Page 1 of 2 12 LastLast
Results 1 to 10 of 16

Thread: Power Wheelchair and OT for C3-C4

  1. #1
    Senior Member
    Join Date
    Oct 2011
    Location
    California
    Posts
    190

    Power Wheelchair and OT for C3-C4

    Hi Everyone,

    I'd appreciate your kind advice.

    My Dad is c3-c4, major fusion, incomplete, on a vent. He has very limited movement of his neck. His operating surgeons have recommended that he always wear a neck brace and that he not have any PT on his neck and that he not try to move his neck... forever.

    My Dad is currently with a Home Health Agency. We've been told that they've never dealt with a patient with such a high level of care. For example, since the nurse, OT, PT, and ST have never been trained on removing and putting on the neck brace -- this put a major delay on getting my Dad in a chair (one of the nurses said that we could just put him in a regular chair).

    1) Power Wheelchair - Yay or Nay if U Can't Turn Yr Head?

    My Dad doesn't have his own 'tailored' wheelchair (I borrowed one). In the last talk with the OT, she claimed that since my Dad can't turn his head, she will not recommend a power wheelchair.

    However, in a talk with a PT, formerly with Craig's -- he has told me that he has worked with a patient who is similarly fused (and can't turn his head) and was set up with a power wheelchair.

    I spoke with a wheelchair provider in Berkeley. The rep who has seen my Dad mentioned both the power and non-power wheelchair.

    2) Power Options

    Does anyone know what options are available? I've been told of a "sip and puff" and another type which uses chin movements.

    My Dad is a bit nervous about "driving" and is willing to forego this -- but he really wants to be able to shift himself.

    3) Ramp on a Stairway

    We have stairs -- unfortunately, my Mother is not supportive and doesn't want to put in a ramp.

    However, the wheelchair rep said that a power wheelchair would not be able to go up and down a ramp which is on so many stairs.


    I'd appreciate any feedback, solutions, and similar experiences.
    Last edited by Joey_SF; 04-30-2013 at 08:01 AM.

  2. #2
    what hospital are you at with him? Think you're on the right track with the wheelchair stuff from what I know. also never heard of someone with a neck brace forever. Someone else will have to help you with that.

    How many stairs?

  3. #3
    I have a full cervical fusion and can drive a power chair perfectly fine (the walls might disagree) by sip and puff. You just develop really good peripheral vision. If your dad is fitted with a well-supporting custom headrest and you can develop a transfer method that doesn't strain his neck, he shouldn't need a neck brace while in the chair - I would think.

  4. #4
    I have had patients with full neck fusions (occipital skull to T2 for example) who use power chairs. This therapist is obviously not very experienced in SCI care. Control options range from sip-and-puff to tongue and lip switches or even a palate control (worn like a retainer and driven with tongue movement). At the very least, he should have a power control that allows him to do independent weight shifts (by tilt-in-space power control) for his skin, even if he chooses not to drive/steer the chair himself. A companion control can be added to the chair to make it easy for someone else to do that for him if needed. We have also set up many of these chairs with small rear-view mirrors to make steering safer (similar to bicycle mirrors worn on glasses).

    Can you get your dad evaluated at Santa Clara Valley outpatient for his chair?? They have excellent therapists who are well versed in the options for someone with no head flexion/extension or rotation ability.

    Stairs into the house or stairs within the house?? How many steps? If at the entrance, the ramp needs to be of an appropriate slope, but certainly a good power chair can do an ADA slope (1' for of ramp for 1" in rise) and many can safely go up steeper ramps. Is a porch lift an option instead?? If you are talking about stairs inside the home (ie, a whole flight to a second floor), no, that cannot be ramped. It sounds like your mother is more concerned about appearance of the home than she is about your dad's quality of life....

    (KLD)
    Last edited by SCI-Nurse; 05-13-2013 at 07:59 PM.

  5. #5
    Senior Member
    Join Date
    Oct 2011
    Location
    California
    Posts
    190
    Wow. Thank you very very very much -- I will tell my Dad since he was kinda sad when the OT told him that she would not recommend (and this is needed to get the approval) a power chair.

    1) SCVM and Payment

    I was told by SCVM that my Dad must have been an inpatient in order to use the outpatient services -- I'll try to call again. By chance, would you know if this is truly true?

    Another problem is payment. Medicare will not allow my Dad to have both the Home Health Agency and external therapists -- if we keep Home Health (Medicare requires that we use their therapists), we must pay out of pocket for external therapists.

    The Home Health Agency OT is a bit scary because she is very very confident. She is the HHA's wheelchair expert.

    Would you have any literature which I can show her? Or, can you recommend a company which may have more expertise and can show her otherwise... someone recommended ATG?

