Power Mobility: Is it Time for Wheels?
Jacqueline A. Hall, MS, OTR/L, MSCS
When do you use power mobility?
Many individuals who have multiple sclerosis (MS) begin to have difficulty with their mobility as the disease progresses. Changes in vision, decreased balance, increased spasticity, muscle weakness, changes in sensation, or a combination of these symptoms can affect mobility. When a decline in lower extremity function occurs, individuals may benefit from assistive devices such as braces, canes, crutches, walkers, wheeled walkers, and manual wheelchairs. But when is it time to transition to a scooter or power wheelchair?
The goal of using power mobility is to maximize access to the home and community, maintain safety and conserve energy. There are several factors that should be considered when transitioning to power mobility. The first is the individual’s current functional status. The individual may report an increase in the number of falls due to muscle weakness/fatigue or loss of balance within the home or community despite using assistive devices. Another change that is commonly reported is a decrease in the ability to complete self-care tasks and instrumental activities of daily living due to generalized fatigue or impaired fine motor function and visual changes from the fatigue.
An individual assessment of mobility and function by an occupational or physical therapist will identify problem areas and lead to a stepwise intervention. The optimal outcome is a good match between the individual’s mobility needs and the power mobility device. The initial choice to be made is usually between a power scooter and a power wheelchair; selection between these two devices is based on the user’s environment, functional status, and available transportation.
Individuals often first experience using a scooter at the local grocery or retail store. To use a scooter, the individual needs to have good trunk control, adequate upper body strength and dexterity to operate the controls, and be able to transfer to/from the scooter seat. Typically, a scooter can be disassembled and transported in the trunk of a car, thus increasing a person’s access in the community; the seat can be turned next to a table in a restaurant to reduce transfers, and baskets provide storage for shopping. On the other hand, scooters require a large area to turn around in and therefore are usually not useful inside the home.
If multiple sclerosis has affected the back and arm muscles, a power wheelchair may be needed to provide adequate positioning to maintain good posture, reduce fatigue, and prevent deformity. A power wheelchair enables the user to operate the wheelchair using a single hand, or head control; and configuration of the base results in a smaller turning radius for in-home use. The primary disadvantage of the power wheelchair is determining how to transport it. Some models of power wheelchairs can be disassembled or are light enough to be loaded into a vehicle using a boom lift. However, most power wheelchairs require the user to have a van with a ramp or lift to transport the wheelchair.
The process of obtaining power mobility within the VA can take 3 to 6 months. A Veteran who would like to be evaluated for power mobility should have their VA primary care provider send a consult to their facility’s wheelchair clinic, physical or occupational therapy. The clinician will evaluate each to determine whether they meet VA medical eligibility criteria for power mobility. After eligibility is determined, the clinician will discuss power mobility options with the Veteran to find the “right fit”. Delivery of the scooter or power wheelchair can take 4 to 12 weeks depending on the complexity and customization of the device. Once the power mobility device is delivered, the clinician will custom fit the scooter or power wheelchair to the Veteran and initial training will be completed. Fit and training may require several sessions based on the complexity of the device and the Veteran's skill level and learning needs.
Over time it may be necessary to return to the wheelchair clinic to transition from a scooter to a power wheelchair, or modify the current power wheelchair. The power mobility user and/or caregivers should monitor the Veteran’s upper extremity function, transfers, fatigue level, and driving safety to determine whether a new consult is needed.
The decision to use power mobility can be life changing by giving the individual the ability to access their environment. Although using a scooter or power wheelchair does not replace the need to exercise, it may improve mobility and energy conservation for greater independence in daily living, work, and recreational activities.
Last Updated: October 2009