Once upon a time, it was clear what separated scooters and power chairs. However, as manufacturers continue to improve both mobility categories, the distinctions between them are starting to blur, some rehabilitation professionals say. If your referral sources ask questions about when and why to use a scooter or power wheelchair, are you prepared to answer intelligently? We asked physical therapist Dorothy D. Aiello and Julie K. Silver, MD, both of Spaulding Rehabilitation Hospital in Framingham, Mass, along with Charles Henry, ATS, of Hutchinson Medical Inc, Salem, Mass, to dissect the differences.
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Charles Henry, ATS, and Dorothy D. Aiello, PT, give a driving lesson.
The Power of Selection
In the past, rehabilitation professionals considered scooters primarily for outdoor use and power wheelchairs for indoor and outdoor use. Power wheelchairs were more appropriate for indoor use because of their maneuverability and because their various driving controls and seating options suited more involved users. Scooters, particularly the four-wheeled models, were preferred for outdoor use because of their ability to negotiate uneven surfaces and their relative portability.
However, now there are short-base, three-wheeled scooters that feature a small turning radius, making them easier to use indoors. Moreover, with the advent of mid-wheel or center-wheel drive power chairs, access to nonhandicapped living and working environments has improved. These chairs can turn in a small radius, making them ideal for users who live in apartments or old houses, or work in cramped situations, such as in office cubicles.
Selecting motorized mobility is very individualized. Rehabilitation professionals must consider the user’s impairment, level of function, surrounding environment, activity level, and seating and positioning needs. In addition, appearance, style, and color of the equipment are important.
Power wheelchairs have more drive control options than a scooter. For example, they can be driven with sip/puff control, head control, joystick, or foot control. Scooters have more limited options and are typically operated with a joystick or steering control similar to a motorcycle.
Power wheelchairs also offer more seating options than scooters. A tilt-in-space seating system, a reclining system, and a combination of these two options are available. Custom-molded seating is available for users with specialized seating needs due to scoliosis, kyphosis, or other fixed musculoskeletal deformities. In addition, a limited number of power wheelchairs offer a standing feature; however, insurance reimbursement may be difficult as the medical necessity of this option is still under debate.
Scooters primarily offer ergonomic seating. However, some models now allow for custom seating by offering a tubular seating frame, which allows more options in seating.
A general rule of thumb is the larger the base, the more stable the vehicle, which gives three- and four-wheeled scooters an advantage in stability. However, a corollary to this rule is that with increased stability comes decreased maneuverability. Consequently, the turning radius of a four-wheeled scooter is larger than any of the other models. Yet this too is changing as manufacturers are making vehicles that are both stable and maneuverable.
Power wheelchairs generally have the smallest turning radius and are the most maneuverable. Often antitippers are added to a power chair to help increase safety.
Transportability
Discussing the method of transporting the scooter or power wheelchair is as important as addressing the motorized unit itself. Generally, scooters are the most portable because they can be folded and have removable seats. A scooter lift for the car can allow some users near-complete transportation independence. For others, a caregiver can transport the scooter by disassembling so that the heaviest part weighs approximately 35-45 pounds.
There are a few models of foldable power wheelchairs; however, the frames of these chairs can still weigh more than 60 pounds. This fact can make a seemingly “portable” chair unportable depending on the user’s or caregiver’s ability to lift this much weight. Generally, a power wheelchair needs to be transported in an accessible van.
Minimizing Risks
There is a significant risk of injury for wheelchair users.1,2 One study found tips and falls to be the most common problems (42%), followed by component failure (33%).1
Tips and falls are usually due to rapid deceleration. Using a seatbelt can reduce the risk of falling from a power wheelchair.2 Ideally, a pelvic belt offers the same safety as a seatbelt and will position the user better in the chair.
Typically, patients who report falling out of a wheelchair fall forward whereas scooter users usually fall laterally. Using legrests can reduce the risk of injury for motorized wheelchair users.2 Scooter users should consider pelvic belt use and armrests to help increase their safety.
Conducting annual maintenance checks can reduce component failure. Active users should consider flat-free tire inserts, which allow a tire to function even when punctured. The inserts reduce the tire’s shock absorption, but they also prevent flats that can strand the user.
As both medicine and technology continue to advance, we will see new motorized mobility options. Helping rehabilitation providers understand the various power wheelchair and scooter options (including style, safety, performance, and portability) will enhance the quality of life for mobility users.
Dorothy D. Aiello, PT, is a senior physical therapist at Spaulding Rehabilitation Hospital. Julie K. Silver, MD, is the medical director of the International Rehabilitation Center for Polio, at Spaulding. Silver is also an assistant professor at Harvard Medical School. Charles Henry, ATS, is vice president of sales and distribution for Hutchinson Medical Inc.
