Dynamic Stories: An interview with Daniel’s Mom

Daniel is a 17 year old young man with the diagnosis of cerebral palsy. He has been successfully using dynamic seating for over 5 years now. He started with a KidRock dynamic manual wheelchair. He currently uses a tilt in space manual wheelchair with a dynamic rocker back and dynamic footrests. I sat down with his Mom, Mary, to ask her some questions.

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Will my client break the Dynamic Seating?

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Dynamic Seating is often used to prevent equipment breakage, specifically the wheelchair frame and seating system. The Dynamic components absorb strong, repeated, sudden, and/or sustained forces, hence protecting vulnerable areas of the seating and mobility base. This was addressed in two prior Blogs (Dynamic Seating to Prevent Equipment Breakage, part 1 and part 2). But what about the Dynamic Components themselves? Just how durable are these?

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Can I get this paid for? Part 4: Dynamic Headrest

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Our last blog provided suggested wording to be used in documentation to obtain successful funding for Dynamic Footrests. In the last of this series, we will look at specific wording for various applications of Dynamic Headrests.

These examples do not replace competent evaluation. Choose the wording that matches an individual’s specific needs and modify accordingly to reflect a specific client’s needs. I find it helpful to begin with a brief definition, as reviewers are often unfamiliar with this technology. For example:

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Can I get this paid for? Part 3: Dynamic Footrests

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Our last blog provided suggested wording to be used in documentation to obtain successful funding for the Dynamic Rocker Back. In this blog, we will look at specific wording for various applications of the Dynamic Footrests.

These examples do not replace competent evaluation. Choose the wording that matches an individual’s specific needs and modify accordingly to reflect a specific client’s needs. I find it helpful to begin with a brief definition, as reviewers are often unfamiliar with this technology. For example:

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Can I get this paid for? Part 2: the DRBi

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

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.

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Can I get this paid for? Part 1: general documentation guidelines

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

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.

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Modular Dynamic Seating Components Vs. Integrated Dynamic Seating Systems

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.

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Advantages of Modular Dynamic Seating Systems

Our last blog revisited the differences between Integrated and Modular Dynamic Seating; specifically, the advantages of Integrated systems.

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.

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Pros and Cons of Integrated Dynamic Seating Systems

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

One of our past blogs, posted September 14th of 2016, explained the difference between Integrated and Modular Dynamic Seating.

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.

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When An Elastomer Goes Flat… The Story of J and the Flattened Elastomers

Jill Sparacio, OTR/L, ATP/SMS, ABDA

Clearly, Something Was Different

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.

Bottom line, something was different.

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