    2) 12 Stairs into the House.

    Yes - you're right. My Mom told me that I should feel "lucky" that she let a lift into the house. Her first protest was that she didn't want such a big item in the house and then, my sister helped her to come up with a more 'politically correct' protest to the HHA that it was "dangerous."

    The lift was a major battle for me -- with the help of a case manager (who much to my sadness is no longer on my Dad's case), my siblings and my Mom relented to allowing a lift into the house.

    I'm told that there are ramps which can be removed or rented... is this true?

    I finally was successful in switching my Dad to Medicare and a supplement program.

    Some tell me that Medicare will not pay for every bell and whistle and will not allow for the patient to pay out of pocket -- it's all or nothing. But, others tell me that it's possible to find companies which are willing to let patients pay for the extras

    Any tips?
    Last edited by Joey_SF; 05-15-2013 at 06:10 AM.

  6. #6
    Quote Originally Posted by Joey_SF View Post
    I'm also told that Medicare may not pay for every bell and whistle and will not allow for the patient to pay out of pocket -- it's all or nothing. But, others tell me that I may find companies which are willing to let patients pay for the extras.
    That is NOT true for power wheelchairs. While the chair will need to be prescribed by a RESNA certified wheelchair expert, with a detailed letter of medical necessity signed by the physician, Medicare will pay a maximum of 80% of the cost of the wheelchair, may deny certain features they don't consider medically necessary (such as a companion control), and you pay the rest. When we got a Permobil wheelchair for my mother, the total was $32,000. Medicare paid $14,000 of that, and my family had to pay the rest.

    12 steps in one flight would not easily be rampable unless you have a very large yard. Is that the only entrance to the home?? A portable aluminum ramp system is best as it can later be removed easily, or moved to a different location, but such a large ramp would be expensive, and probably not covered by insurance. To ramp 12 steps all in one flight, you would need to calculate (based on an 8" rise per step) on 8' X 12 steps minimum length for the ramp (ie, 96 feet of ramp) which would likely need switchbacks to fit into all but the largest yard. A porch lift would probably be better, but the individual situation would have to be assessed. Do you have photos?

    Call SCVMC back. That does not sound right. He should be able to get oupt. services even if never an inpatient. In your situation you may have to pay privately for the wheelchair evaluation though.

    This DME guide from ASIA gives some guidelines on the DME needs of people with various levels of SCI. You could try giving this to the OT: http://www.asia-spinalinjury.org/rehab/dme.php

    (KLD)

  7. #7
    Senior Member
    Join Date
    Oct 2011
    Location
    California
    Posts
    190
    I'll call SCVM back. I'll also take some pics -- but, wow, will Medicare help pay for a ramp?

  8. #8
    Quote Originally Posted by Joey_SF View Post
    I'll call SCVM back. I'll also take some pics -- but, wow, will Medicare help pay for a ramp?
    No, unfortunately Medicare does not pay for ramps or other home modifications. If there is financial need, there may be some local charities that will help with this.

    (KLD)

  9. #9
    Senior Member elarson's Avatar
    Join Date
    Mar 2012
    Location
    The Netherlands
    Posts
    2,222
    I have heard that some Lions Clubs help with building ramps.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  10. #10
    Senior Member
    Join Date
    Oct 2011
    Location
    California
    Posts
    190
    The wheelchair place at Berkeley informed me that Medicare will not pay for Permobils and that Medicare absolutely requires both the doctor and an OT (who works together with the wheelchair place) to do the write-up. They also said that if my Dad had remained with the HMO, the HMO would allow the doctor and the wheelchair place to do the recommendation, without the OT.

    By the way, the RT recommended ATG... anyone have good luck with them?

    Gosh, I (with the help of the ambulance company) just figured out the transportation for my Dad and how to get Medicare to help pay for it. Since there are wheelchair featurs which are perceived as "medically necessary," would the appointment to Santa Clara be viewed as medically necessary?

Similar Threads

  1. Power wheelchair
    By Semper Fi in forum Equipment
    Replies: 7
    Last Post: 04-27-2012, 08:51 PM
  2. 4x4 power wheelchair
    By Semper Fi in forum Equipment
    Replies: 21
    Last Post: 11-17-2011, 06:31 PM
  3. New Power Wheelchair
    By Aspen in forum Equipment
    Replies: 4
    Last Post: 07-01-2011, 06:24 PM
  4. New power wheelchair
    By SKYHAWK in forum Equipment
    Replies: 0
    Last Post: 02-12-2009, 02:14 PM
  5. SOS Power wheelchair!!
    By kyokoluna in forum Equipment
    Replies: 2
    Last Post: 03-13-2008, 08:22 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •