February 2016 • Vol. 15 No. 2 Serving the Seating & Wheeled...

February 2016 • Vol. 15 No. 2

mobilitymgmt.com

Serving the Seating & Wheeled Mobility Professional

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4 mobilitymgmt.comfebruary 2016 | mobilitymanagement

february

Mobility Management (ISSN 1558-6731) is published monthly by 1105 Media, Inc., 9201 Oakdale Avenue, Ste. 101, Chatsworth, CA 91311. Periodicals postage paid at Chatsworth, CA 91311-9998, and at additional mailing offices. Complimentary subscriptions are sent to qualifying subscribers. Annual subscription rates payable in U.S. funds for non-qualified subscribers are: U.S. $119.00, International $189.00. Subscription inquiries, back issue requests, and address changes: Mail to: Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866, email [email protected] or call (847) 763-9688. POSTMASTER: Send address changes to Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866. Canada Publications Mail Agreement No: 40612608. Return Undeliverable Canadian Addresses to Circulation Dept. or XPO Returns: P.O. Box 201, Richmond Hill, ON L4B 4R5, Canada.

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whole or part prohibited except by written permission. Mail requests to “Permissions Editor,” c/o Mobility Management, 14901 Quorum Dr., Ste. 425, Dallas, TX 75254

The information in this magazine has not undergone any formal testing by 1105 Media, Inc. and is distributed without any warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry.

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On the CoverDementia can pose challenges for a number of seating & wheeled mobility clients. Cover by Dudley Wakamatsu.

14 Steering Toward a Bright Future The National Mobility Equipment Dealers Association (NMEDA) plans

for its annual conference and unveils new Quality Assurance Program

requirements. PLUS: Looking forward to National Mobility Awareness

Month, and Accessibility News.

Cover Story23 Dementia, Seating & Mobility Cognitive involvement is among the symptoms for many people who

use wheelchairs, but the presentations can vary greatly.

volume 15 • number 2

6 Editor’s Note

8 MMBeat

21 Marketplace: Accessibility at Home & on the Road

28 New Discoveries: Deep Tissue Injury Research, Finale

30 Ad Index


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I am five feet tall, on a good day, with the wind, as one of my best friends says. I sit on a pillow to drive my beloved Toyota Corolla. I have a footrest under my office desk, and another one at home.

When I was in high school, one of my teachers said if I’d been two inches shorter, my height would have qualified as a disability. I dismissed her comment, in part because that’s what 15-year-olds do, but also because my stature as a disability felt absurd. “I don’t feel short,” I told her.

That’s still true. I usually feel my height is average, and that anyone more than a few inches taller than me is “quite tall.” But really, the reason I don’t “feel short” is because my height is commonly an issue in only two environments:

(1) When trying to put my bag into an overhead bin on a plane.

(2) When trying to reach less-popular items on high supermarket shelves.

Neither is much of an issue. I pack lightly and practice lifting my carry-on bag. And at the supermarket, I nudge boxes of corn flakes on the bottom shelf to make room for

my feet as I climb to reach the Cap’n Crunch All Berries.When this fails — and it does if the Cap’n is on a shelf that’s too high, or if there’s no

room for a toehold on a lower shelf — I get help. I ask a store employee, if possible. But mostly, I ask other customers, even if they aren’t much taller than me. (Once, I recognized a retired NFL offensive tackle in the ethnic foods aisle who was way tall enough to grab the bottle of hot sauce I wanted. But I was too shy to ask.)

This prologue is due to the stunning frequency with which some folks “help” people with disabilities, including wheelchair users. On social media and in blogs, horror stories abound of people with low vision being yelled at or guided across streets they didn’t want to cross. People who use wheelchairs report getting pushed up ramps they didn’t want to ascend or could’ve managed themselves. Shepherd Center has a good-humored video about doorways and people who use wheelchairs: http://tinyurl.com/hdfrl9v. Comedian John Oliver, host of Last Week Tonight, did a spot on behalf of the Cerebral Palsy Foundation on how to start a conversation with someone who has a disability.

“Don’t speak extra loud, as if you think being in a wheelchair is somehow the same as wearing noise-canceling headphones,” Oliver said. “Essentially, the best thing to do is…just say hi.”

These examples are gently good natured, but at the root of it all, I realized — people need these public service announcements. Because people with disabilities are suffering others’ foolish assumptions all the time.

If someone began throwing canned goods and leafy greens into my cart though I didn’t ask for help, I might chuck the kale back at them. What is it about a disability that makes so many other people abandon common sense and basic courtesy?

I suspect that people with disabilities often find the biggest challenges to be not the clinical terminology in their medical files, but the misconceptions of supposedly well-inten-tioned folks around them. This is our annual Accessibility issue, full of technology and solu-tions that can actually help. Here’s hoping that accessibility theme extends to our minds and hearts, as well.

Laurie Watanabe, [email protected]

@CRTeditor

Editor Laurie Watanabe (949) 265-1573

Contributing Editor Elisha Bury

Group Publisher Karen Cavallo (760) 610-0800

Group Art Director Dudley Wakamatsu

Director, David Seymour Print & Online Production

Production Coordinator Charles Johnson

Director of Online Marlin Mowatt Product Development

mobilitymgmt.com

Volume 15, No. 2

February 2016

editor’s note

When I Need Help…

REACHING THE STAFF

Staff may be reached via e-mail, telephone, fax, or mail. A list of editors and contact information is also available online at mobilitymgmt.com.

E-mail: To e-mail any member of the staff, please use the following form: [email protected]

Dallas Office (weekdays 8 a.m. - 5 p.m. CT) Telephone 972-687-6700; Fax 866-779-9095 14901 Quorum Drive, Suite 425, Dallas, TX 75254

Corporate Office (weekdays, 8:30 a.m.-5:30 p.m. PT) Telephone 818-814-5200; Fax 818-734-1522 9201 Oakdale Avenue, Suite 101, Chatsworth, CA 91311

Chief Executive Officer Rajeev Kapur

Chief Operating Officer Henry Allain

Vice President & Michael Rafter Chief Financial Officer

Executive Vice President Michael J. Valenti

Chief Technology Officer Erik A. Lindgren

Vice President, David F. Myers Event Operations

Chairman of the Board Jeffrey S. Klein

SECURITY, SAFETY & HEALTH GROUP

President & Group Publisher Kevin O’Grady

Group Publisher Karen Cavallo

Group Circulation Director Margaret Perry

Group Marketing Director Susan May

Group Social Media Editor Matt Holden

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Convaid’s Chris Braun: “The Complement Is Just Phenomenal”When news of Convaid’s acquisition by Etac AB, the Swedish company that owns R82 (formerly Snug Seat), broke just a few days before Christmas, the partnering sounded logical. As the Snug Seat name suggested, R82’s specialty is pediatric seating & positioning;

Convaid’s forte has been caregiver-propelled mobility bases, largely for children.

Convaid President Chris Braun talked to Mobility Management about what the acquisition would mean to employees, product development and distribution, and two groups of Convaid customers — seating & mobility professionals as well as consumers.

A Phenomenal FitBraun confirmed the excellent fit between the two companies.

“The cultures of the two organizations are very much the same,” he said. “We both have the same mission, which is to serve people with disabilities and to help improve their lives with products, essentially. The complement of the two product lines, I think, is just phenom-enal. For us, it expands a lot into the product areas that we’ve been stra-tegically looking to get into. It opens up a lot more product for our customers and our customer base in a very quick amount of time.”

Additionally, Braun said joining forces with Etac accelerates Convaid’s ability to distribute to international segments in a timely fashion.

“As we develop products now, they’ll immediately have a place in the international markets, which has been a really important part of our planning, too — to figure out how do we solve getting the products into international markets faster as well as getting traction on the product

on a global basis? We’ve done it, but it’s taken a lot of time. I think now the time to do a lot of that compresses.”

What won’t be changing is the Convaid name — or the R82 name either, Braun said.

“As a company, we were able to select who we wanted to try to partner with to do this, and Etac has a fantastic reputation, R82 has a fantastic reputation,” he noted. “They’re planning to keep all of the brands, so there’s no consolidation of efforts. Convaid will remain Convaid, R82 will remain R82, Etac the same.”

While acquisitions can often lead to a blending of the companies involved and a consolidation of similar products, Braun said he doesn’t expect that to happen between Convaid and R82.

“The brands themselves will remain independent,” he said. “We’re not trying to eliminate one to sell the other. In fact, it’s the opposite: How does one complement the other? We actually are going to really support the Convaid brand not only as we have in the past, but also on a more global scale with distribution.

“There should be no reduction of service on any standpoint to the customer, whether it’s Etac, R82 or Convaid. In fact, we have a very big investment into expanding that domestically. My goal has always been to keep improving the service, and I think this allows us to add people and to add services and products, which I think are great for the customer.”

Complex Seating NeedsLast year, Convaid launched the Trekker, a folding, stroller-style manual chair loaded with positioning possibilities. With a total of 50° of tilt and 170° of recline, plus a host of other positioning component options, the Trekker signaled that Convaid was crossing into new terri-tory to support children with very complex seating needs.

Will Convaid continue its foray into this segment?“We’re going to get even more aggressive with it,” Braun said. “I think

the Etac addition is going to help us get further into the spectrum of disability, not only from our own product development internally, but also from the perspective of adding some of the technology and knowl-edge base that they have in that part of the business. We’re going to offer the full spectrum as Convaid, as a brand, as product development and as support and manufacturing. Now we have additional resources and expertise to help further develop our product and knowledge base in those additional ends of the spectrum for our customer groups.”

