Wheelchair

The wheelchair (short Rolli and in the parlance of the tools directory of the health insurance wheelchairs ) is a tool for people who are impaired in the ability to walk because of a physical disability. The wheelchair allows these people to be mobile, it is not a therapy device. In Germany, there are 1.56 million wheelchair users.

• 5.1 Active Wheelchairs 5.1.1 Setting
• 5.1.2 Equipment and Accessories
• 5.1.3 seat unit

• 8.1 liability of the statutory health insurance (SHI ) 8.1.1 legal claim
• 8.1.2 Manual Wheelchairs
• 8.1.3 Electric wheelchairs 8.1.3.1 Liability Insurance

• 8.1.4.1 Individual judicial cases
• 8.1.4.2 Current situation

History

King Philip II of Spain in 1595 had apparently a roller chair with adjustable back and footrest. A self- driven wheelchair constructed the watchmaker Stephan Farfler paralyzed in 1655. The first patent for a wheelchair was issued in 1869 in the U.S..

From the first simple models starting, now a variety of types of wheelchairs has developed, which vary both according to disability characteristics and application purposes. Many features of the construction of the frame, the seat unit and the facilities have differentiated themselves.

Role of chair of Philip II of Spain, 1595

Farflers wheelchair from 1655

Wheelchairs " Westfalia " from before 1914 from the St. Elisabeth Hospital Gütersloh

Electric folding wheelchair, the end of the 1960s, the City Museum Gütersloh

Types of wheelchairs

Distinction according to the framework design

Distinguish the type of drive

Distinction according to POS Power / Regulation Text

For the supply of a wheelchair the medical prescription text is relevant to the performance of the health insurance companies in Germany. A distinction is made between the following types of wheelchairs:

Distinction for special applications

Extremely small and lightweight pram - wheelchair

Ultra-light adaptive wheelchair with a rigid V- framework

Wheelchair racing

Wheelchair Rugby

Children wheelchair supply

A child's wheelchair is not just a scaled- adult wheelchair, but differs in the requirements and consequently in design and equipment.

With the wheelchair supply may already be started very early so that the disabled child can explore his environment and experience and thus be optimally developed cognitively. Already one -to two- year-old children can learn to drive a wheelchair. This causes not, as one might fear that they would be lazy or could not learn later in appropriate ways walking or wanted.

Research

So far it seems from a cultural and sociological point of view no research perspectives on the aids wheelchair and its social and socio - cultural function to give. Also, historical data are rare. Nor is there only a small research for this tool for users and technical innovations have arisen primarily through activities of the user. Since 2005 there has been an initiative of the mechanical engineering departments as well as care and health of the FH Bielefeld, which deals with cooperation partners, including the German Wheelchair Sports Association, with the technical investigation of manual wheelchairs and the needs of wheelchair users. 2010 the first symposium on the theme. With this research project, the poor quality of many wheelchairs were found, especially since they hinder the user in everyday life additionally. The rolling resistance and handling characteristics are often not optimal, the user requirements too high: Wheelchair users must (on average 210 W) afford for their locomotion 10-450 watts, a bicycle rider makes over a period of two hours 130 watts.

Technical details of the wheelchair fitting

Active Wheelchairs

Setting

Is enormously important in wheelchairs for active driving the ease of adjustment to the optimum grip point. For this, the wheelbase and the seating unit must be variable to each other in order to achieve the longest possible Greifweg that begins slightly behind the body and extends as far forward without stressing the shoulders and having to move forward out of the wheelchair out. This particular setting is not possible with lightweight or standard wheelchairs, why can these driving on the hand rims comparatively heavier. Also, the seat height must be optimized in arms hanging the elbow should be just above the drive wheel. A slight (negative ) camber improves the maneuverability of the wheelchair, gives lateral stability and brings the wheels even closer to the user approach, which facilitates the "active" self-drive. The central element of the wheelchair attitude is the turning and tipping point: The axle of the rear wheels should lie close to the body center of gravity, the wheelchair is something while sitting in front of the hip joints. The wheelchair can thereby rotate good and easy crowding, which facilitates the overcoming of obstacles (edge ​​/ level ). The wheelchair must be set so that it is easily ankippbar, but not wobble every time when starting. The safe movement in a wheelchair wobbly set is quick and easy to learn. For inexperienced users the backward tipping over can be prevented by the Antikipp-/Stützräder. " The support wheels are to be adjusted such that the balancing of the rear wheels is possible, but is prevented from tipping over. This is among the major support wheels cranked often not possible because they can not be positioned high enough. "

Equipment and accessories

There is a wide variety of accessories for wheelchairs, but it should only actually required parts are attached so as not to increase the weight unnecessarily.

