Name of the Procedure:

Manual Wheelchair Accessory: Manual Standing System (HCPCS E2230)

Summary

The manual standing system is an accessory for manual wheelchairs that enables users to go from a seated to a standing position. This system helps improve mobility, independence, and overall well-being for those who cannot stand unassisted.

Purpose

The manual standing system is designed for individuals with mobility impairments, such as spinal cord injuries, multiple sclerosis, or cerebral palsy. The main goals are to enhance mobility and independence, promote better circulation, improve muscle tone, and reduce the risk of pressure sores and osteoporosis.

Indications

Use of the manual standing system is indicated for individuals who:

• Have limited or no ability to stand independently.
• Experience frequent pressure sores from prolonged sitting.
• Have a medical condition that benefits from weight-bearing activities.

Potential users should meet criteria like having sufficient upper body strength to operate the system and not having severe spasticity that would obstruct the use of the device.

Preparation

Patients should:

• Consult with their healthcare provider to assess suitability for the system.
• Participate in strength and flexibility training specific to handling the system.
• Undergo a fitting session to ensure proper adjustment and comfort.

Procedure Description

1. Assessment and Fitting: A healthcare professional assesses the patient's needs and fits the device to their wheelchair.
2. Training: The patient and caregivers receive training on how to safely use the system.
3. Operation:
   • The patient manually operates a set of levers and supports to transition from a sitting to a standing position.
   • The systems may use mechanical springs or manual hydraulics to assist the standing process.
4. Use: The patient uses the standing system as needed throughout the day.

No anesthesia or sedation is involved.

Duration

The installation and training process typically takes a few hours over multiple sessions. Daily operations of the system are a matter of seconds to minutes.

Setting

This procedure is performed in outpatient clinics, rehabilitation centers, or at the patient’s home by a trained professional.

Personnel

• Physical therapists
• Occupational therapists
• Rehabilitation engineers
• Wheelchair specialists

Risks and Complications

• Skin irritation or pressure sores from improper use.
• Muscle fatigue due to prolonged standing periods.
• Potential fall if the device is not used correctly.

Trained personnel help manage these risks through proper training and adjustments.

Benefits

• Enhanced mobility and independence.
• Improved circulation and reduced swelling.
• Better muscle tone and bone density.
• Reduced risk of pressure sores and related complications. Benefits can be noticed immediately but improve over consistent use.

Recovery

There is no traditional recovery since it is an accessory rather than a surgical intervention. Patients should follow:

• Regular strength and flexibility exercises.
• Routine checks and maintenance of the standing system.
• Follow-up appointments for reassessment and adjustments.

Alternatives

• Powered Standing Wheelchairs: Provide similar benefits with less physical effort required, but are typically more expensive and bulkier.
• Stationary Standing Frames: Offer a standing option without mobility but don’t support independent movement.
• Assistive Technology: Devices like walkers or crutches, which may not be suitable for all patients depending on their physical condition.

Patient Experience

Patients might experience:

• Increased confidence and independence from the ability to stand.
• Physical benefits in terms of muscle tone and circulation.
• Initial discomfort or muscle fatigue, which decreases over time with regular use. Comfort measures include adjustable padding and regular breaks to prevent fatigue.