February 2014 • Vol. 13 No. 2 Serving the Seating & Mobility Professional

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February 2014 • Vol. 13 No. 2 Serving the Seating & Mobility Professional Tilt by the Numbers

Tilting in a to provide weight shifting is a proven method of pressure relief — but it has to be done correctly. Creating a successful tilt regimen requires more than just knowing the best-practice numbers; it requires teamwork and communication on the part of both ATP and consumer. mobilitymgmt.com On the Cover Understanding tilt 22 Automotive : requires more than just knowing best-practice numbers. What’s Up the Road for 2014? Cover by Dudley Wakamatsu. The adaptive automotive technology segment — aka, the mobility industry — is seeing changes both internally (new players) and in Washington (a push for new poli- cies). Here’s what dealers and manufacturers have to look forward to this year.

8 Editor’s Note 29 Ad Index 9 MMBeat 30 CMS Update

24 Marketplace: Accessibility More K0823 Widespread Review Results Are In 28 Product Revue

What’s New Online: MobilityMgmt.com & TheMobilityProject.com

Make the most of your Mobility Management magazine be viewed 24/7 after registration. Also use MobilityMgmt. subscription by taking advantage of additional resources on com to subscribe to eMobility, our free newsletter that MobilityMgmt.com. Check out the availability of our latest keeps you up to date on industry, and educational Webinars: Past Webcasts are archived and can funding/policy news between MM issues.

Mobility Management (ISSN 1558-6731) is published monthly by 1105 Media, Inc., 9201 Oakdale Avenue, Ste. 101, Corporate Headquarters: Chatsworth, CA 91311. Periodicals postage paid at Chatsworth, CA 91311-9998, and at additional mailing offi ces. 1105 Media Complimentary subscriptions are sent to qualifying subscribers. Annual subscription rates payable in U.S. funds for non- 9201 Oakdale Ave. Ste 101 Chatsworth, CA 91311 qualifi ed subscribers are: U.S. $119.00, International $189.00. Subscription inquiries, back issue requests, and www.1105media.com address changes: Mail to: Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866, email MOBmag@1105service. Media Kits: Direct your Media Kit requests to Lynda Brown, 972-687-6781 (phone), com or call (847) 763-9688. POSTMASTER: Send address changes to Mobility Management, P.O. Box 2166, Skokie, IL 972-687-6769 (fax), [email protected] 60076-7866. Canada Publications Mail Agreement No: 40612608. Return Undeliverable Canadian Addresses to Circulation Dept. or XPO Returns: P.O. Box 201, Richmond Hill, ON L4B 4R5, Canada. Reprints: For single article reprints (in minimum quantities of 250-500), e-prints, plaques and posters contact: PARS International © Copyright 2014 by 1105 Media, Inc. All rights reserved. Printed in the U.S.A. Reproductions in whole or part prohibited Phone: 212-221-9595 except by written permission. Mail requests to “Permissions Editor,” c/o Mobility Management, 14901 Quorum Dr, Ste. E-mail: [email protected] 425, Dallas, TX 75254 www.magreprints.com/QuickQuote.asp The information in this magazine has not undergone any formal testing by 1105 Media, Inc. and is distributed without any This publication’s subscriber list, as well as other lists from 1105 Media, Inc., is available for rental. For more information, warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. please contact our list manager, Jane Long, Merit Direct. Phone: 913-685-1301; e-mail: [email protected]; Web: www. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved meritdirect.com/1105 in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry. mobility 4 february 2014 | management mobilitymgmt.com FREEDOM DESIGNS

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mobilitymgmt.com Volume 13, No. 2 What I in Th is FEBRUARY 2014 Editor Laurie Watanabe (949) 265-1573 Industry (& Why) Associate Editor Cindy Horbrook (972) 687-6573 Group Publisher Karen Cavallo (760) 610-0800 Last month marked my 12th anniversary with Mobility Management, going all the way back to our spring 2002 launch. Group Art Director Dudley Wakamatsu Because of that — and because February is the month that we set aside for recognizing things we Director, David Seymour love, and because sometimes you just gotta throw out some good energy so all the bad news doesn’t Print & Online Production drown you — I’m using this month’s space for a rather arbitrary and nowhere near complete list of what I Production Coordinator Charles Johnson

love about this industry, about your industry. Director of Online Marlin Mowatt I love this industry’s bountiful heart. Countless people working in mobility, seating and accessibility Product Development started here because someone they cared about needed an innovation that would help them get National Sales Manager Caroline Stover out of bed, help them meet friends on the playground, or help them get to grandkids’ soccer games. (323) 605-4398 You have never forgotten why you started here, and you still get your greatest kicks from aff ecting individual lives. In MMBeat this month, we recognize a handful of recent good deeds: Manufacturers, SECURITY, SAFETY & HEALTH GROUP organizations, providers and ATPs putting aside profi t margins and harried schedules for a little while President & Group Publisher Kevin O’Grady to pull together and make something great happen. Group Publisher Karen Cavallo I love innovation. It’s how the industry started, and it’s heartening to see that despite all the funding Group Circulation Director Margaret Perry cutbacks, the red tape, the agencies that so often seem to be letting benefi ciaries down, products are Group Marketing Manager Susan May still being improved. Upgraded. Redesigned. Invented. Take a look at Product Revue (page 28) to see what industry veterans are up to, and also at pages 10-11 to see some mobility concepts a little more outside the box. I love pressure relief. One of the fi rst educational sessions I ever attended was given by Tina Roesler, and it was on pressure sores. I saw those PowerPoint slides of stage 3 and 4 ulcers and was hooked. President & Neal Vitale Pressure mapping? Weight shifts? Cushions and backs? Elevating legrests? If it relieves pressure, I love it. Chief Executive Offi cer So naturally, I also love tilt. Power and manual. (I’m sure it’s sheer coincidence that our cover feature Senior Vice President & Richard Vitale this month is “Tilt by the Numbers,” starting on page 16!) Chief Financial Offi cer I love cars. I originally came from the automotive industry, and since I’m from California as well, in my Executive Vice President Michael J. Valenti head I can’t separate independence from horsepower. See page 22. Vice President, Christopher M. Coates I love WC-anything, of course. WC19 is cool, WC20 is awesome, and I can’t wait to start talking about Finance & Administration WC18, coming up next year. (Again, see page 28!) Vice President, Erik A. Lindgren I love and accessibility. C’mon, I’m 5' tall. How much of my kitchen shelving do you Information Technology & Application Development think I can reach? Vice President, David F. Myers I love ultralights, which get more gorgeous all the time. I see those curves and stances, and I think Event Operations elegance. Or Ferrari. Who says clinical effi ciency and performance can’t also look great? Not ultralight manufacturers! Chairman of the Board Jeff rey S. Klein I love power chairs and their electronics. Some of it is over my head, but I see how these sleek REACHING THE STAFF machines can be driven via, like, a fi ngertip and I think, magic. I love early intervention. The right technology in the hands of the right clinicians and ATPs can result Staff may be reached via e-mail, telephone, fax, or mail. A list of editors and contact information is also available in a kid attaining independent mobility right on time. Enough said. online at mobilitymgmt.com. I love buckles and ankle huggers and armrest pads, and all the components that form something E-mail: To e-mail any member of the staff , please use the much greater than the sum of their parts. I really love how much engineering attention and design following form: [email protected] Dallas Offi ce (weekdays 8 a.m. - 5 p.m. CT) detail these “little” parts receive from their devoted makers. Telephone 972-687-6700; Fax 866-779-9095 I love dynamic seating. I especially appreciate it after I’ve stepped off a plane. 14901 Quorum Drive, Suite 425, Dallas, TX 75254 And speaking of planes, I love the chocolate in Canada. Next month’s issue is our International Corporate Offi ce (weekdays, 8:30 a.m.-5:30 p.m. PT) Telephone 818-814-5200; Fax 818-734-1522 Seating Symposium special, bringing together all these great things and many more in one edition as 9201 Oakdale Avenue, Suite 101, Chatsworth, CA 91311 we head to Vancouver. ●

Laurie Watanabe, Editor [email protected] mobility 8 february 2014 | management mobilitymgmt.com mm beat