• When the footplate is between a continuous and a split, as well as to distinguish between high- hinged, swing-away, removable footplates. The footboard should be height and angle adjustable to ensure optimal leg.
• Side panels, armrests, clothing protector restrict the seating area to the side, is the seat width low they give pelvis and thighs guidance and support. They should be appropriate and not interfere with the active transport, which usually is the case with armrests.
• The drive wheels should be proportional to the frame size, common sizes are 20, 22, 24 and 26 inches, there are tires in different designs.
• The spoke protector prevents pinching of the fingers and damage to the spokes. Today, however, he is not only functional but for many users an expression of individual style and design awareness.
• The front wheels are available as pneumatic tires, solid rubber variants 4-8 inches, soft rolls with 5-6 inch, 4-5 inch plastic wheels and skate wheels 2-4 inches in a flashing variant
• Shock absorbers are available for front and rear, but they have an effect on the power transfer from
• Headrests are for the active user usually not necessary and the possibilities of movement severely limit. However, they are in some forms of disability useful if a discharge of the head and neck is necessary, for example, with muscle wasting. Increase headrests not the road safety and are not designed to!
• Brakes should be easy to use and will not be the one getting in and out or reacting in the way. There are, for example, toggle brakes, drum brakes and hub brakes.
• Orthopedic and therapeutic aids may be attached if necessary.

Seat unit

Just 20 years ago offered wheelchairs no longer sitting comfort as a camp stool, which eventually leads to pressure ulcers and back problems. Today, there are various seating units and back systems that can be integrated into the wheelchair, but it should not affect the right seating position is. Seating systems are designed to provide as a desk chair and provide good support for active sitting and ensure a favorable pressure distribution. The seat unit is an important foundation for movement in a wheelchair and therefore also for locomotion, they should not restrict arm and shoulder and provide the opportunity for relief. The backrest should only extend to the bottom edge of the shoulder blade. It is considered that no man can sit all day just with or without a disability, this is not to be expected of wheelchair users.

Electric wheelchairs

Electric wheelchairs are for users who have next to the general need for a wheelchair and a higher level deficit of arm strength and Arm-/Hand-Beweglichkeit or a generally weak constitution, or which helps the electric wheelchair to a required, increased mobility.

The electric motor that drives the big wheels directly, draws its energy from a battery, control the direction and the speed is usually done using a joystick control. Bauartliche groups are formed in part by the requirements of the German Road Traffic Regulations, for example, after the speed limit ( see below).

Electric wheelchairs are accrued against the electric cars technically and in terms of the concept of aid that are less adaptable to individual disabilities compared to the "E - turtlenecks ", but the boundaries are often blurred. Electric wheelchairs usually allow sedentary activities that require, for example, the frontal approach and use of tables, while electric cars are primarily for outside certain means of locomotion, the steering and front wheel are often centrally located in front of the user.

Through the use of lithium - ion batteries instead of conventional lead-acid batteries you can reduce the total weight of wheelchairs and clearly there are portable, foldable power wheelchairs realized.

A special case of a power wheelchair is a "stair wheelchair " or " stair climber ". The wheelchairs so designated have an electrically operated drive mechanism for negotiating stairs.

Air travel with power wheelchairs can be problematic, as some airlines refuse on principle to ensure the flight safety, to take acid batteries on board. Other airlines for example, require that the batteries are removed from the wheelchair and transported in special boxes of the airline. Some airlines only carry electric wheelchairs with spillable wet cell batteries. If acid batteries not be allowed on board, then the wheelchair before the flight must be converted to the much more expensive dry batteries. Also for dry batteries are certain safety regulations. For example, the cable connectors must be disconnected from the batteries and the terminals of the battery to be isolated.

