SPECIAL NEEDS EQUIPMENT PROGRAM INFORMATION

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SPECIAL NEEDS EQUIPMENT

PROGRAM INFORMATION

General Program Information

Special Needs Equipment Depot

Locations

Universal Loan Equipment

Restricted Loan Equipment

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GENERAL PROGRAM INFORMATION

June 1, 2014

Special Needs Equipment (SNE) is one of the Saskatchewan Aids to Independent Living (SAIL) programs offered by the Ministry of Health. The Saskatchewan Abilities Council operates the program under contract with the Ministry of Health.

Special Needs Equipment is:

• a loan program for people of Saskatchewan

• a recycle program – equipment is provided to clients from an available pool of recycled equipment

• designed to meet the long-term needs of the client when equipment is required for more than three months

• administered from five SNE depots located throughout the province

This manual has been prepared by the Saskatchewan Abilities Council to provide general program information. For a complete list of SAIL

programs and policies please refer to their website at http://www.health.gov.sk.ca/sail.

GENERAL ELIGIBILITY REQUIREMENTS – UNIVERSAL LOAN EQUIPMENT

Applicant must be a resident of Saskatchewan

Applicant must possess a valid Saskatchewan Health Services Card

Applicant must be referred for service by an approved health professional – (Refer to the Appendix for the Special Needs Equipment Eligible Requisitioners list.)

Unless authorized by Saskatchewan Health, the services must be obtained in Saskatchewan

Applicant is not eligible to receive the service from any other agency or government:

First Nations and Inuit Health Branch, Health Canada – contact Non-Insured Health Benefits Saskatchewan at 1-866-885-3933 Department of Veterans Affairs Act (Canada)

Canadian Armed Forces Federal Penitentiaries

Workers Compensation Board

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ELIGIBILITY REQUIREMENTS - RESTRICTED LOAN EQUIPMENT Recipients of the Supplementary Health Program (SHP),

Saskatchewan Income Plan (SIP), or the Family Health Benefits program (FHB) may be eligible for the loan of additional low-cost devices at no charge. The SAIL general eligibility requirements listed above must also be met. For clarification of SHP, SIP, or FHB coverage, contact the Ministry of Health at (306) 787-7121.

SAIL benefits are provided to people residing in the community. Personal care home, special care home, and group home residents are only eligible for mobility equipment (walkers,

wheelchairs with a cushion).

Patients in an acute care facility are not eligible for SAIL benefits except as part of a definitive discharge plan.

ACCESSING THE LOAN

All equipment loans require a requisition to be signed by the appropriate requisitioning authority. Each piece of equipment in the manual has the approved requisitioning authority listed. Refer to the Appendix for a complete listing of program equipment and eligible requisitioners. Requisitions may be obtained by calling the local SNE depot or by

emailing [email protected]. Refer to the Appendix for printable (Adobe PDF) requisition and application forms.

Special Needs Equipment Requisition

Special Needs Equipment Wheelchair Requisition

Requisitioners must be registered in the SNE database. Call your local SNE depot to confirm or have your name added to the requisitioning list. All requisitions must be complete and legible or they may be returned to the requisitioner and cause delays in equipment delivery for the client. Please note the following when completing SNE requisitions:

A shipping (street) address is required if the equipment is to be delivered. Deliveries cannot be made to a PO Box.

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Include relevant equipment sizing information (i.e. client wrist height for walker, desired seat-to-floor height for a wheelchair, cushion size, ceiling height for Sask-A-Poles, etc.) for all requests. Provide an explanation if similar equipment has been issued to the client previously. If equipment issued previously has not been returned and an explanation is not provided, the equipment will NOT be replaced.

The weight capacity varies for all equipment types. Provide the client’s weight to ensure that appropriate equipment is issued. Attach any additional application forms when ordering cushions, specialized wheelchairs, or hospital beds.

Please ensure that equipment needs have been discussed with the client before equipment is requisitioned. Equipment if often shipped back to the program unopened and refused by the client resulting in

unnecessary costs for the program.

Frequently equipment is added on to requisitions in different

handwriting or different pen colour. Please be advised that Special Needs Equipment will not provide this equipment unless it can be

confirmed that the authorized signee has requisitioned and approved the safe use of the equipment.

Models of equipment described within this manual are the current products purchased by the program. Alternate models may be substituted for models described dependent on availability.

Requisitions can be submitted to any SNE depot by mail, fax or dropped off in person. Please confirm with the local depot that the fax has been received and is legible. To avoid duplication of orders please do NOT mail the form to the depot if it has been

previously faxed. EQUIPMENT PICK-UP

Clients wishing to pick up their equipment can do so at any SNE depot. Hours of operation are 8:30 to 4:30 Monday to Friday. (Depots are closed on statutory holidays.) Equipment does not have to be picked up by the client requiring the equipment. Family members or friends can pick it up on their behalf. A completed requisition must be presented in order for the equipment to be released.

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DELIVERY

In stock equipment that is to be delivered to the client is generally shipped within two weeks of the receipt of the completed requisition. Custom orders will be delayed.

Clients living in an urban center that has a SNE depot are responsible for picking up their equipment. If they are unable to do so, delivery costs are charged to the client.

SNE will cover the charges for equipment that is shipped to locations that do not have a SNE depot. Equipment is shipped by the least costly and most direct method.

For larger items such as hospital beds, delivery companies will require assistance from the receiver to help with the unloading of the bed. INSTALLATION OF EQUIPMENT

The SNE program does not install equipment. Installation of equipment is the client’s responsibility, including any costs involved.

EQUIPMENT REPAIRS

Trained technicians at each SNE depot will repair loaned equipment at no cost to the client. Appointments are required to ensure that a technician is available to perform the service. The client’s personal health services number is also required to book an appointment. If equipment cannot be repaired, SNE technicians will provide a

replacement piece of equipment. Exact model replacements cannot be guaranteed due to product availability.

SNE will cost-share the shipping of equipment coming in for repairs for clients living in a center that has a SNE depot. Clients and SNE will each pay for one-way transport. SNE will cover the costs of shipping both to and from the SNE depot for people living in communities that do not have a depot.

