The ROHO Community

The ROHO Group to Unveil New Wheelchair Back at the International Seating Symposium

The ROHO Group — Tue, 21 Feb 2012 13:00:29 +0000

The ROHO Group will unveil the new ROHO^® AGILITY™ Back System at the 2012 International Seating Symposium in Vancouver, Canada.

With the unveiling, The ROHO Group will offer International Seating Symposium attendees a firsthand look at the new ROHO AGILITY Back System. The unveiling will take place on Wednesday, March 7, 2012, at 10:40 a.m. at The ROHO Group Booths 65 and 66 in the exhibit hall located at the Westin Bayshore.

The unveiling will begin with an introduction by The ROHO Group’s President, Tom Borcherding, and followed with a presentation by The ROHO Group’s Sr. Director of Training and Education, Darren Hammond, MPT, CWS. Following the presentation, attendees and media will be able to have hands-on experience with the new product.

“The International Seating Symposium is rapidly becoming the premier global conference for professionals around the world with a focus on seating, positioning and mobility, making it the ideal event for the ROHO AGILITY Back System unveiling,” The ROHO Group’s Senior Vice President of Sales and Business Development Pat Chelf said.

Don’t worry if you can’t attend the International Seating Symposium. You can still sign up to receive the latest scoop on the product at agility.therohogroup.com.

The ROHO Group will also be posting updates from the unveiling on their Facebook Page at https://www.facebook.com/therohogroup and on their Twitter account at @TheROHOGroup.

The International Seating Symposium features the latest developments in the areas of seating, positioning and mobility. Topic areas include product development, research, outcomes and service delivery. More information about ISS can be found online at www.interprofessional.ubc.ca/iss.

For more information, contact:
Danielle Boenisch
eMarketing & Support Surface Product Coordinator
The ROHO Group
800-851-3449 ext. 2220
mediarelations@therohogroup.com
TheROHOGroup.com

The ROHO Group Names Becky Pelton As Vice President of Human Resources

The ROHO Group — Fri, 17 Feb 2012 12:00:15 +0000

Becky Pelton joins The ROHO Group as the Vice President of Human Resources. Pelton previously served as the Director of Human Resources at Home Depot Direct in St. Louis.

The ROHO Group, manufacturer of support surface products for medical and consumer applications, names Becky Pelton as Vice President of Human Resources.

In her new role, Pelton will be in charge of managing staffing, culture and diversity, benefits and compensation and employee relations.

“I am extremely excited that Becky is joining our team as the new Vice President of Human Resources,” said Jeff Baker, CFO of The ROHO Group. “With her human resources leadership experience, Becky will bring her own unique skills and perspective to The ROHO Group’s HR function and to our organization as a whole.”

Pelton has more than 16 years of HR experience, including employee relations, benefits and compensation, staffing, performance management and training and organizational development. Pelton previously served as Director of Human Resources at Home Depot Direct and Vice President of Human Resources at Knight’s Ltd., both in St. Louis, MO.

Specializing in shape fitting technology^®, The ROHO Group manufactures and distributes a variety of standard and custom-size wheelchair cushions and accessories, back systems, powered and non-powered support surfaces and the full line of XSENSOR^® Pressure Mapping Systems. For more information, visit The ROHO Group’s website at www.therohogroup.com or contact customer service at (800) 851-3449.

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Contact:
Danielle Boenisch
eMarketing & Support Surface Product Coordinator
The ROHO Group
800-851-3449 ext. 2220
mediarelations@therohogroup.com
TheROHOGroup.com
Facebook: https://www.facebook.com/therohogroup
Twitter: @TheROHOGroup
LinkedIn: http://www.linkedin.com/company/the-roho-group

Why there is such a big price difference in medical products that look so similar?

The ROHO Group — Thu, 16 Feb 2012 16:56:10 +0000

Guest Blog Post by Bob Vogel

Evaluating a product by price alone can be confusing and misleading. Why do two cushions that “look” similar have significantly different prices? This is an important question, especially when it comes time to order your next cushion. In order for a DME (durable medical equipment) cushion to be sold as a medical device in the US it must comply with a specific set of rules and tests set forth by the FDA. These rules and tests are a good thing — I want to be sure that the cushion under my butt has been tested and proven to protect my skin.

However, there is a big difference between doing the minimum required to meet regulations and doing the maximum to ensure that wheelchair users have the best skin protection possible.

The first expense is research and design costs associated with making a cushion before it can be submitted to the FDA for approval to be sold. Companies like ROHO (and other market leaders) spend a tremendous amount of money in this area, while other companies that might make similar looking products spend very little in this area. ROHO continually invests money in research and design in an ongoing effort to make the best product for consumers. Research costs include a prototype tool for every research cushion — something that is very expensive with no guarantee that it will ever reach the consumer — laboratory studies, clinical studies, and support papers for the research. Examples of published ROHO papers and research can be viewed here: http://www.therohogroup.com/roho institute

The FDA has a specific set of rules and tests it requires for DME complex rehab cushion to be sold as a DME product in the US. The manufacturer has to be registered with the FDA and pay associated fees on an annual basis and must meet FDA quality system regulation (QS) manufacturing requirements for designing, purchasing, manufacturing, labeling, storing and servicing medical devices (in this case, cushions). The manufacturer has to have traceability of the product (cushion) and report if there is any kind of recall or adverse event with the product.

The FDA inspects manufacturing facilities and if an inspection or an FDA audit finds there isn’t compliance with its rules, the FDA can shut down the plant.

ROHO takes quality control much further than the FDA model with its quality management systems’ being certified to two ISO standards — ISO 9001:2008 and ISO 13485:2003, which is a medical device quality standard. Manufacturing all ROHO cushions, except the PostureLITE™ by ROHO Cushion at its plant in Belleville, Illinois, ROHO is able to maintain the highest levels of quality control in every aspect of every cushion.

An example of ROHO quality control is the neoprene used to make its cushions. Instead of relying on an outsourced compound, ROHO compounds and mixes its own neoprene and every batch is tested to ensure each cushion maintains the highest standard. To further enhance quality control, each ROHO cushion has a unique serial number that ties it back to the specific date that it was made and processes under which it was manufactured in order to pinpoint any issue regarding quality if needed.

Each and every ROHO cushion goes though multiple layers of quality inspection to ensure each cushion performs to specification before it is shipped.

Another important thing to consider when ordering a new cushion is warranty return policy and customer service — a manufacturer expense that ROHO feels is of vital importance. If you have a problem with a ROHO cushion you call customer service and give them the serial number of the cushion and tell them the problem. Customer service will be able to immediately tell the manufacture date, exact model and size of cushion and warranty information. If it is under warranty, they will send you a new cushion right away, and have you send your old cushion back in a pre-paid shipping box. This enables ROHO to examine the cushion, document the problem and further enhance quality control by gaining knowledge to take steps to work on eliminating problems and improve cushions.

An example of this is, years ago ROHO identified an area of wear on the cushion where the cell met the base of the cushion. To address this, ROHO Engineering spent a great deal of money to redesign the cushion so the cushion cells had a more gradual taper. The redesign meant great expense for re-tooling for all cushions, but the end result was a longer wearing cushion for the customer.

When it comes to qualifying for reimbursement for a DME cushion, most insurance companies follow Medicare guidelines — the product has to meet a Cal-117 Fire safety test, the cushion must have minimum of an 18-month warranty and show that the cushion will pass a Simulated Immersion Laboratory test — a test that measures a cushion’s ability to allow cylindrical devices (meant to simulate a human pelvis) to sink 40 mm into a cushion with a 31-pound load without bottoming out — about 18 months of use. 40 mm is the goal because it simulates immersion of the entire pelvis.

Unfortunately, the Simulated Immersion Laboratory test does not measure pressure, meaning you could end up with a cushion that passes all of the tests, yet puts tremendous pressure on bony areas of the pelvis and puts the user at risk of a pressure ulcer.

Which brings us to another example how ROHO goes the extra mile for consumer safety. ROHO, in conjunction with Sunrise Medical, has spent considerable time and a huge sum of money to develop a superior Simulated Immersion Laboratory test device — one that is in the shape of a pelvis, designed to address the most difficult seating/pressure challenge. The device has eighteen sophisticated pressure sensors imbedded in the indenter at typical pelvic pressure points so you can see the actual pressure readouts on the pelvis. The device is designed to measure all 18 points when immersed at 40 mm in the cushion — the goal is equal pressure distribution on all areas without any high pressure points. An analogy is a scuba diver under water — they have a ton of force applied to them but it is equally distributed so they don’t develop problems.