Numotion Announces Latest Rehab Business Acquisitions

Numotion continues to grow, as the nationwide provider addition of Barnes’ seven locations in Georgia and Florida greatly announced its latest acquisitions of complex rehab technology expands our coverage and improves access to complex rehab tech- businesses. nology to residents throughout the region.” Numotion has acquired the custom mobility division of Barnes Numotion announced in late December that it had also acquired Healthcare Services, which has offi ces in Alabama, Florida and the Myrtle Beach rehab division of Southeastern Health Plus in Georgia, and serves pediatric and adult clients with complex seating Murrells Inlet, S.C. & positioning needs. “Th e sale of our rehab division allows us to focus almost exclusively In announcing the acquisition, Barnes Healthcare CEO Charlie on our and prosthetics business, which we plan to expand Barnes III said, “Barnes Healthcare Services has been providing into other states,” Southeastern Health Plus CEO Ralph Lombardo various healthcare services to customers in the southeast region for said in an announcement about the acquisition. more than 104 years. Th e sale of our custom mobility division allows Southeastern Health Plus has additional locations in St. Matthews us to position ourselves for the future and focus on other service and Summerville, S.C. Th e company also sells accessibility products, a lines, including pharmacy, respiratory services, nutrition and medical range of DME and adaptive automotive equipment. supplies, as well as develop programs that align with the current and Neill Rowland, a regional VP for Numotion, said the latest future healthcare environments.” Southeastern Health Plus acquisition “allows Numotion to expand its “We are excited about the professional team at Barnes joining complex mobility business throughout the state and provides greater Numotion, as they have a strong reputation in customer service,” access to rehab equipment to residents needing these products and Numotion’s regional VP Bill Boyce said in the news statement. “Th e services.” ● TiLite Expands Sales Rep Agreements

aving already announced a new Canadian sales partnership in additionally sell TiLite products in Tennessee and Mississippi. HSeptember, TiLite has unveiled additional sales representation MSL Associates will continue to represent TiLite in North deals that it says will expand its sales agreements with ROHO Inc., Carolina and South Carolina. Target Medical and Permobil. Th e new sales representation agreements began Dec. 1. In September, TiLite announced that its ultralightweight “We are excited to extend our partnerships with these top players manual would be represented by Permobil in Canada. in our industry,” said TiLite CEO David Lippes in the announce- Th e latest announcement, released at the end of October, said that ment. “Each has proven their dedication to TiLite’s vision that what Permobil will be representing TiLite in Florida and Puerto Rico, matters most is the outstanding wheelchair experience we deliver as well. to the people we serve. Permobil, ROHO and Target Medical will ROHO Inc. will represent TiLite in Illinois and most of now play larger roles in delivering the most advanced and best- Wisconsin, the announcement added. ROHO has been repre- performing manual mobility product line in the world.” senting TiLite in Michigan and will continue to do so. TiLite, headquartered in Pasco, Wash., manufactures ultralight- Target Medical — which already represents TiLite in Ohio, weight, custom-fi tted aluminum and titanium manual wheelchairs Indiana, Kentucky, Pennsylvania and West Virginia — will now for active adult and pediatric consumers. ● mobilitymgmt.com mobilitymanagement | february 2014 9 mm beat

WHILL Sets Power Chair Pricing for 2014 Launch

An Abilities Expo attendee takes a seat in the new WHILL power chair. Photo courtesy WHILL Inc. Expo consumer event in San Jose, Calif., and Mizushima said the manufacturer “received so many good reactions" from event attendees. Th e manufacturer also attended the famous Consumer Electronics Show (CES) in Las Vegas in January.

A New Design Japanese engineers previously with consumer electronics fi rms such as Olympus and Sony designed the WHILL, which has four wheels but can turn in its own space thanks to front wheels that move in multiple directions in a fashion similar to a ball bearing. apanese power wheel- Consumers steer using the levers — which also act as armrests — Jchair manufacturer WHILL is that extend diagonally from the sides of the chair. Th e armrests move preparing to deliver its fi rst chairs in the second quarter of 2014 and out of the way during transfers or to enable its user to roll under a has opened up its Web site to accept pre-orders and $500 deposits. table. Consumers can steer with either their left or right hands. Headquartered in Tokyo, WHILL’s American offi ce is in Menlo WHILL’s Web site says about driving via armrest, “Control is very Park, Calif., and its Web site — whill.jp — said the manufacturer plans intuitive, just like an ordinary joystick.” to hand deliver its fi rst 50 American production units to consumers in Th e WHILL has a top speed of 6 mph and a user weight capacity of California in the April-June timeframe. 300 lbs. Its team says it can navigate 10° slopes, weighs 176 lbs., and Consumers are being invited to order a WHILL by placing a down can climb obstacles up to 3" high. payment of $500. Th e WHILL’s retail price is expected to be $9,500. Th e WHILL measures 23.6" wide and 32.5" long. Its seat width is 17.7x17.7". A Retail Purchase Atsushi Mizushima, WHILL’s director of product development, The First 50 WHILLs confi rmed toMobility Management that the current power chair model Th e manufacturer will start distributing WHILL units in its home does not have a HCPCS code and is not eligible for reimburse- state of California in April through June, Mizushima says. ment — though Mizushima didn’t rule out that possibility for the future. “We’d like to see and interact closer with our early adopters so that “We aspire to get over the stigma attached to wheelchairs and desire we can improve our product further, take responsibility of main- to make people on mobility devices happy just because they are on the tenance and support, and understand how the maintenance and mobility devices,” Mizushima said, in explaining the lack of HCPCS support would work,” he notes in explaining why distribution will code. “As such, we don’t want to make it perceived as or be a ‘medical start in California. device,’ but we want to make it a personal mobility device that even Th ose fi rst 50 units will be delivered by the manufacturer itself. non-disabled people want to ride, so that the users of our device can WHILL is considering a diff erent distribution method for subsequent be proud of the device they are using.” units. Mizushima says, “While we’ve been talking with some candi- He added that WHILL is “defi nitely considering a Medicare- dates, nothing is decided regarding this.” eligible model in the future," but isn't ready to set a timeframe for it. WHILL is aiming to deliver chairs to consumers in other states as Th e WHILL made its American debut in November at the Abilities well as Japan in late 2014, Mizushima adds. ● mobility 10 february 2014 | management mobilitymgmt.com mm beat

Seeing Power Chairs Through Diff erent Eyes Ziesel Off -Road Vehicle Is Joystick Driven

ustrians know a thing or two about snow — navigating Athrough it, working with it, having fun in it. Maybe that heritage led to the development of the Ziesel, an “off-road driving machine” that looks strikingly like a power wheelchair and is driven via joystick. But its manufacturer makes no mention of medical necessity or clinical benefits in discussing the Ziesel — which, incidentally, means “ground squirrel” in German. Instead, the manufacturer — Mattro Mobility Revolutions GmbH — focuses on the Ziesel’s ability to drive in all sorts of terrain… though snowy landscapes seem to get the most attention. In lauding Ziesel’s abilities, its Web site (derziesel.com/ wordpress/?lang=en) describes “unlimited freedom: Ski slope, toboggan run, ski touring areas, cross-country skiing tracks, the Ziesel can do the tasks of a snowmo- Ziesel takes you through them all.” bile, but more closely resembles an all-terrain power wheelchair. Photos The Web site shows the Ziesel performing tasks ranging from courtesy Mattro Mobility Revolutions patrolling snowy hills to pulling a plow on a farm, in addition to carrying users to picturesque, sunny seashores. from Austria to your local ski Internally, Ziesel’s Web site says the vehicle has “2x PMS elec- slope. tric disc motors” and produces more than 368 ft.-lbs. of torque. Mattro Mobility The vehicle’s top speed is faster than 21 mph. The frame is made of Revolutions says it specializes tubular steel, and yes: That’s a rollbar on top. in the “development of future Not surprisingly, all this outdoor ability doesn’t necessarily transportation concepts with translate to indoor accessibility. The Ziesel is more than 5 feet tall, alternative powertrains.” The more than 47 inches wide, more than 51 inches long and weighs company plans to ship its first more than 540 lbs. including batteries. production run — a total of 20 Ziesel units — this month and said All that power doesn’t come cheaply, either. Online science back in November that it had nearly sold out. This month, Mattro publication Gizmag.com, which filed the story in its “Health & Mobility also plans to invite potential investors and distributors to Wellbeing” section, reports that the Ziesel retails for about $29,000 visit and test drive Ziesel personally. ● in American dollars. That doesn’t include the cost of shipping it — Laurie Watanabe And Yet Another Take on the Power Chair…

nlike Austrian-born Ziesel, which doesn’t call itself a mobility Uvehicle, the new UNiMO, from Japanese manufacturer Nano Optonics Energy, is being called a power wheelchair. The UNiMO’s Adventure model is a track-driven all-terrain power chair, while the UNiMO Grace (pictured in the screen capture) looks like something from the bridge of the Starship Enterprise. UNiMO is an abbreviation of “Unique Mobility,” and Gizmag.com described the Grace as having “clean, minimalist Apple-esque lines” as well as having a much lower retail price point than Ziesel. The chairs were reportedly in production late last year. Check out the designs for yourself at nano-opt.jp/UNIMO_en/unimo_en.html. ● mobilitymgmt.com mobilitymanagement | february 2014 11 mm beat