If equipment is being sent in for repair, please ensure that a note is securely attached to the equipment. The note should include the following information:

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Maintenance and repair of privately-owned equipment is not a SAIL benefit.

EQUIPMENT REPLACEMENT

Equipment will be replaced for a client if:

1) The needs of the client have significantly changed making the existing equipment inappropriate (ex. weight gain/loss affecting wheelchair size, etc.) OR

2) The equipment requires extensive repair where SNE technicians have deemed it unrepairable (due to parts availability, cost to repair, etc.). Clients and/or therapists can request an assessment of the equipment be performed however, only SNE technicians will make the decision on whether the equipment requires

replacement.

EQUIPMENT OWNERSHIP

The Special Needs Equipment program retains ownership of all

equipment loaned to beneficiaries for their use. Such equipment must be returned to Special Needs Equipment when a beneficiary:

• has equipment replaced

• is deceased or no longer requires the equipment

• moves out of Saskatchewan

• becomes otherwise ineligible for the benefit. CLIENTS MOVING OUT OF PROVINCE

Equipment such as wheelchairs may be taken to the new province of residency and used during an interim period (approximately 3 months) until coverage is available in the new province. We ask the client or therapist to contact the Special Needs Equipment Manager to obtain necessary approval and discuss equipment alternatives prior to the move.

EQUIPMENT RETURN

When equipment is no longer being used by the client, it must be returned as soon as possible to the nearest SNE depot. SNE will accept shipping charges for equipment that is being returned if the client does not live in a city that has a depot. Please contact the nearest SNE depot for courier/transport company referrals for your location. It is the

responsibility of the client to make the necessary arrangements for pickup of the equipment.

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Please do not return equipment to SNE that is not part of the loan

program. All equipment issued is identified by a Saskatchewan Abilities Council return sticker and identification number.

Clients/caregivers may contact any SNE depot for a list of equipment currently on loan. The client’s health services card number will be required to access this information.

MAINTENANCE

Some items on the SNE program benefit list (i.e. bathtub lifts and hydraulic patient lifts) require regular scheduled preventative

maintenance. Clients with equipment on loan will be contacted by letter when the equipment maintenance is due. Upon confirmation with the client, the nearest SNE depot will replace the client’s equipment with newly-serviced equipment, and the old equipment will be returned to the SNE depot. SNE will cover the costs of shipping associated with this maintenance program.

Clients should inspect all loaned equipment on a regular basis and should concerns arise, contact a SNE depot immediately.

EQUIPMENT IDENTIFICATION

All loaned equipment is identified by a 6-digit unique identification number. This number is the code used to track who the equipment has been provided to and it is not to be removed from the equipment. If equipment does not have this number, and you believe that it is a loaned item, please contact the nearest SNE depot.

Please do not affix labels/stickers or write on equipment with marker to identify which client the equipment is on loan to. Should name

identification be required, please use a hospital band, luggage tag or similar to label.

TRANSFERRING EQUIPMENT BETWEEN CLIENTS

Equipment must be returned to the nearest SNE depot when it requires maintenance, cleaning and safety inspections before being reissued, or if it is no longer required by the client. Please do NOT transfer equipment without the approval of the SNE program.

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EQUIPMENT UPGRADES

Equipment will not be ordered with features that are not a benefit of the program (i.e. seats on walkers, environmental controls on wheelchairs or an elevated seat in a wheelchair). Clients cannot pay the difference in cost to have an additional feature added to a loan item.

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SASKATCHEWAN ABILITIES COUNCIL

SPECIAL NEEDS EQUIPMENT DEPOT LOCATIONS

October 30, 2014

Depots Mailing Address Telephone Number Fax Number Email Address Saskatoon 2310 Louise Ave. Saskatoon, SK S7J 2C7 (306) 664-6646 (306) 955-2162 [email protected] Regina #2-1723 Francis St. Regina, SK S4N 7N2 (306) 569-1262 (306) 352-4282 [email protected]

Prince Albert 1205 1st Ave. E. Prince Albert, SK S6V 2A9 (306) 922-0225 (306) 764-8376 [email protected] Swift Current #2-1505 Chaplin St. W. Swift Current, SK S9H 0H1 (306) 773-2071 (306) 773-7460 [email protected]

Yorkton 144 Ball Road Yorkton, SK S3N 3Z4

(306) 786-9255 (306) 783-1234

[email protected]

Hours of operation are Monday to Friday, 8:30 a.m. – 4:30 p.m. Depots are closed on all statutory holidays.

Use the Saskatoon mailing address above for inquires to be directed to: Carrie McComber, Special Needs Equipment Manager

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UNIVERSAL LOAN EQUIPMENT

April 1, 2014

Mobility Aids

Wheelchairs

Standard manual wheelchairs

Standard recliner manual wheelchairs Ultralight manual wheelchairs

Tilt-in-space manual wheelchairs Standard power wheelchairs Tilt-in-space power wheelchairs Wheelchair cushions

Foam T-foam

Contoured foam

Matrx Posture Seat (PS) Gel

Jay cushions Roho cushions

Vicair Vector cushions Walkers

Folding walkers

Kaye postural walkers

Gutter attachment (accessory) Auto-stop kit (accessory) Paediatric Mobility Aids

Convaid Cruiser Kid Kart

Forearm Crutches

Environmental Aids

Bathroom Accessories Transfer tub seats Stationary commodes Combination commodes Child’s commodes Bathtub lifts Transfer Assists Sask-A-Poles Sask-A-Pole trapezes Sask-A-Pole kneeboards

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Hydraulic patient lifts Hospital Beds & Accessories

Electric hospital beds with mattresses Overbed tables

Other Environmental Aids

Alternating pressure pump and mattress sets Lymphedema control units

Mobility Aids and Environmental Aids listed above are available at NO CHARGE to all SAIL beneficiaries. See general eligibility

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RESTRICTED LOAN EQUIPMENT (SIP, SHP AND FHB)

April 1, 2014

Mobility Aids

Canes & Crutches

Off set handle canes Quad (four point) canes Gutter canes

Walk canes Axillary crutches Quad crutches

Gutter crutch attachment (accessory) Ice gripper (accessory)

Environmental Aids

Bathroom Accessories Bathtub clamps Wall bars

Utility bath seats (with and without back) Raised toilet seats

Toilet arm rest sets Other Environmental Aids

Helping hand reachers Transfer boards

See Eligibility Requirements for Restricted Loan Equipment on page 3.