Standardize

The European Standard EN ISO 9999 (2003) "Technical aids for disabled persons - Classification and terminology " assigns wheelchairs in the group 12-21 with an eleven subgroups.

Other standard works:

• DIN 13240-1 wheelchairs; Classification Issue 12/1983
• DIN 13240-2 wheelchairs; Terms 12/1983
• DIN 13240-3 wheelchairs; Dimensions 08 /1994
• DIN EN 12183 Manual wheelchairs - Requirements and test methods
• DIN EN 12184 Electrically powered wheelchairs, scooters and their chargers - Requirements and test methods
• DIN ISO 6440 wheelchairs; Terms, concepts 1985
• DIN ISO 7176-1 Wheelchairs; determination
• DIN ISO 7193 Wheelchairs - Maximum overall dimensions

Product directories

In the directory on Assistive Rehadat over 400 individual models available in medical supply stores wheelchairs are listed in the product group 12-21.

The resource directory of the German statutory health insurance arranges wheelchairs in the range 18 - " ambulances " one, with the four distinctive areas " inside ", " interior and road ", " road " and " stairs " with further subdivisions.

Legal provisions

Liability of the statutory health insurance (SHI )

Legal right

Wheelchairs are aids according to § 33 Fifth Book of the Social Code.

Thus the cost of the wheelchair may be covered by health insurance, a medical certificate, detailing and medical justification is needed.

The health insurance to the insured usually for the duration of the medical necessity for a contractor to be used again a wheelchair from the resource pool or DRG aids in kind available. The insured is not entitled to a new delivery of a wheelchair. If the insured equipment that are not medically necessary, it has to bear the cost themselves. However, the ownership of the wheelchair remains with the health insurance or at a flat rate per case wheelchair by the contractor the insurance company.

The statutory co-payment for the insured is 10% of the contract price for the wheelchair, at least € 5.00, maximum € 10.00, provided that the insured is not exempt from charges.

The proper use, storage and general maintenance and care coincides with the transfer of sick leave vehicle within the jurisdiction of the insured. The necessary repairs are usually covered by health insurance.

Individual health insurance and contract partners have agreed on a case-fee contract for the provision of wheelchairs. This is a particular member of the suitability of the wheelchair for a defined period of time - at least 2 years, a maximum of 5 years - hired by the health insurance from the contractor - for a maximum period of medical necessity. In this case payment are included for the entire contract period, all prescribed by the manufacturer or MPG special maintenance, normal wear and repair, including all necessary spare parts. This does not apply to repairs that are the result of inappropriate or improper use, lack of maintenance or damages caused by poor storage or transfer of the wheelchair to a third party. In these cases, the insured has to bear the cost thereof themselves.

Manual Wheelchairs

The normal supply for insured SHI is done with a non-motorized standard wheelchair / push rim wheelchair. The supply is usually in a single copy. For cases where a second wheelchair ( one for outdoor and one for indoor use ) is required, a dual supply is possible.

Electric wheelchairs

If the relevant conditions are met, provide health insurance to its insured electric wheelchairs at a speed of 6 km / h. Electric invalid vehicles with more than 6 km / h no aid within the meaning of SGB V. If the insured such of the obligation of health insurance beyond supply (eg with a maximum speed of 10 km / h), he has the option these to avail on the acquisition of additional costs.

" Current costs " incurred for the use of an application made by the health insurance available power wheelchair, fall within the obligation of health insurance ( as the Federal Social Court, in its decision Az 3 RK 12/96 of 6 February 1997) and by the health insurance after the actual consumption refunded. The use of an electric wheelchair is to be determined on the mileage. Depending on the actual uses and the electrical power of the current collecting aid reimbursed, for example, the KKH 0.18 euros per kWh. Many health insurance companies cover the cost of energy at the option of the insured in the form of a lump sum (eg with DAK 2.50 EUR, 5.11 EUR for the AOK per month).

