Need help configuring new Permobil F3 power wheelchair

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NothingButLove

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I have some questions concerning a new power wheelchair I'm configuring for my wife. It's a Permobil F3 we're ording from Numotion. My main concerns are really the backrest and joystick type.

Backrest Type:
There's two backrests: "Corpus Ergo Back (C3GERGBCA)" and the "Solid Corpus Ergo Back". The solid backrest is "no charge" and the other one is $1,058. The ATP who came over to the house did not know the difference between the two backrests. What is the difference between these two backrests? Which one do I want? (Hint: I want the one with the most comfort.)

Joystick Type:
The ATP selected the R-net LED Remote Joystick. There's a note on the order form for this joystick that says, "This joystick does NOT have a Display Screen and does NOT contain mono jacks. Limited to five profiles with this Joystick Module."

I don't know what a mono jack is or if we'll need one. The fact that it doesn't have a display doesn't really bother me. My concern is I never see this joystick when I look at chairs on eBay and I'm wondering why that is? This joystick is a "no charge" item. It's about $1000 to upgrade to the one with a display which I see quite often.

Is it OK to go with this joystick? What will I be missing?

Tires:
Flat Free vs Pneumatic. I can choose either of these at no charge. From reading various threads I gather that pneumatic tires are generally better on bumpy surfaces that you might encounter outdoors. I like the idea of a more "cushy" ride over a bumpy surface. I also like the idea of no flats. What should I choose?

Joystick Mount:
Swing Away vs Retractable. The ATP said he likes the retractable. Any opinions?

Push Buttons or Toggles:
The ATP recommends Toggles for the ICS Switchbox. Any opinions?

Active Reach:
ATP recommends not getting any Active Reach. My wife really only has use of her left arm now and she can't really grab anything too heavy. Any opinions?

Footplate Style:
Any advantage to the Narrow 2 Piece or the Narrow 1 Piece foot plates?

Headrest:
Standard Permobil Headrest or Permobil Ergo Shape Headrest. Opinions?

If there's anything else that's important to consider, please let me know. Thanks for your help!

Rob
 

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I will offer a few opinions:

1. Backrest type: I am not sure what the differences are between those two backs, as I am unfamiliar with them. I can infer from a bit of research that one is like a ROHO cushion and one is foam. If so, most would prefer the ROHO. I am still using foam for all my seatbacks and am pretty comfortable that way. For longer-term seating, I definitely prefer a ROHO seat bottom. I am thinking about going with a ROHO seat back cushion on one of my wheelchairs to see how I like it.

2. Joystick Type. I have 2 wheelchairs with the joystick that has the LCD display and 1 wheelchair with the joystick you linked. I am in the process of buying a joystick with an LCD display for that wheelchair. I would NOT be without the LCD display. I recommend the joystick with the LCD display.

3. Tires: I have both flat free and pneumatic tires. For everyday use, I recommend the flat free tires. I use pneumatic for the snow tires, which gives a bit more traction and perhaps a slightly softer ride. When I have pneumatic tires on the wheelchair, I strap a bicycle pump to the wheelchair and carry a spare tube and tube patch kit (along with all necessary tools) in a pack on the wheelchair. I recommend flat free tires.

4. Joystick Mount: I have a wheelchair that does not have the retractable joystick mount. I find that chair unuseable in tight quarters. I ordered a retractable mount from ebay and am waiting to get it installed. I recommend the retractable mount.

5. Pushbutton vs. Toggles. I presume you mean for the ICS controller. I have push buttons on all 3 Permobil wheelchairs, but am at a point where I wish a had toggles. With weak hands/fingers, I recommend toggles.

6. Active Reach: I was not aware of Active Reach in Permobil wheelchairs. After doing a bit of research, it looks great for someone who still has a bit of mobility. I would want it on my wheelchair (I think), but I have no experience with it.

7. Footplate Style: The single footplate would get in my way. It is great to be able to just flip one up at a time. I also like the narrow footplates, because they allow better navigating in tight quarters. I strongly recommend the narrow, double footplates.

8. Headrest: The Permobil headrests just don't work well for me. I have a Stealth headrest on my primary wheelchair that I prefer.

Good luck.

Steve
 

NothingButLove

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Thanks for the quick reply Steve. Tell me more about what you like about the joystick with the LCD display and what you don't like about the joystick with the LEDs. If you were trying to convince an ATP to upgrade you to the joystick with the LCD display, what would you tell him?

