Mobility Management – DECEMBER 2024

With more designs available, seating teams can better choose the best option for every client

Industry leaders recap 2024, look forward to year to come

December 2024 mobilitymgmt.com

editor’s note

Let’s Take This Outside

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W

ith power seat elevation now Medicare funded (albeit at a stingy rate) and power standing next in line (albeit in what feels like the slowestmoving line ever), what will seating’s next area of advocacy be?

For our power-assist story (page 8), I talked with industry veteran Matt Fitman, president of Rehasense USA. Matt described how power-assist technology of all types can open up the world for manual wheelchair riders. He spoke of how people with disabilities should be able to choose the optimal tools for whatever they do in life — for all their activities, adventures and experiences.

As we spoke, of course Medicare’s longstanding policy of only paying for equipment that’s medically necessary in the beneficiary’s home — the infamous “in-the-home” rule — came up.

When I started covering the Complex Rehab Technology and mobility industries in 2002, I was told by policy experts that the in-the-home rule was likely a misinterpretation. That the original intention was to distinguish between durable medical equipment used in patients’ homes and medical equipment to be used in acute-care hospital settings.

The in-the-home descriptive was never meant to be a means for denying Medicare coverage, I was told.

“Does Medicare, in comparison, pay for medications that are only necessary in the home?” Matt asked. “With pharmaceuticals, is it ‘We’re going to pay for it if it’s only effective in your home?’ Then why does it apply to our segment? It’s absurd if you try to apply it to any other part of health care, right?”

Right. Medications, surgeries, physical therapy, pacemakers, etc., are presumably meant to help us regardless of where we are. Do we talk about in-the-home cholesterol medications? Or do we really expect knee replacements to stay strictly inside the homes of their patients?

This archaic, illogical, possibly misinterpreted policy is the next one that needs to go. It does not lead to better outcomes; it is not functionally superior. And it is not equivalent to how Medicare funds its other pharmaceuticals, surgeries, treatments and interventions. Home medical equipment’s in-the-home limitation is arbitrary and unreasonably restrictive; too often, it stands between patients and the technology that could support their best, most active, most independent lives.

I hope 2025 is the year that we leave in-the-home behind. (And the year we see power standing get the national coverage analysis so long overdue.) m

Late December 2024

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Yamaha Motor Corp. will launch a new power unit to fit manual wheelchairs starting in January 2025.

In an Oct. 31 news announcement, Yamaha said the JWG-1 will be “the first full model change of a wheelchair electric power unit in 10 years, since the JWX-1 PLUS+ and the Joy Unit X PLUS+ in 2015.”

The new JWG-1, which can be retrofitted to manual wheelchairs, has an in-hub design. Paired with the joystick controller unit, the JWG-1 turns a manual wheelchair into a power chair.

Yamaha said the new power unit provides improved visibility on

the controller’s LCD screen; has an additional LCD screen on the assistant controller, plus a lever throttle; and has improved tire axle torque performance.

The JWG-1 has a higher weight capacity of 352.74 lbs. (160 kg) including rider and frame weight vs. the previous unit’s capacity of 275 lbs. (125 kg). Battery weight has been reduced to 5.3 lbs. (2.4 kg) from the previous unit’s battery weight of 7.5 lbs. (3.4 kg).

The new power unit will launch in Japan in January 2025. Yamaha said it expects to launch the power unit in Europe in April 2025, and in the United States in September 2025.

“Going forwards, [Yamaha] will focus on the development and manufacturing of units and system components as a manufacturer specializing in electric power units,” the announcement said. “As a result, the company will discontinue selling completed models as of March 2025. Yamaha Motor will also strengthen collaboration with wheelchair manufacturers and other partners to supply electric power units and create new business areas.”

In addition to manufacturing power units, Yamaha also manufactures power-assist devices, also with an in-hub design. m

Sunrise Medical Launches QS5 X Folding Ultralight Chair Sunrise Medical has launched the QUICKIE QS5 X, an ultralightweight folding wheelchair available with multiple frame angles and two frame versions — swing-away or fixed-front.

In a Nov. 12 news announcement, Sunrise said the QS5 X “sets the new standard for ease and efficiency. With the innovative FreeFold design, enjoy over 40% energy savings with every fold.”

The no-charge option Fold-n-Lock “conveniently keeps the chair securely folded with a simple click,” the announcement added. “There is no need to hold it closed while lifting or storing. The folded chair stands solidly on the ground while folded — a real benefit for transporting.”

The QS5 X weighs 16 lbs. (fixed-front frame) or 16.5 lbs. (swing-away frame). “It is the lightest aluminum box frame wheelchair on the market, making it easiest to lift, handle and transport,” the announcement said. “The combination of various proprietary manufacturing processes and technologies signature to Sunrise Medical — such as specially heat-treated 7000-series aluminum, ovalized tubes, and forged parts, to name a few — all result in creating unmatched strength, rigidity and extra responsiveness for the QS5 X frames. This allows for a more efficient energy transfer

from the rider to the wheels, enabling longer rides with less fatigue.”