To make seating safer for all consumers, ROHO and Sunrise have done all of the testing and research on their Simulated Immersion Laboratory test device, and are offering the research and plans for the device to testing agencies for free to try and raise the bar and make seating better and safer for all consumers.

When looking at your next cushion, do your research:
• Where is the cushion manufactured?
• How long is the warranty? (ROHO cushions’ warranties are 24-months and 36-months depending on model).
• What is the warranty policy?
• Is the manufacturer continually improving the product?
• Does the manufacturer include research papers about its product on its website?

The bottom line of all this is, there are a lot of cushions that “look” like a ROHO but cost less — performance, seating and positioning and how a cushion protects your skin, how a cushion protects your bottom, should be the bottom line on cushion choice. And as always, it is vital to ask and make sure the exact make, model and size of cushion are included on all therapists’ and physicians’ prescriptions as in “ROHO^® Quadtro Select^® High Profile^® Cushion, 16″ X 16″.

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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 online.relations@therohogroup.com.

7 Adaptive Parenting Ideas and Tips

The ROHO Group — Wed, 01 Feb 2012 12:00:30 +0000

Guest blog post by Bob Vogel

A good friend excitedly shared the news that she is expecting her first child. She is a T4 complete paraplegic and asked if I had any adaptive ideas that will make parenting easier.

Although my daughter Sarah is going on 11-years old, it seems like just yesterday that I was asking the same question, and coming up with solutions of my own — here are some of my favorites.

1. Develop a shift schedule for sleeping

The first adaptive parenting hurdle Joanna and I ran into had nothing to do with disability — it was figuring how to adapt and function on little to no sleep. As any parent can tell you, the feeding and changing needs of a new baby quickly lead to sleep deprivation that rivals commercial crab fisherman. Our method to battle this was to parent around a “shift schedule” — “on watch” spending nights on the futon next to the bassinet for 72-hours, while the other parent got to sleep in the bedroom with the door closed.

2. Find a table for changing diapers that’s wheelchair accessible

To make it easier for me to change Sarah we put a changing pad on the dining room table — dinner parties would be a distant dream for a while — because the table was the perfect height and enabled me to wheel right up to the table to change her. A word of caution on changing — there is a Velcro strap in the center of a changing pad, it is there to secure your infant’s mid section so they don’t scoot off the table. Get in the habit of using this early — many parents can attest there is no warning between, “The baby never scoots” and, “I turned my head and the baby scooted off the table and onto the floor!”

3. A high chair with wheels

Kristi Hruzewicz has a 6-month-old boy named Alex. Hruzewicz — a T4 para — adds some adaptive tips. She recommends the Chicco high chair (see resources) because it has wheels and you can roll the baby around the house with you when they are awake or sleeping. It also has a reclined position so you can use it on infants that don’t have the ability to hold their head up yet.

4. Bassinet/crib that has sides that lower or open

For sleeping, Hruzewicz uses a Side Crib (see resources) bassinet that has a side that lowers so she doesn’t have to lift Alex up and over the side of the bassinet. She says when Alex outgrows the bassinet she has a standard size crib that has sides that open like a barn-door so she can easily wheel him in and out of the crib. This is great idea, as I recall it was really difficult trying to get Sarah up and over the rails of her crib from my wheelchair and even more difficult to get her out of the crib.

5. Lifting an Infant or Toddler

To make it easier to pick up your child Hruzewicz suggests a Baby B’Air Flight Vest, a small cotton vest designed to secure an infant to the seatbelt on an airplane (see resources). Hruzewicz says being able to grab the vest makes it much easier to pick her child up from a chair and makes her feel like a momma cat.

6. Use a baby sling or carrier for transporting an infant

When it comes to carrying an infant or toddler all day — we wheelchair users have a huge advantage — a permanent lap. When Sarah was an infant I carried her in a baby sling (see resources). A word of caution, the U.S. Consumer Product Safety Commission issued an advisory safety warning on the proper way to use an infant sling (see resources).

When Sarah was strong enough to hold her head up, I switched from the baby sling to a BabyBjorn baby carrier (see resources). At the time it was the only chest pack baby carrier that enabled carrying a toddler with their legs facing forward, so they can sit on your lap in your wheelchair. Although it’s kind of pricy, you can find them used on craigslist or eBay and when your child outgrows it they sell quickly online.

As Sarah outgrew the need for the chest pack I made a custom seat strap to keep her on my lap, it consisted of a soft stretchy material about 6″ wide and long enough to wrap around my back and Sarah’s waist. It also had Velcro on one side that made it easy to instantly put it on or take it off.

To this day I treasure memories and the time I was able to spend with Sarah on my lap, doing anything from working at the computer and puttering around the house, to going on walks.

I do have a couple important words of caution about wheeling with an infant or toddler in your lap. First, be aware that the extra weight of your child in your lap puts extra load on your wheelchair’s front casters that will make them more susceptible to catch on rocks or cracks. The added weight on your lap also puts added pressure on your butt — it is important to be extra vigilant with mirror skin checks.

7. Develop a method for putting the infant into a car seat

Last, but not least is figuring out how to get an infant into a car seat. I found the best way to do this was to strap Sarah in the car seat when it is free from the base — then with her securely fastened in, move it across the back seat of the car to the car seat base and latch it into the base. It is a maneuver that works, but takes quite a bit of time — and I learned to plan extra time into my trips accordingly.

When Sarah was finally big enough that she no longer needed a car seat — at age 7 — simply getting my chair in and out of the car seems like a breeze.

Resources:

Baby B’Air Flight Vest:http://www.babybair.com/product.html
Baby Bjorn Baby Carrier:http://www.babybjorn.com/products/baby-carriers/baby-carrier-synergy/synergy/
Baby Sling Advisory:http://www.cpsc.gov/cpscpub/prerel/prhtml10/10165.html
Example of Baby Sling:http://www.amazon.com/Karma-Organic-Cotton-Twill-Sling/dp/B001TEIS0A
Chicco High Chair:www.chiccousa.com/gear/highchairs-hookons/polly-highchairs/polly-highchair-adventure.aspx
Side Crib:http://www.diapers.com/p/arms-reach-concepts-inc-mini-co-sleeper-natural-74235?site=CI&utm_source=cse&utm_medium=cpc_D&utm_campaign=Google&utm_content=pla&ci_sku=AR-036&ci_gpa=pla&ci_kw=%7Bkeyword%7D

*The ROHO Group is not endorsing these products and we have not tested them.

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Durable Medical Industry’s Proposal to Fix Medicare’s Competitive Bidding Program

The ROHO Group — Wed, 18 Jan 2012 11:00:01 +0000

Guest blog post by Bob Vogel

The current Centers for Medicare and Medicaid Services (CMS) competitive bidding program is deeply flawed and jeopardizes wheelchair users ability to get the seating and mobility equipment we need. Furthermore, competitive bidding will put the entire Durable Medical Equipment (DME) industry in jeopardy. Dave McCausland, Senior VP of Planning & Government Affairs for The ROHO Group explains that 244 leading economists, including several Nobel Prize winners, have examined the current competitive bidding program and all signed a document stating that the current competitive bidding system will fail, it is not a question of “if,” it is a question of “when.” What makes this all the more dangerous is that DME industry may be irreparably damaged in the process.

CMS competitive bidding has DME dealers bid to provide equipment in a certain category for the lowest price. The winning bidders get the contract to be the exclusive Medicare providers for a specific area for the product category(s) they win. For wheelchair users, this category is “power and manual wheelchairs and accessories.”

Round I of competitive bidding is already in place in 9 regions. Round II of competitive bidding is looming on the near horizon and will include 91 regions, including the largest cities in the country.

Congress’ plan was that competitive bidding would lower prices for DME, thereby reducing Medicare and beneficiary costs, while ensuring that beneficiaries (you and I) have access to quality items and service we need. But because competitive bidding is based on price alone, it is likely to create unrealistic and unsustainably low prices, the result will be that beneficiaries won’t have “access to quality items and service.” This means you and I won’t be able to get the equipment and service we need to stay healthy. McCausland explains that in it’s current state, competitive bidding isn’t really competitive. There is no accountability for bids, there is nothing in place to ensure bidders are truly qualified to provide the equipment and service needed in the areas they bid, and low-ball bids are likely to drive prices to an unreasonably low level that won’t provide a living wage for DME dealers.

