Wheelchairs and Adapted Strollers
What You Should Know About Wheelchairs and Adapted Strollers
- Promote ability and participation with peers.
- Conserve strength for children who may struggle to walk over longer distances.
- Reduce the risk of caregiver injuries linked to lifting their children.
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Photo courtesy of Druidhills through Wikicommons, January 13, 2013 |
- They are easy to load and unload from cars.
- They tend to fit in places where wheelchairs may not, such as small doorways and hallways.
- They have a more flexible than firm seat, adding to sacral pressure.
- Children often need caregivers to push their strollers, but children may learn to drive manual or power wheelchairs on their own.
Getting the First Wheelchair
- Accepting a diagnosis or a permanent disability
- Worry that your child will be seen as different
- The need to make changes in housing or lifestyles.
- One for a wheelchair (or other mobility device)
- One for the PT/OT or seating clinic to evaluate the child for a wheelchair and make a full prescription of the best wheelchair or stroller for the child.
- The parents and child will steer the team with their thoughts about what may work, what has been tried before, and can point out their needs for support with mobility. At the end of the process, the choices are theirs.
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The Physical or Occupational Therapist
(PT/OT) will evaluate fine motor skills (hand), gross motor
skills (total body), touch, and movement; seating and positioning; visual
perception; oral motor skills (feeding/swallowing); and mobility needs
(self-propelled manual wheelchair or powered wheelchair with a joy
stick/head array) for mobility.
- They will evaluate the different settings for use (home, car, school, etc.).
- Therapists will also teach parents/caregivers how to use the wheelchair, how to take the wheelchair apart for transit, how to get the child in/out of the wheelchair, and set up training for the child to learn to use the chair.
- The Speech Therapist will evaluate the child's communication skills – is an augmentative communication device needed to help increase their ability to communicate? If so, how will it be used in the wheelchair?
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Rehabilitation Engineers write prescriptions for the
wheelchair, and other equipment.
- These are often based on recommendations from the PT/OT.
- Sometimes referrals are needed for 3rd party payment.
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Clinicians should write prescriptions for any other
special health needs.
- Clinicians can help show the need for ventilator trays, and adaptations for transporting oxygen, suction and feeding bags on the wheelchair.
- Often a co-signature by the clinician on a letter of medical necessity (LMN) done by the therapist is needed. (See our Writing Letters of Medical Necessity page.)
- It may work to rent a wheelchair when the disability is temporary, such as after a surgery or injury.
- Teachers, rehabilitation counselors, employers, day care providers, respiratory therapists, recreational therapists, nurses, orthotists, friends, and even architects can be useful team members to help decide what accommodations to make at home, school, and other places.
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The Wheelchair/Seating Vendor's agent will send the
paperwork to Medicaid or other health plan.
- They will get prior approval, order the equipment, build, and deliver it.
- Wheelchair vendors are often certified seating
specialists and have good product information and know-how.
- They can explain the pros/cons of each type of wheelchair to the parents and team.
- They can also give price quotes and cost ranges. Vendors have a repair shop where flat tires and other repairs can be made.
Process
- It must be co-signed by the doctor, or a prescription must go with the letter.
- This is sent by the vendor to Medicaid/health plan for prior approval.
- When it is received, a final wheelchair fitting by the team is scheduled to make sure it fits and works for the child.
- Appeals must be done in a timely fashion.
- Check the denial letter for timelines.
- See the Writing Letters of Medical Necessity and Appealing Funding Denialsfor assistance in appealing.
Funding
How to Know if a Wheelchair Fits
- Head and upper body are upright and in the center of the seat with or without support
- Shoulders are over the hips and level with each other
- Legs are straight or slightly open
- Lower body is straight, in an even tilt, and all the way back in the seat
- Weight is on the thighs and backside
- Feet are on the footrest
- Knees are no more than 2-3 finger widths in front of the seat edge (for a growing child)
- Skin is healthy and looks unharmed – check the backside near the bottom of the spine and the back of the legs (if the seat is too deep, the child will lean back to reach the support surface, the pelvis will be in a backward tilt, and the child may have redness behind the knees)
- Eyes are forward
- Chest harness fits and does not cut into the neck and is not a choking hazard (the child should not be "hanging" on the harness)
- Wheelchair has a snug fitting seat belt, with padding if needed
- Wheelchair works correctly and is regularly maintained.
- The child is comfortable for at least 2 hours at a time in the chair
- If a child has a severe impairment and/or contractures, a wheelchair may not fit as described above. With a fixed position, the seating should accommodate the child’s body. Comfort and good skin health may become the top goals.
- If the wheelchair does not fit the right way, a referral to a PT/OT with seating knowledge should be made to solve the problem or suggest a new chair or other choices. If repairs are needed, the parent should call the vendor. If needed, the doctor should write a prescription/referral for the wheelchair repairs.
Follow-up
Resources
Information & Support
For Parents and Patients
Adaptivemall.com
A commercial site offering a variety of strollers, equipment, and assistive technology products.
AbleData.com
ABLEDATA gives objective information on assistive technology and rehabilitation equipment available from domestic and international
sources. Parents can look at items they are thinking about purchasing and see details and the ratings users have given for
them. Sponsored by the National Institute on Disability and Rehabilitation Research (NIDRR).
Services in Nevada
Adolescent Health Transition Programs
We currently have no Adolescent Health Transition Programs service providers listed; search our Services database for related services.
Assistive Technology Equipment
See all Assistive Technology Equipment services providers (13) in our database.
CSHCN Clinics
We currently have no CSHCN Clinics service providers listed; search our Services database for related services.
Local Support Groups, Disability/Diag
See all Local Support Groups, Disability/Diag services providers (28) in our database.
Occupational Therapy, Pediatric
See all Occupational Therapy, Pediatric services providers (8) in our database.
Speech - Language Pathologists
See all Speech - Language Pathologists services providers (13) in our database.
State Institutions for Individuals with Disabilities
We currently have no State Institutions for Individuals with Disabilities service providers listed; search our Services database for related services.
For other services related to this condition, browse our Services categories or search our database.
Helpful Articles
Greer N, Brasure M, Wilt T.
Wheeled Mobility (Wheelchair) Service Delivery.
Agency for Healthcare Research and Quality.
Technical Brief Number 9; January 2012.
/ http://www.effectivehealthcare.ahrq.gov/ehc/products/194/751/TechBrief...
Report prepared by the Minnesota Evidence-based Practice Center; a review of evidence related to wheelchair service, largely
focused on adult services; highlights many of the payer, reimbursement, consumer, and provider issues that are relevant also
for children.
Corbet, Barry.
Spinal Network: The Total Wheelchair Resource Book.
Third Edition ed. Nine Lives Press;
2002.
0971522308
A comprehensive guide to practical information regarding living in a wheelchair.
Butler C, Okamoto GA, McKay TM.
Motorized wheelchair driving by disabled children.
Arch Phys Med Rehabil.
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PubMed abstract
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Powered mobility for very young disabled children.
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PubMed abstract
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Cognitive predictors of young children's readiness for powered mobility.
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PubMed abstract
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PubMed abstract / Full Text
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J Spinal Cord Med.
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PubMed abstract / Full Text
Rodby-Bousquet E, Hägglund G.
Use of manual and powered wheelchair in children with cerebral palsy: a cross-sectional study.
BMC Pediatr.
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PubMed abstract / Full Text
Tefft D, Guerette P, Furumasu J.
The impact of early powered mobility on parental stress, negative emotions, and family social interactions.
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PubMed abstract