It’s back-to-school season, and the transition from a relaxed summer schedule to the more structured school year is a struggle for any student. But for kids who are also complex rehabilitation technology (CRT) users, making that transition can take a bit more planning. 

We recently talked to Cristina Stanila, a Chicago-area mom, who’s hard at work prepping her soon-to-be 5-year-old, Matthew, for the upcoming school year. Matthew, who has a rare genetic disorder called Chromosome 8P and a number of related conditions, is in his third year of preschool and uses a wheelchair for mobility. 

Tips for A Successful Transition from Summer to School

• Transition slowly. Give your child time to adjust.
• Create a schedule that works best for your child and his or her needs. 
• Talk about upcoming changes so your child knows what to expect. 
• Keep bedtimes and wake-up times consistent throughout the year. 
• Practice with new equipment before the school year starts. 
• Talk to teachers and aides ahead of time about your child’s needs and equipment. 
• Get a back-to-school equipment tune-up. 

Matthew’s School Year Schedule

Matthew goes to preschool every weekday, but may leave a little early or get dropped off a little later, depending on his therapy appointments for the day. 

Knowing therapy—which for Matthew includes physical and occupational therapy, speech and feeding therapy, aqua therapy and more—and a full day of school can be exhausting, Matthew’s parents try to schedule his therapy early in the day. Matthew also completes several longer stints of intensive therapy throughout the school year, so he usually takes time away from school during these times. 

“During those times, he has between two to four hours of therapy per day,” she says. “Adding in school at that time would be too much for him.” 

Navigating Change

This year, Matthew will be attending a different school, with a new teacher and unfamiliar staff. Cristina feels a bit anxious about the change and worries about how it will affect Matthew. 

“He does like routine, and he loves people, but he loves people he knows,” she says. “It will be a struggle for him to get used to the new staff and the new school. We’ll probably start slowly to give him time to get used to it.” 

In addition to taking things slowly, Cristina also talks to Matthew about the upcoming changes, even though he doesn’t speak. 

“I tell him about the changes that are going to happen and how those changes might make him feel,” she says. “I assure him that I will make sure he’ll get the care he needs, even when he’s at school and about the new friends he’ll make and the new, exciting things he’ll learn.” 

Consistency really is key, Cristina says, which is why their family strives to keep Matthew’s bedtime and wake-up times the same during the summer and the school year. 

“The new schedule can be stressful enough, and the transition from a more relaxed schedule to a busy one can be tough,” she says. “That’s why I believe that keeping the same wake-up time and bedtime consistent is the first step to a successful start of the year.”

Creating an Optimal Learning Environment

If your child is using new equipment, Cristina suggests getting in a little practice before the school year starts. 

“Start using it in familiar environments and fun activities,” she says. 

The start of the school year is also a great time for a chair tune-up. Set up an appointment with your Assistive Technology Professional (ATP) to make sure the chair still fits your growing child well, Cristina advises. 

“I make sure the foot support is at the appropriate height for him and the same with the head support and chest strap,” she says. “Don’t forget to check if the tires need air.” 

Dennis Ponczek, the assistive technology professional (ATP) and branch manager who works with Cristina and Matthew, agrees, but encourages parents to schedule evaluations for growth adjustments sooner rather than later. 

“Many evaluating clinics are scheduled weeks in advance and the process to get new parts can take a couple of months,” he says. “So don’t wait until the week before school starts to schedule an evaluation.” 

Cristina also tries to make sure Matthew’s teachers have a baseline understanding of his mobility equipment and what to do if something breaks or isn’t working correctly. 

“I always tell the teachers or aides that if anything breaks or they’re struggling to unbuckle a belt to take him out, it’s best to call me,” she says. 

Above all, Cristina says that parents can be their child’s best advocate. 

“Your child has the same rights as everyone else,” she says. “They have to have access to the same areas as other children, and the school has to be accessible for all children.” 

To learn more, Cristina suggests reaching out to a Special Needs Advocate in your area who can help explain your rights and how to navigate any situations you may face. 

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Diane Racicot, National Seating & Mobility Payer Relations Vice President, and Wayne Grau, Executive Director of NCART, offer a candid discussion on the hurdles faced by both providers and consumers, such as navigating complicated policies and dealing with insurance-related delays.

They emphasize the profound impact of the COVID-19 pandemic, supply chain disruptions, and labor shortages on timely repairs. Through heartfelt insights, they underscore the necessity for better education, policy reform, and collaborative efforts among all stakeholders to enhance the repair system. By doing so this ensure that individuals relying on these essential technologies receive swift and effective support.