Other features include touch points on the caster link for gripping the chair during transport; patented caster links to ensure straight tracking; and LED lights integrated into the design.

Sunrise Medical’s 3D Visualizer allows clinicians to configure the QS5 X virtually, a process that “helps everyone on the team get a better understanding of exactly what a specific feature or option looks like. Not to mention ensuring the rider knows how the chair will look aesthetically.”

“Transportation is crucial for wheelchair riders,” said Bernd Krebs, Sunrise’s chief technology officer. “Being able to easily load and unload their wheelchairs means maintaining or regaining independence, and we strive to protect their shoulders.

This is why we are constantly pushing the limits of technology to reduce product weight wherever possible while increasing the rider’s energy efficiency. This allows the QS5 X to fold, unfold, and roll smoothly with the least energy required from the riders. We have applied the latest material science with the highly innovative FreeFold cross brace design to QS5 X, which makes it a game changer for anyone who values independence, performance, and ease of use.” m MOBILITY MANAGEMENT | mobilitymgmt.com

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JWG-1 IMAGE COURTESY YAMAHA MOTOR COMPANY

Yamaha to Launch JWG-1 Power Unit in 2025

The U.S. Department of Transportation (DOT) has fined American Airlines $50 million for mistreating passengers using wheelchairs, and for mishandling those passengers’ wheelchairs and other mobility equipment.

The DOT made the announcement in late October and noted that the fine “is 25 times larger than any previous DOT penalty against an airline for violating disability regulations.”

The DOT added that American Airlines committed “numerous serious violations of the laws protecting airline passengers with disabilities between 2019 and 2023. DOT’s investigation into American Airlines uncovered cases of unsafe physical assistance that at times resulted in injuries and undignified treatment of wheelchair users, in addition to repeated failures to provide prompt wheelchair assistance. American also mishandled thousands of wheelchairs by damaging them or delaying their return, leaving travelers without the device they need for mobility.”

A large penalty that sends a message

DOT Secretary Pete Buttigieg said the hefty fine was intended to substantially change how airlines treat passengers who use wheelchairs — and alluded to lesser past penalties that seemingly failed to impact airlines’ behavior.

“The era of tolerating poor treatment of airline passengers with disabilities is over,” Buttigieg said in the announcement. “With this penalty, we are setting a new standard of accountability for airlines that violate the civil rights of passengers with disabilities. By setting penalties at levels beyond a mere cost of doing business for airlines, we’re aiming to change how the industry behaves and prevent these kinds of abuses from happening in the first place.”

The DOT requires airlines to return wheelchairs and mobility devices to passengers in a timely manner; to return equipment in the same condition in which the equipment was received by the airlines; and to provide prompt assistance with boarding the aircraft, exiting the aircraft, and moving through the airport.

“The Department also considers violations of these regulations for those traveling on domestic flights to be a failure to provide safe and adequate service,” the announcement said.

The DOT said it reviewed multiple complaints filed by Paralyzed Veterans of America, and examined a viral social media video of American Airlines employees mishandling a wheelchair at Miami International Airport in 2023.

In the video, a baggage handler at the top of an airplane jet bridge drops what appears to be an ultralightweight wheelchair down a steep baggage ramp.

The wheelchair hurtles down the ramp, hits the end of the ramp at a high rate of speed, and tumbles onto the tarmac and out of camera range. Then a second baggage handler finally goes to retrieve the chair.

Responding to the video posted on X, formerly Twitter, in November 2023, Buttigieg said, “This is totally unacceptable.

We’ll be investigating.”

American Airlines fined, must invest in future improvements

While the announcement noted that American Airlines was not the only company to mishandle wheelchairs, “American had been one of the worst performers among U.S. airlines in terms of both the total number of wheelchairs and scooters mishandling claims and the rate of mishandling claims, and DOT’s investigation revealed a significant number of violations,” the announcement said.

“These problems are not unique to American Airlines, and allegations of wheelchair mishandling and inadequate wheelchair assistance are far too common. DOT has active investigations into similar violations at other U.S. airlines.”

American Airlines will pay a $25 million fine to the U.S. Treasury.

The rest of the fine is to be spent on “investments in equipment to reduce incidents of wheelchair damage, investments in a systemwide wheelchair tagging system to reduce incidents of wheelchair delay, deployment of hub control center employees to coordinate wheelchair handling on a systemwide basis at large airports, and compensation for affected passengers during the timeframe covered

by DOT’s investigation. If these expenditures are not made, the additional $25 million will be paid as a fine to the U.S. Treasury.” m

Scan this QR code to read Commentary: 3 Takeaways from the DOT’s $50 Million American Airlines Fine, by Editor in Chief Laurie Watanabe, on mobilitymgmt.com.

