POWER CHAIR EVAL

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annlee

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Joined
Jul 27, 2024
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5
Reason
DX MND
Diagnosis
06/2023
Country
US
State
OK
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GUTHRIE
I am 4 years in with LMN. Legs are trashed. Upper body weakness. Wheelchair dependent and ramps have become massive challenge. I have my first power chair assessment in a few weeks. I am clueless on this. Any suggestions on what I should be asking? I live alone and am quite independent. I must be able to use this in my home (in the future.) It also needs to go across a bumpy lawn. I use public transit handicap bus for all doctor appointments, and weekly PT. I will use my regular chair for "car transport ". I drove up to 16 months ago and could load my chair myself. But, life keeps changing. I feel some pressure to be sure I get the right power chair with insurance. I have paid cash for all previous aids and my featherweight chair. Really tight finances at this point.
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The PT or OT at your clinic should write up some specs for the DME. Then your assessment should be in your home so the DME rep can see the lawn, etc. Probably a bumpy lawn suggests a mid-wheel chair but there are several factors so you want to make sure all the things you want to do in your chair are clear to the ATP.

If you use the search function here and elsewhere, you can find a lot of good information on power wheelchairs, though some is more personal preference than science.

If there is more than one DME (equipment firm) in your insurance network, I would keep an open mind about which one may suit you best, regardless of which one your clinic recommends. You can switch midstream if necessary, though of course that slows things down.

Most PALS do best in Permobil chairs. You should be able to drive a loaner or test drive one at the DME's offices. A matrix of their current models so you can check them out is here. This page lists some other resources that you may find helpful.

Medicare should cover tilt, recline, seat elevation and power foot/leg rests. I would also ask about arm troughs and alternative drive controls. Sometimes these are ordered with the chair and added when you need them, since it is harder to get anything approved for the wheelchair after the initial order.

A case can be made for anterior tilt (Active Reach) and I would ask that be included as well. It may be denied initially, so the order should include the appropriate justification (you still have some upper body function and live alone).

You should ask that a ROHO seat cushion be included if they do not bring it up. In fact, you should approve the spreadsheet that is sent to the insurance company for approval to make sure nothing is left out. The dimensions of the chair itself may be important to you since you are using transit and may have narrow entrances at home, so you want to make sure when they measure your body that they are precise.

You also need a safe, comfortable postural support (hip belt or chest harness) on transit; I always recommend that the Bodypoint brand be specified (I used to work there, but they are still the only standards-tested line).

Some of this stuff may annoy the DME. That's one of the benchmarks of a good vs. bad DME -- the one who's less annoyed. If your network includes out of state providers, you do not have to stay in state, but since wheelchairs do need tweaking, especially on delivery, you would want a location that you can get to -- in-home/in-clinic service is less a thing these days with staff shortages.

Documentation at some DMEs is not all that. Keep saying "ALS" and if necessary "terminal disease" to everyone you talk with. Everyone in the supply chain is supposed to prioritize those. If you are working with a care manager at your local ALS charity or a case manager with your insurance plan, they may be able to help grease the wheels to get things done as well. Some orders go smoothly, others not so much.

It's important to keep pressure on if needed because no one has enough parts or resources so sometimes you have to be the squeaky wheel. It used to be pretty reliable that PALS got their chairs within a month or so of insurance approval -- now, that approval may take longer and the post-order interval may be longer as well.
 
Wow! Thanks so much for so much information. I will follow your suggestions. This is so very helpful. I appreciate your time and knowledge. Best of luck to you.
 
Here is a link to a post I wrote. The post is pretty old, but I think much of what is in there is still applicable. Things I have learned about a wheelchair

My specific recommendation is to get a Permobil brand wheelchair. While they have their quirks, I think they are the most robust and the most readily serviced options available in the US. I will note that I do know folks using other brand that are happy with their choice.

A big decision is where the drive wheels are located. Options include rear wheel drive (rare in the US), mid wheel drive, and front wheel drive.

In the US, you will most likely be choosing between mid wheel drive and front wheel drive.

Mid wheel drive wheelchairs can be easier for novice users to control. They pivot about the middle of the wheelchair, so can be used in tighter spaces.

I prefer front wheel drive because I find them better on rough terrain. The drive wheels will climb over obstacles. With mid wheel drive wheelchairs, it is possible for the front and rear caster wheels to lift the drive wheels off the ground, essentially stranding the wheelchair.

I also prefer the larger wheelchairs. I am currently using a Permobil F5 as my primary wheelchair. I have put over 3,000 miles on it. I am in the process of getting a new wheelchair (supposed to get it today) and have opted to go once again with the F5.

Note that Medicare would not cover an F5 for me. They would only pay for an F3. I paid the cost difference to upgrade to the F5 (about $4,000). I did this because the larger wheelchair is more stable and because it can accommodate larger batteries. Even with the larger batteries, the practical range is about 14 to 15 miles.

I have found the Permobil Aggressive tread tires to be very much worth getting. I spend a lot of time outside and the aggressive tread tires really help when driving over loose surfaces. I find they work fine indoors as well.

Steve
 
You should be aware that Medicare now covers power chairs. You have to have a PT write up all the bells and whistles you will require. Find a ver y good mobility company to work in conjunction with your PT. I used Rider Mobility in the. phoenix area. I have a Quantum chair with a RoHo cushion and I am very pleas ed with both.
 
Thank you for this information. It is very helpful to hear from those that have been down this road before me. No experience with this type of thing. Your willingness to share information in invaluable.
 
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