Assistive Technology Test 1

Front 1

Why is good posture easier in standing than seated?

Back 1

Due to locking mechanism of the hips.

Front 2

How should hips be aligned in a WC

Back 2

neutral to slight anterior tilt
*goal is to allow for rest AND mobility AND good posture

Front 3

Def of Assistive Technology

Back 3

any item, piece of equipment or product system whether acquired commercially off the shelf, modified, or customized that is used to increase, maintain, or improve functional capabilities of individuals with disabilities

Front 4

potential outcomes of proper seating and positioning

Back 4

-improved movement
-neutral skeletal alignment
-prevention of tissue breakdown
-improved comfort
-decreased fatigue
-improved respiration
-improved swallowing and digestion
-improved stability thus improved function

Front 5

3 categories of seating intervention

Back 5

1. postural control and deformity management
2. pressure management
3. comfort and postural accommodation

Front 6

Biomechanical principles for seating

Back 6

1. Force-anything that acts on a body to change its rate of acceleration or alter its momentum
-occurs in equal & opposite action-reaction pairs
-applied externally and internally
2. 3 types of force
-tension
-compression
-shearing
3. stress: resulting in molecular change inside biological or non-biological materials
4. pressure- every force is applied over a surface area
-defined as force per unit area
5. Newton's laws of motion
6. Friction (forces)
-static friction
-dynamic friction

Front 7

Standing posture

Back 7

2 feet provide the BOS
COG- upper sacral region
natural lordosis of lumbar spine

Front 8

sitting posture

Back 8

BOS consists of buttocks, back of thighs, feet
COG is lowered
pelvic stability is reduced- passive locking mechanism at hip joint not active
kyphotic posture of lumbar spine and trunk

Front 9

Framework for decision making in positioning and seating

Back 9

1. outcome of needs identification
2.outcome of skills evaluation
3. Matching

Front 10

Outcome of needs identification for positioning

Back 10

identify contexts and related concerns
-setting, accessibility, caregiver concerns, transportation
ID previously used seating systems
ID and prioritize goals

Front 11

Outcome of skills evaluation for positioning

Back 11

physical skills
-orthopoedic, neuromotor, respiratory, circulatory
sensory skills
-vision, perception, tactile
Cognitive/behavior skills
-safety awareness, motivation
functional skills
-transfers, self care, mobility, communication, bladder

Front 12

Matching for seating systems

Back 12

Technology vs postural control vs pressure management vs comfort

Front 13

Critical questions for evaluating seating systems

Back 13

Does it meet consumers goals and needs?
Does it provide stability and allow for function?
Is it comfortable?
Is it durable?
Are there resources for maintenance?
who will finance the system?

Front 14

Pelvis as the key point of control in seating

Back 14

first area addressed
alignment and stabilization
neutral or slight ant tilt
support can be given under, behind, in front, or sides

Front 15

The IDEAL pelvic posture

Back 15

neutral alignment (or slight ant tilt)
head balanced over spine
spine balanced over pelvis
ASIS and PSIS are level
natural spinal curves
shoulders slightly posterior to pelvis
head neutral, eyes forward
equal weight bearing through ischial tub's

Front 16

4 types of asymmetrical postures

Back 16

pelvic obliquity
rotation
severe anterior or posterior tilt
windswept legs

Front 17

Posterior pelvic tilt

Back 17

use pelvic positioning belt
may help to open seat to back angle
give lumbar support
*most people fall into this category
*due to tight hamstrings, low tone

Front 18

Anterior pelvic tilt

Back 18

supportive head rest

Front 19

Purposes of supports

Back 19

provide contact against the body
stable surface
distribute weight
maintain desired position
reduce extraneous movement
limit tone influences
improve function

Front 20

3 types of support systems

Back 20

Planar (linear)
-add on supports
Contoured (off the shelf)
custom contoured (molded)

Front 21

3 point system for control

Back 21

one at apex
one each at top and bottom of curve on opposite side of apex

Front 22

origins of ulcers

Back 22

weight bearing bony prominences most commonly develop ulcers
duration of pressure is a significant variable

Front 23

Factors contributing to ulcer development

Back 23

mobility
spinal cord injury
body type
nutrition
infection
age
sitting posture
microclimate
transfers

Front 24

how often should you weight shift for pressure relief after SCI?

