Ideally, there is no one-size-fits-all mobility device in the world of PTs and OTs; every client is an individual. Mobility devices share a common goal for improved mobility, yet each client has unique needs for their environment, their conditions, and their goals in life.
The good news is that the mobility industry has responded to the niche needs of patients. The bad news is that the cost pressures from serving more clearly defined niche markets may result in fewer new products and choices.
INDUSTRY COST PRESSURES
Due to manufacturers listening to PTs, OTs, and their clients, scooters, wheelchairs, and other mobility products and accessories are more customizable and targeted to different market segments. PTs and OTs help clients choose from a variety of mobility products tailored toward those who are young and small, elderly, athletes, obese, severely challenged, and other submarkets.
While the customization has benefitted patients, it has come at the expense of manufacturers’ bottom lines. More choice and innovation from companies that design products for the same, smaller niche have increased competition for a smaller pool of clients. In addition to competition among providers, the lagging economy and more restrictive insurance reimbursements are forcing vendors to consolidate, reduce costs, and cut budgets for research into future improvements.
Ginny Paleg, PT, MS, DScPT, a pediatric physical therapist who practices in Rockville, Md, and serves as a reimbursement representative for the pediatric section of the American Physical Therapy Association, has seen the effect of industry cost pressures. “I have personally been on five design teams for five different manufacturers, and they are all reluctant to produce a new item that has a small market,” she says.
While the mobility industry will continue to innovate and produce new and better mobility devices, it will be at a slower pace.
“This industry is in a real state of flux, perhaps even more so than last year,” says Mark Schmeler, PhD, OTR/L, ATP, a faculty member in the Department of Rehabilitation Science and Technology at the University of Pittsburgh and a clinician in the Center for Assistive Technology at the University of Pittsburgh Medical Center.
Schmeler says cost pressures have made companies move toward merging products and brands to reduce manufacturing costs. At the same time, he adds, “The only good news is that there still remain enough good products to work with, even if funding is a challenge.”
Paleg is optimistic about several device trends in the market; in particular, lightweight scooters that can be more easily disassembled, and dynamic seating systems that move and encourage patient movement.
Ann Eubank, OTR/L, ATP, executive director of Users First Alliance, views the consolidation and funding problems as ultimately limiting users’ full range of choice. “Many of the current products on the market are reliable and functional. Yet, due to current funding policies, consumers may not be given the choice of the higher-end products,” she says. Regardless of the state of the economy, funding for mobility devices has been a serious issue for years, she adds—but Schmeler is optimistic that once health care overhaul bills in Congress are settled and the industry knows where it stands in regard to new regulations and reimbursement levels, the next generation of niche mobility devices will eventually reach patients. In addition to the devices themselves, Eubank says the need for PTs and OTs with expertise in wheeled mobility and seating is growing due to Medicare requiring PTs’ and OTs’ direct involvement in the assessment and provision of certain complex equipment to patients.
Despite industry challenges, a wide selection of recently released mobility products are available. For example:
Athletic users might opt for manual ultralight wheelchairs (fashioned of magnesium, aluminum, or titanium). Many chairs offer custom rigid frames and adjustable centers of gravity and footrests. A variety of lightweight chairs accommodate adjustable seating systems, and feature independent suspension. Standout features include custom wheel sets, carbon-fiber seating, top-of-the-line components, carbon-and-magnesium disc brakes, and titanium hardware.
Athletes and younger or stronger wheelchair users benefit from equipment from a Kennewick, Wash, manufacturer that employs titanium and aluminum as the primary metals for its mobility systems. Titanium provides superior sturdiness and vibration-dampening properties. Aircraft-grade aluminum enables lightweight yet strong composition. The effect of these metals, according to the company, is that they help reduce user joint stress while adding to chair portability. (The company recently introduced a sports chair weighing 19 pounds and coated in non-chip titanium finish.) These chairs are custom designed for users by means of special computer software.
The Aging User—Older adult or geriatric wheelchair users seek assistive technologies for mobility limitations caused by disability, illness, and debilitating physical conditions. The key concern for geriatric users is safety. When selecting a chair for a geriatric user, consider wheelchair options, components, and accessories. A Texas-based company offers a geriatric chair with a rolling recliner that provides special positioning support. The caster-wheeled chair suits a range of long-term care and clinical seating applications. Its reclining mechanism allows for positioning of the back in a range between 95º and 145º. The suspension system self-adjusts to cradle users from head to heel, helping to eliminate the risk of bottoming out. Many chairs can accommodate users weighing up to 400 pounds.
For the Youngster—Comfort, function, and user independence are the major concerns of a Lebanon, Tenn-based company that designs power wheelchairs for kids that incorporate rear-wheel drive systems, all-wheel suspension systems, and seat elevators—enabling play in many environments. The seat-to-floor height ranges from 3 inches to 26 inches and, with an option added, can tilt 45°. This chair handles riders weighing up to 125 pounds and arrives with standard electronics, a modular seating system, and center-mount adjustable legrests.
New introductions from Burnet, Tex, offer a pediatric mobility base suitable for very small and/or young clients, featuring a depth-adjustable seating system, adjustability of single-platform front rigging, and a back that can be angled at 85°, 90°, and 95°. This model features 10-inch by 2-inch urethane rear wheels and 6-inch by 1.25-inch casters in front.
On the Go—Scooters have assumed an essential role in the mobility industry, offering speed, convenience, and comfort for mobility-impaired individuals. A Sewell, NJ, company offers a scooter that dismantles without tools, for user-friendly transport in cars and vans. Features include proprietary safety stabilizer technology linked to spring suspension, self-centering magnetic caster wheels, an 18-inch-wide swivel seat with padded armrests, and a frame-forward design with a large foot area. Speed, steering, starting, and stopping are controlled with one hand. An optional electric seat lift aids in mounting and dismounting, and a 250-watt motor conveys people weighing up to 450 pounds.
For Bariatric Patients—A Longmont, Colo-based manufacturer recently introduced a chair that includes high-strength steel construction that can accomodate a 650-pound rider.
A Port Washington, NY-based company offers a folding chair with a weight capacity of 700 pounds. A dual axle permits seat-to-floor adjustment, and it features a powder-coated silver-vein frame, adjustable front casters, and steel, mag-style rear wheels.
An Ellis, Kan, manufacturer offers a heavy-duty stainless-steel folding frame and double crossbrace capable of supporting an 850-pound rider. The unit can be acquired with elevating legrests, a telescoping IV pole, and an oxygen tank holder.
Rich Smith is a contributing writer for Rehab Management. For more information, contact .