Categories of Equipment

When looking into what equipment may be appropriate for someone with a disability or sustained injury, there are often many options to consider. However, there are two categories of equipment that have distinct requirements and criteria: Durable Medical Equipment (DME) and Complex Rehabilitation Technology (CRT). DME wheelchairs are the standard wheelchairs you see in hospitals or nursing homes and are purchased in bulk to meet short term needs. DME power mobility devices include scooters and standard power wheelchairs with a captain’s seat and back. CRT products are significantly different from standard DME and include services along with products. For this reason, CRT a rigorous assistive technology that is deemed medically necessary by a licensed healthcare professional. Depending on the patient’s age and medical needs, knowledgeable professionals such as an assistive technology professional (ATP), seating and mobility specialist (SMS), or life care planner can recommend specific CRTs to support individual plans of care, and or improve patients’ quality of life.

Today, we’ll be demystifying common questions behind the differences between CRT products, specifically manual and power wheelchairs, and how they can benefit patients with specific and unique medical needs.

Benefits of Wheeled Mobility

Not everyone will be the right candidate for a wheelchair, but in cases where a patient may be at high risk of falls, is not functionally ambulatory, has decreased functional endurance, or requires increased time to move through day-to-day tasks, an appropriate wheelchair can be life changing. Wheeled mobility can prove to be a huge benefit for boosting quality of life by enabling individuals to access their home and community and allowing them to take part in everyday tasks. Furthermore, wheelchairs can improve one’s functional independence offering many social and mental health benefits.

Am I a Good Candidate for CRT?

To learn if you may be a good candidate for CRT wheeled mobility, you will need to consult your physical therapist, or occupational therapist. They will perform a wheelchair evaluation and identify your functional level as it pertains to mobility related activities of daily living, evaluate your home environment, assess your strength range of motion and posture, discuss your goals etc. You and your therapist will then consult with an assistive technology professional or a seating and mobility specialist to determine the manufacturer, model, dimensions, specific components, seating system and necessary modifications. Once a need for assistive technology is confirmed, your medical professionals will prepare a Letter of Medical Necessity (LMN), which is then sent to a physician for approval and signature. Lastly, you’ll go through a wheelchair fitting at an outpatient clinic or your home, to determine specific fittings, adjustments, programming etc. Here are some more examples of users who may benefit from CRT equipment:

• Needs specific dimensions/customization to maintain proper posture
• Propels on varied surfaces whether indoors or outdoors
• Has a progressive condition
• Is unable to ambulate

Manual vs. Power Wheelchairs

Determining whether a patient needs a manual or power wheelchair depends on several factors. A medical professional will have to evaluate the individuals upper extremity function and specific  needs, in order to understand which features the patient will need.

• Manual wheelchairs are categorized into five options: K0001/K0002, K0003, K0004, Tilt-in-space, and K0005. The only CRT manual wheelchairs are Tilt-in-space and K0005.
  • Tilt-in-space (K004 + E1161): Dependent Manual Wheelchair. This wheelchair is for patients who are unable to perform independent pressure relief and require gravity-assisted positioning. This chair helps increase sitting tolerance, head posture, trunk control, and safe positioning for feeding or gravity-assisted swallowing.
  • K0005: Ultra-Lightweight Wheelchair for the full-time wheelchair user. This wheelchair will have to be customized, from the axle, camber, seat-to-back angle and requires a letter of medical necessity.
• Power wheelchairs are for patients who are unable to consistently propel a manual wheelchair due to upper extremity limitations. In order to use a power wheelchair, the patient’s home must also have adequate access and space for maneuvering a power wheelchair. The categories for power wheelchairs are as follows: scooter, DME group 1, DME group 2, CRT group 3, CRT group 4, and CRT group 5.
  • CRT Group 3: This power wheelchair meets all of the basic power wheelchair requirements and more:
    • Better drive wheel suspension
    • Multiple alternative drive control options
    • Power tilt, recline, power legs, and power elevate options
    • Greater obstacle climb and battery range
    • Tighter turning radius and increased speeds

Patients who require a CRT Group 3 power wheelchair may have additional medical conditions, such as:

• Neurological condition
• Myopathy
• Congenital Skeletal Deformity

• CRT Group 4: Group 4 bases are designed for stability to accommodate power tilt, recline, elevating/articulating leg rests, and standing. It can withstand multiple terrains and decrease bumps and vibrations. Lastly, the Group 4 batteries are more powerful and last longer distances. This category is for patients who require improved suspension to minimize pain over bumps, and need a stable base to use the seat while it elevates.
• CRT Group 5: This category is for pediatric clients.

How to Select Proper Wheelchair Seating

A life care planner can help evaluate realistic costs and replacement schedules in the areas of seating and mobility as it fits into your overall life care plan. Additionally, consulting a licensed medical professional, such as a physiatrist, physical therapist, or occupational therapist can determine your need and requirements for complex rehabilitation technology.