Palm Springs Serenity

Refreshingly Healthy: Fruit Acai Juice

Not all acai health products are in tablet form. These acai products come in a variety of forms, one of which is the fruit acai juice. The fruit acai juice is like your conventional juice, so you can take it anywhere anytime.

fruit acai juice comes in two forms the powder form where you have to mix it with water and the premixed form wherein you can simply drink right out from the bottle. With the accessibility and availability of the fruit acai juice you dont have an reason why you shouldnt drink it, because anyone who wants to be healthy should make this product a part of their diet.

Like other acai products, the fruit acai juice is also loaded with antioxidants and necessary nutrients. So when you drink fruit acai juice you are simply drinking your way to optimum health. The antioxidant content in fruit acai juice is higher than those found in blueberries. In addition, the essential nutrients will certainly help keep the body nourished and functioning smooth. The fruit acai juice is perfect for those in the market for a good weight loss assistant.

So do you want to be fit? Then drink fruit acai juice.

Treatment

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Herbs Colon Cleanse the Best Way to Cleanse Your Colon

Our society has changed over the years and over the years peoples diet has changed as well. Deep fried and processed foods are the main components of our present diet. The reason why people today barely eat home cooked meals is because they dont have enough time. Unlike fresh dishes these deep fried and fast food meals lack a lot of essential vitamins and nutrients. A certain amount of toxins in these foods can build up in our colon if we dont clean our colon. To keep the toxins from building up as well as the waste products it is always best to perform colon cleansing. One of the safest ways to cleanse the colon is through the herbs colon cleanse. So, it becomes important for you to always cleanse your body.

The herbs colon cleanse uses herbs and colon cleansing recipes in order to cleanse the colon . This type of colon cleansing doesnt use any artificial ingredient making it safe to use. Since it is found in your kitchen, local market and even your garden, the herbs colon cleanse is very much affordable. When herbs colon cleanse is employed there is no need to worry about spending more than you could. It is safer but it is still as effective as those commercial colon cleansers. So, try the herbs colon cleanse now.

Treatment

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What You Need To Know About Colonic Hydrotherapy

doing things in line with nature are becoming more and more popular. If you watch TV, you will without a doubt notice people encouraging natural ways of losing weight or people advocating the use of herbs and other natural cures in treating medical conditions. In addition, you will also see a lot of natural dietary supplements being shown on television. A lot of health conscious people are also advocating the natural method of colon cleansing, one of which is colonic hydrotherapy.

For those unfamiliar with the process, they might find it rather harsh or too much. However, colonic hydrotherapy is another process employed in order to aid your body in excreting waste products. When a person is about to undergo colonic hydrotherapy he or she is ushered to lie down on a bench, then a tube is maneuvered into his rectum once in place several gallons of pressurized water are passed through the colon. As the water filters through the colon the hydrotherapist massages the back and the stomach or abdomen of the client. Wastes and extra fluid passes through a different tube. To complete a session of colonic hydrotherapy it may take an hour or more. Kits for home colonic hydrotherapy are available, you can get one if you feel doing it by yourself.

Treatment

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Better Living with Fruit Acai Juice

Not all acai health products are in tablet form. These acai products are available in several forms, one of which is the fruit acai juice. The fruit acai juice is like your conventional juice, so you can take it anywhere anytime.

The fruit acai juice can be in the form of powder where you will need to max it with water or it can also come in a premixed form, no more stirring and mixing. With the accessibility and availability of the fruit acai juice you dont have an explanation why you shouldnt drink it, because anyone who wants to be healthy should make this product a part of their diet.

Like other acai products, the fruit acai juice is also loaded with antioxidants and essential nutrients. So when you drink fruit acai juice you are simply drinking your way to optimum health. The antioxidant content in fruit acai juice is elevated than those found in blueberries. On top of it, the essential nutrients will absolutely help keep the body nourished and functioning smooth. The fruit acai juice can also help those who want to lose weight.

So do you want to be in tip-top shape? Then drink fruit acai juice.