Restricted loan equipment types are also available for purchase at all SNE depots.

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WHEELCHAIRS

Wheelchair Policies

Measurement Considerations

Summary of Eligibility Criteria

Standard Wheelchair

Standard Recliner

Ultralight

Tilt-In-Space Manual

Power

Tilt-In-Space Power

Wheelchair Tray (Accessory)

Oxygen Tank Holder (Accessory)

Elevating Leg Rests (Accessory)

Anti-Tippers (Accessory)

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WHEELCHAIR POLICIES

April 1, 2014 GENERAL POLICIES

Clients are eligible for ONE manual wheelchair through the Special Needs Equipment program. If a replacement

wheelchair is requested, once it has been received by the client, the original chair must be returned to the program. Wheelchairs will be replaced in two scenarios: if there has been a significant change in needs of the client where the equipment is no longer appropriate or, if the wheelchair requires repair and parts are unavailable or it is no longer economical to repair.

A requisition form signed by an authorized requisitioner is required for Special Needs Equipment technicians to make seating adaptations to wheelchairs (size changes, seat-to-floor height changes, etc.)

Clients may contact the Special Needs Equipment program directly to make minor wheelchair repairs (such as replace arm pads, brakes, etc.)

If equipment is custom ordered for the client (i.e. bariatric sized wheelchairs) it will not be re-ordered due to incorrect measurements being provided. Please measure carefully! GENERAL POLICIES – POWER WHEELCHAIR CLIENTS

Clients are eligible for ONE power or power tilt-in-space wheelchair through the Special Needs Equipment program. Clients using a power or power tilt-in-space wheelchair are eligible to receive a standard manual wheelchair as a back-up to their power mobility. Lightweight or ultralight wheelchairs will not generally be authorized as back-up to a power

wheelchair.

SASKATCHEWAN AIDS TO INDEPENDENT LIVING (SAIL) TWO SPECIALIZED WHEELCHAIR POLICY

Two specialized wheelchairs are available to clients under the following circumstances:

Clients with a tilt-in-space power wheelchair who require constant tilt and are engaged in the community on a regular basis may request a tilt-in-space manual wheelchair as a back-up.

Clients will be allowed to keep an ultralight manual wheelchair when transitioning to a power wheelchair if they have a

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When the ultralight requires replacement, a standard wheelchair will be issued.

Applications for a second specialized wheelchair must include a letter justifying how the client meets the above criteria and should be sent to the Special Needs Equipment Manager.

ADAPTIVE SEATING FOR ALL WHEELCHAIR TYPES

Adaptive seating refers to modular or custom adaptations/modifications to a wheelchair. Examples would include headrests, bolsters, trays, drop seats, backrests or other supportive devices. Licensed

occupational and physical therapists as well as specialists such as orthopaedic surgeons and physiatrists have requisitioning authority for adaptive seating components.

Saskatoon

A standard prosthetic and orthotic requisition form should be completed for all adaptive seating and forwarded to the Saskatchewan Abilities Council at 2310 Louise Avenue, Saskatoon SK, S7J2C7.

In Saskatoon, clients may be assessed at seating clinics at Saskatoon City Hospital, at the Alvin Buckwold Child Development Program located at the Kinsmen Children’s Centre or in conjunction with seating

technicians at the Saskatchewan Abilities Council. Contact the

Saskatchewan Abilities Council - Specialized Seating Department 306-385-7215 for more information.

Regina

Adult clients from Regina and southern Saskatchewan who require adaptive seating in their wheelchairs are assessed at weekly held

seating clinics at Wascana Rehabilitation Center (WRC). A referral from a licensed healthcare practitioner is required for this service. Referrals can be faxed to (306) 766-5634.

A team approach is used in the seating clinics and team members include a physical therapist, occupational therapist and seating specialist. Examples of seating that is provided include supportive seats/backrests (custom or commercial), foam in place seats/backrests, head supports, foot supports, custom wheelchair trays and other inserts

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Prosthetic/Orthotics requisition. In addition to the P&O requisition, accurate client and/or wheelchair measurements must also be sent in order to construct the seating components. The requisitioning therapist may be required to attend consult/fitting appointments at WRC with the seating specialist for involved clients.

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MEASUREMENT CONSIDERATIONS

April 1, 2014 SEAT WIDTH

Measure across hips or thighs (whichever is widest)

SEAT DEPTH

Measure from the crease behind the knee to the back of the buttock

For people propelling the chair with their feet, allow 2-3” of

clearance between the seat and popliteal fossa (behind the knee) If a back cushion is to be used, add the compressed cushion thickness to the measurement

SEAT HEIGHT

Measure from the bottom of the heel to the crease behind the knee; knees should be at approximately 90°

Wheelchair standard seat heights are as follows:

• Standard chair =19 ½”

• Hemi low chair =17 ½”

If a seat cushion is to be used, subtract the compressed cushion thickness from the measurement

ARM HEIGHT

Measure from the seat to the bent elbow (90°)

If a seat cushion is to be used, add the compressed cushion thickness to the measurement

BACK HEIGHT

Measure from the seat platform to under the extended arm or to the inferior angle of the scapulae (shoulder blade) If a back cushion is to be used, add the compressed cushion thickness to the measurement

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SUMMARY OF ELIGIBILITY CRITERIA April 1, 2014 Level of Mobility Used <1/week (occasionally required to enhance mobility) Used >1/week but <2 hours/day (can walk <50 m.) > 2 hours/day but <10 hours (can walk <20 m.) Full time (>10 hours/day). Totally reliant on chair for mobility and daily activities. Unable to functionally ambulate. Clients Residing in the community – Independent Propulsion

Not Available Standard Standard Lightweight * Lightweight * Ultralight* Clients Residing in the community – Assisted Propulsion

Not Available Standard Standard Lightweight * Lightweight * Ultralight * Clients Residing in Special Care Homes, Group Homes and LTC – Independent Propulsion

Not Available Standard Standard Lightweight * Lightweight * Ultralight * Clients Residing in Special Care Homes, Group Homes and LTC - Assisted Propulsion

Not Available Standard Standard Lightweight *

Standard Lightweight *

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*Additional criteria must be met.

