(theme music playing) Who let the dogs out? Hi, and welcome to the third episode of The Gene & Dave Show. Today, I'm so excited, Gene, because we're talking about one of my favorite subjects: Assistive Technology. And you know how much I love those gadgets and toys. Dave, Dave's a gadget guy. He's on the bleeding edge. As soon as technology is invented, he's got it. That's right. Or I try to get it, anyway. So, Gene, tell us, what is the definition of assistive technology? The definition of assistive technology is: any item, piece of equipment, or product system, whether acquired commercially or off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities. Just about anything could be assistive technology. Here's a picture we shot. I put a... You could see I put a glass in it. I can't hold the glass myself, but the short holds it. And that... So, that shirt becomes assistive technology. And I can write it off for the show. And the other thing is, even something simple like this wire hanger on this bottle so I can drink and stay hydrated. Now, that's refreshing. There you go. Assistive technology at its finest. We're lucky enough today to have Jamie Judd-Wall with us. Jamie, you and I go back in assistive technology many, many years. I'm not gonna say how many years, but, my gosh, you've been in Austin for so long. You've been such a great help to this community. And thanks for being with us. You're gonna help the community again by telling us about augmentative communication devices. What is an augmentative communication device and who uses them? An augmentative communication device is basically a prosthetic for your voice. So, someone whose speech is not intelligible due to a condition such as cerebral palsy, autism, Down syndrome, even a motor vehicle accident, would be someone that could use augmentative communication to help them be understood by people around them. And we know some folks like that in the community. How do you know which device is right for who? We go through a set of clinical trials with the equipment. We have samples of all these equipment in our office here in Austin. And we go through a series of clinical trials with the person to figure out which one is the best match for them. You're an independent clinic, you're with a school system, or what? The clinic is called Speech Language and Hearing Services, and the company that I work with is called TELL Enterprises which is Technology Enhanced Learning and Living. So, we go through these processes. Someone that has a lot of movement problems, we would not show a very small device to, even from the outset, because that person wouldn't be able to touch the device to be able to activate the voice features. Hmm. Somebody that's very mobile like a six-year-old child, we wouldn't give a very large device because they couldn't carry it around with them. I see. Their being bulky. Yeah. So, there are some things that are very obvious, as kind of delineators, and then there are some things that are a little more subtle that we work with the individual, their family, caregivers and so forth to make sure that our choice is really the best possible choice for that person. We also, I'm so happy to be able to tell you and your audience, have a funding source, which for so many years has been an obstacle to augmentative communication use. And that funding source is available to any Texan, any person who is a resident of Texas. And they are able to submit an application. It has to be signed by a speech language pathologist. Uh-hmm. They're able to submit the application and receive their augmentative communication device at no cost. Now, tell us about these funding sources. Who set this up? The funding source started as a part of the Public Utility Commission. Ah. And it's managed by the Department of Assistive and Rehabilitative Services here in Austin. It started as a program only for the deaf and hard of hearing to provide TTYs. And over the course of time, and I'm, you know, pleased that I, you know, was able to have a small part in changing the outlook  of that agency to realize that more people than just those who are deaf and hard of hearing are challenged in the use of the telecommunication system. So, now they provide TTYs, they provide IMs in Braille, and, big news for listeners of today's program, they provide augmentative communication devices. Boy, that's fantastic. I know in years past, kids who go to school would have to wait for their IAP Program. They come up to their teacher and their parents and assistive technology professionals to decide what augmentative communication device to use. And then the school would, of course, be responsible for paying it. But whether they pay for it or not, sometimes, you know, you never know. So, I'm glad we've got these programs now. It's such a wonderful resource, and it's a renewable fund because everyone pays into this fund on their telephone bill. That small universal service fee, you know, $0.28, $0.38, $1.50, $2. Some unusual amount that no one can figure out how they came up with it or where the money goes. Oh. Well, part of that money goes, each and every month, to provide these specialized pieces of equipment for people with disabilities. So, it really is an ideal example of our tax dollars at work, kind of the way we'd all like to see our tax dollars being used, is to support our, the citizens of the State and folks in need. Oh, that's sheer fantastic. Money well spent. Absolutely. That's great. Well, let's see some of these devices. Okay. Tell us about them and who they would be appropriate for. Oh, I brought two little ones and a big one. Does size matter? I guess it does. Size does matter, especially, as I say, if you're a six-year-old child or if you're a teenager, and you wanna go to the mall, you don't wanna be lugging something 15 or 20 pounds along with you. So... But on the other hand, if you're a person that uses a wheelchair, has cerebral palsy, you'd need something fairly sturdy to be able