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DOT Fines American Airlines $50 Million for Mistreating Wheelchair Riders, Mobility Devices

ATP Series

With more designs available, seating teams can better choose the best option for every client

O

nce upon a time, power assist for manual wheelchairs was dominated by hub-mounted designs incorporated into the wheelchair’s rear wheels.

But over the years, those venerable in-hub systems were joined by power-assist systems that mount to the front or the back of folding or rigid wheelchairs to provide more choices for wheelchair riders and seating teams.

Power assist has grown vigorously, not just in brand names and manufacturer numbers, but in how engineers have envisioned the ideal power-assist system.

Power assist’s many mounting choices

Angela Regier, OT, OTR/L, ATP/SMS, is the senior portfolio marketing manager at Permobil.

“Hub mount, which was the OG and what was available for so long exclusively, was great for those individuals who didn’t have full upper-extremity strength, but they could maybe still do pressure

relief on their own,” Regier noted. “They didn’t want to be in a power chair, but they needed something more than just a standard set of wheels. The hub mount was it, and it was great for that scenario.”

Some downsides to those earlier in-hub models — their weight, for example, which made it difficult for riders to independently load and unload their chairs, as well as the width they added to the chair — have been addressed by today’s renditions.

“I remember some restrictions on the amount of camber you could have, which could obviously impact your propulsion with or without your power-assist device,” Regier added. “Those were considerations that were addressed with the rear-mount device.”

Today, some of the best-known power assists — Permobil’s SmartDrive brand, and Sunrise Medical’s newly launched Empulse M90, as two examples — attach to the back of the wheelchair and are designed to easily detach as well. And front-mounted power assist, which lengthens the wheelchair’s footprint while providing greater pulling-from-the-front strength, is also a growing niche.

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ATP Series | Power Assist’s Exhilarating Evolution Jessica Pedersen, OTD, MBA, OTR/L, ATP/SMS, director of clinical education, and Erica Walling, MPT, ATP/SMS, clinical education manager, both of Sunrise Medical USA, said the larger pool of power-assist choices is definitely welcome.

“It is helpful to have options to meet the various needs of individual riders,” they said. “Different diagnoses and varying levels of upper-extremity function may require different types of power assist. For example, someone with limited upper-extremity strength and impaired hand function may have difficulty gripping the handrims to veer, steer and brake the wheelchair when using a rear-mounted device such as the Empulse R90 or SmartDrive. Instead, the rider with reduced upper-extremity function may have more success with an in-hub power-assist wheel like the QUICKIE Xtenders, Empulse M90 (launched in Australia, launching in the U.S. in 2025), or Alber e-motion, which requires less force to activate and will magnify the rider’s effort to produce the desired power to propel.”

In-hub models have evolved, too.

“Hub-powered assistive devices require less force, and newer models have much lighter wheels, which is more conducive to transporting them when they are taken off to be placed in a car,” Pedersen and Walling said. “The option of adding a joystick is a game changer, as it allows a rider with weak upper extremities to stay in a manual wheelchair. This may be the mode of choice for individuals, young and old, to learn to use a joystick and have self-initiated movement without moving to a power wheelchair.”

Rear-mounted systems, they added, “are great options to help riders traverse long distances and reduce the risk of repetitive strain injuries by maintaining a desired speed without the need for additional pushes. These devices act as a cruise control and significantly reduce the energy required to propel a manual wheelchair.”

While rear-mount and in-hub power-assist systems are relatively inconspicuous, frontmount systems are harder to overlook.

“A front-mounted pull device, such as the Empulse F35 (launched in Europe, launching in the U.S. in 2025), is a fully electric system that lifts the front casters off the ground and allows for easier negotiation of uneven terrain and inclines,” Pedersen and Walling said. “This type of device typically features faster speeds and is great for traveling longer distances in various outdoor environments. With a front-style (pull) device, a rider must have the trunk and arm control to reach up to the tiller to drive the chair.”

being pulled from in front and getting those casters off the ground.”

Pulling from the front

•

The U.S. is about to meet another family of front-mounted power-assist devices.

Industry veteran Matt Fitman, president of Rehasense USA, is bringing the globally successful Rehasense brand to America.

Rehasense’s power-assist brand is the Power Assisted Wheelchair System (PAWS).

Asked about who could benefit from a front-mounted power assist, Fitman said, “The basic patient demographic is pretty diverse because of the pull from in front, from the large wheel.”

He used PAWS as an example, noting it “increases the wheel base of the chair and more importantly, it pulls the front casters off the ground, so the PAWS can achieve speeds much higher than if you were to use the front casters and have them in contact with the ground with a much shorter wheel base.