Thanks for your help!

Rob
 

LizF

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Hi Rob,
I just took ownership of the Permobil M3 and love it; from what I understand the differences are minimal between F3/M3 and have mostly to do with front-wheel vs mid-wheel drive.
Here are my opinions on your questions.

Backrest: I have the standard backrest and no issue with it, I don't recall what the difference was in the 2 when I ordered.

Joystick: Yes to the display. I can change all my seat positions with my joystick and not just the control panel if I wish, which will be more important as my arm function dwindles.

Active Reach: YES. I say it because while I don't have particular strength in my left hand, and the right is going, it allows me to maintain some independence. For example, I can reach the kitchen sink, bathroom sink to brush teeth, upper shelves of pantry, etc.

Footplates: I prefer the versatility of the narrow double footplates.

Hope this helps!

Also, may I ask what ATP stands for? Is it your insurance guy or a sales guy?
 

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With Steve, though neither of those backs is a ROHO back. Get the Ergo of the two, though. You can throw a ROHO back cushion on it (ask about ordering it now).

Vote for pneumatic tires if you are in hard, bouncy territory like city streets. We lived downtown, bounced through parks, etc. and never had a flat, while only topping off the air occasionally. Their advantage, like a car, is that you can adjust the pressure.

If your wife can still lean or assist with transfers at all, Active Reach would be nice. It would still be nice for pressure relief. I'm stumped as to a reason not to have it. It's an option you turn on and off, like a seat elevator.
 

NothingButLove

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Also, may I ask what ATP stands for? Is it your insurance guy or a sales guy?

Hi LizF! Congrats on your new M3! Glad to hear you like it.

Per Wikipedia:

"Assistive Technology Professional (ATP) - A service provider who analyzes the needs of consumers with disabilities, assists in selection of appropriate assistive technology for the consumer’s needs, and provides training in the use of the selected device(s)."

My wife is getting her Permobil F3 from Numotion, a company that sells various mobility devices including Permobil wheelchairs. They employ ATPs and send them to peoples houses to determine what they need. (type of wheelchair, options, etc.)

Rob
 

NothingButLove

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So here's what I've concluded so far:

Backrest Type:
Both backrests are "Ergo". One backrest is listed as solid and one isn't. I noticed the one that isn't solid and costs $1058 has an HCPCS Code of E2620. With a little bit of Googling, I found this: E2620 – Positioning wheelchair back cushion. If I Google "positioning wheelchair back cushion" and look at Google Images, it seems that the wheelchair backs can move up and down. If I Google "permobil e2620 roho", I find the ROHO Agility Series of back rests. They look like they are made to move up and down and have the HCPCS Code of E2620.

So, I'm pretty sure the solid "no charge" backrest is what we typically see on 99% of the Permobil wheelchairs. I'm going to ask the local Permobil rep just out of curiosity. I'll report back.

Joystick Type:
The LCD Display joystick looks cool but I'm still not sure what you get over the LED joystick. LizF mentioned you can position the seat/legs with it but I think you can do that with the LED joystick too. Hmmm...

Tires:
It's a toss up. I really want to get the pneumatic but from a practical sense, I'll probably go flat free. It would be such a bummer to get a flat if we were somewhere away from home.

Joystick Mount:
I'm going retractable!

Push Buttons or Toggles:
Just like Steve, our ATP said the toggles are better as your hands get weaker. Toggles it is!

Active Reach:
If Active Reach can help with positioning by offering a anterior tilt while sitting, I want it. I need to do more research as to how it works.

LizF, How does Active Reach work? Is there a separate button that controls anterior (forward tilt)? Can you tilt forward from a non-elevated position? Is it a permanent anterior tilt whenever you use the elevate function?

Footplate Style::
Narrow 2 piece it is!

Headrest:
Hmmm... don't know. Ergo shaped or regular. Hmmm...

Thanks for everyone's input so far! I appreciate it!

Rob
 

KarenNWendyn

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Rob,
Can you give us a followup 1-3 months after you get the chair, to let us know how the choices you made worked for you and your wife? I'm particularly interested to see how the flat-free tires work out for you. It would be a real bummer to change a flat, particularly if you were stuck somewhere or on a tight schedule.
 