to take with you and to be able to access while you're in your wheelchair, going about your daily business. So, in this, as in many other things, size matters. Fantastic. What have you got for us? So, the first one I'm gonna show you is really kind of the biggest little new thing. And this is an augmentative communication system that fits onto an iPhone or an iPod Touch. Oh, this is amazing. And it is amazing when you think back, Gene, when you and I started doing augmentative communication and assistive technology. You know, we were looking at something around the size of a bread box. Yeah. Well, those were the days. We are dated. Now we're looking at something that can fit in your pocket, you know, and leave room for a couple of dollars. Sure. Yeah. How does this work? So, this one works by touch, and I've gone ahead and programmed some phrases into it. So, here's... Hi. I'm Jamie. "Hi. I'm Jamie." And as your viewers can see, there's even a photograph of me. So, I'm able to import pictures. This is wonderful when we're training children because I can use the built-in camera, take a picture and use the picture in our conversation in a heartbeat. Oh. Isn't that easy? It is so easy. So, the phone is by iPhones by Apple. The system itself is by... The system itself is called Proloquo2Go And that's available on the applications store? It's available on the applications Web site of iTunes. Uh-hmm. And it'll work on the iPhone or on the iPod Touch, which is the exact same size as an iPhone. The difference is, of course, you wanna have the phone if you have the iPod Touch. But for me, that works better because then the phone doesn't ring in the middle of the conversation. Then it will automatically switch applications and go over to the phone. So, I like using it on the iPod Touch better. But for folks that are looking for kind of a one-stop solution... Uh-hmm. You got your phone, you got your music you have your personal photographs and your augmentative communication all in something, you know, smaller than a deck of cards. That's great. That's fantastic. It's very cool. People just love it. It's a very popular item. And I should say, Gene, that in our office, we don't sell any products. We will happily refer you to one of the many, you know, reliable and ethical vendors here in Texas. But we feel like it sort of compromises the process of evaluating to sell a product. So, we made that decision early on, back... Even before you and I met. So, this is Cool Item Number 1. Excellent. Cool Item Number 2 is a little more sturdy. It uses kind of the slightly older technology. Not antique but the slightly older technology of the PDA. So... This uses a two-step process. So, I'll touch the "I Have a Pain," and then select a body part. And it just happened that, just earlier today, I was on a home visit with a young man who had never used augmentative communication before. Sixteen years old. And his mother had invited my colleague Stephanie Jasuta, who is a PhD speech language pathologist. And I went to her home for the evaluation. And I'm demonstrating and making a few changes, and that young man and I are sitting and talking. I'm like, "Wanna do some words?" Nodding his head. And all of a sudden, he goes... I have a pain in my tummy. Went to the bathroom and really was not feeling well. And his mother just looked at him and was like, "You're sick. You're really sick. I didn't know. I'm your mom, and I didn't know. And you're really sick." And he came back and told me of his pain again, and we're like, "Well, you know, let's give you some tummy medicine. Let's make you feel better." And just in that moment, he and his mother's life was changed much for the better. Well, good for him and for his mother. Yes. Well, imagine the frustration of being sick, of feeling nauseous or sick to your stomach, not being able to tell people. And being disciplined for, you know, at school for leaving the room inappropriately. Uh-hmm. You know, the frustration of that, that so many of our young people feel, is really overwhelming. And the, really, elation that his mother felt in understanding, you know, her son had been a little out of sorts that day, and she couldn't figure it out. She was asking him a lot of questions, you know. "Is it too hot? Are you not happy? Don't you wanna go to the mall?" And all of the time, the boy had a stomachache. Well, you certainly made their day. It was a very exciting day for us today. So, is the family gonna get that device? They are gonna get this smaller device which is called the Say-it! SAM Communicator. We looked at the iPhone, and we decided that for their use, this was... For a 16-year-old very active adolescent, this one was a little bit too delicate. They wanted something that has a little sturdier, a little more body to it. And this has, as you can see, this nicely built up case. And it also has a greatly enhanced speaker so that he can be heard in a noisy room. You know, big family dinner and that sort of thing. So, they decided to go with this one. And they are gonna be making their application through the STAP Program. And Dr. Jasuta is gonna sign off on it. We're all very excited. And we think that, within about eight weeks, he'll have Christmas at his house. Oh, that's fantastic. Yeah, I hope they'll have a little celebration. They certainly will. Now, this is something that a student wouldn't carry around with him. Can I have some water? Excuse me. This is something that a student would not carry around, but it might be on their desk all the time if it were to be looked at more as a workstation. Or for a wheelchair user, we would get an arm that would come out and would hold this in front of them. And the arms are made in such a way that they have a flexible joint, and it can swing out of the way so that when you're going someplace, this wouldn't, like, impede your line of vision. Or maybe gonna eat something. Or going to eat. You get it out of the way, so it doesn't get dirty. Or you could lift it