Clinical Justifications for Broda

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Let us help make your clinical documentation process easier. Browse clinical justifications, indications, contraindications, and clinical evidence for our product features and use them as a template for your research, care plan, or insurance claim. If you haven’t yet completed your patient’s seating assessment, you can also visit our online seating assessment form.

What is a Clinical Justification?

In short, a clinical justification provides reasoning for why a patient needs a particular medical device. Insurance companies require such documentation from a qualified clinician in order to approve funding the purchase of a device, such as a wheelchair.

Clinical Justifications for Adjustable Tilt & Recline

Postural Alignment

Adjustable tilt-in-space positioning wheelchairs can promote correct postural alignment and decrease the risk of the development of postural deviations.1 Fatigue can cause postural deviations that can contribute to pressure injuries, discomfort, and falls. Proper postural alignment allows longer engagement in important activities of daily living (ADLs). Posterior tilt efficiently opens the diaphragm, allowing for more significant thoracic expansion. As a result, the patient benefits from improved oxygenation, blood flow, and organ function.

Pressure Redistribution and Skin Integrity

The adjustable nature of Broda positioning wheelchairs makes it possible to change position throughout the day. This is critical for patients who are unable to perform weight shifts independently. Frequent repositioning improves blood flow, oxygenation, and retention of the skin tissue, which is vital for maintaining skin integrity and preventing pressure injuries.1

Musculoskeletal Deformities

Tilt-in-space wheelchairs provide excellent support for individuals with deformities and other conditions of the musculoskeletal system. Deformities such as kyphosis and lordosis can prevent the patient from sitting with proper posture in a non-tilting wheelchair. For example, sliding, lateral leaning, and head dropping can occur without proper equipment. Posterior tilt reduces the effects of gravity on the trunk and upper body and can help to accommodate postural deviations.2 Tilt-in-space best accommodates conditions including but not limited to hypertonicity, hypotonicity, kyphosis, and lordosis. Likewise, posterior tilt helps decrease fatigue associated with hypertonicity and improves postural support and stability for individuals with hypotonicity.3

Decreased Trunk Control

Tilt-in-space chairs are an integral part of effective seating and positioning for patients with decreased trunk control. As a result of poor positioning, fatigue can affect all areas of function including proper respiration, head and neck pain, and the ability to self-feed.4 Good postural alignment maintains vital organ capacity and subsequently reduces the risk of aspiration. Tilt and recline can increase participation in activities of daily living. Therefore, positioning can improve the patient’s quality of life through enhanced environmental engagement, both physically and socially.

Fall Risks with Self-Propelling Wheelchair Users

If a patient is not properly positioned while attempting to self-propel with their hands or feet, they may increase their risk of falling. As a solution, Broda tilt-in-space mobility wheelchairs feature adjustable floor-to-seat height that can accommodate a variety of users who self-propel with their feet. Our mobility chairs are ergonomically designed to provide proper foot-to-floor placement. As a result, the user can maintain the correct position to self-propel. Broda wheelchairs can also be tilted to provide the patient’s arms with a greater range of wheel access for self-propelling with the hands. If a patient is properly tilted, then they experience pressure relief on their bony prominences. As a result, they can enjoy comfort, decreased fatigue, and increased independence.3

Clinical Justifications for Comfort Tension Seating®

Increased Pressure Redistribution

The Broda Comfort Tension Seating® system provides unique pressure redistribution through individual straps that respond to the user’s body shape. Comfort Tension Seating straps redistribute pressure across a large surface area of the seat and back. Subsequently, this increases immersion and envelops any abnormal curvatures, which prevents peak pressure on bony prominences such as the ischial tuberosities, sacrum, and coccyx. Comfort Tension Seating also provides a larger seating surface area than traditional sling seat wheelchairs. In combination with tilt-in-space and recline, the patient can achieve optimal postural alignment. Because tilt-in-space seating systems can move with the user, the patient experiences less shear force and reduces their risk of painful and costly pressure injuries.5

Increased Sitting Tolerance

Proper positioning and weight distribution with Comfort Tension Seating increases sitting tolerance throughout the day.3 Without a doubt, increased endurance helps the user to socialize longer, engage with their surroundings, and spend more time out of bed completing activities of daily living (ADLs). The Comfort Tension Seating straps mold to the body, preventing fatigue and postural deviations.