Invacare Update: Th ird Certifi cation Audit Approval

pproval of Invacare Corp.’s third and fi nal certifi cation audit, Delayed Aowed to the U.S. Food & Drug Administration (FDA) as part of the ongoing FDA consent decree that halted production of of the third certifi cation audit in November 2013. manual and power wheelchairs and components in Elyria, Ohio, Invacare now expects the third-party auditor to return in February has been delayed, the seating, mobility and DME manufacturer has to examine the quality system again. announced. Aft er the third certifi cation report is approved and submitted to the Th e third-party expert conducting the audit met with Invacare FDA, the agency will conduct its own investigation, which could be representatives on Dec. 20 and informed them that “some additional the fi nal step before Invacare is able to return to normal operations. work is required in a few particular areas before the fi nal certifi cation Invacare executives signed the FDA’s consent decree in December report can be provided to the United States FDA,” Invacare said in a 2012. In a Dec. 20, 2012, news announcement, the FDA said its Dec. 23 news release. inspections of Invacare “have documented violations of FDA’s Quality Invacare described the third audit as “a comprehensive review of System regulations, along with failures to properly report adverse the company’s compliance with the FDA’s Quality System Regulation events to the agency.” (QSR) at the impacted Elyria facilities.” Th e consent decree prevented Invacare from designing, manu- facturing and distributing manual and power wheelchairs and A New Complaint Handling System components. Invacare added that the third-party auditor’s remaining concerns In July, Invacare announced that the second certifi cation report center on the manufacturer’s new system for handling incoming had been approved. Th at allowed Invacare to “resume design activi- complaints and Invacare’s risk review processes. ties on the critical new product development projects that will help us “As part of the mediation, the company conducted a comprehensive regain our custom power wheelchair marketshare when we exit the overhaul of its complaint handling system,” Invacare said in a state- injunctive phase of the consent decree,” said Invacare CEO/President ment. “Th is change has led to an increase in the backlog of complaints, Gerald B. Blouch. as the updated procedure now requires the funneling of all sources of In May, Invacare said its fi rst certifi cation report had been approved, complaint data through one system. Th e launch of this new process which regarded “qualifi cation and validation documentation for initially outpaced the company’s ability to add and train new asso- equipment and processes at the Taylor Street manufacturing facility.” ciates to thoroughly address and conduct standard investigations of Th e approval permitted the Taylor Street facility “to resume manu- complaint data.” facturing and distributing parts, components, accessories and subas- Th e backlog of complaints and “the complexity associated with semblies to Invacare facilities other than the Taylor Street or corpo- [Invacare’s] highly confi gurable medical devices” made it diffi cult for rate facilities, for further manufacturing or to provide service related to Invacare to investigate and resolve complaints in a timely manner medical devices manufactured at those other Invacare facilities.” and to demonstrate that it was consistently using the new risk-review In its Dec. 23 announcement, Invacare said it could not predict process, Invacare said. when the third certifi cation report would be completed. In its December 23 announcement, Invacare said the new “While we are disappointed that the fi nal certifi cation report complaint handling system “has been operating for several months, is not ready to be fi led, we have made signifi cant progress in our and the company has been closing signifi cantly more complaints than quality systems improvements over the past two years,” Blouch said are opened. Th e company has added additional contractors to further in the news release. “Notwithstanding our extension of the timeline expedite clearing the backlog in order to achieve and demonstrate resulting from the complexities of this process, the fact remains that sustainable improvement.” our associates have done an incredible amount of work. We remain fully committed to meeting the expectations of our third-party The Timeline Going Forward auditor and ultimately the FDA so we can return to full operations at In earlier announcements, Invacare said it was hoping to get approval our corporate and Taylor Street manufacturing facilities.” ● mobility 12 february 2014 | management mobilitymgmt.com mm beat

A Closer Look: Invacare’s New Complaint Handling System

hile Invacare Corp.’s consent decree with the U.S. Food & complex rehab technology — involved. WDrug Administration is an ongoing situation composed of “We started [the new complaint handling] process and that’s many diff erent components, the focus of the third certifi cation where we weren’t able to add enough associates for what started audit is the manufacturer’s new system for handling and inte- coming through one singular system,” Mahoney explains. “So grating complaints from customers. we’re adding and training associates to help fi nish the backlog, Lara Mahoney, Invacare’s director of investor relations & corpo- and we’re to the point where we’re closing out more complaints rate communications, told Mobility Management, “We met with than are opened. But we just need to work through that process a that third-party expert on Dec. 20 and did get a status report on little further to meet the third party’s expectations.” the third-party certifi cation audit. We’ve made signifi cant progress, The third-party expert is also looking for proof that the new but there were a few areas of the quality system where they said system will work as a long-term solution. we have to do more work, and that was in both our complaint and “We have to manage the backlog, prove that we have this risk review process.” sustainable system, that it’s eff ective,” Mahoney says. “We’re The new system is a complex one that handles all complaints, moving forward. We’re committed to compliance, we’re getting no matter how they were received. this right, it’s just going to take some more time.” “We used to receive complaint data through a variety of areas,” While Invacare doesn’t yet know when it will be back to busi- Mahoney says. “Someone would call into customer service, or ness as usual — after the third certifi cation audit is approved, [the complaint] might come in through the sales force, through the FDA will still need to conduct its inspection and give its fi nal returns, through technical service. Now with our new system, we approval — Mahoney says the changes that have taken place can better track complaints and trend the data to keep better since the consent decree was signed in December 2012 will ulti- track of that. It all goes through one complaint handling system. mately pay off . So all of these diff erent sources of data are now funneling through “All the improvements that we’re making to our quality system, one system.” they’re going to make us a better company,” she notes. “These are The system handles all complaints, regardless of the product good, strong improvements we’ve been making. It’s not just to category — from general DME to respiratory to mobility and get through the consent decree. It’s to continue going forward. ● BOC Announces New Executive Committee & Board Chairperson

he Board of Certifi cation/Accreditation (BOC) has announced a In accepting his new position, Hewlett Tnew chairperson and a new executive committee. said in the news announcement, “I am James L. Hewlett took over the position as the board’s chair on humbled and excited by my colleagues’ Jan. 1, following two terms as its vice chair. Hewlett has also served as confi dence in me, and I recognize the member-at-large and has been a BOC-certifi ed orthotist since 1997. responsibility of leading this important He fi rst joined the board in 2008. organization through a challenging climate. James L. Hewlett “Jim will fi ll the role well,” said John P. Kenney, who completed his I look forward to advancing BOC’s mission two terms as BOC’s board chair. “As vice chair, he already has played to assure patients, physicians, professional organizations, the public an important part in BOC’s strategic direction, and he brings vast at large, and government agencies of the competence, professionalism experience in orthotics, prosthetics and durable medical equipment.” and safe-practice environments of BOC-certifi ed professionals and In addition to Kenney, who becomes immediate past chair, the new BOC-accredited facilities.” executive committee is composed of R. Jeff rey Hedges, vice chair; BOC (bocusa.org), based in Owings Mills, Md., is a not-for-profi t William J. Powers, secretary; James Newberry Jr., treasurer; and Mark agency that provides credentials in the fi elds of orthotics, prosthetics L. Parris, member-at-large. and DME. ● mobilitymgmt.com mobilitymanagement | february 2014 13 mm beat

New Solutions to Distribute PG Drives Technology

PG Drives has named New Solutions its primary In addition, the new agreement gives providers a new way to North American distributor for aft ermarket mobility handle repairs: “Shops can now send in parts to get repaired by controllers. the manufacturer through New Solutions,” the news announce- In a news announcement, New Solutions called the new ment said. “What this means is that DME repair shops can now partnership “great news for everyone.” buy parts, electronic components and make repairs to their “Th is association allows New Solutions to supply PGDT customers’ equipment, all through New Solutions.” products along with its 3,500 other products in its quest to be Curtiss-Wright announced in November 2012 that it had the true ‘one-stop shop’ for all wheelchair and scooter parts.” acquired PG Drives. ● briefl y… Permobil attached a special appreciation card to the joystick of inquire about your copy, every chair it shipped to consumers in the month of December. visit alimed.com or call (800) The card was signed by the Permobil employee who built the 225-2610… Gary Cox, CEO chair — and consumers who return their cards by May 1, 2014, can of PMDRX, has announced choose a free self-levelling cupholder, a $50 Amazon gift card, or his candidacy for state a $50 restaurant gift card courtesy of Permobil “just because your representative, district 30, business is such a great gift to us,” as the appreciation card said. in Arizona. “I decided to run Remind consumers who received Permobil chairs in December because I believe there are that it’s not too late to receive their gifts. Permobil Marketing many issues in the state of Manager Barry Steelman said 2013 was the third year for this Arizona that are not getting addressed in our current legislature,” Cox says. In his position paper, Cox expresses opposition to the Aff ordable Care Act and concern over “Arizona’s Health Care Cost Containment System with the various health plan subcontractors that the state contracts with for the provision of health care coverage. Many of those plans are literally reaping millions of dollars in profi ts at the expense of their contracted physicians, hospitals, medical suppliers, etc., due to the numerous reimbursement loopholes they take advantage of to avoid the payment of legitimate claims.” Cox is planning to run as a Republican candidate in the August primary; the general election is in November… Get ready, curling (and sledge hockey and skiing and biathlon) Reminder: It’s not too late for your new Permobil users to collect their holiday gifts! fans! The Paralympic appreciation program… Author, activist and motivational speaker Games in Sochi, Russia, Spencer West has joined Sunrise Medical Canada’s roster of kick off on March 7. In the Quickie Ambassadors. West, who had both legs amputated United States, a press at the pelvis at age 5, climbed Mount Kilimanjaro using his release from NBC says hands and wheelchair in 2012 and raised nearly $500,000 along it will air 50 hours of Paralympics coverage via NBC and NBCSN, the way to benefi tFree the Children… AliMed has released its sports network. The Canadian Paralympic Committee has its 2014-2015 Rehabilitation, Orthopedics & Skilled Nursing broadcast rights for Canada and is partnering Sourcebook, which includes DME, orthopedic products, wheel- with Sportsnet, Yahoo Canada Sports and other media outlets chair cushions and positioning products, among other items. It’s to broadcast 65 hours of coverage and off er up to 350 hours of free to clinical and administrative staff at qualifi ed facilities: To coverage through digital streaming. ● mobility 14 february 2014 | management mobilitymgmt.com mm beat