up so that you could use it to eat, but you wouldn't spill on it, or, you know... You'd have enough room to be able to talk and eat. Good deal. So, this device has a feature that I really like. And those are these tabs across the top. A lot of times, our consumers are a little overwhelmed by having the screens change within the device on their own. Oh. Especially some of our older consumers that haven't really had a lot of experience during their childhood with augmentative communication device. The tabs enable the person to control the change of screens. So, here, we have the tab for Greetings, Art, which is a favorite activity of the person who uses this device. Playing Cards and Break Time. We need to enter tabs that we can use later to program in for some other things that might come up in her life. She's already asked us to make one for her workshop, where she... The facility that she goes to work at. So, she can have... Take to people about, like, needing supplies, and just talk with her colleagues during the day about, you know, "What's up with you? What are your plans for the weekend?" And that sort of thing. Right, social interaction is very important. Absolutely. Jamie, what would this young lady be like without this device? We tend to see two kinds of responses from folks that don't have augmentative communication. One is where a person just sort of shuts down. They just, you know... After years and years and years of gesturing and pulling people around the room to show them what they want, they just give up. They just feel, you know, kinda bad. I can understand that frustration. You know... Oh, well. "No one's ever gonna know what I want or what I think." Yeah. The other reaction is... The reaction of unacceptable behaviors, frustrational behaviors. So, lashing out, hitting, kicking, screaming. The reaction of anger of a person that isn't able to get their point across, that wants something, doesn't feel well, can't tell people wants to go to the bathroom, and gets punished for getting out of their chair to go the bathroom in school. Hmm. Or that, maybe, is given a food to eat that they don't like, and then told, you know, "No dessert 'cause you didn't eat your dinner." So, really, the importance of this type of devices cannot be overemphasized. No. It's... I know that... This is, like, an extension. Like you said, a prosthetic. It's an extension of that person, and they just can't get along without it. Absolutely not. You know, Jamie, sometimes folks just get too stubborn and don't want to carry their communication device with them. Let's see what happened to one of my friends, Sparky, when he didn't carry his with him. Okay. ("The Godfather" theme playing) Okay, Sparky, that does it. Tell us where the money is. We know you took the money from Polkapalooza. He says he's not talking. Well, don't play games with us. We know you took the money. He's still not gonna tell, he says. Alright. Somebody saw you take it, Sparky. You better come clean. "I don't have it," he says. That does it, Sparky. Either you tell us, or we're gonna shoot your scooter, then we're gonna shoot you. He says no matter what you do or say to him, he's not gonna tell you where the money is. Ahh! Ahh! (applause) We need to talk a little bit more about assistive technology, specifically that it's got some legalities attached to it. For example, it was written into a law during the 1988 Technology Assistance Act. And it's been revised a number of times since then. But the important point is because there are legalities attached to it, people have certain rights. For example, at a plane, a person that's blind, you can't take his cane away from him. He needs that. If a person's bringing a service dog into a restaurant, you can't stop him. Right, right. And some of those assistive technology devices can be so expensive. But we found ways around that. Or at least, tax breaks that folks can get. Tell us about that, Gene. Yeah. One of my favorite authors, Steve Mendelsohn, who is an lawyer, wrote a book "Tax Options and Strategies for People with Disabilities." He tells you how you can take tax advantages of both source of services or technology you buy. Now, if you were to bring an interpreter to a job interview, and you get that job, well, you can write off whatever you're paying for that interpreter as a work-related expense. However, if you don't get the job, I'm not sure that there's a tax refund for that. It's all explained in Steve's book, and it's good for us to know. Take advantage of it, save some money. Right, definitely. Check out that book. But we should say there's assistive technology products and assistive technology service. Services, we're talking about interpreters, service dogs. And then whatever you pay for veterinarian fees for your service dog, it's a tax treatment. Food for the dog, as long as you're using it in your line of work, you take it to work with you, all that stuff is tax, uh... Has a certain tax treatment involved with it. So, how about products? Products, same thing. If you need special products to take to work with you, you could... There's a tax treatment available for that. I wouldn't say it's a whole tax write-off, but you get some preferential treatment, so you could save a little bit of money. Also, like purchasing a vehicle, if you haven't adapted with a ramp and hand controls and things like that, you don't have to pay any sales tax on that vehicle. So, there's all kinds of tax breaks that you can take. Check out that book and find out what you can do. Yeah. And the taxes on a vehicle, like your type of vehicle, could be several hundreds, maybe even thousand dollars. Right. So, we're talking a lot of money. Dave, well, you've got a lot of toys in your home. You wanna tell us about some of them and get you on to the folks at home? I sure do. The other product that I like to use that's really opened up a whole new world for me on what kind of attendants that I can have to help me get in and out of bed in