But there is a plan to fix these flaws with competitive bidding. The American Association for Homecare (AA Homecare, the largest association of DME manufacturers and providers) worked with DME manufacturers and providers and created a plan to fix the problems that arise with competitive bidding. They created a legislative proposal called the Market Pricing Program (MPP). AA Homcare submitted the MPP to Congress and is asking that the proposal be included in the final doc fix bill to be sent to the President.

The current competitive bidding system allows a company with no physical presence in an area, to still submit a bid for that area. This encourages low-ball bids and there is no accountability. A dealer with no physical presence can submit a ridiculous low-ball bid that guarantees that the dealer wins the contract. Let’s say a local dealer needs to sell a product for $100 to stay in business. Another out-of-town dealer submits a low-ball bid for $50 to guarantee a wining bid and get the contract. Because actual reimbursement prices are based on the median price of bids, the winning bidder will get paid at the median price, lets say that ends up at $80. Now, the winning bidder from out-of-town looks at the reimbursement price of $80 and decides if they can make a profit. If they can, great they accept the contract and move into the market. If not, they can just walk away. But the rate is still set at $80 — CMS doesn’t adjust the price, they just go to the next bidder, and the next, until they find somebody desperate enough to take the bid — the problem is that a dealer can’t survive by being reimbursed $80 for a specific product in that specific market. The only way for a desperate dealer to survive in this situation is to substitute the cheapest equipment and services allowed within Medicare guidelines, at the expense of the health and mobility of wheelchair users. This is explained in an earlier blog post, “Why You Need to Ask for Your Cushion by Name.“

To address low-ball bidding and accountability, and make sure only serious DME dealers bid, the MPP requires bids to be binding. This means that the dealer must accept the offer presented by CMS, rather than being able to pass it off to another dealer. The MPP also requires bidders to put up a cash deposit with their bid. If the dealer wins the bid, it is binding and they must accept it. If the dealer walks away, they loose the cash deposit. This wipes out the out-of-town speculators and low-ball bidders. In addition, the MPP insists that the final price of a DME item be based on the “market clearing price” rather than the median price. This helps ensure that the winning bid allows enough profit to provide a living wage for the DME dealer and enable them to provide the proper equipment and services for wheelchair users.

As described previously, another problem area in the current competitive bidding system is that there is nothing in place to ensure bidders are qualified to provide the equipment and service that beneficiaries need in the areas they bid. A quality DME dealer has spent years developing relationships with therapists, rehab centers and hospitals in the area, has established a working relationship with wheelchair users they service and are well equipped to handle the equipment and service needs of their area. With the current system, speculative dealers with no physical presence in a market can submit low-ball bids all over the country with no knowledge of the equipment or service needs of the area — these bids may overwhelm local dealer’s bids. And, if a speculative dealer wins a bid they can turn it down if there is no profit, or they can swoop in and grab it, leaving wheelchair users at their mercy.

The MPP says that in order to bid in a market area, DME dealers must have a history of doing business and providing equipment to the population — based on Medicare records — in that area. This will ensure the winning bidder has a presence and working relationship in the region.

AA Homecare is asking all of its members — DME manufacturers, dealers and providers — to contact their Representatives and Senators to support the Market Pricing Program proposal and ask that it be included in the upcoming doc fix legislation.

The Market Pricing Program proposal is one example of the many ways the DME industry is working to insure that beneficiaries like you and I have access to the equipment we need. Thanks to the ongoing hard work by many individuals and groups within the rehab sector, Congress passed legislation to specifically exclude complex power wheelchairs from competitive bidding. And recently, CMS officially announced that ultra-light weight manual wheelchairs, power assist accessories for manual wheelchairs and adjustable skin protection cushions will be removed from the upcoming round of the competitive bidding program!

Working together we can make a difference!

More information on the Market Pricing Program can be viewed here.

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Irony of the best-known wheelchair user

The ROHO Group — Wed, 04 Jan 2012 12:00:07 +0000

Guest blog post by Bob Vogel

Ironically, the best-known wheelchair user these days doesn’t even use a wheelchair. Non-disabled actor Kevin McHale plays Artie Abrams, a 16-year-old high school student in a glee club who became a paraplegic in a car crash at age eight. Each week over eight-million TV viewers tune in and watch Artie on the hit TV show Glee on FOX Broadcasting Network. Hiring a non-disabled actor to play Artie has stirred up a lot of controversy in the disability community. The huge TV audience, along with the controversy prompted New Mobility Magazine to name Artie as their Person of the Year.

What bothers me about Artie’s character is, it appears that (at least for the first two seasons) the TV show didn’t bother hire a consultant (a physical therapist, occupational therapist or paraplegic) to create an accurate portrayal of a paraplegic. This is glaringly apparent by Artie’s ridiculous seating and positioning. The promotional photos of Artie — including the ones in New Mobility — are typical of Artie’s seating for the first two seasons, lower body contorted to the right, and his right leg is jammed against frame of the chair. Most of his weight is shifted onto his right side — right ischium — and he is sitting on a foam cushion. Apparently the folks involved with Glee thought this made Artie “look” paralyzed.

I took a small unofficial poll of wheelchair users and therapists and asked them what they thought of Artie’s seating and positioning, most quickly noticed that his seating was poor, and was an inaccurate portrayal of the way an average paraplegic sits.

“If an actual para sat like that he would quickly end up with multiple pressure ulcers that would likely land him in the hospital for months and cost $100,000,” Delia Freeny an occupational therapist registered/licensed (OTR/L) and an assistive technology professional (ATP) says. “Proper seating and positioning are preventative — it helps prevent pressure ulcers and orthopedic problems. Spending the time and money to get the proper equipment for each wheelchair user is inexpensive compared to the serious medical problems and huge hospital bills the wrong equipment will cause.”

Like it or not, television and media define much of our reality. The way Artie has been portrayed teaches the general public — including policy makers that decide on equipment funding — that a contorted seating position and sitting with all of your weight on one ischium on a foam cushion is the norm. We never see what would really happen with this kind of seating, a lengthy and expensive hospital stay with life threatening pressure ulcers.

Unfortunately, failure to see the importance of proper seating and positioning is not limited to TV shows. Although some progress has been made, it seems the people who create Medicare policy have also failed to see how crucial proper seating and positioning is. They’ve failed to see the difference between standard durable medical equipment (DME) like a wheelchair or foam cushion you can purchase at a drug store, and complex rehab equipment — a cushion, wheelchair etc., specifically fitted by a rehab team and prescribed by a physician to address the seating requirements of a specific individual. New Mobility provides an in depth explanation of complex rehab vs. standard durable medical equipment here.

This why it is important for each of us to continue calling, emailing and writing our senators and legislators, elected officials that work for us, and tell them we do not want complex rehab equipment included in competitive bidding. The continuous efforts of everyone so far have mattered because on December 27, 2011, CMS officially announced that cushion codes E2622–E2625 have been removed from the competitive bidding program! To find out how to contact your senators and legislators are see, “A Step-by-Step Guide to Contacting U.S. Representatives and Senators.”

Back in the TV world of Glee, after enduring two seasons of poor seating and positioning, Artie’s seating improved in season three. He is sitting straighter, his legs are no longer contorted to the right and his right leg is no longer pressed against the frame. It also appears he is sitting on some type of complex rehab cushion that addresses his seating needs, rather than the foam cushion. I imagine this change came about because folks at Glee either hired a consultant, or took heed of criticisms — including mine — about Artie’s seating. Either way — good for them!

In my imagination, one of two story lines transpired in Artie’s TV world to change his seating.

In my first storyline, Artie ends up in the hospital with massive pressure ulcers on his right calf and his right ischium. He develops osteomyelitis in his right ischium and almost dies. The kids at McKinley High School hold a constant vigil for Artie during the weeks he is in intensive care on strong antibiotics to kill the infection. He manages to beat the infection and undergoes surgical skin flaps to repair the wounds and spends another three months in the hospital to recover.

