Home > For Physicians & Professionals > Technology Reviews > Wheelchairs

Wheelchairs

What you should know about wheelchairs – Mobility is very important to all of us. Allowing a child who cannot walk on their own to be able to move, even if that requires assistance from others, is very important for cognitive development and social learning. Children are naturally curious and want to explore their environment, and maybe even run away when they are upset. Wheelchairs may allow a child to participate with others at peer level and improve function and independence. They also assist parents and other caregivers by reducing the physical stress of carrying a child.
Smiling boy in wheelchair
The First Wheelchair – Most children walk by 18 months of age. If a child does not have independent mobility by then, it is time to discuss mobility options, such as a wheelchair. Some children with significant motor impairment will need positioning/seating before 18 months. The process should begin whenever a child needs support for function/mobility or a parent needs "another pair of hands."
The process of obtaining a wheelchair can be exciting and overwhelming, both emotionally and financially. It can sometimes trigger painful emotions that you may not expect. These may relate to accepting a diagnosis or a degree of permanence of disability, or that the disability will now be obvious to others, or the need to implement changes in housing or lifestyles. Anticipating these feelings and helping families work through them is essential.
First Step – Find a Physical or Occupational Therapist with seating and positioning experience (see Resources>Services below). Ask the family if their child receives physical or occupational therapy services through Early Intervention, school, or privately. If this therapist has experience in wheelchairs, this is a perfect fit since he/she already knows the child and family.
The Assessment – A team evaluation is recommended. All team members work closely together and make a unique contribution. Team members may include, but are not limited to:
  • The consumer and/or family members drive the team with their unique insights into what may work, what has been previously tried, and can identify their needs for assistance with mobility. Ultimately, the decisions are theirs!
  • Occupational or Physical Therapist (OT/PT) will evaluate fine motor (hand), gross motor (total body), touch, and movement abilities; seating and positioning; visual perception; oral motor skills (feeding/swallowing); and mobility needs (self-propelled manual wheelchair or powered wheelchair with a joy stick) for mobility. They will evaluate the environment for access (home, car, school, etc.). Therapists will also instruct parents/caregivers in the use of the wheelchair, how to assemble/disassemble the wheelchair for transportation, how to get the child in/out of the wheelchair, and set up training opportunities to allow the child to become as independent as possible.
  • Speech Therapist will evaluate the child's communication abilities – is an augmentative communication device needed? If so, how will it be used in the wheelchair?
  • Rehabilitation Engineers design and make customized technology. They often "fine tune" wheelchairs for a better fit, particularly for people with significant disabilities.
  • Physicians write prescriptions for the assessment, the wheelchair, and ancillary equipment. These are generally based on (or just co-signatures of) recommendations from the PT/OT. Sometimes referrals are needed to facilitate 3rd party payment. The physician should communicate any special medical needs to be considered. It may be appropriate to rent a wheelchair when the disability is expected to be temporary, such as following a surgery or injury.
  • Teachers, rehabilitation counselors, employers, day care providers, respiratory therapists, recreational therapists, nurses, orthotists, friends, architects, etc. can also make valuable team members to guide practical and usability decisions and to assist in devising accommodations at home, school, and elsewhere.
  • Wheelchair/Seating Vendor's representative will submit all the finished paperwork to Medicaid or other insurance. They will obtain prior approval, order equipment, assemble, and deliver it. They can explain the pros/cons of each type of wheelchair to the parents and team. They can also provide price quotes and cost ranges. Vendors have a repair shop where flat tires and other repairs can be made.
Funding – Most wheelchairs or other assistive technologies are covered by Medicaid or private insurance as long as they meet a medical need. In general, wheelchairs can be replaced every 5 years or sooner if medical justification is documented and approved. Modifications to wheelchairs, such as for growth, are usually approved yearly. Some state agencies, charitable organizations, or private funding organizations can assist with the cost of the assessment and/or equipment.
Process – Following the assessment, a letter of medical necessity is written (usually by the PT or OT) to justify the medical necessity for the wheelchair. It must be co-signed by the physician or a prescription must accompany the letter. This is submitted by the vendor to Medicaid/insurance for prior approval. Once approval has been received, the equipment is ordered. When the equipment is received, a final wheelchair assessment by the team is scheduled to ensure an appropriate fit. This process generally takes 2-3 months. If the wheelchair is denied by Medicaid/insurance, APPEAL the decision! Appeals must be done in a timely fashion. Check the denial letter for specific timelines. See the Writing Letters of Medical Necessity (general) Issue page and Resources>Services below for assistance in appealing.
Follow-up – Training is essential to maximize the use of the wheelchair, or other Assistive Technology (AT) device, and can be provided by the involved PT or OT. The team should follow-up with the individual to ensure the wheelchair is acceptable and meets the needs of the patient and family. It is not uncommon to have to make "adjustments" after the wheelchair has been in use for some time.
Periodic Re-evaluation – How well the wheelchair meets the child's and family's needs should be reassessed periodically by the involved therapists or other team members. Children grow and the wheelchair needs to adapted or replaced to meet evolving needs. See the How to Know If a Wheelchair Fits Issue page. Medical needs, function, and preferences change with time also and each should be continually addressed. Repairs may also be needed.

