Picking the Perfect Scooter

Subscribe | Advertise | About Us | Contact Us | Home

December 2002

By Laura J. Cohen, PT, ATP

In the United States today, there are more than 142,000 people who use scooters, the majority (62.2%) of whom are under 65 years of age.¹ According to the Disability Statistics Report of 2000, scooter users are most likely to have diseases of the nervous system, such as multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS), or diseases of the musculoskeletal system such as osteoarthritis, rheumatoid arthritis, and spondylosis.¹

Scooters, also known to third-party payors as power-operated vehicles (POVs), are battery-operated, three-wheeled or four-wheeled vehicles, primarily designed for individuals who have difficulty walking. There are three categories of scooters: indoor use, outdoor use, and combination indoor/outdoor scooters. There are assortments of manufacturers and models to choose from. While equipment features vary from manufacturer to manufacturer, each scooter normally comes equipped with the following components: base assembly, drive train, tiller controller, seat, armrests, wheels and tires, batteries and battery charger, and antitip wheels (see Table 1).

QUESTIONS, QUESTIONS

With all of these choices, how do you, the rehabilitation provider, make an appropriate equipment recommendation for your client? The first step is to complete a comprehensive interview to identify your client’s needs. This will help you to make the best match between the individual and the technology. Consider the following questions:

How accessible is your client’s home or living environment?
What are the dimensions of the narrowest door your client will use?
What are the dimensions of any tight or confined areas in which your client will need to operate the scooter?
How tall are thresholds, steps, or curb cuts your client will need to navigate?
Where will the scooter be used? Primarily indoors? Primarily outdoors? Both indoors and outdoors?
What type of weather and terrain will your client typically encounter?
Will the scooter be transported from one place to another? How will it be transported (taken apart to stow for transportation, internal or external vehicle lift, public transportation)? How often?
How much will the scooter be used? Hours per day? Days per week? Distance?
What is the height and weight of your client?
Does the client have any special transfer considerations?
Are there any special dexterity needs?
Does your client require any special accessories (cane holder, oxygen holder, basket, lights, seat lift)?
What is the source of funding?

The answers to these questions will dictate the features required as part of the equipment recommendation. The following information will also be necessary in order to secure funding if a third-party payment source is being used: mobility status, transfers (type and assistance level), postural evaluation (sitting and supine), physical measurements, range of motion, strength, endurance, equipment trial, and driving safety. Be sure to be specific and demonstrate what has been tried, what has worked, what did not work, and why. A careful environmental assessment will also be needed to ensure the scooter can be used within the desired environments (eg, home, school, or workplace).

Finally, it is time to synthesize your findings and recommend a specific scooter. In addition to your interview and evaluation findings, other information that you can research and use to assist with your problem-solving process includes safety and standards testing results. Scooter safety and standards testing is a voluntary practice. Many of the answers to the following questions are available from the manufacturer and/or the equipment supplier, and will help you to compare and contrast the plethora of equipment options and make an educated recommendation for the most appropriate scooter for your client. Some questions to consider are:

What are the safety, reliability, and comfort features of each model being considered?
What is the manufacturer’s warranty?
How stable is the scooter under consideration (Maximum Incline Stability)? Does its top speed promote instability?
How reliable are the scooters? (Ask the service department for the repair incidence.) Are parts readily available?
How does the scooter fit? Is it comfortable? Are the seat and tiller adjustable enough to fit your client’s needs?
Does the scooter’s electronics system contain electromagnetic interference shielding to protect against external interference from radios, garage door openers, and cellular phones?

Be clear about the rationale for your decision and how you arrived at the final equipment recommendation. This is essential so that the funding reviewer can follow your process and recognize that you have considered all options, weighed the alternatives, and did not overprescribe or underprescribe the level of equipment that is medically necessary for your client.

