There are endless, diagnosable and financial reasons as to why certain individuals choose a manual wheelchair over a power chair. Commonly, a manual chair provides mobility in a paralytic situation while allowing the individual to maintain independence in self-propelling the chair (i.e. paraplegic spinal injuries, lower leg amputations, etc.). Being able to push a wheelchair may be the only form of exercise the user may have access to, which keeps their arms and upper body strong for transfers elsewhere including in and out of the chair to their bed, the toilet, the shower, and the car.
Some people get landed with a manual chair because it is their only affordable option. In the U.S., patients and clients have to jump through hoops to get insurance coverage for wheelchairs, both manual and powered. Some of those hoops include obtaining a doctor’s prescription, contacting a medical equipment provider, contacting a specialist (occupational therapist, physical therapist, etc.) who is willing to conduct the assessment, and then wait for an extended period of time hoping that their insurance will approve coverage. Sometimes after 6 months of waiting, they get nothing from insurance and have to rely on their own out-of-pocket payments. Such results end with individuals getting the wrong chair for their personal needs, which can end in additional physical deformities, lack of independence, and a severely decreased quality of life.
So, aside from the financial dilemma, how does a wheelchair user or a caregiver determine if someone is in need of an upgrade from a manual wheelchair to a power chair? How do they know when it is not an appropriate upgrade?
Physical changes: Bodily changes that affect self-propulsion of a manual chair will include the following: the arms, endurance, cardiac deficits, general pain, and pulmonary deficits.
- Arms: Can the user independently self-propel a manual chair given their current upper extremity strength and range of motion? Typical wear and tear from manual wheelchair use frequently includes rotator cuff injuries. Anyone who has attempted to continue using a manual wheelchair with a torn rotator cuff or a shoulder replacement would understand the difficulty and pain that comes with it. Sure, there are customized options that could update a manual wheelchair including switching out parts for lightweight equipment and installing a power-assist system (i.e. the chair assists in propulsion to reduce the user’s exertion). However, if lightweight and powered options aren’t enough and the user has to take an exorbitant amount of rest breaks due to pain, then a power chair would be a better option.
- Endurance: Does the user of the physical capacity to push a manual chair for a given duration of time to get from point A to point B with few rest breaks? Insurance companies may require detailed evaluations regarding an individual’s endurance level and their alternative attempts to improve it (i.e. exercise, therapy, diet, etc.). The user would need to keep track of how many rest breaks they require in self-propulsion to get to basic or required destinations (i.e. bathroom, kitchen, bedroom, bus stop, doctor’s office, etc.). Specialists conducting the evaluations may also require an endurance assessment.
- Cardiac Deficits: Insurance companies are more apt to supporting power chair coverage when vitals are compromised, especially the heart rate. Diseases include congenital heart defects, congestive heart failure, coronary artery disease, pacemaker placements, stent placements, recent history of heart attacks, etc. A common example includes individuals who can no longer lift or push certain weight capacities per doctor’s orders in order to prevent further heart complications or death. Such weight capacities that sometimes go ignored would include self-propelling a chair which is an obvious combination of the frame and the individual’s body weight. If the user has a history of heart problems that negatively impacts their heart rate and blood pressure while propelling a manual chair, then it is time to look at a power chair which requires much less exertion.
- General Pain: Supportive diagnoses of pain include (but are not limited to fibromyalgia, osteoporosis, arthritis, rheumatoid arthritis, recent history of traumatic fractures, brain injury resulting in unexplained joint pain throughout the body, lower back pain, spinal injuries and herniated discs. If an individual claims that they “just hurt” without any diagnosis to back it up, then insurance companies normally dismiss the evaluation. On the other hand, just like in an exercise regimen, it should NOT consistently hurt to push a chair. If the pain is so bothersome that it forces the user to take several rest breaks (or even worse, makes the user avoid utilizing the chair entirely), then it is time for a change.
- Pulmonary Deficits: What we look for in this area is any type of lung disease that reduces breathing capacity and reduces oxygen saturation requiring a wheelchair user to be on an oxygen supplement via cannula. True, some wheelchair users with oxygen supplements can and will continue to use a manual wheelchair. It becomes a health concern when oxygen saturation drops with self-propulsion (as measured by a pulse oximeter, typical percentage must be above 90% with activity and at rest).
