If you are working with an occupational or physical therapist from an MDA/ALS Clinic or ALSA clinic you will probably also be seeing a wheelchair seating specialist, probably one who is certified. They will be familiar with your needs as ALS progresses, what is available among wheelchair brands, the picky paperwork, and time frames for getting Medicare/insurance approval. Buying a power chair without this level of experienced help is risky. They aren't infallible but your odds of getting through the process successfully is improved. With their help you will have minimum hassle with the paperwork. They will see that it is properly completed and the process is moved along as fast as possible. Regardless, it will probably take 4 to six months to get your chair and about an extra 3 months if there are screw ups. The process is getting faster but don't expect miracles.
As for choosing the chair, you will have input but they will guide you. You will get to make one decision all on your own though. You have to pick the color. That means choosing black, black, or black for 90% of the chair and a color for some of the trim. Whoopee.
The essentials are tilt/recline, "articulating" leg rests that extend as you recline, a ROHO or similar cushion, not a manufacturers seat cushion that cannot be removed. Joystick driving controls are the norm but make certain that the electronics of the chair are adaptable to other types of driving controls later as needed. Also, if you may be using BiPAP or a ventilator later on, make certain that it can be mounted compactly on the chair. It is frustrating to find out later that the BiPAP or vent has to be mounted on a tray that considerably extends the length of the chair. That can be enough to make it hard to get into bathrooms, your van, elevators, and my all time favorite, those entrances that require a turn to get through two doors that are barely five feet apart!
A chair that can lift you up is nice but is nearly always a battle to get covered. It is very helpful for those who can still transfer in and out of a chair with minimal help because it is easier for a helper to get you on your feet. However, if you need a wheelchair now, your standing transfer ability probably won't last all that long. The cost of a lift chair is in the $2,000 to $3,000 range. Your money may be better spent on a lift or overhead lift system. Its use in getting things from high shelves is also limited by the progression of arm weakness. The one thing that you won't "outgrow" is the ability to be at eye level with standing people. That is great social improvement but it will be self pay and probably shouldn't be used in an insurance claim justification as it is not a medical need.
The front, middle, or rear wheel drive choice depends a lot on whether you are going to be using the chair out doors. Front wheel drive is the best for getting over curbs and other obstacles, and for rough ground, but is slower to prevent the back casters from going nuts at higher speeds.
Mid wheel is best for its tight turning radius and therefore for indoors especially for homes with smaller rooms. Outdoors it hangs up on uneven ground - any spot where the front and back caster wheels are on the ground but the drive wheel is over a low spot. It is also prone to what is called caster jerk, a jerk to the left or right as you come to a stop. It can be mild but can also be a real ankle basher that requires a quick turn in the opposite direction right before stopping to compensate for it.
Rear wheel drive is a good middle choice for those who want to get outside on grass and bumps, have good sidewalk speed, but also want a housebroken chair. It handles well indoors with a turning radius that won't turn on a dime but more like a quarter. In small spaces it will need a three point turn instead of a spin in place.
You may be nudged in the direction of a low priced brand, but insist on comparing that choice to other brands. This chair is going to be a huge part of your life and although you can get a different chair if this one proves to be unsuitable for your basic needs, it can be difficult to get approval for a new chair within 5 years.