Braun praised R82’s design and engineering capabilities, adding,

They’re planning to keep all of the brands, so there’s no consolidation of efforts

— Chris Braun

Chris Braun

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mobilitymgmt.com 9 mobilitymanagement | february 2016

“That’s one of the things that’s been so attractive to our company —we both place a lot of emphasis on that, and we are committing a lot of resources into the divi-sion, into making better products in all of these brands.”

To streamline the ordering and delivery processes, Braun said Convaid and R82 are examining how distribution could be improved by using both of their American headquarters as distribution points. Convaid is based in Torrance, Calif.; R82 operates its American business from Matthews, N.C.

“We’re looking to basically get better coverage for all of the compa-nies through the use of two facilities for distribution,” he explained.

Beyond that, Braun described the situ-ation as largely business as usual, with Convaid’s team remaining in place.

“All of us will stay on,” he said. “There’s no consolida-tion effort as it relates to elimination of people or positions

in manufacturing or distribution. That’s not the reason for the struc-ture of this deal. It was to complement each other, and I think the

first half of the year for us will be working with our product devel-opment group and our management team in putting together a

plan along with ETAC and R82 to see how do we best improve what we’re doing as a company."

Another aspect of Convaid that won’t change: the company’s dedication to custom-building its chairs.

“We’re going to emphasize that as we move forward,” Braun said. “That is our business model and will continue to be our business model.”

Braun expressed gratitude to existing and new shareholders for their support of the

deal, and appreciation to Merv Watkins and family, who founded Convaid in 1976.

Working alongside R82, Braun added, should provide Convaid professional and end-user customers with even more options going forward.

Said Braun, “I very much am looking forward to the next chapter.” l

Convaid’s new Trekker wheelchair can accommodate kids with highly complex positioning needs.

mm beat

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The publication of a final rule from the Centers for Medicare & Medicaid Services (CMS) brings the DME industry a step closer to a Medicare prior authorization process for many DME items.

In a Dec. 29 bulletin to stakeholders, the American Association for Homecare (AAHomecare) said CMS indicated implementation would begin 60 days after publication of the final rule in the Federal Register, which happened on Dec. 30. According to that timetable, prior authori-zation would begin Feb. 28. AAHomecare added in that bulletin, “CMS is still working on the timelines and process.”

The purpose of implementing a prior authorization policy, the final rule said, would be to reduce “unnecessary utilization and aberrant billing of certain DMEPOS items.”

DME That Could Be IncludedDME with an average purchase price of $1000 or more or an average monthly rental fee of $100 or more would be considered for prior authorization inclusion, though the final rule indicated that not all items meeting that criteria would be subject to prior authorization.

The prior authorization process would require “a prior authorization requester” to “submit evidence that the item complies with all appli-cable Medicare coverage, coding and payment rules,” the final rule states. After receiving the documentation, CMS or a review contractor would “communicate a decision that provisionally affirms or non-affirms the request.”

Getting a “provisional affirmation” would be required for the DME supplier to be paid, the final rule added: “We are finalizing the provi-sion to automatically deny payment for a claim for an item on the Required Prior Authorization List that is submitted without a provi-sional affirmation prior authorization decision.”

A CMS fact sheet on the new final rule said the nature of the docu-mentation required would not change.

“Under the final rule, the prior authorization process will require the same information necessary to support Medicare payment today, just earlier in the process,” the fact sheet said. “It will not create new clinical documentation requirements. The prior authorization process assures that all relevant coverage, coding, and clinical documentation require-ments are met before the item is furnished to the beneficiary and before the claim is submitted for payment.”

CMS said it has identified 135 DMEPOS items “as being frequently subject to unnecessary utilization.” The items on this Master List have also been scrutinized in Department of Health & Human Services Office of the Inspector General or U.S. Government Accountability Office national reports in 2007 or later, or been the subject of Comprehensive Error Rate Testing Improper Payment Reports for DME.

Timelines for Approvals & Non-ApprovalsCMS added that the reviewer would “make a reasonable effort” to communicate the results of a prior authorization determination within 10 business days and to make a decision on a resubmitted prior autho-rization request within 20 business days. “These are maximum time-frames and will be adjusted downward for items that require less time for making a determination,” the fact sheet said.

CMS’s final Master List of DMEPOS “subject to frequent unneces-sary utilization for prior authorization” includes mattresses, hospital beds, CPAP devices, oxygen concentrators, K0004 manual wheelchairs, power wheelchairs (including Group 1, 2 and 3), and prosthetics.

To read the CMS fact sheet, which includes a link to the final rule, go to http://tinyurl.com/pel7hf2.

Current PMD Prior Authorization Demonstration Continues Into 2018Of course, the anticipated DME prior authorization policy would not be unique to the industry.

Power mobility devices (PMD) including scooters and some power wheelchairs have been subjects of a prior authorization Medicare demonstration going back to September 2012 in a handful of states with high beneficiary usage.

The demonstration project started with California, Illinois, Michigan, New York, North Carolina, Florida and Texas. In July 2014, CMS announced it was adding 12 more states to the demonstration project: Maryland, New Jersey, Pennsylvania, Indiana, Kentucky, Ohio, Georgia, Tennessee, Louisiana, Missouri, Washington and Arizona. Those states entered the demonstration in October 2014.

The demonstration was originally due to end Aug. 31, 2015. But CMS extended the length of the demonstration, which is now scheduled to finish on Aug. 31, 2018.

The PMD demonstration has been lauded by stakeholders as successful in part because the program gives PMD providers a better up-front understanding of whether Medicare believes the beneficiaries in question would or would not medically qualify for the PMD before the providers purchase and deliver them.

In addition, CMS responded positively to several critically impor-tant comments prior to the demonstrations’ implementation. Among the changes that the agency made in response to comments was to eliminate the pre-payment review phase of the demonstration, which was to have been the program’s first phase. Instead, CMS went forward with the prior authorization phase.

CMS also reduced the timeframe to evaluate resubmitted prior-authorization claims from 30 business days to 20, thereby helping to expedite the process for providers as well as beneficiaries. l

CMS Publishes Final Rule for DME Prior Authorization

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http://tinyurl.com/pel7hf2


briefly…travel alerts!

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The complex rehab event season gets off to a fast start in February. The consumer/caregiver-targeted Abilities Expo show series opens this year at the Los Angeles Convention Center, Feb. 5-7. That will be followed by events in Edison, N.J. (New York Metro), April 29-May

1; Chicago, June 24-26; Houston, Aug. 5-7; Boston, Sept. 16-18; San Jose, Calif., Nov. 18-20; and D.C. Metro, Dec. 2-4. All events include free registration (sign up in advance at abilitiesexpo.com), educational workshops, exhibit halls, demonstra-

tions and activities for attendees of all ages. Check out the specifics for each Abilities Expo venue — they include personal care service attendants, service dog relief areas, free scooter loans and wheel-chair repairs, American Sign Language interpreters and Braille/large print accommodations — at the Abilities Expo Web site. And look for Mobility Management’s free, show-exclusive edition, The Mobility Project, at all of the 2016 Abilities Expo stops… The U.S. Department of Transportation (DOT) has announced a $2.75 million fine against United Airlines, in part because of the way the airlines has treated passengers with disabilities. In the Jan. 7 announcement, the DOT said, “It is our duty to ensure that travelers with disabilities have access

to the services they need.” The DOT noted it had “a significant increase in the number of disability-related complaints that United received from consumers in calendar year 2014.” When the DOT investigated, it determined that the airlines “failed to provide passengers with disabilities prompt and adequate assistance with enplaning and deplaning aircraft, and with moving through the terminal at Houston International Airport, Chicago O’Hare International Airport, Denver International Airport, Newark International Airport and Dulles International Airport.” The DOT review also said there were “numerous instances” in which United “failed to return passengers’ wheelchairs, other mobility aids, or other assistive devices in a timely manner, or in the condition in which the airline received them.” The infrac-tions will cost United $2 million, some of which is to be spent on future quality-assurance audits to make sure timely assistance is provided to wheelchair users, and a program to develop a system to help passengers to request wheelchair assistance via United’s mobile device app. The rest of the DOT’s $2.75 million fine was tied to several instances in which United stranded planes on tarmacs beyond

the time periods the DOT allows. l

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Protecting CRT Wheelchair Accessories to Be a Top Industry PriorityAt the end of 2015, it was a bad news/good news scenario for the complex rehab technology (CRT) industry.

First, language to stop Medicare funding cuts for accessories on CRT wheelchairs was left out of Congress’s vast omnibus spending bill, the industry learned on Dec. 15. That, obviously, was critically bad news.

Then came the update on Dec. 17 that language calling for a one-year delay to those CRT funding cuts was instead attached to a bipartisan Medicare bill, the Patient Access & Medicare Protection Act, being expedited through the U.S. Senate via a 24-hour “hot line” process.

And on Dec. 18, the final day of the 2015 Congressional session, the industry learned that the bill, formally known as S. 2425, had passed. President Obama signed the bill into law on Dec. 28.

The catch for the industry was that the bill only delayed the funding cuts to accessories used on CRT power wheelchairs. Accessories for CRT manual wheelchairs were still subject to the Medicare cuts sched-uled to go into effect Jan. 1, 2016.

NCART Executive Director Don Clayback explained to Mobility

Management, “Unfortunately, Congress did not include the full text of H.R. 3229/S. 2196 in the bill that was passed, and this delay only applies to accessories used with complex power wheelchairs, not to accessories used with complex manual wheelchairs.”

H.R. 3229 and companion bill S. 2196 were the original bills seeking to prevent the Centers for Medicare & Medicaid Services (CMS) from using competitive bidding-derived pricing to create allowables for accessories used on CRT wheelchairs.