To learn more, please find the linked article found below.

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• Talk to the airline. “Talk to them when you buy your tickets and call them multiple times before your trip to remind them that you are traveling with a wheelchair,” Perkowski advises. “Get the names of everyone you speak to.” 
• Tape instructions to the wheelchair. Both Lengel and Morris suggest taping specific instructions to the wheelchair, specifically detailing any actions baggage handlers might need to take to load your chair onto the plane. Perkowski says to go one step further, especially if the chair belongs to a child. “Take a picture of your child and tape it to the chair or stroller with a sign on the chair that says, ‘My wheelchair is my legs.’”
• Remove any and everything you can. Wheels, joysticks, headrests, cushions. If it comes off the chair, take it off before your wheelchair is loaded into the cargo bay. 
• Document the condition of your equipment before and after your flight. Prior to getting on your flight, document the condition of your mobility equipment from every angle. When the wheelchair or device is returned to you following your flight, go through the process again, documenting any damage. “If something is wrong when you land, do not sign for a replacement at the airport,” Perkowski warns. “Make sure to tell the airline you want your original provider to evaluate the chair for damages as soon as they can to ensure nothing is missed.” 
• Drive your chair as far as you can. When it’s time to gate check your chair, talk to the people who will be handling it and explain any specific actions they should or shouldn’t take, like turning the chair on its side. “If you can watch them load your chair onto the plane, do it,” Perkowski recommends. 

To learn more or plan for an upcoming trip, permobil.com/travel-support.

Read our guide on buying a Wheelchair

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Transportation is vital for living an independent life—and a broad coalition of manufacturers, advocacy groups and more are working together to make it more accessible to people who use mobility equipment. 

The SecureRide Coalition began their work last fall. The group, led by United Spinal Association,  National Coalition for Assistive and Rehab Technology (NCART), and General Motors, currently includes  a number of complex rehabilitation technology (CRT) equipment manufacturers such as Invacare, Ki Mobility, Permobil, Pride Mobility Products/Quantum Rehab and Sunrise Medical as well as the automobile manufacturer, Volkswagen Group of America. The coalition is working to develop a standard securement system that will allow wheelchair users to safely stay in their chairs while utilizing ground transportation—and eventually other forms of transportation. 

“Now is a good time because there has been such a huge focus on accessible transportation,” said Alex Bennewith, United Spinal’s vice president, government relations. “We are developing a standard securement method so that we can make accessible travel available to as many people as possible.” 

Much of the coalition’s current work, which is centered on creating a standard device used to secure wheelchairs, when used as seats in motor vehicles, will focus on ANSI/RESNA WC19 and ISO 7176-19 standards. These standards specify design requirements, test procedures and performance requirements for wheelchairs used as seats in vehicles. 

The SecureRide Coalition plans to complete this work in three stages: developing a concept, engaging with organizations to test and publish standards and deploying a plan to engage with federal agencies and legislators. Bennewith says the group is currently working together to develop a standard securement prototype. 

“Transportation is a huge issue for our membership,” Bennewith said. “There are certain components out there that people might not feel comfortable adding to their chairs without a safe, standard securement system. We’re currently looking at different mounts and components of securement devices so that we can work together to create a standard prototype.” 

Wayne Grau, the executive director of NCART, a non-profit organization of suppliers and manufacturers of Complex Rehab Technology (CRT) products and services, says the coalition’s work is important and will lead to advancements. 

“Our first goal is to come up with one securement method that will work with as many chairs, both manual and power, as possible,” Grau said. “Then, that securement device could be used on a variety of transportation methods, like trains, planes and more. We want to make this securement method standard so everyone can take advantage of it.” 

With all major wheelchair manufacturers involved in the work, Grau estimates that they bring more than 300 years of combined manufacturing experience and know-how to the table. 

“We have a really good group and the right people are working to solve this issue,” Grau said. “Our first goal is to develop a standard device that can work to secure as many chairs as possible, and our focus is on the consumer. We want to help people live the life they want to lead, and this is a way to be actively involved in expanding opportunities for people.” 

The Biden Administration has made a priority of increasing access to all modes of accessible transportation. Just last July, there was an historic Department of Transportation (DOT) announcement of a final rule requiring accessible lavatories on single-aisle aircraft. Earlier this year, DOT published a proposed rule “ Ensuring Safe Accommodations for Air

Travelers With Disabilities Using Wheelchairs.” 