Back 24

every 15-30 min
*buttocks needs 3 min to allow tissue perfusion return to uncompressed level

Front 25

Properties of cushion materials

Back 25

density
stiffness
sliding resistance
resilience
dampening
envelopment
recovery

Front 26

Scope of mobility limitations

Back 26

Full ambulatory- no impairment
marginal ambulatory- walks short distances. needs chair at times
manual wc user- propels manual chair
marginal manual wc user- UE impairment. Manual is not most efficient
Totally/severely mobility impaired user- power mobility is the only option

Front 27

3 broad categories of mobility

Back 27

dependent
independent manual
independent powered

Front 28

WC frame types

Back 28

standard or conventional
lightweight
ultra-light
heavy-duty
hemi-height
reline chairs (low or zero shear)
tilt in space chair
power chair

Front 29

Rigid and folding chairs

Back 29

Rigid
-box
-T or I frame
Cross brace (traditional folding)
**rigid has better ride but more expensive

Front 30

Rear-wheel, mid-wheel and front wheel drive

Back 30

*power goes to 1 sets of wheels, the others provide stability
Rear-wheel is behind user
-low ratio-drive wheel well behind the user
-high ratio- drive wheel closer to users COG
Midwheel- drive wheel under user's COG
front- less common, fish tail

Front 31

Types of power mobility controllers

Back 31

toggle/knob- high and low
torque
acceleration
braking
momentary vs latched
forward, turning, and reverse speed
tremor dampening
short throw
attendant control
auxiliary control

Front 32

Evaluating for WC must include...

Back 32

seating and mobility eval
MAT eval
*consider WC standards, maintenance & repair, skill development

Front 33

User Satisfaction Outcome Measurements

Back 33

COPM
QUEST

Front 34

Quality of Life Outcome Measurements

Back 34

Health Related Quality of Life (HRQL)
Psychosocial Impact of Assistive Devices (PIADS)
*PIADS more appropriate for AT

Front 35

Psychosocial Impact of Assistive Devices (PIADS)

Back 35

26 item, self report questionnaire
Designed to assess:
-effects of assistive device on functional independence
-well-being
-quality of life
3 Subscale Scores:
-competence
-adaptability
-self-esteem
Takes 5-10 min
*used to minimize abandonment of technology

Front 36

Need and rationale for using the PIADS

Back 36

-research has shown that AT is sometimes abandoned or rejected
-AT may be threatening for some people
-providers need improved understanding of psychosocial factors
-works across all major categories of AT

Front 37

Instructions on completing the PIADS

Back 37

stick closely to the script
every item must be answered
if client unsure, mark "0"
if client needs definition, use glossary

Front 38

The components of the HAAT model

Back 38

-Human
-Activity
-Assistive Technology
all within Context

Front 39

Developing a funding strategy for AT

Back 39

1. define and document the need
2. identify equipment and/or services needed
3. determine if an alternative device will meet the need
4. determine potential funding sources
5. gather all info needed for funding
6. submit for approval
7. appeal if needed

Front 40

Public Funding

Back 40

-federal, state, local govt agencies
-usually authorized by Congress
-in some cases federal agency oversees program(Medicare)
-fed and state work together. State ensures compliance (Medicaid)
-IDEA extends federal presence to local govt
-each program has a set of reg's that mandate services
-Medicare billed first, then Medicaid
-

Front 41

Medicare

Back 41

established by Congress 1965
covers 65+ and under 65 who are blind, totally and permanently disabled, and have received SSDI for at least 2 years
-Administered by Health Care Financing Admin (HCFA)
-2 types of coverage (A, B)

Front 42

Medicare Part A

Back 42

inpatient hospitalization
SNF
home health
hospice

Front 43

Medicare Part B

Back 43

supplemental policy
ind. pays small premium to cover outpatient therapy, DME, MAE