“When it comes down to uneven terrain or off pavement, it has the advantage because anytime you have a 5" or smaller front caster wheel, its relation to terrain becomes pretty difficult. You still feel every bump and vibration. That’s the big advantage to pulling from in front. Anytime distance and speed and terrain come into the equation, there’s a distinct advantage of

Particularly if it’s someone who’s been in a chair for a long time, it might take two, three, four or five years to have that discussion from a clinical perspective — Angela Regier

Changing client perspectives

Regardless of their physical forms, all power-assist systems are designed to reduce the physical effort required to self propel a manual wheelchair.

Pedersen and Walling provided a long list of clinical and functional justifications for power assist: • • •

•

• • • • • •

Inability to manage functional distances/ speed due to upper-limb weakness.

Pain or range-of-motion limitations.

Upper-limb dyskinesia that prevents functional wheelchair propulsion.

Pain with propulsion that limits the ability to meet functional goals.

Inability to manage functional endurance demands due to comorbidities such as cardiovascular issues/cancer/diabetes.

Inability to manage inclines and uneven terrain.

Difficulty or inability to cross a street in a safe and functional time frame.

History of repetitive strain injury, such as tendinitis, rotator cuff injury, bursitis.

Inability to carry items during propulsion.

Experiencing fatigue throughout the day.

Asymmetrical ability with the upper extremities.

Power assist can address present and future needs by improving propulsion efficiency and potentially reducing risk of future injuries to shoulders, arms and hands.

Yet despite its enormous proactive potential, power assist has been a tough sell to many ultralightweight wheelchair riders who have prided themselves on self propelling without help, often for decades.

That mindset has extended to clients with tetraplegia, known in the past by the nickname “super quads” due to their determination to self propel despite their higher levels of spinal cord injury.

It was a perspective, Fitman recalled, echoed by some health-care professionals.

“They told individuals with tetraplegia that they needed to roll and push: ‘You don’t want to lose it,’ and everything else.

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ATP Series | Power Assist’s Exhilarating Evolution

Taking time to play the long game

When clients are newly diagnosed — such as with new spinal cord injuries — Regier acknowledged they might not always be immediately receptive to power-assist conversations.

“A lot of times, people don’t want to be in a chair, period,” she said of their reluctance to talk about power assist. But generally, “I would say yes, I think people are definitely getting more proactive.

And there are just so many more options now that don’t have such a significant impact on the vehicle situation and all of those things to consider. It can be more modular. You can use it when you want it, not when you don’t.”

The most progressive segment of our industry is pediatrics, because parents see the benefit. Parents want the best quality of life — Matt Fitman Supporting reimbursement for outside the home

As for changing that other perspective — that of the funding sources — Fitman would especially like to see Medicare’s Complex Rehab Technology benefit expand from the current “in the home” coverage to outside the home, as well.

“How much of life happens outside your home?” he asked. “That’s really the benefit of [power assist]. But I think we’re seeing a shift from people that get the idea that for a well-rounded human experience and to be living rather than just being alive, these changes are very important. It’s being able to go to the right tool in the toolbox for what you choose to be doing with your time and your day. It’s having the tool that will do that best. This rule of what’s medically necessary in the home: Well, what about oxygen concentrators?

You’re only going to pay for it if I don’t leave my house?”

Going outside their homes and into the whole wide world is exactly the future Fitman imagines for clients empowered by power assist. “[Power assist] expands people’s worlds, when you can get out there and be in community. Human beings are not isolated individuals. We’re very much community-based beings that need involvement with other human beings to have a better quality of life.” m

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“But we know full well that the shoulders were not built as a joint that moves a person through their environment. It’s not built for that. It has distinct disadvantages compared to a hip.”

Working as an ATP at the time, Fitman said he encouraged self propellers, especially those with tetraplegia, to consider alternatives.

“Back in the day, I always talked to people: Go find a used power chair. You can get them very cheaply. Because if you’re going to the museum with your family, what are you going to feel like when you get to that museum finally, after pushing for a mile or half a mile from where you parked to get into that facility?”

And as power-assist choices expand, Fitman said he’s seeing client perspectives expand as well. “I see the shift going on now,” he said. “Once you tell them the possibilities, they get that ‘light bulb’ moment. Where it really becomes interesting is pediatrics, because parents really recognize the difference very quickly: ‘I want my child to be able to go out and take a bike ride with their friends. They can’t do that. But I want them to be able to go to school and be able to get out to recess as quickly as everyone else.’ The most progressive segment of our industry is pediatrics, because parents see the benefit. Parents want the best quality of life.”

Regier added that some resistance to additional equipment is to be expected: “Everyone always wants to use the least amount of equipment to help them feel as ‘normal’ as possible. I remember when I [worked] in rehab, everyone wanted something more.