Th e IndustryCreating Personal Gives Mobility BackVictories:

ews outlets are quick to pick up any healthcare story loaded sports program, would cost $40,000 to $50,000, so VGM associates Nwith buzz phrases like “Medicare fraud” or “wasted tax dollars,” paid $10 each for the privilege of wearing jeans to work the week of but seem far less interested in the humanitarian work being done by Dec. 30. Th e dollars collected were matched by VGM Group and by industry professionals. Van Miller, the organization’s founder. For instance, Sunrise Medical’s ongoing Propel Donation U.S. Rehab, VGM’s complex rehab division, also contributed to Program awards seating & mobility assistance to consumers who the fund, and U.S. Rehab President Greg Packer worked with manu- might not be able to acquire the technology on their own. Kristyn facturers associated with VGM to replace the chairs. Th e chairs are Campbell, Sunrise’s marketing manager, says Propel Donation serviced by JVA Mobility in VGM’s hometown of Waterloo, Iowa. program committee members review applications once a quarter and And the industry’s recent good deeds extend well beyond North select one or more consumers to receive product donations. American boundaries. Convaid announced in late October that it “Once our recipients have been selected, we work with their local had donated four pallets of lightweight wheelchairs and compo- supplier and ATP to custom confi gure the product that best comple- nents to UCP Wheels for Humanity, an organization that distributes ments and enhances the lifestyle of that individual,” Campbell says. chairs to children and adults in developing countries. UCP Wheels Among the latest for Humanity Executive Director Michael Allen said in the news Propel Donation announcement, “We are so grateful for this gift and our long-standing Program recipients partnership with Convaid. Th eir contributions over the years have is Brandon Holiday, allowed us to provide mobility to thousands of children in need who helps people with around the world, making opportunities like school participation and to express community engagement available to them for the fi rst time.” their competitive fi re Closer to home, Convaid was a sponsor at November’s via adaptive sports. International Rett Syndrome Foundation’s annual Strollathon Holiday — a below- fund-raiser in Th e Woodlands, Texas. Convaid donated a new wheel- the-knee amputee with chair, complete with customization, to the Strollathon raffl e, and systematic lupus and Convaid volunteers performed free seating & positioning adjustments Addison’s disease — had a Quickie 2 ultralight chair, but couldn’t get for event participants who brought along their Convaid chairs. his seating components funded. Bruno Aids helped make a Christmas wish With the support of Curtis Boyer, ATP, from Numotion’s come true for a young baseball fan with cerebral palsy. Sam Wedig, Hatfi eld, Pa., offi ce, Holiday was supplied a JAY Lite cushion and solid 10, is devoted to the Iowa Cubs, the Chicago Cubs’ Triple-A minor insert for added stability, plus a JAY J3 league team. Sam’s aunt called a Des Moines, Iowa, radio station that back with posterior and lateral thoracic was granting holiday wishes and explained that Sam and his grand- support. parents, who are raising him, needed a way to transport the power Th e Propel Donation Program also chair that Sam had received through Iowa Medicaid and Advanced recently awarded a Quickie Q7 and Rehab Technologies, a provider in Urbandale, Iowa. a QM-710 to the Dogsong Animal Th e folks at Advanced Rehab Technologies contacted Bruno, Training & Behavior program in who heard Sam’s story and donated a Joey platform lift to use with Dillon, Colo. Th e chairs will be used to Sam’s grandparents’ 2009 Dodge Caravan. Th e Advanced Rehab help service dogs in training become Technologies crew donated its installation time free of charge. accustomed to wheels, handrims and Now that Sam has a ride, he’s preparing to throw out the fi rst pitch motors. Trainer Lyn Manton Krueger at an Iowa Cubs game this season. ● points out, “It is critical that the dog is comfortable doing all their tasks with their handler in the chair.” Do you have your own story of how your mobility or complex When the VGM Group heard of a Grinch-like crime — a trailer rehab technology business or organization is giving back? Send it carrying sports wheelchairs stolen from a Cedar Rapids YMCA (and high-resolution photos, if available) to the editor: parking lot the week before Christmas — its employees sprang into [email protected]. action. Replacing the chairs, which belonged to the Iowa Chariots mobilitymgmt.com mobilitymanagement | february 2014 15 Seating & Positioning Series

Combining Best Practices with Best Strategies to Create Real-Life Pressure Relief By Laurie Watanabe the surface, a tilt regimen for pressure relief can seem like a numbers from the commonly referenced Consortium of Spinal Cord On mathematical equation: How many degrees? For how many Medicine, administered by Paralyzed Veterans of America (PVA), minutes? How many times a day? To offl oad how much weight? advises that wheelchair users activate their tilt systems every 15 to 30 But complicating this numbers game is the human factor: Th at minutes and remain in the tilted position at least one minute — which every client’s skin health and breakdown risk is diff erent, impacted by equates to tilting two to four times an hour. diff erent circumstances, such as nutrition, age, moisture, heat, sensa- Chris Maurer, MPT, ATP, at the seating & mobility clinic at tion or lack thereof. Th at each client has a diagnosis, but that each Shepherd Center in Atlanta, calls those recommendations “a base- client is unique within that diagnosis. Th at each client has diff erent line.” While Maurer acknowledges that there’s no guarantee that seating equipment in addition to the tilt system: diff erent backrests tilting two to four times an hour will absolutely prevent all skin break- and seat cushions, diff erent legrests, perhaps a recline system as well. down, she says for new patients in a rehab facility setting, “We start And of course, the human factor culminates in diff erent personali- everybody off on that. It gives them somewhere to start.” ties, lifestyles and behaviors. In fact, perhaps the only thing an ATP or She also acknowledges, “When they go home, we know they don’t seating clinician can count on is that a client will not perfectly adhere consistently do that. Aft er they go home and everything settles down, to best practice standards regarding how much to tilt, how oft en and I think the individual fi nds their own frequency at which they need how long. to tilt to keep their skin healthy” — with further recognition, of Th at leaves seating professionals with the challenge of helping course, that “some people do it correctly, and some people come back clients to develop weight-shift strategies that will work clinically as for skin surgery.” well as within the framework of everyday life. Maggie Love, OTR, clinical education specialist for Permobil, calls the PVA guidelines “a great place to start.” But she adds, “Other Tilt Best-Practice Standards factors need to be considered when developing a comprehensive skin- Tilt recommendations vary somewhat from entity to entity, but the management program. Clients that have partial to full sensation may mobility 16 february 2014 | management mobilitymgmt.com be less prone to skin breakdown because they will naturally shift their weight while uncomfortable. Younger clients with new injuries are Typically, tilts greater than 30° are less prone to skin breakdown. As the individual ages and the gluteal considered pressure-relieving tilts tissue atrophies, there is greater risk for skin breakdown.”