Front 44

Types Mobility Assistive Equipment (MAE)

Back 44

walkers
canes
crutches
manual wheelchair
power wheelchair
power operated vehicle (scooter)

Front 45

Definition of MAE under part B

Back 45

-equipment primarily used to serve medical need, can withstand repeated use, generally not useful to a person in the absence of injury or illness
-must be used in the home and deemed medically necessary
-therapist writes the Specialty Evaluation (also known as LMN)

Front 46

Medicaid

Back 46

-established in 1965 by Title XIX of SSAct
-developed for people who are unable to pay costs of their medical care
-administered at state level
-federal govt mandates certain services, eligibility, and benefits requirements
-federal govt matches state govt based on per capita income
-AT is NOT an optional or mandatory service
-general criteria-medical necessity
-prior authorization is required
*payer of last resort

Front 47

Sooner Care

Back 47

-most children go through screenings
-if diagnosis made through screenings, then all secondary treatments that occur may be paid for by this program
-ages 0-21
*payer of last resort

Front 48

Medicaid-Community Waiver

Back 48

-requires primary dx of mental retardation
-eligibility for medicaid
*payer of last resort

Front 49

Medicaid- DDSD- in home supports waiver

Back 49

-started in jan 2000 to minimize waiting list
-families receive plan of care, which they cash in for services, equipment, etc
-Voucher for children is approximately 12,000/yr
-voucher for adults is approximately 18,000/yr
*payer of last resort

Front 50

Supplemental security disabled children's program

Back 50

-covers non medicaid covered items
-federal/state match
-must be SSI eligible-medical determination
-receives approx. 250/month

Front 51

Tricare

Back 51

federally funded
Civilian Health and Medical Program of Uniformed Services
provides medical to dependents and retired members
contracts with health insurance companies for AT

Front 52

AT for Education

Back 52

-Education for All Handicapped Children Act of 1975 (IDEA)
-AT as written into the IEP
-AT as identified as being necessary for a free and appropriate public education

Front 53

Vocational Rehabilitation

Back 53

-individual Written Rehabilitation Plan outlines objectives related to vocational planning
-AT to complete training in vocational rehab or to obtain employment

Front 54

AT through Dept of Veterans Affairs

Back 54

-provides AT services for service related injury
-contracts with outside agencies to provide the service

Front 55

Worker's Compensation and AT

Back 55

-work related injuries covered by benefits
-AT may be covered under certain conditions
-benefits are financed jointly by employers and state
-private companies typically administer the policy

Front 56

Private Health Insurance and AT

Back 56

-some plans cover DME. Some do not. Check!
-CPT codes may be used
-may have an approved list of vendors
-plan may be capped
-based on diagnosis and medical necessity

Front 57

Other sources of funding for AT

Back 57

-Civic organizations (Kiwanis club, rotary club, shriners)
-Disability Foundations (MD association, UCP...)
-United Healthcare Childrens Foundation (pay up to 5,000)

Front 58

General Funding Process

Back 58

1. intake referral
2. funding is secured for eval
3. eval completed
4. recommendations made with justification
5. supplier pulls together paperwork (LMN-therapist; pricing codes-vendor; physician paperwork)
6. funding is requested
7. consider sources for training, maintenance, and follow-up

Front 59

Funding Justification

Back 59

1. description of functional limitation that the device and service addresses
2. detailed description of device including features, accessories, and customization
3. how the device will alleviate or ameliorate the functional limitation
4. description of evaluation process
5. explanation of why device is least costly
6. description of evaluator/team

Front 60

Coding

Back 60

diagnosis codes: describe a person's condition
HEalth Care Financing Admin (HCFA) common procedure coding system (HCPCS) used for DME
CPT: pertain to medical services
-diagnosis is given an ICD 9 code
-HCPCS codes are assigned to procedures and AT
-allowable WC as identified by a HCPCS code depends on ICD 9 code

Front 61

CPT Codes for AT Assessment and WC Management and propulsion

Back 61

AT Assessment- 97755

WC management- 97542