Eclipse Clinical Notes

Clinical Issue
Solution
Why PDG

Working through the paperwork needed to get funding, include each of the categories listed here in your letter of Medical Necessity to be sure Eclipse funding authorization is successful.

Patient Diagnosis

The Basics - Clearly indicate the patient’s medical diagnosis and weight. Specify the patient requires an Eclipse to achieve independent mobility for function both in and out of their home environment.

Patient Physical size and Proportions – Large individuals may be unable to sit up straight or may experience ongoing back pain. The Eclipse 600 includes an adjustable backrest and adjustable back upholstery with allowance for redundant buttock tissue, ensuring obese clients are able to sit up straight without back pain. The Eclipse is also the only extra-wide manual wheelchair with an adjustable-tilt seat and/or reclining backrest, adjustable seat height and adjustable seat depth. These features are essential to achieve a good fit for large clients.

Patient’s Abilities and Limitations as they relate to the equipment (e.g. degree of independence/dependence, frequency, and nature of the activities the patient performs)
The Medicare Certificate of Medical Necessity form includes a question specifically asking if the patient can self propel. Many large clients have great difficulty propelling other manual wheelchairs. When casters are turned the wrong way, the client can not get the chair to move appropriately. Client's weight is too much on the casters. Heavy patients need a wheelchair designed so that weight is distributed with most of the load being carried on the rear wheels and not on the casters Eclipse front/rear wheels are located to optimize client's weight distribution. Rear wheels are adjustable so that weight can be shifted onto the rear wheels. Front casters and rear wheels are moved forwardly compared to other heavy duty or extra wide wheelchairs. This is a feature unique to PDG.             
Client has difficulty reaching push rims. The rear wheels are too far back to reach. Need a wheelchair with rear wheels moved forwardly to allow easy push-rim access. Eclipse rear wheels can be adjusted forwardly, allowing user to reach hand rims, even when upper arm mobility is a factor. Eclipse wheelchair is the only extra wide wheelchair offering this important feature.
Many larger-than-average-size patients are unable to independently transfer. Heavy patients need a wheelchair with seat height appropriate to patient needs and their home environment. Eclipse seat height can be located much lower than with other extra-wide wheelchairs, facilitating safe and easy transfers. Lowest Eclipse seat height is 14".
Client needs an extra wide chair but also needs to get through a standard doorway. The overall width is too wide. Need an extra-wide wheelchair with as narrow overall width as possible Eclipse overall width is 7" wider than the seat pan. This allows it to go through doorways more easily. All other extra wide wheelchairs are at least 8-1/2" wider than the seat pan.
Client is short. Seat height is important since there may be a need to optimize the wheelchair for foot propulsion. Need to obtain a wheelchair that can be set at low seat height. Eclipse wheelchairs can be set up as low as 15" seat height. This feature is especially important when client foot propels.
Client is very tall. Need to obtain a wheelchair that can be set at high seat height, deep seat depth and tall backrest. Eclipse can be adjusted on-site to fit individuals up to 6' 7" tall. Most other suppliers would have to supply a special order custom wheelchair.

Duration of the condition

Long-term or Short-term use – When recommending an Eclipse, be sure to indicate that the patient’s condition is a long-term disability and the equipment will therefore be required for a long-term use.

 

Expected Prognosis
Weight changes - It is common for obese individuals to gain or loose significant weight over a relatively short time period.  Need an extra-wide wheelchair that can be adjusted as client weight changes. Justification should identify that an Eclipse wheelchair can be adjusted in width, depth and seat height to compensate for weight changes. Other extra-wide wheelchairs generally do not have adjustment capability.
Upper body weakness It is important to identify that many obese patients may not become stronger over the medium to long term.  Need an extra-wide wheelchair where the rear wheel position makes the chair easy to propel Eclipse rear wheels can be located so the client can easily reach the push-rims. Generally, other extra-wide wheelchair can not be configured to ensure good functional hand access to push-rims since their wheels are located too far rearward.
Client's buttock extends into back upholstery making it difficult to sit up straight. Need a backrest with allowance for excessive redundant tissue Back upholstery on E600 is adjustable to address this type of problem. Adjustable upholstery can also be ordered with an E350. This adjustable back upholstery can eliminate the need for added seating components in most cases.
Client has difficulty sitting up and propelling the chair. Adaptive seating, tilt and recline are an issue if full function is to be achieved. Need an extra-wide wheelchair designed to fit individuals with excessive redundant tissue and facilitate optimal positioning for hand propulsion. Eclipse can be set up with tilted seat and/or reclining backrest. Seat height and seat depth are also fully adjustable. Adjustable tilt, recline, seat height, and seat depth are unique to Eclipse wheelchairs.
Past Experience using Similar Equipment
Client has worn out their existing wheelchair too quickly. Chair does not stand up to client's weight. Requires frequent service. Need a wheelchair designed to take extra-heavy use. Eclipse wheelchairs are rigid frame construction, designed and tested to carry up to 1000 lb. Other extra wide wheelchairs are designed to carry heavy weight, but usually are built on less durable folding frames.
Client has large body mass. This makes assessment for a properly fitting wheelchair very difficult. Need to obtain a wheelchair with reasonable assurance it will fit and can be adjusted as client needs change. Eclipse wheelchairs are very adjustable. Seat height, seat tilt, seat depth, back height, back recline can be adjusted during delivery set-up. Eclipse wheelchairs come with a TGIF warranty. PDG guarantees a good fit or we will exchange the new chair for the correct size.