Once healed, Artie’s physician refers him to a much-needed evaluation at a seating and positioning clinic. At the clinic, Artie’s wheelchair and cushion requirements are evaluated by a team including a physical or occupational therapist, as well as an ATP and a physical medicine and rehab (PM&R) physician. After the evaluation, his PM&R physician carefully writes a prescription for his new equipment needs making sure to write the exact manufacturer, brand and size, of each piece of equipment to ensure he gets exactly what is prescribed. Because of Artie’s hospitalization, the physician is sure to write “to prevent re-hospitalization” on the prescription — key words that quickly get his equipment requests authorized and delivered. Artie is now sitting straighter and enjoys a successful season three.

In my less dramatic, but much more hopeful storyline, Artie notices a red area on his right ischium and right calf during his daily skin check. His parents make an immediate appointment with his primary care physician — she looks at the red areas and writes a referral to the seating and positioning clinic (described in the previous paragraph). Artie gets a full seating evaluation and a prescription for the proper equipment. Over the summer he does extra weight shifts, and extra skin checks until his new equipment arrives. When his new equipment arrives, his seating is improved, he has no more red “hot spots” and enjoys a successful season three.

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Christmas with the Mermaids (Manatees)

The ROHO Group — Wed, 21 Dec 2011 11:00:03 +0000

Guest blog post by Bob Vogel

Bob and his daughter, Sarah, steer the pontoon boat before they snorkel with manatees

Rays of sunlight broke through early morning mist as I piloted the pontoon boat toward an area where the gentle giant manatees are known to congregate. Our eyes combed the calm waters looking for swirls created by the mammal’s huge, flat, mermaid-like tail. “I see a swirl! Look there’s another!” shouted my daughter Sarah and her best friend, Alyssa, as they excitedly watched a mother and her calf swim by the boat. Dropping anchor, we donned our gear, I transferred to my ROHO^® ADAPTOR^® Pad protector on the deck of the boat and got ready to join the others in the water to begin our quest — snorkeling with manatees.

In early December, my ten-year-old daughter Sarah and I flew to Florida for an early Christmas vacation — snorkeling with manatees was our main goal. Sharing our adventures were Sarah’s best friend Alyssa and her mother Debbie Pettit.

Our base for the manatee adventure was the town of Crystal River, Florida, home of the Crystal River National Wildlife Refuge — an area that supports the Florida’s largest concentration of manatees during winter months.

Manatees have a walrus-like face, two front flippers, and a large, flat, rounded tail. Adult manatees average 10–12 feet in length and they weigh between 1,000–1,500 pounds. When ancient sailors saw their long flat tails they mistook them for mermaids or sirens and were disappointed that they weren’t as attractive as the legends say. During the summer months they roam in warm, shallow coastal waters from Virginia to Louisiana. As ocean waters grow colder during winter months they swim inland to Florida’s warmer spring fed rivers — peak months to view them in these areas are November through March.

Bob and his daughter, Sarah, post for a picture after snorkeling with manatees.

Protected by strict state and federal laws, it is illegal to harass manatees — this includes swimming toward them. But manatees are curious and playful and when you remain still, they will often swim up and gently rub against you in a motion that any dog owner will recognize, “rub my back.” According to the rangers I spoke with, when a manatee swims up to you, it is OK to gently rub or scratch them.

As we hovered in the water, the first manatee gently swam by — for Sarah and Alyssa, having a 10-foot creature swim this close was a bit scary at first and they decided to get back in the boat and watch. The manatee came up to me and I gently scratched its back and it rolled over like a 1,000-pound puppy wanting a belly rub. After playfully scratching its back and belly for a while I slowly swam back to the boat — and the manatee followed, wanting more scratches. At this point Sarah, Alyssa and Debbie joined me and we all took turns letting the gentle giant swim up to us for back scratches and belly rubs.

When we finally climbed back in the boat I checked my watch — thinking we had been in the water for about ten minutes — we had been in the water for 1½ hours, the experience was so powerful that we lost track of time.

The dock and pontoon boat at the Crystal River Lodge Dive Center were fairly easy to wheel onto and there was plenty of width to spare on each side of my (14” seat width) chair. There is no lift on the boat, so getting into and out of the water requires good upper body strength and/or strong companions.

Our next stop was an amazing visit to Homosassa Springs Wildlife State Park. The fully accessible park that offers manatee encounter programs, boat tours and showcases native Florida wildlife including alligators, panthers, black bears, bobcats and key deer.

A trainer feeds Winter, the dolphin from A Dolphin's Tale at Clearwater Marine Aquarium in Clearwater, FL.

The following day we drove to Clearwater Marine Aquarium to see Winter the dolphin, star of the film “A Dolphin’s Tale,” the true story about a bottlenose dolphin that was fitted with a prosthetic after he lost his tail from becoming entangled in a crab trap. It was very cool that the aquarium and animal rescue center are exactly as they appear in the movie — and fully accessible.

Bob poses with Winter the dolphin's prosthetic tale

After watching Winter, Debbie said, “You swim like him.” When Winter isn’t wearing his prosthetic tail he propels himself with his pectoral fins. When I snorkel I propel myself by waiving webbed finger gloves at my side. Debbie said “I was following you when we were with the manatees, and the way you swim with your webbed gloves looks just like Winter when he swims.” I thought. “Wow, me and Winter. That is cool!”

Last but not least on our adventure was a day at Universal Studios, — Sarah and Alyssa’s focus was The Wizarding World of Harry Potter. I haven’t read the Harry Potter books and have only seen a few of the movies, however the park is so cool that I got caught up in the excitement along with the other muggles and I’m now looking forward to reading the books.

Bob getting ready to board Harry Potter the Forbidden Journey ride at Universal Studios

The feature ride of the park is Harry Potter and the Forbidden Journey, which takes you through fully accessible passageways and corridors of Hogwarts Castle and School of Witchcraft and Wizardry. The tour culminates with a state of the art, four-person flight simulator that takes you on a wild flight behind Harry on his broomstick through the castle, past the Whomping Willow and a horde of Dementors, into a Quidditch match. There is a secret (much faster) wheelchair entrance and a car reserved for wheelchair users and their families.

The side-to-side, up and down movement of the ride is intense and wheelers must be able to transfer to the (hard plastic) seat under their own power to be able to go on the ride. Once again, my ROHO ADAPTOR^® Pad enabled me to safely enjoy the ride. Because the ride was a bit much for Sarah, the staff let Debbie and Alyssa go first. When they returned from the 5-minute ride it was my turn — Debbie stayed with Sarah and Alyssa got to stay on the ride with me. Alyssa got to ride twice and the ride was amazing! As a hang-glider pilot it takes quite a bit to impress me — this really felt like flying — flying through the world and stories of Harry Potter from the Forbidden Forrest to playing Quidditch! Even better — when the ride was over, the staff said, “You are welcome to stay on and ride again if you want!”

On the flight home I reflected on sharing the adventures of our Florida Christmas trip — more adventures to add the treasure chest of memories.

Resources:

Clearwater Marine Aquarium: www.seewinter.com
Crystal Lodge Dive Center: www.manatee-central.com
Homosassa Springs Wildlife State Park: www.floridastateparks.org/homosassasprings/

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Try Out a New Adaptive Sport this Winter Season

The ROHO Group — Wed, 07 Dec 2011 12:00:53 +0000

Guest blog post by Bob Vogel

Winter is here, temperatures are falling and so is the snow. This is Mother Nature’s way of telling wheelchair users “I’ve covered the outdoors with an amazing accessible blanket of snow and ice. Switch from wheels to skis or skates, and come out and play!”

Adaptive gear for winter sports has evolved to the point where people with almost any disability level can actively participate. It’s time to grab your warm clothing, choose your preferred method of gliding, skating or sliding and play in the winter wonderland. Here are some ideas.

Adaptive Downhill Skiing

A bi-skier races down the hill while being tethered during a lesson at Disabled Sports USA Far West at Alpine Meadows in Lake Tahoe, California.

For enjoying a dance with gravity in stunning mountain surroundings, adaptive downhill skiing is the ticket. There are several types of adaptive skis for wheelchair users. One option is a bi-ski — a molded bucket-style seat mounted to a frame attached to two, wide, specially designed skis — enables anybody to ski. For skiers that have hand movement, bi-skis can be turned using outriggers — forearm crutches with small skis attached at the tip used for balance and for turning. Bi-skiers are usually “tethered” — a stand-up skier holds a tether made of climbing webbing to assist speed control and turning — and also assisted on and off the lift. If you have the ability to move your head you have the ability to turn a bi-ski and enjoy the slopes.