the morning is my barrier free lift. It lifts me into the bed... Out of my chair, into the bed. And also, out of bed. The track runs into the bathroom, the shower, the toilet. I can get pretty much anywhere in my bedroom/bathroom area with this lift and not having to rely on somebody that can lift me and throw me around. So, it's really opened up a whole new world for me. Well, let's check it out. Yeah. First of all, I'm gonna get my attendant to help me strap into the lift by using the two-strap system. First, I'll lower the bar down into its proper position. Remote control is very simple. Up/down, left/right, and rotate. There is a safety mechanism to stop it from lifting too high. I can now position myself directly over the bed... and go back down once again. Ah, safe and secure in bed. Just to swing in. Yeah, it looks like fun. Yeah, that has got to be such a big advantage because, like you say... you can have a lot more leeway in who you hire as an attendant to help you out. It doesn't need to be someone big and strong. It could be anyone that could just push you along that gliding frame there, I imagine. Right. You know, that reminds me. It's been said that technology, for a lot of people, makes things easier. But for people with disabilities, technology makes things possible. That's right. I call 'em toys, but, boy, they sure... They sure changed my life. Don't let your wife hear you calling them toys. She'll cut you off. Speaking of changing my life, probably the product that's my life the most is this wheelchair that I sit in. Really? Yeah, I can, uh... Let me do a little... Let's show a little video here of the demo of me in my chair and the things that it does standing up, sitting down. Check this out. Okay, so this is my Levo Wheelchair. It's got plenty of bells and whistles on it, including headlights, turn signals, flashers, and even a horn. (horn sounds) Yeah, as wimpy as it is, it does have a horn. But one of my favorite features that's really opened up a whole new world to me is being able to stand up in my wheelchair. So, I can not only raise myself up, but, once I'm up, I can also drive. And once you're in this position, it has limits on how fast you can go. And if I get tired in the middle of the day, I can also lay back... and take a nice little nap. Ahh. That's pretty comfortable. So, you could possibly get in the cupboards or get things off of higher shelves. I imagine when you go grocery-shopping, you won't necessarily need to have someone with you there 'cause you can reach up to the shelves. Right, and not just the physical part of it. But the first time that I got the chair, I can remember shopping in the grocery store, and actually stood up and rode around to see what was on the upper aisles. Wow. And just being able to ride around in that stand-up position and look at all the people that were passing me, looking at them in the eye, just gave me a whole new perspective. And it was just a whole different feeling than being, riding down low, as I have all my life, and, you know, having people look down at you as they pass by. It was a whole new experience that was amazing for me. So, now whenever I go shop, I usually raise the chair up as high as I can, and it's nice to be able to look people in the eye as they walk by. Well, it's great. And it also has some health benefits. When you're in the standing position, you're putting some weight on your bones. Right. So, your bones are absorbing the calcium, becoming a little bit stronger. And if you're not able to do stand up, or have people do exercise with your legs, the bones in the legs become weak, so... That's right. So, that has some health benefits attached to it. That sounds great. It is. You know, you folks can Google just about any type of technology you're looking for, but don't forget there's also something out there called a library. And they have books. And there's plenty of books. The one we just talked about before, Guides, Options and Strategies for people with disabilities. And there's books on Assistive Technology, any kind of technology you need, it's out there. There's also books on how to build ramps and such. Gene, the Internet and books, they're a great way to find out things for you. But just sometimes the situation that you're in can be a little bit harder than what's in a book. You know, we're all individuals, and we all need things that fit us differently. Take our wheelchairs, for example. I mean, there are so many options and so many things in CD that it makes it really hard to find out what you need on the Internet or just a book. But we've got a friend that we talked to about such things. Yeah, Brit Sitzes from the National Seating and Mobility. This can help clear this matter up for us because, you know, they write questions on getting a wheelchair, who's gonna pay for it, where do they go out in the process. So, Brit came into our studio, and we had a nice chat with him, and this is what he told us. We're here today with Brit Sitzes from the National Seating and Mobility Company here in Austin. Brit's gonna talk to us about assistive technology, how to find it, how to buy it, how to find ways to purchase it. Brit, thanks for being with us today. You're welcome. Brit, now you've been around for a long time. You've been an OT for what, 20 years, 30 years? About 20 years now. A little over 20 years. 