(This letter was written because claim was denied by the insurance company)

To Whom It May Concern:

I am writing this letter on behalf of (your name, group insured number, identification #) for pre-determination of benefits for a LifeStand sitting to standing wheelchair. In regards to the statement that benefits are not available for a LifeStand wheelchair and that it is not an item of durable medical equipment, I have documentation noting that this is indeed not a fact. In regards to the article on the physiological aspects of immobilization and the beneficial effects of passive standing which was written by Thomas T. Stewart, Ph.D., I will quote the following areas: prolonged immobilization of the body whether due to injury, illness, or other cause of extensive deleterious, physiological and biomechanical consequences for practically every major organ of the system or body, collectively changes which result from immobility is called immobilization syndrome.

In regards to the musculoskeletal system, it has been demonstrated that immobilization of muscle and lack of weight bearing on bones causes demineralization and true osteoporosis. This may cause pathological fractures. It may cause loss of bone calcium which also leads to deposition of calcium in the soft tissue and joints causing ankylosis or permanent fixation of the joint. It may also cause renal calculi or stones in the urinary tract. Prolonged muscular mobilization had a direct effect on joints. Contractures of the joint capsule and surrounding muscles can cause restriction of the range of motion of the joint, lack of movement in the joints result in a lack of synovial fluid and will lead to irreversible degenerative changes in the joint cartilage. Another area that is of an importance is skin and the underlying tissue. Immobilization causes subtle changes in the decomposition of skin and it is strongly associated with the development of pressure ulcers or decubitus ulcers. When tissue is exposed to pressure greater than intracapillary pressure for long periods of time, blood flow is decreased and tissues are obstructed. Tissue ischemia leads to destruction of soft tissue and skin.

Respiratory System ñ Immobilization causes diminished respiratory capacity and stasis of secretions which render the patient more susceptible to conditions such as pneumonia and atelectasis.

Cardiovascular System - Immobilization causes orthostatic hypotension or low blood pressure.

Digestive System - Digestive system is also affected by prolonged immobilization. There is a general decrease in gastrointestinal activity. The decrease in mobility and secretory function often leads to constipation and constipation can lead to fecal impaction in serious intestinal dysfunction.

Passive standing has been demonstrated to prevent, reverse, or improve many of these adverse affects of prolonged immobilization. Some of the benefits of passive standing include:

• Prevention or reversal of osteoporosis and the resultant hypercalciuria
• Prevention of contractures and improvement of joint ROM
• Reduction of spasticity
• Improvement of renal function, drainage of urinary tract and reduction of urinary calculi
• Prevention of pressure ulcers
• Improvement in circulation
• Improvement in bowel function

In response to the statement that it has no direct therapeutic or restorative value, it allows the immobilized person to assume a standing position independently without assistance by another person several times a day. Clinical and experimental studies have shown that passive standing prevents and even reverses a number of pathological consequences from immobilization. In this case, each of the pathological consequences of immobilization including two pressure sores, increased spasticity, muscle contracture, and osteoporosis are present, and she would definitely derive therapeutic benefit from passive standing. In this case, the standing wheelchair would serve to cure and heal the above mentioned conditions. It would not serve to cure the underlying disease of MS, but it would cure and prevent further immobilization-type syndromes.

Last year when this patient had a LifeStand wheelchair at home for a trial run she was independent in operation and it convinced me of the beneficial effects of the wheelchair. Beneficial effects were as follows: decreased leg spasticity, decreased ankle edema, and decreased frequency of constipation were apparent. Patient would stand for one hour per day and would be spasm-free for seven hours. She also had a decrease in Lioresal dose by 20mg.

In conclusion, it has been well documented that pathological changes that can occur due to immobilization may be prevented, reversed, or improved by regular passive standing regimen.

Your consideration in this matter would be greatly appreciated. If I can be of further help, please feel free to contact me.