Complex bodies: start here

Which professional to contact first

Different problems start with different professionals, and any of them can usually point you toward the right next one if they aren’t it.

• Physical therapist (PT) — mobility, wheelchair and seating evaluations, standers, gait trainers, and walking equipment.
• Occupational therapist (OT) — daily living tasks: bathing, toileting, transfers, dressing, positioning for eating or schoolwork, home and community access, and sensory equipment.
• Speech-language pathologist (SLP) — AAC and access technology, and swallowing or feeding safety.
• Physiatry, orthopedics, or neurology — when a specific diagnosis (spasticity, scoliosis, a seizure disorder affecting positioning) is driving the equipment need; a physician’s order is usually required regardless.
• Primary care or a complex-care clinic — the hub that can coordinate when several specialists and equipment types are involved at once. See Complex Care Coordination.
• Equipment supplier or ATP (Assistive Technology Professional) — the person who configures, fits, and orders equipment once it’s prescribed. Complex rehab equipment such as custom power wheelchairs generally has to be supplied by a credentialed provider working with an ATP, not an ordinary retailer.

Describing the problem

A clear, concrete description gets a faster and more accurate response than a request for a specific product. Try to cover five things:

• The activity — what the person is trying to do (sit through a school day, get in and out of the bath, reach a communication device, eat safely).
• Where it happens (home, school, the car, the bathroom).
• When and how often (every morning, only after an hour, only when tired).
• What actually happens — pain, unsafe movement, exhaustion, or something becoming physically impossible.
• What would help, if you have a guess — but this part is optional.

For example, instead of “we need a better wheelchair,” try: “She slides down in her wheelchair within 20 minutes at school, and by the afternoon her hips hurt and she can’t reach her communication device anymore.” That sentence gives an evaluator everything they need to start.

Why positioning and fit matter

Equipment that doesn’t fit well is not just a comfort issue. Poor positioning can affect:

• Skin — sustained pressure or friction can cause skin breakdown, which is easier to prevent than to treat.
• Breathing — a collapsed or poorly supported trunk can restrict how much a person can expand their chest.
• Swallowing — head and trunk position affects how safely someone swallows food, liquid, or saliva.
• Pain and fatigue — asymmetrical or unsupported positioning is tiring and can be painful over a full day.
• Participation — a person who can’t reach their communication device, see their classmates, or reach a desk is limited by the equipment, not by their own ability.

This is also why complex rehab equipment — custom-configured wheelchairs and seating in particular — is treated differently than standard equipment: it requires individualized fitting, not just a size chosen off a shelf.

The equipment pipeline

Most equipment moves through the same general sequence, though the details vary by item and by insurer.

• Evaluation. A therapist — often with the equipment supplier present for complex items — assesses the need, tries options, and documents why the equipment is medically necessary.
• Prescription. A physician signs a written order describing the equipment.
• Authorization. The insurer (a TennCare managed care plan or a private insurer) reviews the request, often requiring a Letter of Medical Necessity explaining why this specific equipment is needed and why a less expensive option won’t work. This step is commonly called “prior authorization.”
• Ordering. Once approved, the supplier orders the equipment — sometimes built to custom specifications.
• Delivery. The equipment arrives at the supplier or the home.
• Fitting. The supplier, often alongside the original therapist, adjusts the equipment to the person.
• Follow-up. A check-in — sometimes required by the insurer — confirms the equipment is working as intended.
• Repair. Ongoing, as needed, once the equipment is in daily use. See Equipment Maintenance, Repair, and Replacement.

Why timelines run long

Custom or complex equipment commonly takes weeks to several months between evaluation and delivery. Insurance review has its own timeline, custom builds take time at the factory, and parts can be backordered. None of that is unusual, but you don’t have to just wait it out:

• Ask the supplier about a loaner while custom equipment is on order.
• Ask about TTAP’s Device Demonstration and Device Loan programs, which let you try or temporarily borrow equipment through a regional assistive technology center.
• Ask about TTAP’s Device Reutilization program, which redistributes donated, gently used equipment — sometimes a practical bridge, sometimes a longer-term solution.
• Keep using current equipment if it is still safe, even if it’s imperfect. If it isn’t safe, see the Important note above.

• What professional should evaluate this, and how do we get a referral?
• What specific problem are we solving, and what would success look like?
• Will this go through insurance, and what does the prior-authorization process involve?
• Is a Letter of Medical Necessity needed, and who writes it?
• How long does this typically take, from evaluation to delivery?
• Is loaner or interim equipment available while we wait?
• Who do we call if the equipment doesn’t fit right, breaks, or causes pain?
• What paperwork should we keep, and where should we keep it?