Justify a Fuze T20 and/or Bentley as SADMERC K-0009
Introduction
The Fuze T20 and Bentley are unique wheelchairs designed to maximize function and independence for the beneficiary. Unique features include;
- tilts to 20 degrees for optimal user positioning, stability and independent mobility as follows;
Ideal for foot propulsion, either in or out of tilt
Ideal for hand propulsion, either in or out of tilt
Multi-adjustable to ensure a good fit over many years of use and changing need
Most Fuze T20 and Bentley applications fall in to two groups.
- Frail Elderly – Individuals who are unable to sit for long periods of time unless the chair can be tilted. Due to spinal deformity, low tone, or limited stamina, (examples) dynamic tilt may enable the person to maintain spinal alignment and may prevent them from sliding of the wheelchair. These individuals frequently are unable to reach the rear wheels to hand-propel a standard wheelchair. The Fuze T20 and Bentley dynamic tilt dramatically improves rear wheel access and mechanical advantage for frail individuals. These clients often use a combination of foot propulsion and hand propulsion to mobilize the wheelchair. Weight range for this group is usually 80 – 250 lb. but larger sizes can also be custom ordered.
- High Agitation (Bentley application only) – Individuals who are unsafe in a wheelchair unless the chair has a larger-than-normal footprint to keep it from tipping over (Huntington’s Chorea, some CP applications, and some dementia applications, for example). These individuals often foot-propel the wheelchair. The seat can be tilted during mobility to aid in preveting the client from sliding forward. Small rear wheels, located further rearwardly, are used when larger rear wheels would pose a safety hazard for clients hands. Weight range for this group is nearly always less than 150 lb. (since they are doing aerobics all day). However, this group can be very aggressive. The Bentley wheelchair frame is designed for ‘heavy use’.
K-0009 SADMERC Code Justification (Excerpt from SADMERC Coding Submission)
The K-0009 code is reserved for wheelchairs that differ from any of the other defined codes. The Fuze T20 and Bentley are unique when compared to the existing K codes. The following characteristics supply justification for K-0009 coding. These characteristics formed the core of the SADMERC coding submission were the K-0009 code was determined for this product.
The Fuze T20 and Bentley Manual-tilt Wheelchair are not designed specifically to provide effective pressure relief. Our research and experience shows that for people who require tilt, 20° of tilt optimizes a beneficiary’s ability to accomplish mobility related activities of daily living. More than 20° compromises independent mobility.
- 20° of tilt is deemed sufficient to provide improved stability for the client’s trunk and head. Essentially, gravity assists in positioning at tilt angles of 10° - 20°.
- 20° of tilt is deemed the maximum tilt angle where a client can independently foot-propel a wheelchair. If the seat is tilted beyond 20°, the client’s ability to effectively foot propel the wheelchair becomes significantly compromised. To maintain optimal foot-propulsion, the seat must tilt about a line drawn along the front edge of the seat, keeping the knees at the same height at all tilt angles. If the front of the seat moves upwards as the chair tilts, the client will not be able to get their feet to reach the floor while in tilt. Tilt wheelchairs that tilt 45° always tilt about a fulcrum located further back along the seat. Otherwise the seat will drop too low as it tilts.
- 10° - 20° of tilt is deemed the optimal tilt range where a client can independently hand propel a wheelchair. As the seat is tilted beyond 20°, the client’s ability to effectively hand propel the wheelchair starts to be compromised. At 45° of tilt, an able-bodied person has difficulty propelling the wheelchair. A person with significant disability will have great difficulty propelling a wheelchair in 45° of tilt.
45° of tilt is ideal for pressure reduction. If a tilt wheelchair is also intended to optimize a beneficiary’s ability to accomplish mobility related activities of daily living, 45° of tilt is too high. Our experience suggests 20° is ideal for maintaining the ability to accomplish mobility related activities. 20° is the maximum for successful foot propulsion.
Photo shows a Bentley Manual Tilt Wheelchair, tilted to 20°. The user can both foot-propel and hand-propel while in tilt. Frail elderly clients are often more successful in independent mobility when both hand and foot propulsion are used together.
The Fuze T20 and Bentley are manual tilt wheelchairs, performing similarly to other manual tilt chairs except that they do not dynamically tilt to at least 45°. They dynamically tilt to 20°. Experience suggests independent mobility is significantly compromised at angles above 20°.
Photo shows a Stellar Manual Tilt Wheelchair, tilted to 45°. Independent hand propulsion at 45° is quite difficult. This user brings the chair back up to approximately 20° when hand propelling
- The Fuze T20, Bentley, and Stellar are the only manual tilt wheelchairs designed to allow the client to operate the tilt mechanism independently. All other manual tilt wheelchairs listed in the Manual Wheelchairs Product Classification List require attendant operation of the tilt mechanism, thereby preventing the beneficiary from operating the tilt mechanism independently.
- The Fuze T20 and Bentley are the only manual tilt wheelchairs designed to allow the client to foot propel independently while seated at any tilt angle. All other manual tilt wheelchairs listed in the Manual Wheelchairs Product Classification List limit independent foot propulsion because the front of the seat moves upward as the seat is tilted.
- The Fuze T20. Bentley, Fuze T50 and Stellar are the only manual tilt wheelchairs designed specifically to facilitate independent mobility via hand function by the beneficiary. These wheelchairs include adjustable rear axles that can be optimized for beneficiary hand access. Other manual tilt wheelchairs listed in the Manual Wheelchairs Product Classification List include either non-movable rear axles, or the rear axles have limited adjustability, reducing potential for effective access by the beneficiary. In cases where some adjustment is possible, the client’s hands move away from the rear wheels as the chair tilts, limiting the potential for practical hand access to the rear wheels.
- In cases where high agitation is of concern, the Bentley can be configured with heavy duty rear stabilizers, thereby improving stability. Other manual wheelchairs in the Manual Wheelchairs Product Classification List do not have this potential.