Clayback, however, is still keeping a positive outlook regarding the issue in the new year. “This one-year delay provides us the opportunity in 2016 to further our work on the wheelchair accessories issue and to establish needed improvements for CRT within Medicare and other health insurance programs,” he said.

In a Dec. 23 bulletin to the industry, Clayback said about the one-year delay, “While not a complete win, it is an important one. This one-year delay provides us time for the additional work that must be done, which includes pursuing protection for accessories used with complex manual wheelchairs. We must continue to collaborate with Congress in 2016 to establish the separate recognition of CRT within the Medicare program. Through these efforts, we will achieve the needed comprehensive and permanent changes.” l

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It’ll be an all-for-one gathering in July, as the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) and the National Coalition for Assistive & Rehab Technology (NCART) combine forces to hold a joint conference focusing on education and advocacy.

The “Promoting Access to Assistive Technology” event takes place at the Hyatt Regency in Arlington, Va., July 10-14. In addition to taking advantage of clinically focused workshops and research and poster sessions, attendees can participate in professional development and leadership training opportunities, tour the exhibit hall, and visit legislators on Capitol Hill as part of the complex rehab technology industry’s advocacy efforts.

The event will include student competitions and free exhibit hall hours for consumers to attend.

The deadline for scientific and student scientific papers is Feb. 17.

For more information, go to resna.org. l

RESNA & NCART Combine 2016 Events

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Cytokinetics Announces Phase 2 Clinical Trial for Teens, Adults with SMAA late-stage biopharmaceutical company in South San Francisco is seeking adolescents and adults who have been diagnosed with spinal muscular atrophy (SMA) types II, III or IV to take part in a new Phase 2 clinical trial.

At the center of the study is CK-2127107, described by Cytokinetics as “a novel fast skeletal muscle troponin activator.” In a news announce-ment on Jan. 4, Cytokinetics said the trial would “assess the effect of CK-2127107 on multiple measures of muscle function in both ambu-latory and non-ambulatory patients with SMA, a severe, genetic neuromuscular disease that leads to debilitating muscle function and progressive, often fatal, muscle weakness.”

Cytokinetics is working with Astellas Pharma U.S. to develop CK-2127107 “as a potential treatment for people living with SMA and certain other debilitating neuromuscular and non-neuromuscular diseases and conditions associated with skeletal muscle weakness and/or fatigue.”

The trial is described as double blind, randomized and placebo

controlled. A suspension form of CK-2127107 will be administered orally to study participants not in the placebo group. In addition to testing the drug’s effectiveness, the trial will also examine how well the study participants tolerated the dosages.

In all, the trial will have 72 participants split into two groups. Half of each group will consist of SMA patients who are ambulatory and non ambulatory. They will receive CK-2127107 twice a day for eight weeks — or placebo doses over that same time period.

The study is seeking participants who are 12 years or older.Robert I. Blum, CEO/president of Cytokinetics, said of the study,

“Initiating this first Phase 2 trial of CK-2127107 represents a major step forward given our interests to serve the many adolescents and adults who are living with SMA, a disorder with few treatment options. We look forward to working closely with the investigators and clinical trial sites to evaluate the effects of our next-generation skeletal muscle acti-vator, which we believe holds promise for the potential treatment of patients battling this devastating disease.” l

Go to www.mobilitymgmt.com/renew and use priority code MHR so you can keep pulling your issue of Mobility Management out of your mailbox each month.


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This time of year, with winter in retreat (we hope), days lengthening and skies brightening, our thoughts turn to the promise of the open road and its adventures.

Of course for mobility dealers, the open road is a passion, and their all-season calling is supporting consumers who need adaptive auto-motive equipment to make road trips possible, practical, safe and comfortable. That support comes in a variety of forms, from education to advocacy, to installing and servicing adaptive equipment and helping both drivers and passen-gers make the most of it.

As the National Mobility Equipment Dealers Association (NMEDA) geared up for its annual February conference — this year in Dallas — Mobility Management spoke to Chuck Hardy, the organization’s VP of quality assurance & compliance. On the table: New NMEDA require-ments, anticipated highlights from Dallas, and that National Mobility Awareness Month project that has generated billions — yes, with a b — of online impressions in the name of education.

Attention to Quality Hardy began by outlining more recent changes to NMEDA’s member-ship requirements — requirements that impact both mobility dealer-ships and automotive mobility manufacturers, since both types of busi-nesses are eligible to join the organization.

“Over the past 12 months through its various committees, NMEDA has been strengthening its programs to not only assure the highest quality, reliability and safety to consumers, but also to fortify and elevate the brand of ‘QAP’ as the exclusive Quality Assurance Program in the mobility industry,” he said. “While there have been many devel-opments and improvements to the various documents and policies, here are four of them that stand out.”

The first concerns a mobility dealer’s technicians. “Beginning in 2016, QAP dealers will be required to have at least

one NMEDA Certified Technician on staff,” Hardy said, explaining that the organization considers technicians the “life-blood” of the QAP provider.

“Technicians are not only the ones installing the adaptive equip-ment, but are also the ones interfacing directly with the client during fittings and servicing. Having a NMEDA Certified Technician raises the bar for our members to help set themselves apart from non-QAP dealers. It also strengthens NMEDA’s government relations case when approaching Veterans Affairs (VA), state vocational rehab programs, etc., and asking them to preference or endorse NMEDA-QAP dealers. We can say we require a higher standard of technical competency from our member service departments, where the actual modification work takes place. In fact, the program has been received so well that many

Automotive Accessibility Special

By Laurie Watanabe

Chuck Hardy


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of our dealers have made it mandatory for not only one, but all their technicians.”

Quality control was also the key point in a 2016 rules change regarding inspections.

“QAP Rules have been clarified and improved for final inspections of installations,” Hardy said. “While it was generally assumed that the physical inspection of an installed product was performed by someone other than the installing technician, the rules have been clarified to state that the inspection shall be performed by someone other than the technician who installed the product, and that the person performing the inspection is certified to the product installed or as a minimum has successfully completed all NMEDA quality assurance program training. The QAP committee felt it was important to clarify this prac-tice in writing, to assure the customer that all installations are indepen-dently inspected for quality, and that the inspections were objective.”

New Rules for Mobility ManufacturersIn the new year, NMEDA’s quality assurance goals are extending to the companies that manufacture the mobility equipment being installed. The new requirements are part of the Manufacturers Quality Assurance Program, also known as MQAP.

“NMEDA has three types of membership,” Hardy noted. “A dealer member, a manufacturer member, and an associate member.” In the past, NMEDA Manufacturer members needed only to submit an appli-cation and pay NMEDA dues. But that has changed.

“Unlike the dealers, manufacturer members were not ever bound by any rules or guidelines,” Hardy said. “The concern here is — how can

we have any level of assurance that the manufacturers’ product is safe and has been tested to meet federal standards? While not requiring any type of structured and documented quality system does not necessarily mean that the manufacturer is not producing and delivering a quality product to the consumer, it also does not assure the manufacturer is producing a reliable and quality product. Additionally, without any rules for the manufacturer, there is also no acknowledgement that there is a quality system of any kind in place.”

Manufacturer members of NMEDA in the past have promoted the organization in its marketing materials, and other NMEDA members were concerned that poor-quality manufacturing could tarnish NMEDA’s reputation.

“The [manufacturer] member has the ability to promote the NMEDA brand in their literature, Web sites and any other media,” Hardy pointed out. “Some dealers have complained about product quality coming from NMEDA manufacturing members, and feel that NMEDA’s reputation is at stake because of the lack of any rules for manufacturer members. Therefore, in listening to the concerns of our dealer members, and starting in 2016, Manufacturer members will now be required to comply with the newly formed ‘MQAP Rules.’”

Hardy added that MQAP requirements will be implemented via a step-by-step process.

“The MQAP rules are similar to the QAP rules for the dealers in the sense that there are minimum requirements placed on the manufac-turer,” he said. “The MQAP will be rolled out in three phases. The first phase is Mobility Vehicle Manufacturers; the second phase will include Seating Systems, Restraint Systems, Mechanical Hand Controls, and


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Steering Toward a Bright FutureLifts; and the third phase will be all other mobility equipment compo-nents. To retain membership, all manufacturer members will be required to submit test data to the Compliance Review Program, also known as CRP. We know that there is a possibility that we may lose some members as a result of this change in membership policy; however, we also know that being a NMEDA manufacturer member will now mean something more than just submitting a form and dues payment. It will mean the manufacturer is following MQAP Rules and has submitted test data to show compliance with all requested federal safety standards. It’s a big win for dealers and for consumers who rely on the NMEDA and QAP brand for their adaptive mobility product needs.”

New Mobile Installation RulesThe last significant NMEDA program improvement is its new Mobile Installation and Servicing Policy.

“Until now, all QAP dealers have been required to perform mobility equipment installations in their stores,” Hardy said. “There are many reasons for this approach, including knowing there is a controlled envi-ronment, that there is adequate insurance and proper tools to perform the job.”

The problem: NMEDA dealers said they were losing business to companies that were willing to do work off site.

“Over the past several years, we have received many complaints from our dealers saying that they are losing business from agencies that require installations for their clients to be done on site at the client’s

home property,” Hardy said. “We want not only our dealer members to remain successful, but also for the client who will be receiving the work to be taken care of by a qualified mobility equipment installer. The big question was how can we satisfy the dealer’s interest and perform off-site installations in a way that will retain the integrity of the QAP?”

