“A Medical Necessity” Part 2

written by James S.

Well part two of “A Medical Necessity” has been a learning experience for me to say the least. I started out with very good intentions hoping to find an easy way for all of us parents to get some help with acquiring adaptive cycles or recumbent tricycles for our children and for our disabled veterans, what ever special needs they have.  This  endeavor is going to take a little longer than a night or two from the looks of it. All that I can promise is to compile as much information as possible that will be the most beneficial  to everyone.

This is an excerpt from www.thefreelibrary.com along with a link to the complete article.

Typically, a piece of adaptive equipment is utilized to increase a child’s function. Examples of adaptive equipment or assistive technology are wheelchairs, lifts, standing frames, gait trainers,augmentative communication devices, bath chairs, and recreational items such as swings or tricycles. The process of obtaining a particular piece of equipment is defined primarily by the funding source. The funding source may be through your child’s health insurance; it may be through the child’s school system; or it could be through private funding.

My child needs a piece of adaptive equipment now what? Well, it depends!.

I have tried to find information on writing a letter of medical necessity and who is supposed to actually do the writing, us, the doctor/therapist, or both.

This is an excerpt from the article “Writing letters of medical necessity“, also from www.thefreelibrary.com.

While it is typically the duty of a medical professional to write a Letter of Medical Necessity, there are other people whose opinions can help sway those reviewing the claim. Teachers, case managers, counselors and parents all provide different points of view that are valid to establishing medical necessity. Their description of how the patient functions in various settings and how that can be improved with the desired intervention can not always be provided by a medical professional. While their views should not be submitted alone, they are an excellent complement to a medical opinion.

There is more information to come in the next installment of A medical necessity.

“A Medical Necessity” Part 1

written by James S.

I have been doing some research recently on the positive effects that bicycling can have on children and adults with disabilities. Having watched videos on the subject, read articles and listened to remarks from therapist on Youtube, everything seems to point to one conclusion. Bicycle riding is therapeutic, both mentally and physically for children as well as adults. The  problem is the cost. Most parents and adults wanting to get a recumbent tricycle or a bicycle that is made specifically for persons with disabilities can’t afford them. Carrying price tags ranging from two hundred eighty dollars for a basic tricycle to over five thousand dollars for a tandem cycle. If  a doctor and/or therapist decides that a child or adult needs the bicycle and/or tricycle for physical and emotional therapy, and tells the insurance company that it is medically necessary to help the child/adult with their therapy, then the insurance company should pay for it.  Right?

I began my search for the answer on About.com where Michel Bihari M.D. writes “ Health insurance companies provide coverage only for health-related services that they define or determine to be medically necessary.”
I have posted a link to the ABOUT.COM website Medical Necessity – Definition of Medical Necessity.

The link below is to the Free Online Medical Dictionary along with their definition of “medically necessary” and its criteria.

via medically necessary – definition of medically necessary in the Medical dictionary – by the Free Online Medical Dictionary, Thesaurus and Encyclopedia..has this definition:
Managed care adjective Referring to a covered service or treatment that is absolutely necessary to protect and enhance the health status of a Pt, and could adversely affect the Pt’s condition if omitted, in accordance with accepted standards of medical practice. See Futility.

a. Appropriate for the Sx and diagnosis or treatment of a condition, illness or injury
b. Provided for the diagnosis or the direct care and treatment of the condition, illness or injury
c. In accordance with the standards of good medical practice in the service area
d. Not primarily for the convenience of a plan member or a plan provider
e. The most appropriate level or type of service or supply which can safely be provided to the plan member.
From the criteria that is listed, a special needs bicycle,tricycle, or recumbent tricycle  seems to meet everything that is required for these to be deemed medically necessary.
This a YouTube video about Freedom concepts bikes. In the video a therapist talks about how bicycling helps children and adults with disabilities.

Lightfoot Cycles Two-Fun

Over the course of four months, BikeAble has found itself recommending one bike again and again for a variety of situations. That bike is the Lightfoot Cycles Two-Fun, a hybrid tandem that features a full recumbent trike up front and the rear 2/3 of an upright bike in the back.

lightfoot-cycles-two-fun-2

The Two-Fun is ideal in situations where assistance is required but some sense of independence is desired.  In its stock configuration, the Two-Fun has a steering system that is link to a set of grips at the rear of the front trike.  This allows for control from behind both for a second cyclist or for someone simply walking/pushing from the back (the rear bike is easily detached).

So how is it that we’ve managed to mention this tandem to so many people lately?  Simple – we’ve had questions come in from folks who have very unique situations and all of them require an assistant for propulsion and control.

lightfoot-cycles-two-fun-4The first instance was for a student who had outgrown her guided trike.  Guided trikes are relatively common for children from toddlers to early teens, but that particular market does not usually extend to products for adults.  This student, however, had reached adult size and would soon need a guided solution in order to continue her therapeutic cycling.

