Clinician Interview: Becky Breaux, PhD, MS, OTR/L, ATP
Michelle L. Lange, OTR/L, ATP/SMS

Becky Breaux is an occupational therapist who works extensively in wheelchair seating and mobility. She is an Assistive Technology Specialist and Senior Research Instructor at the Assistive Technology Clinic, part of the Center for Inclusive Design and Engineering (CIDE) at the University of Colorado in Denver. She is also the co-author of a chapter on Power Mobility Categories and Clinical Indicators in the new 2nd edition of Seating and Wheeled Mobility: a clinical resource guide.

Becky was more than willing to share her thoughts on the value of Dynamic Backs in our ongoing efforts to achieve a reasonable funding amount for this component under the new CMS fee determination schedule.

Becky, can you summarize your concerns about the implications of the new CMS fee determination schedule for Dynamic Backs?

I am an occupational therapist with more than 28 years of experience in the provision of complex rehabilitation technologies. I am greatly concerned about the new fee schedule for dynamic positioning hardware for backs (E2398) which is equal to the reimbursement for shock absorbers for manual wheelchairs (E1015). Insufficient reimbursement rates for dynamic back support hardware can potentially eliminate this product from the industry. If this occurs, many of my clients will face significant adverse consequences, including injury, loss of function, and reduced ability to participate in important life activities. The financial and emotional costs of denying individuals the equipment they need far outweigh any cost-savings for CMS.

What is your experience when using Dynamic Backs for the clients you work with?

Over the past ten years, I have recommended dynamic hardware for back supports for more than 25 clients on my caseload. Dynamic hardware for back supports is a robust and complex technology that meets a unique need based on its design. These devices can sustain significant forces applied by clients during whole body extensor spasms or repetitive rocking for sensory stimulation. Research shows that some individuals exert forces up to 200 times their body weight during whole body extensor spasms.

Client Injury. I’ve worked with multiple clients who have injured themselves when extending against an immovable back support, and in some cases even stand up in their wheelchairs. Their injuries have included bruises, scrapes, skin injuries (i.e., open sores on their torso and shoulders), and severe pain.

Equipment Damage. In my experience, dynamic hardware for back supports not only reduces incidences of client injury, but also reduces damage to wheelchairs and seating systems. I work with clients who break their back supports repeatedly without this equipment. For example, one client broke the hardware on her back more than five times in one year before she started using the dynamic backrest hardware. Since receiving the dynamic hardware, these problems have been eliminated. When a client’s hardware breaks, the wheelchair may be unsafe or unusable, stranding a person at home until their wheelchair is repaired. Repairs can unfortunately take several weeks or more per incident, which has led to some of the clients I work with spending many weeks per year without a working wheelchair and seating system.

Maintaining Posture and Function. Dynamic hardware for back supports also helps clients maintain their position in the wheelchair. For example, I work with several clients who must have dynamic hardware on their back supports to operate their power wheelchairs independently. Without this hardware, their bodies will migrate out of position in the seating system and make it very difficult, unsafe, or impossible for them to operate the power wheelchair using their joystick, head array, or other driving method.

Anything else you would like to add?

Dynamic back supports meet a unique but critical need for many clients using wheelchairs. These devices are saving money in the long run by reducing the rate of repairs to equipment and by preventing client injuries. No other products on the market, including seating suspension, will adequately and effectively address these problems.

Thanks so much for sharing your thoughts on this important subject, Becky! And thanks for all you do for the clients you serve and for our industry!