Our last blog provided suggested general wording to be used in documentation to obtain successful funding for Dynamic Seating components. In this blog, we will look at more specific wording for various applications of the Dynamic Rocker Back Interface. The justifications we provide in a Letter of Medical Necessity will vary with the specific dynamic component as well as the individual reasons the client would benefit from this technology.
I personally recommend Dynamic Seating components for the clients I work with, as well as provide education in this area of practice. One question that is often posed to me is, “Can I get this paid for?” My answer – “Yes!” Of course, funding varies by payer, coding, and the direction the wind is blowing. I find that clinicians are often unsure of how to justify the need for this equipment in their documentation. Documentation is key to getting funding approval and so I have compiled some suggested wording for you here. If you require further assistance with documentation, please contact Seating Dynamics or myself for help.
Our last two blogs have addressed Integrated and Modular Dynamic Seating. Integrated systems are a dedicated mobility base incorporating several areas of movement. Modular components can be retrofitted to a mobility base and used individually or in combination with one another.
Let’s take a look at Spencer’s transition from an Integrated system to Modular components.
Spencer’s Dynamic Wheelchair Story
Spencer is a young man who has used an Integrated Dynamic System for a number of years. He has increased muscle tone and frequently extends with significant force. Before receiving the Integrated Dynamic System, he had broken numerous components on his seating system and manual wheelchair.
In this blog, we will highlight the advantages of Modular Dynamic components. Whereas Integrated systems are a dedicated mobility base incorporating several areas of movement, Modular components can be retrofitted to a mobility base and used individually or in combination with one another. The ability to place these Modular Dynamic components on a variety of mobility bases is a critical advantage. This allows Dynamic Seating to be added to an existing mobility base without having to replace, and fund, a new integrated base.
When boiled down to the basics, the difference between the two options is:
Integrated systems come as a unit – the dynamic components are a part of a dedicated wheelchair.
Modular components can be retrofitted to an existing wheelchair and can be used at just one body site (such as the knees) or combined with other components to provide movement at more than one body site.
The Advantages of an Integrated Dynamic Seating System
So what are the advantages of choosing an Integrated dynamic seating system?
As the system is designed from the ground up for movement, the dynamic components are designed to move in unison in an effort to capture movement that may occur throughout the body. This is a very important consideration. Each client will display a unique pattern of movement, but the movement is inter-related. Clients who exhibit an extensor thrust pattern can easily activate dynamic components simultaneously at the hips, knees, and head.
Some basic items need to be routinely checked when using dynamic wheelchair components. Usually the idea of routine “maintenance” worries me, however what I found can be easily checked.
This is the story of J and the flattened elastomers. J is a young man with an incredibly strong extensor tone pattern that usually initiates in his hips. He uses a Seating Dynamics Dynamic Rocker Back to absorb these forces. He resides in a long term care facility and has multiple caregivers who have known him for many years.
I was receiving complaints from his caregivers that he “just doesn’t look right in his wheelchair anymore”. When passing him, I also noticed that he was no longer sitting on his seat. Instead, his feet were firmly planted on his footplates, with hips extended and his buttocks lifted off of the seat. His arching/extension pattern had returned. At times, the staff were unable to get his feet on his footplates due to this extension. Others commented that he sat much better if his feet were left hanging off the front edge of his footplates. Observation revealed a more exaggerated, compromised posture with his hips far forward on his seat.
Vince is a young adult with the diagnosis of cerebral palsy. He had significant muscle tone throughout his body and frequently extends in his current wheelchair seating system. We were anxious to explore dynamic seating options to diffuse some of this extensor tone. However, Vince had very little hip flexion or extension beyond his current seated position and, as a result, he could not benefit from a dynamic back which allows movement past this point. He had no knee extension past 90 degrees and his range limitations prevented him using even the telescoping feature of a dynamic footrest. We were unsure if we could provide any dynamic intervention when Vince broke yet another head support.
The Dynamic Head Support Solution
We decided to try a dynamic head support hardware. With the addition of this dynamic component, we found that Vince’s head was in an aligned position most of the time, rather than his typical hyper-extended position. He experienced less force through the cervical area, as well, which we hoped would protect his neck from injury and increase his comfort. His overall extensor tone and posturing improved when force was diffused at his neck. Finally, Vince has yet to break his head support hardware since “going dynamic”!
On St. Patrick’s Day, we had the opportunity to participate in the Salisbury, MD Numotion NuFair. Approximately 45 therapists from the surrounding areas attended 3 CEU courses and the extensive exhibits.
Michelle Lange presented on Dynamic Seating and Seating Dynamics exhibited. The attendees were great and enjoyed learning more about this practice area!
This is our third and last blog summing up a wonderful 2017 International Seating Symposium in Nashville. I had the privilege of presenting a workshop on the topic of “Positioning the Head.” A great group gathered in the ballroom in search of answers for those clients who persist with less than desirable head positions despite our best efforts.
Now, I tend to throw chocolate in my sessions, and I have a pretty good arm, but I could only throw about a third of the length of this room, so I encouraged folks to move up for chocolate – and to see the screen! Continue reading →
President and Principal Designer, Seating Dynamics
Having attended all but five of the International Seating Symposiums since 1987, I can say that it has always been the greatest place on earth to learn about wheelchair seating, simple as that. The opportunity that I have had as a designer to meet and listen to people about the problems that they face on a daily basis is unbeatable. Those of you who know me undoubtedly know that I love a challenge and when someone explains a problem that has no solution, I don’t see it as a problem, but as an opportunity. Often I say, “I can fix that”! Continue reading →