Resources

Information & Support

For Professionals

Rehabilitation Engineering and Assistive Technology Society of North America
RESNA is an interdisciplinary association of people with a common interest in technology and disability. The website includes: ADA information services, legislative updates, section 508 news, credentialing program, professional standards, annual conference, and a directory of providers.

For Parents and Patients

Utah Assistive Technology Program (UATP)
Non-profit organization at Utah State University located at the Center for Persons with Disabilities (CPD). In coordination with community organizations and others who provide independence-related support to individuals with disabilities, they provide Assistive Technology devices and services, and train university students, parents, children with disabilities and professional service providers about AT.

Utah Assistive Technology Foundation
the UATF is a private, not-for-profit organization that works with Zions bank to provide low or 0% interest loans, and some limited small grants, to purchase assistive technology to enhance independence, education, employment, and quality of life for Utah citizens with disabilities.

Utah State Office of Rehabilitation
A point of access for a number of state-related services for people with disabilities.

Access Utah
A statewide information and referral service providing information on issues related to people with disabilities; provides a list of equipment for sale.

Adaptivemall.com
A commercial site offering a variety of assistive technology products.

Rifton
A commercial site offering a variety of assistive technology products

Invacare Corporation
A commercial site offering a variety of assistive technology products.

Services

The search for a qualified physical therapist (PT) or occupational therapist (OT) to serve on the team should start with the child's current providers, whether they are through the school, hospital, or clinic. If they are experienced, willing to help, and relate well with the family, you need look no further. Below you will find links to lists of local providers/sources of these and other related services.

General Legal Services

See all General Legal Services services providers (37) in our database.

Health Insurance/Funding, Transition

See all Health Insurance/Funding, Transition services providers (47) in our database.

Occupational Therapy

See all Occupational Therapy services providers (27) in our database.

Physical Therapy

See all Physical Therapy services providers (31) in our database.

Speech/Language Therapy

See all Speech/Language Therapy services providers (35) in our database.

For other services related to this condition, browse our Services categories or search our database.

Helpful Articles

Greer N, Brasure M, Wilt T.
Wheeled Mobility (Wheelchair) Service Delivery.
Agency for Healthcare Research and Quality. Technical Brief Number 9; January 2012. / http://www.effectivehealthcare.ahrq.gov/ehc/products/194/751/TechBrief...
Report prepared by the Minnesota Evidence-based Practice Center; a review of evidence related to wheelchair service, largely focused on adult services; highlights many of the payer, reimbursement, consumer, and provider issues that are relevant also for children.

Corbet, Barry.
Spinal Network: The Total Wheelchair Resource Book.
Third Edition ed. Nine Lives Press; 2002. 0971522308
A comprehensive guide to practical information regarding living in a wheelchair.

Butler C, Okamoto GA, McKay TM.
Motorized wheelchair driving by disabled children.
Arch Phys Med Rehabil. 1984;65(2):95-7. PubMed abstract

Butler C, Okamoto GA, McKay TM.
Powered mobility for very young disabled children.
Dev Med Child Neurol. 1983;25(4):472-4. PubMed abstract

Tefft D, Guerette P, Furumasu J.
Cognitive predictors of young children's readiness for powered mobility.
Dev Med Child Neurol. 1999;41(10):665-70. PubMed abstract

Authors

Author: Terry Holden PT, 1/2005
Content Last Updated: 1/2009