References
1. Gaal RP, Rebholtz N, Hotchkiss RD, Pfaelzer PF. Wheelchair rider injuries: causes and consequences for wheelchair design and selection. J Rehabil: Res Dev. 1997;34:58-71.
2. Cooper RA, Dvorznak MJ, O’Connor TJ, Boninger ML, Jones DK. Braking electric-powered wheelchairs: effect of braking method, seatbelt and leg rests. Arch Phys Med Rehabil. 1998;79:1244-1249.
| Mobility Insider Dealer/Provider spoke with Larry Jackson, president of Permobil, Lebanon, Tenn, about legislative issues within the mobility segment of the home health care industry and how Permobil’s products are helping those with disabilities lead a more active lifestyle. “One of the things that is stagnant in the industry is innovation,” says Jackson. “We do not limit products based on coding. We look at every option that can make someone’s life better.” Q How do you see legislative issues affecting Permobil this year?
A The Advance Beneficiary Notice (ABN) will make a difference; it is finally going to give people what they really want instead of getting what the insurance will cover. If they have the ability to pay, they can get the right products that meet their needs. In the past they could do that, but they had to pay up front and bill it on the side. With [the ABN], more functional products will come out on the market. Permobil has historically considered the consumer’s function more than the medical necessity. Permobil offers features such as seat elevator, tilt and recline, and custom seating to accomplish this. We were founded on this premise and continue with these core values. The whole idea behind disabled people and mobility products is that you want to get them back into a normal lifestyle. We want to enable disabled people to achieve a higher standard of living, not just give them a simple mobility device. It is not about price, it is about function. Q How is the TRAX™ power wheelchair helping people become more active outdoors?
A TRAX is the third generation of this model but the first one marketed to the United States, primarily because the United States is a funding-generated industry. In Europe clients are allowed to have an indoor chair and an outdoor chair. We just want to give that opportunity to our clients in the United States, even though there is not a Medicare code. Many people are injured while hiking, offroading, biking, or in car accidents. [Our clients] just want to go to their child’s baseball or football game, but the paths to those fields are not always paved. This is a terrific time for the product and the response has been tremendous. Q What can our readers look for in 2002?
A We are working on our education program. We have about 54 of these planned across the United States on seating and positioning which focus on functional mobility. Therapists, providers, and dealers are invited to participate. There have been a lot of recalls within the industry and, knock on wood, we have not had any in the past. What is happening is that everyone is pushing for lower prices. Dealers are forced to provide a product that the consumer does not want to buy and the dealer does not want to sell. This is what I call the cesspool of wheelchairs. I think consumers and dealers have lost sight of fighting a little bit for what is right and instead are just taking what they can get. We want to energize everyone toward that fight. The dealer needs to look at the true costs associated with selling and repairing a product. Not what discount is available from the manufacturer, but how many times one must go to the client’s house to fix a warranty item, which is quoted free of charge. However, it still costs the dealer time and effort to go out there. There should be a Consumer’s Report for wheelchairs. [Right now there is] a mixed message. It seems that the company with the biggest marketing budget gets their message heard. Permobil is increasing its efforts to have our message heard. |
| Mobility Market To Top $1 Billion by 2008 |
| The latest study by marketing consulting firm Frost & Sullivan contained some good news for the mobility market. Industry analyst Collin Tam found that despite limitations on Medicare reimbursement, the revenues for wheelchair, scooters, and patient lifts will increase steadily over the next 6 years to reach $1 billion by 2008. In 2001, the North American mobility industry generated sales of close to $766 million. The sectors Tam predicts will grow most rapidly are bariatric product lines, patient lifts, and stair lifts. The slowest will be standard wheelchairs. “Its growth will be pretty flat and perhaps even shrinking a little,” Tam says. Standard wheelchair sales might grow more if reimbursement for them increases. Cutbacks in Medicare, Medicaid, and health maintenance organization (HMO) reimbursement have put pressure on manufacturers to keep prices down, discouraging the development of premium models that could attract new buyers to the market, Tam says. |
PMC Is Out To Fix Reimbursement Problems
Last month the Power Mobility Coalition (PMC) hosted a meeting with top Centers for Medicare & Medicaid Services (CMS) staff and home care industry leaders. Tom Barker, CMS’s senior outreach advisor, and representatives from the American Association for Homecare, the Coalition for Medicare Advocacy, and the National Association for Home Care, attended, says Steve Azia, PMC’s attorney.
It was an impressive group, especially considering the host group is barely 2 years old.
