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Published on December 14, 2021

Making the switch to a wheelchair

Wheelchair

A wheelchair becomes a necessity for people for many different reasons.

It can be a sudden loss of mobility caused by a stroke, loss of a leg or a spinal injury. Or it can be a slowly emerging situation, resulting from worsening symptoms of diabetes, cardiovascular disease, muscular dystrophy or neurological disorders, including ALS (amyotrophic lateral sclerosis) and MS (multiple sclerosis).

It can also be temporary, as a person recovers from an injury or improves with therapy after a stroke.

Whatever the reason for needing a wheelchair, It does not mean the end of an active life, said Heather Ward, physical therapist at Falmouth Hospital and a certified adaptive technology professional (ATP). As an ATP, Ward assesses what people with disabilities need to perform their daily lives, determines which equipment might best help them, and trains them in the use of those devices, according to the Rehabilitation Engineering and Assistive Technology Society of North America.

“A lot of people have negative feelings,” she said. “Society says, ‘Oh, and now they’re in a wheelchair.’

“(But) it’s really a tool. It lets you do the things you need to do.”

There are different types of wheelchairs, depending on the user’s abilities and preferences.

A basic wheelchair moves because the user pushes it along – usually using their arms to rotate the wheels.

“Somebody with a (leg) amputation might end up with a (basic) wheelchair,” Ward said. “They’re probably pretty healthy in their arms and trunk.”

For people lacking adequate upper body strength or an arm to push themselves along, wheelchairs with lower seats, called hemi-height, allow them to use one or both feet to move. The footrests on most chairs can be swung out of the way. Stroke patients often use this type of chair, Ward said.

“The seat is lower to the ground, so they can use a foot to propel, without sliding forward and reaching with their toes,” she said.

Today, wheelchairs come in a variety of colors and styles, including folding chairs for portability, added suspension for a smoother ride, even racing and off-road models, according to the Christopher & Dana Reeve Foundation, founded by the late actor who used a wheelchair after a horseback riding accident in 1995, and his late wife. Some offer hand-crank or lever options for propulsion, or a small engine to take over when needed – a hybrid of user and engine power.

Medicare covers (80 percent after meeting your annual Part B deductible) powered scooters and non-powered wheelchairs, if prescribed by your doctor.

Power Chairs

“Power mobility is a much bigger chair’ more expensive chair; more customizable chair,” Ward said.

People who use these devices lack the strength or ability to push themselves along, so rely on a motorized chair. They may have an injury high on the spinal cord and are able to use their shoulders and breathe independently but have little or no use of their arms and legs. They may have ALS or MS and be gradually losing the ability to walk and need a power chair to prevent falls and preserve their energy for times when they get out of the chair.

“They might be able to walk a few steps to get into the shower or into the bathroom,” Ward said.

Power chairs can be a boon to folks with progressive neuromuscular diseases, such as teenage boys with Duchenne muscular dystrophy. This type of dystrophy rarely affects girls. Ward said a power chair allows them, “without using up their energy, to go to school and hang out with their friends.”

While some people require their power chairs all the time to move about, many use them part-time.

“They might have really good days or really bad days,” Ward said. “People with MS often feel really good in the morning. They might use a walker in the morning.”

Power chairs vary considerably in placement and type of wheels, seat cushion options (to prevent pressure sores), add-ons to help keep a user’s head or legs in place, control panels or joysticks and niceties such as cup holders, cell phone holders, work trays, lights, storage bags, etc. Some allow a user to fully recline or bring him or her to a standing position. Because children grow, you can buy power chairs that adjust to their lengthening bodies.

Some power chairs are relatively lightweight, can even be folded, and can be placed in a car or behind it on a rack, like a scooter. But most weigh hundreds of pounds and will require a ramp to get in and out of a home and a customized vehicle to carry it around.

Medicare covers power wheelchairs, if deemed medically necessary for home use, and the business selling the chair has to be enrolled with Medicare. It doesn’t cover household ramps or vans and other vehicles with ramps or lifts and other modifications to accommodate a power wheelchair. The cost of these modifications can be as much as the price of the original vehicle, so many people rely on more affordable used converted vehicles and may seek out grants and assistance from local and national disability organizations.

When to Get a Chair

“That’s a hard decision. It’s good to have a good team,” Ward said. “It’s important for people to know they don’t have to figure this out all on their own.”

She advises a needs assessment by your doctor and physical therapist, with input from others who have the same illness or injury as you. Listen to family members concerned about your safety, care and living situation. All these sources can help make that decision, she added.

A physical therapist can work with a DME (durable medical equipment) provider and your doctor to navigate the application process with your health insurer to see what it will cover. They will prepare a “letter of medical necessity,” which defines your equipment needs and their recommendations for the equipment to meet them.

“Sometimes it’s easy, but it can take months” of negotiations with a private or government insurer, Ward said. It may also take extra time for the manufacturer to add any personalized options.

Opting to start using a wheelchair can be difficult and emotional, not only for the user, but for family members. Getting the right equipment can reduce stress for all involved.

“This is something for their loved one; to boost their independence, maximize their safety, maximize their mental health” Ward said. “Especially for someone who’s having frequent falls. To get somebody out and about and not worry about falling.”

The best-case scenario for someone needing a chair and their family?

“The wheelchair becomes an extension of the person,” Ward said.