Speaker: Use data, commit your time

Physical therapist Jean Minkel believes if clinicians can provide evidence that manual wheelchairs, used over time, can result in injuries--and they can, she says--the agency needs to open up its wallet for power wheelchairs. Here's what Minkel, the featured clinical speaker at CELA in February, told HME News about comparing wheelchairs to shoes.

HME News: You work with adults, so you see what happens when a person doesn't get the right wheelchair early on in life.

Jean Minkel: The information regarding aging with a disability should be influencing our practices today. I love the expression "the genius of and" as opposed to "the tyranny of or." We need to think in a big picture way about how many young people could really benefit from a power chair and a manual chair. A power chair is more about efficient, long-distance, get-where-you-need-to-go and a manual chair is about access and/or exercise. It's two sets of shoes for two separate purposes.

HME: What does the evidence say about using manual wheelchairs over an extended period of time?

Minkel: There's an abundance of evidence that increased force and increased repetition from pushing a manual wheelchair, from doing push-up pressure relief--all of these activities have a cumulative effect that results in carpal tunnel, rotator cuff problems and even some elbow bursitis problems.

HME: Is having both a manual and power wheelchair realistic from a funding perspective?

Minkel: It's not fair to say, "There's no funding for that." We have to professionally advocate the data. You can get a $15 piece of foam at Michael's, but it's going to bottom out and you're going to have really high interface pressures. That's why I need a high-end, matrix-molded foam cushion. We need to apply the same clinical evidence to justify an efficient mobility system.

HME: What about other funding sources?

Minkel: I do think there needs to be a certain amount of creativity. If you have a 12-year-old child, do you really want to replace the manual chair with another manual chair or is this a chance to use the manual chair as a back up and introduce power and alternate the chairs? Also, I think all too often we don't include people in resource allocation.

HME: Are providers hesitant to provide what you recommend because of funding difficulties?

Minkel: It's using evidence and being willing to, professionally, invest the time. So no, my providers don't push back.