Patients on the ventilator just wanted to be off the vent. The C4 quad just wanted to be able to use a joystick, and the C5 quad just wanted [an ultralightweight wheelchair]. I’m sure that still happens and is still part of the discussion.”

So we’re not to the point where all newly injured spinal cord injury clients are embracing the idea of power assist. “But I feel like it’s more proactively discussed as an option early and often,” Regier said. “And hopefully, it’s one of those things where sometimes it’s a long game. Particularly if it’s someone who’s been in a chair for a long time, it might take two, three, four or five years to have that discussion from a clinical perspective, where you can say, ‘Hey, have we thought about this? Let’s just try it this year.’ Or ‘How about we come back to it next year?’ Ultimately, we hope they’ll make the decision to give it a go.

“I don’t think that dynamic [of resistance to power assist] will ever be totally gone. But I think we’ve made good progress. I would say since I started as a clinician, 17 or 18 years ago, I think it’s definitely shifted for the better. It’s just going to take time, I think. But there’s more options, which is nice.”

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Today’s Power Assist: Offering Riders More Choices

The evolution of power-assist systems for manual wheelchairs gives seating teams more options when trying to match a client’s activities, goals and environments with the optimal technology. Does your client need full-time or nearly full-time support, or does your client prefer to use power assist only in certain situations?

Today’s power-assist systems can answer a wide range of calls. Here’s a selection of current power-assist technology … with more to come in 2025.

Alber e-motion

Alber Twion

Alber has a pair of in-hub power-assist systems. e-motion drive wheels can be added to almost any manual wheelchair; sensors built into the pushrims “measure your drive movement and provide you with the desired power,” the Alber website said. The e-motion M25 is “stronger, faster, lighter and smarter” than its previous M15 rendition, with increased maximum user weight of 330 lbs.

The in-hub Alber Twion system features hub motors “equipped with the most modern software and electronics to provide the extra power needed to travel further and more efficiently.” The Twion has a top speed of 6 mph, and its lithium ion battery has a range up to 12 miles.

Alber (440) 329-6705 alber-usa.com

Alber (440) 329-6705 alber-usa.com

Electric 2 Handbike

Companion Series

Smoov one

Batec calls its devices “handbikes” rather than power-assist systems, and its lineup includes options that indeed bring bicycles and motorcycles to mind. The pictured Electric 2 handbike, Batec said, is a versatile choice for both rural and urban areas thanks to an 18" ultra-grippy tire.

Cheelcare’s Companion Plus, Companion One, and Companion Q systems mount to the front of folding or rigid manual wheelchairs. The systems weigh less than 20 lbs. and feature a quick-release mechanism to attach/detach from the wheelchair in less than 10 seconds, Cheelcare said.

The systems can be customized with vinyl wraps that include Canadiana, Americana, French Motif, and camouflage designs.

The SMOOV one from Invacare Corp. mounts “to just about anywhere” on a manual wheelchair, the manufacturer’s website said. The 16-lb. system has a top speed of up to 6 mph and a range of up to 12 miles, with slope capability of up to 16% and a maximum rider weight of 310 lbs. The rubber drive wheel can handle varied terrains, including gravel, cobblestones and wet roads, while the 356° swiveling fork provides power into turns.

Cheelcare (888) 948-2680 cheelcare.com

Invacare Corp.

(888) 426-8581 alber-usa.com/us/products/active-drives/ smoov

Batec Mobility/49 Bespoke (416) 661-4499 batec-mobility.com/en

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Today’s Power Assist: Offering Riders More Choices

SmartDrive MX2+

PAWS

Firefly

The mounting location of Permobil’s SmartDrive MX2+, its ergonomic handle, its weight and OmniWheel “were all designed to give manual wheelchair user access to fewer pushes,” the manufacturer said. The MX2+ is easily removable for transport and can attach to almost any manual chair. The rear-mounted system weighs 13.2 lbs. Options include operation through an Apple Watch or Samsung Galaxy watch.

The Rehasense Power Assisted Wheelchair System (PAWS) mounts to the front of wheelchairs and has a top speed of 22 mph, with a single-battery range of 20-plus miles (40-plus miles with the dual-battery option). PAWS requires no mounting hardware or bracket on the wheelchair frame.

The Rio Mobility Firefly attaches to the front of most manual chairs, with an oversize tubing kit available for diameters up to 1 3/8". After initial installation, Rio Mobility said the Firefly can be removed and reattached in seconds.

The five speed modes can reach up to 12 mph. The removable lithium ion battery provides up to a 16-mile range.