Hardy said finding a solution was challenging, “but the QAP committee finalized a policy that will allow mobile installations to become a reality, and it will be done while retaining the integrity of the QAP. For a dealer to perform mobile installations, including installa-tions performed at a client’s home, there are several criteria to be met that are all outlined in the Mobile Installation and Servicing policy.”

Those criteria include that the dealer must first have a dedicated mobile installation and servicing vehicle, and that the vehicle must contain at least a minimum set of tools and provisions. The dealer must also become accredited for mobile installations, and this new accredita-tion type will be audited by a third party.

“Additionally, specific environmental considerations must be satis-fied before the dealer can commence with the installation,” Hardy said. “We will not allow installations in inclement weather, for example. The last thing to say about mobile installations is that it only applies to certain types of mobility equipment, all of which are what we would call ‘low tech.’ The new policy prohibits structural modifications and high-tech equipment installations, as these are only to be accomplished under controlled conditions. This policy paves the way for increased volumes of work made available to our dealers through prescribing

The National Mobility Equipment Dealers Association (NMEDA) is headed to the Big D for its Annual Conference & Product Exposition — and it’s a fitting location, according to Chuck Hardy, NMEDA VP of quality assurance & compliance.

“The conference in Dallas is going to be our biggest conference ever,” Hardy said. “Not only because it’s in Texas, where every-thing is big, but because our association continues to grow through membership and expanded outreach to certified driver rehabilitation specialists, and occupational and physical therapists. We have also invited partner organizations, such as the Multiple Sclerosis Society, the American Stroke Association, the ALS Association and more.”

The conference, Feb. 17-19 at the Kay Bailey Hutchison Convention Center and Omni Hotel, will support today’s mobility dealers via networking opportunities and education on best business practices.

“We have two incredibly talented keynote speakers who are focused on improving and growing your business,” Hardy said. “We will have award-winning author and mobile marketing guru Gary Swartz to open the conference on Wednesday, and recording artist, CEO and best-selling author Robin Crow to close the conference on Friday. Also, we have two new exciting workshops: Paul Webb, who was a big hit at

last year’s conference, will host the morning sales training workshop on Thursday, and Larry Oxenham, one of America’s top asset-protection

experts, will host the afternoon workshop designed to show business owners how to protect against lawsuits and how to reduce taxes.”

NMEDA leaders will also update members on the progress of ongoing advocacy efforts.

“Other highlights of the conference will be to share our work on Capitol Hill,” Hardy noted. “A Congressional bill pending approval that could help bring Veterans Affairs in line with a better way for selecting

suppliers, plus all the new legislative friends we have made, should provide an informative and lively Government Relations workshop on Wednesday that you won’t want to miss.”

And the conference will let members get up close and personal with new Quality Assurance Program (QAP) requirements.

“Last but not least, learning about all of the activity with the QAP, everything from the newly rolled out QAP-Express tool that assists dealers with completing QAP documents with ease, to the new policy for mobile installations and the manufacturer quality assurance program,” Hardy noted. “All in all, it’s an exciting time for NMEDA, and

this is one conference you don’t want to miss.” l

Destination: Dallas in February!


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As industries go, adaptive automotive accessibility is a fairly narrow niche — and that’s why the success of National Mobility Awareness Month is so noteworthy.

Several years ago, members of the industry decided to raise the profile of adaptive automotive equipment and the freedom it can offer to people who use wheelchairs or have mobility-related conditions.

The result has become a popular and exciting tradi-tion — one that reaches more consumers, caregivers and clini-cians each year and educates them along the way.

“The National Mobility Equipment Dealers Association (NMEDA) is proud to announce that we will promote May 2016 as National Mobility Awareness Month for the fifth year consecu-tive year and launch the Local Heroes Contest in mid-April,” said Chuck Hardy, NMEDA VP of quality assurance & compliance. “Again this year, we expect to receive dona-tions from our generous sponsors that will allow NMEDA to offer completely adapted lowered-floor minivans, customized to their needs, to three deserving winners. Chrysler, Toyota and Honda have all supported the program with vehicles in the past, along with conver-sion manufacturers BraunAbility, Vantage Mobility International and ElDorado National.”

One reason for Mobility Awareness Month’s expansive reach is the format of the vehicle giveaway, which encourages interactivity among consumers who participate, their families and friends, their local NMEDA dealers, and adaptive automotive OEMs, conversion manufacturers and accessibility component manufacturers.

“The contest will be structured similar as previous years,” Hardy

entities such as the VA.”

The Road AheadDespite a full agenda for 2016, Hardy indicated NMEDA is already looking forward.

“Having worked closely with the major vehicle OEMs, we are expecting some significant changes to vehicle platforms in the 2017 model year release,” he noted. “This will mean some equipment instal-lations will need to be redefined, and some conversions will need to be retested for F/CMVSS compliance.”

Hardy added that NMEDA will also forge ahead with ongoing education and advocacy. “We will continue our work with the VA and vocational rehabs on establishing criteria for mobility equipment installers,” he noted, “And we ask all our members to write to their

members of Congress to support H.R. 3471, the Veterans Mobility Safety Act bill that is moving through Congress.”

That’s the bill that would give veterans with disabilities a greater voice in the cars and modes of transportation provided by the VA, and provides minimum safety and quality standards for that adaptive equipment. That would include certification of dealerships and indi-viduals who perform vehicle modification services or work with such equipment. Providers of adaptive automotive equipment and services would also need to meet requirements set forth by the Americans with Disabilities Act and the National Highway Traffic Safety Administration Federal Motor Vehicle Safety Standards.

Hardy said the upcoming NMEDA conference would “be our biggest conference ever (see sidebar)” — just like the plans NMEDA has for 2016. l

explained. “People who have a disability or their caregivers can enter the contest by submitting their written or video story explaining what makes them a ‘local hero’ in their communities. That is, what have they done to give back to others and become an inspiration to those around

them? The stories are placed online, and the contestants get their friends and relatives to vote. The idea of the contest is to spread the word, creating aware-ness through social media about the types of automotive mobility solutions available that can contribute to a person’s freedom and independence, while showing how inspirational and giving people with disabilities can be in their everyday lives.”

While the contest is energizing and engaging, NMEDA and program sponsors also use it as an opportunity to teach and share.

“People can earn extra votes by answering questions about mobility solutions and becoming better educated about mobility products,” Hardy said.

The results speak for themselves.“Over the past four years, National Mobility Awareness Month has

generated more than 5,200 entries, which were viewed by more than 12.5 million Web site visitors and produced more than 3 billion media impressions,” Hardy said. “NMEDA member dealers and healthcare providers get involved by helping contestants write and promote their stories. This is the single largest consumer outreach program NMEDA sponsors, and so far it has increased awareness tremendously among people with disabilities and the general public.”

Does that sound like your idea of fun, advocacy and education? Find out more about 2016’s National Mobility Awareness Month and previous

Local Hero winners at mobilityawarenessmonth.com. l

Steering Toward a Bright Future


An Industry Unites for National Mobility Awareness Month



Auto shows blend the here-and-now with the what-could-be. It’s always exciting to see new production models, the cars we can imminently expect to see in automotive dealer showrooms in our neighborhood. But the most colorful auto show moments often come courtesy of the concept cars — fantastical vehicles that burst from the imaginations of designers and engineers unhindered by practical concerns such as How would we ever mass produce that? and How much would it cost?

At the 2015 Tokyo Motor Show in Novem-ber, Japanese automotive manufacturer Daihatsu Motor Company highlighted the Noriori, an accessible vehicle designed to appeal to multiple generations of families.

Looking like a cross between a subway car (thanks to its double sliding doors) and a minivan, the Noriori boasts highly configurable seating that

can be rearranged as needed to accommodate everything from kids’ strollers to luggage, bikes and wheelchairs.

Ramps can deploy from the side or the rear of the vehicle, and Daihatsu’s video shows a rear ramp — which slides into the passenger area of the car — with a built-in wheelchair securement system. The Noriori also lowers to facilitate ramp use and loading cargo.

The notion is that the Noriori can adapt to meet its owner’s needs, even as those needs evolve from day to day, as well as from year to year.

In Japanese, noriori means boarding and disembarking a vehicle — an apt name for a car that seems designed around easy access for all passengers.

For more details on the Noriori, go to daihatsu.co.jp/motorshow2015_en/car/noriori.htm. l

Auto Access News

Daihatsu Shows Accessible Concept Car at Tokyo Motor Show

Images of the Noriori from Daihatsu’s Web site show an accessible concept car that transcends generations.

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Public and commercial transit is still a battle-ground for many wheelchair users who need accessible transportation that’s affordable and dependable. While many consumers have hailed ride-sharing companies such as Lyft and Uber as cheaper and more efficient alternatives to traditional taxicabs, consumers who need rides in accessible vehicles have complained — anecdotally and through legal chan-nels — that they’re being literally left at the curb.

Wheelchair users in New York, however, may be encouraged by news that AbiliTrax has been awarded a state contract to furnish Ford Transit 350 vans with the company’s highly config-urable seating and flooring systems.

According to a news announce-ment, the contract makes it easier for a number of New York State agen-cies — from local governments to public authorities, public schools,

fire districts, libraries and other non-profit organizations to purchase accessible vehicles.

AbiliTrax’s “Step N Lock” system uses a uniform flooring system that can be used across a fleet of vehicles, thereby making it easy for different vehicles to share seats and other compo-nents as vehicle configurations change.

The AbiliTrax system makes it easy to combine regular seating with specialized configurations including wheelchair securement and stretcher securement. Because installing and removing the seats can be done quickly, a single vehicle can serve a range of needs — even operating as a vehicle with entirely traditional seating when wheelchair accommoda-tion isn’t needed.

