Preparing for a New Wheelchair Telehealth Evaluation

The COVID-19 pandemic has led everyone to make numerous changes in their lives over the past year. Wheelchair users in need of a new wheelchair have faced closed clinics and limited access to the knowledgeable & experienced therapists who are so essential to the process. Fortunately, the Centers for Medicare and Medicaid Services (CMS) approved the use of telehealth for medical services. Telehealth is the exchange of medical information from one site to another through electronic communication to improve a patient's health.

Telehealth is definitely a new format that many of you may not have experienced. You may wonder, "How will this work for me, and what can I do to prepare for this type of evaluation?" I assure you the process can go very smoothly, but may require additional time to complete and possibly more than one visit. Normally, the supplier will be the person who visits you in-person in your home and the therapist will connect remotely.

Here are some pointers on how best to prepare for this service so the team can be efficient and address your needs. Be prepared to give your full attention to the supplier and therapist for at least two hours!

1. Provide information to the therapist ahead of time. Request your physician to send the therapist/supplier a current clinical note with your history and physical information, including all diagnoses, medications, and some past history. Complete an intake form for the therapist if they send you one, or complete your own. Manual wheelchair users may refer to the My Wheelchair Guide smart phone app's "My Wheelchair Checklist." Information the therapist may ask ahead of time includes:
   1. Your body weight and height
   2. Skin condition, including history of or current pressure injuries
   3. Location, level, and cause of pain & how you manage pain
   4. Your functional needs
   5. Past and planned surgeries
   6. What wheelchair and seating system you currently use (manufacturer, model, size, condition), when you received it, who your supplier was, and who paid for it
   7. How your current wheelchair and seating is working or not working for you
   8. How you transfer into and out of the wheelchair
   9. Information about your home environment -- access into your home, type of flooring, doorway and hallway widths
   10. Your goals for new equipment or changes you need for your equipment to work better for you

Provision of this information ahead of time allows the supplier and therapist to prepare ahead of time and bring more appropriate sample frames, seat cushions, back cushions, and wheelchairs to your home for assessment.

The exciting thing about telehealth is the supplier and therapist can provide a more thorough home assessment, since they can visually see you navigate around your home and assist with finding solutions to make your life easier.

2. Make sure you have a sufficient Wi-Fi connection for the supplier to use their laptop or tablet to connect with the therapist
3. Dress in clothing that allows the therapist to easily observe your posture on camera through the computer screen. No baggy clothes!
4. Have a firm surface available for short sitting to allow the therapist and supplier to assess your posture and take body measurements.
5. Adjust the lighting in the room so the video allows the therapist to clearly see you and not just shadows. This may mean closing the curtains or blinds to reduce the glare from outside and turning on overhead lights.
6. Do everything you can to ensure your home is quiet, without any excess noise.
7. Consider using a headset with a microphone to make sure you can hear the therapist and the therapist can hear you.

While assessing your current Complex Rehab Technology (CRT), the therapist will need to pay specific attention to your postural alignment, pressure distribution, stability, and dynamic movement during functional use of your equipment. The therapist will also need to assess your joint range of motion and strength. Therefore, sometimes a family member, friend, or caregiver may be needed to assist with the assessment. They will simply follow the therapist's instructions.

This person may also be needed to move the audio/video equipment to show the viewer your current CRT equipment, your environment of use, your postural alignment, etc. while the supplier is assisting you.

For users who are unable to speak for themselves, input from family members, caregivers, and treating therapists is important.

In addition, if you are currently receiving therapy, be sure to inform that therapist in case they want to provide input to the seating clinic therapist.

Currently, the Complex Rehab Technology Remote Services Consortium is working on advocacy to obtain permanent approval for telehealth after this public health emergency ends. As a stakeholder in the need for CRT, I encourage everyone to visit www.ProtectMyMobility.org to learn more and to email your Member of Congress.

If your therapist or supplier is unsure about the use of telehealth for a CRT evaluation, please recommend they visit www.ClinicianTaskForce.us for a new resource released on February 16, 2021: "Clinician's Guide to Use of Telehealth for CRT Service Provision."

About the Author

Barbara S. Crume, PT, ATP became RESNA Certified as an Assistive Technology Professional in 1997. She is currently employed with MountainCare Services in Asheville, NC as a Seating and Wheeled Mobility Specialist. She previously worked for CarePartners Health Services in Asheville, NC for 35 years. Barbara provides evaluations, fittings, and training for clients of all ages and all diagnoses to obtain manual and power wheelchairs. She works closely with a variety of suppliers and consults with manufacturers on product development. She is a member of the Sunrise Medical Clinical Advisory Board. Barbara has presented courses at Medtrade, International Seating Symposium, RESNA Annual Conferences, and APTA CSM. She has taught several webinars through NRRTS and RESNA. She is an active participant in the Clinician Task Force and assisted in writing the "Clinician's Guide to Use of Telehealth for CRT Service Provision."

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