Oskar Krantz & Hanna Egard Purpose: The aim of this study was to describe the everyday life experience of being an experienced active wheelchair user in Sweden. Method: A qualitative approach, based on interviews, was chosen. Eleven active wheelchair users were interviewed; the results analysed by means of a thematic content analysis. Results: Two main categories, each with two sub-categories emerged: (1) Challenges and changes (life-course perspective); and (2) the ambassador of differentness (activities and situations). The first sub-categories: (1a) the changing self (attitudes and values); and (1b) getting older (the meaning of experiences for future expectations). The second sub-categories: (2a) the responsible representative (having to represent a general image of disability); and (2b) other's attitudes (interactants' expressions of attitudes). Conclusions: An active wheelchair user can be seen as an open person, a representative of other wheelchair users. Interactants can actively engage in solving non-existing problems, or over-estimate actual problems, i.e. over-attentiveness.
The personal experience can change over time, e.g. to care less about over-attentiveness, or to engage less in situations where over-attentiveness is likely to occur, i.e. impression management. Also, regular interactants can learn to see the wheelchair as something normal, sometimes even forgetting it.To use an active wheelchair affects interaction in everyday life, rendering the user an open person, possible to address at will as a representative of other users as well.The experienced user of an active wheelchair is the expert concerning her/his present capacity in activities in everyday life; possible obstacles remain inert until defined otherwise by the user.Keywords:Active wheelchaireveryday lifenormateopen personover-attentiveness Log in to Taylor & Francis Online Or purchase it * 24 hours access for USD 54.00 30 days access for USD 236.00 * Local tax will be added as applicablePlease, wait while we are validating your browserUltralights Can Maximize Consumers' Independence, but First, ATPs and Clinicians Have to Make Their Case
The calling card of the ultralightweight manual wheelchair (HCPCS code K0005) is indeed its very light weight. Thanks to the best materials (top-grade titanium and aluminum) and the best engineering practices and designs, many of today’s K0005 frames weigh far less than 20 lbs. Their high-level performance and their sleek good looks make ultralightweight chairs much revered and sought after by active full-time wheelchair users. Ultralights are also admired by the ATPs and clinicians who work with those consumers. K0005s can offer customized fit and configurability unmatched by other manual wheelchair types (see sidebar), which occupational and physical therapists certainly appreciate when working with clients who have complex seating & mobility needs. On the funding side, however, ultralight chairs can be a challenge to get approved by payors who would rather pay for less expensive, less adjustable and less fully featured equipment…and scrutinize K0005 claims accordingly.
Manual Chair HCPCS Codes K0001: Standard manual wheelchair K0002: Standard hemi-height manual chair K0003: Lightweight manual chair K0004: High-strength lightweight manual chair K0005: Ultralightweight manual chair K0006: Heavy-duty manual chair K0007: Extra heavy-duty manual chair Therefore, the seating & mobility team has to do more than just think about a K0005 in terms of clinical need. The team also needs to document that need well enough to satisfy the funding source. What clinical issues might lead a clinician or ATP to consider assessing a client for an ultralight chair? Tina Roesler, MSPT, ABDA, director of education and international sales for TiLite, notes the importance of getting a good client history and says key questions include, “Does the client have a history of upper-extremity pain or dysfunction? Is the client experiencing any pain with propulsion currently?” Asked which mobility-related diagnoses might signal a need for an ultralight chair, Steve Boucher, OTR/L, ATP, clinical educator for Sunrise Medical, says, “Personally, I do not focus as much on diagnosis as I do on clinical presentation.
However, individuals with paraplegia, higher-level quadriplegia, hemiplegia, multiple sclerosis, brain injury or those with developmental disorders such as cerebral palsy, spina bifida and muscular dystrophy can maximize their independence with the use of a K0005 mobility base.” Roesler agrees that using diagnoses to choose a chair isn’t the best strategy: “Every client is different, and really, I don’t believe selection of an ultralight chair should be solely driven by diagnosis. The important piece is the client’s functional potential and the long-term goals that have been determined in therapy. If the client has the motivation and the functional capacity to self propel, an ultralight is appropriate.” Once you’ve determined that the K0005 frame will meet your client’s needs, the second challenge begins: convincing your funding source. Lois Brown, MPT, ATP/SMS, director of clinical operations & education for National Seating & Mobility, says it’s important from the start to establish how an ultralight — compared to a less-adjustable chair — will significantly improve the client’s ability to perform at least one mobility-related activity of daily living: toileting, bathing, feeding, dressing or grooming.