Treatment

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Acai Supplement and Life

A lot of speculation has been made. It is usually about the latest breakthrough in dietary supplements. This latest product is said to be loaded with a lot of vitamins and minerals and contains high levels of antioxidants too. This supplement was introduced through a talk show by a famous talk show host. It is the acai supplement that is being talked about.Products that contain acai berries is otherwiseknown as the acai supplement.Acai berry supplement is the other term for it. A lot of health benefits can be found in this supplement. One of benefits of acai supplement is boosting the immune system, another is preventing cancer through the protection provided by the antioxidants, and lastly it also helps improve ones mental capacity. These benefits are endless that is why more people are taking an acai supplement.

Acai berrysupplement is widely available. The easy accessibility of this product enabled the people to benefit from it. Acai supplement can do make a difference. A lot of people consider this acai berry supplement as a gift, the kind of gift they will enjoy every day as long as they take it.

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Natural Colon Cleansing Recipes Can Also Be Delectable

The reason why we love food so much is because it tastes good. People cant say no to delectable meals. such is the reason why we dont say no to anything that is delicious and we usually turn a blind eye to the cholesterol content simply because we are enjoying the taste too much. The mere thought of fine dining and delicious food can already put a smile on our face. However, if you take into consideration the potential for diseases and the role that natural colon cleansing recipes can have on it, send a lot of us packing. the misconception of natural colon cleansing recipes often portray it as something not tasteful and taste really, really bad.

That wrong belief has to be readdressed, because there are a lot of natural colon cleansing recipes that are not only attractive but delectable as well. These recipes usually include fruits, vegetables, herbs and other foods that can enable the body to rid of waste products.

High fiber foods are great at cleansing your colon. How to make your natural colon cleansing recipes delectable is actually up to you, this because each one of us have our own preferences. So if you prefer spicy, you can make spicy natural colon cleansing recipes or sweet or sour if would rather have those too.

Treatment

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Acai Weight Loss Is What Youve Always Wanted

Seeing someone overweight or obese is no longer shocking to us. It is no surprise that most of us are putting on more weight than we should especially if you take into consideration the life we are living, less activity more food.

A lot of people get fat because the excess calories we get from the food we eat get kept and if unused, it will eventually turn into fat, thus adding one or two more pounds to our present weight. If the trend continues that next thing we know is that we are already overweight. When we realize our shortcomings, we would then find ourselves looking for the exceptional weight loss program. However, for best results, weight loss programs are often combined with supplements like the acai products. Acai products are known to be effective when it comes losing weight, and this effect is otherwise known as the acai weight loss.

Acai weight loss is the result of mixing exercise, healthy diet and taking acai berry products. This is because acai berries are known to hasten up the bodys metabolism thus allowing it to burn more fat while also unlocking stored energy giving more stamina while working out. The acai weight loss is indeed a great result, especially if you were working hard just to get it.

Treatment

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Acai Berry Juice: Bring More to Juice

There are times when the idea of taking tablets can be repulsive. Some people, no matter how important the tablet is for, will still find the idea of swallowing a pill problematic. Unfortunately, we cant rely on our body alone to fight off those viruses and bacteria nor can we rely on will alone to be able to get past the day even when we are already tired. We use health supplements to facilitate our bodys lack of strength at times when we are sick. These health supplements are most of the time formulated to help buff up our immune system or unlock our stored energy. Fortunately, not all supplements come in tablet form; some of them come in liquid form like the Acai Berry Juice.

Acai Berry Juice is infused with acai berry extracts making it as effective as the other acai berry products. Acai Berry Juice is also overflowing with flavor making it more gratigying to the taste, so even your children will like it.

There is no limit as to how or when you can take the Acai Berry Juice, morning, noon or night. The unending list of benefits you can get from Acai Fruit Juice should encourage you to use it more; so be healthy, drink healthy with Acai Berry Juice.

Treatment

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Live Longer with Colon Cleansing Diet

Toxins may take some time to build up in our colon. And it may even take more years for it to accumulate to alarming levels. Hence our continued nonchalance when it comes to eating anything and everything under the sun. Unfortunately, that is not the case, toxic substancescan be found the food that we eat and of course the medicines we take. Slowly but surely these toxins will amass and if we neglect it we might end up having colon issues, be it severe or mild. In addition, colon problems are difficult to diagnose because the symptoms can mimic other forms of diseases. If you do not want this to happen to you, it may be best to consider the switch to a colon cleansing diet.