Wheelchairs are loaned for long-term use only. (The need for the wheelchair should be a minimum of three months.)

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STANDARD WHEELCHAIRS

November 15, 2015

MODELS/DESCRIPTION Invacare Tracer SX5 SPECIFICATIONS

Overall chair weight is 34 lbs.

Seat widths of 14-22” wide; seat depths of 16-18” deep

250 lbs. maximum weight capacity (300 lbs. on the 20” and 22” chair widths)

Standard adult wheelchair height is 19.5” from the floor 24” urethane rear tires with mag rims

8” front solid casters

Standard swing-away foot rests

Standard back upholstery height of 18”

Adjustable height (10-14”) flip-back arm rests with full arm pads (14” long)

Auto-style buckle seatbelt Push to lock brake assembly AVAILABLE OPTIONS

Lower seat-to-floor height options – 16.5” or 17.5” (height requested will determine size of rear tires and front casters) Desk length arm pads (10” long)

Elevating swing-away leg rests with calf pads Brake extensions

Anti-tippers (rear or front) Angle adjustable foot plates Amputee kit

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One-arm drive (must be previously trialed; not available on a 16.5” or 17.5” seat to floor height chairs)

Oxygen tank bracket (for clients on SAIL Home Oxygen Program) Wheelchair tray

ALTERNATE WHEELCHAIR MODELS

The standard Invacare Tracer SX5 model of wheelchair may be

substituted with a model listed below dependent on a variety of factors including client weight, requested chair size (width & depth), hip-angle adjustability, transit requirements, etc.

Model Available Widths Available Depths Seat To Floor Heights Weight Capacity Overall Weight Invacare 9000 XDT 16”- 22” 16” – 20” 17.5”, 19.5” or 21.5” 350 lbs. 36 lbs. Invacare Tracer IV 18” – 24” 18” – 20” 17.5” or 19.5” 350 or 450 lbs. * 42 lbs. Quickie LXI 12” – 20” 12” – 20” 16” – 20” 265 lbs. 30 lbs. Invacare Topaz (bariatric) 20” – 30” 18” – 20” 17.5” or 19.5” 700 or 1000 lbs. * 82 lbs. Quickie M6 (bariatric) 22” – 30” 18” – 22” 17” – 20” 650 lbs. 53 lbs. * Dependent on configuration

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ELIGIBILITY

Must meet general eligibility requirements

Must be required for use more than once a week (refer to Summary of Wheelchair Eligibility Criteria chart on p. 17-18). REQUISITIONING AUTHORITY

Physiatrist

Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse

ORDER DETAILS

Chair sizes must be ordered in even-numbered width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.)

Please ensure that accurate measurements are provided and a home assessment has been completed to ensure that the chair

will fit in the environment it will be used.

Approximately 8” should be added to the seat width of the wheelchair to estimate the overall width of the chair needed. FORMS

Special Needs Equipment Wheelchair Requisition

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STANDARD RECLINER WHEELCHAIRS

April 1, 2014

MODELS/DESCRIPTION

Invacare Tracer SX5 Recliner SPECIFICATIONS

Seat widths of 14-22”

Seat depths of 16” or 18”; 20” depth available by custom order only

Seat-to-floor height of 19 ½”

24” back height plus 10” removable head rest extension Dynamic recline range from 90 to 180 degrees

250 lbs. maximum weight capacity (300 lbs. on 20” and 22” widths)

Full length arm rest pads

Elevating swing-away leg rests Anti-tippers (rear)

ELIGIBILITY

Must meet general eligibility requirements

Must be required for use more than once a week (refer to Summary of Wheelchair Loan Criteria chart on p. 17-18). OPTIONS AVAILABLE

Hemi–low chair height of 17.5” from the floor Desk length arm pads

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REQUISITIONING AUTHORITY Physiatrist

Licensed Occupational Therapists and/or Physical Therapists ORDER DETAILS

Chair sizes must be ordered in even-numbered width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.)

Approximately 8” should be added to the seat width of the client to estimate the overall width of the chair.

FORMS

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ULTRALIGHT WHEELCHAIRS

August 1, 2014

Adult: Quickie 2 (folding), Quickie GPV (rigid) Paediatric: Zippie 2 (folding), Zippie GS (folding) SPECIFICATIONS Model Available Widths Available Depths Seat To Floor Heights Weight Capacity Overall Weight Transit Option Available Quickie 2 12”-22” 12”-20” 14” – 22” 265 lbs. (HD - 350 lbs.) 29 lbs. Yes Quickie GPV 12”-22” 12”-22” 15” – 23” 250 lbs. 24 lbs. No Zippie 2 12”-16” 12”-18” 15” – 20” 165 lbs. 25 lbs. Yes Zippie GS 10”-18” 10”-20” 14” – 20” 165 lbs. 29 lbs. Yes

Quickie 2, Zippie 2 and Zippie GS are transit approved models for the occupant

24” mag full polyurethane rear wheels 8” polyurethane front casters

ELIGIBILITY

Must be required for use more than once a week (refer to Summary of Wheelchair Eligibility Criteria chart on p. 17-18).