In mid-May, President Joe Biden signed the FAA Reauthorization Act of 2024 into law. The act reauthorizes the Federal Aviation Administration through 2028, and includes a number of important provisions to make air travel more accessible and safer for people who use wheelchairs. While the law doesn’t apply directly to the SecureRide coalition’s work, it has brought attention to the need for more accessible travel. 

It’s a moment the SecureRide coalition doesn’t intend to miss. 

“We are focusing on personal vehicles, rideshares and public transit right now, but a lot of what we’re working on is transferable to airlines,” Bennewith said. “The Department of Transportation is currently very focused on accessible travel, so we have a great opportunity to build on that momentum.” 

To learn more about the SecureRide Coalition, visit https://unitedspinal.org/secureride/.

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Last summer, Jonathan Lengel had the opportunity of a lifetime. A musician and an actor, Lengel, 17, was excited to take part in a study abroad music program in Spain. The trip was also the first time Lengel took his power chair on a flight. 

“I took all the necessary precautions for traveling abroad,” recalls Lengel, who has a rare form of muscular dystrophy and uses a power chair for mobility. “We bubble wrapped parts of my chair, took parts of it off, put a sign on the seat with all the information the ground crew would need to know about how to handle the chair.” 

When Lengel arrived in Madrid, his power chair arrived mostly intact. The seat cushion had been damaged, but the wheelchair was usable, and Lengel had an unforgettable experience in Spain. His return trip to the United States, an Iberia and American Airlines partner flight, was also unforgettable—just for a different reason.

“My dad and I were waiting for my chair to arrive at the jetway, but they told me I had to go through customs first to claim my chair,” Lengel said. “So I went through customs in an uncomfortable pushchair, and then we went down to baggage claim. We communicated to the crew that I really needed my chair. Then we heard a crash.” 

Turned on its side and dripping wet from the summer storm soaking the airport, the 400-pound wheelchair was on the heavy luggage conveyor belt some three feet above the ground. Parts of the power chair were missing, while other broken components were piled atop the chair. With no one to help them get the heavy chair off the conveyor belt, Lengel and his dad left the airport without his power chair. The damaged chair was delivered to his driveway the next day. 

“It was just such a terrible experience after such a wonderful experience in Spain,” Lengel says. “I hope no one ever has to go through something like I did that night.” 

Digging into the Data

While he hopes for the best, Lengel knows that many wheelchair users have faced similar experiences. 

On average, according to data from the February 2024 Air Travel Consumer Report, the top 15 airlines damage about 63 mobility devices each month, for a total of 11,289 per year. It’s one thing to look at the data and another to recognize that it means more than 11,000 people who rely on mobility equipment for independence can’t live the kinds of lives they want to live. 

“I don’t think that anyone purposefully or intentionally damages equipment,” said Brian Perkowski, an assistive technology professional (ATP) and NSM branch manager in New Jersey. “But until it happens to you or someone you know, unfortunately, you often don’t know how [damaging mobility equipment] really affects someone. Obviously, the mobility equipment we provide is completely customized. It’s priceless to the user. It’s their legs.” 

The data, self-reported by the airlines and collected by the Bureau of Transportation Statistics, tells a sobering story that’s only getting worse, with damage equipment increasing year over year. 

Perkowski says that some of the most common damages include ripped cushions and damage to anything that sticks out from the chair, such as headrests, joysticks and sensitive gimbals that allow users to control the chair and can’t always be removed. Broken straps and damaged harness clips, says Derek Miller, Division Vice President at NSM, are often common, as well as paint scrapes and push handle damage. Additionally, when a highly customized chair is tossed or mishandled, the frame can easily become twisted, which can cause catastrophic damage to the wheelchair. 

“I remember working with clients who would come in and their chairs would come with a bent frame,” Miller says. “You can’t repair something with a twisted frame.” 

Perkowski agrees.

“Think about when a car seat is in an accident,” he says. “If it’s in a crash, it’s out. You get a new car seat. If a wheelchair frame is twisted, you need a new chair.” 

According to John Morris, the creator of Wheelchair Travel, a website devoted to accessible travel, damages to wheelchairs during travel aren’t uncommon. Damages like this are more than an inconvenience, Morris says, something airlines and the general public may not understand. 

“We know how critical mobility equipment is to the freedom and lifestyles of disabled people, when that wheelchair, scooter or whatever it may be is damaged, it sends many people back into bedridden state and that’s not acceptable,” Morris said. “But there’s also a lot of uncompensated time involved, from waiting in the airport to working with the airline and scheduling a new fitting. It’s really frustrating.” 