A colon cleansing diet usually starts with the modification of your usual diet. Then it is followed by including high fiber foods which are very good when it comes to colon cleansing. In addition, On top of that, colon cleansing diet also requires you to limit the amount of alcohol, caffeine and sodas you take in regularly and instead add to your water intake. Once your diet has been modified to suit your needs, you may now take in supplements to work together with your colon cleansing diet.

A colon cleansing diet is a great way to help your body get rid of toxins and avoid spending too much money.

Treatment

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How to Find the Best Acai Berry Drink

Every since the health benefits of acai berry were made known in popular talk show more and more people are now in the quest of finding acai berry products. People are willing to try products that promises them immediate weight loss and healthy body because of their increasing concern with their weight and current state of health. One example of these acai berry products is the acai berry drink. Squeezing the acai berry pulp dry results to the acai berry drink. The acai berry drink contains the same health benefits as with other acai berry products since it came from the same plant.

Some people are thinking of taking advantage of the popularity of the acai berry drink. Low quality acai berry drinks are made by these individuals. To keep yourself from becoming a victim here are some tips. One is reading product reviews. Users often make reviews of products that they use. Look for an acai berry drink that has the most positive reviews. Another is asking your friends who are also acai berry drink users. Ask them if the product they are using is indeed effective. Lastly, consult a professional.

Treatment

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Distribution and cost of wheelchairs and scooters provided by Veterans Health Administration

During fiscal years 2000 and 2001, the Veterans Health Administration provided veterans with more than 131,000 power wheelchairs and medical scooters at a cost of $109 million. This national study is the first to investigate Veterans Health Administration costs in providing wheelchairs and scooters and to compare regional prescription patterns. With a retrospective design, we used descriptive methods to analyze fiscal years 2000 and 2001 National Prosthetics Patient Database data (cleaned data set of 113,724 records). Wheelchairs were categorized by function, weight, and adjustability options for meeting individual needs (e.g., axle position, camber, position of wheels, tilt, and recline options). Results displayed a cost distribution that was negatively skewed by low-cost accessories coded as wheelchairs. Of the standard manual wheelchairs, 3.5% could be considered beyond the customary cost. Regionally, 71% to 86% of all wheelchairs provided were manual wheelchairs, 5% to 11% were power wheelchairs, and 5% to 20% were scooters. The considerable variation found in the types of wheelchairs and scooters provided across Veterans Integrated Service Networks may indicate a need for evidence-based prescription guidelines and clinician training in wheeled-mobility technologies.

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Testing of gel-electrolyte batteries for wheelchairs

A simple test rig was developed to measure the capacity of the lead-acid gel-electrolyte batteries used to power wheelchairs and medical scooters. Results of 166 tests revealed a wide scatter of battery life with different users and also showed that, in many cases, the two batteries used in a wheelchair became unequal in charge capacity after some time in use. It is recommended that pairs of batteries should be charged in series to overcome this problem.

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Power wheelchair range testing and energy consumption during fatigue testing