The AbiliTrax contract is for three years, with options for fourth and fifth years. For more information on AbiliTrax, go to abilitrax.com. l

AbiliTrax Wins New York State Accessible Vehicle Contract

Auto Access News

The AbiliTrax system enables easy reconfiguration to accommodate tradi-tional passengers or those using a range of mobility devices.

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AbiliTrax FlooringThis versatile flooring and seating system enables commercial vehicles to accommodate passenger seating, wheelchairs and even stretchers in whatever configuration needed. AbiliTrax features a uniform design — “X” track rails are installed on a uniform floor grid — so fleets of different vehicle brands can share the same system and components. Seat bases can be added, moved or removed in seconds to ensure vehicles can meet whatever configura-tions are required at a specific time.

AbiliTrax/Fenton Mobility(800) 500-6181abilitrax.com

MXVBraunAbility’s MXV combines advanced tech-nology with the space-saving Ford Explorer. The result: An accessible SUV with a power door, kneel and ramp system, plus redesigned, removable front seats to enable the wheelchair user to drive, ride as a passenger or ride in the center. The sliding front shifter provides extra space up front. Outdoors adventurers can add the optional tow package. The MXV has a 28.5" door opening width, 55" door opening height, an interior height of 59" and a 28"-wide ramp.

BraunAbility(800) 946-7513braunability.com

Foam GuardsUse Permalight cushioned foam guards wherever you need a little extra visibility and protection indoors or outdoors. The guards easily attach to walls, corners and protrusions in impact-prone areas — such as clinics, hallways and spaces where wheelchair training and practice take place. Made of durable, recyclable polyurethane foam with strong adhesive backing, the corner and wall guards come in 15 shapes in white, black/yellow, or black to protect the environment and the people in it.

American Permalight Inc.(310) 891-0924americanpermalight.com

FreeWheel AttachmentBy attaching to rigid-framed manual wheel-chairs (or to folding chairs via an adaptor), FreeWheel enables consumers to push over surfaces that would otherwise be difficult or impossible to navigate. The attachment is designed to provide a longer wheelbase and reduce resistance and drag when rolling over broken sidewalks, curbs, carpet, gravel, dirt, grass and snow. Encourages a more active lifestyle by improving accessibility in all sorts of everyday and exceptional situations.

Epical Solutions(517) 488-7315epicalsolutions.com

Scout 2 Pool LiftThis new generation of the Scout pool and spa lift features an adjustable seat pole, updated base and upgraded electronics to accom-modate a higher consumer weight capacity of 375 lbs. The Scout 2 also now allows up to 25" of wall clearance on a 16"-wide profile when used with the pull-out legrest. The lift has 360° of rotation to provide a versatile, easy-to-use and affordable solution that complies with Americans with Disabilities Act requirements in residential or commercial environments.

Aqua Creek Products(888) 687-3552aquacreek.com

SUITCASE GF RampThis new, single-fold addition to the SUITCASE line was designed to provide a lifetime of acces-sibility and ease of use. Made of glass-reinforced graphite fiber, the GF ramp is ultralightweight, yet durable and boasts a 660-lb. weight capac-ity. It’s available in five sizes (from 29" to 82") and weighs from 7.75 to 21 lbs. A full-length folding joint provides additional strength, while a slip-resistant coating offers superior traction, and visibility lines on outer edges enhance the ramp’s safe use.

EZ-ACCESS(800) 573-0181ezaccess.com

accessibility marketplace

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MiniLift200A mobile sit-to-stand lift, the MiniLift200 moves the user forward and upward in a natural movement pattern for an optimally comfortable experience, while at the same time exercising leg muscles and balance. Combined with the appropriate lifting accessories, the MiniLift200 can provide its user support under the feet, for the front of the lower legs and behind the back. The result is a safe, secure and active sit-to-stand process. The MiniLift200 can accommo-date up to 440 lbs.

Handicare(866) 276-5438handicare.com/us

QLK-150Designed to provide maximum indepen-dence, the QLK-150 docking system is ideal for wheelchair users who drive their own vehicles or want to quickly secure their own chairs via a single-point system. The QLK-150 has been successfully crash tested to higher WC19 loads, and has been tested forward, rearward and sideways. It features a compact design with a larger touch area and embedded LED indicators to show system status. Check the Q’Straint Web site for up-to-date bracket info.

Q’Straint(800) 987-9987qstraint.com

ELEV8A self-supporting adjustable aluminum threshold ramp, the ELEV8 was designed to provide safe, gradual passage through door-ways that swing in or out. The ramp is made of slip-resistant, grooved aluminum to accom-modate wheelchairs and scooters of various configurations. ELEV8 aligns directly against the threshold and adjusts thanks to bullet feet that fit precisely to the height needed. The ELEV8 has an 800-lb. weight capacity, and comes in four lengths and two widths.

Prairie View Industries(800) 554-7267pviramps.com

Lift Finder ToolConsumers or providers looking for the right combination of Pride Mobility lift, automo-tive vehicle and Pride mobility device have a powerful new tool in their corner. Users select a combination of automotive vehicle and mobil-ity device, then the online Lift Finder reveals a list of compatible lifts. Visitors can compare lifts and click on links to read each product’s specifi-cations. Consumers can also ask to be contacted by a Pride Lift provider in their neighborhoods. The Lift Finder database is updated constantly.

Pride Mobility Products(800) 800-8586pridemobility.com


AfariDescribed as a “stylized adaptive mobility and fitness device for outdoor move-ment,” the Afari looks like a cross between a bicycle and a three-wheeled rollator. And that’s roughly the idea. The mobility aid was designed “to facilitate movement for individuals who have balance deficits, a fear of falling and/or a condition such as osteoarthritis that is eased by unloading body weight, so they may participate in upright, outdoor walking, jogging or running on diverse terrain,” according to a news announcement from Mobility Technologies, which owns Afari. Afari’s team, including inventors Elizabeth DePoy, Ph.D., and Stephen F. Gilson, Ph.D. — both professors of interdisciplinary disability studies at the University of Maine — and University of Maine mechanical engineering professor Vince Caccese, Ph.D.,

will be working with the R.M. Beaumont Corp. on a $225,000 National Institutes of Health Small Business Technology Transfer grant to complete testing on Afari’s design, safety and usability, and Mobility Technologies indicates it is “scaling up for larger manufacturing opera-tions” in the next three years.

Mobility Technologies(207) 735-6181mobility-tech.com

Technologyto Keep

Your Eye on

0216mm_AccessMarket2122.indd 22 1/14/16 2:27 PM

http://www.mobility-tech.com


Alisa Brownlee, ATP, has personally heard it multiple times during her long tenure at clinics specializing in amyo-trophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.

Already dealing with a devastating diagnosis, family members aren’t always prepared to hear that in addition to progressive loss of muscle control, ALS often also impacts a patient’s cognition — for instance, the decision-making processes, and how patients think about the people around them.

“They will tell us,” Brownlee said, “‘Okay, he’s got ALS, but you can’t tell me he’s got anything else going on. Because that’s enough.’ So they’ll bury the cognitive component.”

Nevertheless, researchers are finding that cognitive involvement for patients with ALS is much more common than previously thought. And healthcare professionals already know that cognition can be affected with such diagnoses as multiple sclerosis — though in very different ways.

Therefore, knowing what to expect from and how to best serve any seating & mobility client with dementia is a challenging task.

Defining DementiaThe mainstream public most commonly associates dementia with Alzheimer’s disease, which, despite early onset types, is itself most commonly associated with advancing age.

In reality, dementia simply refers to impact on a number of cognitive

abilities and skills.The Mayo Clinic says, “Dementia describes a group of symptoms

affecting memory, thinking and social abilities severely enough to interfere with daily functioning. Dementia indicates problems with at least two brain functions, such as memory loss and impaired judgment or language, and the inability to perform some daily activities, such as paying bills or becoming lost while driving.”

From a seating & mobility perspective, clinicians are still learning which clients are impacted, how and why — and are also investigating why some, but not all, clients are affected.

Jay Doherty, OTR, ATP/SMS, senior clinical education manager, East Coast, Quantum Rehab, said of this ongoing research, “Interestingly, the presence of cognitive impact on those with ALS is a relatively newer discovery, with extensive research occurring as recently as the last two decades. While it was long thought that ALS only affected motor skills and respiratory function, researchers now know that there can be cognitive and behavioral components. The current research shows that 50 percent of those with ALS have no cognitive impairment. However, the other 50 percent have some level of cognitive and behavioral impairment, and 25 percent of that popula-tion experiences diagnosed dementia.”

Contrast that with how Doherty describes cognitive impact common in multiple sclerosis (MS) patients: “Cognitive impairment among some people who have MS can manifest in a variety of ways. It

ATP Series

By Laurie Watanabe

More Common than Traditionally Thought, Cognitive Impairment Can Challenge Clinicians, ATPs & Clients

0216mm_Dementia2326.indd 23 1/14/16 3:39 PM


Dementia, Seating & Mobilitycan involve memory, problems with planning or prioritizing, atten-tion and concentration, processing sensory information, and other issues with everyday life. As the individual working with a person who has MS, you may need to help them develop strategies in order to over-come some of these cognitive limitations, but we also must look closely at this cognitive involvement and ensure that the person will be safe using their complex rehab technology (CRT). This process may include further training of the individual in order for them to use the CRT safely. As always, involving caregivers in this process to support a repet-itive learning process is exceptionally helpful.”

Cognition & ALSCognitive involvement in ALS patients is healthcare research’s equiva-lent of breaking news: So much has been learned so recently, with new information still coming in all the time.

