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POWER MOBILITY
POWER MOBILITY EQUIPMENT TRAIL
Group-base Capabilities
Top Speed
Battery range
Suspension
Can overcome obstacles up to
Has incline of
Has Expandable Electronics
Group 2 Base
3mph
7miles
No
1.5 inches
6'
No
Group 3 Base
4.5mph
12miles
Yes
2 inches
7.5'
Yes
Equiment Trails
Does not meet mobility needs due to Mark sll boxes that indicate inability to use the specific equipment listed
Meets needs for safe independent functional ambulation/mobility
Environmental limitations
Cognition
Safety concerns with physical ability
Decreased/limitations endurance&strength
Decreased/limitations motor skills&coordination
Pain
pace Speed
Contra-indicated by diagnosis
Group 2 Base
Group3 base
Scooter
Power Chair Standard Joystick
Power Chair Alternative Controls
Power Chair with Single Power Seating System
Power Chair With Single Power Seating System
Patient's needs and Equipment trial
Patient needs
Top speed>3mph?
battery range>7miles?
suspension?
to overcome obstaces>1.5inches?
to incline>6?
expandable electronics?
Group-base capability was successfully tested by the pataient?
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Yes
N/A
Special Instructions
ATP Name:
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