Mono-Ski

Bob Vogel mono-ski races at Alpine Meadows Ski Resort in Lake Tahoe, California.

A mono-ski — a molded bucket-style seat mounted on a suspension system and shock absorber mounted to a standard snow ski — is arguably the ultimate sports prosthetic. Expert mono-skiers shred the entire mountain and back country — from powder, to terrain parks, to extreme steeps and huge jumps the same as stand-up skiers. The learning progression, and length of time it takes to become proficient at mono-skiing is similar to stand-up skiing. Although trunk muscle control makes the sport much easier to learn, I know several low level quadriplegics — including a C6/7 complete quad — that are accomplished mono-skiers.

Nordic Sit Ski

Candice Cable (far left in green jacket) teaches an adaptive XC ski clinic in Sun Valley, Idaho.

If you are looking to get away from the crowds and glide through the beauty and quiet of nature — nordic sit skiing is for you. A nordic sit ski (also called XC sit ski) is a lightweight molded bucket-style seat mounted on two cross-country skis — the rig is propelled with ski poles. XC sit skis are surprisingly easy to propel, and the polling action helps keep shoulders healthy and balanced by working the muscles in the back of the shoulder. The sport can be as simple as a XC glide over a meadow or through the woods, to multi-day hut trips — skiing from one cabin to the next, to races of anywhere from half-kilometer to 20 kilometers.

Skijouring

A fun addition to XC sit skiing that I enjoy is skijouring, getting towed by one or more dogs. When I’m out XC skiing with my daughter Sarah and Schatzie, my German Shepherd service dog, I attach a tether to Schatzie’s harness and yell “squirrels!” to enjoy a high-speed winter dog tow.

Sledge Hockey

Photo Credits: Doug Pensinger/Getty Images

Perhaps hockey is your game. Sled hockey, also known as “sledge” hockey is an international and Paralympic sport with the same the same high-speed excitement as stand-up hockey, but adapted to a sitting position. A hockey sled is a molded bucket seat mounted on a lightweight aluminum frame, mounted on standard hockey skate blades. Players hold a hockey stick in each hand, the bottom of the each stick is fitted with a serrated spikes used to propel the sled. Simple adaptations like duct tape enable people without hand-grip to play. Hockey sleds are easy to propel, and a good player can reach high speeds and carve sharp turns and high speed check stops.

Adaptive Skating

Bob Vogel adaptive ice skates with his daughter, Sarah.

A very cool spin off of sled hockey is adaptive skating. The potential for possible high-speed impact in sled hockey is a bit much for my aging brittle bones — but thanks to sled hockey’s popularity, many ice rinks offer hockey sleds, usually at no cost, or the cost of rental skates. I have a blast going to my local rink, strapping into a hockey sled and skating with Sarah. It is a fun workout and also helps keep shoulders healthy by working the same muscles as cross-country skiing. Ask your local rink if they offer sleds, if they don’t suggest they get one, most will be happy to purchase one since it means more business for them.

Dog Sledding

Dog sledding is another unique activity, ready made for wheelers. I’ve had the opportunity to go dog sledding and it’s an amazing way to travel into the winter wilderness. Riding in a dog sled, the only sounds are the hiss from the runners of the sled and the pitter-patter of dog paws. The tether to the dog team seems to make a direct connection to your senses, and watching ten wagging tails in front of you — running with its pack towing a sled through the snow on a crisp clear winter day, must be a blast for a dog. The experience is sure to put an ear-to-ear grin on your face. Dog sled operations are surprisingly common in snow country and trips range from 45-minute outings, to half day and even full day trips.

So pick a winter pastime, and enjoy mother nature’s winter adaptive blanket. See you on the snow!

Resources:

Adaptive Ski Programs

Adaptive Adventures: www.adaptiveadventures.org
Disabled Sports USA Far West: www.dsusafw.org
Disabled Sports USA: www.dsusa.org
Adaptive Ski & Sport Programs — Once on the page, scroll down to the map of the U.S. and click on the state where you want to ski: www.sitski.com/pg3.htm
National Ability Center: www.discovernac.org

Dog Sledding:

Wilderness Inquiry: www.wildernessinquiry.org
Wintergreen Dogsled Lodge: www.dogsledding.com

Nordic Sit Skiing:

Environmental Traveling Companions: www.etctrips.org
Crested Butte Adaptive Sports Center: www.adaptivesports.org
National Ability Center: www.discovernac.org
Northeast Passage: www.nepassage.org
Ski For Light: www.sfl.org
Turning Point Tahoe: www.turningpointtahoe.com
Wilderness Inquiry: www.wildernessinquiry.org

Sled Hockey:

National Ability Center: www.discovernac.org
Ski For Light: www.sfl.org
United States Sled Hockey Association: www.usahockey.com/disable_hockey/default.aspx?NAV=AF_14&ID=62272

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Gift Ideas for the Holidays

The ROHO Group — Tue, 06 Dec 2011 11:00:53 +0000

The holiday shopping season can be a little intimidating, especially when you’re trying to find the perfect gift for the person who has everything. We’ve compiled a few ideas for an assortment of interests to help inspire your wish list and gift giving this year. Now, we aren’t endorsing these products, nor have we tested them. We just thought that they looked pretty cool.

Children

Wheelchair Pals

Wheelchair Pals are fun and practical by covering the armrest for extra comfort while adding personality to the wheelchair. ($29.95)

Build-A-Bear with Wheelchair

Gift the gift of a personalized stuffed animal from Build-A-Bear that’s perfect for any kid. You can customize the animal’s clothing and accessories to match the interests and personality of the child.

Convertible Sled & Wagon

Enjoy more outdoor adventures with the kids in the snow and sun. The kids will love this wagon from Mountain Boy Sledworks during the summer months that easily converts into a sled during the winter months. ($279.99 US, $299.99 CAD)

Explorer™ Learning Game: I SPY® super Challenger!

Enjoy the game of I SPY from your own childhood while using logic, language and math skills to solve 50 riddles and 4 arcade-style games. ($24.99 from LeapFrog)

Tech Geeks

Speech Recognition Software

Speech recognition software or speech-to-text software can be a lifesaver for anyone with limited hand dexterity. The software allows for you to control a computer by voice such as surfing the internet or typing an email and it has increasingly improved over the past few years. There are several different software options but the best are Dragon by Nuance ($99.99 to $199.99) and Windows Speech Recognition. Apple has also just released Siri on the iPhone 4S that allows you to make phone calls, schedule meetings, send text messages and more just by your voice.

Tablet

Tablets make reading magazines, books or newspapers a lot easier and more convenient. Not only do you eliminate fumbling through pages, you can also surf the web, check your email or even play a game of Angry Birds. With the growth of the Android operating system, new tablets have appeared on the scene. A few of the most popular are the Apple iPad 2 ($499 and up), Amazon Kindle Fire ($199), Samsung Galaxy Tab 10.1 ($629.99), HTC Flyer ($299 and up), HP TouchPad ($99.99–$149.99), BlackBerry PlayBook ($199 and up), Motorola Xoom ($199.99) and the Barnes & Noble NOOK ($99–$249).

TV Show Seasons on DVD

Catch up on a few of the missed episodes or seasons of your loved one’s favorite TV shows. Or, why not expose them to one of your favorites. A few of my favorites to consider are Friends, Dexter, Arrested Development, The Office or Law and Order.

Fashionistas

3E Love Gear

3E Love’s International Symbol of Acceptance (the wheelchair heart logo) drives the company’s mission to “provide the tools for others to embrace diversity, educate society, and empower each other to love life.” The company has both an amazing back story and cool gear. They have a wide selection of apparel and accessories on their store including t-shirts, sweatshirts, necklaces, tote bags and more.

Adaptive Clothing

There are several companies that specifically make clothing to fit the needs of wheelchair users that provide both comfort and style. A few of the modificationsA few of the more popular brands are Lega Wear, Versa Access Wear, AG Apparel and Rollin’ Wear.

Touchscreen Gloves

Now you can keep your hands warm while still being able to use your touchscreen gadget. ($17.99 and up from Agloves)

Active Lifestyle

Fishing Pole Holder for Wheelchairs

The Fishing Pole Holder for Wheelchairs clamps your fishing pole onto your chair for one-handed use. ($39.95)

Adaptive Sports Equipment

If there’s a sport or activity that you enjoy, chances are that there’s an adaptive chair or equipment for you. Whether it’s a handcycle, snow chair that easily convert to an outdoor wheelchair ($1995), tennis wheelchair, wheelchair for hunting or camping and more. You can find more products on USA Tech Guide’s list of adaptive sports equipment.