Liability Insurance

Standard power wheelchairs, which are provided by the health insurance companies available, have a top speed of max. 6 km / h and are therefore exempted from compulsory insurance. Nevertheless, liability insurance makes sense if, for example, be caused when operating a wheelchair to car scratches. Non- compulsory insurance wheelchairs can be included in a personal liability insurance; the insurer however, this is display. The cost of a private liability insurance are not covered by health insurance.

Maximum design faster wheelchairs (> 6 km / h) but are subject to compulsory insurance, that is, there must be a special " wheelchairs insurance" ( some insurance companies offered this under the name " moped insurance" are ) to be completed. Valid for one year until the end of February each year. ( Distinction each year through print and color)

These electric wheelchairs over 6 km / h require in Germany in addition a type - single - TÜV test ( light plant of STZO and EU standard and proved braking, etc.) and this must be unique (usually at the first delivery from the manufacturer or importer) through a written demonstrated expertise and given to the user. This report shall also be available during the creation of the insurance policy.

If the health insurance is a wheelchair that is subject to compulsory insurance, approved for medical or special traffic legitimate reasons, the health insurance company to insure the vehicle and for this purpose to bear the costs. Because the auxiliary supply also means that it is provided in operable condition and that includes the insurance. ( See Federal Social Court of 14 September 1994, AZ: 3/1 RK 56/93 )

Wheelchair care in nursing homes

According to § 33 paragraph 1 of the SGB V have insured person is entitled to be supplied with aids. Health insurance companies are in principle obliged them to supply regardless of whether insured live in their own apartment or in a home. This principle finds, however, the " insured event " in-patient nursing care, ie at the inpatient care in a nursing home ( § 71 paragraph 2 SGB XI) or in an inpatient facility for the disabled ( § 43a SGB XI), a limitation. The duty of the statutory health insurance for treatment of insured persons with aids ends after SGB V and XI of the Social Code Book where in inpatient care the duty of the home carrier to supply the residents used with tools. The associated costs are included in the maintenance kit. The provisioning requirement is limited to the area within the home and the home grounds.

Individual judicial cases

The obligation of health insurance is not excluded by the fact that the insured person belongs to the circle of dependent persons under § § 14, 15 SGB XI (eg heavy nursing care according to care level III) and the wheelchair is also used to facilitate their care. ( BSG judgment of 10 February 2000, B 3 KR 28/99R )

A claim against the statutory health insurance company to be supplied with a prescribed by doctors wheelchair as a tool exists whenever the person concerned the wheelchair for activities outside the home needed (especially walking trips; satisfaction of a general basic need - mobility and social contact in order to avoid isolation, also exits with relatives, etc.). (see BSG, judgment of 10 February 2000, Az: B3 KR 26/99 R)

Unless a resident is dependent on a wheelchair, the home but does not leave, but this has a claim against their own insurance if he can still his ways and whereabouts, at least within the home itself determine. The statutory health insurance has thereby to provide only such tools available that are not attributable to the "sphere" of inpatient care. These are mainly:

This is not the case when it comes only to the pure Stroll down in the fresh air on the home grounds. The sphere of the home is also not left, if it is organized around common trips of residents, or to any of the Home manager and was responsible for activities outside the home (eg joint stroll ) is. Regular activities of the patient outside the home (excursions, walking tours, visits to coffee shop, restaurant, theater, cinema, etc.), alone or in the company of relatives, friends and acquaintances, regardless of the nursing staff, however, can no longer be the sphere of the home and its responsibility be attributed. An explanation of the relatives that the patient is regularly picked up several times a week outside the home to rides (eg, cemetery visits, etc.) usually triggers from an obligation to pay the health insurance. The home operator has only to stand up for the supply of customary auxiliaries within the nursing home and the home site. ( see the judgment of the SPA dated 20 February 2000 3 B KR 28/99 R)

