Multiple Sclerosis Centers of Excellence
Power Mobility: Is it Time for Wheels?
Jacqueline A. Hall, MS, OTR/L, ATP -- Seattle, WA
Many individuals who have 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?
When do you use power mobility?
There are several factors that should be considered when transitioning to power mobility. The first is your current functional status. You may be experiencing an increase in problems with your balance, near or actual falls because of muscle weakness, and fatigue or other symptoms. You may also be having more difficulty completing self-care tasks and instrumental activities of daily living (home management, shopping, cooking, etc.) due to the additional effort it is taking to move around, keep your balance, and use assistive devices such as a walker or manual wheelchair.
Generalized fatigue, impaired fine motor function, and visual changes from the fatigue effect at least 2/3 of individuals with MS and also contribute to limitations in daily activities. While medications are available to combat primary fatigue in MS, many times secondary fatigue can be effectively managed by activity modification, energy conservation, balancing work and rest, and use of adaptive equipment. The goal of using power mobility is to maximize access to your home and the community, maintain safety, and conserve energy. Power mobility is an effective tool to reduce fatigue during daily activities by limiting the need for standing, reducing walking distances, and providing a method for “mobile” rest breaks during the day.
How do you choose the appropriate power mobility device?
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 your mobility needs and the power mobility device. The initial power mobility choice to be made is usually between a power scooter and a power wheelchair; selection between these two devices is based on your home environment, your functional status, and available transportation for the device.
It is very important to choose the best power mobility device to keep you as independent as possible in daily activities, and assist with management of your symptoms, rather than a device that can be transported in any vehicle. With many advances in the design of power mobility devices and the large selection available, most of the time both the goal of remaining independent and transporting your device can be met.
What are power scooters?
Individuals often first experience using a scooter at the local grocery or retail store. Scooters are 3 or 4-wheel power mobility devices that steer like a bicycle using the tiller, and are operated with both hands (either fingers or thumbs) controlling the forward and reverse levers. Scooters are intended for part-time use during the day despite having different options for seat size and back support. The seat can be turned next to a table in a restaurant to reduce the need for transfers, and attached baskets provide storage for shopping.
Scooters range in weight from 80 pounds to over 250 pounds. Some can be disassembled and transported in a vehicle, however, frequently a vehicle lift is more desirable to reduce the work involved in getting around for daily living and community activities. Because of their design, scooters require a large area to turn around in and therefore are usually not useful inside the home.
To use a scooter safely, it is important that you have good trunk control, adequate upper body strength and dexterity to operate the controls, and the ability to transfer to/from the scooter seat.
What are power wheelchairs?
If MS has affected your back and arm muscles, a power wheelchair may be needed to provide adequate support to maintain good posture, reduce fatigue, and prevent deformity. A power wheelchair is operated using a single hand, or other drive controls such as head movement. Because the batteries, motors, and drive wheels are directly under the seat, a power wheelchair has a much smaller turning radius which is helpful for in-home use and on public transportation.
There are numerous options to customize the seating system for help with transfers, reaching higher surfaces, independent pressure relief, and rest breaks. The primary disadvantage of a power wheelchair is its weight, and inability to disassemble it for transport. Power wheelchairs range in weight from 200 to 500 pounds. Most private vehicles will require a vehicle lift to transport the device, or an adapted van with a ramp or wheelchair lift.
What power mobility devices does the VA offer?
The process of obtaining power mobility within the VA can take 3 to 6 months. While procedures may vary between VA facilities, most are similar in evaluating you, ordering the power mobility device, and then seeing you for follow up. The VA has direct access scheduling so if you would like to be evaluated for power mobility, you should contact your Rehabilitation or SCI/D scheduling department to be scheduled for an appointment.
At your appointment, the clinician will evaluate you to determine the most appropriate mobility device for you and whether you meet VA medical eligibility criteria for power mobility. After eligibility is determined, the clinician will discuss power mobility options with you to find the “right fit” and order the device. 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 schedule you for a follow up appointment to adjust the seating, check the seat fit, and complete the initial training. Fit and training may require several sessions based on the complexity of the device and your familiarity with power mobility.
What is a follow-up program?
Over time, if you experience further mobility limitations, it may be necessary to return to the VA to transition from a scooter to a power wheelchair, or modify the current power wheelchair. It is important that you and/or your caregivers routinely monitor changes in your functional abilities such as upper extremity strength and dexterity, transfers, fatigue level, and driving safety to determine whether a follow up appointment is needed.
The decision to use power mobility can be life changing by giving you back the ability to access your indoor and outdoor environments. Although using a scooter or power wheelchair does not replace the need to exercise, it may improve your mobility and energy conservation for greater independence in daily living, work, and recreational activities.