Monday, March 26, 2018

Buying a wheelchair is like buying a car

So many types and models, and so many do I know what is best for me?

Quest Magazine has some great articles. A while back, there was one written by Kathy Wechsler called, “Front, Middle or Rear … Finding the Power Chair Drive System that’s Right for you.” For anyone in need of a wheelchair, new or replacement, this article is a good read.

Ms. Wechsler wrote that it is best to work with a certified rehabilitation technology supplier (CRTS) as well as an occupational or physical therapist who specializes in wheelchairs. They will perform an assessment and evaluate your particular needs and capabilities. She also recommends that you ask a lot of questions, and not quit asking until you feel comfortable with the answers you are getting.

My first wheelchair was a mid-wheel. It served its purpose, but the seat would not elevate. After about three years, I found myself having difficulty standing up from the chair. When I upgraded to a new chair, I spent several hours with a seating-specialist and occupational therapist. They evaluated my situation and my current capabilities. They asked dozens of questions regarding what my needs are today and what my capabilities might be five years out. Yes, five years.

Chairs are an expensive investment and you do not want to purchase one that will only fit your needs for the next 2-3 years. When I transitioned from a mid-wheel to a front-wheel drive with seat elevation, it was very different and I scarred a few door-frames in the first few weeks. I tend to like front-wheel more, but it took a little while to get used to it because of my experience with a mid-wheel.

Based upon information provided in the article and my personal experiences, I have listed some questions and considerations before purchasing a chair.

  • Don't just consider today's needs. Since you want to have a chair that is comfortable and yet capable, always consider your lifestyle, capabilities and needs, now and five years into the future. Take your time and consider the right chair for the right reasons.
  • How is your home configured? The size and setup of your home and office is very important in helping to make the right decision. Does the home have an open floor plan? How tight are the kitchen turns? Carpeting takes a beating with a wheelchair. Hardwood floors and tile are far more accepting. What are your home’s exterior and interior door widths? You want to be able to access your kitchen, living room, bedroom, bathroom, and closet. 
  • What is the width and turning radius of the chair you are considering? Mid-wheel chair require a smaller turning radius. Are the chair’s arms adjustable? 
  • How will you gain access to your home? There are portable ramps that are
    reasonably priced, or you can build a ramp. Portable ramps are nice when you visit other locations that are not handicap accessible. But, they are not light and easy to handle. Always consider a secondary exit plan in case of a fire or other emergency. Do you have a rear deck or porch that you want to access? 
  • What type of seat and backrest do you need? Comfort is king. Since you will be spending several hours a day in your chair, a properly measured seat and backrest are important. There is nothing worse than having a seat or backrest that is uncomfortable or not quite right. An improper fit can also cause pressure ulcers (bed sores).
  • How will you transport your chair? Do you have a wheelchair accessible vehicle?
    If so, will the new chair work with it? If you do not have a vehicle, what is needed to be able to take the chair with you? Wheelchair accessible vans are a fantastic tool. Fortunately, there are many used vans available today. There are also transport platforms that can be used on sedans or SUVs. 
  • What type of suspension system do you need? Do you spend a lot of time outdoors? Usually front and rear-wheel drive units perform the best. There are also specialty chairs for the outdoorsman. 
  • What kind of obstacles and inclines will you encounter during normal use? Front-wheel drive units perform the best for curbs, grass, gravel, snow and uneven terrain. Mid-wheel drive chairs can become hung up because they have front and rear casters. On the other hand, mid-wheel drive units are usually the most stable on inclines and declines. Normally, rear-wheel drive units are the least stable on inclines and declines, so it is important to have anti-tippers installed. 
  • How fast do you need to go? For speeds up to 5 or 6 mph, all chairs perform well. For higher speeds, front and rear wheel drive chairs are more stable and easier to drive. 
  • Do I need a Group 2 or Group 3 chair? Group what? There are seven groups of chairs. Most of us living with Kennedy's Disease will start out with a Group 2 chair and at some point might require a Group 3. Within these two groups, there are a variety of options (like accessories on a car). Some are not needed, but others might be helpful or even needed. 
  • New or Used? There are a lot of good quality used chairs available. Most are a cost-efficient way to purchase your first chair when it is not medically needed yet. The key learning to take from a used chair consideration is the next point on who will service the chair. Do not assume your local dealer will service your chair if you buy it somewhere else. I learned this the hard way and it was no fun.
  • Who will service your chair? Just like your car, this is very important. And, it is especially important if you purchase a used chair. I know of one man who lived two hours away from the nearest dealer. When his chair needed servicing, he could not find anyone who would make the trip. In-home-service is a wonderful convenience especially if the chair stops working for some reason.
  • And, what will be your out-of-pocket costs - those not covered by your insurance provider? Most every provider has certain pre-purchase requirements. Know what they are ahead of time. With Medicare, for example, requires a Certificate of Medical Necessity (CMS) provided by your doctor. Also, they do not cover any of the cost for an elevated seat. They do not feel it is necessary. Those of us living with Kennedy's Disease might reach a point where the only way to transfer from a chair is with an elevated seat. 

To summarize—all three models of chairs have their pros and cons. That is why it is important to get a personal evaluation and assessment as well as to ask a lot of questions. I also advise asking an occupational therapist to tour your home. He/she will see things that you and I would not even consider.

If you have questions or additional comments based upon your experience, please let me know.

1 comment:

  1. For suggestions to prepare for insurance coverage:

    On ever Doc visits have a note made on issues that may be addressed by a powerchair (PC) or some other adaption or action.

    e.g. If you have leg edema (even minor) have that noted on your record. If reasonable have the Doc enter a recommendation for leg elevation. This will support the elevating foot rest option.

    If you have trouble with trunk strength or sitting posture issues/pain this would support the seat and back tilt. Back tilt is not as good as seat tilt when the chair is used outside slopes.

    If you can't get up from a standard height chair document that you need to have a seat height of at least 27" (or whatever) to do a self-transfer. Have it documented that you do not have enough strength to do a side transfer. This will support the seat elevation.

    When doing the PC eval mention these same items. Emphasize you expect to be strong enough for a self-transfer well into the future if you can depend on starting a standing transfer from 27" or so.

    There are a lot of used chairs out there too, at or near the copay you may face. The disadvantage of used is lack of coverage for major repairs like a controller or motor. Not a lot of the used chairs come from the ALS (or similar) community and do not have elevating seats as the patients are not weight bearing so can't do a standing transfer in any case. DO NOT buy a PC without elevating seat unless you cannot stand today.


Please feel free to comment. By taking a moment to share your thoughts you add much to these articles. The articles then become more than just something I said or believe. In addition, by adding a comment, you might just be helping the next reader by sharing your opinion, experience, or a helpful tip. You can comment below or by sending me an email. I look forward to hearing from you.