Sample Medical Justification – Dynamic Footrests

The following are sample medical justification wording for the Seating Dynamics Dynamic Footrests for wheelchairs which may be used in funding documentation, such as a Letter of Medical Necessity. Justifications are listed by features and clinical indicator and a client may benefit from a Dynamic Seating component for more than one reason. In that case, you may combine sample wording to address each application. Justifications should also be customized for a specific client’s needs. These examples do not replace competent evaluation. If you require further assistance with documentation, please contact us for help.

Dynamic Footrests are available with a telescoping (downward) feature standard. Dynamic Footrest options include knee extension, plantar / dorsi flexion, and footplate rotation.

When ordering Dynamic Footrests for wheelchairs, we recommend you also order shoe holders with straps to secure the client’s feet to the footplates to activate the dynamic movement (available from other manufacturers). You may also consider pads on the medial surface to prevent contact with the hardware, as appropriate. These lateral knee pads are available from Seating Dynamics and the justification for this item is listed below. These items will be justified separately in your funding documentation.

Please Note:

Dynamic footrests are not standard footrests (which are considered to be included and paid for with the wheelchair purchase)
Dynamic footrests are not a replacement footrest. Replacement parts are considered to be “like kind”, as the original.
Dynamic footrests provide function not offered by any “standard” wheelchair footrests by moving in response to client forces (involuntary or intentional). These do not move the leg as a power elevating legrest does.
DO NOT ABBREVIATE “DYNAMIC” IN ANY OF YOUR DOCUMENTATION. The reviewer may not know what the abbreviation refers to.

Dynamic Footrests: telescoping only

By providing the telescoping feature only, rather than knee extension, pelvic position is more readily maintained in clients with tight hamstrings.

To prevent equipment breakage and/or client injury:

For the client with a history of equipment breakage and/or client injury:

Dynamic Footrests lengthen in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces exerted which have led to client injury and/or equipment breakage in the past and to reduce risk of future breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed. (Include a full list of past equipment damage and/or client injuries).

For the client who does not have a history of equipment breakage and/or client injury, but has the potential for both:

Dynamic Footrests lengthen in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces which could lead to client injury and/or equipment breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed.

To absorb extensor tone:

Dynamic Footrests lengthen in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb forces resulting from active client extension. By absorbing and diffusing these forces, extensor tone may be decreased. Reducing extensor tone may increase function and sitting tolerance, maintain client alignment with the support surfaces, and conserve energy.

Dynamic Footrests: telescoping, knee extension

To prevent equipment breakage and/or client injury:

For the client with a history of equipment breakage and/or client injury:

Dynamic Footrests lengthen and extend at the knee in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces which have led to client injury and/or equipment breakage in the past and to reduce risk of future breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed. (Include a full list of past equipment damage and/or client injuries).

For the client who does not have a history of equipment breakage and/or client injury, but has the potential for both:

Dynamic Footrests lengthen and extend at the knee in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces which could lead to client injury and/or equipment breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed.

To absorb extensor tone:

Dynamic Footrests lengthen and extend at the knee in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb forces resulting from active client extension. By absorbing and diffusing these forces, extensor tone may be decreased. Reducing extensor tone may increase function and sitting tolerance, maintain client alignment with the support surfaces, and conserve energy. Active range of motion at the knee is also provided, reducing risk and progression of range of motion losses.

To provide movement:

Dynamic Footrests lengthen and extend at the knee in response to client forces and then return to a starting position. Dynamic Footrests are recommended to allow movement of the client for the goals of providing vestibular input, increasing alertness, decreasing agitation, increasing sitting tolerance, and increasing function without loss of client alignment with the support surfaces.
(Please only list those goals relevant to an individual client).

To increase lower extremity strength:

Dynamic Footrests: telescoping, knee extension, plantar/dorsi flexion

To prevent equipment breakage and/or client injury:

For the client with a history of equipment breakage and/or client injury:

Dynamic Footrests lengthen, as well as extend at the knee and ankle, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces which have led to client injury and/or equipment breakage in the past and to reduce risk of future breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed. (Include a full list of past equipment damage and/or client injuries).

For the client who does not have a history of injury and/or equipment breakage, but has the potential for both:

Dynamic Footrests lengthen, as well as extend at the knee and ankle, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces to reduce risk of client injury and/or equipment breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed.

