When we think of different prosthetic devices that are helpful to people with spinal-cord injury or disorder (SCI/D), often the first and only one that comes to mind is the wheelchair. However, when we fully consider the many activities of daily living—e.g., showering, cooking, or driving—a broad array of tools and devices such as wands, cushions, or shower benches comes to mind. Prostheses allow individuals with SCI/D to maintain and enhance their quality of life after disability.
When we think of different prosthetic devices that are helpful to people with spinal-cord injury or disorder (SCI/D), often the first and only one that comes to mind is the wheelchair. However, when we fully consider the many activities of daily living—e.g., showering, cooking, or driving—a broad array of tools and devices such as wands, cushions, or shower benches comes to mind. Prostheses allow individuals with SCI/D to maintain and enhance their quality of life after disability.
The Department of Veterans Affairs (VA) provides stellar medical and rehabilitative care that is supported by prosthetics services forveterans with disabilities. Within VA, the Prosthetics and Sensory Aids Service (PSAS) works to provide a wide range of equipment to aid disabled veterans with activities of daily living, from artificial limbs to simple eating devices (1). The mission of PSAS is to “provide specialized quality patient care by furnishing properly prescribed prosthetic equipment and sensory aids and devices in the most economical and timely manner in accordance with authorizing laws, regulations, and policies”(2).
Every Veterans Integrated Service Network (VISN) has a qualified VISN prosthetics representative (VPR) who serves as the technical expert responsible for ensuring implementation and compliance with VA’s national goals, objectives, policies, guidelines, and regulations on all issues of interpretation involving prosthetics policies. Once a veteran receives a medical prescription from a VA clinical team, PSAS works to ensure he/she obtains the required equipment or service.
SCI/D and Prosthetics
It is vitally important for people with SCI/D to maintain personal independence in the home and workplace as well as on the social scene. To help maintain this independence, VA’s PSAS provides assistive tools and home and automobile adaptive equipment to eligible veterans. VA defines the term prosthesis as “a device that supports or replaces a body part or function.” In terms of SCI/D, prosthetics can also include equipment that increases access and mobility for personal independence.
Wheelchairs
PSAS provides wheeled-mobility assistance to eligible veterans who use wheelchairs, motorized scooters, or power wheelchairs. VA provides prescribed wheeled-mobility support through the SCI/D centers, and PSAS works to ensure veterans receive high-quality equipment that meets their physical and aesthetic needs.
As modern science and technology advance, the appearance and function of prosthetic devices also develop. For example, there are more power-mobility options for motorized chairs, with multiple seating, standing, or stair-climbing functions. Also, wheelchairs and other devices such as home stair-lifts are available in a variety of colors for users’ visual pleasure.
In addition to VA’s providing veterans with quality wheeled-mobility support, PSAS also offers maintenance assistance and a secondary wheelchair for them to use in the absence of their primary chair. The secondary chair must be “equal in quality and function” to a veteran’s primary wheelchair. PSAS will pay for wheelchair repairs, as long as such maintenance is not the result of neglect or abuse.
ADLs and Home Accessibility
In VA, PSAS is referred to as the “one-stop shop to receive all the equipment needed to achieve activities of daily living (ADLs)”(3). In general, ADLs include dressing, bathing, eating, and administering daily medication or medical needs. Using a wheelchair can restrict range of motion and movement when performing ADLs; therefore, PSAS provides assistive equipment to alleviate this challenge. For instance, PSAS can give veterans assistive tools such as button hooks, patient lifts, reachers, or long-handled sponges (4). These assistive devices are essential to disabled veterans’ independence.
Prosthetic equipment such as grab bars and shower chairs enable independence.
As many veterans prefer performing ADLs within the comfort of their homes, PSAS provides prosthetic equipment such as grab bars and bathtub benches to make home more accessible (5). Specifically, the PSAS “Special Programs” component encompasses Home Improvement and Structural Alterations (HISA) Grant and Automobile Adaptive Equipment programs. The HISA Grant Program provides eligible veterans with “home improvements and structural alterations” such as ramps or widened doorways that help ensure they have full access into their homes’ entrance and “bathroom facilities.”
The Automobile Adaptive Equipment Program provides adaptive equipment to enter, exit, and operate a vehicle. This grant requires that veterans first become eligible for an Automobile Grant from VA’s Veterans Benefits Administration before receiving the adaptive equipment. VA SCI centers have driver training for veterans who require adaptive equipment.
To participate in the special programs, veterans must meet all VA eligibility requirements. To obtain further criteria regarding the grants, contact your local PVA National Service Office, VA medical center, or Prosthetics chief.
Sports and Recreation
Another key element of independence is maintaining a social outlet outside of the home, among friends, or within a professional or civic community. PSAS provides prosthetic equipment that not only increases mobility and access for veterans but also allows those with disabilities to participate in social and recreational activities via sports teams or civic organizations.
Once VA issues a medical prescription for recreational or sporting equipment, PSAS provides or modifies the gear to address the person’s individual needs. Examples of adaptive equipment from PSAS include handcycles, mono-skis, and sports wheelchairs for various games. Every year, veterans participate in sporting events such as the National Veterans Wheelchair Games, the PVA National Trapshoot Circuit, and PVA’s Bass Tour and boating program. For some of these, PSAS adapts sports and recreation equipment—e.g., devices that allow or improve grip on fishing poles—to meet veterans’ needs. The camaraderie, physical exercise, and sense of being a part of any sporting activity has the potential to reinforce their sense of self and inner drive and ambition.
Key Elements of Independence
Independence requires that people have the freedom to do the things they enjoy, when they want to do them; barrier-free accessibility; adequate support and assistance to be self-sufficient; and confidence in their physical and mental capabilities.
The use of assistive tools gives veterans with disabilities the opportunity to be self-reliant and have the self-esteem that is necessary for physically and socially active lives. Over the years, PVA has worked with PSAS to help ensure veterans receive quality prosthetics services. As veterans’ healthcare needs evolve, PVA will continue working with VA to guarantee delivery of quality healthcare.
To receive prosthetics services from VA, veterans must meet all eligibility requirements. For further details and additional information on prosthetic equipment or eligibility, contact your PVA National Service Office or local VA medical center, or visit VA’s PSAS Web site, www.prosthetics.va.gov.
Contact: AletheaP@pva.org.
References
(1, 2, 3) The Department of Veterans Affairs: Prosthetics and Sensory Aid Service, www.prosthetics.va.gov
(4) “What to Expect from Your VA Prosthetics and Sensory Aid Service.” Retrieved from www.prosthetics.va.gov /docs/IB-10-62-v3.pdf
(5) The Department of Veterans Affairs: Prosthetics and Sensory Aids Service, www.prosthetics.va.gov