A Matter of Degrees ulcers than people who don’t move that much, in addition to studying Th e other critical factor for pressure relief is the number of degrees their actual pressure reliefs. that the wheelchair user tilts back. “We weren’t made to sit stationary.” In a research paper called “Use of Power Tilt Systems in Everyday Life” — published in Disability and Rehabilitation: Assistive Technology Why Don’t Consumers Tilt Enough? in January 2009 — authors Sharon Eve Sonenblum, Stephen Sprigle Th e 2009 study on how and why consumers use their tilt systems and Chris Maurer examined how and why consumers used tilt, and uncovered some interesting information on why clients might not be whether or not they used tilt to perform pressure-relieving weight as compliant as their clinicians would like them to be. shift s. Instrumentation attached to the power chairs recorded how oft en For instance, consumers cited a number of reasons for using tilt. consumers tilted, how many degrees they tilted, and for how long. “Most subjects reported using their tilt for physiological reasons,” Th e authors divided the amounts of tilt used by consumers into Maurer says. “A lot of people did it to address comfort or discomfort, four categories: small (0° to 14°), medium (15° to 29°), large (30° to 44°) rest and relaxation, functional independence and for posture.” and extreme (greater than 45°). Some participants also specifi cally said they tilted to perform pres- One of the conclusions: “Although people used the [tilt] system sure relief. But Maurer says, “Th e subjects who reported pressure relief frequently, so they were moving it a lot, it was seldom used for as a purpose for tilting didn’t perform more pressure-relieving tilts — performing greater than 30° tilts,” Maurer says. Typically, she adds, those greater than 30° — or spend more time in larger or extreme tilts tilts greater than 30° are considered pressure-relieving tilts. than anybody else. Th ey were saying they were doing it for pressure “In a study prior to [the 2009 one], we looked at how does pressure relief, but compared to the others, they didn’t spend any more time in change with increasing angles of tilt, and it turned out to be a linear greater amounts of tilt.” relationship,” Maurer says. “Basically the farther you tilt, the more Why not? Th e answers are complicated, can be unique to the indi- pressure off your seated area occurs. So basically to get the best benefi t vidual consumer, and can range from a lack of knowledge about the out of a tilt system as far as pressure relief is concerned, you need to seating & mobility system to discomfort in social situations. tilt as far as the system goes. Your pressures continue to go down the Equipment wise, Maurer says, “A lot of people I fi nd are very scared farther the system goes, so you need to maximize your tilt.” of using the full range of the tilt: ‘I can’t go this far back, I’m going to Th e 2009 study that used instrumentation to measure amounts of slide right out of my chair.’ It’s scary to them that they can’t move their tilt, Maurer adds, “showed that pretty much nobody did that.” bodies: If the chair starts to tip, there’s nothing they can do about it. I Th e report did note that consumers used tilt frequently. think what’s important to have happen is to have the system delivered “Even subjects who spent 90 percent of their days in small tilt angles in a setting where a therapist and a supplier are together so the thera- used the tilt feature at least once per hour,” Maurer says. Th ose partic- pist can reiterate the need for the weight shift and its eff ect on the skin, ipants routinely sat in a tilted position, but “still moved the system in and they can actually show the patient, bring them through the full and out of it, whatever degree they chose.” range of tilt and prove to them that the chair isn’t going to fall over.” Could using tilt to make those frequent if small adjustments in Maurer says she’s tilted clients back, and then “I’ll hang on the back positioning be similar to the type of constant shift ing and fi dgeting of the chair to show them: ‘Look, I’m sitting on the back of the chair that able-bodied people do while sitting in offi ce chairs, for instance? with you in it and it’s still not going anywhere.’ Just to ease their fear Sharon Sonenblum, Ph.D., senior research engineer at the Center that the chair is going to fl ip over on them.” for Assistive Technology & Environmental Access, Georgia Tech, thinks that’s an apt metaphor. Perceived Compliance with Tilt “It has always been our belief that in general, activity is good,” she says. Other clients may believe they are achieving pressure-relieving tilts Sonenblum and Sprigle authored another tilt-related study in 2011, when they actually aren’t. published in the Journal of Tissue Viability, called, “Th e Impact of “Oft en, patients believe they are being compliant with the tilt Tilting on Blood Flow and Localized Tissue Loading.” Sonenblum regimen when they are not tilting enough to cause tissue reperfusion,” says the research “looked at how the buttocks respond to tilts, and Love says. “It may not be as cut and dried as that, though. I think some- found that even when you do a small movement, the blood fl ow to the times patients believe that while 45° to 50° of tilt is the best, some tilt region increases. So there are physiological benefi ts to the small move- must be ‘pretty good.’ However, the research and pressure mapping are ments. And our current ongoing work is looking at whether people showing that is not the case. Th is is where the pressure mapping system who move — i.e., shift , fi dget — more frequently have fewer pressure puts a visual to the therapist’s words and can be a benefi cial educational mobilitymgmt.com mobilitymanagement | february 2014 17 Seating & Positioning Series Tilt by the Numbers

tool. Pressure mapping was very helpful biofeedback for the clients to for patients with a spinal cord injury, as these individuals pressure see that tilting 25-30° was not an adequate pressure relief.” map diff erently than control subjects, and put more pressure on the IT Other clients may have trouble achieving enough tilt to provide [ischial tuberosity] areas (Jan et al., 2013; Park & Jang, 2011).” pressure relief because they typically sit with their systems tilted to Elevating legrests (ELRs), Love adds, can also help to achieve begin with. optimal weight shift s for pressure relief. “Research has shown that “You’re limited with how far the system tilts back,” Maurer says. using tilt in conjunction with recline and ELRs provides a better pres- “Th e system is only tilting to 50-55° degrees, probably. Th ere are many sure shift than any of the power seat functions alone,” she explains. people that sit at 25° to 30° degrees of tilt, and that’s their constant. So tilting back only gets them another 15° to 20°. People who sit in that When Life Gets in the Way mid range of tilt don’t get much more by going further back.” Some of those scenarios — not knowing how much tilt a system off ers And that 15-20° isn’t enough tilt to attain the amount of tilt needed or being afraid that a fully tilted power chair will tip over — can be to perform the pressure relief that clinicians are aiming for. solved through demonstrations and education. Unfortunately, that’s For those clients, Maurer says, “We tend to tell them, ‘You’ve got not always the case. to go back, and you also have to come all the way up. Because then “If was just an education issue, this would be an easily solved you have more degrees going forward, and that also changes pressure problem!” Love says. “A good portion of clients know they are not as from where you were. At that point they’re sitting on their sacrum, so compliant as they should be and still fail to follow the guidelines due they’ve got to sit up for a short period of time as well as go fully back. to the same reasons some people don’t stick to their diets, or diabetics Th e whole concept is that you’ve got to move your position in which- don’t check their blood sugar, etc. It’s a lifestyle change. Perhaps there ever direction you need to go depending on how you typically sit to are a portion of clients who also don’t believe that skin breakdown change the pressure off that particular spot.” will happen to them: ‘I’m healthy and I move around a lot’ or ‘I’ve had Speaking of tilting all the way back: Maurer suggests making sure a spinal cord injury for years and have never done pressure shift s as that clients realize how much tilt their systems off er. In the 2009 study, oft en as you have told me to.’ Th e reasons for non-compliance are very “the perception of tilt angle was oft en misconceived. Th ey thought individual, and one needs to get to know the client in order to deter- they were all the way back, but they weren’t. Th ey said, ‘Th is is my fully mine the reasons… in order to come up with solutions.” tilted chair,’ and then you’d press the button and they’d keep going Maurer points out that when properly and fully executed, “Tilt is back further. So they think they’re all the way there, but they’re not.” a non-functional position. It highlights their disability, so they don’t Adding recline to the system can be another way to achieve pres- want to. A lot of business workers are in meetings where they’re not sure relief, Love says: “Research is also showing that 25-35° of tilt plus going to pull back from their table and tilt no matter what I say.” 120° of recline is the optimal pressure-relieving position — especially Th erefore, outside-the-box thinking on the part of the ATP and Tilt vs. Life: Real-World Tips “Real life interferes.” curious eyes could make them more willing to perform weight That’s the opinion of Chris Maurer, MPT, ATP, who works in the shifts. Maurer says she’s worked with a businesswoman “who is in seating & mobility clinic at Shepherd Center in Atlanta, regarding why an offi ce by herself, and she’s still self conscious. I said, ‘Just shut the so many wheelchair users don’t use their tilt systems as often as they door so you can do it without worrying about people watching you should to perform weight shifts. tilt back.” “Most spinal cord injury systems do educate people about skin ● “I’m just stretching”: Maggie Love, OTR, clinical education issues,” Maurer says. “They have ugly pictures and all sorts of things to specialist with Permobil, suggests teaching clients to perform other scare people into doing their weight shifts. I also think that when they types of weight shifts that they can use if they feel uncomfortable go home, real life interferes. You go back to work, you’re watching TV, tilting in public, such as “leaning forward on a desk while doing you’re talking to people, and you forget to [perform weight shifts] two computer/school work. ‘Stretching’ while leaning to each side was to four times an hour.” The most eff ective way to change a client’s actions for the better another weight shift that many of my clients felt was more socially might not be showing more pictures of stage 4 pressure sores, but acceptable in a public setting.” rather looking for ways to work weight shifting into the client’s day. ● Incorporate technology: Love points out that weight-shift Some tips: reminders via cell phone, watch or timer “are noticed immediately ● TV commercial = Time to tilt: “Do a weight shift during every by the user, but not overly distracting in a public situation.” And commercial,” Maurer suggests. “At the end of a half-hour show, don’t overlook the potential value of old-school technology, either. weight shift.” The idea is to pair weight shifting with an activity “I even had a client achieve success by using a clicker to log how that happens regularly, so that weight shifting becomes easier to many weight shifts she performed each day,” Love says. “She was remember. shocked to discover she only performed three weight shifts that ● Privacy, please: Helping clients to create a way to tilt away from fi rst day.” ● mobility 18 february 2014 | management mobilitymgmt.com Help Your Clients Transition to a Wheelchair

