When A Wheelchair Is Not A Wheelchair
When a Wheelchair is Not a Wheelchair
By Derek Logan PT, ATP
Stop for a moment and imagine in your mind’s eye a wheelchair. Are you envisioning something typically found in the lobby of a hospital or front entrance of a grocery store; or perhaps being used to transport someone to their gate at the airport? More likely than not, it’s what you remember a loved one struggling to use in a nursing home setting.
What you’ve identified is undoubtedly a low cost, low featured, standard manual wheelchair. This style or classification of chair offers no adjustability, customization or accessories; and is available in only very limited sizes. Constructed of steel, they weight between 36 and 45 pounds. These chairs are intended for basic self-propelled manual mobility for only short periods of time. They are typically prescribed for use during recovery from surgical events when safe and functional ambulation is contraindicated. The user would not have other significant medical or physical disabilities, and the use be of short duration.
With that in mind, the characteristics of an APPROPRIATE standard manual wheelchair user are as follows:
• Ability to stand and transfer to another seating surface once they use the chair to get from one point to another.
• Good postural control. Ability to sit upright. No postural deformities.
• Ability to shift weight and change position
• Only sits in the wheelchair for short periods of time (not all day every day).
• No significant pain or discomfort with prolonged sitting.
• Adequate strength, tone, coordination, balance and cognitive skills to propel the weight of the standard wheelchair to perform all necessary activities of daily living (ADL’s) within their environment in a timely manner.
Unfortunately, these characteristics do not correlate with a great many of the individuals expected to live their lives in this style of chair.
So what’s the answer?
To begin, the process of wheelchair prescription must recognize each person as an individual as we begin to assess mobility capabilities and limitations in relation to their everyday activities. A wheelchair system has been properly prescribed when it allows the user to complete needed and desired activities in a safe and timely manner throughout the day without undue fatigue, pain and stress. Provision of the right chair not only provides an efficient means of independent mobility, but increases independence and participation in daily life; and improves a user’s quality of life and medical health.
So how do we do that?
At the other end of the spectrum from standard manual wheelchairs are ultra-lightweight wheelchairs. This style of chair offers the greatest degree of adjustability and options, allowing their fit and configuration to be tailored exactly to the user’s seating and functional needs. The available combinations of dimensions, frame angles and axle positions are almost infinite. These chairs can be as light as 12 pounds and are built for performance, maneuverability and efficiency for all day, every day use; for multiple activities and across varied terrain.
BUT aren’t these chairs just for young, active user? They can be, but …
Many users who may be older, less active, or perhaps marginal self-propellers can realize great functional success with a custom ultra-lightweight chair owing to their decreased weight, improved rear wheel access and enhanced postural assistance. These factors combine to reduce the time and effort required to access the user’s environment while helping sustain endurance for maximal ADL participation throughout the day.
BUT don’t these chairs cost more? Yes.
Won’t insurance companies deny the expense? No.
Success in acquiring funding comes down to a number of factors: completion of a thorough evaluation by both a therapist and the DME provider’s ATP whereby the functional and postural needs of the individual have been assessed and clearly documented; understanding the features that differentiate these higher end chairs from lower cost alternatives; understanding the clinical criteria required by insurance payers to qualify for these features; and providing clear documentation to support their medical need and the likely consequences in not funding an ultra-lightweight chair. This type of client centered approach to care is at the heart of NEHME’s mission. By evaluating each of our clients as an individual, understanding how they live their lives and the roles they play from day to day, we can better collaborate and together make decisions based on their specific limitations, capabilities and needs.
It is a disservice to anyone needing wheeled mobility assistance to provide them a lower cost alternative due to false assumptions about their needs, diagnosis, age or presumptions about funding and the actual accessibility to reimbursement for ultra-lightweight chairs.