The Centers for Medicare and Medicaid Services (CMS) is one of the nation's largest purchasers of wheelchairs (CMS, 2003; Shalala et al., 1996). However, neither CMS's coverage nor payment of wheelchairs is always in the best interest of the patients who need them (Collins et al., 2002). Wheelchairs are considered by CMS to be durable medical equipment (DME) and must meet the following criteria: capable of withstanding repeated use; primarily used to serve a medical purpose; not useful to person in absence of illness or injury; and appropriate for in home use (CMS, 2003). The last criterion is often interpreted by Durable Medical Equipment Regional Carriers (DMERC's) to exclude payment of wheelchairs that would provide community mobility and improve function outside the home (Fitzgerald et al., 2001a). Depot wheelchairs represent wheelchairs that are essentially designed for depot (e.g., airport, amusement park) or temporary institutional use (e.g., hospitals) and are generally not appropriate as a long-term mobility device. The obvious attraction of depot wheelchairs is their low purchase price, see Fig. 11.1(c). Lightweight and ultralight wheelchairs provide clinicians and consumers greater ability to select and adjust the wheelchair to the user and accommodate the consumer's functional needs. Ultralight manual wheelchairs are moderately adjustable or selectable manual wheelchairs intended to be used by a single individual, see Fig. 11.1(a). Lightweight manual wheelchairs are minimally adjustable or non-adjustable manual wheelchairs intended for an individual or for institutional use, see Fig. 11.1(b).
All manual wheelchairs are not alike. There are variations in the quality and performance of manual wheelchairs (Cooper et al., 1994a, b, 1995, 1996, 1997a). It is important for clinicians to realize the benefits of a proper wheelchair prescription, not only for the consumer's comfort and mobility needs but also in the quality of the wheelchair that will last with minimal repairs (Cooper and Cooper, 2003c; Cooper et al., 1999a, 1999b; Fitzgerald et al., 2001).
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