20 years. Okay. So, you've seen all sorts of changes in the field, all sorts of changes in technology. Uh-hmm. And now you're working with National Seating and Mobility, which is, what it's done... Durable medical equipment provider. It's a what? Well, in a sense, we are a DME provider, but more importantly, we're a complex medical equipment provider. Meaning that our focus is on more higher-level types of mobility bases, customized wheelchairs, manual or power. Customized seating systems. Things for people who have, you know, more... You know, they're gonna spend more than just a few hours a day in a wheelchair. People are gonna be, basically, living out of their wheelchairs. We focus on that population of people. So, a person like myself, and I would say probably anybody with a more evolved disability would be looking for a vendor like yourself, probably to replace or get themselves those little Hoverounds or whatever. Right. Because I spend an entire day in a wheelchair, and if it's not fitting just right, I know it. I could tell you. Uh-hmm. Yeah, you need people... You need to work with a vendor that has the experience of working with people with complex medical needs. You know, has very limited mobility. Has, maybe, a history of skin breakdown, a history of contractures, a history of secondary issues from being in an equipment that needs to be, you know, particularly looked upon, or looked at, to make sure you don't make that situation worse. 'Cause a lot of times, you know, while the wheelchair and the equipment doesn't make... Doesn't improve the... Or can improve the person's mobility, definitely in their positioning, and have some impact on that. Mostly we're looking at trying to not cause new problems. You know, cause new contractures, new deformities, new skin breakdowns and things like that. Well, let's say, um, you're just about anybody like myself. Besides, you know, my needs are quite getting met whatever technology I'm using. I want a new piece of technology. Whether it be a wheelchair, a bed or whatever. The first step is, you know, what kind of funding you have to work with. While we've always, and I've always said it to people, you know, I don't want the funding to determine, you know... We're not gonna try to get what they'll pay for for you. We needed to know who you're working with. Whether it'd be Medicare or Medicaid or some commercial insurances, have different rules or different priorities or different steps that we have to go through to get you into the part that you need and want. It'd be best, in the very beginning, to just go ahead and discuss it with your doctor. And make sure that particularly in the Medicare situation that they're documenting your chart, that you would need, or she, discuss the need for the power wheelchair. And that sort of opens the path. I mean, it can be done retroactively once you've started some of the other steps. But it's... But if you know you're going to do it, anyway, and you know you're going to see your doctor, and sometimes some of the doctors are difficult to get to. So, it's just what I can start with first. Uh-hmm. Right. Then the next step... It kind of take... 'Cause Medicare has the most specific sequence of things you have to do. For power, the next step is to have a mobility evaluation conducted. Mobility eval has to be done by an independent PT or OT that's not associated financially with the equipment provider. So, then, the next... Once the mobility evaluation is done, usually, what would happen is you would have your vendor, your durable medical equipment provider, or complex medical equipment provider already in place, so they would be present at the mobility evaluation with the PT and with you. So, at that point, a lot of the discussions as far as what specific sizing of the equipment, measurements... Specific needs of the individual. Yes, specific needs. The input device. Would it be in joystick or head array or foot patrol? Whatever it might be, you know, those kind of things are discussed and, you know, kind of puzzled out at that point. But if you're doing, you know, the project, another thing to look at, at a trip with Medicare, is you also have... Your vendor has to be what they call ATP, which is an assistive technology professional. Another good, uh... Another step in that evaluation process is trials. I mean, a lot of the times, if we're dealing with someone who's been in a wheelchair for, you know, an extended period of time, Maybe this is their second or third or fourth mobility base that we're working on, they cut... They have a probably better than anybody's idea of what they need. So, it's a little... It gets actually a little easier probably as the process goes on to refit them for any chair. 'Cause you're really gonna mimic a lot of the same things that have been working for them. And the things that haven't been working, we're gonna find different ways to address those issues. But I think, though, it's the rarity that you don't wanna do trials, especially when you're looking at the first, second, maybe in the third mobility base. You definitely want people to have the ability to try something on or at least to see something that you're recommending to them. I wanna share with the audience that when I was looking for a power chair, you recommended that I at least try the center-drive chair. And the center-drive has a much smaller turning radius which just makes it a much harder chair to drive. But I just couldn't be using another thing. Yeah. I've been in this chair for, like, over 30 years. You know, I can very well drive it for 30 years. Right. Yeah, it's so hard. You know, if the person's been doing, you know... You know, well, I'm working with people that don't have their ability to move independently, is restricted quite a bit by their injury, in your case, your spinal case injury, you know, the things that you've developed over the years to adapt with your equipment, to be able to be as independent as you are, once you change one little thing, once you start altering something, it's not usually in isolation. It usually cascades out to a bunch of other problems. Or, you know... And, you know, kind of the old attitude, "If it's not broke, don't try to fix it." And so... But I still think, as the vendor, as the person who's working with, you know, the person the end user would know, is that, you know, you need... Part of my job is to educate people to let them know what's out there, and that there are other options, whether or not, you know, it's appropriate, or they wanna... I'm not gonna show stuff that they're not gonna even need. But things