Bowling Ramp

The bowling ramp can be easily placed at the front of the lane and can be used while sitting or standing. The bowler just gives the bowling ball a slight push to roll it down the lane. ($188.20)

Nikon COOLPIX® AW100 Camera

The Nikon COOLPIX AW100 Camera has a built-in GPS, survive in up to 33 feet of water and is freeze-proof. It can take 16-megapixel photos and has a 1080p HD video camera. Take a camera along that can survive all of the adventures. ($379.95)

Pocketknife

Every outdoor adventurer needs a pocket knife. Find the perfect pocket knife for your love one’s activities whether it’s hunting, camping, cycling or basketball.

Gamer

Evil Controllers Game Controllers

Evil Controllers is a company that specifically designs accessible controllers for gamers. They offer standard products, but can also custom build controllers for an individual’s specific needs. A couple of these include a six-button programmable controller, one-handed controllers, Thumb-Stick Click Mods and a Sensitive Controller .

My Golf Game featuring Ernie Els

“My Golf Game featuring Ernie Els” is a one-switch golf game for PC can be played using touch-screen, joysticks, speech recognition and other accessible equipment. ($34.95)

QuadJoy

QuadJoy is an orally-controlled mouse for those unable to use a hand-held mouse. The inventor of the product, Tom Street, was quoted saying, “It might not open doors, but it will open many Windows.” ($800 for the complete basic unit)

Trabasack Connect

No more worrying about dropping the expensive controller on the floor. Trabasack is a bean bag laptray that allows you to mount switches, consoles and adapted controllers to the soft velour surface using ‘hook’ tape to provide a secure and comfortable mount. Not only that, but it can also be used as a backpack for easy transportation. (£34.95–£44.95)

MattVision Card Holder

Unlike other card holders on the market, the MattVision Card Holder uses mirrors to let the player see their own cards while preventing other people from sneaking a peek. There are two versions, a 2 Card Viewer ($75) and a 13 Card Viewer ($80).

Foosball Game

Adventure back to dorm-room days when a rec-room classic.

Traveler

ROHO Cushion for Travel

Gift the gift of a travel cushion for the car, plane, construction or farm work or the office. You happen to be in luck because The ROHO Store is having a special sale for the month of December. The Black Ultra Leather® Cover LTV® Seat Cushion and the AIRHAWK™ Truck Seat Cushion System are both $20 OFF.

Travelon® Smart Tubes

Travelon Smart Tubes are perfect for airport travel. They’re spill and leak proof, dishwasher safe, and easy to open and close. ($24.99)

Takeout-Menu Organizer

Alright, so this one might have more to do with staying in than going out, but we still think it’s a great idea. Give the gift of a little organization. ($21 from Knock Knock)

Online Music Gift Card

Gift the traveler in your life the gift of music to pass the time on a 10-hour flight. A few options are gift cards to iTunes, Amazon or Spotify.

Wheelchair Accessories

ROHO Cushion

Why not add a back-up or travel ROHO Cushion to the list this year? Protect you or a loved one while providing extra comfort.

Umbrella Holder for Wheelchairs

The Umbrella Holder for Wheelchair easily attaches to the wheelchair, walker or even a stroller. It not only holds the umbrella while it’s in use, but it can also hold it folded. ($42.95)

Wheel Covers

Wheel covers are great for helping keep the home and office floors clean. The wheel covers are especially great during the winter to prevent dragging snow, ice and slush indoors.

Host(ess) Gifts

Wine Sampler

Why give the host(ess) just one bottle of wine when you can give a sample of six. You can choose from several different collections like Napa’s Hidden Gems ($39.99) or make your own from Tasting Room. Right now they’re running a special that you can save $10 any sampler if you sign up for their email list.

Chocolate Assortment

Who doesn’t love chocolate during the cold months? You can buy the gift from a local candy shop or find shop online.

Do you have other ideas that you think would be great to add to the list? We’d love to hear your suggestions.

How to Keep Your Equipment Clean

The ROHO Group — Wed, 23 Nov 2011 11:00:59 +0000

Guest blog post by Bob Vogel

One of the perks of being a journalist is having the opportunity to attend many wheelchair events — like the Abilities Expo. One of the things that puzzles me — you may have noticed it, too — are wheelchair users who have a disconnect between how they dress and how they care for their mobility equipment. I could never figure out how somebody takes the time to be clean and dress well, but neglects cleaning their chair. A quick reminder — spending a few minutes wiping down your chair with a damp cloth or having your personal care attendant clean it for you — does wonders for your appearance.

People DO notice whether your chair is clean — or not. My wife — now ex-wife, good friend — said one of the things she noticed about me when we first dating was that I kept my chair clean. To her, this is a sign of self-confidence and comfort with my disability. She found this attractive.

Even more important than keeping your chair clean is making sure to keep your cushion clean! Keeping a cushion clean is something I rarely hear mentioned, but it is important — a cushion can get pretty funky if you don’t clean it now and then. We get used to our own odor, so if our cushion starts smelling rank, we probably won’t notice it. However, other people do notice the odor. To make matters worse, it is unlikely that even your close friends and family will tell you because there doesn’t seem to be a polite way to say it. Here is a hint — if people seem to give you a lot more personal space than everybody else, you may want to do some cushion cleaning.

The first step in avoiding cushion odor is to wash your cushion cover on a regular basis. After all, we change our underwear every day — I hope. I have two cushion covers and I change mine every couple of days. Standard size ROHO cushion covers can be purchased at authorized online retailers or The ROHO Store. Cushion covers can also be purchased at your local DME dealer. I find washing the covers on the “gentle” cycle and hang drying them helps them last much longer.

To purchase a cover for a custom size ROHO cushion, call customer service at 800-851-3449. The average cost of a custom cushion cover is around $70. Be sure to have the serial number of your cushion handy when you call. It’s printed on the white tag on the bottom of the cushion.

The next step to avoiding cushion odor is cleaning your cushion on a regular basis. With a ROHO cushion this is a quick and easy process. I give my cushion a quick clean every week or two when I’m in the bath or shower. I grab my cushion (still inflated with the valve closed) remove the cover and take it into the tub or shower with me. I clean it with a washcloth and soap — I use Irish Spring — by gently scrubbing around all the air cells, rinse thoroughly, especially around each cell and then towel dry around each cell. The process takes about 3–5 minutes total.

In-depth cleaning instructions can be found on The ROHO Group’s website at Cleaning and Disinfecting ROHO^® DRY FLOATATION^® Products.

For stubborn odors, like dreaded bladder or bowel accidents, go to the section on deodorizing under Cleaning and Disinfecting ROHO® DRY FLOATATION® Products.

Here are the directions:

Deflate the cushion and close the valve(s). Make a mixture of one tablespoon of baking soda per quart of water (25 gm/l) or a solution of 1 part vinegar in 10 parts water — make enough to soak the cushion in deep wash basin.
Soak the cushion in the basin for several hours, rinse and let dry. For really stubborn odors you may need to repeat the process.

I find using some type of weight — I use a small barbell — keeps the cushion immersed in the solution. It helps if you have an extra cushion — see “How Often Should You Replace Your Cushion?” — to sit on while the other one is being cleaned.

Remember to keep your mobility equipment clean. Here is to hoping that a significant other — or potential significant other — notices the effort!

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How Often Should You Replace Your Cushion?

The ROHO Group — Wed, 09 Nov 2011 11:00:34 +0000

Guest blog post by Bob Vogel

Two questions I’ve frequently been asked at consumer shows is, “How often should I replace my cushion?” and, “How often will insurance pay for a new cushion?” These are important questions. Every brand, make and model of cushion will break down over time. When this happens the cushion no longer supports and protects your skin the way it was designed — putting you at risk of a pressure sore. It is important to replace your cushion long before this happens.

A good rule of thumb is to replace your cushion every three years — which is how often most insurance companies will pay for a new one. To arrive at this answer, I turned to Dave McCausland, Senior VP of Planning & Government Affairs for The ROHO Group. McCausland says in general, Medicare sets the trend for how often a new cushion will be paid for — Medicaid and private insurance companies tend to follow Medicare’s lead. McCausland has studied Medicare guidelines and says although they don’t specify an exact length of time on how often they will pay for a new cushion, he is confident they will pay for a new one ever three years.

