My FIRST PowerChair, please help me avoid mistakes.

[MrMarkin281]

Aug 2019


First-time Powerchair purchaser, my daughter, 35yr old. C3 Spinal tumor, operated 8 yrs ago, partial removal, chemo and radiation. Was still walking and driving in Feb '19 but tumor issues have her ordering the first powerchair. She has very little arm strength must be assisted for transfers, so not a driver (yet, maybe someday). Deficit free from the neck up. Probably not able to work (no driving). Feel free to provide links to other sources.


What features should I get that you wish you would have gotten if you were getting your First Powerchair now?

Getting the most from Insurance.
Vendor pricing on non -covered features? Negotiable?
Transport? HOW ?.TMI with vehicles and trailers and hydraulic seats and ramps. What way did you settle upon.. ( trying to minimize missteps and buy the proper solution first)
Tilt and recline. (apparently covered due to pressure abrasions)
Elevation? Necessary or not

Thanks so much for any thoughts you have as I am on overload.

[Rustyjames]

Does your Daughter have a spinal cord injury? If so then tilt will probably be a necessity from your discription. Elevation is always nice to have but I don't think all insurances will cover that. At this point in time you'd probably do best by taking your time with a vehicle and concentrate on the wheelchair.

[SCI-Nurse]

What is your daughter's insurance? If it is Medicare, she will have to have a power chair evaluation by a RESNA certified wheelchair specialist (usually a PT or OT) and they will then write a letter of justification for the chair and chair features being requested that must be signed as a "prescription" by her physician. Medicare will not cover all features, even with justification. For example, they will rarely covered seat elevators. Many private insurances follow Medicare's policies in this area.

If you daughter cannot transfer independently, then your best bet for transporting the chair is a lift or ramp adapted van, not a bumper lift, especially if there is a chance that down the road she may be driving. You can buy a used low mileage van such as this with passenger accommodation for riding in her wheelchair (tie downs, ideally automatic tie downs) fairly cheaply on the used market. Many times people have bought one for an elderly relative who then passes away, and they need to unload the van. Good places to look include our site here, Blvd.com, Craig's List, and eBay.

Pressure injuries (not abrasions), formerly called bed sores, decubiti, or pressure ulcers, are most common in those who are not only paralyzed but lack sensation. You don't mention what your daughter's disability is actually, but that would be a factor in getting justification for a tilt-in-space seating system. Recline is not a good way to reduce or relieve pressure. If she is at risk, she will also need a custom fit wheelchair cushion as well as the tilt-in-space feature.

(KLD)

[Gearhead]

A 4" Roho cushion is the best if evaluation Ok's it (unless her disability requires a form fit cushion). Sitting in it = 2" higher than seat pan.

The below is in reference to Permobil C300 and F3 (these chairs weigh 350 lbs with out rider), not sure how/if it applies to other makes/models. .
Chairs; Front drive, mid drive, or rear drive are user and terran specific. My preference is front drive because I can go in yard with out getting stuck. Mid drive gets stuck on non hard surface, has rough ride, and casters might damage doorways. Rear drive, front casters hit doorway if parked in doorway then back out, also has bigger turn radius.
If your getting a new chair, insure DME programs it so it suits her abilities. It may take a few tries to get it set right for her abilities. Don't accept an improper programs settings that aren't compatible with her abilities. Too fast or sensitive, joystick can cause lots of home damage, frustration, and potential danger. Too slow/delayed joystick function is frustrating if operator has ability to handle more speed/sensitive joystick.
Power recline, tilt, a leg elevate (all 3 together) will help with feet swelling and relieves most butt pressure. All covered by medicare in most chair bound situations.
I've been told several times by DME and PT/OT that medicare doesn't cover elevate. A $1500 out of pocket expense. I ordered it for my new Permobil F3 (will arrive 8/30/19) for 2 reasons; it allows more anterior (forward) tilt, and (as per DME) seat pan height (lowered and w/o cushion) is 17" verses 19" w/o elevate. Seat height combined with most table heights can be an issue.

Many vehicle designs available. I've been told to stay away from rear ramp vans unless 99% of use is on flat surface, especially driveway to street transition.
Side ramp, side lift, or rear lift are the most popular.
Full size vans usually have lifts (side or rear). Most full size vans w/lift have high roof tops added. This means it cannot use parking decks or car wash. Unless you require standing fully up right in van, a high top is not needed. Many standard roof ones out there, used, that can have lift added.
Mini vans w/side ramps can be expensive due to complex structure modification. New or used, prepare for sticker shock w/side ramp models.

The hard part, determining which chair and vehicle is best for users environment and abilities. No right or wrong debate, only what's best for your situation.
Just my experiences for 8 years. Other folks experiences will differ.