LizF

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>>LizF, How does Active Reach work? Is there a separate button that controls anterior (forward tilt)? Can you tilt forward from a non-elevated position? Is it a permanent anterior tilt whenever you use the elevate function?<<

Hi Rob,
Yes, the anterior tilt is a separate button on my control. I do not need to be elevated to tilt forward, although it works better if I'm slightly elevated as then there's room for my knees to "dip". No, it is not a permanent tilt with the elevate function. I can elevate in regular seated position along with many other positions.

Also, I don't know if this is of any assistance with your ATP (thanks for the definition!), but here is the letter I submitted (along with my doc's and OT's paperwork) to insurance to cover the chair that explains specifically WHY this chair was necessary for me as an ALS patient. Please feel free to use any/all as necessary if you think it will help.

PERMOBIL M3

Reviewed for personal use of a 52-year-old person with sporadic limb-onset ALS, currently using a power chair as condition has progressed beyond ability to use a manual chair.

Maneuverability & Handling

Responsive joystick and mid-wheel base allows for exceptional maneuverability in a small space with narrow doors. Ideal for my housing situation. M3 felt stable outside, on grass, and ramp.

Controls

Control panel well placed off the forward edge of the right armrest. Responsive joystick. Four main seat position buttons easily accessed with little hand movement or pressure. Ideal as arm strength continues to weaken.

Comfort

The test model came with a combination gel-foam cushion, after a couple of hours, I replaced this with a ROHO cushion as I found the original cushion painful. Because I cannot use my legs, I require something to keep them from falling open and sliding off the footplates. This model has a knee brace that proved ideal for security and leg comfort, but it did start to become sore at point of contact after a time. The addition of thigh guides to the chair should alleviate some of the pressure and prevent discomfort and pressure sores.

Special Features, Benefits

Because my time for the foreseeable future will be spent in this chair, comfort and usability are crucial. In addition to those things noted above, the M3 has several special features that are of interest to wheelchair-reliant people, including a nearly infinite number of seat and footrest positions.

The chair has a 12” seat lift that enables the user to rise to eye level of standing people. Along with the social benefit of not having people talk “over our heads”, it alleviates neck strain from looking up. Most importantly for me, the extra height allowed me to reach into the cupboards, fridge, and shelves that had been out of reach. This ability adds to continuing independence, a key factor in quality of life .

With the many possible combinations of leg rest/foot/seat/backrest positions, I was able to lie prone, stand nearly upright, lean forward at an elevated position to reach things, and more. Circulatory benefits, such as prevention of edema, are also to be had.
The most important benefit for me was the alleviation of sciatic pain. I have dealt with sciatica and lower back pain for years, but being confined to a chair means that I am unable to stand, stretch, and move around. Therefore, I have relied on medication or staying in bed for relief, neither of which is desirable.

ALS progression means as muscles atrophy, they gradually begin pulling away from the bone, leading to extreme pain in the sinews and tendons. Range-of-motion exercises help, but are not always enough. In the chair, I was able to manipulate the seating/leg position to stretch several leg muscles (what’s left of them) including my hamstrings.

The weakness and extreme fatigue that accompanies ALS progression can lead to severe discomfort in body positioning, as something as simple as shifting a leg or arm a few inches can be impossible. In this case, I was able to move as much as liked, to get myself into many different positions. The difference of a few degrees back or forth can be the difference in painful and comfortable. I was able to control and maintain my own comfort for the duration of the test period with the M3, something I could not do, if at all, without relying on others while in a regular PWC.

As muscle mass is lost, pain is also caused from pressure, as fat is not the protective padding one might think. Even with my cushion, I get tailbone pain after sitting for a long time. With the M3 tilt capabilities, I could relieve the pressure off my tailbone for instant relief.

While using the M3, I was largely pain-free, and far more comfortable. Chronic pain, I cannot overstate, is debilitating. With ALS, any pain medication or muscle relaxant can affect the body in more ways than intended. If I take a pain reliever that is a muscle relaxant, for example, I am exhausted well into the next day, and that’s one day less to enjoy in a predicted shortened lifespan.

Summary

The M3 is capable of providing everything I can foreseeably require for the rest of my life with ALS: Pain-free comfort, more independence, better health, and adaptability to my progression.

By providing these things, it alleviates stress to both me as patient, and to caregivers. It will prevent issues that will cost the insurance system more, such as prescription drugs for pain associated with wheelchair bound immobility, or a more advanced chair as ALS progression continues.

The M3 will allow me to continue to enjoy the best quality of life for whatever time I have left, and that is priceless.
 

