Is a custom manual wheelchair with a power-assist device medically necessary to alleviate severe fatigue, leg weakness, dizziness, tachycardia, and associated musculoskeletal pain due to prolonged use of a standard manual wheelchair?

From the Guidelines

I would be willing to support your request for a custom manual wheelchair with power-assist by writing a letter of medical necessity. Based on your description, you're experiencing significant secondary complications from your current standard manual wheelchair, including shoulder pain that suggests possible nerve impingement or muscle strain, as well as back and sitting discomfort from inadequate support. These complications are directly interfering with your mobility and independence. A custom wheelchair with power-assist would address these issues by reducing the physical strain of self-propulsion while maintaining your ability to perform transfers and limited movement, which is important for your functional independence. The power-assist feature would specifically help prevent further shoulder injury while the custom seating would provide proper postural support to alleviate back pain.

According to the guidelines for adult stroke rehabilitation and recovery from the American Heart Association/American Stroke Association 1, adaptive equipment, including wheelchairs, should be used to maximize independent functioning. The guidelines also emphasize the importance of considering the patient's needs and environment when prescribing a wheelchair. In your case, a custom manual wheelchair with power-assist would be an appropriate solution, as it would provide the necessary support and assistance to improve your mobility and reduce the risk of further complications.

To proceed with this request, I'll need documentation of your underlying medical conditions causing the mobility limitations, records of treatments attempted, and specific measurements for proper wheelchair fitting. This solution represents an appropriate middle ground between a standard manual chair (which is causing new medical problems) and a full power chair (which would be unnecessarily restrictive for someone with your level of function). The use of adaptive and assistive devices, such as a custom manual wheelchair with power-assist, is recommended for safety and function when other methods of performing tasks are not available or cannot be learned, or if the patient's safety is a concern 1.

Key considerations for the prescription of a custom manual wheelchair with power-assist include:

• The patient's level of functional ability and mobility limitations
• The need for proper postural support and pressure distribution to prevent further complications
• The importance of maintaining independence and functional ability
• The potential benefits of reducing sedentary behavior and promoting physical activity, as highlighted in the guidelines for adult stroke rehabilitation and recovery 1.

Overall, a custom manual wheelchair with power-assist would be a suitable solution to address your mobility-related issues and improve your overall quality of life.

From the Research

Request for a Letter of Medical Necessity

The user is requesting support for a custom manual wheelchair with a power-assist device due to the development of new physical issues while using a standard manual wheelchair. These issues include worsening pain in the right shoulder, lower back, and bottom pain from prolonged sitting.

Current Mobility Issues

• Severe fatigue, leg weakness, dizziness, and heart rate spikes when standing or walking
• Worsening pain in the right shoulder from pushing the chair
• Lower back and bottom pain from prolonged sitting without adequate postural support

Power-Assist Devices for Manual Wheelchairs

Studies have shown that power-assist devices can improve mobility and reduce exertion for manual wheelchair users 2, 3, 4. These devices can be particularly beneficial for individuals who have sufficient upper body strength and coordination to use a manual wheelchair but require additional support.

Benefits of Power-Assist Devices

• Improved mobility and reduced exertion 2
• Increased community participation 4
• Ability to perform mobility tasks more quickly and confidently 3
• Potential to delay transitioning to a power wheelchair, reducing perceived stigma and impacting health outcomes 4

Considerations for Power-Assist Devices

• Safety concerns, such as indoor maneuverability and user preferences, highlight the need for specialized training and retrofitting 2
• Different power-assist devices may be more suitable for specific environments, such as indoor or outdoor use 4

Medical Necessity

The user's current mobility issues and the development of new physical problems while using a standard manual wheelchair suggest a need for a custom manual wheelchair with a power-assist device. This device could help alleviate the user's symptoms and improve their overall mobility and independence 5, 2, 3, 4.