Putting aside the unanswered questions of "Use it or lose it" versus "Exercise hastens progression", there comes a point when refusing a wheelchair is not only impractical but unsafe and self-defeating. Using a wheelchair doesn't mean giving up walking completely and it doesn't mean giving in to the disease. Letting the disease limit your life too much, too soon, and cause dangerous falls is giving in to ALS!
The trick is to recognize the point at which you begin narrowing your life by refusing a wheelchair. That moment isn't as clear-cut as it sounds because we all tend to not want to recognize what is going on. Here is my list of subtle hints that it is time for a wheelchair:
When you limit your fluid intake because walking to the bathroom is so tiring and risky.
When you leave without going into a store because there is no parking space near the entrance.
When you pay outrageous prices for groceries at the Quick Mart because a trip through a real grocery store is so tiring you can barely make it back to your car.
When you have to use the curb cut outs anyway because a curb is a risky climb.
When you find your self making decisions on where to eat based on whether or not they have a drive-thru.
When a trip to the refrigerator or bathroom cannot be navigated during a commercial break.
When you regularly hear yourself saying "I'll just wait in the car".
When you stay home because you know your family will have more fun if you are not along to slow them down or limit where they can go.
When you sit through an entire half hour of "Saved By the Bell" because the TV remote is across the room.
The obvious: When you fall down even while wearing the ankle-foot orthosis (brace) made to keep you from tripping. If you fall while using a walker, it is a red alert to get a chair NOW. It will take months to get a power chair so if you want a power chair, get started on the ordering process yesterday!
Many people resist going to wheelchair use for a variety of reasons; it is embarrassing to be seen in one, it is giving in to ALS, their legs will lose whatever strength they have left. News Flash: You won't look half as pathetic in a wheelchair as you will sprawled on the floor after a fall, so get over it, suck it up, etc. Using a wheelchair gives you the mobility ALS is trying to rob you of so it is definitely not giving in, it is fighting back. Your legs may lose some strength but they will lose it anyway when (that is when not if) you are laid up after a fall. Broken bones, concussions, sprains and torn ligaments on top of ALS weakness are very disabling, and ALS people rarely get back to where they were before the injury.