The Two-Fun fit the bill easily as a adult guided trike.  By removing the back bike half of the Two-Fun, the attendant is able to push the trike along using the rear grips and provide steering through the same.  The trike is able to be modified to suit the student’s positioning needs.  And, on top of that, the trike can be converted to a fixed gear transmission so that the student receives the therapeutic range of motion activity that she needs.

The second instance was for an individual who wished to include an elderly family member on rides.  The elderly rider was described as being unable to cycle indepdently.  There are a few possible solutions for this scenario (using wheelchair bikes), but the Two-Fun was the solution that had a comfortable seat height, lateral seat supports, access to pedals for what assistance the rider can provide, and the ability to become an independent trike should the elderly rider wish to attempt solo cycling at some point in the future.

lightfoot-cycles-two-fun-3The third instance was one rather close to my heart – a father/son cycling need.  The needs are slightly reversed here, though.  In this case, the father wanted to ride recumbent and maintain control of the bike while his 34 year old son with a developmental disability wanted to remain on an upright bike.  Bikes such as the Hase Pino and Bilenky Viewpoint would not work in this scenario as both place the control of the bike with the upright rider in the rear.

The Two-Fun would work well for this team as the controls from the rear could be disconnected so that the father can maintain all steering, shifting, and pace control from the comfort of a recumbent trike while his son enjoys the upright position he so desires.

Is it any wonder we keep coming back to the Two-Fun as an incredibly versatile accessible cycling solution?  Its flexibility and customizability mean that it can suit nearly any mixed ability tandem need.  On top of that, Lightfoot Cycles has a strong history of supporting special needs with a wide range of product.

Unfortunately, Lightfoot Cycles does not list the price of the Two-Fun on their site.  We do know that the Two-Fun without the rear bike runs for $3600.  Guessing from that, we would expect the full Two-Fun to cost in the $4300 range.

More information on the Two-Fun can be found at the Lightfoot Cycles web site.

ONE-OFF Titanium – the mountain handtrike

Image of ONE-OFF rider on trail, gritting his teethI was recently contacted to do research into a variety of handcycles. The parameters were fairly straightforward: satisfactory gear inch range; adjustable foot rest position; seat that won’t be a problem for spine curvature.

That sent me off on a search for a good solution, a search that pretty much ended with the Hase Kettwiesel handcycle. But I didn’t want to stop there. A little more digging turned up the ONE-OFF Titanium, a full blown mountain bike/trike that puts the rider in a prone position.

The core advantage of the ONE-OFF is instantly recognized: it is an off-road handcycle. In the niche that is handcycling, most cycles are either for racing or for casual use. Nobody tackles the handcycling equivalent of mountain biking. What’s amazing is that the ONE-OFF hasn’t been more widely copied since its introduction.

So what are the other advantages of the ONE-OFF?

It offers a prone position, allowing the rider to put their body weight into stabilizing the trike. That body weight serves a second purpose – it can also control steering. The torso cushion of the ONE-OFF rests on a pivot that links to the steering. Lean to the left and you’ll turn left. Lean to the right, turn right. The result is the ability to turn the trike without having to let up on the pedaling.

Photo of back side of ONE-OFF handtrikeThe ONE-OFF also allows steering through the handles to which the brake levers are mounted. This allows the rider to switch to a more stable control mechanism for high speed descents. It also provides a resting point for the hands should the rider want to flex a bit and relieve some of that torso pressure.

Unfortunately, the ONE-OFF site doesn’t provide much more detail about the specs of the bike. No word on gear inch range, types of disc brakes, wheel sizes, or availability through third parties. Judging by the contact info on the ONE-OFF site, all ONE-OFF handcycles are made to fit the rider’s specifications.

If you’re a handcyclist who knows there’s more to trail riding than riding rail trails, the ONE-OFF is probably worth some investigation. No other handcycle that we know of will get you up a mountain.

For those who might be interested, included below is a YouTube video showing a method of transferring into and out of the ONE-OFF.

High ride tadpole trike

Recumbent trikes have an instant appeal for both disabled and elderly riders as they provide stability and support that are lacking in cycles of the two-wheeled variety. However, a trike isn’t just a matter of having three wheels. They come in all shapes and sizes, not all of which suit every rider.

One common comment made when people see a standard tadpole trike is that it is far too low to the ground to be entered and exited comfortably. For anyone with back problems, body strength issues, or reasonable fears of being far too low to be visible, tadpole trikes seem like a very cool but very unpractical solution. Delta trikes, with their higher center of gravity and chair level seat, often become the ride of choice for that audience.

Photo showing Cycle Genius logo at the front of the tricycle.