that, at least, be aware of that they're available on new technologies, the new ways to get around the same problems you've been doing for a long time, and see if it's something you might wanna try. But then again, doing trials or at least looking at it, or exploring options or opportunities are critical. You know, once you get put into a piece of equipment, the funding source usually is... Once they pay for it, they're done for about five years. There's no going back if you find out, "Oops, this really didn't work the way I thought it was gonna work." So, you don't get it done right the first time. Yeah, you're kinda screwed if you don't get it right. So, when you start off the process early on, you know you're gonna be working with a medical supplier, either a complex medical equipment provider... Uh-hmm. ...you wanna make sure that they have, or you can, in some way, arrange trials of different types of chairs. Yeah, I mean, you know, if you're... I think on any level of equipment, you know, the worst thing is to rush into doing something. I mean, we're, um... I mean, there's a lot of companies that, you know... I, you know, I try to spread the word. You know, "Don't buy stuff you see on television, any kind of product, particularly." But specifically, you know, the providers that advertise on television, you know, that you're gonna get something, you know, tomorrow, is... Well, what you're gonna get is probably not gonna meet your needs. Yeah. However, if it meet your needs, it's only gonna meet them for today. It's not gonna meet them for, you know, years from now or... So... But I think the equipment provider should be providing you as many options as there are out there for you to consider and look at. And I think the process should take, you know, there should be some thought put into it each time you go back into a new chair. Because even a chair that mimics what you had before is still new, it's gonna be a little different. The products are gonna change. The sizing may be a little bit different. You may be a little bit different. And so, all those things have to be considered. Most likely, I won't be any fitter, but maybe a little different. Yeah. Alright, so I've got this evaluation... Obviously, do we get to that part where the therapist does the evaluation? Okay, when the therapist does the eval, the therapist would then... My job would be then to do the clothing of the equipment to prov... You know, to go back to the manufacturers that we've decided as a team to go with or to look at, and then get the quotes together and get all the details, specific details. Alright. So, my job would be then to create that paperwork. And then, in the Medicare situation, the PT or OT that did them a billed eval would actually write up the letter of justification. And I would provide them a list of all the different line items that are gonna be billed to Medicare, and they have to go through on each of those line items and clarify why that part is needed based on what your medical needs are. So, that's why, for instance, if you wanted some custom paint job, you know, there's really no medical reason for that custom paint job, so that's not gonna be a billable. That's something that'd have to come out of your pocket. Okay. But other things, say, for instance, elevating leg rest on a power or a manual chair. Why do you need them? You know, maybe because you have lower-extremity swelling edema that needs to be... Your feet need to be elevated at a certain point to allow that blood flow to return from their feet to reduce some of the swelling. So, things like that could... Or you being an OT, or just having a lot of years in the business, maybe you know about secondary disabilities. And maybe I don't need the elevated footrest right now, but in a couple of years, I may need them. Uh-hmm. So, we should get that now. Could be. There's a little, you know, there's... It's prevention or getting equipment for preventative purposes. While it should never be not considered because obviously, you know, not to wait until you need something, and then do it 'cause usually then it's too late, there is some challenges, though, to getting that funded when there's not a medical documented reason why you need it. So, it's... There are some... For instance, a good example is skin integrity. You have a person that needs, say, that can't really do pressure relief but needs a... The smart thing to do, to put them on a cushion that provides optimal pressure reduction, such as a ROHO cushion, or a J-Gel cushion. The problem is a lot of times, if there's not been a history of any breakdown, Medicare particularly won't pay for that cushion. They won't show as a need. Even though, we can... Now, we can argue the fact that while they say that they have no upper-body function, they can't do a pressure relief, that's part of the reason why say, we put, like in your case, we'll put you in chair to tilt. So, you can use your tilt. You can do your pressure relief. Well, I couldn't live without the tilt and the roll cushion. Right. Then everything is submitted, in our case, the National Seating and Mobility, we have what we call a Medicare Prescreened Department. And we take all the medical documentation, all the mobility evaluation, all the parts that are being recommended, and send that all back to our Prescreened Department, who are most of them, many of them are former Medicare employees. So, they're used to the paperwork. Well, yeah. And they know what Medicare's gonna be looking for. We don't have to go back and scramble to try and get the paperwork together. It could be out there. It's just gonna take too long to get it. It could be frantic. Another reason why people should deal with someone that's experienced in that... Yeah, I think there's several major players around the country, and it's something first or second largest company in the country that does this kind of work that you ought to be working with because, I mean... I mean, the reality, the