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Sorry, I meant to say, get the non-solid back -- more configurability.

Don't make assumptions about what backs or any other part are ordered more often, nor care. A PALS is special. And a lot of things on that order form are not good things.
 

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Here are some thoughts on LCD vs LED controllers. Note that I have both, but the LED one is relatively new to me, so it may have some capabilities of which I am not yet aware.

The LED controller (the one with just lights):
1. Does allow you to control the seat's movements (tilt, recline, etc.).
2. Does not allow you to display time
3. Does not allow you to display distance.
4. Does not allow you to display the speed.
5. Does not allow you to display diagnostic codes.
6. I don't think it allows you to know if you are in the various "turtle" modes

I like the time display because it is quite difficult for me to get my sleeve out of the way so I can look at my watch.

I like the distance display because I have found the "fuel gauge" lights (or bars on the LCD display) to be virtually useless. They really do not give much of an idea of how much range is left. By using the odometer, I can see how far I have gone on a ride and estimate how much remaining range I have.

I like to display the speed because it is the easiest way for me to moderate my pace so my wife and I can walk together. I find it quite difficult to go at a slow enough speed for her to be comfortable (or even keep up) just by seeing her (or not:)) in my peripheral vision.

Being able to display the diagnostic codes is essential! The wheelchair will malfunction. Being able to make a phone call and read off the diagnostic codes can save a trip to the wheelchair folks (though, often, it just confirms a trip to the wheelchair hospital is needed:().

Knowing that you have entered turtle mode is also important. This means the chair is operating in a degraded mode. Perhaps it is simply because the seat is positioned so that it would not be safe to go at a high speed. But, I have had my chair enter turtle mode because of a malfunction. When a malfunction occurs, the more information you have, the more likely you are to be able to resolve the problem.

For all these reasons, I strongly prefer and recommend the LCD joystick over the LED joystick.

Note that if you wind up with an LED joystick, you can add an Omni Display for a large sum of money. That display takes up a lot of space and makes getting around in tight spaces difficult or impossible. I far prefer the integrated unit.

Alternatively, the LED joystick can be replaced by the LCD joystick in the future (at least it works that way across my 3 Permobil wheelchairs).

Steve
 

NothingButLove

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Karen - I will write up a full review of the ordering process, options chosen along with the reasons and how everything worked out.

LizF - That's exactly what I wanted to know about Active Reach. I went back to my ATP and he agreed to 5 degrees of Active Reach (anterior tilt). I asked about 10 degrees but he felt at some point she might not be able to pull her head up and it may cause problems. (like death) Do you know how many degrees of Active Reach your chair was configured for?

Also, thank you so much for the letter of medical necessity!

Steve - I don't know man... $1,000+ plus seems like quite a bit for those benefits. Honestly, I don't care about saving my insurance company money but I just don't think I could justify the upgrade to the ATP based on those benefits. Not with a straight face. :) I took a look at the R-Net Technical Manual and it's got some diagnostics based on the LED lights. Also, there is a light combination that signifies when the speed of the wheelchair is being limited for safety reasons.

Concerning the backrest type... I called Permobil today and they explained the "Corpus Ergo Back (C3GERGBCA)" and the "Solid Corpus Ergo Back" are the same backrest. When I asked why he said it had to do with the HCPCS code E2620 and funding, blah, blah, blah. I asked him how come the 14" width is only under the Corpus Ergo Back (C3GERGBCA). He said they have to customize a 16" back to create a 14" back and they need to charge for the added labor. So there you go...

Got to get to sleep. Goodnight!

Rob
 

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LizF

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Hi Rob,
You're very welcome!
My anterior tilt is 20%; I have the knee brace and chest strap to use with it, so I don't, you know, fall out on my face!

Hope you get exactly the chair your wife needs
xo
 

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It is hard to believe the cost difference between LED and LCD controllers (joysticks) is over $1,000, yet after dealing with wheelchair providers, I do indeed believe it.

The color LCD controllers sell on ebay for about $300 to $500 (used). You can swap out the LED controller for LCD controller at any time. Just unplug the old one, plug in the new one, power up (will probably get lots of ICS lights flashing red), power down, and then power up again. I have done this several times across my wheelchairs.

A benefit of the LED controller is that it is a bit more compact. I don't think the small difference in size makes much of a difference, but it will make some difference when navigating tight spaces.

I wish you the best in getting the wheelchair and hope that it makes a great positive difference for you PALS.

Steve
 
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