Sample Medical Justification – Dynamic Rocker Back interface

The following are sample medical justification wording for the Seating Dynamics Dynamic Rocker Back interface which may be used in funding documentation, such as a Letter of Medical Necessity. Justifications are listed by 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 funding documentation, please contact us for help.

To prevent equipment breakage and/or client injury

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

The Dynamic Rocker Back moves posteriorly in response to client force and assists the client back to an upright starting position. The Dynamic Rocker Back is 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. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, and hardware. Breakage may result in the client being unable to use their wheelchair and/or seating system until repairs are completed and in injury to the client from contact with damaged or broken wheelchair components. (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:

The Dynamic Rocker Back moves posteriorly in response to client force and assists the client back to an upright starting position. The Dynamic Rocker Back is recommended to absorb client forces which could lead to client injury and/or equipment breakage. The dynamic components absorb these excessive forces, reducing risk of client injury and breakage of the wheelchair frame, seating system, hardware and in injury to the client from contact with damaged or broken wheelchair components. Breakage may result in the client being unable to use their wheelchair and/or seating system until repairs are completed.

To absorb extensor forces

The Dynamic Rocker Back moves posteriorly in response to client force and assists the client back to an upright starting position. The Dynamic Rocker Back is recommended to absorb forces resulting from active client extension. By absorbing and diffusing these forces, active extensor tone may be decreased. Reducing extensor tone may increase function, sitting tolerance, and conserve energy. Active range of motion at the hips is also provided, reducing risk and progression of range of motion losses.

To provide movement

The Dynamic Rocker Back moves posteriorly in response to client force and assists the client back to an upright starting position. The Dynamic Rocker Back is recommended to allow movement of the client for the goals of providing vestibular input, increasing alertness, decreasing agitation, increasing sitting tolerance, and increasing function.

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

To increase trunk strength and postural control

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