After their experience last summer, Lengel and his mother, Cheryl Dispoto, agree. 

“Iberia Airlines actually called me at one point, after the replacement chair was already ordered through Global Repair Group (a Chicago-area company that works with many U.S. airlines to coordinate repair to mobility equipment damage during flights),” Ms. Dispoto recalls. “They asked us to give them receipts for what we’d already expended to rent a wheelchair and tell them the cost of a new chair, as if I was going to go to CVS and buy a custom-built wheelchair. So there was very little to no understanding from Iberia at all.” 

Advocacy, Reform and Education

Advocacy and reform are vital to solving the problem, but Morris and Lengel are taking slightly different approaches to achieve that goal. 

Lengel initially shared his story on Instagram and has continued to use the platform to advocate for change in addition to other avenues. 

“I strongly encourage wheelchair users who experience any kind of damage to file formal complaints with the Department of Transportation, even if the airline fixes the damage. The government needs to be alerted every time this happens,” Lengel says. “As a young person who loves to travel, I’m not going to be satisfied until I can bring my power chair on the plane.” 

Lengel is putting actions behind his words. He includes a link on his Instagram account that helps followers find and contact their state and federal legislators, and he and his family have contacted their local, state and federal representatives about the issue and their experience last summer. They’ve also filed a formal complaint with the Department of Transportation regarding the damage to Jonathan’s chair, in the hopes that his experience can help bring about change for others. 

“Something really has to change,” Lengel says. “It can’t take 10 to 20 years.” 

While legislation and government regulations are vital, Morris says transforming the travel experience for people who use wheelchairs has to involve the airlines and the people who design and build planes.

“Our government regulations are the foundation for civil rights and accessibility, and that shouldn’t be discounted,” Morris says. “But regulation is reactionary and rarely ahead of the curve. If we want to transform the experience that people are having today or at any point in the next two decades, it will have to come from working with the industry to demonstrate the challenges to create better design and better policies.” 

Legislation and advocacy are key components of changing the status quo, but so is education, Miller says. 

“The root of the problem is the mishandling of equipment,” Miller says. “If equipment was handled in a different manner, airlines wouldn’t need to pay for a $30,000 wheelchair that gets completely damaged.” 

Perkowski also stresses the importance of educating airline employees from baggage handlers to gate agents about how to handle and care for mobility equipment. 

“Education has to be the starting point,” he says. “But how do you teach that many people? Not just the baggage handlers, but the people at the gate and in the airport? Clients like Jonathan couldn’t even get help from the people coordinating luggage coming off the conveyor belt.” 

Humanizing the problem is key and a good starting point, Perkowski says. If more people understand that a damaged wheelchair isn’t just an inconvenience, maybe that knowledge can become a catalyst for change. 

“Change has to start somewhere,” Perkowski said. “If someone’s experience can help humanize the problem, then maybe that’s the starting point. Maybe that’s how we get something done.” 

Forecasting on the Future

While both Morris and Lengel are looking forward to the day when people can remain in their wheelchairs while flying—Delta Air Lines revealed a prototype for an in-flight docking system last summer—both recognize that’s likely still years away. 

Currently, most power chairs must be placed in the plane’s cargo hold with passenger’s luggage and other items. One way airlines could help, Morris says, is by being more transparent about the dimensions of the cargo door and hold. 

“United agreed to list cargo door dimensions and other information on their website as part of a settlement agreement with the Department of Transportation,” he says. “It’s kind of sad that people have to come to my website to get a list of cargo door dimensions.” 

According to Morris, most plane cargo doors are accessed by an opening that’s “significantly smaller than one would expect.” 

“The most popular plane in the world is the Boeing 737, and the clearance space is only 33 inches,” he says. “So, compare that to the height of a typical power chair. That means, as wheelchair users, we have to think of some ways to reduce the size of the chair.” 

That might mean removing the seat back or reclining the power chair before it goes in the cargo hold or removing pieces that might be easily damaged. That could include the joystick, which can be removed in some models, seat cushions, headrests, and, for manual wheelchair users, the wheels. 

“It’s also helpful to provide information to the folks who will be handling your device,” Morris said. “Attach instructions to the chair, detail how to put it into free wheel mode, which can be difficult to decipher, and do what you can to make the process faster and easier for the staff.” 

There are small signs of change, though. On May 16, President Joe Biden signed the FAA reauthorization bill into law. The bill reauthorizes the FAA through 2028, but also includes provisions to improve evacuation procedures for people with disabilities, create stronger enforcement of the Air Carrier Access Act and mandate training for personnel handling and storing wheelchairs during flights among other provisions. 