Rehasense USA (630) 756-3145 rehasense.us

Permobil (800) 736-0925 permobi.com/en-us

Rio Mobility (415) 552-6277 riomobility.com

Xtender

Empulse R90

NAVIONE

QUICKIE Xtender’s electronically synchronized rear wheel units “continually communicate with each other and adjust their speeds to facilitate smooth, straight propulsion,” Sunrise Medical said via its Xtender website. A quick-release design facilitates easy removal from the wheelchair so riders can choose between using the power assist or propelling on their own without help.

Rollback prevention and downhill speed control require zero programming.

In September, Sunrise Medical launched the Empulse R90 that sits “discreetly below the seat, thus maintaining the chair’s original size and turning circle.”

The R90 can be raised when not in use to eliminate rolling resistance.

The removable battery lightens the unit’s weight; an extended-use battery provides a range of up to 19.5 miles.

Yamaha Motor Corp.’s NAVIONE uses the Smart Control System operating system to customize sensitivity and driveability, and to troubleshoot issues.

The NAVIONE’s Smart Tune can adjust power level and the levels of right- and left-arm assist needed. The wheels can fit a wide range of wheelchairs and come with built-in control features such as rollback prevention, downhill speed control, uphill ascent assist, and sideslope stability control.

Sunrise Medical (800) 333-4000 www.sunrisemedical.com

Sunrise Medical (800) 333-4000 www.sunrisemedical.com

Yamaha Motor Corp.

(714) 229-7959 yamahanavi.com

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ATP Series

Industry leaders recap 2024’s big events, look forward to the year to come

As we look to 2025, the topic most on my mind is …

Using AI to streamline processes. — Bret Tracy, MBA, ATP, EVP of operations, ATLAS Enterprise Software The pressure that our members face with increased inflation costs, regulation, and other costs, while insurance companies continue to demand price cuts. — Wayne Grau, executive director, National Coalition for Assistive & Rehab Technology (NCART) Finishing the RESNA [Rehabilitation Engineering & Assistive Technology Society of North America] position paper (posture care

management in the lying posture) with the working group! — Lee Ann Hoffman, OTD, MSc, OTR, ATP/SMS, CAPS, assistant program director and assistant professor, University of St. Augustine for Health Sciences: Dallas Campus; OT programs The ongoing quest for coding, coverage, and reimbursement to align with design innovation and technology advancement. — Julie Piriano, PT, ATP/SMS, senior director, payer relations and regulatory affairs, NCART Advocating for CMS oversight with Medicare Part C (disadvantage); titanium/carbon fiber upgrade within code; CRT repair reform (service what you provide). — Dan Fedor, BS Economics, director of reimbursement, U.S. Rehab

A 2024 industry high point was …

Achieving coverage for seat elevation. — Tamara Kittelson, MS, OTR/L, ATP/SMS, Posture 24/7; incoming Clinician Task Force [CTF] executive director

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hat a year 2024 has been. For every triumph (Medicare funding for power seat elevation, at last!), there seemed to be a disappointment (but what about power standing?).

As we head into 2025, we asked industry leaders to share their thoughts on a number of topics. Their answers suggest a new year already shaping up to be memorable.

ATP Series | Good-bye, Hello!

Seeing the technology come to my OT students on the Dallas campus and watching students’ excitement to be able to drive a power wheelchair powered by Munevo. I love seeing the CRT excitement through the students’ eyes. — Lee Ann Hoffman, University of St. Augustine for Health Sciences The receipt of a dedicated code for power seat elevation, as it has opened the doors for coding, coverage and reimbursement discussions in the state Medicaid programs that did not follow the NCD [national coverage determination] when it was released in 2023. — Julie Piriano, NCART Power seat funding! — Bret Tracy, ATLAS Enterprise Software The implementation of coverage, coding, and payment for seat elevation. A great day for consumers! — Wayne Grau, NCART

And an industry low point was …

The continued CMS [Centers for Medicare & Medicaid Services) non-response on the power standing national coverage determination reconsideration request. — Cara Masselink, Ph.D., OTR/L, ATP, HPCS, executive director, Clinician Task Force The industry needs reform on repairs.

Hopefully, the new administration’s push for “cutting red tape” will help remove cumbersome processes that slow patient care down. — Bret Tracy, ATLAS Enterprise Software Another year without any movement on access to power standing systems for Medicare beneficiaries. — Julie Piriano, NCART

Continued delay on power chair standing. — Tamara Kittelson, Posture 24/7; incoming Clinician Task Force executive director

those that utilize Complex Rehab equipment. — Wayne Grau, NCART Medicare Part C plans can no long run deceptive advertising and can’t induce beneficiaries with “gift cards, etc.” to sign up for their private for-profit health insurance. Beneficiaries have the choice to upgrade to titanium/carbon fiber wheelchair on assigned claims. — Dan Fedor, U.S. Rehab