In addition to the above eligibility requirements the following must be met:

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CHILDREN UNDER 16 YEARS OF AGE

The client requires the aid of a wheelchair to perform the activities of daily living, and

The client can independently perform more activities using an ultralight wheelchair (i.e. demonstrates a significant improvement in functional independence), and

The client can propel an ultralight wheelchair independently from both physical and cognitive perspectives, and

The client does not require specialized seating or a tilt-in-space mobility base. Extra support for the child’s trunk and sitting posture (adaptive seating) may be used if it does not impair the ability to propel the wheelchair.

OPTIONS AVAILABLE

20” or 22” rear wheels and 6” casters; to accommodate varying seat heights

REQUISITIONING AUTHORITY Physiatrist only

NOTE: Licensed Occupational Therapists and/or Physical Therapists may requisition replacement wheelchairs for clients once the initial approval has been provided by the physiatrist. ORDER DETAILS

Order chairs in even width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.) whenever possible

Odd sized wheelchairs (i.e. 17” width) are custom ordered and will only be considered for clients who are established independent wheelchair users. If a custom back is required, please consult with a Seating Technician to ensure that the back required is available in an odd width.

Approximately 8” should be added to the seat width of the client to estimate the overall width of the chair.

FORMS

Special Needs Equipment Wheelchair Requisition Specialized Wheelchair Application

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Application for ultralight wheelchairs (signed requisition and completed application form) must be sent directly to the Special

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TILT-IN-SPACE MANUAL WHEELCHAIRS

April 1, 2014

Advanced Mobility Systems (AMS) iTilt1 & iTilt2 SPECIFICATIONS

Seat widths of 14” – 24” Seat depths of 15” – 20”

30 degrees of maximum tilt for iTilt; 47 degrees on iTilt2 Overall chair weight 60 lbs.

Weight capacity of 250 lbs. (350 lbs on 22” and 24” widths) ALTERNATE WHEELCHAIR MODELS

The standard AMS iTilt model of wheelchair may be substituted with a model listed below dependent on a variety of factors.

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Model Available Widths Available Depths Seat To Floor Heights Weight Capacity Overall Weight Maximum Degree of Tilt Zippie TS paediatric 10” – 18” 13” – 20” 15.5” – 20” 165 lbs. 29 lbs. 45 Kid Kart TLC 6” – 13.5” 8” – 14” 75 lbs. 43 lbs. 30 Invacare Solara 12” – 24” 12” – 22” 12.5” – 19” 300 lbs. 73 lbs. 50 Quickie TS 14” – 20” 14” – 22” 16.5 – 20.75” 250 or 350 lbs. * 65 lbs. 53 PDG Stellar 14” – 32” 16” – 22” 14” – 20” 500 lbs. * 60 lbs. 45 PDG Bentley 14” – 32” 16” – 22” 15” – 20” 450 lbs. * 70 lbs. 20 * Dependent on configuration ELIGIBILITY

The following guidelines are intended to assist therapists with

applications. Although clients should meet the following criteria, it is not absolute. Each client will be considered individually.

The client is wheelchair-dependent and their average daily use is at least 4 hours (adults) or 1-2 hours (children).

They meet one of the following two categories:

They have poor trunk and/or head control, and require support from the chair, or

the client requires pressure relief that cannot be addressed with cushioning.

The following factors will also be considered:

The client cannot consistently perform independent transfers. Caregiver availability and safety may be an issue.

The client demonstrates altered muscle tone that impairs trunk balance.

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The client has demonstrated benefit from the system through a trial.

Selection Committee for Specialized Seating

Designated therapist working as part of the seating team at Wascana Rehabilitation Centre

SASKATOON

Specialized seating refers to specialized manual wheelchairs (such as tilt in space) with custom or modular adaptations to provide a comfortable and supportive seating position for a client. Applications for specialized seating are completed by a licensed occupational therapist or physical therapist and are reviewed by the Selection Committee for

Specialized Seating. The application form provides detailed

information regarding orthopaedic/skin health considerations; critical details for fitting including height, weight, seating measurements; client and caregiver goals; identification of major seating concerns and

therapist goals. A physiatrist serves as a member of the Selection Committee so requisitions are completed at the meeting as applications are approved.

Specialized Seating clients may be assessed at seating clinics at Saskatoon City Hospital, at the Alvin Buckwold Child Development

Program located at the Kinsmen Children’s Centre or in conjunction with seating technicians at the Saskatchewan Abilities Council. Contact the Saskatchewan Abilities Council to obtain Specialized Seating application forms or for additional information contact Specialized Seating at 306-385-7215.

REGINA

Adult clients from Regina and southern Saskatchewan who require adaptive/specialized seating are assessed at weekly held seating clinics at Wascana Rehabilitation Center (WRC). A referral from a licensed healthcare practitioner is required for this service. Referrals can be faxed to (306) 766-5634. A team approach is used in the seating clinics and team members include a physical therapist, occupational therapist and seating specialist. Contact WRC – Adult Program at (306) 766-5517 for more information.

ORDER DETAILS

Chair sizes must be ordered in even-numbered width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.)

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FORMS

Special Needs Equipment Wheelchair Requisition Application for Specialized Seating Device

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POWER WHEELCHAIRS

August 1, 2014

Quickie P222 Invacare 3G Arrow MODELS/DESCRIPTION

Quickie Xperience Invacare TDX

Quickie P222 Invacare 3G Arrow Quickie Z500 Invacare TDX Spree Quickie Xcel SPECIFICATIONS Model Drive Wheel Position Overall Chair Width Available Seat Widths Overall Chair Length Available Seat Depths Weight Capacity Seat to Floor Heights Quickie Xperience (adult or paediatric) Mid Wheel 24” 10” – 22” 43” 10” – 22” 300 or 400 lbs. 15.75” – 20.5” Invacare TDX Mid Wheel 23.5” or 25.5” dependent on battery type 12” - 24” 45” 12” – 22” 300 or 400 lbs. 16.5” – 20.5” Quickie Xcel Mid Wheel 27.375” 20” – 28” 43.5” 17” – 24” 550 lbs. 16.5” – 20.5 “ Quickie P222 Rear Wheel 22” or 24.5” dependent on battery type 14” – 24” 43” 14” – 20” 350 lbs. 18” – 20”