The range of a power wheelchairs and medicare power wheelchairs depends on many factors including: battery type, battery state, wheelchair/rider weight, terrain, the efficiency of the drive train, and driving behavior. The purpose of this study was to evaluate the feasibility of three methods of estimating power wheelchair range. Another significant purpose was to compare the current draw on pavement to current draw on an International Standards Organization (ISO) Double Drum tester at one m/sec. Tests were performed on seven different power wheelchairs unloaded, and loaded with an ISO 100 kg test dummy. Each chair was configured according to the manufacturer’s specifications, and tires were properly inflated. Experienced test technicians were used for the tennis court tests, and treadmill tests. An ISO 100 kg test dummy was used for the ISO Double Drum test. Energy consumption was measured over a distance of 1500 m for each of the three test conditions. The rolling surface was level in all cases. Repeated measure analysis of variance (ANOVA) revealed a significant difference (p = 0.0001) between the predicted range at maximum speed for the three tests. Post hoc analysis demonstrated a significant difference (p < 0.01) in estimated range at maximum speed between the Double Drum test and the treadmill test, as well as between the Double Drum test and the tennis court test. Our results indicate no significant difference (p > 0.05) between the predicted range at maximal speed between the treadmill and tennis court tests. A simple relationship does not exist between the results of range testing with the Double Drum tester and the tennis court. An alternative would be to permit the use of a treadmill for range testing as simple relationships between all pertinent treadmill and tennis court range data were found. For the Double Drum tester used, the current demand is higher than under normal usage. This presents a problem as current is related to load torque in a power wheelchair. Hence, the Double Drum tester friction must be reduced. The predicted range for the tennis court test at maximum speed ranges from a low of 23.6 km to a high of 57.7 km. The range of the power wheelchair can be improved by the use of wet lead acid batteries in place of gel lead acid batteries.

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Perceptions of power mobility use and safety within residential facilities

BACKGROUND: power wheelchairs and medical scooters enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities. PURPOSE: As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use. METHOD: In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members. RESULTS: A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions. PRACTICE IMPLICATIONS: Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.

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Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury

OBJECTIVES: To determine if a standard of care for wheelchair provision exists within the participating centers and if there is disparity in wheelchair customizability among the study sample. DESIGN: Convenience sample survey. SETTING: Thirteen Model Spinal Cord Injury Systems that provide comprehensive rehabilitation for people with traumatic spinal cord injury (SCI) and that are part of the national database funded through the US Department of Education. PARTICIPANTS: A total of 412 people with SCI who use wheelchairs over 40 hours a week. INTERVENTION: Survey information was obtained from subjects via telephone and in-person interviews and from the national database. Collected information included age, race, education, level of injury, and wheelchair funding source. MAIN OUTCOME MEASURES: Number and type (manual or power) of wheelchairs. Wheelchair customizability as defined by design features (eg, adjustable axle position, programmable controls). RESULTS: Ninety-seven percent of manual wheelchair users and 54% of power wheelchairs users had customizable wheelchairs. No power wheelchair user received a wheelchair without programmable controls. Minorities with low socioeconomic backgrounds (low income, Medicaid/Medicare recipients, less educated) were more likely to have standard manual and standard programmable power wheelchairs. Older subjects were also more likely to have standard programmable power wheelchairs and handicap scooters. CONCLUSIONS: The standard of care for manual wheelchair users with SCI is a lightweight and customizable wheelchair. The standard of care for power wheelchairs users has programmable controls. Unfortunately, socioeconomically disadvantaged people were less likely to receive customizable wheelchairs.

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Technological advances in powered wheelchairs

