Equipment Corner September 2005

by Alyssa Quintero on Thu, 2005-09-01 17:00

Scooter not always wise in ALS

If the Segway is a pedestrian vehicle that offers innovative mobility assistance to those who need it, a more recognizable solution is the motorized scooter.

From television commercials to mail order to major retail stores, scooters are everywhere.

Motorized scooters come in three- or four-wheeled designs for outings or trips that require a lot of walking.

Scooters can cost as little as $500 and go up into the $2,000-$5,000 range, depending on the features and capabilities.

Several varieties are available, from models designed for indoor use, outdoor use or both. Some heavy-duty models can handle rugged, outdoor terrain, while others are especially lightweight, and can be folded or easily disassembled for travel.

But, careful thinking should precede the decision to buy a scooter.

Scooters vs. wheelchairs

Man on a scooter

For many, a scooter is an ideal step between being fully ambulatory and needing a wheelchair. Unlike power wheelchairs, scooters don’t require much adjustment for seating and positioning.

While a scooter is an early option for people with ALS, though, many occupational therapists caution that you must be realistic about the disease’s progression when choosing mobility equipment.

“No, I wouldn’t recommend a scooter because scooters can’t handle progression,” said occupational therapist Jenny Lieberman of the MDA/ALS Center at Mount Sinai Hospital and Medical Center in New York.

“Since ALS is a progressive disease, scooters can’t be adjusted or modified properly [as a power wheelchair can] for that progression over time.”

Lieberman explained that most people with ALS go straight to a power wheelchair with power seating because it’s better equipped to handle the stages of progression.

Pam Glazener, an occupational therapist based at the Vicki Appel MDA/ALS Center at Methodist Hospital in Houston, agrees that scooters aren’t as practical as power wheelchairs.

“The scooters just don’t work as well for this population,” Glazener said. “They have their place, just not for ALS.”

Practical investment?

Paying for a scooter is also a consideration. Most insurance plans lump motorized scooters into the same equipment category as the much more expensive power wheelchairs. Most insurance carriers, including Medicare, will pay for an item in that category about once every five years.

Occupational therapists are consequently apprehensive about recommending scooters to those with ALS.

“You always have to look at the long-term benefits. Is this going to be beneficial for two months or six years? We have to look at what will be the best use of their available funds in the long term,” said Gail Miller, an occupational therapist at the MDA/ALS Center at Johns Hopkins University in Baltimore.

“With the pricing on scooters, the vast majority are still paid for as an out-of-pocket expense,” said Patrick Foy, sales director for Bruno Independent Living Aids. “People will pay cash for them because they are less than half the cost of a power wheelchair.”

MDA assists with the purchase of scooters and wheelchairs prescribed by MDA clinic physicians.

Asking important questions

Miller, Glazener and Jodi Bales, an occupational therapist at the Forbes Norris MDA/ALS Research Center at California Pacific Medical Center in San Francisco, suggest that you look at a scooter’s long-term benefits and ask yourself the following questions:

  • Do you have trunk control and the ability to sit upright for an extended period of time without extensive head, neck and shoulder support?
  • Are your arms and hands strong enough to manipulate the scooter’s hand controls?
  • If you answered yes to both questions, will you still be able to do so in five years?

Bales doesn’t recommend scooters because “scooters highlight what someone with ALS can no longer do.”

Glazener added, “For those who are progressing quickly, we look at a chair for the duration of the disease. If they lose arm/hand function, head function or trunk control, a scooter simply won’t work.”

Several occupational therapists advise that you actually go to a medical equipment store and try out a scooter.

“You should be prepared to evaluate your muscle loss and how realistic it will be to use a scooter,” Bales added.

Bottom line: Always consult your physician, physical therapist and occupational therapist before purchasing a scooter, or other mobility aid.

If you and your health care team think a scooter might be of some benefit, it’s a good idea to obtain one from a source they recommend. To save costs, scooters often can be borrowed from an MDA loan closet or rented.

Alyssa Quintero
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