Choices in Power Scooters and Wheelchairs

One of the most difficult decisions for a person who is mobility impaired is if and when to pursue power mobility.

Everyone I know wants to preserve his or her independence as long as possible. Some prospective users may be frightened of being made more conspicuous, while others may fear that reliance on a motorized device will hasten weakness or amount to a surrender to a disabling condition.

Compared to manual mobility, power mobility is more expensive, more difficult to transport, and, by being more mechanically complex, has more systems that can break down.

Before you consider a motorized device, it is critical that the factors that are limiting your walking or manual propulsion are understood. You might be able to reverse the cause of your limitation with proper medical care. For example, if last year you were able to walk a mile easily, but this year you feel pain in your legs after 100 yards, you might have a nerve injury or a vascular problem that is amenable to treatment. I am uncomfortable recommending equipment if I don't understand the cause of the problem.

Secondly, once the problem is understood, it is valuable to comprehend the expected duration and course of the problem. For example, a person with a walking problem because of a hip replacement would normally be expected to improve in a short course of time (weeks) and might only need the temporary assistance of a simple manual wheelchair. Someone with a similar problem because of a rapidly progressive course of multiple sclerosis might need a fully adjustable power-base wheelchair to not only take care of current needs, but to take care of future needs as they arise.

There are three major power options with some variations:
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• Power Scooters
• Power Wheelchairs - Centered on Modification of Manual Chair Designs
• Power Based Wheelchairs

Power Scooters
In general, the least expensive power devices are scooters. Scooters typically have motors in the back and are steered with a tiller (looks and acts like the handlebar on a bicycle). Because of their conformation, scooters have a relatively wide turning radius. This means that they require more room and effort to maneuver in closed or tight environments. If you choose a scooter, ask about the turning radius to make sure that it will work in its intended environment.

Power scooters usually come with a padded captain's swivel chair, although bucket seats are available on some models. Three-wheeled scooters are most common. Four-wheeled scooters can traverse more rugged terrain, but are so large that they are impractical in most indoor settings. A feature available in many scooter product lines is power seat elevation. This can aid in transferring to different surface heights and in improving reach (bed, accessible toilet, low shelves). Compared to other powered options, most scooters are relatively easy to disassemble for storage in a car or trunk. Depending on the scooter, the heaviest portion weighs about 50 pounds.

A perceived advantage for scooters is their appearance, which looks different than that of wheelchairs. Some people associate the look of a wheelchair with a kind weakness or helpless dependency and therefore prefer the styling of scooters.

There are three significant limitations to scooters besides their relatively limited maneuverability and requirement of some level of upper limb strength, dexterity, and range of motion:

1. They are difficult to sit down in and rise from if you cannot stand and transfer independently.

2. They lack the capacity to allow modification of seating to accommodate postural deformities (i.e. contractures).

3. They have very little adjustability to change as the user's needs change. They cannot be transformed into joystick-controlled devices, cannot have advanced electronics installed, and cannot be upgraded to accept power tilt-in-space or low shear power recline.

The typical scooter user can still walk but has limited endurance because of cardiac, pulmonary, rheumatologic, or neuromuscular disease (i.e. congestive heart failure, emphysema, rheumatoid arthritis, or stable multiple sclerosis). Those without the ability to walk (i.e. those with a complete spinal cord injury) or with poor trunk stability are usually better served with a power wheelchair.

Power Wheelchairs Centered on Modification of Manual Designs
This category of power devices encompasses power wheelchairs that have been designed around adding a motor and drive wheels to existing manual chair frame. Most of these wheelchairs employ an X-frame seen on standard folding chairs; a few borrow rigid frame designs. By their very nature, the seating systems of these chairs are integrated into the base of the chair (as with manual chairs).

And, as with manual chairs, a full line of seat cushions and backs are available to add in pressure relief and posture support. Most of these chairs can be disassembled to be transported by car, but the heaviest parts weigh approximately 60 to 80 pounds, which is not practical for many people. Depending on the design of the chair and the car, the batteries may be taken off, and the frame folded and bumped into the back seat of the car without actually lifting the frame entirely off the ground.

Although these chairs are not the most rugged or most powerful, they provide reliable, economical mobility with a smaller turning radius than found in scooters. They are appropriate for indoor and outdoor use in mild-to-moderate terrain. They are typically equipped with swing-away footrests, which can ease access to the chair, and detachable armrests, which can aid in side-to-side transfers. Power seating options, such as tilt-in-space, power recline and seat elevation, are not available for these chairs.

Power-Base Wheelchairs
Power-base wheelchairs are in the next category. A cardinal feature of these chairs is that the seating system is separate from the base. This means that, within certain limits, a variety of seating systems can be attached to a particular base. The seating system might have tilt-in-space or recline, or it might have the seat-to-back angle opened up to accommodate a specific user.

(Tilt-in-space is a motorized system that allows pivoting of the whole seat backwards and forwards in a manner similar to leaning back on the rear legs of kitchen chair. Recline refers to keeping the seating surface stationary while the chair back moves. This power feature is similar to the adjustability in seat-to-back angle found in airplane and automobile seats).

Power base chairs are more rugged and stable than comparable collapsible chairs.

Power base chairs can either have rear-, mid- or front-wheel drive. This refers to where along the base of the chair the motorized wheels are located. Rear-wheel drive chairs tend to feel the most stable and are usually the chairs of choice for those with poor trunk stability (i.e. tetraplegia, quadriplegia). They also tend to allow the greatest range of power seating options.

Mid-wheel drive chairs put the drive wheels more toward the center of the chair. The main effect of this is to decrease the turning radius. The smaller the turning radius, the easier it is to maneuver in crowded environments. In mid-wheel drive power chairs, the weight of the user sits more directly over the drive wheels, which can result in increased traction. However, many mid-wheel drive chairs can feel a bit tippy during the start and stop motion, especially when driving down inclines.

Front-wheel drive chairs are less common than the other two options. They allow a small turning radius on a stable base, and depending on the model, offer a full range of seating options.

The world of wheelchairs changes quickly, and the discussion above is meant as an outline only. There are at least a few chairs that don't easily fit in the schema that I have described. For example, the Quickie P200 is a rigid frame power wheelchair that can be disassembled and offers a rugged frame, narrow turning radius and high performance.

The Viva by Electric Mobility is a power-base chair that can be disassembled. The consumer is cautioned to evaluate each option closely. If you have questions about specific products, contact our SpinLife.com professionals at: 800/850-0335.