During the last 40 years, there have been revolutionary advances in power wheelchairs. These unique wheelchair systems and handicap scooters, designed for the physically immobile patient, have become extremely diversified, allowing the user to achieve different positions, including tilt, recline, and, more recently, passive standing. Because of this wide diversity of powered wheelchair products, there is a growing realization of the need for certification of wheeled mobility suppliers. Legislation in Tennessee (Consumer Protection Act for Wheeled Mobility) passed in 2003 will ensure that wheeled mobility suppliers must have Assistive Technology Supplier certification and maintain their continuing education credits when fitting individuals in wheelchairs for long-term use. Fifteen other legislative efforts are currently underway in general assemblies throughout the US. Manufacturers, dealers, hospitals, and legislators are working toward the ultimate goal of passing federal legislation delineating the certification process of wheeled mobility suppliers. The most recent advance in the design of powered wheelchairs is the development of passive standing positions. The beneficial effects of passive standing have been documented by comprehensive scientific studies. These benefits include reduction of seating pressure, decreased bone demineralization, increased bladder pressure, enhanced orthostatic circulatory regulation, reduction in muscular tone, decrease in upper extremity muscle stress, and enhanced functional status in general. In February 2003, Permobil, Inc., introduced the powered Permobil Chairman 2K Stander wheelchair, which can tilt, recline, and stand. Other companies are now manufacturing powered wheelchairs that can achieve a passive standing position. These wheelchairs include the Chief SR Powerchair, VERTRAN, and LifeStand Compact. Another new addition to the wheelchair industry is the iBOT, which can elevate the user to reach cupboards and climb stairs but has no passive standing capabilities. In addition, the physically immobile patient must be seated on an ERGODYNAMIC Seating System 2000, which is inflated by the alternating pressure compressor 8080. This seating system has a deep center seam between the two ischial-support chambers, which provides a recess for the coccyx. The pre-ischial crossbar compartment inflates during each cycle to prevent the pelvis from slipping forward. It is essential that the physician of the immobile patient order two ERGODYNAMIC Seating Systems 2000 because the patient must have an additional seating system in the case one leaks. Moreover, two compressors are necessary because each compressor must be serviced after 2500 hours of use. For the protection of the consumer, these pressure relief systems must be supplied and serviced by a Certified Rehabilitation Technology Supplier such as Wheelchair Works Inc. Despite the indisputable scientific evidence of the medical benefits of passive standing for the immobile user, few individuals have access to these revolutionary wheelchairs. Consequently, it is mandatory that the medical community, headed by specialists in physical and occupational therapy as well as rehabilitation medicine, CRTS, and manufacturers collaborate in a national education campaign to convince Medicare/Medicaid and all commercial insurance companies to approve immediately these assisted technologies. This program is essential so that the physically immobilized patient can achieve the undisputed physical benefits of passive standing.

Treatment

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Real-time head movement system and embedded Linux implementation for the control of power wheelchairs

medicare power wheelchairs has become very important for our quality of life. A loss of mobility due to an injury is usually accompanied by a loss of self-confidence. For many individuals, independent mobility is an important aspect of self-esteem. Head movement is a natural form of pointing and can be used to directly replace the joystick whilst still allowing for similar control. Through the use of embedded LINUX and artificial intelligence, a hands-free head movement wheelchair controller has been designed and implemented successfully. This system provides for severely disabled users an effective power wheelchairs control method with improved posture, ease of use and attractiveness.

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Characterization of power wheelchair use in the home and community

OBJECTIVE: To characterize the use of power wheelchairs and handicap scooters to determine if multiple measures of mobility and occupancy jointly provide a more comprehensive picture of wheelchair usage and daily activity in full-time power wheelchair users than daily distance alone. DESIGN: Prospective observational study. SETTING: Subjects’ everyday mobility was measured in their homes and communities for 2 weeks, and prompted recall interviews were conducted by phone. PARTICIPANTS: A convenience sample (N=25) of nonambulatory, full-time power wheelchair users. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Wheelchair usage was logged electronically, and geolocation and interview data were used to isolate chair use to (1) in the home, (2) not in the home indoors, or (3) outdoors. Distance wheeled, time spent wheeling, number of bouts, time spent in the wheelchair, and the percentage of time in the wheelchair spent wheeling were measured to describe wheelchair use. RESULTS: The median wheelchair user spent 10.6 hours (range, 5.0-16.6h) in his/her wheelchair daily and wheeled 1.085 km (range, 0.238-10.585 km) over 58 minutes (range, 16-173 min) and 110 bouts (range, 36-282 bouts). Wheelchair use varied across subjects, within subjects from day to day, and between environments. Mobility bouts outdoors were longer and faster than those wheeled indoors. In a regression analysis, distance wheeled explained only 33% of the variation in the number of bouts and 75% in the time spent wheeling. CONCLUSIONS: Power wheelchair use varies widely both within and between users. Measuring distance, time, and number of bouts provides a clearer picture of mobility patterns than measuring distance alone, whereas occupancy helps to measure wheelchair function in daily activities.

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Pediatric power wheelchairs: evaluation of function in the home and school environments

The purpose of this study was to compare the performance of four power wheelchairs and handicap scooters when used by children to perform a variety of indoor activities. Eight boys and eight girls performed a series of 11 functional tasks when positioned in each of four different power wheelchairs reflecting different design classes. There were no significant differences for many of the dependent variables. However, the Everaid Turbo was significantly better for functional positioning at a standard kitchen table and at school desks and for accessing objects at different heights. By contrast the Invacare Jaguar was better for straight-line driving speed. Other findings include children’s subjective impressions of the four power wheelchairs.

