To gather information concerning the current state of students' wheelchair (WC) use in US schools from the perspective of school-based therapists. This descriptive study used a Web-based survey to gather information regarding factors that facilitated or hindered student WC use at school, the frequency at which various tasks related to WC provision were performed, and factors that would facilitate students' independence with WC use. A dependent manual WC was the most common type of WC mobility used at school. Various student and nonstudent factors were reported as a facilitator or a barrier to students' WC use at school. Although most respondents reported working with a student who used a WC, few reported active engagement in tasks related to WC service provision. Future research exploring potential attitudinal issues influencing students' WC use at school and ways to optimally support students' independent WC use is indicated.

ABSTRACT The purpose of this RESNA Position Paper is to provide evidence from the literature and share typical clinical applications supporting the application of ultralight manual wheelchairs (ULWCs) to assist practitioners in decision-making and justification of wheelchair recommendations.

In the early 2000s the Centers for Medicare and Medicaid Services determined that power seat elevation systems did not meet the definition of durable medical equipment, and therefore are non-covered items. Yet, power seat elevation systems are covered by other funding sources, and many power wheelchair users utilize these systems regularly when performing tasks such as transferring, reaching, and looking at objects in environments designed for ambulatory people. Adjusting for height when performing these tasks may reduce the onset of pain and comorbidities. To improve access to power seat elevation systems, a clinical team of 4 Clinician Task Force members investigated applicable literature, compiled evidence, and evaluated existing policies to explain the medical nature of power seat elevation systems as a part of a greater interprofessional effort. This manuscript aims to analyze Medicare's policy decision that power seat elevation systems are not primarily medical in nature using Bardach's 8-step framework. As a special communication, this will inform health care professionals of the medical nature of power seat elevation systems and the evidence-based conditions under which power wheelchair users may need power seat elevation systems, as well as empower clinicians to engage in policy directives to affect greater change.

Power wheelchairs provide people with mobility disabilities opportunities for independence in mobility and repositioning themselves. However, current power wheelchair power options covered by Medicare limit the person to a horizontal plane. In the home, access to the vertical plane is also required for mobility related activities of daily living. Power standing systems on power wheelchairs are one option for providing access to the vertical environment, although currently these systems are not covered by Medicare. Power standing systems also aid in medical management and in preventing common comorbidities associated with chronic neurological and congenital healthcare conditions. Therefore, a legal group led an interdisciplinary effort to change Medicare policy on power standing systems. A policy analysis using Bardach’s Eightfold policy framework was conducted to analyze a clinical groups’ action within this interdisciplinary team. The clinical team considered three viable options to address the problem and evaluated these options against five criteria. Ultimately, a national coverage determination reconsideration would provide a needed opportunity for the coverage of power standing systems. Suggested coverage criteria for power standing systems, based on existing literature and expert clinical experience, are proposed.

<h3>Research Objectives</h3> To identify optimal manual wheelchair configuration for people who self-propel for full-time wheeled mobility. To identify new evidence on how prescribing an ultralight weight manual wheelchair can minimize secondary complications in the body functions, promote functional independence with mobility related activities of daily living, and provide opportunities to participate in life roles <h3>Design</h3> This position paper was written following a scoping literature review process, open review period through RESNA and peer-review process. <h3>Setting</h3> This position paper is relevant to any prescribers or clinicians recommending manual wheelchairs. The results of the scoping review is applicable to treatment settings where people use a manual wheelchair for primary mobility, from pediatrics to long term care. <h3>Participants</h3> N/A. <h3>Interventions</h3> The RESNA Paper on the Application of Ultralight Manual Wheelchairs was published in 2012 and sought to provide evidence to support the application of fully customizable manual ultralight weight wheelchairs. Since that time, new developments in clinical research in our understanding of manual wheelchair considerations have prompted a revision of this foundational document. <h3>Main Outcome Measures</h3> The presentation will describe the intention of the revision and review new evidence based topics incorporated into the new position paper including: Manual wheelchair configuration, wheelchair training and wheelchair skills relating to function, rolling resistance and propulsion effort, various propulsion styles and considerations for overuse injuries in all extremities. <h3>Results</h3> The results of the scoping literature review and position paper will provide supportive evidence for the need for ultralight weight manual wheelchair configuration and the impact on body functions and structures, activities of daily living, and participation. <h3>Conclusions</h3> This scoping review and position paper will allow the clinician and practitioner to have supportive evidence for equipment recommendation for their patients who use a manual wheelchair full-time for mobility. <h3>Author(s) Disclosures</h3> Jennith Bernstein is a full-time employee of Permobil, Inc.; however, this work is presented on behalf of an entire work group of clinicians, engineers, and professors.

