It’s a classic referral to the wheelchair clinic/therapist from the patient’s primary care physician: Evaluate patient for scooter. I’ve come to take these referrals with a grain of salt as many have come to use the word “scooter” as a catch-all phrase for all powered mobility equipment. This is possibly due to the increase of direct-to-consumer sales marketing with the word scooter in it, or, unfortunately for consumers, it also could be the result of a gap in the knowledge of available technologies for the mobility impaired. But there are a number of patients whose needs make a scooter a perfect choice, and there are some things we can do to make sure they are getting the right product.
|Photo: Michael Justice|
With any mobility evaluation, the technology should be matched to the consumer through a comprehensive evaluation of their physical presentation, the environment in which the device is to be used, their ability to perform their activities of daily living, and their mobility needs and goals. If an evaluation is not completed, it’s not possible to ensure that a patient is getting the precise piece of equipment they need. Consider this scenario for comparison: you’ve been intensely training a patient with a walker but you discharge them with a pediatric cane. It sounds crazy, but the equivalent is done every day with power mobility equipment because the technology is not matched properly to a patient. Only after the evaluation process is completed can the decision that a scooter is the right choice be made. It is imperative to know the anatomy of a scooter to understand the clinical implications of matching the technology to the consumer’s physical presentation and needs.
FROM THE PLATFORM UP
Let’s start with the platform. There are short ones, long ones, and three- and four-wheeled versions. There are fixed frame units and portable units. As with any powered mobility device, the shorter the platform length, the shorter the scooter’s turning radius. Generally speaking, a four-wheeled version can add more than 10 inches to the turning radius over its three-wheeled counterparts.
Next let’s examine the transaxle. This houses the mechanical components that propel the device and is primarily located in the rear of the unit with the exception of some commercial models utilized as shopping carts at retailers. The scooter platform along with the size of the transaxle will determine the weight capacity of the unit and its performance over varied terrain. Therefore, the user’s physical weight and the environment in which the device will be used are key throughout the evaluation. You wouldn’t want to match an elderly lady with the turbo-boosted four-wheeled heavy-duty model if she is only going to use the device to assist her with getting to the dining hall in an assisted living facility. Nor should the 350-pound avid fisherman be fitted to a three-wheeled light-duty portable unit when he will use it to travel down a steep grassy incline to the neighborhood lake.
Last is the tiller. This is the contact point where the consumer interfaces with the technology. It is what allows the consumer to steer and control drive parameters like speed. The tiller’s console holds basic components that give the user feedback about the device such as battery charge remaining. Some consoles are more advanced, depending on the model of scooter, and provide access to accessories such as lights and horns. Under the console is the throttle pot that connects to the throttle lever or wig-wag. This is used to operate the device. There are variations of throttle lever placement such as the delta-style tiller where the lever is in the front of the console and is meant to be operated by flexing the fingers versus the traditional levers that are meant to be operated with the thumbs. The lever is one piece and functions on a pivot point inside the console with one side of the lever controlling forward motion and the other controlling reverse. So from a clinical standpoint, it would take two fully functioning upper extremities to access the tiller and control the levers. The consumer would likely have range of motion at the shoulder joint to forwardly flex the shoulders and extend the elbows enough to grasp the handgrips. Adequate hand functioning is required to operate the throttle with the thumbs or the delta-style lever with the fingers. The physical assessment of the patient during evaluation would reveal if there were other limiting factors to scooter operation such as joint pain that would be only aggravated with repetitive movements of outstretched arms, vision impairments that would need to be considered with the console’s display, or abnormal tonal responses that are initiated with the dynamic posture changes that come from upper extremity movements.
A SHIFT OF PERCEPTION
The perception of scooters in the mobility industry has shifted due to the change in Medicare funding for scooters. Accepting assignment has, for many, become a thing of the past. Many scooters are now being viewed more as retail items since their allowables have decreased. However, scooters must be taken into consideration as part of the Medicare Mobility Assistive Equipment (MAE) Algorithm. A scooter’s usefulness to the client must be weighed along with the level of reimbursement Medicare will provide.
Consumer demand continues to trend toward smaller, more portable units as aging Baby Boomers look for products that help prevent physical limitations from slowing down their participation in the community. There are other considerations that must be taken in regard to portable units. I have yet to meet anyone who needed power mobility equipment and who should be independently disassembling and loading a device multiple times a day. Note that I said should. It usually takes a tactful conversation between a therapist and a patient regarding their physical limitations and the reality that they would be the one who performs this activity. In the case of smaller portable units, I discuss the actual weight of each component when the unit is disassembled and ask patients if they can manage lifting the pieces from the ground and into the vehicle. If the patient is not capable, then you must look at the health and physical functioning of the caregiver.
|Image courtesy of Quantum Rehab, a Division of Pride Mobility Products Corp|
Recently, I evaluated a woman in her home who made sure that I knew she wanted a scooter that she could take apart and put in the car and not a power wheelchair. After gathering the medical and physical information, here were the facts. She recently weighed 250 pounds. She had been hospitalized and had lost some weight, but was still a larger framed person. Her daughter was the primary caregiver, and during the evaluation, I learned about the caregiver’s recent treatments for knee and back pain. So, the likelihood that she would be able and willing to disassemble the unit for transportation was not looking good. I also explained the funding issues that would surround obtaining such a light-duty unit—durability and the need for it to last at least 5 years under the patient’s Medicare benefits. Her physical evaluation revealed significant limitations to her mobility and need for power mobility as her primary means of accessing any areas of her home. The kitchen was small and would not have supported the use of the scooter. Therefore, the mobility device needs were not lining up for the portable unit she desired. I presented her with my concerns and explained each in detail. She was grateful, as there were many things she and her daughter had not considered or didn’t know. So what turned out to be a scooter evaluation initially turned into another recommendation with education on other available options to transport the device that were more feasible for her situation.
Power mobility recommendations consist of many factors, but when all are considered and coupled with knowledge of available technologies, the outcomes can be truly satisfying for all involved.
Jodie Stogner, PT, ATP, is a physical therapist and owner of Southeastern Assistive Technology Solutions LLC, Jackson, Miss. For more information, contact .