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clinician can be helpful. “It can be tempting to constantly harp on our patients to stick “Standing can be very benefi cial to decreasing the risk of pres- with the established PVA pressure ulcer guidelines,” Love says. sure ulcers — and an integrated system that allows the user to stand “However, it is important to empower the individual to take control without transferring out of the system can increase compliance,” of their skin management, which can be an important step in long- Love says. “Standing is a very functional weight shift , in addition to term success. having many other medical benefi ts, and may be perceived as more “In addition, it is oft en more helpful to establish yourself as an socially acceptable.” advocate for the patient and encourage open and honest communica- Th e assistive technology providers can help to remove potential tion about skin management solutions. I almost think of the weight tilt barriers by making sure clients remain in control of the system shift program as similar to a diet. We all know that we should eat throughout the tilt range. Th at’s especially a concern for clients who healthy, small portions throughout the day as well as regularly exer- become progressively weaker and fi nd it harder and harder to reposi- cise — however, we don’t always do this. We get tired, social obliga- tion their arms on wheelchair armrests. tions get in the way, etc. Th e most successful lifestyle changes are ones “Make sure they can access their tilt buttons through the full range that are incorporated seamlessly in our daily lives — made convenient of tilt,” she says. “A lot of people who are weak lose contact with the with minimal barriers.” switch when they’re tilted all the way back, so they’re scared and they Sonenblum suggests taking time to train new tilt users: for can’t reach the switch to come back up. Th ey limit how far back they example, “Make sure the client knows that a full tilt feels like [and] go so they can reach the switch.” that they are comfortable, not afraid that the chair will tip over.” And even those frequent less-than-extreme tilts can be encouraged, Aiming for Long-Term Solutions she says. Using tilt to its maximum eff ectiveness requires a high level of educa- “Of course, there’s value in recommending that people move tion — and resolve — from everyone on the seating & mobility team, around between pressure reliefs. When they are not tilting all the way especially the client. back, lots of small movements might help.” ●

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Educating Both Consumers & Policy Makers

Will Remain a Top Priority in 2014 By Laurie Watanabe ere’s a number for you: 1.2 billion. Th at’s the number of media Grass-Roots Success Himpressions that National Mobility Awareness Month made Th e culmination of National Mobility Awareness Month is the in 2012, according to Dave Hubbard, CEO/executive director of the announcement of consumers who have been elected, through public National Mobility Equipment Dealers Association (NMEDA). voting, to receive free mobility vehicles customized to their needs. Th at incredible number is also indicative of the inroads made by Th e contest invites consumers to submit their personal stories the automotive mobility industry in the mainstream media and the and to explain how a new mobility vehicle would impact their lives. minds of the mainstream public, many of whom undoubtedly didn’t Families, friends and entire communities have rallied around contest know that adaptive automotive equipment even existed beforehand. participants to drum up support and votes. National Mobility Awareness Month — again scheduled for May, Th e Awareness Month campaign won a regional marketing with associated activities starting in February — is probably the best award in Florida and won an honorable mention for Integrated known and most widely publicized of NMEDA’s projects, but it’s Communications Campaigns from the American Society of just one of many priorities for the organization this year. Association Executives. mobility 22 february 2014 | management mobilitymgmt.com As for those 1.2 billion impressions from a contest that was held for facturers, like Sure Grip, MPS Hand Controls, Drive-Master, donate all just the second time last year, Hubbard says, “It is amazing, consid- the parts. Th ey’ve all stepped up, and NMEDA coordinates it.” ering it was a grass-roots PR campaign that started as a social media One vehicle winner last year was from Canada, making the eff ort. We’re really proud of the eff ort, and it seems to be generating Mobility Awareness Month program a genuinely international aff air. more and more awareness for the solutions that are available out there Even contestants who don’t win a vehicle can gain valuable atten- and where to buy them. We hope that it generates positive awareness tion through their campaigning eff orts. for NMEDA and its members.” “Local news programming or newspapers and media are picking Th at awareness is critical. Behind the contest’s entertainment value up on the heroes who are campaigning,” Hubbard says. “Th e whole and good-natured competition is the very real fact that too many point is that you’ve got people out there with disabilities who are people with mobility disabilities, their families and caregivers remain campaigning for votes and getting people to vote. And in their unaware of adaptive automotive solutions and the professionals who campaigns, social media is out there, and the media is tracking what’s specialize in them. going on. A lot of these stories are being picked up locally. Th e program is now in its third year, and Hubbard has noticed a “A lot of times the local community will get involved to support change in entrants’ approaches. this hero, and it just begins to mushroom. Th e really beautiful thing In its inaugural year, he recalls, “We got a lot of ‘I need, I need, I need.’ from our standpoint is it generates awareness for mobility solutions But the second year, they caught onto the idea that we were looking for and comes back to that age-old problem in our industry: that people the inspirational stories. It is a question of need in a lot of cases, but it’s just don’t know what’s available.” also a question of ‘What are you doing in your life to be inspiring to other people with disabilities or other people who need help?’” Educating Policy-Makers NMEDA’s 2014 educational plans don’t end with consumers and Industry-Wide Donations caregivers. Hubbard says the organization will continue to spread the In return, the mobility industry has come together to donate equip- word about the value of the technology and its professionals to policy- ment and expertise to ensure that the winners receive vehicles that are makers, as well. individually customized to their particular needs. “Our government relations eff orts this past year have focused on While the automotive manufacturers — such as Chrysler and Congress and the VA (Veterans Aff airs),” he notes. “We’ve been trying Toyota, who have already agreed to donate new vehicles for the to get the VA to establish criteria for selecting mobility dealers; they 2014 contest — oft en get the most attention for their contributions, don’t have anything in place right now. Th ey can send [a veteran in Hubbard points out that many other sponsors also donate products to need of mobility equipment] to anybody, whether they’re qualifi ed or make customizations possible. not. And we’ve got veterans that don’t even know there’s a [mobility “Our own manufacturers — Braun, VMI, some of the smaller ones equipment] grant program out there for them.” like Q’Straint and Drive-Master — they’ve all stepped up and donated NMEDA is also working to teach the value of its members’ experi- products to this,” Hubbard says. “Th e way it works is that we have a van ence and expertise to other funding sources. donated and we get a conversion donated. And then the smaller manu- “We’ve been trying to focus on getting ourselves introduced or Seniors in the Spotlight for 2014 Mobility Contest free vehicle giveaway is the high point of not have the social networks that young people do. So The the mobility industry’s National Mobility we want to be sure that it’s fair and that they have an Awareness Month project, with entire communities equal shot." rallying around their local heroes in hopes of voting Making seniors aware of mobility equipment is a them to victory. In late February, the mobilityaware- prime NMEDA goal, Hubbard says, since seniors often nessmonth.com Web site will start accepting contest don’t get the sort of assistive technology education that’s submissions, with winners announced in May. provided by rehab hospitals or clinics that specialize in But there are changes to the contest for 2014, says mobility-related conditions like spinal cord injury. Dave Hubbard, CEO/executive director of the National “If you’re aging into a disability, you probably Mobility Equipment Dealers Association (NMEDA). have no idea what’s available to help you out there,” “This year we have three categories: people with Hubbard points out. disabilities, caregivers — they can talk about people they care for — The industry supports the contest by donating vehicles, conver- and seniors,” Hubbard says. “We want to make sure that seniors get an sions, customized adaptive equipment and related installation services even play in this because we realize that while seniors these days are to the winners. Hubbard says Chrysler and Toyota have already technically adept and know about Twitter and Facebook, they may committed to donating vehicles for the contest. ● mobilitymgmt.com mobilitymanagement | february 2014 23 Automotive Access Special Making Inroads