end user, once you have it, it's yours. You know, it really, you know... It's not really your concern if I get paid or not. Right. Except for one important thing. If I don't get paid, your chair doesn't get repaired. Oh. Not just by me, not just because I'm vindictive. But because if Medicare doesn't pay for it, they're not gonna pay for anybody to repair it. So, it's real important that you get it processed through the system correctly. Let's say someone wants to get a wheelchair, and maybe they, you know, someone like myself, has been spinal cord-injured for 11 years. And then, if... The therapist knows that down the road, there maybe some secondary disability issues. Uh-hmm. And a person may need a more complex chair. What would they need to do? What are they looking for in a vendor? Well, I think, a lot of what you're looking... You want to be looking at the same thing. I think you still want to look a vendor that has, you know, has some history in the community, has a longevity, just like you would look for any business. You also want... You know, just like with any other business, if you can get some word-of-mouth feedback on what kind of experiences people have had with that company. You also... The ATP, I think you want to look at companies that, you know... Still, even if you're looking at less complex equipment, I still think you want to be considering working with companies that hire, provide the ATP level of personnel to come out and meet with you. Assistive Technology Provider. Professional. I've got a number of people right now that have this presence... A real common diagnosis that this occurs in people with multiple sclerosis. Now, again, it's a very broad diagnosis. There's a lot of different manifestations of it. But for people that, a lot of times, need just a little bit of mobility assistance in the beginning, will, you know, get something very simple, very basic. But unfortunately, sometimes their needs progress more rapidly than they thought. And within a couple of years, now they can't really use that product. There are... We have had some success arguing back to the funding sources that this product doesn't meet their needs anymore. We need to adapt. You know, we need to do something different. And sometimes, that'll do. Sometimes, it won't. Generally speaking, you know, the product you end up in needs to be functional for you for five years. And if, you know, sometimes... Because the insurance will pay for whatever you get. Right. Right. Yeah, you're kinda limited to that, that five-year period. So, um... So, you better get it right the first time. Yeah, if possible. So, they're dealing with something that's been around for a number of years. Right, and people that are gonna, you know, really look out into the future for you and not just what they can sell you today. Boy, that Brit's a pretty sharp guy, and he's been in the business for a lot of years. Yeah, he's been an OT for 20 years and in the wheelchair business for quite a long time. Brit had some suggestions for us on how we might choose a DME dealer or even a complicated medical device dealer. You wanna find someone that's been around for a long time. If they're new in the neighborhood, you know, they might be good, but they may not last. So, you want someone's who's been around a while. You want someone that has a assistive technology professional on staff, on hand. You want to be aware of sit-and-go-type chairs. For example, you've seen commercials like on the Hoveround. Every night. Yeah. Things in that nature, you could buy something like that. But it's really are the modifying work just if your needs change. For Dave and I, our chairs are as specific for us as, say, prescription glasses for somebody else. So, you gotta find a chair that fit and grow with your needs. Exactly. Find somebody with a good maintenance program, as well, 'cause the chairs are just like your cars. They need regular maintenance, and they occasionally... They break down. And you don't wanna be stuck with a broken-down chair. Absolutely. And you wanna make sure the people that you ordered the chair from that they also deliver it because if it's not exactly what they ordered, they're gonna find out right then and there. Otherwise, you're gonna have some problems. Absolutely. So, thanks, Brit, for definitely pointing those things out, things to watch out for. And thanks for coming in and talking to us about durable medical equipment. But you know, Dave, no matter how much we talk to these wheelchair vendors, sometimes they don't really understand what we need the chair for, so we just had to make a little clip to show them, "Dear Mr. Wheelchair Maker," to let them know what we really need. It's the kind of chair you need, right? Exactly. Alright, let's watch that. "Sincerely, Gene R. Rodgers." Alright, let's read that from the beginning, and see how it sounds. "Dear Wheelchair Maker, please build me a new wheelchair. I don't need anything fast and maneuverable, like what Aaron has. He's just a show-off, anyway. It doesn't have to super strong, like what Brad, aka "Brad the Tank" uses. Just something simple so I can take my doggie, Cheyenne, for a walk. It does have to be small enough to fit on your standard elephant. While I'm scuba-diving, I leave my chair in the boat. Sometimes I just ride on the flying bridge of the boat when we're coming back from a dive. Therefore, it must be resistant to saltwater sea spray. It must be small enough so that when I take the rear wheels off, I could sit on the bow of a riverboat to explore the Costa Rican jungles, or fit in an elevator in Italy, or sit on a mountain slope in Switzerland in preparation to go paragliding, or get carried down steps into a long-tailed boat in Thailand to explore the floating market, or go trekking at Macchu Picchu in the Peruvian Andes. The chair must be lightweight and resistant to extreme temperatures, so I can take it with me when I go camping in the Himalayas with my Sherpa friends. It has to