstable based on actual drive wheel position e FWD Mass over drive wheels decreases with acceleration Directional stability decreases exponentially as speed increases Fish Tailing CONFIDENTIAL AND
26. s Improve head control and postural stability CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS er Jasia Talery amp Gdscethe Proprars 43 Justification Power Center Mount ELR s Elevates LE to Accommodate knee extension contractures Accommodate orthotics prosthetics casts Prevent formation of edema Provide position change support with power recline CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 44 Justification Seat Elevator e Client needs varying seat height to Reduce shoulder pain with transfers May help delay secondary complications to the shoulders Degree of the upper arm elevation during reaching influences the load on the shoulder When reaching from a elevated position the load is reduced Interact at peer level Access environment Perform ADL IADL Perform vocational or school activities CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited S E a S T 6 2014 Jasia Tairg Edatea Progrars 45 15 6 16 2014 Additional Power Seating Power Sliding Seat Pan Allows for up to 6 of forward and rearward travel Assists with transfers Assists with COG placement CONFIDENTIAL AND PROPRIETARY Duplication or Distributio Ip is n Prohibited STEPS p Satthad Taio ry amp Ejacoai Proprars 46 Pieces of the Power Puzzle Evaluation Seating amp Positioning Power base Elect
27. ss within the base between drive wheels and casters Using stabilizers or anti tippers e Stability might also be challenged by external forces Gravity acceleration deceleration etc CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 68 Stability MWD need stabilizer wheels since mass is over drive wheels RWD and FWD stable since mass Is between drive wheels and casters oBe Stability is also affected by the position of the client s COG CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited STEPS l 69 6 16 2014 23 Clinical Justification e Match client s needs to necessary PWC package Explain need for base e Match current coding requirements Identify how client s diagnosis and function support choice Discuss negative affects to client if chosen base is not approved CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibite STEPS gt Pieces of the Power Puzzle Evaluation Seating amp Positioning Power base Electronics amp Programming Access gt Training Documentation amp Funding CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 71 Things to consider Input device Location Programming Electronics package CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibit steps oa 72 6 16 2014 24 6 16 2014 Flexibility Clients needs goa
28. the ground CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 STEPS 57 19 Grade Transition FWD No front or rear anti tipper or stabilizers might more easily transition onto an incline cs amp CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibite STEPS F Uphill Performance RWD e COG moves back towards drive wheels e Improves traction very good control e Anti tippers required to prevent chair from flipping over COG position COG position CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 59 Uphill Performance FWD e COG moves towards casters e Loses traction on drive wheels e Poorer chair control COG position COG position CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited steps i 6 16 2014 20 6 16 2014 Uphill Performance MWD e COG moves towards casters e Loses some traction on drive wheels e Reasonably good control COG position COG position STEPS e COG moves forward towards casters e Reduces traction on drive wheels e Decreased directional and brake control COG position COG position CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 62 Downhill Performance FWD e COG moves forwards towards drive wheels e Increases traction on drive wheels e Good control COG COG Risk of lifting rear casters till front anti tips or
29. tion Prohibited 6 2014 119 Sunrise Training amp Education Programs Thank You For Attending Embrace every challenge Determination and perseverance will significantly impact someone s life Steve Boucher steve boucher sunmed com Always remember that at the end of the day your clientis your number one priority Angie Kiger Clinical Education Specialist angie kiger sunmed com MANUAL POWER ADULT PEDIATRICS SEATING GERIATRICS CONTROLS FUNDING 6 16 2014 40
30. y conservation Protect conserve upper extremity UE function and health Increase socialization Increase self esteem and motivation Improve quality of life CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 14 Long Term Manual Chair Users e Manual wheelchair propulsion involves UE muscles propelling weight of chair and user UE muscles joints used in abnormal positions UE muscles are over stretched and overused e With pre existing injury Muscle imbalance already exists due to weakness or paralysis of specific muscles e Atsome point power becomes a safer more functional option as t CONFIDENTIAL AND PROPRIETARY Duplication or Distributio plication n Prohibited STEPS san Jasia Talery amp Sdacetas Propers 15 6 16 2014 6 16 2014 Bariatric Considerations Dimensions Weight Altered body proportions Increased tissue in the buttocks and lower back Increased thigh and abdominal tissue Distribution of weight Increased risk of RSI and physiological stresses e g cardiac due to weight and ergonomics CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibite STEPS Zz 16 Pieces of the Power Puzzle Evaluation Seating amp Positioning Power base Electronics amp Programming Access gt Training Documentation amp Funding CONFIDENTIAL AND PROPRIETARY Duplication or Distribution Prohibited 6 2014 17
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