I’ve always enjoyed traveling. One of my favorite movies is the 2009 comedy-drama “Up in the Air.” I easily identify with the main character, Ryan Bingham, played by George Clooney. Bingham, who loves his job although it requires him to fly around the country, has a goal of accumulating 10 million frequent flyer miles, putting him in lofty company, indeed. In the late 80’s through the 90’s, I had a job where I found myself on a different flight four or more times a week, and I loved it. While Clooney’s character briskly walked through airports, I, as a T10 complete para, was much quicker wheeling through airports. Domestically, I flew around the country from Maine to Alaska. My international assignments took me from Europe to Mexico and Central America.
Among my jobs, I write about traveling in a column called “Travel Matters” for New Mobility magazine. In addition to my own travel experience, I’ve learned valuable travel tips writing columns and profiles. In March, I went on a seemingly “easy” one-hour flight from Sacramento to Los Angeles to attend the L.A. Abilities Expo, a trip that seriously tested many of my travel tips. Here’s a look:
Skin protection on aisle chairs:
The surfaces of some aisle chairs on planes offer, at best, minimal skin protection. Most of them, however, offer no skin protection. Over the years, I’ve written about quite a few wheelers that have experienced skin breakdown caused by aisle chairs, especially as their skin gets more fragile with age. At 53, and in my 28th year as a para, this is something I’m well aware of.
Tales of aisle chair-induced pressure ulcers I’ve written or heard about were either the result of spending too much time strapped in the aisle chair or from a hard or worn surface of the aisle chair itself. For this reason, I always travel with THE ADAPTOR® PAD by ROHO in my daypack and put it on the aisle chair before transferring.
The least amount of time spent in an aisle chair the better. When boarding the plane, I make it a point to be sure there is clear path to my seat with no other passengers clogging the aisle and that the aisle chair attendants are ready to go before transferring to the aisle chair. When deplaning, I make sure the path is clear, my chair is ready and waiting at the jet way and the aisle chair attendants are ready before transferring from my seat to the aisle chair.
Putting your cushion on the airplane seat:
I place my wheelchair cushion on the airplane seat—being sure it is properly oriented, with the back of the cushion at the back of the seat, and the seatbelts are cleared to the sides of the seat—before transferring onto my seat. At cruising altitude, the cabin pressure of an airplane is the equivalent of being on top of an 8,000 foot mountain—this means a ROHO cushion will become quite firm, so I open the air valve and let some air out. When I land, I re-inflate the cushion. As a caveat, don’t bother with the ROHO inflator pump; I clean the air valve off with a handi-wipe and blow into the valve to re-inflate the cushion.
Protect your skin on accessible hotel shower benches:
The surfaces of hotel shower benches are usually rock-hard and.to make matters worse, they often have water-draining grooves in them that can become a recipe for skin breakdown. THE ADAPTOR PAD provides great protection for this, and I always use one. However, as the photo shows, this “accessible shower” was an epic fail because the water control was out of reach from the shower bench—a problem I’ve encountered before. Who designs these things anyway?
My solution in this case was placing the hose of the shower nozzle in between the grab bar, turning on the water and adjusting the temperature while still in my wheelchair, then transferring onto the shower bench while pushing my chair out of reach of the water. I lifted the nozzle up for my shower, finished, placed the nozzle back in between the grab bar, transferred back to my chair and turned off the water. I somehow managed this feat three days in a row without soaking the chair.
After three exciting days at the Abilities Expo, I returned to LAX with plenty of time—or so I thought—to make it to my quick one-hour return flight. After passing through the long TSA line, I found my return flight was leaving from a satellite gate serviced by bus located outside the first floor. I went to the accessible elevator, only to find it was out of service.
By the time I finally located a working elevator and took the bus ride to my gate, it was time to board. Unfortunately, I had forgotten one of my important travel tips.
When booking a flight, ask for a seat with a moveable aisle armrest:
Although bulkhead seats have more room, the armrests don’t move. Requesting a seat with a moveable aisle armrest–usually the seat behind the bulkhead–can be done when booking a flight or during check-in. Moveable armrests make it easier and safer to transfer from the aisle chair to your designated seat. I know stories of people that have gotten serious pressure ulcers from bumping their backsides on a fixed armrest during a transfer. Since I forgot to ask about this, and it was a full flight and time to pre-board, I channeled my inner Homer Simpson and thought: DOH! Fortunately, I was able to direct the aisle chair attendant to position me for an easy transfer.
