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MS Clinical Messenger Volume 11, Issue 3

FALL 2009

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

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 livCommittee Chair ing, and providing more choices of activities and greater satisfaction in Barbara Green, M.D. participating in activities. Although mobility devices can have a positive St. John’s Mercy Medical Center impact, the devices can be difficult to acquire due to problems associated West County MS Center with obtaining the appropriate and optimal fit of reliable, affordable and durable mobility devices. The system for obtaining a mobility device has Committee Members many steps and can be difficult to navigate. Below are steps and resourcElissa Held Bradford, PT es for acquiring a mobility device. St. John’s Sports & Therapy

Gateway Area Chapter Clinical Advisory Committee

Evaluation – Wheelchair vs. Scooter During the evaluation a decision needs to be made on what type of mobility device is appropriate (e.g., manual wheelchair, power wheelchair, and scooter). Each type of device has positives and negatives and the Gerard Erker, PhD challenge is selecting the device that may be the most effective in the SSM Rehab activities and environments the person is going to experience daily. For St. Mary’s Health Center instance, manual wheelchairs are the lightest weight and therefore most likely the easiest to transport. However, the person that will be using the Penny James OTR/L, MS wheelchair needs to have enough strength and endurance to propel the Veteran’s Administration manual wheelchair or have assistance to push them. Power wheelchairs Medical Center require more consideration for transportation needs because they are heavy and difficult to break down into smaller pieces for transport, but Michelle Keating RN, OCN MSCN a power wheelchair can allow a person to have independent mobility in St. John’s Mercy Mecical Center environments that are accessible. Scooters are a good option when the device is only needed to cover the Robert Naismith, M.D distance to and from certain places Barnes-Jewish Hospital rather than using it as a full-time deJohn L. Trotter MS Center vice. Some scooters can come apart into pieces for transport. However, Barry Singer, M.D. scooters may not be appropriate if Missouri Baptist Medical Center someone has very specific seating and postural needs. No matter what Florian Thomas, M.D. device is selected, proper fitting of Saint Louis University the device and training in device-use Beverly, diagnosed in 2001 Health Sciences Center must be part of the process. Mary DuParri, M.A., LPC Private Practice


Wheelchair seating clinics are often good places for a person to visit when pursuing an order for mobility equipment as these locations have knowledgeable therapists and demonstration equipment. Wheelchair seating clinics are a part of many rehabilitation hospital outpatient therapy departments 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 Technology Professionals (ATP) through the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). ATPs that are certified Michael, diagnosed in 2004 with RESNA have demonstrated a knowledge specific 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 Expectations The 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 accessibility 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 & Reimbursement If 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 general 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 consumer 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, weaknesses 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.


Reimbursement for mobility devices varies by insurance company (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 durable 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 significant medical status change such as weight gain or loss of 30 pounds or more or an additional diagnosis that impacts activities of daily living and mobility. Funding Options Occasionally 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 programs 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 community, 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). Washington D.C.: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.

Chris, diagnosed in 1993

Resources

Professional Resource Center: www.nationalmssociety.org/for-professionals 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 information, 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).

MS Clinical Messenger © 2009 Mission Statement: We mobilize people and resources to drive research for a cure and to address the challenges of everyone affected by MS. A newsletter published by the National MS Society. 1867 Lackland Hill Parkway St. Louis, MO 63146 (314) 781-9020 or 1-800-344-4867 info@gatewaymssociety.org President: Phyllis Robsham Editor: Elissa Held-Bradford, MPT


Upcoming Chapter Events and Programs Bike MS: Express Scripts Gateway Getaway Ride 2009: Columbia, MO September 12-13

For 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 16-18

Family 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 7

This 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 rwheeler@heuga.org.

Registration and more information:

Call 1-800-344-4867 or 314-781-9020 or go to www.gatewaymssociety.org.


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