The Federal Social Court has specified in its judgment (ESR of 22 July 2004, B 3 KR 5 /03 R, inter alia, in NZS 2005, 533) this again: The demarcation of the contractual obligation of the statutory health insurance in the resource supply in nursing homes from the Vorhaltepflicht the home carrier has to be made as to whether even a medical treatment and disability compensation within the meaning of medical rehabilitation takes place (resulting contractual obligation of the statutory health insurance ) or predominantly the care is important, because a self -determination and equal participation in the life of society is no longer possible (resulting in Vorhaltepflicht of home support). It must be taken of the specific circumstances of the individual case. Thus, even such items of home decor are (possibly including wheelchairs ) are attributed, in which, although a certain amount of disability compensation is yet to be seen, predominantly but the care is important, because a self-determination and participation in the life of society is no longer possible rehabilitation and therefore no longer occurs. Is crucial as to whether the individual concerned is responsible determination over one's own fate is still possible or not, or whether he is not only become the " object of care" because of the lack of this ability. For the individual case, it is important whether the person concerned of his whereabouts nor can actively define and him thus an independent and conscious design of community life in the home is possible. In the case decided by the local seriously BSG case of care ( care level III = ) applicant was still able to perceive themselves impressions to laugh, and to respond to verbal stimuli. However, this passive reaction was not sufficient to trigger the obligation to pay the health insurance.

For Disabled facilities that residents are only equipped with a wheelchair at the expense of health insurance, if it is needed in order to make walking trips outside the home can or if not committed to the agreements made by the welfare agency agreements, the carrier of the institution for disabled, within the home vorzuhalten the handicapped for the care of persons requiring wheelchairs. Given the diversity of disabled facilities, such Vorhaltepflicht not generally be affirmed as in -patient care facilities. ( BSG judgment of 10 February 2000, B 3 LR 17/99 R)

Current situation

This law has now also the legislator felt to be appropriate and adapted the tools Directive to § 33 SGB V in the context of health care reform in 2006 ( GKV-WSG Act): " The necessary for the normal operation of ambulances ( use by several residents to pure Transport-/Transferzwecken ) or the implementation of the basic care ( serving measures to support the elimination and personal hygiene ), for example, are featured in a nursing home. Wheelchairs that enable active or passive participation in community life, fall within the obligation of SHI, provided they are used exclusively by an insured. In the assessment of the performance responsibility, it does not matter whether the wheelchair will be used inside or outside the inpatient facility. " In conclusion, now since 1 April 2007 every resident of a nursing home is entitled to be supplied with a wheelchair from his health insurance, if it is used exclusively by him.

Road traffic act

For the equipment and approval of wheelchairs are made in the regulations of road traffic law ( Road Traffic Regulations ( Highway Code ), Vehicle Registration Regulation ( FZV ) and the currently still existing Road Traffic Licensing Regulations (StVZO ) ) some special rules.

The electric wheelchairs there usually designated as "motorized wheelchairs " are after the Vehicle Registration Regulation motor vehicles, are made for certain derogations against the other motor vehicles. However, these are only valid up to a defined size from the attack, the normal rules apply to all motor vehicles.

FZV § 2 Clause 13 defines electric wheelchairs or motorized wheelchairs as " single-seat, according to the type for use by physically handicapped persons certain vehicles with electric drive, with an unladen mass not exceeding 300 kg including batteries but without driver, a maximum mass of not more than 500 kilograms, a maximum design speed of not more than 15 km / h and an overall width of up to 110 cm ".

This definition also applies to room electric wheelchairs, if they are used on public roads.

Shift and Greif wheelchairs are no vehicles within the meaning of the Highway Code.

In the regulations of road traffic law special covers are in the following paragraphs contain (as of 2007 ): Road Traffic Regulations ( Highway Code )

• § 2 road use by vehicles
• § 24 Special means of transport

Vehicle Registration Regulation ( FZV )

• § 2 Definitions
• § 3 Requirement for authorization
• § 4 requirements for commissioning admission -free vehicles

Road Traffic Licensing Regulations ( Road Traffic Licensing Regulations )

• § 16 Principle of authorization
• § 50 headlights for high and low beam
• § 51a Lateral identification
• § 52 Additional headlamps and lamps

Relevant provisions:

• Where pedestrian traffic is allowed may be driven with electric wheelchairs at walking pace.
• Each electric wheelchair which is used in public transport must (according to ECE Regulation 69, retro-reflective red triangle) comprises, be equipped with a lighting system, the driving headlights, taillights, rear and side reflector, and a rear marking plate for slow-moving vehicles.
• Electric wheelchairs up to a maximum design speed of 15 km / h, shall be operated without a license.