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Invacare 3G Arrow Rear Wheel 25.5” 12” – 24” 45” 12” – 22” 300 or 400 lbs. 17.5” – 19.75” Invacare TDX Spree (paediatric) Mid Wheel 24” 12” – 16” 39” 12” – 18” 165 lbs. 14.5” - 18.5” ELIGIBILITY

In addition to meeting general eligibility requirements, the following must be met:

16YEARSANDOLDER

Beneficiaries who are functionally non-ambulant and are unable to manually propel a conventional lightweight or ultralight

wheelchair, and

the power wheelchair will be used as the client’s primary mode of mobility; and

beneficiaries who demonstrate sufficient cognition, judgement, spatial perception, and social interaction skills to safely control a power wheelchair in his/her environment, and

beneficiaries whose home or place of residence is accessible for power wheelchair use

CHILDREN UNDER 16 YEARS

Children who are wheelchair-dependent and are unable to propel a manual wheelchair in an efficient manner

Children who have had a home and/or school visit completed by a licensed occupational therapist and/or physical therapist

Children who are aware of the cause and effect of using switches as determined by an assessment (preferably in a trial wheelchair) Children who will demonstrate sufficient cognition, judgement, spatial perception, and social interaction skills to safely control a power wheelchair in his/her environment

A home assessment by a licensed occupational therapist and/or physical therapist is required.

OPTIONS AVAILABLE

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FORMS

Application for power wheelchairs (signed requisition and completed application form) must be sent directly to the Special

Needs Equipment Manager/Coordinator.

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TILT-IN-SPACE POWER WHEELCHAIRS

August 1, 2014

Mid Wheel Tilt / Recline/ Power Legrests MODELS/DESCRIPTION

Quickie Xperience Invacare TDX SP Quickie P222SE Invacare 3G Arrow Quickie Xcel Invacare TDX Spree SPECIFICATIONS Model Drive Wheel Position Available Seat Widths Available Seat Depths Weight Capacity Seat to Floor Heights Maximum Degree of Tilt Quickie Xperience (adult or paediatric) Mid Wheel 10” – 22” 10” – 22” 300 or 400 lbs. 15.75” – 20.5” 50 Invacare TDX Mid Wheel 12” - 24” 12” – 22” 300 or 400 lbs. 16.5” – 20.5” 60 Quickie Xcel Mid Wheel 20” – 28” 17” – 24” 550 lbs. 16.5” – 20.5 “ 50 Quickie P222 Rear Wheel 14” – 24” 14” – 20” 350 lbs. 18” – 20” 50

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ELIGIBILITY

In addition to meeting general eligibility requirements, the following must be met:

Beneficiary meets the criteria outlined for a power wheelchair, and

demonstrates compliance and understanding of using tilt-in-space feature, and

has a history of pressure sores, or

has a significant predisposing condition to skin breakdown, such as C5 or higher quadriplegia, or

shows measureable limitations in respiratory function where documentation of objective data can be provided as to how a power tilt-in-space would maximize respiratory function, or requires trunk support from the chair, or

experiences progressive fatigue due to diagnosis OPTIONS AVAILABLE

Right or left hand proportional control Full or desk length arm pads

70, 80 or 90 degree swing-away footrests; Centre mount footboard; manual elevating leg rests

Attendant control - NOTE: this option will not be provided for clients using a standard joystick controller.

FORMS

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Application for power wheelchairs (signed requisition and completed application form) must be sent directly to the Special

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WHEELCHAIR TRAY (ACCESSORY)

April 1, 2014

SPECIFICATIONS

Made of white plastic

Secures to wheelchair arm assembly with Velcro straps Fits wheelchairs 16” and 18” wide

ELIGIBILITY

Provided for use on Special Needs Equipment issued wheelchair only.

ORDER DETAILS

Please provide the ID number and type of wheelchair being used by the client

Can be ordered on chair with a new equipment issue or as a replacement part at a later date

Custom size or padded trays are to be ordered through Specialized Seating – Saskatchewan Abilities Council / Wascana Rehabilitation Center – Prosthetic & Orthotic requisition required

FORMS

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OXYGEN TANK BRACKET (ACCESSORY)

April 1, 2014

SPECIFICATIONS

Securely attaches to most models of manual wheelchairs ELIGIBILITY

• Must be on SAIL Home Oxygen Program

• Provided for use on Special Needs Equipment issued wheelchair only.

ORDER DETAILS

FORMS

Special Needs Equipment Wheelchair Requisition (on chair) OR, Special Needs Equipment Requisition (replacement part)

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ELEVATING LEG RESTS (ACCESSORY)

April 1, 2014

ELIGIBILITY

Provided for use on Special Needs Equipment issued wheelchair only.

ORDER DETAILS

Indicate right leg, left leg or both legs as required

FORMS

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ANTI-TIPPERS (ACCESSORY)

April 1, 2014

ELIGIBILITY

Must meet general eligibility requirements REQUISITIONING AUTHORITY

Physiatrist

ORDER DETAILS

Provide current seat-to-floor height of client’s wheelchair Can be ordered on chair with a new equipment issue or as a replacement part at a later date

FORMS

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CUSHIONS

Cushion Policies

Foam

T-Foam

Contoured Foam

Invacare Matrx Posture Seat (PS)

Gel

Jay 2 / Jay 2 Plus

Jay 2 Deep

Jay Active

Jay Easy

Roho Quadtro Select High/Low Profile

Roho Enhancer

Roho Contour Select

Roho Nexus Spirit

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CUSHION POLICIES

June 1, 2014 GENERAL POLICIES

• Clients are eligible for ONE cushion with cover through the Special Needs Equipment program to use as an accessory to their wheelchair. If a replacement cushion is required, once it has been received by the client, the original cushion must be returned to the program.

♦ Note: An exception may be granted to the policy above to allow clients who are at such high risk of skin

breakdown and cannot be without the cushion for an extended period of time (i.e over the weekend while the SNE depots are closed). A letter of medical rationale and requisition form signed by a Physiatrist or Plastic Surgeon is required. These requests should be directed to the Special Needs Equipment Manager. The back-up cushion provided will be the same type/size of the originally issued cushion.

