Is Power Mobility Right For You?
Laura Juel, MS, OTR/L, CDRS
Duke Outpatient Occupational Therapy, Duke University Medical Center, Durham
The symptoms of MS can vary from weakness, sensory loss, poor balance and/or fatigue. If any of the above symptoms limit your independence, then power mobility may be right for you. A seating evaluation can be helpful to determine the correct power mobility device. Aside from function, the correct device should be comfortable and support your posture, not hinder it. Physical and occupational therapists have knowledge of disease course, body mechanics, functional activities and adaptations. Areas of evaluation may include strength, coordination, range of motion, balance and endurance. Impairments of sitting posture, spasticity and spinal deformities may also impact a person's functional abilities if not adequately supported. Many people with MS are able to ambulate earlier in the day but become limited by fatigue as the day progresses. Power mobility may enable a person to maximize use of their energy throughout the day; to conserve energy for purposeful activities. The therapist works closely with the client and equipment vendor to best match a client's needs with the correct mobility device. Seating clinics may have a selection of wheelchairs and scooters that allow you to take a ‘test drive’ before you decide on a device. As with all major purchases, it is important to do your homework. There are many devices and brands on the market and a knowledgeable therapist will be able to discuss pros and cons of all devices for your particular situation.
Many insurance companies, including Medicare and Medicaid, follow specific guidelines for power mobility. One of the steadfast guidelines is that power mobility must be used primarily in the home. We all know that many clients with mobility difficulties also rely on power mobility out in the community. Power mobility used strictly for leisure and recreational activities or for mobility outside the home is not covered by insurance. If you are interested in pursuing power mobility through insurance, they may request that you have a seating evaluation with a therapist. This evaluation can document difficulties you are having with mobility and the impact on your daily activities. It will also ensure that you get the proper mobility device. It is important to check with your insurance company for co-payments and deductibles, as there may be some personal expenses depending on your insurance coverage. For example, Medicare will pay 80% of the cost of a device if medically justified. Power mobility can cost as little as $2000 or as high as $30,000 depending on the type of device and seating functions. Certain accessories or equipment may not be covered under any circumstances. For example, NC Medicaid does not cover any costs related to purchasing a scooter. As with all insurances, the need for power mobility must be medically justified. Insurance companies will not reimburse you for another power mobility device within this five year window.
Your home environment should be an important consideration when deciding on the type of power mobility device that will best fit your individual needs. For example, a ramp or stair lift can provide safe accessibility in and outside of your home. Ramps need to be built to the correct specifications for grade and material to prevent injury. Power mobility devices can be a great asset within the home but the configuration of the device may impact maneuverability. A scooter takes a large space to turn around in, making this a less than optimal choice in smaller homes. Power wheelchairs have tighter turning radii and allow users to have a more supported seating system. Meal preparation can be challenging if you are positioned in a chair that is too low. A seat elevator allows the seat to rise up 6-8 inches for improved access to appliances and countertops while also optimizing positioning for transfers. If you spend extended hours in your chair and need assistance with transfers, power tilt and recline features can allow you to change positions and relieve pressure while minimizing the need to transfer back into bed. In addition, configuration of footrests and armrests can also impact your accessibility of tables or positioning for transfer to other surfaces. The correct power mobility device can greatly increase your mobility, comfort and independence while also meeting your needs within your home environment.
These devices are heavy, weighing anywhere from 100 to 400 pounds. Some scooters are marketed as having the ability "to be disassembled.” The heaviest piece is approximately 40 pounds, requiring good strength and balance to stow in your vehicle. This may be a good option for some, but the scooter’s features may not be the correct configuration for many users. When transporting a power mobility device, a tailgate/hitch lift or ramp entry vehicle is necessary. These vehicle adaptations are not covered by insurance, therefore are a personal expense. A rear vehicle lift can only be outfitted on vehicles that can accept a Class 2 hitch. If you remain in your wheelchair during transport, lock down systems need to be considered to safely secure your chair. If you transfer into a car seat, it is important to consider how you will stow your power mobility device. Clients who are able to drive may need to consider positioning options and adaptive driving equipment. Many local communities provide alternative means of transportation with accessible buses or van services. Given the financial burden to transport a power mobility device, many clients opt to use a manual wheelchair for community use while limiting power mobility devices to their home.