Another reason to request a new cushion every three years is that the ordering process is slow. It’s much better to be evaluated by your clinician and order a new cushion while the cushion you are sitting on is still in good condition and you are in no hurry. Waiting too long to order a new cushion may risk developing a pressure ulcer from sitting on an older cushion that may be breaking down. Getting a new cushion every three years has other benefits as well. You can keep your old cushion for back-up use, use it as a spare to sit on while you are cleaning your newer cushion, and you can place it on the seat of your car for extra skin protection.

Sometimes circumstances require a new cushion before 3 years. It is crucial to check the skin on your butt with a mirror every evening and every morning. If you start seeing that your skin is red after a long day of sitting, it is important to ask your doctor for a referral to a seating clinic for a seating evaluation with a clinician — a PT (physical therapist) or OT (occupational therapist).

“Anytime the cushion you are on is proving ineffective at protecting your skin you should look into getting a cushion evaluation for a new or different cushion,” says Jim Munson, District Manager for The ROHO Group. Munson adds that anytime you have a documented change of medical condition that effects your skin, such as weight gain, weight loss, or the cushion you are on is no longer effective, insurance should pay for a new cushion.

So three years have passed and it’s time to get a new cushion — how do you go about it? First of all — be a squeaky wheel — ask! Munson says the usual, and easiest route is to go to your local DME (durable medical equipment) supplier and tell them you need a new cushion — they will be happy to guide you through the step-by-step process of getting a 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 On the main page pull down Resource Locator, 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.

Your DME supplier will team you up with an ATP (Assistive Technology Professional) certified through RESNA (Rehabilitation Engineering and Assistive Technology Society of North America). It takes experience, training and testing to earn an ATP certificate. It is a cool idea to ask the person working with you with if they are an ATP — a certified ATP will be proud you asked.

The ATP will gather your information, current wheelchair, cushion, insurance information, etc. They will contact your physician and get a referral for a clinician to do a seating evaluation.

The goal of the seating evaluation is to find out if your present cushion is still appropriate, or whether your body changed that may require an adjustment in cushions — say going from a ROHO® LOW PROFILE® Cushion to a ROHO® HIGH PROFILE® Cushion. Following the seating evaluation, the clinician takes the information and writes a Letter of Medical Necessity to submit to the insurance company for your cushion.

As I mentioned in an earlier blog, Why You Need to Ask For Your Cushion by Name during your seating evaluation it is vital to speak up and tell the clinician that the Letter of Medical necessity and the doctor’s prescription needs to include your exact seating needs, for example ROHO® HIGH PROFILE® Single Compartment Cushion (4″). Make sure that the dimensions of the cushion needed is included on the prescription, for example 16″ x 16″. This ensures your new cushion is the exact cushion you need and expect.

From there the ATP gathers and organizes all the documentation and the DME supplier submits the paperwork to the insurance company for approval. If all goes well your cushion is ordered and you are soon styling around on a new cushion.

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Two ROHO Employees to Present at European Seating Symposium 2011

The ROHO Group — Tue, 01 Nov 2011 11:00:13 +0000

Dave McCausland, Senior Vice President of Planning and Government Affairs, and Bart Van der Heyden, PT, Director of European Training and Education, will present at the European Seating Symposium in Dublin, Ireland, from November 7–10, 2011.

Dave McCausland will be presenting “Cushion Characterization” on Wednesday, November 9 from 12:00–1:00 p.m. in the Dublin Room, Liffey A with Dave Brienza. The session will cover risk factors for developing pressure ulcers in nursing homes. It will also discuss a randomized control trial on the prevention of pressure ulcers with wheelchair cushions.

Bart Van der Heyden will be presenting “Why Similar Seating Problems are Solved Differently Across Europe” on Thursday, November 10 from 12.00–1.00 in the Eindhoven Room, Liffey Meeting Room 2. The presentation will discuss how perception of disability impacts medical care, with a focus on seating assessments. The perception of disability has shifted from a ‘medical model’ to a ‘social model.’ The ‘medical model’ treats the physical problems and tries to find a way to fix it. It focuses on how to cure. By distinguishing between impairment and disability, the ‘social model’ and creates an environment of inclusion and promotes a person’s abilities, rather than disabilities. The key learning objectives are:

Understand how perception of disability impacts service delivery and AT provision
Understand the importance of respecting the individual’s wishes, even when there are medical concerns that need to be addressed
Assess the relevance of different seating assessments
Seating techniques and seating interventions on several case studies in multiple care settings

The Symposium will be held that The Convention Centre Dublin off the River Liffey in Dublin, Ireland.

Click here for the European Seating Symposium’s program.

The ROHO Group will be exhibiting at booth F7 at the back right corner of the Exhibition Hall. Stop by the booth and say hello to the ROHO team members.

The Last Dog Tow

The ROHO Group — Wed, 26 Oct 2011 12:00:06 +0000

Bob with his daughter, Sarah, and service dog, Schatzie, in August 2010

Guest blog post by Bob Vogel

Schatzie — my German Shepherd service dog — provides furry four-legged power assist to my manual wheelchair. One of Schatzie’s main tasks is to tow me around during my day and help keep my shoulders healthy by easing the repetitive stress and strain of constant pushing.

Schatzie’s K9 power assist has also proven to a lot of fun for my daughter Sarah. Riding in her dad’s lap, being towed by a German Shepherd is akin to having a full-time dog sled — Sarah refers to this as “dog-towing.”

Sarah came up with commands for Schatzie to increase speed — when I want to go faster the command is “Squirrels.” The command for “faster still” is “double-squirrels” and for a flat-out run is “triple-squirrels.”

On a smooth flat surface, Schatzie was able to tow us up to a full-speed run, much to Sarah’s delight. She would hold her arms out and say “Daddy I’m flying.” The excitement of going so fast in my chair — feeling like I’m flying myself — combined with holding onto the back of Schatzie’s harness, being able to feel her powerful shoulder and back muscles work, and seeing how happy this made Sarah was powerful and amazing.

Dog-towing has also proved extremely convenient. Looking around I can see how difficult and tiring a long day of errands and shopping must be for a non-disabled parent that has to carry, or walk slower with younger children. For Sarah and I, a day of errands and shopping was like a fun day of dog sledding — Schatzie swiftly towing us from store to store, up and down isle after isle. The best was grocery shopping, a full cart in front of me, Sarah on my lap and Schatzie towing us. Not only was it fun, it was swift and easy — we were the envy of other kids and other parents. More than a few times I would hear “I wish my mom or dad was in a wheelchair and a German Shepherd to tow me.”

Having Schatzie travel with Sarah and me on vacations has been priceless. With Sarah in my lap, Schatzie has enabled us to make connecting flights at the farthest gates at airports — traveling at “triple-squirrel” speed. At “double squirrel” speed we have been able to cover vast distances and see every exhibit in places like Kennedy Space Center and Sea World in a single day.

At home, one of our favorite activities during the summer was going on a mile-long dog-tow into town to check my post office box and get an ice-cream sundae at the local soda fountain — at a real old-fashioned pharmacy/sundry/soda fountain — one of the benefits of living in a small town. On the way home, just across the railroad tracks, the path becomes flat and pool-table-smooth for about half a mile. Sarah would always say “Daddy can we go fast?” And we would have Schatzie tow us at “triple-squirrel” speed and Sarah would with delight, put her arms out to the side in imaginary flight.

I’ve always heard people say, “enjoy every minute of Sarah’s childhood because they grow up before you know it.” And I did — I never took a single episode of dog-towing for granted and always appreciated how amazing it was when it was happening — especially on dog-tows to get ice cream.

Between Sarah’s busy school schedule, a long rainy winter and summer vacations, we hadn’t had an opportunity for a dog-tow and ice cream trip in a long time — until a warm, lazy afternoon a few months ago. On our way back from town we crossed the railroad tracks and Sarah said “Dad” — at age 10 I’ve become “Dad” instead of “Daddy,” one of the rites of passage — “Dad, can I ride on your lap for a dog tow.” I said, “Sarah, you are growing so quickly and getting so big, I can’t see over your head anymore. You are getting too tall to ride in my lap.” Sarah replied. “Dad, please just one more time?!” And I said, “I’m glad you are growing up, and this is something I will miss too. Plus, Schatzie is 9-years-old and her muzzle is getting as gray as my beard. So, yes, we can do one more dog tow.”