be easy to be disassembled, so I could put it into a doko on the back of a Sherpa. The chair must reflect my personality. It should be rugged yet handsome. Sometimes my chair and I get separated, so I want to spot it easily. I'm thinking painting it Hummer yellow will help. The chair must be easy to take up or down steps. Oh, and it has to be cool enough, I could still have fun with the ladies. Sometimes I just don't know what to expect when I go traveling. So, make it small and light enough to fit on this three-wheeler in the Philippines, on this stair machine in Japan, and on this bridge in Costa Rica. When I sail on this tall ship, the Tenacious, I like to sit on the bowsprit. But I don't want to tip over backward, so I use these sea legs my brother and I invented to keep me upright. I also take my turn at the helm, and definitely don't want to flip backward when we hit the big waves. Occassionally, I'll go up to the crow's nest to get a better view. I want a chair that's easy to haul. That goes double when I'm lifted out on one of these Zodiacs. It would be both embarrassing and dangerous if my chair fell apart and is dropped into the ocean. It must be strong enough, it'll not fall apart when I check out the cliffs in Socorro, New Mexico, or when I go bridge swinging in South Africa. Sometimes I just like to hang around. Oh, did I mention it has to be cool enough, I can still have fun with the ladies? Last but not least, it must be low enough that I can win the next limbo contest. (applause) Sincerely, Gene R. Rodgers." Hmm. I'm thinking that should be it. Well, hopefully, that clip on "Dear Mr. Wheelchair Maker" gives them a better idea of what we need. But you know, sometimes, we get a new chair, doesn't meet our expectations. There's something we can do about it. And that is to go to usatechguide.org, and you fill out a survey about the technology you bought. In my case, it was a wheelchair. But it could be something else, perhaps some refreshable Braille unit you bought, whatever. But if you fill out a survey, say what you like, what you didn't like, if other people are considering the same purchase, and they see what a lousy review you wrote about a product, they may know to stay away. And it's a great help 'cause assistive technology is so expensive. It'll also help you find some of the things that you might be looking for at the TechGuide 'cause they list out all the products. So, definitely check that out. Yeah, in my case, I mean, TiLite, they did such a horrible job. And you know, we have tech standards we gotta meet when we're broadcasting a show. We can't say anything bad about someone or a company, especially if it's not true. But in this case, I'm just relaying what I wrote. And that is that TiLite really did a horrible job. But enough of that. You can go to that Web page yourself and check it out. Gene, so far, we've been talking about a lot of electronic products, things that plug into the wall or things that have batteries, or, you know, things like wheelchairs that are big-ticket items. But also, another service that's out there, an assistive technology, are our service animals, our service pets. And we've got a great group right here in Austin that helps people line up assistive dogs. And assistive dogs aren't only used for people that can't see, people that are blind, they also are great companions for folks, and also help to pick things up off the floor and turn on light switches for people that have mobility impairments. That's right, Dave. These dogs are amazing. They can do all sorts of things. Now, a little bit earlier in the year, the Texas Hearing and Service Dogs organization here in Austin had a walk with the... They had the 2009 Mighty Texas Dog Walk. That's right. That's right, Dave. And our good friend, Chris Hyatt, was there with his dog, JJ. And this is a great pair. JJ helps Chris out so much. But Chris Hyatt, a fellow scuba diver, was telling us about the organization and what they do. My name is Chris Hyatt. And I am here at the Mighty Texas Dog Walk in 2009, benefitting Texas Hearing and Service Dogs. I'm here with my dog, JJ, who is a service dog and who helps me with tasks such as picking things up that I drop on the floor, or opening doors and closing them behind us, or the lights are getting bright. Today, we have, I think, 10,000 participants. Texas Hearing and Service Dogs, its two-fold mission is to save dogs from shelters and then train them to help the disabled or the hearing-impaired. Today, we have about 10,000 participants, I believe. I'm not quite sure of the exact number. But they really are a wonderful program. They've helped me build a lot of goals, and they also are just wonderful companions. And it's nice to be able to take your dog anywhere you'd like, or otherwise, would go into a restaurant, or on a bus, or even on an airplane. I also want to say that the program is very expensive. So, they have to do it, and it is a 501(c)(3) nonprofit organization. So, they've got to raise money in order to train these dogs at no charge to people like myself. So, in any case, it's a wonderful program. And I encourage you all to look up their Web site at servicedogs.org. And I'd like to say hi to Gene and Dave and just say thanks for coming out here and showing a little bit of information on the Texas Hearing and Service Dogs. I'd love it if people can get involved and learn about the program, and come out, maybe, next year and walk with us. Real good time. Thank you. You know, that's great, Dave. But I think I'll wait till they teach a service animal to open a bottle of beer before I get one. I bet they can do that. Call Chris, give him a call. Put me on the list, and I'll get one of those dogs. Well, Dave, think we've said enough about assistive technology? You're not gonna make me disappear again, are you, Gene? No, not at all. But we will wish our friends and the audience out there an accessible day. And we'll catch you later on our next show. And thanks for tuning in.