In late February, the Department of Transportation (DOT) also announced a proposal designed to “ensure airline passengers who use wheelchairs can travel safely and with dignity,” according to a DOT press release. Among other things, the proposed rule would mandate enhanced training for employees who physically assist passengers with disabilities and handle mobility equipment while also making it easier for DOT to hold airlines accountable when they damage or delay the return of mobility devices. DOT has called for public comment on the proposal.

While these moves symbolize a bit of progress, it’s still a waiting game for complex rehabilitation technology (CRT) users. Lengel, who has passionately campaigned for FAA Reauthorization on social media, remains committed to advocating for change with a better future in view. 

“It’s 2024, and traveling on a plane is still inaccessible,” he says. “I want to travel. I want to do the things anyone else can do and expect equal treatment. It shouldn’t be an ordeal.” 

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The future of healthcare will be driven by data, experts say, and data has a big role to play in proving the value and efficacy of complex rehabilitation technology equipment and interventions. 

“Most payers, including the government, do not put a lot of value on interventions that are not supported with research evidence. Unfortunately, highly customized wheelchairs tend to fall in this dilemma given little has been studied to show the critical role this equipment plays in a person’s ability to function and participate in life,” says Mark Schmeler, Ph.D., who serves as the vice chair for clinical services and policy in the Department of Rehabilitation Science and Technology at the University of Pittsburgh. “Policy makers really need to see that research studies show the value of complex rehabilitation technology versus just taking our word for it. Clinicians are excellent at providing service but do not always have training or experience on how to measure the effectiveness of their work.”

Rather than complain about the problem, Schmeler and the Department of Rehabilitation Science and Technology at the University of Pittsburgh want to be part of the solution. The university recently received a five-year grant from the National Institute on Disability, Independent Living and Rehabilitation Research that will support clinicians with post-doctoral fellowships designed to advance their careers in assistive technology research, as well as practice and policy. 

Schmeler, who is an occupational therapist (OT) and an assistive technology professional (ATP), has been providing custom wheelchairs to people with disabilities for the past 34 years. While occupational and physical therapists have long made recommendations according to the “clinical common sense” evidence they’ve developed through their careers, few have been trained about how to more formally gather data and research that could make a difference on a larger scale. 

That’s the problem that the new grant and the post-doctoral fellowship seeks to solve. 

“This grant will allow us to train more therapists on how to implement research in the clinic while continuing to provide high quality services,” Schmeler says. “More research evidence on the benefits of custom wheelchairs provided under the proper best practices will inform other stakeholders, especially payers, to apply these findings to evidence-based policy.”

While the fellowship will help to train clinicians about assistive technology research and the impact it can have on practice and policy, CRT users also have a role to play. Data gleaned from patients is already helping to shape best practices as well as policies in today’s value-based healthcare system, but more research and data are needed when it comes to assistive technology, according to Schmeler. 

“Value is a measure of both cost and quality, and we know what the cost is, but we have very little data and research on the quality side of it,” Schmeler says. “If CRT is going to exist in the new world of value-based care, we need consumers willing to share their feedback in a de-identified manner; suppliers and clinicians who are willing to collect that data in an efficient manner; and clinical investigators with some research training to analyze the data.

“If we cannot provide this information or are unwilling to do so, payers and policymakers will continue as they do now,” Schmeler continues, “by limiting access as we’re not able to provide them with any research evidence that these CRT interventions really work.”

To learn more about Schmeler’s work, check out some previous Let’s Get Moving Journal articles he’s contributed to, including “Right to Repair,” “Data-Driven Change” and “A Better Way to Pay.”

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The holiday season is here, and we want to help you keep it merry and bright. From adaptive clothing to the latest in gaming tech, here are a few of our favorite products, gadgets and gear, curated specifically for people who use mobility equipment.

For the Sports Fan

The NFL released a special collection of adaptive and assisted apparel for all 32 teams. Available from Fanatics, the collection features adaptive and assisted short- and long-sleeved T-shirts as well as adaptive pullover hoodies. Some of the shirts use magnetic snaps at the shoulders, making it easier to pull the clothing overhead. Other items include adaptive bungees and extended adaptive zippers. Grab the perfect gift for your football fan at fanatics.com.