How to empty your bladder while flying.
Bladder management while flying is a subject near and dear to my kidneys, and something I wrote about in “Bladder Matters: Airline Bladder Management.”
The bottom line is to try to avoid having to empty your bladder while flying by keeping fluid intake to a minimum before a flight and avoiding coffee and other caffeinated drinks. Caffeine is a diuretic and causes your kidneys to work overtime. On this particular day, waiting for my cab for the airport, I was thirsty and tired, so I drank a cup of coffee and a bottle of water. I thought to myself, “I have plenty of time and it’s only a one-hour flight!”
Because of the gate change and the elevator debacle, I was running late and didn’t have time to visit the restroom before boarding the flight. Again, my thought process was, “It’s a one-hour flight and my bladder isn’t full…yet.” Like clockwork, the sardine can of a commuter jet, with every seat full, pulled back from the gate right on time and proceeded directly to the departure runway, where unfortunately, it proceeded to stop. The engines shut down and the captain announced that due to air traffic we would be waiting for at least an hour before take-off. DOH!
Now I was in trouble. My bladder was quickly filling up and the plane I was on was so small they didn’t have an onboard aisle chair for the restroom. Over the years I’ve heard tales of (male) wheelers discreetly draping a blanket over their laps and catheterizing into an empty plastic water bottle or closed system catheter (internal catheter that drains into a bag that can be capped when finished) bag. I asked the flight attendant if they had a blanket—despite the fact that it was quite warm—they didn’t. Luckily, I had my jacket and a closed system catheter—also luckily, the passengers around me were either dozing or immersed in a book. Throwing embarrassment and modesty to the wind, I draped my jacket over my lap, hoping the plumbing wouldn’t come apart and hoping my jacket would stay tucked around my sides and not slide off, which would leave me in full flash mode, complete with filling a clear catheter bag.
Fortunately, it worked! The closed system bag was full and capped, my bladder was empty, pants zipped up, jacket still over my lap and nobody seemed to notice. I managed to continue my ruse and carefully slid the capped-off, closed system bag inside an airsickness bag and sealed the top. Just as I was finishing doing that, the plane’s engines revved up and the captain announced we would be on our way. AS it turns out, we only sat on the runway for 10 minutes instead of the hour we were told. DOH!
=Accessible Air Travel, A Guide for People With Disabilities: http://www.unitedspinal.org/pdf/2012-accessible-air-travel-brochure.pdf
=Bladder Matters: Airline Bladder Management: http://www.newmobility.com/articleView.cfm?id=12014&srch=Travel%20Matters
=Travel Matters: Air Travel 101: http://www.newm
Guest blog post by Bob Vogel
My previous column, The Importance of Back Support in Overall Health With SCI, discussed how crucial proper back support is; having a positive effect on everything from pressure reduction in the lower pelvis—meaning reduced risk of pressure ulcers—better posture, reducing or eliminating back and neck pain, healthier shoulders, to improved breathing. This column is about how get the proper back support, including how to get it funded.
“There are a couple ways to go about getting the proper wheelchair back,” explains Tricia Garven, PT, ATP, Clinical Applications Manager at The ROHO Group. A rule of thumb is to have your wheelchair back evaluated each time you replace your wheelchair cushion—every three years, which is how often most insurance and funding sources will pay for a new cushion—something I wrote about last year in “How Often Should You Replace Your Cushion?”
The steps on how to get properly evaluated for a wheelchair back and cushion (seating evaluation) start off with you being the squeaky wheel—you need to speak up and ask. One way to start the process is to tell your physician you are due for a new cushion and ask for a referral to a seating clinic for a seating evaluation with a clinician—a PT (physical therapist) or OT (occupational therapist).
Another option for getting the process started is to contact your local DME (durable medical equipment) supplier and tell them you need a new cushion and require a seating evaluation to see if changes are needed in your current wheelchair back and/or cushion — they will be happy to guide you through the step-by-step process of getting the wheelchair back and cushion based on your seating needs.
If you don’t already have a working relationship with a DME supplier, locating one is your next step. ROHO makes this easy. To find a DME supplier go to www.therohogroup.com/where_to_buy.jsp and click on Buy from an Authorized Retailer Near You.