What we know now, Brownlee said, is that while about half of ALS clients do have cognitive impairment, it can be mild, moderate or severe in nature — and researchers aren’t sure why that’s the case, or which ALS patients are more liable to have involvement.

Researchers also know that in ALS, “the portion of the brain that is affected is the frontal lobe, the decision-making portion,” Brownlee said. “If you’re looking at that in terms of, for example, assistive technology, we have people who are impulsive. They have poor decision making or no decision making. They lack empathy. They lack the ability, when it comes to driving a wheelchair, to know safety precautions. So it would almost be like driving a car: You don’t want someone who first of all has problems with reactive time, or problems with judgment, driving any type of vehicle, whether that be a wheelchair or a car.”

Currently, Brownlee added that one of the challenges is the fact that not all ALS patients are undergoing the screenings that could help to identify cognitive issues.

“If somebody comes to an ALS clinic, we screen for cognitive impair-ment,” she said. “But there are only 46 clinics in the United States. So the significant number of PTs, OTs and ATPs are seeing people who haven’t been to an ALS clinic. And [the seating team] doesn’t know the cognitive impairment, so they’re not necessarily screening for it.”

Unlike the prototypical memory loss in Alzheimer’s patients that can become quickly obvious even to the casual observer, cognitive involvement in ALS patients can be more subtle and harder to detect.

“Even if you do a general cognitive screen, [symptoms might] not show up on your radar unless you ask more explicit questions,” Brownlee said. “So for example, because our folks have problems with executive function and decision making and impulsivity, the care-giver might say, ‘Well, yes, they’re a little impulsive when it comes to this.’ But then we see it come out as people who absolutely devas-tate a bank account. They go online and spend money crazily. But you wouldn’t know that unless you asked someone, ‘What do you mean they’re impulsive?’ Unfortunately, the other part of impulsivity is we have other people who act out sexually, who touch strangers in places they’re not supposed to be touched. But again, that’s not something you normally [ask about] during a seating eval.”

So rooting out a cognitive component in an ALS situation can be very different than noticing forgetfulness in a patient with Alzheimer’s.

“Our folks don’t have a memory problem, they have a behavioral problem,” Brownlee said. “And that behavioral problem can cause them, when driving a wheelchair, to crash into the wall. Our folks don’t necessarily have issues remembering how to use the joystick or how to engage a scanner in a different mode. But they have problems when they’re in the mode to either put a stop to the wheelchair, to slow down, or not to hit someone. The other thing is our folks lack empathy. So their impulsivity literally might make them run over someone, and they can’t be sorry they did it.”

The possibility of making bad decisions — and being unable to learn from and correct them due to accompanying lack of empathy — can put seating & mobility clinicians and ATPs in a very difficult position as they decide on the assistive technology to recommend and provide.

Safe to Operate a Power Wheelchair?While it can present in younger adults, ALS typically is diagnosed in middle age, among patients who are raising or have raised families, built careers and are active in their communities. Therefore, the poten-tial loss of independence strikes them and their families very hard.

ATP Series

More than Mobility: Which Diagnoses Have Cognitive Involvement?Understandably, during a seating & wheeled mobility evalu-ation, most attention can be focused on questions such as range of motion, shoulder and arm strength, repositioning, and the ability to reach and maneuver a joystick. But for many people who use wheel-chairs, cognitive involvement is also part of their diagnoses.

In addition to amyotrophic lateral sclerosis (ALS) and multiple scle-rosis, which diagnoses that you’re likely to see in clinic commonly have cognitive components?

Parkinson’s disease: The Parkinson’s Disease Foundation says most Parkinson’s patients are cognitively affected, resulting in “slowness in memory and thinking.”

Huntington’s disease: Difficulties with thinking, remembering, orga-nizing, making judgments, communications and visual spatial ability,

plus a lack of awareness of potentially dangerous situations, can result from damage to neurons and neural connections, according to the Huntington’s Outreach Project for Education at Stanford University.

Spinal Cord Injury: A University of Maryland School of Medicine study in November 2014 said, “Spinal cord injuries can cause widespread and sustained brain inflammation that leads to progressive loss of nerve cells, with associated cognitive problems and depression, researchers have found for the first time.”

Spastic Cerebral Palsy: “Evidence points to specific impairment of attentional, visuospatial, and executive functions, although both atten-tion and executive functions are relatively unexplored in spastic cerebral palsy,” according to a report by the U.S. National Library of Medicine at

the National Institutes of Health. l


news:So


Often caught in the middle are the clinicians and ATPs who have to balance their clients’ continuing desires for autonomy for as long as possible with the very real possibility that operating a power wheelchair safely and responsibly may not be possible.

“I think the challenge with our clinicians is to determine whether someone is safe to drive,” Brownlee said. “And unfortunately, the crux of the problem is it can come to the PT or the OT to say to the caregiver or the patient, ‘You’re not safe to drive, and I’m not going to recom-mend this power wheelchair.’ Which of course leads to anger issues or people exploding at the PT or OT that won’t give them permission to drive the wheelchair.”

Even if an ALS client doesn’t act aggressively or impulsively toward others — and Brownlee pointed out that clients often “put on a better face for the clinician than what is happening in the home” — that client could still be endangering himself by, for instance, taking the power chair outside alone and driving it in unsafe locations or in bad weather.

“Instead of running over someone, maybe they would take them-selves into the wall and hurt themselves or be out in the community,” Brownlee said. “That’s what is really disconcerting.”

While it’s not always possible to watch how an ALS client acts and reacts over a long period of time, Doherty said observation, when possible, can help seating team members detect potential problems.

“For example, if a client struggles with interpreting or remembering screen functions on a power chair, a simplified way of controlling the different functions of their power wheelchair may be needed or a different form of CRT may need to be considered — an example would be an attendant control,” he explained. “As ATPs and clinicians, we’re trained to have an awareness toward evaluating a client’s cognitive abil-ities toward using CRT, and such immediate signs as a client’s inability to follow or remember instructions are among key indicators that some level of cognitive impairment may be present.”

Brownlee acknowledged that a diligent clinician who declines to recommend a power chair for an ALS client unable to safely operate it runs the risk of not just alienating the client, but also motivating the client to go elsewhere — to a clinician or supplier willing to provide the equipment without questioning the cognitive component.

A Multi-Disciplinary ApproachIn this quest to provide the best support for clients with ALS — particu-larly ones with tricky cognitive involvement — Brownlee suggested there can be strength in numbers.

That’s again where ALS specialty clinics can help.“ALS clinics have an interdisciplinary team,” she said. “We have 10

or 12 professionals who make up the team, and the patient sits in the room, and the physicians go in one by one to talk with them. And then at the end of the day, we’ll do rounds. I might say, ‘He’s really saying that he wants to communicate, but he just doesn’t care to communi-cate.’ And then another person might chime in, ‘Well, you know he cleaned out their bank account.’ And our PT might chime in, ‘He fell three times because he doesn’t want to use the walker.’ So that kind of tells us there’s a pattern.”

Involving family members and caregivers from the start, Doherty

said, is also critical.“Progressed ALS always involves caregivers — whether family

members or hired caregivers — and their needs must be considered as well in the CRT process,” he noted. “Even if the client possesses full cognitive abilities, his or her primary caregiver should be equally familiar with the CRT. In the event that cognitive abilities are affected — either in the present or future — the caregiver is then fully prepared to use the needed CRT. Therefore, in selecting and fitting CRT, both the client and primary caregivers should be included in the process.”

“If I take away anything from our caregivers and knowing this cogni-tive component,” Brownlee said, “it’s just acknowledging to the caregiver that something is wrong. I can’t stress how important that is. So many caregivers don’t understand it: This is not the man I married, this is not the woman I married, it’s not their typical behavior. So we acknowledge it. Maybe they won’t process it, but at least we’re acknowledging it — and we’re saying maybe they’re not safe to drive right now. It doesn’t mean they can’t be. There’s always that hope.”

The assistive technology provider is also in a vital position to observe cognitive difficulties.

“If the suppliers are getting calls all the time — ‘We need to reduce the speed,’ or ‘We need to do this or that’ — they also have to be cogni-zant that maybe this is not a problem with the wheelchair. It’s a problem with the personality. The PT or OT who does the eval might see [the ALS client] one or two times, but the supplier is going to take over from there, and they’re going to be the ones getting calls for tweaks or modi-fications to the wheelchair, and they should also know about the issues. Granted, they’re not the people who are going to establish whether [clients are] safe to drive, but they’re going to be ones on the front lines that the families are calling, saying, ‘But I want him to drive.’ So they need to be able to stand up for themselves and say, ‘No, you need to go back to the person who prescribed the wheelchair.’ They need to be able to be comfortable saying, ‘I think you need another evaluation. We can’t do this until you see [the clinician], or I need to talk to the doctor.’”

Equipment such as head arrays or attendant controls for power chairs can sound like perfect solutions for ALS clients, and indeed do help many such clients to preserve independent function. But if clients have cognitive impairment, the situation can get murkier.

“We get a lot of calls about people who, because this is a progres-sive disease, say ‘Oh, I need a head array,’” Brownlee said. “Our stan-dard protocol [at our ALS clinic] is no, you can’t get a head array until you go back to the person who’s evaluated you. But I’ve also heard other clinics ordering it without them ever being tested. The patient will say, ‘I can’t get back [to the clinic].’ Then the supplier says, ‘I want to do what’s best for them,’ and I get that. It’s a vicious cycle. That puts suppliers in a really awkward predicament. It puts a tremendous pressure on our suppliers.”

