Previous Prescriptions Do Not Need to Be for Enablensw Funding

Seated Mobility: Wheelchair Accessories/Modifications APPENDIX A

This list is not exhaustive and may be changed without notice. EnableNSW will make the final SEATED MOBILITY: Wheelchairs Accessories and Modifications

Accessories or modifications Clinical Criteria Eligible Prescriber Request Process

STANDARD ACCESSORIES or MODIFICATIONS not provided as standard feature for basic model of the requested wheelchair.

 Stump support  Provided on request Registered  Pelvic/lap belt occupational  Standard pressure reducing foam therapist; cushion Registered  Amputee set up Physiotherapist *  Standard head rest or head rest extension  Vehicle tie down points  Solid tyres  Anti tips  Brake extension handles  Scissor style brakes  Standard footrest available with model of wheelchair  Hip or skirt guards  Portable oxygen holder  Lights for PWC  Growth kits Meets at least 1 of criteria below:  Child anticipated to grow during the life of the chair  Person has history or frequent excessive weight gain or weight loss CUSTOMISED ACCESSORIES or MODIFICATIONS that are not provided as standard feature on the base model of the requested wheelchair.

Armrest options: Meets all criteria below: Registered Occupational Additonal Information: removable; drop down; lock down; front  Standard options trialled and not suitable therapist or Registered Information regarding functional locking; safety flip up or similar; wider pads;  Required for postural control, safety or Physiotherapist with > 1 outcomes of trials of standard trough supports; modified height security during mobility, self care tasks or to year experience and 3 items is required. facilitate transfers previous prescriptions ** Frame: Modified height (lowered or raised)  Required for independent standing or sliding

* Registered nurses may request items in this category in circumstances in which an occupational therapist or physiotherapist is unavailable. Please contact a n EnableNSW Equipment Advisor before submitting a request transfers Backrest – Basic: Meets at least 1 of criteria below: Tension adjustable; Padded; Flat; modified  Body shape or size requires non-standard height; Mesh; backrest to provide sufficient postural support  Required to allow use of lateral supports Footrest options: Meets all criteria below: Non-standard angle; modified height or  Standard options trialled and not suitable size;  Required for postural control, safety or security during mobility, activities of daily living or to facilitate transfers Headrest - custom: Meets all criteria below: Off set mounting, non-standard head rests  Standard options trialled and not suitable  Required for postural control, safety or security during mobility, communication and/or activities of daily living Handrims: Successful trial of this item with documented Ergonomic, capstan, rubberised increase in propulsion or reduction of symptoms Plus meets at least 1 of criteria below:  Documented history of wrist and upper limb pain  Person has insufficient hand and/or upper limb function to use standard push rims Leg rests – manual elevating Meets at least 1 of criteria below:  Required due to postural support needs  Person has a health condition, that requires leg elevation  There is demonstrated reduction in leg odema with leg elevation that is unable to be managed by other strategies  Power conversion kit for manual See Seated Mobility Clinical Criteria for manual wheelchair wheelchair with power conversion kit/ power assist wheelchair – self propelled or attendant controlled.

**Previous prescriptions do not need to be for EnableNSW funding Seated Mobility Clinical Criteria –Appendix A: Wheelchair Accessories and Modifications – August 2016 Additional wheel for manual wheelchair Meets all criteria below:  Person lives on a rural property Not provided:  Person is an independent wheelchair user - for recreation  There has been a trial in the environment of - in addition to a power conversion kit use that demonstrates measureable improvement in mobilising (e.g. endurance, speed) compared to using a manual wheelchair alone  Person is able to independently remove the additional wheel for access within the home and for transfers

Non-standard wheels, tyres and castors Meets all criteria below:  Person is an independent wheelchair user  There has been a trial in the environment of use that demonstrates measureable improvement in mobilising (e.g. endurance, speed) compared to using the included tyres, wheels or castors for requested model of wheelchair