You can find Medicare DME provider(s) in your area by going to www.medicare.gov. Pull down Resource Locator on the main page, scroll down to Medicare Supplier Directory; from there type in your zip code and hit submit. On the next page check Wheelchair Seating/Cushions and hit View Results. The “default” setting on View Results is 10 miles — to find more DME supplier options it is helpful to expand the View All Suppliers Within (on the right side of the page) to a larger distance in order to find a Medicare DME provider that is also a ROHO authorized retailer.
Once you contact a DME supplier, be sure to ask the person working with you if they are an ATP (Assistive Technology Professional) and/or SMS (Seating and Mobility Specialist. These are credentialed professionals trained to identify postural (proper posture) and seating issues and have the knowledge to provide the appropriate back support and cushion solution to address your seating needs. The ATP and/or SMS will gather your information, current wheelchair, wheelchair back, cushion, insurance information, etc. They will contact your physician and get a referral for a clinician to do your seating evaluation, or they can do the seating evaluation themselves.
The goal of a seating evaluation is to find out if your present wheelchair back and cushion is still appropriate, or whether your body has changed that may require an adjustment in your wheelchair back and/or cushion. “In order to make sure the back support is addressed during the evaluation, it is important to communicate with your clinician,” explains Garven. At the beginning of the seating evaluation, ask the clinician, “How does my posture look? Does it look like my seat back is providing the proper support? Would an aftermarket solid back improve my seating?”
Garven explains that changes in posture are gradual and can cause many problems including skin issues and reduction of function. During a seating evaluation it is important to tell your clinician if you have any redness or skin issues in the seated area of your pelvis, or back pain, or shoulder pain, or neck pain, or if you are finding it more difficult to push up hills or over small threshold—all of these are indicators of possible changes in posture. These changes can often be addressed and improved by proper back support. Garven explains that while most clinicians will put two and two together and look at back support as a way to address these issues, it is important for you to speak up and ask, “Is this something that additional back support can help?”
Most seating evaluations should include trying different wheelchair backs to ensure proper back support. As an example, if somebody needs more posture support than their standard sling back provides, a clinician would put a ROHO® AGILITY™ Mid Contour Back System on their chair to see if it improves their posture. When a wheelchair back maximizes posture and your function, the clinician has a match. Following the seating evaluation, the clinician takes the information and writes a Letter of Medical Necessity to submit, along with a doctor’s prescription to the insurance company for the wheelchair back and cushion.
Sometimes circumstances require getting a new back support before it is time to get a new cushion. Garven explains the sooner a posture issue is identified and addressed by proper back support the easier it is to correct. “Anytime you have issues that may be related to postural changes, like back pain, skin redness, shoulder pain, neck pain, trouble getting up hills or over small thresholds. You should bring this up with your doctor and ask if it may be a postural issue and ask for a referral to a seating clinic for a seating evaluation to look at a back support,” she says.
When it comes to funding wheelchair backs, Dave McCausland, Senior VP of Planning & Government Affairs for The ROHO Group explains that wheelchair backs are coded under Medicare (meaning they will be reimbursed with the proper documentation) and since Medicaid and private insurance companies tend to follow Medicare’s guidelines, he is confident that most will cover wheelchair backs as well.
Garven explains that the steps to get funding for wheelchair backs are the same as they are for cushions. That is, a Letter of Medical Necessity and a doctor’s prescription–like any custom mobility product, it is extremely important to make sure the exact make, model and manufacturer is on the Letter of Medical Necessity. For example, the Letter of Medical Necessity would include:
ROHO AGILITY Mid Contour Back System, 14“.
This ensures that your new wheelchair back is exactly what you tried, need and expect. Although an ATP and/or SMS will know this, in order to get a wheelchair back funded, it is important that the Letter of Medical Necessity describes your “significant postural asymmetry” which is funding terminology for not sitting in a proper upright position, along with your diagnosis.
From there, the team gathers and organizes all the documentation. Then the DME supplier submits the paperwork to the insurance company for approval. If all goes well, your back (and cushion) is ordered and you receive the proper back support and are soon sitting up straighter, and looking and feeling good!
Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at email@example.com.
This past summer the National Pressure Ulcer Advisory Panel hosted two webinars on pressure ulcers. Because of the limited capacity and high interest, the NPUAP is now offering recordings of the webinars. For a limited time only, you can save $25 when you purchase BOTH webinar recordings!
More information on the educational webinars is below.