To absorb extensor tone:

Dynamic Footrests lengthen, as well as extend at the knee and ankle, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb forces resulting from active client extension. By absorbing and diffusing these forces, extensor tone may be decreased. Reducing extensor tone may increase function and sitting tolerance, maintain client alignment with the support surfaces, and conserve energy. Active range of motion at the knee and ankle is also provided, reducing risk and progression of range of motion losses.

To provide movement:

Dynamic Footrests lengthen, as well as extend at the knee and ankle, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to allow movement of the client for the goals of providing vestibular input, increasing alertness, decreasing agitation, increasing sitting tolerance, and increasing function without loss of client alignment with the support surfaces.

(Please only list those goals relevant to an individual client).

To increase lower extremity strength:

Dynamic Footrests: telescoping, knee extension, plantar/dorsi flexion, rotating footplates

To prevent equipment breakage and/or client injury:

For the client with a history of equipment breakage and/or client injury:

Dynamic Footrests lengthen, extend at the knee and ankle, and rotate at the footplate, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces which have led to client injury and/or equipment breakage in the past and to reduce risk of future breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed. (Include a full list of past equipment damage and/or client injuries).

For the client who does not have a history of injury and/or equipment breakage, but has the potential for both:

Dynamic Footrests lengthen, extend at the knee and ankle, and rotate at the footplate, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb client forces to reduce risk of client injury and/or equipment breakage or loss of footrest / footplate alignment. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware, as well as loss of client alignment with the support surfaces. Breakage may result in injury to the client from contact with damaged or broken wheelchair components and or the client being unable to use their wheelchair and/or seating system until repairs are completed.

To absorb extensor tone:

Dynamic Footrests lengthen, extend at the knee and ankle, and rotate at the footplate, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to absorb forces resulting from active client extension. By absorbing and diffusing these forces, extensor tone may be decreased. Reducing extensor tone may increase function and sitting tolerance, maintain client alignment with the support surfaces, and conserve energy. Active range of motion at the knee and ankle is also provided, reducing risk and progression of range of motion losses.

To provide movement:

Dynamic Footrests lengthen, extend at the knee and ankle, and rotate at the footplate, in response to client forces and then return to a starting position. Dynamic Footrests are recommended to allow movement of the client for the goals of providing vestibular input, increasing alertness, decreasing agitation, increasing sitting tolerance, and increasing function without loss of client alignment with the support surfaces.

(Please only list those goals relevant to an individual client).

To increase lower extremity strength:

Dynamic Footrests lengthen, as well as extend at the knee and ankle, and rotate at the footplate in response to client forces and then return to a starting position. Dynamic Footrests are recommended to allow movement of the client against resistance for the goal of increasing lower extremity strength.

Lateral Knee Pad

Lateral Knee Pads are available for any Dynamic Footrest with knee elevation. These pads are indicated for a client who would otherwise contact the metal surfaces of the Dynamic Footrest with the lateral knee and/or lower leg.

The Lateral Knee Pad is used with the Dynamic Footrest to reduce risk of lateral knee and lower leg contact with the metal surfaces of the Dynamic Footrests (which could lead to pressure or injury) and keeps the lower extremity in alignment with the pelvis, limiting excessive hip abduction.

One Piece Footboard

Manual and Power Wheelchairs include footrest hangers with footplates as a standard option. The footrest hangers typically swing-away and the footplates flip-up to move out of the way for transfers. There are times when standard footplates do not meet the needs of an individual client and a footboard is required instead. The Seating Dynamics Footboard can be used on numerous wheelchairs and flips-up to accommodate transfers. The One-Piece Footboard is available for any Seating Dynamics Static or Dynamic Footrest. The One-Piece Footboard only flips-up on the Static Footrest, at this time.

Depending on available range of motion or contractures of the knee and ankle joints, a client’s foot position may not align with a standard foot plate position. A footboard provides a wider surface to accommodate unique foot placements. Other Seating Dynamics hardware can also be used to accommodate these needs.

The Seating Dynamics One-Piece Footboard is being recommended to accommodate the feet in an atypical location that cannot be supported by standard footplates.

Sometimes standard footplates chronically sag down medially, leading to foot pronation. The One-Piece footboard can be used to prevent this.

The Seating Dynamics One-Piece Footboard is being recommended to prevent medial sagging of the current footplates which is leading to ankle pronation.

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