Clinical Justifications for Dynamic Rocking

Improved Ability to Self-Soothe

Broda pedal rocker wheelchairs that feature Dynamic Rocking capabilities allow the patient to experience a gentle rocking motion that helps calm agitation. Independent movement can create a soothing effect for the user.6 On the other hand, the caregiver can easily lock the mechanism to prevent rocking, if desired. Additionally, caregivers can adjust the low seat surface height to help the user ergonomically rock or pedal to their contentment.

Mild Rigidity

The gentle rocking motion of Broda pedal wheelchairs with Dynamic Rocking helps soothe and relax the body.7 In addition, caregivers can adjust the rocking tension to match the preference and weight of the patient.

Clinical Justifications for Adjustable, Swing-Away Arm Supports

Decreased Muscle Tone & Shoulder Subluxation

Adjustable arm supports help patients maintain proper height positioning of their upper extremities. Postural deviations can be decreased by adequately supporting and positioning the pelvis, trunk, and upper extremities.2 With this in mind, Broda swing-away arm supports assist in managing current or potential shoulder subluxation by allowing for frequent adjustment and proper positioning of the arm. Correct arm position also helps the patient support a proper trunk posture by promoting a midline position. When the patient is in a correct posture, they benefit from optimal respiration, swallowing, and digestion.4

Promoting Safer Transfers

Swing-away, removable arm supports make it easier to use mechanical lifts and slide boards. Removing the arm support of a wheelchair helps facilitate safer transfers by making more room to access the patient’s body. With a capable positioning wheelchair, such as the Synthesis, the caregiver can recline the patient to a flat, supine position. Afterwards, the arm supports can be removed for a sliding side transfer. This is especially useful for bed-to-wheelchair transfers.

Casts, Slings, or Braces on Upper Extremities

The ability to remove an arm support can accommodate a patient with a cast, sling, brace, or other types of devices that may be inhibited by a traditional wheelchair arm support. Arm supports can also be adjusted to support the weight of a cast, sling, or brace, which can improve patient comfort, sitting endurance. Because of this, the patient experiences an increased ability to engage with their physical and social surroundings. Height-adjustable arm supports provide proper arm alignment and make it easy to reposition the upper extremities. This can help with management of conditions such as pain and edemas.

Indications & Contraindications for Positioning Belts

Positioning belts restrict patient movement and should only be used with complete documentation of medical necessity. However, they can be beneficial for some users. A physician’s order and a patient care plan must document and prove the medical necessity of any restraint prior to implementation.8 It’s important to note that belts are not considered restraints if they can be removed by the individual independently and are used for positioning or for enabling patient participation in activities of daily living (ADLs). Provided that they are necessary and properly documented, there are a few scenarios where a person could benefit from a positioning belt.

When should I use a thigh positioning belt or pelvic positioning belt?

Positioning belts are often medically necessary for patients who require:

  1. A positioning device for added safety while seated in a wheelchair
  2. A positioning device used in conjunction with the Broda Huntington’s Specialty Padding (HSP) Package
  3. Enhanced patient safety measures in accordance with an individualized care plan and a physician’s order

Under these conditions, a person can benefit from using properly-placed positioning belts.

When should I refrain from using a thigh positioning belt or pelvic positioning belt?