reintroduced to a number of the state [vocational] rehabilitation Asked if the new QAP standard has had a positive eff ect, Hubbard departments, and talking to them about what our dealers do and says, “It’s helped a lot. We don’t have a dual standard at NMEDA the fact that they’re audited every year against a given set of criteria,” anymore. When we go in and talk to Congress or make [Capitol] Hill Hubbard says. “We’re basically asking [the departments] to make it visits, we can say unequivocally, ‘Th is is what our members stand for’: easy on themselves and choose NMEDA dealers to do their work.” the training, the facilities that they have to have, and so forth. And it One of the legislative items on NMEDA’s watchlist concerns auto- helps us in that we don’t have to try to service two diff erent statuses of motive franchise laws, Hubbard adds. members. We’re able to tighten up the QAP program, make it stronger “We’ve got a couple of state legislative eff orts going on with respect and more defi nitive, which gives you a stronger platform to stand on to licensing mobility dealers in states where the states have held up when you’re talking to government offi cials or telling somebody that franchising laws that might — they have not yet, let’s make that clear they need to put criteria in place — and if it’s not QAP, it should be — but could in fact prohibit the sale of mobility vehicles from mobility very similar to QAP.” dealers because they don’t have a new car franchise license with their Given that a mobility dealer is called upon to do comprehensive OEM,” he says. “It’s just a gap in the law, so wherever that exists we go mobility assessments, anticipate clients’ clinical progressions, stay up in and correct that situation. We’ve been successful in about seven to date on the latest equipment applications, work with referral and states, so that’s good.” funding sources, collaborate with specialists, and NMEDA and its members also expect to continue sharing a general install and service a wide range of products — Hubbard believes that message about the organization’s criteria and the special skills that a the QAP actually comprises the most basic standards. NMEDA mobility dealer has. “To me, it really is the minimum requirements for getting into NMEDA’s Quality Assurance Program (QAP), originally an optional business as a mobility dealer. It is the highest standard in the industry, upgrade for organization members, became mandatory in 2011. but it is still a minimum standard of what a dealer should be doing.” ● automotive accessibility marketplace

IDS LEESS Spirit APS This modifi ed electric steering system reduces TrekAway Lift s The Adjustable Positioning System (APS) car the eff ort needed to operate an OEM electronic The TrekAway Independence series off ers fully seat can accommodate both little kids (from power steering system. Via the LEESS system, automatic lifts with simple, nearly eff ortless 25 lbs.) and big kids (up to 130 lbs. and 5'6" in the eff ort required can be set from zero to the operation and a 350-lb. lifting capacity (400-lb. height). Its low-profi le sides make transfers factory standard amount. LEESS includes a option available). SmartPoint technology easier, and the Spirit APS can be outfi tted built-in backup system and dual battery. The enables the lift to fold out of the way when with positioning options such as swing-away system continues to provide reduced-eff ort operated. The TrekAway series includes a adjustable trunk supports, hip supports and an steering even after a loss of ignition or total wide range of accessories so consumers can abductor. The multiple accessories grow with engine failure. The system can be returned to customize their lifts to meet their particular the child. the OEM settings with the push of a button. transportation needs. Columbia Medical Drive-Master Co. Inc. Prairie View Industries (800) 454-6612 (973) 808-9709 (800) 554-7267 columbiamedical.com drive-master.com pviramps.com

mobility 24 february 2014 | management mobilitymgmt.com automotive accessibility marketplace

QRT-360 Retractor Recaro Monza Reha Q’Straint’s new QRT-360 is a four-point, heavy- Designed to provide superb positioning in the duty, fully automatic retractable tie-down car for kids with , the Monza Reha Milford Person Lift system that has performed successfully in a 30- booster seat features adjustable lateral sup- With a lifting capacity of 300 lbs., the Milford mph frontal crash of a WC19 power wheelchair ports and a full-range positioning harness. The Person Lift off ers a highly adaptable and versa- and lapbelt in a motor vehicle. The shorter popular swivel base makes it easy for parents tile way to transfer consumers from wheelchair retractor footprint allows more fl exibility in to transfer children in and out of the seat. The to vehicle. The lift is designed to be quick and vehicle anchor points to better accommodate lightweight (12-lb.) seat is also easy to move easy for consumers to operate. The Smartbase larger chairs. The QRT-360 meets RESNA’s from vehicle to vehicle as needed. With weight option can be used in traveling situations to higher-strength WC18 requirements that will capacities of 33.1 to 110.2 lbs, and with back take the Milford lift along for the ride. take eff ect in December 2015. heights of 23.6" to 30.3". Pride Mobility Products Q’Straint Thomashilfen (800) 800-8586 (800) 987-9987 (866) 870-2122 pridemobility.com qstraint.com thomashilfen.us

home & environmental accessibilitymarketplace

Omni Transfer System Pathfi nder Able to perform multiple functions in the The newest lift in the Aqua Creek family, the home, the Omni system can be used as a bed- Pathfi nder can support 300 lbs. and is the side commode, an over-the-toilet commode, No-Drill Grab Bar company’s most aff ordable ADA-compliant lift. a roll-in shower chair and a bath slider. The Thanks to their patented mounting hardware, The sleek, compact design was created to fi t tub base transfer frame folds for easy storage, these grab bars don’t require drilling or profes- any commercial or residential pool deck and to and the Slider Safe Auto-Stop Safety System sional assistance to install in minutes. The grab blend right into the environment. The stainless prevents the chair from coming off the base. bars come complete with all necessary attach- steel construction and white powder-coated Custom tub lengths are available. Caregivers ment materials and can be added to almost fi nish make Pathfi nder a durable solution. Path- can upgrade to the next size of the Omni for a any room in the house to improve safety and fi nder weighs 120 lbs. and stands 48.25" tall. fraction of the cost of a new system. security. Limited lifetime warranty. Aqua Creek Products Columbia Medical Drive Medical (406) 549-0769 (800) 454-6612 (877) 224-0946 aquacreek.com columbiamedical.com drivemedical.com mobilitymgmt.com mobilitymanagement | february 2014 25 home & environmental accessibility marketplace

VPL Express Deck Helix Curved Stairlift Designed to help easily complete vertical plat- Going up! This next-generation stairlift features form lift (VPL) installations, the new VPL Express an ultra-smooth ride and quiet operation. The Deck off ers an attractive and universal solution Rio Bath Lift new True-Curve rail was designed to provide that requires no construction or building per- The Rio’s modern design features an aluminum smoother transitions and tighter bends so it can mit. The deck features a standard 5x5' landing frame and smooth surfaces that are easy to mount more closely to the wall. The ergonomic area and adjusts for rises up to 4'. Units can be keep clean. Its small footprint makes the bath seat has a standard manual swivel feature and combined to create a larger deck. The deck is lift easy to move from place to place and fl ip-back arms for easy transfers. The simple- all aluminum with powder-coated handrails. convenient to store when it’s not in use. The to-connect rails and lighter chassis will be Its universal design allows VPL handrails, doors installation requires no tools, and the Rio can be welcomed by dealers doing the installations. and steps to be positioned on any side. assembled by the end user or caregiver. Harmar Harmar Invacare Corp. (800) 833-0478 (800) 833-0478 (800) 333-6900 harmar.com harmar.com invacare.com

• • • • •

mobility 26 february 2014 | management mobilitymgmt.com home & environmental accessibility marketplace

C500 VS Stander Advance Bath Chair When reaching a top shelf requires a diff erent Available in four sizes, the Advance can ac- and higher perspective, Permobil’s C500 VS Serta Perfect Lift Chair commodate consumers up to 159 lbs. The standing power chair delivers. In addition to Consumers will recognize the Serta name, and removable cover is washable, and the Advance its standing function, this chair off ers power this lift chair has plenty of special features — features a lap belt and adjustable lateral guides tilt (0-25°), power recline (90-175°), 10" seat including premium Cool Action Gel Memory made of mesh material. Options include an elevator, and power elevating legrests (90-175°) Foam for cooling comfort and support — to abduction belt, a headrest and a shower trolley. that function independently of tilt/recline. Con- live up to that reputation. The chair boasts a A standard adjustable frame provides multiple sumers can drive up to 1.5 mph while standing premium Dacron top layer and Pirelli webbing positioning options. The seat cover is available (with a top speed of 5 to 6.5 mph while seated). for comfort that’s personalized, plus individually in six colors (we’re a fan of the pink!). The C500 VS has a 265-lb. weight capacity. wrapped coil springs and a No-Sag spring base. Ottobock Permobil Pride Mobility Products (800) 328-4058 (800) 736-0925 (800) 800-8586 ottobockus.com permobil.com pridemobility.com

