Justify 'em: K0005s for Kids
Research on kids, ultralightweight wheelchairs and propulsion is limited to date, but still plays an important role in how Lauren Rosen, PT, MPT, MSMS, ATP/SMS, approaches her documentation work as program coordinator for the Motion Analysis Center at St. Joseph’s Children’s Hospital of Tampa.
“I treat a pediatric wheelchair the same way that I treat an adult wheelchair in that I still submit [claims] with an average of seven or eight peer-reviewed articles referenced in there,” she says.
Rosen uses research regarding adult ultralight usage based on the fact that a study published in the journal for the American Academy of Physical Medicine & Rehabilitation “basically comes to the conclusion that pediatric propulsion and adult propulsion are the same — the kinematics of it. I use the same information to justify a pediatric chair that I do for adults. I talk about the research that the longer that you use a chair, the more likely you are to suff er shoulder and other upperextremity problems. I talk about the higher the weight of the person in the chair, the more chance of having median nerve compression and other injuries. I use a lot of the same information that I would put on my submission for an adult chair in those pediatric submissions.”
In addition to that background sort of material, Rosen has included information on:
Wheelchair weight relative to the child:
“I do talk about if we were to get some of the other kinds of chairs, that the chair itself would weigh more than the child weighs. I take pictures of the kid on the scale with the weight [visible]. I try to make it as obvious as it can be."
Overall weight of the mobility system:
“I do also discuss what I’m putting on the chair, the weight of what I’m putting on the chair — lighter-weight cushions; if I can, I go with a back with basic upholstery if he’s got enough trunk for that; or if he needs more support, staying with as lightweight options as I can and pointing out to my funding sources that I’m picking this because of its light weight.”
“I need to dial it in just as I would for any fulltime adult chair user. I need that axle adjustability — especially as the kid grows, I need the ability to move that axle where it needs to be. If it’s a teenager and she’s approaching puberty, all of a sudden I’ve got a different weight ratio than when I first did the chair when she was 9. I need to be able to adjust that for her.”
“Kids who have been full-time chair users just about from birth have a different trunk-to-arm ratio than an adult who starts using a wheelchair. Their arms are long relative to their trunks in a lot of cases. When you’re not weight bearing, your trunk doesn’t tend to grow as much. Think of a lot of kids with spina bifida: They’ve got short trunks. But their arms are normal length, so you really need to accommodate for that.
“The basic setup on most chairs K0004 and lower don’t allow me to put the height and the forward/rearward of the wheel where I need it to be.”
“We’ll talk about school, especially if it’s a kid who needs to change classes, if they’ve got long distances. Some high schools have campuses, and we will certainly discuss that with payor sources.”
“In order to get rid of it, I’ve got to make the kid functionally and efficiently mobile by the age of 4, is what all the research tells us. With everything I do, I’m not just focused on today. I’m focused on 10 years from now. So when I think about learned helplessness and I think about how that kid is not as high an achiever at school, is not going to do as well on a job, that’s of paramount importance, to get that functional, efficient mobility.”
This article originally appeared in the January 2014 issue of Mobility Management.