Objective To determine the medical complexities and comorbidities of individuals who utilise wheeled mobility devices. As well as, to examine costly events including the number of urinary tract infections (UTIs), hospitalizations, urgent care(UC)/emergency department (ED) visits that are commonly seen in this population over a period of time one year prior to and one year post receiving their wheeled mobility equipment. Design/Setting A retrospective data review of 857 individual medical charts at a Level 1 Trauma Hospital and Clinic System Participants 330 male and female (24–92 years old) mobility device users with a wide range of diagnoses, of which: 56 used manual wheelchairs (MWC),138 scooters (POV), 123 power wheelchairs without integrated standing (PWC), and 13 power wheelchairs with integrated standing (iS-PWC). Results Overall, 92% (n = 304) had at least three medical comorbidities and medical complexities. The most common comorbidity was pain (91%). A change was noted in a lower incidence of UTIs in those using an iS-PWC, respectively 23% with at least 1 UTI in the year prior to and 8% in the year after the mobility device evaluation. Conclusions The large number of comorbidities and medical complexities amongst all mobility device users is concerning. The burden and the accompanying healthcare costs of this population is high. The potential that iS-PWC and other interventions could have on reducing these issues should be explored further. Implications of rehabilitation Regardless of a person's primary diagnosis or the wheeled mobility device they use, 100% have at least one and 92% have at least three comorbidities and medical complexities if they spend the majority of their day sitting The high healthcare cost situations such as Emergency Department visits, Urgent Care visits, hospitalizations, and Urinary Tract Infections are present across those that use all mobility device types and the means to potentially reduce these incidences should be further explored The introduction of integrated standing within a power wheelchair, as a means to minimize the frequency of comorbidities and medical complications, should also be investigated further

Abstract Date Presented 03/28/20 The Explorer Mini is a new power mobility device designed to enhance childhood development and provide access to early mobility for infants and young children. Children with delayed motor skills risk additional cognitive, sensory, and motor delays from limited physical ability to explore through traditional locomotion of crawling or walking. This proposal describes how infants and young children responded to the first opportunity to explore their environment with the Explorer Mini. Primary Author and Speaker: Eleni Halkiotis Contributing Authors: Teresa Plummer

Abstract Date Presented 04/04/19 This survey of patient members of an online health community who use power wheelchairs suggests that OTs may better meet patient functional and social needs during power wheelchair assessment by discussing power wheelchair features that are available but may not be covered by insurance, as well as recommendations for avoiding complications. While most respondents felt their medical needs were assessed, few patients felt their social needs are being discussed in assessments. Primary Author and Speaker: Sherry Xiao Additional Authors and Speakers: Helene Svahn, Karin Leire, Angela Regier Contributing Authors: Kristina Simacek, Paul Wicks, Elizabeth Lawler, Christopher Curran, Jamie Granskie

The aim of the study was to examine the circumstances surrounding the worst fall experienced by full-time manual wheelchair users in the past 12 mos, the recovery process, and influence on community participation. A mixed-method research study was conducted. Semistructured interviews were conducted to understand the circumstances of the worst fall experienced and the recovery process. A quantitative fear of falling assessment and the community participation indicators were used to further evaluate the influence of the fall. There were 20 manual wheelchair users (mean ± SD, 47 ± 13 yrs, 55% male). Falls most commonly occurred outside during wheelchair propulsion. Falls were attributed to both intrinsic and extrinsic factors. Seventy percent of participants reported a fear of falling and 80% required assistance to recovery. No significant correlations were found between fall frequency and community participation indicator scores. Participants who needed assistance to recover (56.70 ± 17.66) had lower community participation indicator importance scores compared with participants able to recover independently (88.93 ± 22.13), P = 0.05. Falls are complex and most manual wheelchair users need assistance to recover. Comprehensive programs including education on prevention and postfall management are needed. Results may increase understanding of the circumstances associated with falls and inform the development of evidenced-based clinical practice guidelines.