The US economy has spiraled into a recession of significant proportions. Yet, even at that, there are those who see the potential for things to improve in the world of lightweight manual wheelchair manufacturing, clinical specifying, and servicing.

“I tend to be an optimist, so I see the numerous opportunities for our industry and profession,” says Carmen P. DiGiovine, PhD, ATP, RET, owner and president of 6 Degrees of Freedom LLC in Wheaton, Ill, a rehabilitation engineering consulting firm that works mainly with school districts, clinical facilities, manufacturers, and suppliers.

“For one,” he continues, “I believe there will be a stronger sense of community that develops in our field as we all find it necessary to pull together in order to survive these difficult times. And out of that stronger sense of community—the idea that we need the involvement of truly solutions-oriented multidisciplinary teams—will come a recognition that in both the short and long term it is best to provide a manual wheelchair that can be set up to precisely suit the user’s unique physical needs.

“I think this recognition will also extend to a general agreement that the best type of manual product for this purpose is an ultralight wheelchair,” he adds.

BETTER CODES

Another positive development despite the drag of recession is the new Medicare reimbursement codes currently in the works. DiGiovine expects that these, when completed, will more precisely reflect the actual composition of the market for lightweight manual wheelchairs.

“The proposed new codes—at least in the form they’ve taken at this juncture—acknowledge that there are multiple types of wheelchairs on the market and that there are more options available for those wheelchairs than ever before,” he says.

However, DiGiovine confesses to harboring fears that the new codes could turn out less than ideal. “To my thinking, the new codes will be truly positive only as long as they allow for innovation in the future,” he says.

Worrisome, too, is whispered talk of applying to lightweight manual wheelchairs the recently adopted 9.5% cut in the amount of Medicare reimbursement that providers of durable medical equipment (DME), prosthetics, orthotics, and supplies who participate in competitive bidding can collect.

“If this cut should ever be extended to lightweight wheelchairs, it would have a significant adverse impact on the industry,” DiGiovine says. “Such a cut would make it very difficult for rehab technology suppliers to offer service of what they sell. In fact, the service component would in most instances have to be eliminated to offset the lost reimbursement dollars. But it will be consumers who emerge as the hardest hit by this. With service no longer offered by suppliers, the person with the disability will be required to constantly go to the clinic for small adjustments and repairs. In most rural areas, there are no such clinics to go to. If it’s not the supplier providing the service, then nobody will provide it. So there would have to be some mechanism for professionals to get reimbursed for providing this service, ideally in the home.”

Perhaps clinicians could recapture lost reimbursement dollars by sharing their expertise via Internet Webcam encounters with clinicians in foreign lands, as suggested by Mark Schmeler, PhD, OTR/L, ATP, Department of Rehabilitation Science and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh. “There is growing demand for wheelchair professionals in the United States to work with their counterparts abroad—and receive payment for it,” he says, pointing to Europe and South America as leading examples.

BIG YEAR FOR RESEARCH?

Another positive of this recession, as DiGiovine sees it, is the way the economic downturn is already beginning to bring together manufacturers, clinicians, and consumers here at home in order to “figure out what is truly important and then explore ways to prove to everyone that what we’ve identified as truly important truly is.”

He points to the push for evidence-based practice. “It’s gaining momentum,” DiGiovine says. “The manufacturers want it because it means equipment will be recommended more appropriately and that then is going to translate into better results—which will engender wider satisfaction with that manufacturer and its offerings,” DiGiovine predicts. “Consumers want evidence-based practice because they don’t want mistakes to occur during the evaluation process. And, of course, the clinicians want it because if they have clear protocols and research to guide them in making more appropriate decisions, then that makes their job easier.”

DiGiovine expects that 2009 could see a jump in both the quantity and quality of supportive research. “There are a lot of questions to be answered by research as to whether this or that technique, device, or accessory is really efficacious and therefore worth utilizing,” he says. “But there’s already a lot of evidence in the literature that simply is not being utilized as fully as it could. And that’s because too many professionals are reluctant for whatever reason to devote the time and energy necessary to poring through the existing research, journal article by journal article.”