Sarah got on my lap and Schatzie started to tow as Sarah called out “Squirrels!” Then, “OK, Schatzie, double squirrels!” And finally, “Yeah Schatzie, Triple squirrels!” She held out her arms and pretended she was flying, understanding it was for the last time. We reveled in every second of it.

When we got home Sarah and I both needed tissues — we both had tears in our eyes.

That evening Schatzie received extra treats and many extra hugs and belly rubs, and she was quite content. As I hugged her I was grateful, grateful for dog-tows, but more importantly, grateful for helping me live in the present and appreciate the fleeting time as Sarah grows up.

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A Step-by-Step Guide to Contacting U.S. Representatives and Senators

The ROHO Group — Wed, 12 Oct 2011 10:00:30 +0000

Guest blog post by Bob Vogel

For all my writing about competitive bidding, I’m embarrassed to admit I’ve never contacted my senators and representatives — the people elected to work for us — to let them know, as a voter that I’m against competitive bidding, until now!

As I wrote in my previous blog “Why You Need to Ask for Your Cushion by Name” round II of CMS (Centers for Medicare and Medicaid Services) competitive bidding is looming on the horizon and it is crucial that each one of us contact our senators and representatives and let them know we are opposed to competitive bidding.

It was time to take my own advice — make my voice heard and become part of the solution. Here is my experience and a step-by-step guide on how to contact your senators and representative and speak up against competitive bidding.

First I located my two U.S. senators and representative by going to: www.usa.gov/Contact/Elected.shtml

I clicked on “U.S. Senators” and went to the “Choose a State” bar — scrolled down to California, clicked, and up popped the contact information for my two U.S. Senators, Barbara Boxer and Dianne Feinstein.

Next I went back to: www.usa.gov/Contact/Elected.shtml and clicked on “U.S. Representatives.” When the Representative’s page opened up, I clicked on “Find Your Representative” typed in my zip code, clicked, and there was contact information for my U.S. representative, Tom McClintock.

Armed with contact information, I set about the first task — emailing both U.S. senators and my representative to explain that I am opposed to competitive bidding. The easiest way to do this is go to go to ROHO’s form, fill in the blanks and email it to your U.S. senators and representative. I chose to write my own, based on a combination of my experience of getting a pressure ulcer caused by a memory foam cushion — when I had requested a ROHO — and information from my previous blog post, “Why You Need to Ask for Your Cushion.” The total amount of time it took me to look up and email senators and congressman was 8 minutes.

I’ve heard a letter sent via U.S. mail has more power than an email so I printed out my email letters and invested $1.32 in stamps and mailed them to all three individuals. The total time to mail all three letters was 10 minutes, plus a nice walk with Schatzie — my German Shepherd service dog — to the post office.

Last but not least, I phoned all three. It’s funny, I’ve spoken in front of groups of 1,500 people with no problem. I knew when I phoned I would just be speaking with an aid — but I was still a bit nervous and had to remind myself, “they work for me, and I am making a difference.” I had my cheat sheet “bullet points” ready:

*My name, that I’m a registered voter, and my zip code.

*I’m calling about Medicare, specifically Round II of the CMS competitive bidding program. I am against CMS competitive bidding and I urge the (senator/congressperson) to speak out against competitive bidding.

* I’m a paraplegic and competitive bidding takes away my ability to choose a DME dealer that puts my health and equipment needs first. Competitive bidding will force me to use a DME dealer that may be in it for price alone.

*(I took much of this from my previous blog). The way competitive bidding is set-up encourages DME dealers that are only concerned with profit to submit a lowball bid and enables them to make a lot of profit by becoming the only dealer in town, if they provide poor service or try and make an extra buck by cutting corners, most people will just put up with it.

An example of how they can legally cut corners and make a lot of profit is by looking at the government HCPCS (Healthcare Common Procedure Coding System) code for the type of cushion that many paraplegics and quadriplegics use, E2622. Medicare will reimburse $347.69 for this type of cushion (if a person is in a manual wheelchair). For many wheelchair users, $347.69 is barely enough to cover the cost of the type of cushion they need to prevent pressure ulcers. However, Medicare’s Pricing, Data Analysis and Coding (PDAC) for E2622 includes 915 different cushions in this category. A dealer that is only in the business for profit can find a cushion on the list that retails for $39. If I had to sit on this cushion I would quickly develop a pressure ulcer that would likely land me in the hospital for months and cost taxpayers upwards of $50,000. This would likely happen to many other wheelchair users as well. But the dealer could easily continue to rack up big profits by placing these cushions under unsuspecting clients.

The aids I spoke with were very helpful and wanted to hear what I had to say. In all three phone calls I would stop and say, “Does what I’m saying make sense?” In each case they understood Round II of competitive bidding, understood that I was against it. In each case the were interested when I reiterated how crucial the proper cushion is to help me avoid pressure ulcers and if I had to sit on one of the cheaper cushions approved under code E2622 on the PDAC list I would be in danger of being hospitalized with a pressure ulcer which would put my life in danger and be a massive expense to taxpayers.

By doing this I have now officially become part of the solution. I encourage each of you to use this as a guide. Please join me and get involved. Contact your senators and representatives and please post a comment after you do — it will help encourage others to follow our lead. I also encourage you to ask your family and friends to use this blog post as a guideline to contact their senators and representative, as well. Contacting senators and representatives and becoming part of the solution feels pretty cool!

____________________________________________________________________

Dear Senator __________,

As a registered voter in your district I am against Round II of CMS (Centers for Medicare and Medicaid Services) competitive bidding program.

I am a 51-year-old paraplegic — paralyzed for 26 years. Like many wheelchair users, I sit on a wheelchair cushion — the proper cushion is crucial to avoid getting a pressure ulcer (skin breakdown). A pressure ulcer is life threatening and commonly results in months of hospitalization at an average cost to tax payers of $50,000–$70,000 (average costs for a full-tissue depth pressure ulcer).

Currently I can choose which DME (durable medical equipment) dealer I use to get my cushion. I choose a dealer that provides me the best DME (wheelchair, cushion etc.) for my needs within Medicare reimbursement guidelines.

The cushion that I require to prevent pressure ulcers is approved by Medicare, assigned to HCPCS code E2622 and reimbursable by Medicare with an allowable of $347.69, of which I am responsible for at least 20% of the payment.

However, under competitive bidding, the incentive for DME dealers to strive to provide the best equipment for their clients is replaced with the necessity of reducing their costs as much as possible. In addition, competitive bidding opens the door for a DME dealer who is only interested in profit to make easy, quick and massive profits by submitting a “lowball bid.” An example of how this can be done is: there are more than 900 cushions under code E2622 on the PDAC list, including one that lists on the internet for $39.95. A “profit only” business could fit unsuspecting clients with this type of cushion, make large profits and still be within government guidelines — resulting in countless life threatening pressure ulcers, and massive hospital bills that will be passed on to the taxpayer.

When I first left the spinal cord rehabilitation hospital, I was placed on an inferior cushion that caused a tiny pressure ulcer (about the size of a pimple). I immediately saw the pressure ulcer because I check my skin with a mirror each day, but this could have resulted in a massive pressure ulcer within a few days. Instead, I was able to resolve the issue with bed rest and the proper cushion. The average wheelchair user would not have noticed the red spot before it became a life-threatening pressure ulcer — requiring a lengthy and expensive hospital stay. This is why I urge you to speak out against Round II of competitive bidding.

Sincerely,

Robert H. Vogel

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ROHO to be at HCR in Tokyo

The ROHO Group — Tue, 04 Oct 2011 20:47:45 +0000

The ROHO Group will be at the International Home Care & Rehabilitation Exhibition (HCR) in Tokyo, Japan from October 5–7, 2011. The ROHO Group will be at booth number 4-03-09 in the Tokyo Big Sight (Tokyo International Exhibition Center) in the East Halls. Admission to the event is free to the public.

HCR is the largest international home care and rehabilitation exhibition in Japan. Approximately 120,000 people are expected to attend this year’s event, with a mix of care managers, home helpers, staff from social welfare organizations, doctors, nurses, PT’s, OT’s, end users and more.

HCR is organized by the Health and Welfare Information Association and the Japan National Council of Social Welfare.

Stop by the booth and say hello to Moni, Tom, Pat C. and Pat M.

Visit www.hcrjapan.org for more information.