Spokes – non standard, custom or Meets all criteria below: designer spokes, mags, spoke  Person requires a non-standard spokes in decorations order to remove wheels independently in order to stow in car  There has been a trial that demonstrates a measurable difference between use of standard and non standard/custom spokes Spoke guards Meets all criteria below: Not provided as a replacement for carer  Transit wheels are other style of wheels have education/supervision been considered and not suitable/available  Person has poor hand function/sensation/upper limb extensor tone and is a risk of injury due to trapping fingers in spokes

**Previous prescriptions do not need to be for EnableNSW funding Seated Mobility Clinical Criteria –Appendix A: Wheelchair Accessories and Modifications – August 2016 NON-STANDARD POWER FEATURES FOR POWER WHEELCHAIRS not provided as standard feature on base model of the requested wheelchair

Attendant control only The person’s weight, ancillary equipment (e.g. Registered Occupational Additional Information: ventilator), carer abilities or main environment of therapist or Registered Complete Relevant section of Not provided for residents of aged care use prohibit pushing an attendant propelled Physiotherapist with > 1 Question 4 on seated mobility facilities wheelchair. year experience and 3 Equipment Request form and previous prescriptions ** provide documentation of carer’s health condition if required

Attendant control mounting in addition Person has sufficient ability to control the power Additional Information: to individual’s controller chair in some situations but not others, due to Details of frequency and manoeuvrability in confined spaces, safety environments of use for Provided as standard where a person uses concerns, variable consumer skill or fatigue independent and attendant an alternative controller (eg chin or head levels control use is required control)

Elevating leg rests - power Meets at least 1 of criteria below:  Required due to postural support needs  Person has a health condition, that requires leg elevation  There is demonstrated reduction in leg odema with leg elevation that is unable to be managed by other strategies

Recline – manual Use of Tilt-in-Space has been considered and is (non-standard feature) not suitable to address pressure care, postural needs or accommodate deformities

Recline - power Meets all criteria below:  Use of Tilt-in-Space has been considered and is not suitable to address pressure care, postural needs or accommodate deformities  Person is able to reposition self when return to upright position

**Previous prescriptions do not need to be for EnableNSW funding Seated Mobility Clinical Criteria –Appendix A: Wheelchair Accessories and Modifications – August 2016 Seat elevation – power Meets all criteria below: Not provided to replace the need for  Raised or changeable seat height enables the environment / household/workplace person to independently transfer modifications  The required transfer height is not functional for other activities  Person does not use a hoist  Feature is used for majority of transfers

Seat to floor – power Meets all criteria below:  Provided for people who can mobilise in some manner on the floor and can transfer independently to the seat when aligning with floor level  This feature is used for the majority of transfers  Person does not use a hoist CUSTOM-MADE ACCESSORIES AND MODIFICATIONS

Alternate controls (i.e. chin Meets all criteria below: Eligible Prescribers: List names and clinical service control, sip and puff, head array,  The person cannot use a regular joystick Registered Occupational of members of multidisciplinary scanners)  Person has demonstrated safe control of Therapist or registered team consulted and in An attendant controller is provided as wheelchair with alternate control physiotherapist with > 3 agreement with prescription standard year experience and 5 must be listed on equipment Ventilator trays or mounting for Meets all criteria below: previous prescriptions** request form. respiratory equipment  Need for respiratory support when using plus 1 or more members wheelchair of multidisciplinary team  Other options such as bags are unable to be or prescribed in mounted due to stability issues consultation with a  Respiratory team have been consulted seating service. regarding the type of equipment and need for mounting Excluded accessories or modifications  Bags and bag hooks  Cup holders  Non-standard colours and upholstery  Sunshades  Sit to stand power function  Vehicle docking systems

**Previous prescriptions do not need to be for EnableNSW funding Seated Mobility Clinical Criteria –Appendix A: Wheelchair Accessories and Modifications – August 2016  Designer spokes and spoke decorations

**Previous prescriptions do not need to be for EnableNSW funding Seated Mobility Clinical Criteria –Appendix A: Wheelchair Accessories and Modifications – August 2016