FUNDING AND OTHER CONSIDERATIONS

The goal of high-quality health care is to maximize an individual’s functional capability and independence. Medicare requirements often set the standards for private coverage. Unfortunately, the Medicare durable medical equipment (DME) standard is at odds with the goals of federal policies aimed at integrating individuals with disabilities into the mainstream and returning to work. Specifically, Medicare interprets “reasonableness and necessity” of an item of durable medical equipment based solely on an assessment of the individual’s need for the device arising within the four walls of his or her home. There are many clients who would benefit from the use of a scooter and unfortunately will not meet these criteria. Occasionally, with proper eligibility, other funding agencies such as Vocational Rehabilitation or Independent Living can assist with funding equipment that is determined not to be “medically necessary.” For these individuals, funding through nontraditional venues may be the only choice (eg, private pay, loans, or supplemental insurance plans).

Typically, third-party funding sources will reimburse for a power mobility device only once every 5 to 7 years depending on medical need. This is based on the estimated lifetime of this type of equipment. It is important to consider the future needs of your client so the equipment you recommend will serve your client’s needs for that time period. Otherwise, it is imperative to document any dramatic changes in order to deem the existing equipment obsolete.

Scooters are generally not the best option for individuals with degenerative conditions such as MS and ALS because physical changes can occur rapidly, resulting in diminished upper body strength, coordination, endurance, and balance. These physical changes can affect an individual’s ability to operate the tiller controller or even transfer on and off the scooter. It takes more upper extremity strength to operate a tiller controller on a scooter than a joystick controller on a power wheelchair. On a scooter, the upper extremities are positioned in front of the individual on the tiller with minimal to no upper extremity support, whereas on a power wheelchair, the joystick controller is positioned to allow continual upper extremity support. Furthermore, steering the tiller is essentially the difference between manual and power steering. The front wheel(s) are manually turned with the tiller controller on the scooter, while the power wheelchair is operated with minimal exertion through a proportional joystick controller. Finally, the electronics on a scooter are not programmable and the tiller access method is only minimally modifiable, whereas on a power wheelchair, specialty controls and programmable electronics can often compensate for impaired upper extremity function, allowing continued access to power mobility.

The results of the National Health Interview Survey on Disability (NHIS-D) found that overall, the top three leading conditions associated with scooter use in all age groups include: cerebrovascular disease (11.05%), osteoarthritis and allied disorders (10.43%), and MS (5.02%).¹ This finding is surprising to me, as my experience has found the majority of scooter users to be individuals with various forms of heart disease, respiratory disease, and orthopedic impairments. For many of these clients, the major mobility impairment involves community mobility. The scooters they require are primarily for use outside of the home to allow access to and participation in community activities and independent living, making the securement of funding problematic.

Scooters are an appropriate power mobility option for many clients. As the rehabilitation practitioner, it is important to consider your client’s needs, evaluation findings, equipment trials, safety and performance results, and funding options as you try to document and justify medical necessity. Be sure to document your trials, failures, and successes. The more thorough your letter of medical necessity, the higher the probability you will have of securing funding for these devices.

Laura J. Cohen, PT, ATP, is a doctoral candidate at the Rehabilitation Science and Technology Department, University of Pittsburgh; a research associate at the Human Engineering Research Laboratories, Pittsburgh; and consults as a second level reviewer for DME claims in 16 states.

REFERENCES

Kaye HS, Kang T, LaPlante MP. Mobility Device Use in the United States. Disability Statistics Report 14. Washington, DC: US Department of Education, National Institute on Disability and Rehabilitation Research; 2000.
Abledata. Scooters Abledata Fact Sheet #26. Available at: www.abledata.com. Accessed October 29, 2002.

LOOKING FOR EXPERT ADVICE?

Experts here are available to answer all your questions!

Please contact us for more information about this feature, or to become an expert.

MEDIA CENTER

Interactive Media

Resources

	Calendar
	Consumer Resources
	Media Kit
	Advertiser Index EAB Reprints Submit an Article

ADDITIONAL ONLINE RESOURCES

Allied Media
24X7mag Clinical Lab Products (CLP) Orthodontic Products The Hearing Review Hearing Review Products Rehab Management		Physical Therapy Products Plastic Surgery Practice Imaging Economics RT Magazine Sleep Review

Subscribe | Advertise | About Us | Contact Us | Home

December 2002