For the Gamer

Looking for a gift for the gamer in your life? Sony has the Access™ controller for PS5. The controller is highly customizable and is designed to help players with disabilities play their favorite games more comfortably. The controller features swappable buttons and stick caps, allowing users to configure it to fit their range of motion and preferences. Players don’t have to hold the controller to play, and the controller includes expandable inputs, allowing players to use more than one Access controller simultaneously or add additional control devices. The design team worked closely with accessibility experts throughout the design process. Click here to learn more about the controller. 

For the Traveler

For the traveler, the best gift may be an unforgettable experience—and there are plenty of tools out there to make that happen. Last year, Airbnb launched an Adapted category that allows travelers to find accessible homes in locations around the globe. To be included in the category, each home must have step-free access and dedicated accessibility features, and would-be travelers can use filters to search for specific needs. Becoming RentABLE offers a similar service, but focuses solely on the United States. Created by wheelchair user Lorraine Woodward, the site includes an extensive list of accessibility accommodations, allowing travelers to find a short-term rental that meets their exact needs. 

For the Chef

From a cookbook recommendation to tools to make cooking easier, we’ve got a few gift ideas for your consideration. Adaptive cutting boards (some with spikes to keep food in place while chopping) and bowls with non-slip bottoms can be great gifts for people who love to cook. Jules Sherred’s Crip Up The Kitchen, which was released in mid-2023, is also a great option. With tips for organizing the kitchen and ideas to make cooking a bit more accessible, the book also offers recipes organized by how much prep and effort are required. 

For the Fashion Icon

Need a gift for the fashion lover in your life? There are plenty of options. Nine West and Kohl’s recently announced a new adaptive clothing collaboration, which will add even more adaptive apparel to the retailer’s growing list of fashion options.

Victoria’s Secret and PINK also released their first-ever adaptive collection this fall, offering intimates in a variety of colors and prints that feature magnetic closures, front strap adjusters and more. Looking for footwear?

Sorel, in collaboration with Zappos, has released an adaptive version of its popular Out n About III Classic Waterproof boot, just in time for cooler weather. The shoe features an adjustable strap and an enlarged heel loop, making the shoe easier to take off and put on. People with disabilities tested the shoes, providing vital feedback to ensure quality and functionality. 

Looking for more options? Check out this gift guide from our friends at New Mobility Magazine or this one from BraunAbility.

The post Last Minute Holiday Gift Guide for People with Disabilities appeared first on NSM — National Seating & Mobility.

In May 2023, the Centers for Medicare and Medicaid Services (CMS) issued a decision regarding the coverage of power seat elevation systems for complex rehabilitation technology (CRT) users. We’re weighing in on the details of that decision, next steps in the process and what it all means for you. 

What was the decision? 

CMS found that power seat elevation equipment falls within the benefit category for durable medical equipment. According to the decision, power seat elevation equipment is considered necessary for individuals using complex rehabilitative power-driven wheelchairs who meet specific conditions: 

1. The user undergoes a specialty evaluation that confirms his or her ability to safely operate seat elevation equipment in the home, completed by a physical therapist, occupational therapist, assistive technology professional (ATP) or other licensed/certified medical professional.
2. At least one of the following apply:
   1. User performs weight-bearing transfers while in the home;
   2. User requires a non-weight bearing transfer while in the home;
   3. User reaches from the power wheelchair to complete one or more mobility related activities of daily living. 

Read the entire decision here. 

So what does this decision mean for CRT users?
“This is an incredible decision,” says Wayne Grau, executive director of the National Coalition for Assistive and Rehab Technology (NCART). “It allows for a much-needed and very well-received product to be made available across the board to individuals who qualify for it.” 

So, CMS made the decision to cover seat elevation. What’s the next step in the process? 

The next step in the process, Grau says, is determining the Medicare reimbursement codes as well as pricing. “We submitted for codes on July 3,” Grau says. “That was something manufacturers and many other people were working on for more than three years because we needed to explain the coding we had suggested and back that up with data.” CMS is also working to determine pricing, using information and a report supplied by members of the  Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition. “We’re hoping to hear something by late November, maybe a preliminary decision,” Grau says. “CMS will then release the final decision regarding coding and pricing, which could happen as early as December or January.” 

This is a CMS coverage decision, but is it  likely to affect what private insurance providers cover? Why or why not? 

This decision currently only affects those covered by Medicare and Medicare Advantage plans, but since CMS is the model most commercial insurance providers follow, Grau and other industry experts are hoping other private insurance providers will soon do the same. “A number of other states and private insurance providers are already covering and paying for power seating elevation,” Grau said. “This may be a state-by-state issue, but we are hoping other commercial insurance providers will soon follow suit.” 

