A roundtable forum on the latest breakthroughs in products designed to aid patients in mobility and activities of daily living.

In recent years, there have been significant developments in assistive devices and aids. As they better understand patients’ needs, manufacturers of assistive technologies are making adjustments to create the most efficient and effective products.

Physical Therapy Products rounded up four industry professionals to discuss what’s coming up on the assistive technologies market and how physical therapists (PTs) can find the best equipment for their patients’ needs. Elizabeth Cole, MSPT, is director of education for Sunrise Medical, Carlsbad, Calif; Mary Halloran is vice president of marketing for Full Life Products, Moorestown, NJ; Susan Tulanowski is marketing manager for Maddak Inc, Wayne, NJ; and Anders Drechsler is president of Guldmann Inc, Tampa, Fla.

What are the current trends in assistive technologies?

Drechsler: There is a greater acceptance of a Zero Lift Policy across the health care industry. We see increasing concern throughout the medical community regarding professional caregivers who experience pain or injury when manually lifting and transferring patients—despite the best training. Add the increase in bariatric patients, and many health care facilities are experiencing an increase in employee health claims, job burnout, and hiring problems. Patient ceiling-mounted lifts and floor lifts can provide a safer and more comfortable lift and transfer for the patient, while preventing back stress and strain for the caregiver.

Cole: Technology in the seating and mobility arenas continues to show tremendous growth with new developments in power products, manual products, sports products, and seating products. We are seeing innovative new options for alternative ways to operate a power chair—not only to drive the chair, but also to operate powered seating and auxiliary devices like communication devices, environmental-control units, and computers through the same device. Different materials are being used for frame construction, such as titanium in manual chair frames. We are seeing sleeker, more “minimalist” frame designs for manual mobility, as well as more dynamic options like suspension in both the chair frames and in moving parts. We are also seeing more integration between product lines—for example, innovative seating products are being designed and offered on power chairs, and power assists are being developed for manual chairs.

Halloran: Manufacturers are starting to think more about what the patient needs. Previously, they were driven more by price and economics.

Tulanowski: In the aids-to-daily-living market in general, I think companies are producing products that are less “institutional”-looking and less conspicuous; they don’t stand out as much.

How have assistive technologies evolved in the past few years to better serve patients?

Drechsler: Patient lifts have gotten smaller and more discreet. They are capable of lifting more weight—up to 1,000 pounds in some models. Portable models now offer more flexibility. Personal and disposable slings are now available that can follow a patient throughout their treatment.

Cole: There are many more types of products to choose from, and many more options and accessories. This increased variety allows each end-user to find a product that more completely meets his/her specific functional and medical needs. The variety, as well as the types of products available, also allows more end-users to achieve the most optimal level of independence in mobility, control over their environment, communication, activities of daily living, and other areas of function.

Halloran: As manufacturers think more about patients’ needs, new features are developed to help patients in their daily lives. For example, walkers now have seats that are Medicare-reimbursable so patients with limited mobility can rest, bigger wheels so they can better roll over uneven ground, and better glides so patients don’t need to resort to the unsightly tennis balls. More color and design is used, too, so the products look less institutional.

Tulanowski: Manufacturers are realizing that “one size does not fit all.” Two examples of this are the increasing number of pediatric and bariatric products being introduced each year.

What reimbursement issues should providers and patients be aware of?

Cole: Reimbursement in seating and mobility has undergone tremendous changes over the last 6–9 months, and the changes are continuing. More than 12 new reimbursement codes for seating products were introduced last fall to replace the existing four codes. More than 40 new reimbursement codes for power wheelchairs have been announced and will become effective in January 2006; these replace the current four codes now in existence.

In addition, the Centers for Medicare and Medicaid Services (CMS) has introduced a proposal for a new coverage determination for mobility devices. This could significantly change Medicare’s determination of who is appropriate for ambulatory aids, scooters, and manual and power wheelchairs, and will hopefully make these products available to more end-users who require these devices for function and medical health. CMS has also recently begun work on revising the current seven manual-mobility codes. It is extremely important to keep current with these funding changes and to take advantage of the opportunities to express feedback on these proposals, such as through open door forums and Internet responses. These changes could significantly change access to assistive technology for many end-users.