As for attendant controls that allow a caregiver to do the power wheelchair driving, Brownlee said funding is a common dilemma. “Because of the medical model we’re under, I’ll say, ‘She can drive the wheelchair with her hands, but she’s not cognitively able to do that.’ Medicare will come back and say, ‘But she can drive the wheelchair.’” And there goes the argument for attendant controls.



The Cognitive Take-AwaysDespite the many challenges of working with ALS patients who have cognitive involvement — or any wheelchair user who does — Brownlee said there are valuable take-aways to be had.

For example, thanks to ongoing research along a number of paths, the cognitive components of ALS are getting more attention, and the healthcare community is learning more all the time.

At December’s International Alliance of ALS/MND (Motor Neurone Disease) Associations event in Orlando, Fla., Brownlee said discussions included the physiology of cognitive involvement — why certain patients are affected while others aren’t, and what makes some people more susceptible. Attendees discussed “ALS-Plus Syndrome,” whose simple definition is ALS plus non-motor symptoms. An April 30, 2014, story on ALS-Plus Syndrome in Neurology, the journal of the American Academy of Neurology, described ALS-Plus symptoms as including such diverse conditions as gaze abnormalities, excessive sweating, loss of taste and smell, apraxia and dystonia.

“Why will some people get ALS-Plus, and some people don’t?” Brownlee asked. “There’s a whole bunch of genetic dispositions. We can’t say, ‘Of Joe, who was diagnosed today, and Ron, who was also diag-

nosed, which one of you will have a genetic component, if either of you.’ So they’re really trying to figure out why, and there’s a lot of studies going on across the United States and the world to figure this out.”

Attendees also discussed sharing information and the different cognitive screenings being used on ALS clients, including the Edinburgh cognitive screen.

“Not that we all have to get in line, but we’re all trying to share infor-mation so we know who’s doing what and getting the best results,” Brownlee said. “That’s where we are at this point, eight or nine years into the cognitive involvement. We’re still all figuring it out.”

At this still early stage, the greatest take-away may simply be to be aware of how common cognitive involvement is, so clinicians and ATPs know what to look for. When cognitive impact makes independently driving a power chair impossible, the seating team can be ready to offer options, such as manual mobility that will still enable repositioning for comfort and weight shifting. But for the client’s best interests, seating professionals should also be ready to say no when needed.

“Call your local ALS chapter,” Brownlee said of pulling in other resources. “Call the neurologist, ask the questions when something doesn’t feel right here.” l

Dementia, Seating & Mobility

ATP Series

New studies show the pervasive toll that the many forms of dementia take on patients and their families, as well as their communities and the healthcare infrastructure.

Last year, the Alzheimer’s Society partici-pated in a Nanos survey in Canada “to gauge Canadians’ knowledge about Alzheimer’s disease and other dementias,” the organiza-tion said in a January news announcement that coincided with World Alzheimer’s Awareness Month. The responses of the 1,500 survey participants were sobering: 47 percent said people with dementia could not live well.

The Alzheimer’s Society added that 747,000 Canadians are living with Alzheimer’s or other forms of dementia today, and that figure is expected to rise to 1.4 million within 15 years. In the United States, the Alzheimer’s Association says 5.3 million Americans are living with the disease; in another 10 years, the number of Americans aged 65 years and older who will be living with Alzheimer’s is estimated at 7.1 million. The percentages and numbers of people affected by Alzheimer’s should continue to rise as greater portions of the population reach older age, unless a cure or preventive measures are developed.

Already, dementia is taxing the healthcare system.An October news release from the National Institute on Aging (NIA)

said caring for patients with dementia is more expensive than caring for patients with any other diagnosis.

“In the last five years of life, total healthcare spending for people with dementia was more than $250,000 per person, some 57 percent greater than costs associated with death from other diseases, including cancer and heart disease,” the NIA announcement stated. “The new analysis, appearing in the Oct. 27 online issue of the Annals of Internal Medicine,

estimates that total healthcare spending was $287,000 for those with probable dementia, and $183,000 for other Medicare beneficiaries in the study.”

Those costs included funds supplied by Medicare, Medicaid, private insurance companies and by the patients and families themselves.

The NIA study suggested the disparity in costs for the different diagnoses could be due to the fact that patients with dementia

typically needed care much earlier versus patients who eventually died of cancer or heart disease. For example, five years before their deaths, 21 percent of the dementia patients in the group studied were already using Medicaid benefits. At the start of that same five-year time period, just 8 percent of cancer patients and 8 percent of heart-disease patients were using Medicaid benefits.

In addition, the NIA study found that families spent much more of their own money caring for loved ones with dementia versus other illnesses. The study found that 11 percent of a household’s wealth was spent caring for patients with other diseases in the last five years of their lives. Caring for dementia patients cost a household an average of 32 percent of its overall wealth.

Despite the sobering statistics, the Alzheimer’s Society is focusing on preserving dignity and quality of life for its patients and families, in part by using the #StillHere hashtag on social media.

“Our cognitive abilities alone do not define us,” said Pia Kontos, senior scientist of the Toronto Rehabilitation Institute-University Health Network. “People with dementia can continue to engage with the world in many other meaningful ways. And supporting their dignity

and worth improves their well-being and quality of life.” l

The Financial & Emotional Costs of DementiaAl

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Soft Fit OptionThanks to input from seating professionals, Ride Design is now offering a “Soft Fit” option for its Custom cushions. Traditionally, the Custom cushion has had a single layer of spacer mesh fabric. But because clini-cians and ATPs wanted a Custom cushion feel that’s more comparable to Ride’s Java cushion, the company now has a Soft Fit option consisting of two layers of spacer fabric (whose vertically oriented fibers help wick away moisture) with cutouts for the ischial tuberosities. That provides increased softness and comfort at the loading contours, but with a functionally deepening well to improve offloading. A third layer of spacer fabric on top of the first two layers completes the Soft Fit.

Ride Designs(866) 781-1633ridedesigns.com

Quickie 7 SeriesFor active users wanting the highest level of customization combined with the lightest-weight materials, Sunrise has introduced the Quickie 7 series of rigid ultralightweight chairs, with frames made of 7000-series aerospace aluminum. The 7R line has an adjustable frame for quick back-angle adjustments, while the 7RS has a fully rigid backrest and axle plate to create the most efficient, lightest ride. The 7R fea-tures the Freestyle Backrest System option, available exclusively with the JAY J3 back, which eliminates traditional back canes and improves the user’s range of upper-body motion.

Sunrise Medical(800) 333-4000sunrisemedical.com

CONCIERGE Power Door OpenerThis cost-effective, lightweight power door opener was designed for residential use with interior or exterior doorways. It’s easy to install without needing modifica-tions to the door or jambs, and the system plugs into a regular 115 vac wall outlet. The CONCIERGE can be opened manually from either side and automatically closes according to the hold-open time chosen by the user (from 0 to 30 seconds). Available controls include a wall-mounted push plate, a digital key-pad, a choice of wireless remotes, and a system with sip-and-puff functionality. For added safety, the system detects when the door encounters an obstruction.

EZ-ACCESS(800) 573-0181ezaccess.com

WheelbladesInvented by Swiss wheelchair user and outdoor enthusiast Patrick Mayer, Wheelblades offer chair users greater access in snowy conditions. Wheelblades attach to front casters of manual chairs; the Wheelblades’ greater width distributes the user’s weight and propulsion energy over a greater surface area to keep casters from sinking into the snow. Two tracking channels on the underside of the Wheelblade compresses snow to ensure stability. Wheelblades can be easily and quickly attached to front wheels measuring 1.8 to 6 cm wide (approximately .71" to 2.36" wide). Check out wheelblades.ch, or Wheelblades’ American distributor for more information.

Mobility Direct (U.S. distributor)(877) 914-1830mobilitydirect.com/wheelblades-s/156.htm

Mount’n Mover SystemAs great as today’s consumer electronics are, some wheelchair users need those devices positioned just right to make the best use of them. The Mount’n Mover mounting system offers flexible, secure positioning of tablets, speech devices, laptops, cameras and trays on wheelchairs, as well as on tables and floor stands. The mounting system can be moved and adjusted by the wheel-chair user or a caregiver to accommodate fatigue or changes in the environment, or to make it easier for the user to see and communicate with others. The system also makes it possible to move devices out of the way for transfers or when pulling up to a table.

BlueSky Designs(612) 724-7002mountnmover.com

product revue

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In 2014, Mobility Management began a series on the pressure ulcer research of Amit Gefen, Ph.D., professor in biomedical engi-neering at Tel Aviv University. Gefen, immediate past president of the European Pressure Ulcer Advisory Panel, brought a new perspective and new tools — including laboratory-generated cells and tissues that could be tested, and those results then modeled and extrapolated via computer programs — to the task of better understanding what pressure ulcers are, why they form, and how they challenge seating & positioning professionals trying to keep wheelchair users safe.

That series of clinical articles led into a second research series in 2015, this time concentrating on deep tissue injuries (DTI).

The traditional view of pressure ulcers focuses on ischemia. Ulcers of that type were thought to be caused by inadequate blood flow, often as being a result of prolonged pressure over a bony prominence, such as an ischial tuberosity (IT). Current clinical practices for reducing that sort of pressure ulcer risk include watching for changes in skin color and temperature. But Gefen’s research, as well as research by other notable scientists around the globe, indicated that ischemia is not the only way pressure ulcers form — and DTIs are not so easily identified by looking for changes in skin texture or color. In fact, DTIs are influ-enced by factors we’re only now starting to understand.

Gefen’s industry partner in this research has been Kara Kopplin, BSc, the Senior Director of Efficacy & Research for ROHO Inc.

