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WHEELCHAIRS

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Canes, walkers, crutches, manual wheelchairs, power wheelchairs, and scooters are examples of mobility assistive equipment (MAE). Power wheelchairs and scooters are referred to as power mobility devices (PMDs). The first section of this chapter reviews the basic components of manual wheelchairs, power wheelchairs, and scooters. Included in this discussion are criteria used when prescribing a mobility device and documentation requirements. Also discussed are the types of wheelchairs used by patients who have had a stroke, spinal cord injury (SCI), or amputation; those who are obese; as well as pediatric patients with cerebral palsy.

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In order to prescribe the most appropriate MAE, a physician needs to know the key elements of the patient’s medical history, past medical history, social history, current functional status, and recent changes in the medical condition. Equally vital components of the decision-making process are the cognitive status of the patient and his or her ability to use the equipment. The amount of assistance needed for transfers, activities of daily living (ADLs), and mobility within the home are extremely important, as well as whether the patient has assistance from a home health aide or family member. The physician needs to fully examine the patient and assess the range of motion and strength in all joints. Joint contractures, spasticity, amputations, joint abnormalities, and weakness affect the patient’s ability to safely transfer, ambulate, and perform ADLs.

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An important factor considered by the U.S. Centers for Medicare and Medicaid Services when approving a patient for a PMD is the inability to perform mobility-related activities of daily living (MRADLs), such as toileting, feeding, dressing, grooming, and bathing in the home using a cane, walker, or manual wheelchair. Documentation of functional mobility should include the following information:

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  • Mobility limitations and how they interfere with the performance of ADLs.

  • Ability to use a cane or walker independently to accomplish all MRADLs in the home in a safe and timely fashion.

  • Ability to use a manual wheelchair to meet mobility needs in the home.

  • Changes in the patient’s condition or functional limitations that now necessitate a PMD.

  • Physical and mental abilities that may prevent safe transfer into, and operation of, a PMD.

  • Whether the patient is willing and motivated to use a PMD in the home.

  • Whether the patient’s typical environment supports the use of a wheelchair or PMD.

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CLINICAL EVALUATION

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Before prescribing an MAE or a PMD, a physician must perform a face-to-face examination with the patient, and the date of the examination must be documented. The face-to-face examination should include the patient’s past and present medical history, social history, functional mobility and ADL status, review of systems, and a physical examination. It should also include the weight and height of the patient and whether the patient has the ability to safely propel a manual wheelchair or safely drive a PMD. The physical examination should include documentation of cardiopulmonary, neurologic, ...

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