I have an evaluation coming up for a new wheelchair. What do I need to do? 

At your evaluation, talk with your physical therapist or assistive technology professional (ATP) to see if you qualify for seat elevation. If you do, your care team will include this information in the documentation that is required by your health insurance provider, who will review it. Please remember that the CMS decision about seat elevation coverage only applies to those covered by Medicare and Medicare Advantage plans. Private insurance providers may not cover it yet, so be sure to talk with your care team, who know the specifics of your case and your coverage options, to navigate this process. 

So CMS decided to cover power seat elevation, but what about power standing systems? 

Initially, the ITEM Coalition asked CMS to consider power seat elevation and power standing systems together, but the CMS decision issued last May only considered seat elevation. “Power standing systems are on the published waiting list for CMS coverage determinations, but we don’t have an indication right now about when they might consider it,” Grau says. “They have heard our concerns and asked for some additional data that had been released since the initial submission, so we feel like that is a good sign.” CMS coverage of power standing systems is something Grau says industry advocates will continue to press for, but, for now, they must wait until CMS opens up the coverage determination process. 

SIDEBAR: How did we get here? 

Wondering about the timeline for the CMS decision about power seat elevation? Here’s a glimpse at the process. Making changes to CMS coverage determinations is a lengthy process that often involves work and support from consumers and partners across the CRT industry. 

August 2018: The ITEM Coalition wrote to CMS Administrator Seema Verma and then-Health and Human Services Secretary Alex Azar seeking a review of the CMS coverage policies for power seat elevation and standing systems. The coalition met with CMS nine times between 2018 and 2020 to discuss these policies and got to work drafting the 91-page formal request for reconsideration that was submitted to CMS in September 2020.  That document can be viewed here.

September 2020: A coalition of patients, providers, researchers and subject matter experts (the ITEM Coalition) submitted a formal request for reconsideration of the National Coverage Determination for power seating elevation and power standing systems. 

August 2022: The Centers for Medicare and Medicaid Services (CMS) opened public comment for power seat elevation, but not power standing systems. 

May 2023: CMS posted their final decision, finding that power seat elevation equipment falls within the benefit category for durable medical equipment (DME). 

NOW: Both CMS and CRT stakeholders are working to determine coding and reimbursement for power seating systems as well as pricing. More information is expected this fall with final implementation anticipated in 2024. 

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Michael England never really expected to open a coffee shop. 

His career, Michael thought, would probably stay focused in the automotive industry. His dad had worked in the industry Michael’s entire life—and Michael had assumed he would, too. But a few years ago, after Michael had moved back home to Crossville, Tennessee, and reconnected with Cigi, a college acquaintance who is now his wife, a love for running and a chance encounter changed everything. 

“One Saturday, Cigi and I were walking to lunch in downtown Cookeville, Tennessee, and Ainsley’s Angels was set up outside a grocery store there,” Michael recalls. Ainsley’s Angels is a nonprofit that pairs runners with individuals who have disabilities to complete races, among other advocacy and inclusion efforts. “I’m a runner, and I’d always wanted to know more about the program.” 

The Styer family was working the Ainsley’s Angels table that afternoon, and the chance encounter led to Michael pushing Bradley, who uses a wheelchair, in several races. The connection began to open the Englands’ eyes to how Bradley’s life differed from theirs. 

“I didn’t have someone in my family who had mobility issues or special needs, so I just didn’t know the issues people with disabilities faced,” Michael says. “We learned very quickly that the world isn’t built for people with disabilities.”  

Through his relationship with Bradley, Michael and Cigi began to see that accessibility was about more than wider doors and ramps. It was about employment and more than that, community. 

“Another thing I’ve taken for granted most of my life is making friends and being part of a community,” Michael says. “But think about where you meet people. Sixty percent of our lives, we’re at work. Bradley was 33 and desperately wanted a job.” 

One Sunday afternoon, while Michael and Cigi were watching a documentary on European coffee shops, a new idea began to brew. 

“The documentary talked about how coffee shops provide employment, but they’re also the hub of the community, where people can gather and find community and build relationships,” Michael says.

So the Englands began to “kick around” the idea of opening a coffee shop that provided employment opportunities for people with disabilities but also created a sense of community. The Exceptional Bean opened its doors in July 2022.

“One of the first people we told we were going to do this were Bradley and his family,” Michael recalls. “Bradley started crying. 

