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Patient has a manual or power wheelchair and is in need of a new or different type.*
  • A new or different type of wheelchair is often required when there is a change in neurological condition.
To qualify for a manual wheelchair, the patient:
  • must be unable to ambulate safely within the home, with or without an assistive device, and complete mobility-related activities of daily living (MRADLs) in a reasonable amount of time (i.e. get to bathroom before incontinent episode, get to kitchen for basic meals, get out of the home in the event of an emergency, etc.); and
  • has the upper body strength and endurance to propel a properly configured manual wheelchair throughout a given day and complete MRADLs in a reasonable amount of time.
    • If the patient is also unable to change his/her position for an adequate pressure relief, and does not have the cognitive abilities to safely use a power wheelchair, he/she would likely qualify for a manual tilt in space wheelchair.

To qualify for a power wheelchair, the patient must fulfill requirements for a wheelchair and must be unable to:

  • ambulate in the home as his/her primary mode of mobility throughout the day even with an assistive device; or
  • propel any type of manual wheelchair as primary mode of mobility to complete his/her self-care and activities of daily living in a reasonable amount of time.

General Recommendation: Evaluation** and documentation in collaboration with a certified assistive technology professional at the nearest health system or hospital-based outpatient facility or clinic (search here) who can advise on considerations of insurance stipulations, assistive technologies, wheelchair selection, vendor selection, wheelchair fitting, and seating evaluation.


Notes
*In general, most insurances will not authorize a new wheelchair if the current one is not 5 years old. (Exception may be indicated , if it can be shown that the current wheelchair is not medically appropriate due to a medical change in condition or if the cost to repair the current wheelchair outweighs the cost of a new wheelchair, the request for a new wheelchair can be submitted.

**Some insurance will require an evaluation by a licensed PT or OT. Some therapists may be comfortable performing these evaluations but others may not and can help with referring to a qualified therapist to do a thorough evaluation.

 

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The University of Alabama at Birmingham Spinal Cord Injury Model System provides this website as an auxiliary resource for the primary care of patients with spinal cord injury.The contents of this website were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90SIMS0020). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this website do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

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