To order, please go to http://www.regonline.com/recordings. To obtain your $25.00 savings on the purchase of both webinars, please select the first product option to purchase the recordings of webinars 1 AND 2 for $125.00.
Pressure ulcers are avoidable — Or are they?!
June 22, 2011
Participants will learn how to:
1. Compare and contrast the terms “avoidable” and “unavoidable”
2. Identify physiological issues and clinical conditions that may contribute to the development of unavoidable pressure ulcers
3. Identify other factors potentially contributing to pressure ulcer development (nutrition, staffing, medical devices, etc.)
Diane Langemo, PhD, RN, FAAN
Laura Edsberg, PhD
How do I stage THIS pressure ulcers?! Staging issues and root-cause analysis for pressure ulcer development
August 3, 2011
Participants will learn how to:
1. Delineate staging challenges and how to address them
2. Describe the root-cause analysis process for agency-acquired pressure ulcers
3. Discuss patient scenarios of pressure ulcer development within the root-cause analysis process
Diane Langemo, PhD, RN, FAAN
Joyce Black, PhD, RN, CWCN, CPSN, FAAN
You can earn .2 CEU from the National Registry of Rehabilitation Technology Suppliers (NRRTS). NRRTS will be hosting a webinar every two weeks, beginning June 21, 2011 and running until December. The webinars are designed for CRTSs, RRTSs, ATPs and physical and occupational therapists (advanced or intermediate). The webinars will be broadcast for respective Pacific and Eastern time zones. The CEUs will be certified by The University of Pittsburgh.
Darren Hammond, MPT, CWS, The ROHO Group’s Senior Director of the ROHO Institute will be presenting one of the webinars on July 21, 2011. The webinar is titled Pressure Sore Management and will run from 5–7 p.m. EDT. You must register by July 18 to participate.
- NRRTS Registrants $0
- Friends of NRRTS $20
- All Others $35
2011 NRRTS Webinars
Positioning the Trunk: Stabilizing the Core
Tuesday, June 21, 2011 • 5:00pm to 7:00pm Pacific
Michelle L. Lange, OTR, ABDA
Outcomes Management: The Strive to Prove Complex Rehab Equipment Really Matters
Thursday, June 23, 2011 • 5:00pm to 7:00pm Eastern
Dr. Mark Schmeler, OTR/L, ATP
Controlling the Pelvis in Wheelchair Seating
Tuesday, July 19, 2011 • 5:00pm to 7:00pm Pacific
Pressure Sore Management
Thursday, July 21, 2011 • 5:00pm to 7:00pm Eastern
Darren Hammond, MPT, CWS
Positioning the Extremities: Complete the Process
Tuesday, August 16, 2011 • 5:00pm to 7:00pm Pacific
Michelle L. Lange, OTR, ABDA
Applications and Principles of Power Ac tivated Power Assist Wheels
Thursday, August 18, 2011 • 5:00pm to 7:00pm Eastern
Theresa Berner, OT
Mounting Assistive Technology Devices to Wheelchairs
Tuesday, September 20, 2011 • 5:00pm to 7:00pm Pacific
Michelle L. Lange, OTR, ABDA
I know the best product for my client, but will it be funded?
Thursday, September 22, 2011 • 5:00pm to 7:00pm Eastern
Claudia Amortegui, MBA
Standing Improves Health of your Customers as it Improves Your Business
Tuesday, October 18, 2011 • 5:00pm to 7:00pm Pacific
Andy Hicks, ATP, SMS
Clinical Up date on Wheelchair Transportation Safety
Thursday, October 20, 2011 • 5:00pm to 7:00pm Eastern
Dr. Mary Ellen Buning, OTR/L, ATP
Car Seat and Wheelchair Transportation Safety As A Collaborative Approach
Tuesday, November 15, 2011 • 5:00pm to 7:00pm Pacific
Sue Johnson, CPST
Marketing, Joint Ventures and Arrangements with Referral Sources While Remaining Within Legal Parameters
Thursday, November 17, 2011 • 5:00pm to 7:00pm Eastern
Jeffrey S. Baird, Esq.
Making Outcome Measures Pay: How to Translate the Data into Better Business
Tuesday, December 13, 2011 • 5:00pm to 7:00pm Pacific
Kevin Phillips, ATP, SMS, RRTS®
The Ins and Outs of Custom Molding
Thursday, December 15, 2011 • 5:00pm to 7:00pm Eastern
Jill Sparacio, OTR/L, ATP, ABDA