Funding for Manual Tilt-in-space Wheelchairs

Prescribing therapists must complete AADL 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 an individual and answers must reflect the client’s situation. This information is only a guide.

1. Alberta Aids to Daily Living (AADL) Wheelchair Authorization Form  ( Form 1251)

Direct link to the form:

http://www.seniors.gov.ab.ca/AADL/AV/manual/PDF/62_wheelchair_authorization_form_1251.pdf

Section 3

 

AADL Catalog # ___________  Stellar W321    Comparable Substitute Acceptable   NO

                                             Bentley W322

 

(it is important to answer No for substitution if this is case)

 

See Sample page AADL Wheelchair Authorization Form with key parts completed

  

Section 4

 

Manufacturer’s specification Sheet Attached   YES

 

Bentley  Specification sheet

http://www.pdgmobility.com/PDG-Literature/specifications/200511R2-Bentley-tilt-in-space-Wheelchair-SpecCA.pdf

 

Stellar Specification sheet

http://www.pdgmobility.com/PDG-Literature/specifications/200511R2-Stellar-tilt-in-space-Wheelchair-SpecCA.pdf

 

Section 6

 

Additional Information.  This is a good area to write anything specific about your client that is not covered in the assessment, or these forms, such as skin integrity.


2. Alberta Aids to Daily Living (AADL) Manual Wheelchair Assessment Tool

The therapist can use either their own assessment or the assessment sheet provided by AADL

 

http://www.seniors.gov.ab.ca/AADL/AV/manual/PDF/64_assessment_tool_manual_wheelchair.pdf

  

Primary Features of Requested Chair

 

If you want to prescribe a PDG tilt-in-space wheelchair, the following helps describe unique properties of PDG chairs, which may help address the needs of the client.

 

  • The Bentley/ Stellar tilts from the front  providing good posture and allowing for foot propulsion while in the tilted position.
  • The Bentley/ Stellar has plug in foot rests, which eliminates the possibility of injury from the swing away hanger for clients that foot propel.
  • The Bentley/Stellar allows for self tilt, providing independence for the client.
  • The Adjustable rear axle allows for good positioning for hand propulsion.
  • While tilted the Bentley/Stellar provides access to tables since knees stay low.
  • The seat to back spring promotes durability of the chair.
  • The adjustable gas strut provides easy tilt for the caregiver no matter what the weight of the client which improves the safety of both the client and the caregiver.

 

See Sample page AADL Wheelchair Assessment Tool with key parts completed

 

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.