mobilitymgmt.com mobilitymanagement | february 2014 27 product revue

6-Inch TRA Casters Now available for the M300 and M400 power bases: 6" casters to As the newest provide tighter front-legrest positioning and improved maneuverabil- member of TiLite’s ity, since the chair can maneuver with its legs at 90° angles. Permobil titanium chair reports minimal loss in climbing performance vs. the larger 8" casters, line, the TRA takes which also remain available. The 6" casters can be ordered as a custom- the TR — the ization for the M300 HD (heavy-duty) power base. manufacturer’s fl agship — and Permobil adds the benefi ts (800) 736-0925 of full adjustability. Features include a dual-tube frame geometry that permobil.com stiff ens the chair and transfers more of each push stroke directly to the forward motion of the chair. The TRA is also “TiFit,” a made-to-measure Glide Suspension Fork wheeled prosthetic built to fi t just one person. Choices of colors, wheels, handrims, tires, wheel locks, tattoos, etc., ensure that each TRA As wheelchairs roll forward, their front wheels are the fi rst to meet is as unique as its owner. the bumps in their way. The Glide is designed to maximize vibration TiLite dampening in both horizontal and vertical directions, thus minimizing (800) 545-2266 vibration transfer to the consumer. The Glide is available in dual and tilite.com single-sided fork designs and comes in three diff erent durometers (elas- tomer hardnesses) based on rider weight. Currently available on new TiLite chairs — Out-Front is seeking more OEM partners — the Glide was invented and tested by Human Engineering Research Laboratories, a joint venture of the University of Pittsburgh and the VA Pittsburgh Vertical Platform Healthcare System. Lift s Out-Front (480) 833-1829 This new indoor/outdoor line of out-front.com vertical platform lifts can provide direct access to almost any area in a home and can be adjusted Folding Steel Walker to the height required by the Benefi tting from steel’s strength wheelchair user. The lifts have and durability but while maintain- an easy-to-use control paddle ing the lightweight convenience and key lock for safe and reliable found in aluminum models, this operation. Standard features walker features easy push-button include 42" high solid side folding, newly designed rear glide panels, automatic folding access caps for smooth sliding over most ramp, emergency stop switch, surfaces, vinyl contoured hand grips non-skid platform and ramp, and 5" wheels. Height adjustable and powder-coated fi nish with so consumers can choose the most weather-sealed controls. comfortable confi guration. Butler Mobility Drive Medical (888) 847-0804 (516) 998-4600 butlermobility.com drivemedical.com mobility 28 february 2014 | management mobilitymgmt.com ad index

advertisers’ index

Company Name Page # Company Name Page #

Alumiramp ...... 27 Open Sesame ...... 20

Aqua Creek Products ...... 27 Ottobock ...... 2

Columbia Medical ...... 26 Permobil ...... 32

Curtis Instruments ...... 19 Pride Mobility Products/Quantum Rehab . . . . . 3

Freedom Designs ...... 5 Q’Straint ...... 21

Harmar ...... 6, 7 SKYLINK Group ...... 29

accessibility marketplace Company Name Page # Company Name Page # Aqua Creek Products...... 25 Ottobock...... 27

Columbia Medical...... 24, 25 Permobil...... 27

Drive-Master Co. Inc...... 24 Prairie View Industries...... 24

Drive Medical...... 25 Pride Mobility Products ...... 25, 27

Harmar...... 26 Q’Straint ...... 25

Invacare Corp...... 24 Thomashilfen...... 25

product revue Company Name Page # Company Name Page # Butler Mobility...... 28 Permobil ...... 28

Drive Medical ...... 28 TiLite ...... 28

Out-Front ...... 28

manag lity em bi e o n t m

editorial advisory board

MM Editoriale Advisory Board d rd it a o o ria b l advisory Josh Anderson TiLite Joe McKnight Aero Mobility Pat Boardman Consultant Amy Morgan Permobil Lois Brown National Seating & Mobility Julie Piriano Pride Mobility Products/ Quantum Rehab Group Publisher Karen Cavallo Jay Doherty Quantum Rehab (760) 610-0800 Lauren Rosen St. Joseph’s Children Rick Graver Medtech Services Hospital of Tampa Nat’l Sales Manager Caroline Stover Ryan Hagy Numotion Comfort Company (323) 605-4398 Jean Sayre Rita Hostak Sunrise Medical Sales Assistant Lynda Brown Mark Smith Wheelchairjunkie.com (972) 687-6710 Julie Jackson Invacare Corp. Stephanie Tanguay Motion Concepts Advertising Fax (866) 779-9095 Karen Lundquist Ottobock ROVI Cody Verrett mobilitymgmt.com mobilitymanagement | february 2014 29 cms update

NHIC Reports Q3

Power Chair Review Results briefl y… National NHIC Corp. has released scooter) and missing documentation, including the results of a widespread prepayment review for missing physician signatures, signature dates or Attention, funding specialists: Medicare consumer power chair claims processed in date stamps. Th e next time you’re electroni- cally billing a HCPCS code with the third quarter of 2013. The second-most commonly seen errors a narrative description that The review is for Group 2 power wheelchairs in the involved issues with the Licensed Certifi ed indicates “not otherwise clas- K0823 HCPCS code, defi ned as having captain’s-style Medical Professional (LCMP) examination (e.g., sifi ed” (NOC), unlisted or seating and a user weight capacity up to and including the LCMP exam was missing the physician’s nonspecifi ed, the DME MACs 300 lbs. agreement or disagreement with the OT or PT are reminding you that you must include “in the SV101-7 For the July 1-Sept. 30 review period, NHIC, the evaluation). Detailed product description errors segment for HIPAA 5010A1 Jurisdiction A DME MAC, examined 333 claims were seen in 20.1 percent of denied claims, claims, a concise description of submitted by 132 diff erent suppliers, who were issued while 19.3 percent of denied claims had seven- the NOC code” or else the claim Additional Documentation Requests (ADR). element order problems, and 13.4 percent will be rejected by the CEDI. In For 79 of the claims, NHIC said it did not receive the of denied claims had problems with home loop 2400, segment NTE01 of the ANSI X12N, version 5010A1 required additional documentation. assessments. (electronic claim) or item 19 Of the 254 claims for which suppliers did provide “Based on the results of this prepayment (paper claim), you’ll also need to additional documentation, NHIC said 98 claims were review, DME MAC A will continue to review provide a concise description of allowed, and 156 claims were denied. claims billed with HCPCS K0823,” NHIC stated. the item being billed; the manu- “The total denied allowance amount — dollar facturer’s name; the product name and number; the model amount of allowable charges for services determined More than One Error number and serial number; the to be billed in error — divided by the total allowance NHIC provided examples of actual claim denials MSRP or MSP acronym, plus amount of services medically reviewed resulted in an from third-quarter 2013 and noted that some the manufacturer’s suggested overall charge denial rate of 52.8 percent,” NHIC said in denied claims contained more than one error. retail price (or “No MSRP,” if a Dec. 27 bulletin. For instance, in the fi rst example provided, the price isn’t available). You don’t have much room — only NHIC said the claim’s seven-element order A Decline from Previous Quarters 80 character spaces — in the line didn’t include the length of time that the note, so get ready to do your best The 52.8-percent charge denial rate was a sharp power chair would be needed and was missing abbreviating… A new Medicare decline from previous quarters’ rates. The second- the date of the face-to-face examination. Learning Network (MLN) quarter 2013 denial rate was 82.8 percent; the rate for Also: “The seven-element order and face- “MLN Matters” paper has been released on the upcoming tran- the fi rst quarter of 2013 was 86.6 percent. to-face examination did not include confi rma- sitions of dozens of DME and tion that the supplier received a copy of these complex rehab technology items Th e most common documents within the 45 days of the comple- from the routinely purchased tion of the face-to-face examination as veri- category to the capped-rental fi ed with a date stamp or the equivalent from category. Th e change takes eff ect reason for denials was April 1 for items that are not the supplier,” NHIC said. “The documentation part of the Medicare competi- one or more issues with submitted did not contain a detailed product tive bidding program; the items description or proof of delivery.” involved in round 2 or the round the face-to-face exam Other examples also showed that claims 1 recompete will transition to contained multiple errors that ranged from the capped-rental category at later dates. To access the MLN NHIC said the most common reason for denials was missing confi rmations that documents were Matters paper, type “MLN one or more issues with the face-to-face examination. received within the prescribed 45 days after Matters 8566” into a browser That problem was present in 56.3 percent of claims the face-to-face exam to the fact that the face- and click on the corresponding that were denied. to-face exam “was completed on a supplier- cms.gov link. Fift y wheelchair Specifi c face-to-face exam problems included a generated form with insuffi cient information and wheelchair-related HCPCS codes, including adult tilt-in- failure to demonstrate medical necessity for the power regarding the benefi ciary’s specifi c mobility space chairs and pediatric bases, chair (e.g., documentation did not rule out lesser limitations to support medical necessity for are impacted by the change. ● types of mobility equipment, such as a cane, walker or [the] power wheelchair.” ●

30 february 2014 | mobilitymanagement mobilitymgmt.com Introducing the NEW mobilitymgmt.com

Now there are more reasons than ever to visit your favorite mobility website! The C500 Corpus® 3G is designed for the collage of life… busy streets, meetings, lunches, entertainment and nightlife. With its independent suspension, the powerful C500 provides a smooth ride over a variety of terrains from sidewalks to grassy parks, while the Corpus 3G seating system offers the ultimate in comfort for your exciting lifestyle. Permobil.com