• ONE cushion cover will be provided with the cushion.

• Clients who do not use a wheelchair for their primary mode of mobility are eligible for the loan of one cushion if they meet all of the following criteria:

♦ the client has a current pressure ulcer, past history of a pressure ulcer, or wound on the area of contact with the seating surface;

♦ the client has a Letter of Medical Necessity which

demonstrates a valid medical rationale for the provision of this cushion; and,

♦ the client is eligible for coverage through the

Supplementary Health Program, Seniors’ Income Plan, or Family Health Benefits Program.

• Cushions will be supplied in the most appropriate size to fit the wheelchair used by the client.

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FOAM CUSHIONS

April 1, 2014

Low density foam with a cloth cover

Low pressure relief and low positioning benefits

Primarily used to provide comfort on wheelchair seat SPECIFICATIONS

2” foam thickness

Available in 12-20” widths and 12-20” depths Weight capacity is 250 lbs.

Cushion weighs approximately 1 pound ELIGIBILITY

Client requires the use of a wheelchair for mobility and will use the cushion as an accessory to the wheelchair

SIP/SHP/FHB clients may be eligible for a cushion without the use of a wheelchair – see cushion general policies

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FORMS

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T-FOAM CUSHIONS

April 1, 2014

MODELS/DESCRIPTION Medium density foam

Provided with an incontinence cover – zipper closure

Body heat and weight causes the cushion to conform to body contours

Good pressure protection for low to medium risk clients Firmness increases when cold

SPECIFICATIONS 3” foam thickness

Available in 12-30” widths and 12-22” depths (Note: not all sizes are kept in stock)

Weight capacity is 350 lbs.

Cushion weighs approximately 4 lbs. ELIGIBILITY

Client requires the use of a wheelchair for mobility and will use the cushion as an accessory to the wheelchair.

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ORDER DETAILS

Specify size required

Order in even-numbered width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.) - odd-sized cushions are not available. FORMS

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CONTOURED FOAM CUSHION

April 1, 2014

Nighthawk Superior Thin Contoured Cumfy Cushion

Contoured foam cushion with a cloth cover (zipper closure) and a rubber non-slip base

Soft Sunmate top layer with hard-medium density foam base Built in leg channels

Design of cushion contours to eliminate pressure in the ischials Laterally beveled to accommodate sling of wheelchair

SPECIFICATIONS

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ORDER DETAILS

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INVACARE MATRX POSTURE SEAT (PS)

April 1, 2014

Designed to provide superior positioning, stability, skin protection and comfort

Contoured shape incorporating a waffled ischial relief recess to provide ischial/sacral immersion and helps maintain pelvic position and prevent sliding

Reversible outer cover (incontinent/cloth) with zipper closure and inner liner provides moisture protection to the foam

SPECIFICATIONS

Bariatric sizes greater than 20” wide x 20” deep are available by special order

Bariatric cushion weight capacity up to 600 lbs. Cushion weighs approximately 3 lbs.

ELIGIBILITY

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Plastic Surgeon

Licensed Occupational Therapists and/or Physical Therapists Home Care Nurse (in consultation with an Occupational Therapist or Physical Therapist)

ORDER DETAILS

Special Needs Equipment Requisition Specialty Cushion Application Form

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GEL CUSHION

April 1, 2014

MODELS/DESCRIPTION Akton Gel Pilot

Low profile cushion to enable foot propulsion Cloth cover with zipper closure

Sheer/friction protection, pressure and shock protection The gel will not leak, flow, or bottom out

SPECIFICATIONS

1” low profile polymer

Available in 16-20” widths and 16-20” depths; other sizing available by special order

Plastic Surgeon

Licensed Occupational Therapist and/or Physical Therapists Home Care Nurse

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FORMS

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JAY 2 & JAY 2 PLUS

April 1, 2014

Jay 2 / Jay 2 Plus pre-contoured foam cushions feature a Jay Flow fluid tripad with up to 3” of loading for superior skin protection and an easy to modify base with optional positioning components for optimal stability.

Designed for the client who is high risk for skin breakdown and poor skin integrity

Cushion contains molded foam base with non-skid bottom Fluid maintains its viscosity at high and low temperatures Requires no regular maintenance or adjustment

Fluid level self-adjusts for different body types, resulting in less bottoming out

Ballistic-edge stretch cover SPECIFICATIONS

• Jay 2 available in 14-24” widths and 14-20” depths; Jay 2 Plus 20-26” widths and 18-22” depths

Jay 2 weight capacity is 250 lbs. Jay 2 Plus weight capacity is 650 lbs.

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Plastic Surgeon

ORDER DETAILS

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JAY 2 DEEP CUSHION

April 1, 2014

Jay 2 Deep pre-contoured foam cushions feature a Jay Flow fluid tripad with up to 3” of loading for superior skin protection and an easy to modify base with optional positioning components for optimal stability.

Designed for the client who is high risk for skin breakdown and very poor skin integrity

Fluid maintains its viscosity at high and low temperatures Requires no regular maintenance or adjustment

Zipper enclosed ballistic-edged cover SPECIFICATIONS

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Licensed Occupational Therapist and/or Physical Therapist

Home Care Nurse (in consultation with an Occupational Therapist or Physical Therapist)

ORDER DETAILS

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JAY ACTIVE CUSHION

June 1, 2014

NOTE: This item is being discontinued by the manufacturer. Effective June 27, 2014 we will be no longer able to order new product and we will issue recycled stock only.

Jay ® Active is a lightweight, pre-contoured foam cushion with a Jay ® Flow fluid pad and AirExchange ™ cover, designed for the active client at low risk of skin breakdown, who requires mild to moderate positioning.