Cycle Genius is of the opinion that tadpoles don’t have to be low riders, and they’ve proven it with the introduction of their Phoenix tricycle.

Dubbed the “Mobility Extender”, the Phoenix was meant to bridge the gap between the height of a delta and the lateral stability of a tadpole. It does this admirably though at a cost.

The sheer size of the Phoenix gives it some real heft, so keep that in mind if you need to load, transport, and unload the trike yourself for travel. With that heft comes a very smooth ride – you’ll have none of the jarring ride of tadpoles like the Catrike and WizWheelz models. For those seeking a sense of thrill, the Phoenix is not your bird. If, however, you’re seeking what might be called a “cruiser” trike that gives up fast handling and high speeds for a softer, slower ride, then the Phoenix is right up your alley.

Upon first seeing the Phoenix, my thoughts instantly went to trail use. The Phoenix seems an ideal trike for casual rides away from busy streets. That is until I measured its width. Most trails, whether multi-use paths or rail trails, feature gate posts to prohibit motorized traffic. Those posts are typically 36″ inches apart from one another. Fine for most bikes and trikes, and enough width for wheelchairs and scooters, but guess what? The Phoenix measures 42″ across at its widest point. If rail trail use is your plan, you may need to look to a slimmer trike.

Fortunately, that’s the only real negative to the Phoenix. Unlike many trikes, the Phoenix adjusts for rider height via an adjustable seat. There is no boom to adjust. This means that everybody from a height of 4’1″ to 6’8″ will be able to use the Phoenix easily. The seat angle is also adjustable to suit those who wish for a greater or lesser degree of recline.

Image showing heel strike while turning the Phoenix tricycle.The pedals will take platforms for foot restraints, but a word of caution: if you need to use restraints, try them on the Phoenix at a dealer before purchase if at all possible. While riding the Phoenix myself, I noticed that the heel of my size 11 shoe was striking the steering linkage during tight turns. You’ll want to make sure that any pedal platforms you need to use are going to clear the linkage. Note, however, that I was pedaling using the balls of my feet. If you tend towards the middle or heel of the foot as your point of contact with the pedal, you’ll probably have room to spare. Most casual riders will place the foot further forward, and some platforms are designed to hold the foot at the middle position.

Of interest to those who lack the use of both arms – the Phoenix by default links both front disc brakes to a single brake lever. This lever can be placed on the same side as the rear shifter for one handed operation. There is a second brake lever for the rear tire, but that is used mostly as a parking brake. Also, the shifter is an SRAM Dual Drive, giving you access to all 24 gears from a single grip.

All in all, the Cycle Genius Phoenix isn’t a bad trike. If you are performance oriented or are looking for something sleek, the Phoenix is not for you. If you are looking for an adaptable trike that lets you pedal around with ease, the Phoenix is worth a test ride.

At print time, Cycle Genius was offering the Phoenix for $1,600, minus shipping and assembly. For complete specifications, please see the Cycle Genius site.

Bikes for Boomers

TV host sits on RANS recumbent bikeMSN is carrying video of a segment from the May 25, 2008 episode of The Today Show. The segment is all about bikes for baby boomers – comfort bikes!

All of the bikes featured are stock bikes with no modifications whatsoever. If you’re getting on in years and finding that cycling is just a bit too painful, one of the featured bikes is bound to be great for you.

The bikes featured were:

  • Electra Townie Balloon 8 ($750)
  • Trek Lime ($850)
  • Sun EZ Sport AX ($1350)
  • Biria EX Board Top 3 ($440)
  • Dahon Ciao 8 ($790)

Hase revises the Trets trailerbike

Hase Spezialrader has offered the Hase Trets trailerbike for some time. The utility of the Trets was that it was a recumbent trailerbike into which a child with limited trunk support could be strapped and still have access to his/her own set of pedals. It also employed a 7 speed shifter and a freewheel to allow the child to determine his/her level of work while pedaling. The one main requirement, however, was that it be hitched to a lead bike that would provide it with direction.

Not any more. Hase has modified the Trets so that it can now accept a front fork, turning the Trets into an independent delta trike.

The Hase Trets Trailerbike with delta trike fork accessory

The Trets is largely unchanged aside from the fork modification, though it should be noted that the shifter remains in the lower position (by the seat) even with the addition of the handle bars. If a child needs help keeping their hands in place on the grips, they will likely be unable to move their hands to change gears.

The downside to these revisions is, as usual, the cost. The Trets originally sold for around $1,350. The price with the trike revision, according to BentRider Online, is now $2,490. That puts it well within range of adapted trikes from the likes of Adaptivemall. The main question becomes one of positioning – is your child able to pedal from a recumbent position or does he/she require a more upright stance?

It’s always good to have alternatives, and the nice thing about the Trets is that when your child tires of pedaling, you can convert it back into a trailer to just bring them along for the ride.