[MrMarkin281]

Thanks, we are working with OT and Aetna Ins. She should qualify for top level (indoor). I edited top post with more details

[Gearhead]

Thanks, we are working with OT and Aetna Ins. She should qualify for top level (indoor). I edited top post with more details

When they say "indoor", most of the time they are referring to mid drive as it's basically a hard surface only chair. They test well at DME or OT/PT. Get one stuck out doors and you'll have to deal with 350 lbs + rider weight. A lot of people prefer mid drive. I like riding outdoors so I need front drive. Again, every situation is different.

Not sure why but DME & OT/PT tend to promote mid drive, especially to first time power chair folks.

If you have Medicare and no supplemental insurance, be prepared for a $7k bill (20% not covered by Medicare).

[MikeP2013]

When they say "indoor", most of the time they are referring to mid drive as it's basically a hard surface only chair. They test well at DME or OT/PT. Get one stuck out doors and you'll have to deal with 350 lbs + rider weight. A lot of people prefer mid drive. I like riding outdoors so I need front drive. Again, every situation is different.

Not sure why but DME & OT/PT tend to promote mid drive, especially to first time power chair folks.

If you have Medicare and no supplemental insurance, be prepared for a $7k bill (20% not covered by Medicare).

One of transit mini vans they send out here for some reason ramp is bit steeper than others. The bus has been broke all summer.
My usual doc appointment chair is 6 wheel job for tight quarters. Try go on normal it high centers and spins. The driver tried to push first time, said happens often. I ask them not to do this now. I now know the van with steep ramp so I get running go. Most times once is all takes but if raining and ramp is wet sometimes I have to get second run.
Now when go I use really old backup chair that is front wheel drive, I figured was on it's last legs, nearly 20 years old but new set batteries so far(knock wood) she pulls steep ramp no problem and even our steep driveway.
Only draw back on the old FWD is one of the rear entry mini-vans. It's built to carry two chairs and has short raise after entering to front position and it often hangs on front tips on that bump.

As far as obtaining powerchair do homework on specs and on DMEs you have any options. Check with others about service after the sale, loaners when her chair is down. Cause it ain't if but when it will break down. We keep a few backups, just in case.

[mrb]

You need to determine what the majority of use will be, indoors/outdoors determines it front/mid/rear. Mine is a lot of bumpy outdoors so I always go RWD. Then consider how far the maximum journey will be, that determines battery size, important if you don't want to be stuck somewhere. Will she always have someone with her? If so do you need power recline given that whoever is with her can manually adjust. Cushion, whilst high profile cushions are supposedly better they are unstable, I found that a slightly lower cushion contoured to butt shape can be better. There are numerous items to pay attention to like padding in headrest, gutter armrest and you really need someone who understands all these options to explain them.

[jnanda]

I have a Quickie QM 710 which is a mid drive power chair and Medicare covered it and I also don’t have secondary insurance so Permobil prices were not an option. I also have a Quickie S-46 SE, which is a rear wheel power chair that I bought used. My 646 has tilt recline but not leg elevation or seat elevation. The Quickie QM 710 has all the features available too.
I use the QM 710 mid drive exclusively for outdoors because it has front and rear wheels with something they marketed as Spider Trac suspension. I live in a rural area and am able to go over or through nearly any terrain without problems, wet and dry, which is why I chose this particular chair. I have taken it on hiking trails with my husband and some places I wouldn’t try again, but if I got stuck it was an easy push from my husband to get unstuck. I have never tried a front wheel drive. I use this chair independently alone on daily outings to walk my dog.
I do not have SCI so my needs are different. I have been both much worse and much better throughout the years of illness with MS.
We have a van and portable ramp and can put the power chair up behind the passenger by my husband guiding the chair inside by doing the hand controls. I’m not able to drive. I’m easily lifted by my husband into the passenger seat and don’t need a lift or to stay in the chair during transport, so again my needs are maybe different.
I use a high profile cushion on both power chairs, Roho Quadtro and it works great in my situation. One thing I would change now is a narrower seat width from 16 to 15. I feel like I have too much “slop”
in my power chair and the DME I think was being maybe “old school” about how much room I should have on either side of my hips. Since I am currently better and mostly using a manual chair, except for some daily excursions, it’s not worth asking for a modification. My back is a Comfort Care back product which accommodates my spine better than a basic Jay back non contoured back cushion. I’m sure new things are available now. I did a ton of homework because in my experience the DME’s didn’t always suggest all available options or manufacturers. The power chairs they initially suggested were truly awful, but I didn’t have problems getting the chair I wanted approved but I had to look on my own for something that fit my situation. I think asking questions and finding out what people like pros and cons is so helpful. I really hope your daughter gets an awesome chair!
Jnanda