A few words that describe how I feel about the new year are …

Intentional. Mindful. Creative. — Angie Kiger, M.Ed., CTRS, ATP/SMS, senior marketing operations manager, Permobil Americas Optimistic. Passionate. Determined. — Dan Fedor, U.S. Rehab

Power standing is funded. — Bret Tracy, ATLAS Enterprise Software

Energized, optimistic, and prepared. — Julie Piriano, NCART Words matter. I would like to say, “Eat more cheese”; however, after much thought and reflection, my three terms: Resilient Dreamer, Creative Luminary, and Grounded Mindset. — Lee Ann Hoffman, University of St. Augustine for Health Sciences

“Wow, imagine that?! Finally, no more denials – you get your equipment, and you get your equipment, and even YOU get your equipment. Equipment for everyone who needs it.” — Lee Ann Hoffman, University of St. Augustine for Health Sciences The students in our rehabilitation disciplines at Western Michigan University are excited about assistive technology! — Cara Masselink, Clinician Task Force

Cautious, open. — Tamara Kittelson, Posture 24/7; incoming Clinician Task Force executive director Cautiously optimistic. — Wayne Grau, NCART

PWC standing devices are funded! — Tamara Kittelson, Posture 24/7; incoming Clinician Task Force executive director

Proactive advocacy. — Cara Masselink, Clinician Task Force

What most impresses me about CRT is …

Optimistic, hopeful and excited. — Bret Tracy, ATLAS Enterprise Software

The dedication to servicing the needs of their clients regardless of the overwhelming challenges with reimbursement — one of the most selfless industries. — Dan Fedor, U.S. Rehab

A year from now, I’d like to be able to say …

Waiting for our chance to prove to CMS that power standing is medically necessary and will benefit consumers who qualify for this incredible product. — Wayne Grau, NCART

We accomplished what we set out to do: Achieve Medicare coverage for power standing devices, secure coverage and reimbursement for power seat elevation in all 50 state Medicaid programs for beneficiaries of all ages, and continue to improve access to CRT products and services across all payers through coding, coverage and reimbursement initiatives. — Julie Piriano, NCART

Conference drought: No ISS and no RESNA conferences. — Lee Ann Hoffman, University of St. Augustine for Health Sciences

We got power standing covered, we reformed the service and repair system, and we protected the CRT industry for providers, manufacturers, and most importantly to

What we can accomplish with teamwork. — Cara Masselink, Clinician Task Force The constant innovation and collaboration with manufacturers and clinicians to meet the needs of the individuals who need and use CRT — we are better together, like PB & J. — Lee Ann Hoffman, University of St. Augustine for Health Sciences The commitment of the people and their willingness to fight to do what is right. — Wayne Grau, NCART

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ATP Series | Good-bye, Hello!

Resilience to the ever-changing reimbursement environment. — Bret Tracy, ATLAS Enterprise Software How similar the “why” is for many of us in the CRT industry. — Angie Kiger, Permobil Americas The dedication and commitment of everyone involved to make a difference in the daily lives of others. — Julie Piriano, NCART

A personal goal I’m setting for 2025 is …

To wrap up my second doctorate — this time for Doctor of Education. — Lee Ann Hoffman, University of St. Augustine for Health Sciences To take one day at a time. — Julie Piriano, NCART One hundred hours of hot yoga and 600 miles of running. — Bret Tracy, ATLAS Enterprise Software To lessen multi-tasking and select priority projects to give my time and attention. — Cara Masselink, Clinician Task Force To remain calm as the storm approaches and passes. — Wayne Grau, NCART

I’d like to give a shout-out to …

Mickae Lee (of Permobil) on being voted president of NCART. Her knowledge and passion will help drive NCART’s mission to new heights. — Bret Tracy, ATLAS Enterprise Software Michelle Lange, Jean Minkel, and my esteemed colleagues for completing and bringing to publication the second edition of the Seating and Wheeled Mobility Clinical Resource Guide. — Julie Piriano, NCART All the NCART volunteers and our staff. We could not do what we do without this tremendous group of people. — Wayne Grau, NCART

Greg Packer for his years of dedication and passion for the CRT industry and his lasting legacy of improving access for those in need of CRT. — Dan Fedor, U.S. Rehab The CRT industry legends that pulled up a seat and joined me as a guest on Wheelchair Nerds in 2024. including Michelle Lange, Cathy Carver, Alexis Ward, Amy Morgan, and Cody Verrett. — Angie Kiger, Permobil Americas The amazing CTF [Clinician Task Force] executive board! I roll off the board this month after three years of voluntary service! Thank you for all your support throughout this time. Makes it easy to give your time and energy when you have amazing humans to serve alongside. — Lee Ann Hoffman, University of St. Augustine for Health Sciences Everyone who participated in a Mobility Management interview, survey, podcast, webinar, etc. Everyone who took time to share their wisdom so graciously. Thank you. — Laurie Watanabe, editor-inchief, Mobility Management