Documentation needs to specifically involve performing an MRADL, rather than just the client’s ability or inability to get to the kitchen or bathroom. So Brown says documentation could describe specific adjustments to the ultralight frame that would significantly impact MRADL performance, decrease pain using a pain scale rating, reduce the need for pain medication due to improved chair configuration, or enable full-day wheelchair use versus frequent rests. While the client may have sufficient strength and range of motion for manual wheelchair propulsion, Brown says clinicians should note cardiac or respiratory issues when the weight or configuration of an ultralight frame could make a diff erence versus less-adjustable frames. “Ultralights are prescribed when end users are unable to or have increased difficulty propelling a lower-coded chair due to clinical deficiencies such as a compromised cardiopulmonary system, upper-extremity (UE) weakness, a decrease in UE range of motion, decreased endurance for propulsion, spasticity, pain with propulsion, and orthopedic deformities,” Boucher says.
“In some situations, the client’s ability to transfer to and from their wheelchair requires a lower or higher seat-to-floor height that K0001-K0004 chairs cannot offer.” Being able to offer data about how a client could benefit from a K0005 — such as how he says his shoulder pain decreases from a score of 7 to 1 when propelling an ultralight — requires understanding how the ultralight differs from lower-coded chairs, particularly the highstrength, lightweight K0004 chair. Key points to remember about the K0005: This is the K0005’s ultimate distinction for clinicians and ATPs who need to dial in a chair to very exacting and unique specifications for complex rehab clients. “The adjustable axle plate allows for center-of-gravity (horizontal shift ), seat-to-floor height (vertical shift ), camber, and lateral axle spacing (inward or outward) adjustments,” Boucher says. “These adjustments offer a tremendous benefit to our end users when implemented correctly.”
Brown points out that K0004 chairs have some ability to adjust, but at a price: “You can change a K0004 to have a lower rear seat-to-floor height than front, but you need to change the rear wheel and the casters to accomplish that, which aff ects the ability of the chair to roll efficiently. So when I want to achieve a lower rear seat-to-floor height than the front, that’s a critical feature of the K0005: I’m able to accomplish it without changing the roll of the chair.” Seat back options: “There’s also seat-to-back angle adjustment and back height specificity,” Brown says. “If you use a K0004 and that back’s too high, it can push the shoulders forward, which changes the biomechanics of the upper body and also affects the client’s ability to efficiently propel and, again, complete their daily activities.” Weight: This is probably the most popular factor among consumers, and it’s true: Ultralight frames can weigh far less than lower-coded ones. The key, however, is to underline the importance of that weight savings by tying them back to those MRADLs.
“[K0004s] are supposed to be less than 34 lbs., but you can have a K0005 that weighs significantly less,” Brown points out. “Remember the weight of the total system you’re creating. If you start with 33 lbs. and you add a 5-lb. cushion and a 4-lb. back, then you have to look at the effect on the person’s propulsion abilities based on the total weight of the chair. If you start high, based on what you have to add, obviously propulsion efficiency is decreased, there’s more respiratory demand, there’s more fatigue, the whole system is heavier for pushing.” “Advancements made with implementing 7000-series aluminum in K0005 frames have further provided benefit to end users, as these frames can reduce the weight of a wheelchair significantly,” Boucher says. As mentioned, the K0005 isn’t the only type of manual chair capable of being adjusted. It stands alone, however, in its wide range of adjustability. “Study after study shows the importance of made-to-measure chairs in relation to maximizing function and preventing upper-limb injuries,” Roesler says.
“Ultralight chairs are more adjustable, lighter weight, and overall more efficient to propel. While Medicare focuses on the ability to change rear wheel position as a differentiating factor — it is much more than that. The ability to change rear-wheel position for optimal propulsion is extremely important, but the type and amount of adjustment is, too.” Roesler explains that for complex rehab consumers, seemingly minute adjustments can make a huge functional difference. “For some people, proper configuration means moving the axle forward 1/2". While some lightweight chairs might offer one or two rear wheel positions, you really aren’t able to fine-tune or optimize for the individual. You also tend to have more options available for critical components, such as rear wheels, handrims, front wheels, tires, and frame sizes and geometry. All of these options will help maximize someone’s functional potential.” In other words, it’s not just an optimized configuration, but also improved ride that can make the K0005 a much better choice for the full-time self-propeller. "