He says he plans to drive home that last point in a seminar he will help lead in March at the 25th International Seating Symposium (ISS), to be held in Orlando, Fla. “I’m focusing on evidence-based practice because I believe that’s key to the advancement of our profession, which begins with taking the research and incorporating it into one’s own clinical practice. My message will be that there is excellent research ready to be tapped into; take fullest advantage of it.”

DiGiovine, as a member of the International Seating Symposium faculty, will make a total of three presentations during the event’s nearly week-long run. “The first will be on the topic of ultralight wheelchairs with emphasis on materials selection, while the other two are going to be overviews of manual wheelchairs and assessment processes,” he indicates.

In this recession year—as in years of prosperity past—the importance of the International Seating Symposium is its role as an intersection of consumers, suppliers, researchers, and manufacturers. “These different types of professionals come together in one place and acquire a common set of knowledge,” DiGiovine says. “So, when later we encounter one another in the field either directly or indirectly, having knowledge in common means we’re all on the same page. This helps our work as a team go more smoothly and helps us deliver a more successful result to the wheelchair user.”

PRE-ISS CONFERENCE SEMINAR

One preconference seminar at the symposium should prove particularly valuable to clinicians who are seeking a better understanding of the unique features and limitations of current manual wheelchair technologies, or who are simply looking to improve their ability to perform and teach advanced manual wheelchair mobility skills and objectively measure and document outcomes surrounding manual wheelchair use, promises symposium course director Schmeler.

The all-day seminar—slated for March 11 at the Buena Vista Palace Resort and Spa (where all of the symposium events will take place)—seeks to provide comprehensive knowledge and skills for offering appropriate manual wheelchairs and associated education and training.

“Participants will learn to compare and contrast various frame styles and recommend configuration options and accessories to guide best selection for individual clients,” Schmeler says. “We’ll have case examples to demonstrate the evaluation process, product trials, generation of the final wheelchair prescription, the definitive fitting process, troubleshooting, and client education. A significant portion of the seminar will be dedicated to hands-on lab work with emphasis on wheelchair propulsion and skills-training techniques—everything from basic maneuvers to advanced wheelie skills. And there will also be discussion and demonstration of quantifiable outcome measures relative to manual wheelchair prescription and functional skills.”

Plans are to incorporate in this seminar relevant research findings, with extra attention paid to current funding strategies, Schmeler adds. “Active audience participation and interactive discussion throughout the day will help participants improve competence and confidence in providing optimal manual wheelchairs and associated education and training,” he says.

The seminar boasts an impressive faculty. It will be composed of DiGiovine as well as Kendra L. Betz, MSPT, ATP, of the Prosthetics and Sensory Aids Service at the Veterans Administration Central Office in Washington, DC; Laura Wehrli, DPT, ATP, of Craig Hospital in Englewood, Colo; and Theresa F. Berner, MOT, OTR/L, ATP, with the Spinal Cord Injury System of Care and Outpatient Neurorehabilitation at Ohio State University Medical Center in Columbus.

The full International Seating Symposium will include presentation of scientific and clinical papers, research forums, in-depth workshops, panel sessions, and extensive exhibits. “Presentations will address the wheeled mobility and seating challenges and solutions for people with disabilities across their life span and across conditions such as neuromuscular disorders, spinal cord injury, diseases of the spinal cord, orthopedic conditions, systemic conditions, obesity, and polytrauma,” Schmeler says. “As for the exhibit halls, they’ll be filled with commercial products and innovations from North America and abroad, and there will be ample opportunity to explore technical wheeled mobility and seating options.”

The International Seating Symposium represents “perhaps the one major conference that’s focused less on the business side and more on the clinical and research side of this field,” according to Schmeler, who says he hopes that, if it accomplishes only one thing this year, the symposium will act as a platform for greater exchange of information, thought, and strategies across the developed countries of the planet. “Wheelchair professionals everywhere are all dealing with the same challenges and are all doing innovative things in response, but there’s far too little collaboration as far as sharing solutions or strategies. And a big part of the explanation is there are language issues from one country to the next. We hope this International Seating Symposium will be a bridge across which information and ideas can more freely travel.”

Rich Smith is a contributing writer for Rehab Management. For more information, contact .