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Medicare program; conditions for payment of power mobility devices, including power wheelchairs and power-operated vehicles. Final rule

This final rule conforms our regulations to section 302(a)(2)(E)(iv) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This rule defines the term power mobility devices (PMDs) as power wheelchairs and medical scooters power operated vehicles (POVs or scooters). It sets forth revised conditions for Medicare payment of PMDs and defines who may prescribe PMDs. This rule also requires a face-to-face examination of the beneficiary by the physician or treating practitioner, a written prescription, and receipt of pertinent parts of the medical record by the supplier within 45 days after the face-to-face examination that the durable medical equipment suppliers maintain in their records and make available to CMS or its agents upon request. Finally, this rule discusses CMS’ policy on documentation that may be requested by CMS or its agents to support a Medicare claim for payment, as well as the elimination of the Certificate of Medical Necessity (CMN) for PMDs.

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Wheelchairs, walkers, and canes: what does Medicare pay for, and who benefits

Medicare’s role in the distribution of mobility-related assistive technology has not been well documented, yet rapid growth and regional variation in spending, and concerns over “in-the-home” coverage criteria, highlight the need for facts. Using the 2001 Medicare Current Beneficiary Survey, we find that 6.2 percent percent of beneficiaries obtained mobility assistive technology under the Medicare durable medical equipment (DME) benefit. These beneficiaries were disproportionately poor, disabled, and users of both acute and postacute services. Average per item spending ranged from $52 for canes to $6,208 for power wheelchairs and handicap scooters. Among beneficiaries who acquired such technology through the DME benefit, these devices comprised just 2 percent of overall Medicare spending.

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The clinical decision-making process of prescribing power mobility for a child with cerebral palsy

PURPOSE: Powered mobility has been shown to be an effective method for children with disabilities to achieve independent mobility. The purpose of this case report is to describe the physical therapist’s clinical decision making related to power mobility for a child with multiple disabilities. CASE DESCRIPTION: Power wheelchair evaluation for a nine-year-old child was conducted using Furumasu’s tasks for wheelchair readiness moving through a doorway, maneuvering through three cones, and medicare power wheelchairs driving in a hallway. Ongoing team assessment with family consultation informed clinical decision-making. OUTCOMES: A mid-wheel-drive chair afforded improved performance on Furumasu’s tasks compared with a rear-wheel-drive chair. SUMMARY: This case describes the clinician’s role in prescribing power wheelchairs to affect the user’s functional skills, as well as how, in the absence of evidence, clinical experience and patients’ needs can guide clinical decision-making.

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Considering powered mobility for individuals with stroke

medical scooters and power wheelchairs is an option that provides many disabled individuals with a means of locomotion. Stroke is the leading cause of long-term disability in this country. Unfortunately, there is currently a lack of published material that expounds on power mobility as it relates to clients who have had a stroke. We will present the benefits and considerations for choosing power wheelchairs for this client population. A brief review of seating and mobility evaluation and funding considerations is included with an emphasis on specific issues concerning stroke clients. Finally, a call for further research on this topic is presented.

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Comparative evaluation of chargers for wheelchair gel cell batteries

This study was undertaken as part of our ongoing work to upgrade wheelchair quality. Laboratory tests were conducted to determine which battery chargers would ensure that the user’s batteries are fully charged each night and also ensure that the battery lifetime was not diminished. Five commercial chargers were tested on a standardised pair of gel cell batteries of a type commonly used to power wheelchairs and medical scooters. Results of this study indicate a clear preference between chargers. As a result, we have changed the chargers we purchase. We anticipate that our clients will now experience longer life from their wheelchair gel cell batteries.