“For me, employment opportunities are almost endless, but that wasn’t the case for him,” Michael continues. “Now, Bradley comes into the building and the first questions out of his mouth are, ‘Are there boxes to break down? Is there trash to take out?’ For Bradley, it’s not ‘I have to go to work.’ It’s ‘I get to go to work.’”

Michael and Cigi set up the Exceptional Bean as a nonprofit, meaning that while Cigi is the founder and Michael the general manager, a board of directors oversees the coffee shop. The nonprofit status also allows the board to fundraise, which is vital to fulfilling the Exceptional Bean’s mission. But it’s also reflective of the type of space Michael and Cigi are working to create: a community. 

“Our employees feel a sense of purpose in their work,” Michael says. “They meet here to go to the library or the park; they hang out here. I have a stack of applications from people who want to work here, but we don’t have the ability to hire them right now. We need partners.” 

All donations are helpful, Michael says, but he and Cigi are working to build a consistent donor base built on monthly recurring donations. 

The Exceptional Bean is about finding a community, a sense of belonging. 

“For us, it’s about making the world more accessible,” Michael says. “I look at my friend Brandon, one of our employees. He has cerebral palsy and uses a wheelchair, and I know if he were in my spot, he’d try to make a place for me.”

To learn more about the Exceptional Bean or to donate, visit theexceptionalbeancookeville.com.

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As creator of the iAccess.Life app, Brandon Winfield is used to giving elevator speeches. When it comes to the lifestyle app, his speech is short and to the point. 

“We’re the Yelp of accessibility,” Winfield says. “Yelp rates places based on ambiance, culture and experience, and we rate them on how easy it is to get around and access them.” 

iAccess.Life is a lifestyle app that allows users to research, rate and review locations—think everything from restaurants and retail stores to parks and public spaces. Built upon the Google Maps platform, the app gives users the chance to weigh in on a location’s accessible parking, bathrooms and entrances as well as how easy it is to get around once they’re inside. While rating, users can also note the types of mobility equipment they use to get around. 

“For people using iAccess.Life to research new locations, this allows them to see how the person who wrote the review gets around and if it pertains to how they get around,” Winfield says.

The idea for the app, Winfield says, came from his own experience. 

“I grew up racing motocross at the competitive level,” he recalls. “When I was 14, I got hurt in a race. It wasn’t the first time I got hurt, but it was the most severe and life-changing.” 

The accident left Winfield paralyzed from the chest down. A wheelchair user since then, he quickly realized that not all accessibility is created equal. 

“As I got older and able to venture out in my own community, I began to realize how inconsistent access is from place to place,” Winfield says. “Sometimes, you’d get to the restaurant just to see that there were steps to get in the front entrance or you’d go to the bathroom but wouldn’t be able to fit in the stall. I just knew there had to be a better way to allow people to know more about a place’s accessibility before they go.” 

The idea for an app, Winfield says, came after a church service. 

“I went to church one day with my mom, and it was a New Year’s Eve service,” Winfield remembers. “They were talking about ways that you could help your community, and I had one of those cartoon lightbulb moments, and I realized I needed to develop an app.” 

Bringing that idea to life took a few years and involved a lot of trial and error, Winfield says. The startup officially launched the app in 2019. With rated locations in all 50 states and more than 30 countries, iAccess.Life is one of the more successful accessibility apps available. 

“We just hit 10,000 unique locations rated in our app,” Winfield says. “It’s so cool to come to the dashboard and see all these ratings come in from different locations—Canada, the UK, South Africa and South America. We are the most successful accessibility app out there and one of the first with international reach.” 

Winfield and his co-founder, Sayeed Mehrjerdian, have plenty of plans for the future of the app. The startup recently partnered with Passport Parking, a move that allowed them to roll out in-app pay-for-parking at a limited number of partner parking lots. 

“You can pay from the comfort of your car,” Winfield says, “and won’t have to deal with kiosks.” 

Winfield and the iAccess.Life team are also working to develop a companion product that will allow them to come alongside businesses seeking to improve accessibility. 

“We’re working on a business-to-business product, an analytics tool that will help businesses find out what people are saying about their accessibility and make changes to become more accessible,” Winfield says. 

Most of all, Winfield wants to encourage users to keep adding ratings to the app. 

“iAccess.Life is catered toward community,” Winfield says. “We want people to share their experiences. We want to show the world that we’re a community that loves to go out, that we have a social life and a love life. Our goal is to keep getting users onto the application and keep getting ratings in so that our voice can be amplified.” 

The iAccess.Life app is available in the Apple App Store as well as Google Play. 

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