It’s an evolving area of study, one that will impact not just today’s wheelchair users, but tomorrow’s. Here we wrap up our series by discussing how wheelchair users’ changing bodies can affect their risk. Differences in Scar TissuesAs discussed in November, Gefen’s research covered not just how healthy tissue responds to forces and distortions, but how compro-mised tissue does as well. DTIs are caused by sustained tissue deforma-tions. Gefen wanted to determine whether the immersion and envel-opment strategies advanced by ROHO’s air-celled cushions would succeed in those environments, including “different types and shapes and sizes of scars that clinicians see in the real world.”

Gefen explained that ultrasound scanning work and anatomical mapping done for example in Japan could identify existing scars by looking at deeper tissues as well as what was visible on the skin. “So if you see something, that can give you a hint that this patient had a pressure ulcer already,” he noted. He used the names that Japanese researchers created to differentiate the types of scars that seating specialists often see in their clients (see diagrams).

In the illustrations, the ischial tuberosity is white. The gluteus muscle is red and is seen directly around the IT. Surrounding fat tissue is yellow, and scar tissue is blue.

In the cross-sections, you’ll see the “Thin” example

has scar tissue on the surface of the skin. “Deep” has scar tissue at the IT and gluteus muscle interface. The “Sandwich” (abbreviated “SW”) scar shows scar tissue both internally at the IT and on the surface of the skin. And the “Hourglass” scar (abbreviated “HG”) has scar tissue that traverses the distance from the IT to the surface of the skin.

Gefen pointed out that it’s important to understand how scar tissue differs from healthy tissue, and how it reacts differently to force.

In the Sandwich scar, for instance, he noted, “You can see how the scar concentrates the mechanical forces. The forces are basically going through the scar. That’s a well-known principle in mechan-ical engineering: Forces will always tend to go through stiffer struc-tures. They go all the way down through the scar. But the scar cannot deform much, so at the interface, the non-scar tissues are deforming, and they’re deforming a lot. They’re deforming for themselves and compensating for the tissue that can’t deform, which means that they deform excessively.”

Gefen said he found that if scar tissue is milder, the immersion and envelopment offered by the ROHO air-cell cushions he used did greatly compensate for it.

“If the scars are more mild, you actually get load values in the tissues that are similar to what you have in tissues and skin that are normal,” Gefen said. “The immersion and envelopment effect is so strong that it can mitigate not only the presence of force between the bone and the soft tissue, but also the presence of the [mild] scar. And we quanti-fied that. In each and every case, we divided the value of the mechan-ical loading in the tissues where there is a scar by the volume of the mechanical loading as if there was no scar there.

“So ideally, you would want these values to be around 1 or lower than 1. On a ROHO cushion, in some of the [more severe] scars, you do get values above 1.”

But Gefen added that for less severe scars, “most of the time, it’s controllable. [The ROHO air-celled cushion] contains them.”

In other words, those immersion and envelopment strategies can significantly compensate for and manage those scar conditions. Managing Scars as a Chronic Condition

This research suggests that even when scar tissue is already present, it can be possible to manage pressure ulcers and deep tissue injury risk safely, as a chronic condition — depending on the severity of the scar-ring as well as the intervention chosen.

Gefen visited long-term care facilities and rehab centers all over the world, and noticed that the most aggressive, significant seating interventions were often reserved for “patients in the worst condition.”

That means other patients thought to be at lower risk for pressure ulcers could be denied the most effec-

new discoveries By Laurie Watanabe

Deep Tissue Injury Research, Part IV:How Clients Change & What We’ve Learned

More: Pressure UlcersAdditional research at mobilitymgmt.com,

key word Gefen.

0216mm_DeepTissue2829.indd 28 1/14/16 9:51 AM


tive interventions until they deteriorate. That’s far from ideal, but Gefen pointed out that the reasoning has been that clinicians in those settings haven’t understood why those immersion and envelopment strategies work — thereby making them more difficult to justify.

In pointing out the importance of these research findings, Kopplin explained, “Now that we have the evidence, we can start those conver-sations with them, with research data instead of anecdotal or subjec-tive information. That’s part of the broader plan with this research. We’ve never known why some people with scars can be managed, and some with scars can’t.”

“It all points to immersion and envelopment,” Gefen said. “And as you increase immersion and envelopment, you minimize the internal tissue deformations. You buy yourself more safe sitting time.” Clients’ Bodies Change — QuicklyAnother feature of the research to emerge is how quickly a client’s body can change, for example, after a spinal cord injury (SCI). Gefen’s research discussed how rapidly fat can encroach upon muscle in newly injured SCI patients. Intramuscular fat can increase significantly, within the weeks post injury, thereby drastically changing the nature of the tissue that wheelchair seat cushions are trying to protect.

“Before the person breaks down, there are so many changes that are ongoing,” Gefen said. “That all takes place in weeks. Dramatic changes. In about 20 to 40 weeks, [newly injured SCI patients] lose 40 to 50 percent of their bone and muscle mass in the buttocks. In half a year.”

That’s a problem, Gefen pointed out, given that those clients continue to use the same seat cushions prescribed for them months before, when their bodies were much different.

“Here in the States, [funding sources and insurance companies] are pushing for a reimbursement factor of [one cushion] every fifth year. They’re thinking about the cushion. They’re thinking about the mate-rials of the cushion — for instance, when the foam collapses. They’re not thinking about the patient. The cushion still hasn’t aged; it’s still brand new. But the person has gained a little bit of weight. If this is a non-adjustable, contoured foam cushion for example, it would not fit the shape of the buttocks after that weight gain. The buttocks are not sitting in the holes [of the cushion] any more.”

As intramuscular fat continues to develop, Gefen said, “It’s practi-cally taking over, and if you wait long enough, there will be practically no muscle. You have stripes of fat in between muscle layers. These muscles internally slide against each other [on the cushion]. That will add even more shear internally in the tissues.”

So in addition to its ability to immerse and envelop the client’s shape when it’s prescribed, Gefen said a cushion needs to adjust to the client’s evolving body shape as long as he/she is using that cushion. This feature is called adjustability, and Gefen said it is a critical design feature of a good wheelchair cushion.

“So how well can the cushion adjust as the person changes?” Gefen asked. “What we find is that at the time of the fitting, you get shear deformation levels that are tolerable by themselves. A few weeks later, it’s tripled. The patient doesn’t even know that; it all happens internally. It’s not only the immersion and envelopment, but also the ability of the cushion to adjust to body changes.”

Kopplin said that when a person needs to function in their daily living environment, for example shifting in the chair, reaching for objects (and therefore changing sitting posture ), or even changing clothes, the cushion needs to accommodate these movements to continue to protect the client. That’s the real-world interaction between the client and the cushion. They refer to this critical cushion function as adaptability, and it’s needed not just as a client changes over weeks, but even during a typical day.

“You shouldn’t have to constantly adjust your cushion every time you’re going to lean forward to work on your computer,” she said. “It needs to respond and adapt to you.”

Gefen referred to a study that Kopplin conducted at ROHO to look at the drastic postural changes that take place simply when a client changes from flat shoes to high-heeled ones.

“I can imagine what’s happening internally at that bone and in the soft tissues surrounding it, and what a great risk that person is at, just from changing their shoes,” Kopplin said.

The current understanding of deformation and DTI, along with these research studies of the effects of scar tissues, body changes, custom contoured cushions (which may no longer “fit” over time) and even daily movements and wardrobe changes, led Gefen to a conclu-sion about what seating clinicians, ATPs and cushion manufacturers should strive for.

“We can actually say here,” he noted, “that Envelopment + Adjustability + Adaptability = Safety.”

Editor’s Note: Read “Computer simulations of efficacy of air-cell-based cushions in protecting against reoccurrence of pressure ulcers,” research by Gefen, Kopplin, and Ayelet Levy, in the Journal of Rehabilitation Research & Development (rehab.research.va.gov/jour/2014/518/jrrd-2014-02-0048.html) Mobility Management illustrations by Dudley Wakamatsu, based on research by Gefen, Kopplin and Levy. l

0216mm_DeepTissue2829.indd 29 1/14/16 9:51 AM


MM EditorialAdvisory Board

Josh Anderson Permobil/TiLite

Mike Babinec Invacare Corp.

Pat Boardman Astrum Healthcare

Lois Brown Consultant

Beth Cox The VGM Group

Susan Cwiertnia VARILITE

Jay Doherty Quantum Rehab

Amit Gefen Tel Aviv University

Rick Graver Medtech Services

Ryan Hagy Numotion

Chuck Hardy NMEDA

Julie Jackson Invacare Corp.

Angie Kiger Sunrise Medical

Kara Kopplin ROHO Inc.

Karen Lundquist Ottobock

Joe McKnight Access Medical

Steve Mitchell Cleveland VA Medical Center

Amy Morgan Permobil

Julie Piriano Pride Mobility Products/ Quantum Rehab

Lauren Rosen St. Joseph’s Children Hospital of Tampa

Mark Smith Wheelchairjunkie.com

Rita Stanley Sunrise Medical

Barry Steelman Stealth Products

Stephanie Tanguay Motion Concepts

Cody Verrett ROVI

Group Publisher Karen Cavallo(760) 610-0800

Sales Assistant Lynda Brown(972) 687-6710

Advertising Fax (866) 779-9095

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product revue

Abilitrax/Fenton Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

American Permalight Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Aqua Creek Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

BraunAbility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Epical Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

EZ-ACCESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Handicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Prairie View Industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Pride Mobility Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Q’Straint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Mobility Technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

BlueSky Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

EZ-ACCESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Mobility Direct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Ride Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Sunrise Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

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Company Name Page #

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