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Medicare program; conditions for payment of power mobility devices, including power wheelchairs and power-operated vehicles. Interim final rule with comment period

This interim final rule conforms our regulations to section 302(a)(2)(E)(iv) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108-173). This rule defines the term power mobility devices (PMDs) as power wheelchairs and
medicare power wheelchairs. It sets forth revised conditions for Medicare payment of PMDs and defines who may prescribe PMDs. This rule also requires a face-to-face examination of the beneficiary by the physician or treating practitioner and a PMD prescription and pertinent parts of the medical record that the durable medical equipment supplier maintains in records and makes available to CMS or its agents upon request. Finally, this rule discusses CMS’ policy on documentation that may be requested by CMS or its agents to support a Medicare claim for payment, as well as the elimination for the Certificate of Medical Necessity for PMDs.

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The ANSI/RESNA wheelchair standards: sample evaluation and guide to interpreting test data for prescribing power wheelchairs

This study is a joint project of ECRI and the National Rehabilitation Hospital, supported by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR, U.S. Department of Education, Agreement No. H133E80016). ECRI is the first independent laboratory to test power wheelchairs and medicare power wheelchairs according to the standards of the Rehabilitation Engineering Society of North America (RESNA), now known as the Association for the Advancement of Rehabilitation and Assistive Technology (AART); these standards will ultimately be distributed by the American National Standards Institute (ANSI). We tested 10 power wheelchairs, which are similar in size and configuration, from seven manufacturers; all units are intended for adult use. Our testing showed that none of the sample wheelchairs are ideal for all environments in which these devices are typically needed. Each unit has advantages that should be carefully considered when specifying a power wheelchair. Numerous factors are involved in prescribing power wheelchairs, and learning the subtle differences in features and performance of a particular model and how they will affect the user is difficult. In addition, acquiring objective information about power wheelchairs from manufacturers is not typically easy. Considering these factors, and because the standards on which we based our testing do not generally provide criteria for passing or failing models under test, we did not rate the units. The purpose of this article is to present the data collected in our study, using wheelchair performance characteristics based on some parts of the ANSI/RESNA wheelchair standards, as an example of what prescribers can expect to receive from manufacturers and to provide guidance in interpreting and applying the data in writing power wheelchair prescriptions. Thus, this article provides an overview of the types of problems faced by those who specify power wheelchairs for users, the problems faced by the users themselves, and the components that are most susceptible to damage during use.

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The Hephaestus Smart Wheelchair System

The Hephaestus Smart Wheelchair System is envisioned as a series of components that clinicians and wheelchair manufacturers will be able to attach to standard power wheelchairs to convert them into “smart wheelchairs.” A prototype of the system has been developed and mounted on an Everest and Jennings Lancer2000 wheelchair. The prototype bases its navigation assistance behavior on the behavior developed for the NavChair Assistive Wheelchair Navigation System, but the underlying hardware and software are being designed to facilitate commercialization. This paper describes our design goals for the Hephaestus system and discusses the current status of the system prototype as well as plans for future work for medical scooters.

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Reliability and validity of the power-mobility community driving assessment

The Power-Mobility Community Driving Assessment (PCDA) is a performance-based measure designed to assess driving performance of individuals using power wheelchairs or handicap scooters in community environments. This article reports the results of pilot testing and an evaluation of the assessment’s reliability and validity. Pilot testing was conducted with a random selection of Canadian occupational therapists working in the area of mobility. Although the response rate was very low, feedback confirmed the utility of the measure and contributed to one substantive scoring revision. Reliability and validity testing was conducted with a sample of 34 drivers. Internal consistency results were positive. Interrater reliability was fair to high but limited by the lack of variability in the scores. Construct validity hypotheses were tested on the relationships between PCDA scores and vision, perception, cognition, and environmental accessibility. Results indicated no relationships between the PCDA and perceptual and cognitive function and only a weak trend for a relationship with environmental accessibility. Concurrent validity was established: PCDA scores were positively associated with the judgments of therapists familiar with the driving performance of participants. In summary, the PCDA has moderate to good reliability, and content and concurrent validity results were found. More research is needed, particularly on the underlying constructs of successful driving performance. At this point, rehabilitation professionals and their clients are urged to use this assessment to establish driving performance rather than relying on assessments of perception, cognition, or environmental accessibility to predetermine whether someone will receive power mobility. Clinicians may find this a useful tool to identify where clients are able to drive safely in community settings, to identify specific learning needs, and, through those, to promote independent living for drivers of power-mobility devices.