If I could pick a city to host an event, it would be …

Calgary, Alberta, or Austin, Texas. If I could teleport, Japan or Thailand would be really cool to see! — Cara Masselink, Clinician Task Force Tokyo. — Wayne Grau, NCART Kansas City, Missouri. — Bret Tracy, ATLAS Enterprise Software Wherever the majority of my people, aka Wheelchair Nerds, can attend. Seriously. Industry events are way more about the people I get to connect with as opposed to the destination city. — Angie Kiger, Permobil Americas Rome. — Julie Piriano, NCART Dallas, Texas, ’cause that’s where you will find me. — Lee Ann Hoffman, University of St. Augustine for Health Sciences Vancouver. We miss you, B.C. — Laurie Watanabe, Mobility Management m

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The passion people feel for their work. — Tamara Kittelson, Posture 24/7; incoming Clinician Task Force executive director

manual wheelchair marketplace

Little Wave Flip

Vision Package

PDG Fuze T50n

Little Wave Flip is a pediatric tilt-in-space chair that makes the first step toward early intervention more natural for both parent and child. It integrates design elements, such as flat folding like a typical stroller, into the durability of a wheelchair. Use the new paradigm in adjustability to embrace a pediatric client’s growth.

With fewer parts, changing seat height, depth and width has never been easier. In addition, the tube-in-tube seat rail design is a modular system that allows you to make those changes without replacing parts. Little Wave Flip easily transforms into a small package that fits into the trunk of the tiniest cars. Kids can choose from more than 500 different color combinations.

The Vision Package comprises high-visibility orange accents, a carefully selected color that enhances contrasts and makes key wheelchair parts easier to see and use. The result is a safer, more confident experience for a wide range of users, including those with low vision or cognitive differences. Users with dementia or other cognitive differences may struggle to locate and operate essential components, which increases the risk of accidents and limits their independence. The vibrant color of the Vision Package is easily seen in various environments and in low light to make footplates, wheel locks and armrests, for example, more easily distinguishable.

The PDG Fuze T50n features a sleek aluminum frame and an infinitely adjustable tilt range of 50°. The “n” in the chair’s name stands for “narrow,” a reference to the Fuze T50n’s overall seat width of seat width plus 4". The chair’s exclusive features include a unique center-of-gravity pivot point; effortless and maintenance-free tilt performance; and simple center-of-gravity adjustments.

Options include WC19 and ISO 7176-19 transit tie-downs; 30° of manual dynamic recline; power tilt up to 350 lbs.; an adjustable-width frame; and a take-apart frame.

Ki Mobility (800) 981-1540 www.kimobility.com

Motion Composites (866) 650-6555 www.motioncomposites.com

Permobil (800) 736-0925 www.permobil.com/en-us

TiLite X

Rehasense PAWS

QUICKIE QS5 X

The new TiLite X folding ultralightweight wheelchair is lightweight, easy to transport, and has standard adjustability features. A single-piece side frame optimizes weight savings and maintains performance and durability. A redefined oval-shaped cross brace is secured by C-shaped seat rail clamps designed for increased rigidity during propulsion. The new GearLock caster adjustment system provides single-tool caster squaring in 2" increments. Seating teams can change seat-to-floor height, camber, seat-tofootrest height, backrest angle, center of gravity and more after the chair is ordered to adapt to changing needs. The TiLite X has flip-back or removable T-style armrests.

PAWS (Power Assisted Wheelchair System) is a power add-on to provide manual wheelchair users of various function levels with more independence on all types of terrain. It attaches to the front of the wheelchair and is similar to an ebike. With a max speed of 22 mph and a single-battery range of 20-plus miles (40-plus with dual-battery option), PAWS can be easily attached to most wheelchairs with the patented Auto Lift/Auto Attach or manual lift/attach systems. With 4-wheel sizes, traction control, cruise control, regenerative braking, self-centering steering, walk-along mode, tetra and hemi control options and a range of accessories, the PAWS can help people be part of a bigger world.

The QUICKIE QS5 X is built to deliver outstanding performance, versatility and reliability. Its FreeFold mechanism ensures smooth, hassle-free folding, keeping casters steady for a seamless experience. The lightweight frame makes lifting, transporting and handling easier, adding to its overall portability. Engineered for durability, the rigid frame minimizes vibrations, resulting in a smoother, more comfortable ride that reduces rider fatigue, especially on longer journeys. Personalization is a key feature: With adjustable frame options, including swingaway or fixed configurations, and multiple frame angles, the QS5 X adapts to meet riders’ evolving needs.

Permobil (800) 736-0925 www.permobil.com/en-us

Rehasense USA (630) 756-3145 Rehasense.us

Sunrise Medical (800) 333-4000 www.sunrisemedical.com

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