Includes removable lateral thigh supports

Curved bottom helps neutralize the effects of sling seating

Incontinence base cover to protect foam from moisture absorption Non-skid bottom

SPECIFICATIONS

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Plastic Surgeon

ORDER DETAILS

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JAY EASY CUSHION

November 15, 2015

Jay ® Easy ™ is a skin protraction and positioning cushion

featuring a hi-resiliency, contoured foam base that accommodates a curved or flat seating surface and Jay ® Flow ™ fluid tripad Most suitable for client at moderate to high risk of skin breakdown SPECIFICATIONS

Plastic Surgeon

ORDER DETAILS

Specify base to accommodate flat or curved seat

Order in even-numbered width by depth dimensions (i.e. 16” x Photo Unavailable

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ROHO QUADTRO SELECT HIGH/LOW PROFILE

April 1, 2014

Low High

Quadtro Select features ISOFLO ® Memory Control ® Unit offers shape-fitting capabilities while the client is seated, allowing quick and easy, on-demand adjustment to maximize function

Cushion is divided into four sections, which allows for progressive positioning for short and long term changes

Frequent monitoring of the cushion is required to ensure that proper levels of inflation are maintained

SPECIFICATIONS

Available in 12-28” widths and 12-20” depths Cushions are available in two different cell types:

Low Profile: 2” cells High Profile: 4” cells

Cushions weigh approximately 5 lbs.

Do not overinflate the ROHOs as they are not designed to provide pressure relief when they are fully inflated. The general rule is to allow only a finger’s space (½”) between

the buttocks and the base of the cushion. ELIGIBILITY

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Plastic Surgeon

ORDER DETAILS

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ROHO ENHANCER

April 1, 2014

The Enhancer is a dual-valve system for midline channeling of the femurs, lateral stability and tissue protection

Recommended for enhanced pressure distribution, positioning and posture

Frequent monitoring of the cushion is required to ensure that proper levels of inflation is maintained

SPECIFICATIONS

Available in 12-20” widths and 12-20” depths

Contoured cushion containing a combination of low (2”) and high (4”) profile cells.

Do not overinflate the ROHOs as they are not designed to provide pressure relief when they are fully inflated. The general rule is to allow only a finger’s space (½”) between the buttocks

and the base of the cushion. ELIGIBILITY

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Plastic Surgeon

ORDER DETAILS

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ROHO CONTOUR SELECT

April 1, 2014

The Contour Select stabilizes the pelvis back in the wheelchair and centers the client comfortably in the middle of the cushion

Air is locked into each of the four quadrants

Recommended for enhanced pressure distribution, positioning and posture

SPECIFICATIONS

Available in 15-20” widths and 15-20” depths

Contoured cushion containing a combination of low (2”) and high (4”) profile cells.

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Plastic Surgeon

ORDER DETAILS

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ROHO NEXUS SPIRIT

April 1, 2014

Nexus Spirit provides the stability of a contoured foam base and a Roho cell insert

Allows for increased stability for transferring and positioning of the pelvis and lower extremities for enhanced sitting posture

SPECIFICATIONS

Available in 14-20” widths and 14-18” depths Cushions weigh approximately 3 lbs.

Plastic Surgeon

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ORDER DETAILS

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VICAIR VECTOR 6 & VECTOR 10

August 1, 2014

Vector 6 Vector 10 MODELS/DESCRIPTION

Designed for high level skin protection and a stable seating position

Reversible outer cover - cool breathable cloth on one side and incontinent on the other

Inner cover features two elevated side compartments (front to back) and front-middle pommel filled with SmartCells TM air packets

Low maintenance, no inflation required SPECIFICATIONS

Vector 6 is a 2” high cushion; Vector 10 is a 4” high cushion Vector 6 available in 14-20” widths and 16-20” depths – sizes larger than 20”x20” are not available

Vector 10 available in 10-20” widths and 10-20” depths - larger sizes (up to 24”x24”) are available however are custom and will not be kept in stock

Weight capacity of 551 lbs.

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Plastic Surgeon

ORDER DETAILS

Order in even-numbered width by depth dimensions (i.e. 16” x 16”, 18” x 18”, etc.) to fit wheelchair size. Odd-sized cushions are not available.

Indicate cushion type desired – Vector 6 (low) or Vector 10 (high) FORMS

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WALKERS

Folding

Kaye Postural

Gutter Attachment (Accessory)

Auto-Stop Kit (Accessory)

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FOLDING WALKER

April 1, 2014

Adult Walkers Bariatric Paediatric MODELS/DESCRIPTION

Adult Large - G07755 Adult Medium - G07756

Bariatric Adult Large – G30754B Bariatric Adult Medium – G07768 Paediatric – G07749

SPECIFICATIONS

Lightweight aluminum material Height adjustable

Walker folds flat to approximately 4” Provided with standard legs (as shown)

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Model Walker Wrist Height Range Weight Capacity Overall Width Overall Depth Inside Grip Width Wheel Kit Options G07755 32.5 – 39.5” 350 lbs. 19.5” 14” 16.5” 3” fixed single wheels and rear glides G07756 27.25 – 34.25” 350 lbs. 19.5” 14” 16.5” 3” fixed single wheels and rear glides G30754B 32 - 39” 650 lbs. 27” 17.5” 22” 5” fixed dual wheels G07768 27.5 – 34.5” 400 lbs. 24.5” 14.5” 19” 5” fixed dual wheels G07749 24.5 – 28.5” 200 lbs. 16.5” 13.5” 12.75” 3” fixed single wheels ELIGIBILITY

Must meet general eligibility requirements OPTIONS AVAILABLE

Gutter Attachment

Auto-Stop kit (3” fixed single front wheels and rear glides) Bariatric Front Wheels (5” fixed dual)

Paediatric Front Wheels (3” fixed single)

The 5” dual fixed wheels are NOT designed for use on the standard G07755, G07756 and G07749 models.

Licensed Occupational Therapist and/or Physical Therapist Orthopedic Surgeon

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ORDER DETAILS

Specify client floor-to-wrist height

If ordering an Auto-Stop kit or wheels; specify if they are to be installed on walker or provided separately. Note: Wheel kits add 1” to the overall height of the walker

FORMS