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The smart wheelchair component system

While the needs of many individuals with disabilities can be satisfied with power wheelchairs and medicare power wheelchairs, some members of the disabled community find it difficult or impossible to operate a standard power wheelchair. To accommodate this population, several researchers have used technologies originally developed for mobile robots to create “smart wheelchairs” that reduce the physical, perceptual, and cognitive skills necessary to operate a power wheelchair. We are developing a Smart Wheelchair Component System (SWCS) that can be added to a variety of commercial power wheelchairs with minimal modification. This paper describes the design of a prototype of the SWCS, which has been evaluated on wheelchairs from four different manufacturers.

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Integrated control and related technology of assistive devices

Assistive devices are now available that allow persons with severe physical disabilities to complete tasks independently. When the user has severe physical limitations, it may be advantageous to have an integrated control system where a single control interface (e.g., joystick, head switches, voice recognition system, keypad) is used to operate two or more assistive devices (e.g., power wheelchairs, augmentative communication devices, handicap scooters, computers, environmental control units, and other devices that are controlled electronically). The advantages of integrated control are that persons with limited motor control can access several devices with one access site without assistance, and the user does not need to learn a different operating mechanism for each device. The purpose of this review is to convey the depth and breadth of the research that has been conducted on integrated control systems, as well as to provide some insights into future directions. We reviewed research works pertaining to communication and environmental control, computer access, and wheelchair guidance systems. Information gathered in this study will help people become fully aware of the status of contemporary integrated control technology in order to increase the quality of life of people who use electronic assistive devices.

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Satisfaction with technological equipment in individuals with tetraplegia following spinal cord injury

OBJECTIVE: To measure the acquisition, use and satisfaction with high technology equipment by spinal cord injured tetraplegic subjects. DESIGN AND SETTING: A questionnaire was mailed to 102 tetraplegic subjects who were hospitalised in the rehabilitation center of Kerpape (Ploemeur, France) between 1998 and 2004, and 59 subjects responded. The questionnaire asked about the use of telephones, computers, wheelchairs and environmental controls at home. RESULTS: When a piece of equipment was acquired, it was very often used. Patient satisfaction with equipment was 79.3%. Home phones and mobile phones were often used with options such as hands-free devices (78 and 59% respectively). A total of 64.4% of subjects acquired a manual wheelchair and 61% a power wheelchair. The most commonly acquired options on the power wheelchairs were the powered recline (73,7%) and tilt (71,1%) systems. All options were used but all were more desired than acquired. A total of 27.1% of subjects desired a pushrim-activated handicap scooters, but only 15.3% had acquired one; 695% of subjects had a computer. Communication was the first use for the computer (82.5%); 49.2% of subjects had acquired an environmental control system, but 20% desired one. The first reason for lack of acquisition was financial difficulties but also accessibility and information problems. The factor that influenced the acquisition and need for equipment was the degree of spinal cord injury. No other factor reduced patient satisfaction with equipment. CONCLUSION: Patients were satisfied with the equipment they acquired. But their needs, especially wheelchair options and environmental control systems, were not satisfied.

Treatment

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Consumer participation in identifying research and development priorities for power wheelchair input devices and controllers

A focus group comprised of persons who use power wheelchairs, handicap scooters and professionals working in the field were asked to participate in a brainstorming session to determine priorities for the development and application of power mobility input devices and control concepts. The group consensus was that durability and reliability are the most important criteria. Essentially, the expectation is that a power wheelchair must work everyday in the way a person needs it and wants it. At the same time, there is a desire to enhance and advance the features of input devices and control systems. Many would say these changes constitute designing “smarter” power wheelchairs, such as systems that can independently detect obstacles and can provide users with more feedback. This paper presents the rationale behind forming this focus group and details of the results of a brainstorming session where ideas were generated and prioritized. The five most important issues as determined by the group are discussed in depth.

Treatment

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