What sparked the creation of PMC was one man, Doug Harrison (left), president and CEO of The Scooter Store, New Braunsfels, Tex. As a power mobility provider, he took seriously his role in ensuring that all eligible Medicare beneficiaries received the equipment they were entitled to. Too often, however, paperwork hindered his ability to operate, and as a result, Medicare beneficiaries were denied access to power mobility equipment and services, he says.
In the spring of 2000, Harrison decided to do something about this problem. He realized that other power mobility providers faced the same issues he had with contacting their Durable Medical Equipment Regional Carriers (DMERCs) and keeping up with paperwork requirements. However, their individual complaints were too disorganized to be heard.
To create a unified voice to speak to lawmakers about these problems, he founded the Power Mobility Coalition. “We discovered that it would take an industry voice to get anything accomplished,” says Tim Zipp, PMC president. “This has proven true in the last year and a half.”
Although Zipp could not release a current member list, he says the PMC is represented in all four DMERC regions and one half of the national market for power mobility equipment.
One of the biggest issues PMC members face is the DMERCs requesting additional documentation on claims for power mobility equipment in addition to the Certificate of Medical Necessity (CMN).
“We realize the DMERCs must have the authority to investigate suppliers and rid the system of fraud and abuse,” Zipp says. “But this is not happening. Quality companies all over the country are having payments held up or denied.”
PMC says the DMERCs often ask for doctors’ notes and evaluations by physical therapists and occupational therapists, in addition to the CMN, to determine medical necessity. “We already have a process in place, the CMN, and the name says it all: it certifies medical necessity,” Zipp says. “CMS and the DMERCs built this process, and now they say they dislike it. The problem with the supplier community is, when you read a chart note, what must it say...to provide coverage?”
PMC members realize the CMN may not encompass all the criteria that CMS or the DMERCs want, so the members would like to help change the form to get the necessary information, Zipp says.
The group continues to ask CMS if there is information to properly establish medical necessity, that they follow the Office of Management and Budget (OMB) approval process for information collection. “Suppliers need to know the criteria for coverage so we can properly inform beneficiaries of their options,” Zipp says.
To learn more about PMC, call Maria Spencer, at (202) 776-7871, or visit www.pmcoalition.com.
| Home Care Industry Remembers Zella Burke |
| Leisure-Lift, Kansas City announces the passing of one of its founders, Zella L. Burke, who died January 15, 2002. Burke, along with her husband, Wilbur Bill Burke, who died in 1992, were pioneers in the mobility products industry. In 1965 they founded Burke Inc/Leisure-Lift. The Burkes innovated an advertising-driven mail-order system to sell mobility products at a time when there was not an HME industry. As the industry developed in the 1970s, Leisure-Lift was founded to work with HME distribution and Burke Inc ceased direct-sales efforts. |
| A Playground for Everyone  Permobil president Larry Jackson and Lily Shaw, 3, hold the Lily’s Garden logo.
Playgrounds are a haven for children to have fun, act silly, and run around. But what if you are a child in a wheelchair who cannot maneuver through the average playground? Lily Shaw, 3, became familiar with this situation after being confined to a power wheelchair because of spinal muscular atrophy. When Lynne Shaw, Lily’s mother, saw that most playgrounds in their hometown of Nashville, Tenn, were inaccessible to Lily, she contacted Boundless Playgrounds™, a nonprofit organization that guides groups in building playgrounds geared toward children with disabilities. Since it was founded in 1997, Boundless Playgrounds has helped create 31 playgrounds in 15 states and Canada. The goal is to eventually create at least 1,000 playgrounds, and considering the support the group has garnered from major corporations, including the Hasbro Children’s Foundation, they may be well on their way. In the case of the Shaws, mobility manufacturer Permobil, Lebanon, Tenn, donated time and money to turn an older, inaccessible playground into a playground designed to offer 70% accessibility for physical, sensory, and learning disabled children. The playground, was renamed Lily’s Garden and opened on December 15, 2001. It features rubberized surfaces, raised flower beds, benches, and a water play area for all children. There is also a swing set that children in wheelchairs can use. Watching Lily use the playground to race with her brothers—Will, 9, and Sam, 5—for the first time was a joy, says Lynne Shaw. “We were all just tickled pink.” Kids, handicapped and not, have really embraced the park. “It is just such a crowded park now that I think Lily is a little dumbfounded,” Lynne Shaw adds. You need not be a major multinational corporation to help bring a handicap-accessible playground to your community. Companies of all sizes can get involved by visiting www.boundlessplaygrounds.org. Those who would like more information on Lily’s Garden can visit it at Blakemore and 24th Avenues in Nashville, or look it up online at www.lilysgarden.org. |
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