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March 2005

By Rachael Finke, PT

Choosing a scooter to suit your patient’s needs involves thorough knowledge of the equipment.

Author Rachael Finke, PT, helps a patient determine if her scooter height is compatible with her work space.

As physical and occupational therapists, we are trained to treat a variety of diagnoses and problems, even to specialize in different areas. However, when it comes to the specifics of prescribing powered mobility devices, many therapists believe that they do not have enough knowledge to guide a client to get the appropriate equipment that is suited personally for them. When assessing a client for a powered mobility device, it is important to know:

The differences between a scooter and a power wheelchair.
How to identify which clients are appropriate to utilize a scooter.
The key elements for properly assessing the client’s individual needs.
The components and options available for scooters.
How to write an effective letter of medical necessity for insurance funding.

When deciding whether a client would benefit from equipment to aid in mobility, it is important first to understand the main differences between a scooter and a power wheelchair. Both are useful for giving a client the needed independence that has been lost due to issues such as loss of balance, weakness, and limited endurance, issues that inhibit the ability to be functionally safe and mobile.

SCOOTERS VS POWER CHAIRS
Scooters come in several sizes to suit the height of the individual. All scooters have a long base or deck where the client’s feet can rest. The steering mechanism is on a tiller or column located on the front end of the deck. Often, it will fold down to allow for easier stowage. The throttle—forward and backward controls—requires the client to have a moderate amount of finger and hand dexterity. Many clients find that this type of steering control is easy to manage, and many prefer it to the standard joystick control on a power wheelchair. Seats have variable options for back height, swivel forward, and turning out to the side, easing transfers in and out of the scooter.

In comparison, power wheelchairs offer different options. For example, they come with front, mid-wheel, and rear-wheel drive options. All have a slightly different turning radius depending on the footprint of the chair. The turning radius of a power wheelchair is smaller than that of a scooter, which should be considered depending on the environment in which the chair will be used. Power wheelchairs are able to handle uneven terrain well.

There are multiple options for seat, back, arm/leg/headrest, and steering controls that can be individually adapted for each client In addition, tilt and recline options are available for the client who needs frequent position changes. This may be the case if the client is not able to bear weight through their spine for extended periods of time, or has trunk fatigue. In addition, it may be an option to consider if the client has spinal pathologies or skin-related issues.

Overall, a multitude of postural corrections can be achieved very accurately with less stress on the musculoskeletal system by using a power wheelchair. Diagnoses that typically are justifiable for a power wheelchair are multiple sclerosis, postpolio syndrome, and many of the dystrophies. These disorders may also be considered for scooters.

Remember function while assessing your client since access to tables and desks is simpler in a power wheelchair versus a scooter as the client can pull straight up to the surface without adjusting the base. However, power wheelchairs are more difficult to transport as they weigh more and are less compact/foldable, thus they may require a vehicle change. Clients initially may have a psychological problem using a power wheelchair because of its medical look.

USER PROFILE

A powerchair evaluation includes assessing range of motion, strength, endurance, balance, and the ability to negotiate community barriers.

Clients who need motorized mobility and fit the following guidelines may be excellent candidates for the use of a scooter:

Do not require significant postural adaptations for the seat or trunk;
Do not have significant pathologies in the lumbar, cervical, or upper extremity region that need postural adaptations, ie, median or ulnar neuropathies, cervical impingements, and rotator cuff tendonitis;
Have trunk and neck mobility for making a full turn in a scooter;
Have acceptable grip strength to manage the throttle.

In addition, clients with diagnoses like COPD, rheumatoid arthritis, osteoarthritis, and other cardiac disorders can be considered for a power wheelchair.

SCOOTER OPTIONS
Scooters come with many options. Conducting your evaluation with a skilled and reputable vendor ensures that your client receives the most up-to-date information about the products available on the market. New and innovative products become available on a regular basis. A good vendor will have access to them and will allow the client to trial them during the evaluation.

Many scooters come with baskets for storage. Some have lights for night use; some have horns. Items such as cane or crutch holders and oxygen tank holders can be added and justified as needed on an individual client basis.

Prior to considering the color of the scooter and the location of the basket, there are more important fundamental factors to consider. For instance, scooters can come in three- or four-wheeled options. A three-wheeled scooter offers more agility, which may be appealing if the client is planning to use this scooter in an environment requiring a smaller turning radius. Or the individual may want to consider a hybrid scooter, which is a cross between a scooter and a power wheelchair, having a very small footprint and small turning radius. The scooter may fit in the trunk of a standard vehicle with the use of a mechanical lift.

Scooters with four wheels have more stability and may be more appealing if your client plans to use it on more uneven terrain. Likewise, tire options are important. Pneumatic tires give a cushy ride and offer better shock absorption. Using solid inserts on the tires helps with ease of care and decreases maintenance on the tire.

The length of the deck will vary with the model of the scooter. This will also depend on the height of the patient, their leg length, and if they have any lower leg braces or contractures.

Other components that vary depending on the model are: how far the chair will travel on a full battery charge; speed of the chair; adjustability of the seat and armrests; ground clearance; weight of the scooter/individual components; and tiller adjustability.

A THOROUGH EVALUATION
A standard therapy evaluation with all of its pertinent parts should be completed in order to proceed toward assessing the need for powered mobility. As a therapist, you are trying to make a case for why your client needs this particular piece of equipment. Specifically, you must identify why they cannot successfully ambulate normally in the home or in the community.

Standard evaluation items—including range of motion, strength, endurance, balance, transfer ability, gait ability, and ability to negotiate community barriers such as curbs, ramps, steps, and un-level surfaces—all need to be included. Be clear in depicting a decline in the client’s status. Highlight if the client has had falls or injuries related to falls, or may need additional time for mobility, especially if community-based distances cannot be negotiated in a timely manner.

Scooters are affordable practical solutions for clients with limited capabilities for mobility in the home and community setting. Knowing how to properly assess the clients and knowing what types of equipment best suit different pathologies will ensure that the therapist is prescribing the correct equipment.

Rachael Finke, PT, is a therapist at Spaulding Rehabilitation Hospital, Framingham, Mass.

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