Do not use positioning belts if:

  1. Less restrictive measures are available and will maintain patient safety8
  2. You plan to leave the patient unattended or unsupervised following the placement of the positioning belt
  3. An existing condition or disorder may cause a positioning belt to become unsafe
  4. The patient is or may become aggressive, combative, agitated, or suicidal
  5. If the use of a positioning belt would worsen any wounds, irritation, or swelling at the site of placement
  6. Colostomy bags, foley catheters, post-surgical incisions, or other conditions render the use of the positioning belt unsafe

Carefully monitor your patient and discontinue positioning belt use if redness, irritation, or swelling occurs on the areas of the body in contact with the positioning belt.

Clinical Justifications for Trays

Trays can be an excellent tool for positioning or for helping an individual with their activities of daily living (ADLs). Therefore, it’s important to properly document the use of a tray so that the patient can enjoy the full benefits. However, please note that trays are not considered restraints if they can be removed by the individual independently and are used for positioning or for enabling patient participation in ADLs. A physician’s order and a patient care plan must document and prove the medical necessity of any restraint prior to implementation.8

When should I use a wheelchair tray?

Trays are often medically necessary for patients who require:

  1. Anterior posture support
  2. A support surface for placement and support of flaccid extremities or for a cast, brace, or other device that causes strain to the patient
  3. Aid in the treatment of conditions that affect the upper extremities, such as edema, subluxation, etc.
  4. Assistance in completing activities of daily living (ADLs) such as feeding, grooming, etc.
  5. Enhanced patient safety following an individualized care plan and a physician’s order

When should I refrain from using a wheelchair tray?

Do not use a wheelchair tray if:

  1. Less restrictive measures are available and will maintain patient safety8
  2. You often leave the patient unattended or unsupervised following the placement of the tray
  3. There is an existing condition or disorder that may cause tray use to become unsafe
  4. The patient is prone to sliding down and out of the wheelchair while seated
  5. The patient is or may become aggressive, combative, agitated, or suicidal

Always Provide Continual Documentation

Always document the care staff’s education and training on the medical equipment’s proper use and document observations and safety checks following the implementation of new equipment. Review and document continued medical necessity at each care plan meeting following the original equipment implementation. In conclusion, always use the medical equipment as ordered by facility protocol and state/provincial and federal regulations.

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  1. Ding, D. (2008). Usage of tilt-in-space, recline, and elevation seating functions in natural environment of wheelchair users. The Journal of Rehabilitation Research and Development, 45(7), 973–984.
  2. Dicianno, B. E., Lieberman, J., Schmeler, M. R., Souza, A. E. S. P., Cooper, R., Lange, M., Liu, H., & Jan, Y.-K. (2015). Rehabilitation engineering and assistive technology society of north america’s position on the application of tilt, recline, and elevating legrests for wheelchairs literature update. Assistive Technology, 27(3), 193–198.
  3. Dewey, A., Rice-Oxley, M., & Dean, T. (2004). A qualitative study comparing the experiences of tilt-in-space wheelchair use and conventional wheelchair use by clients severely disabled with multiple sclerosis. British Journal of Occupational Therapy, 67(2), 65–74.
  4. Lange, M. L., & Minkel, J. (Eds.). (2018). Seating and wheeled mobility: a clinical resource guide. Slack Incorporated.
  5. Lange, M. L., Crane, B., Diamond, F. J., Eason, S., Presperin Pedersen, J., & Peek, G. (2021). RESNA position on the application of dynamic seating. Assistive Technology, 1–11.
  6. Watson NM, Wells TJ, Cox C. Rocking chair therapy for dementia patients: Its effect on psychosocial well-being and balance. American Journal of Alzheimer’s Disease. 1998;13(6):296-308. DOI:10.1177/153331759801300605
  7. Julia Van Deusen & Jean M. Deusen (1986) An exploration of the rocking chair as a means of relaxation. Physical & Occupational Therapy in Geriatrics, 4:2, 31-38, DOI: 10.1080/J148V04N02_04
  8. Centers for Medicare & Medicaid Services, 42, vol. 5, § 482.13(e)(1) (2011)