Halloran: It’s the manufacturer’s job to make Medicare aware of new products coming out and to get approval for reimbursement. Then, it’s their job to get that information distributed to the providers and medical professionals. It’s a need to have Medicare reimbursement, not a want.

What tips can you provide PTs on patient fitting and finding the right product?

Drechsler: Manufacturers offer a wide range of information and training materials. Sling training is available from most manufacturers to ensure proper sizing and fit. Manufacturers’ Web sites also provide valuable information on the wide variety of ceiling-lift and floor-lift choices.

Cole: Learn how to do a complete seating and mobility evaluation, including the mat evaluation, and how to take accurate client measurements. If you do not have a mentor where you practice, there are a number of excellent courses taught throughout the country. Keep up with what products are available on the market. With the huge number of choices out there, this can be a challenge. Develop relationships with your manufacturer’s sales reps to find out about new and existing products, and to access demos for evaluation. Log on to the manufacturers’ Web sites for further familiarity with their products. Attend industry shows such as Medtrade, International Seating Symposium, and Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). Develop a relationship with a good rehabilitation supplier, and work as a team to combine your clinical and technical expertise. Finally, if a client has problems and needs that are beyond the knowledge and skill level of you and the supplier, get someone with the appropriate experience involved.

Halloran: It’s often a challenge for PTs to find out about new products that might better meet their patients’ needs. PTs are more likely to encourage risk-averse dealers to take on new products, if they are proactive with their dealer in continually asking what is new and in asking dealers to take on new products they see in magazines or at shows.

What is the best way to get patients to adapt to assistive technology comfortably?

Drechsler: Confident caregivers, well trained in the use of ceiling lifts to transfer patients, can carefully explain to the patient each step they are taking to ensure a smooth and safe transfer. Brochures and videos can provide additional information.

Cole: Keep the client and/or the caregiver directly involved in the equipment prescription right from the beginning, so that they understand exactly what each product and product option does, how it can meet their needs, and why it is chosen. Involve them as much as possible in the decision-making process. During the evaluation, try to simulate the final product as closely as possible using demonstration equipment, and allow appropriate trials. This can help to increase comfort level with the device. When the equipment is delivered for final fitting, explain the reasoning for any necessary adjustments or changes, and provide the opportunity for practice and skill development.

Halloran: I think the better the product meets the patient’s needs, the easier it is for them to adapt to it. For example, for patients that use walkers, one may have limited arm strength to rise from a seated position. Another may only be able to walk a short distance before resting, while another may need to carry an oxygen tank or be tethered to an intravenous (IV) pole. A standard walker will not work optimally for all three patients; they each need walkers that address their unique needs.

Tulanowski: Education. There definitely needs to be more industry and consumer awareness of assistive technology. Over the past few years, awareness has increased. However, there are still many people out there that don’t know these products exist.

In closing:

Cole: It is a very exciting and challenging time to be involved in the area of seating and mobility assistive technology. The advances in power chairs are providing many more people the opportunity to drive a power chair, perform their own weight shifts, and communicate, and control their environment. These are people who just a few years ago might have been totally dependent. We are seeing children have the opportunity to become independent at younger ages, providing them further opportunity to develop and grow with their peers.

The advances in materials and frame designs are providing lighter and sleeker manual chairs that can help prevent some of the long-term effects of propelling a manual wheelchair and allow people to go farther, faster, and more efficiently. Improvements in materials and design in seating systems provide increased safety, comfort, stability, and function.

Halloran: It’s wonderfully rewarding to see how much the new products can help improve the quality of patients’ lives. And it is great fun to work with PTs on developing new products. They are very passionate about helping their patients, and their passion is contagious.  

Julie Z. Lee is a contributing writer for Physical Therapy Products.