Cognitive changes: The physical changes listed above fully support health reasons for why people should upgrade to a power chair. When users demonstrate a shift in cognition, that typically indicates that power chair use would be unsafe for themselves and for others. Diagnoses that would negatively impact cognition include: stroke, multiple sclerosis, Parkinson’s disease, dementia /Alzheimer’s disease, Huntington’s disease, and traumatic brain injury. Disorders that frequently make individuals impulsive in their driving include substance abuse disorders and psychotic disorders (schizophrenia, bipolar disorder). Other disease that are less commonly considered include uncontrolled Type 2 diabetes which can not only result in reduced safety awareness, but also make the user perpetually fatigued placing a drowsy driver on top of a heavy motorized chair.
Cognitive disturbances that decrease an individual’s safety awareness while operating a chair would look like any of the following scenarios: a user frequently hitting others with the chair, the user attempting to stand up with the control system still on, the user speeding through their environment with no regard for surface changes, the user hitting walls and other inanimate objects, and the user driving off into the community requiring assistance to get back. Specialists, equipment providers, doctors, and caregivers would have to seriously consider cognitive factors of anyone’s case before obtaining a power chair. Users and caregivers need to seriously consider (it could not be emphasized enough) cognitive capacities and potential changes over time.
Visual changes: The convenient realization about manual chairs is that it is very difficult to build a substantial amount of speed via self-propulsion. For users who have decreased vision, a manual chair is a safer option in order to prevent injury to themselves and to others. Decreased vision could include basic near-sightedness, macular degeneration, cataracts, optic nerve damage, glaucoma, brain injuries resulting in vision impairments, etc. Another deficit that often goes ignored is a recent or chronic reduction in neck rotation. Without neck rotation (due to a spinal injury, joint degeneration, etc.), users severely reduce peripheral vision which is important when driving around corners or crossing busy hallways in a power chair. Doctors and specialist will have to acknowledge on assessments any visual changes that could impede on safely operating a power chair, despite additional adaptive equipment features (clip-on mirrors, glasses, etc.)
The following products are available on amazon.com and may assist in making the decision about whether or not a user should switch over to a power chair. Consult with medical providers to explore pricing options and to make sure that individual parts fit the power chair accordingly.
Powered-assist chairs: This would be a combination of manual propulsion and hydraulic assist/electric assist requiring no motor. A powered-assist chair is the “in-between” option that allows for user’s to maintain independent self-propulsion while limiting pain and injury. Note: manual powered-assist chairs by their very nature can be expensive. It is worth it for users to go the physician’s route to obtain a prescription for insurance coverage if it is available.
Clip-on mirrors: These are beneficial for folks who desperately need a power chair, but are concerned about making turns or safely backing up. Wheelchair mirrors are not universal and may not fit all arm rests. The majority of mirrors have an adjustable arm. As mentioned previously, failure to accurately use a back-up mirror due to reduced vision or range of motion in the neck should accurately determine whether or not a power chair will be a safe option for the user.
Pulse oximeter: This measures both heart rate and oxygen saturation. Consult with a physician regarding YOUR typical and healthy rates with rest and with activity.
- ACCURATE AND RELIABLE - Accurately determine your SpO2 (blood oxygen saturation levels), pulse rate and pulse strength in 10 seconds and display it conveniently on a large digital LED display.
- FULL SPO2 VALUE - The ONLY LED pulse oximeter that can read and display up to 100% for SpO2.
- SPORT/HEALTH ENTHUSIASTS - For sports enthusiasts like mountain climbers, skiers, bikers or anyone interested in measuring their SpO2 and pulse rate. SpO2 and Pulse Rate now faces instead of away from the user for an easy read.
- ACCOMODATES WIDE RANGE OF FINGER SIZES - Finger chamber with SMART Spring System. Works for ages 12 and above.
- LOADED WITH ACCESSORIES - Include 2X AAA BATTERIES that will allow the pulse oximeter to be used right out of the box, a SILICON COVER to protect your pulse oximeter from dirt and physical damage and a LANYARD for convenience. Comes with 12 months WARRANTY and USA based technical phone support.