Funding for Manual Tilt-in-space Wheelchairs (updated December 2006)
Prescribing therapists must complete ADP forms to apply for funding for mobility devices. PDG provides the following information to assist prescribing therapist with respect to Manual Dynamic Tilt Wheelchairs. Each client is considered as an individual. Answers must reflect that client’s situation. The following is only a guide.
Here is a direct link to the required application forms.
There are 2 levels of manual dynamic tilt wheelchairs:
Manual Dynamic tilt wheelchair – basic
Manual Dynamic tilt wheelchair – requiring an upgrade
The following information relates to areas on the ADP Application for Funding Mobility Devices that must be filled out when applying for a manual dynamic tilt wheelchair. Therapists must fill out all other required information.
1. Application for Funding Mobility Devices (ADP Application - back of Page 1)
Look for the following boxes to check; Choose ONE of these 2 choices:
A manual dynamic tilt wheelchair to achieve independent mobility
or
A manual dynamic tilt wheelchair to achieve mobility dependent for propulsion
As also check ( if applicable)
Positioning devices (seating) for a wheelchair – modular and/or custom fabricated
click here to go to ADP Applicaton sample page (back of page 1)
2. Application for Funding Mobility Devices (ADP Application - Page 3)
You must answer EVERY question. Questions 7-10 specifically relate to TILT
Questions 7 – 10 Suggested responses: ( if you want your client to qualify for manual dynamic tilt)
7. Applicant can weight shift independently in the sitting position NO
8. Applicant demonstrates a history of tissue trauma and/or a significant risk of tissue trauma when sitting and skin integrity cannot be maintained with the addition of fixed seating alone. YES
9. Applicant cannot maintain functional posture in sitting due to abnormal tone and/or joint contractures and posture cannot be supported with the addition of fixed seating alone. YES
10. Applicant demonstrates an intolerance for sitting which cannot be increased for mobility with the addition of fixed seating alone. YES
Base Device and ADP Code – you must check one
Check Either:
WMA5 for an adult requiring a manual tilt chair
or
WMK5 for a child requiring a manual tilt chair
IF YOU ARE NOT REQUIRING AN UPGRADE, THIS IS ALL YOU NEED FOR A BASIC MANUAL DYNAMIC TILT CHAIR
If your client requires a tilt chair to improve independent mobility (you answered YES to number 1 and/or number 2 of Section 3 on page 3)
or
to accommodate seating and possible change in seating angles/contours etc. (you answered YES to 8, 9, and 10 of Section 3 on page 3) then you need to ask for the Additional ADP Funded Options Required for Prescribed Manual Wheelchair.
click here to go to ADP Application sample page (page 3)
3. Additional ADP Funded Options Required for Prescribed Manual Wheelchair (ADP Application - back of Page 3)
PDG ‘s Stellar, Bentley and Astrotilt require the upgrade if adequate funding is to be obtained through ADP.
To qualify additional ADP funded options, you must complete information required on the back of page 3
This information is required to obtain funding for a wheelchair frame that offers ongoing adjustability such as seat-to-back angles, seat-to-floor heights, seat depths and centre of gravity adjustment. This part of the application is also needed to justify a wheelchair frame that facilitates independent mobility.
Clinical Rationale may include the following: (selected device provided by the dealer must meet the clinical requirements)
click here to go to ADP Application sample page (back of page 3)
The first part of this page asks for a variety of basic wheelchair dimensions required for this client.
Additional ADP Funded Options Required for Prescribed Manual wheelchair (check one or more)
The therapist MUST check off :
Standard Manual Wheelchair Frame with Manual Dynamic Tilt *
* Provide Clinical Rationale
In the space provided, the therapist must write the clinical rationale as to why the upgrade is required.
Potential clinical rationale:
| Client medical Needs | Product requirements |
|---|---|
| Independent Mobility with Arms | Adjustable axle, choice of wheel size |
| Independent mobility foot propulsion | Adjustable seat height, pivot from the front |
| Stability and safety/ shear reduction- postural support | Adjustable axle, suspension/centre of gravity adjustments |
| Postural support | Accepts custom or complex seating components |
| Independent tilt *not an ADP justification | Mechanism for self-tilt |
| Changing needs /progressive disability *use in conjunction with postural support justification not acceptable as a stand-alone to ADP | Adjustable components, seat height, depth seat to back angle |
Sample sentences for the clinical rationale section:
(selected device provided by the dealer must meet the clinical requirements)
Client requires a lower seat to floor height with adjustable axle positions and different size wheels in order to be independently mobile with their feet.
Client has many deformities in which very “complex” seating must be added to the chair. This complex seating can not be fitted into a more basic wheelchair as it does not allow for seat-to-back angle adjustments or accommodate for centre of gravity positioning once seating is in place.
Client requires different wheel sizes or heights with the ability to adjust centre of gravity to allow for independent hand propulsion.
Client has anatomical deformities or changes in tone. Complex seating must be added to the chair. This seating system will not fit into a more basic style wheelchair.
The wheelchair can accommodate the seating system through adjustable seat-to-back angles and adjusting the centre of gravity and/or seat depth to accommodate for seating changes such as scoliosis, kyphosis, pelvic obliquity, rotation, or windswept positioning. These changes can be accommodated upon delivery and as the client changes over time. This system will improve overall performance, stability and safety for the client in the wheelchair.
Client requires a chair with many adjustments including seat to back angle for postural control, and an adjustable axle position for manual mobility and stability
Client requires postural control for independent function both with their hands and feet. Client requires a low seat to floor height for foot propulsion.
The following statements will likely NOT qualify the client for an upgrade:
The client requires tilt for pressure relief as they are unable to weight shift on their own. This is not sufficient as it simply justifies a WMA5 or WMK5 chair which is already addressed by answering questions 1-13 on page 3.
Some clients simply need a chair to allow them to weight shift throughout the day but do not require complex seating, nor are they independently mobile.
The request for an upgrade for a manual dynamic tilt wheelchair is not an addition to a wheelchair previously funded by ADP.
