Home     |     News     |     Buyer's Guide     |     Features     |     Products     |     Education     |     Archives

April 2004


Easier Access

By Kathleen Drab, MS, OTR/L, and Sandy Sisenwain, COTA
Rehabilitation professionals are continually challenged with the task of ensuring that clients are afforded every opportunity to function at the most independent level possible. Whether those clients are patients in a private practice or residents of a long-term care facility, independence can be threatened if an individual becomes incapable of walking long distances or propelling a standard wheelchair due to illness or accident.

Until roughly 20 years ago, the wheelchair was the only option available to persons who lacked the physical ability or stamina to get around within their environment by walking.1 The development of motorized mobility aids, such as battery-powered scooters, expanded the opportunities for many more people to enhance the level of independence in their daily lives. Although the earliest scooters provided minimal power and range,1 today these devices offer a variety of models and options that allow users to move around more freely and comfortably within their homes and communities. Rehabilitation practitioners who are knowledgeable about the benefits of motorized scooters have the opportunity to greatly enhance quality of life for their clients.

The individuals who benefit from scooters primarily have experienced significantly reduced mobility. They may be elderly and facing decreased agility due to generalized deconditioning or a debilitating condition. However, the devices are also beneficial for others who have lost ambulatory capabilities due to a disabling condition.

Studies have shown that the majority of scooter users are likely to have conditions that affect the nervous system or the musculoskeletal system.2 These disorders include osteoarthritis and rheumatoid arthritis, or early stages of diseases such as multiple sclerosis, Parkinson’s, cerebral palsy, amyotrophic lateral sclerosis, or muscular dystrophy. Individuals dealing with the aftereffects of a stroke comprise another large group of scooter users, along with those who have a joint replacement, heart condition, emphysema and other breathing difficulties, lower extremity vascular problems, or lower leg amputation. To benefit from a scooter, the individual must have the cognitive ability to be aware of where he or she wants to go and to control the device to get there.

INCREASING INDEPENDENCE AND CONFIDENCE
The single most important benefit of using a scooter is increased mobility. Freedom of movement provides greater independence and reduces reliance on a caretaker for accomplishing daily activities (eg, the scooter can help the individual get to meals and doctor appointments). For the person who has lost functional mobility, yet wants to be active socially, there can be a significant improvement in quality of life. In an independent living situation, the individual can move around his or her kitchen, apartment, or community more freely. Within the facilities where we have worked, the result of added mobility has been that scooter users often are the most social people.

On a physical level, utilizing motorized transportation may help alleviate pain, conserve energy, and also maintain health simply by facilitating an increase in activity level. As a result, numerous psychosocial needs are fulfilled, often with a significant decrease in isolation and depression, as well as an increase in self-esteem and confidence—and it all begins with mobility.

One noteworthy example is a quadriplegic patient we work with in a long-term care facility. A scooter was adapted using a “sip and puff” mechanism that allows him to control the device with his mouth. He can puff into the straw to move forward and sip it to move backward, and thus travel around the facility. The new sense of freedom significantly elevated his mood. As rehabilitation professionals become more keyed into the concepts of wellness and aging in place, ensuring that clients maintain functional capabilities can offer a major key to achieving the positive outcomes we all desire.

COMPARING MOBILITY DEVICES
Measured against other mobility devices, scooters offer several benefits. They are designed to be user-friendly, with easy-to-manipulate controls, swivel seats, and plenty of options. Scooters are smaller and lighter weight than wheelchairs, and generally take less effort to operate, which can be important for someone who does not have a lot of energy to expend. Other benefits include: ability to travel faster and farther, easier to maneuver, indoor and outdoor models, “younger” image, more comfortable, and easily customized.

While customizing is not necessarily exclusive to these devices, it is important to be able to adjust seat height, back height, or width and armrest characteristics. For instance, with an overweight person, wheelchair sides may irritate the hips and thighs. A scooter with removable armrests can eliminate that issue. Motorized mobility devices should be carefully evaluated to ensure the appropriate choice for the individual’s needs. Decisions to consider include:

Three wheels vs four wheels: Four-wheel models offer increased stability and functionality for outdoor use. Three-wheel models are more maneuverable for use inside a home, store, or the hallways of a care facility.

Front-wheel vs rear-wheel drive: Front-wheel drive provides less power, speed, and traction, reducing its potential for outdoor use. The range is shorter, but it is also more maneuverable, and therefore, a better choice for indoors—although some are usable in flatter, paved outdoor areas. Rear-wheel drive offers greater stability and traction, a more powerful motor, greater climbing ability, speed, and traveling range for outdoor use, but less maneuverability indoors.

Options: Steering mechanism possibilities include a single-post tiller, handlebar, joystick, or even a lever controlled by one finger, depending on individual needs. Seats can be chair-style, backless, plastic or padded, ergonomically designed, powered or foldable. Removable or flip-up armrests are also available. Selecting the appropriate options and test-driving the vehicle provide the best opportunity for purchasing the device that benefits its owner the most.

LIMITATIONS ON SCOOTER USE
For rehabilitation providers who are in a position to advise clients on assistive devices, it is critical to be aware of situations where a scooter is inappropriate or dangerous. Generally, this involves physical or cognitive limitations.

Sometimes, even with the best adaptations and training, a person may be physically unable to operate a motorized apparatus. Without the necessary eye/hand coordination, quick reaction time, and ability to sit upright and to use a steering mechanism, operating a scooter could be dangerous for the driver or others. Cognitive ability is equally important. Perception, ability to follow directions, awareness of people and objects, and an understanding of what is happening around you are all critical. Fine motor skills, coordination, safety awareness, and judgment are also crucial.

DETERMINING WHO CAN BENEFIT
Occupational and physical therapists, whether in private practice or in an institutional environment, may be called upon to assess and advise clients in terms of mobility options and specific benefits. Therapists who make it a priority to specialize in these assessment skills and knowledge of the assistive devices can provide a valuable service for their clients.

We have seen that many who could benefit from scooters are not taking advantage of this opportunity to improve mobility. The most common obstacle is affordability. Although scooters generally cost as much as 20% less than motorized wheelchairs,3 the price still can be prohibitive for someone who has lost a job due to disability or is on a fixed income. Other obstacles include lack of knowledge concerning scooters and the perception that utilizing a mobility device will make the rider look old or weak. Education can play an important role in changing these perceptions.

In an independent living, assisted living, or long-term care setting, rehabilitation professionals have a compelling opportunity to provide a learning environment with a framework for determining who can benefit from motorized mobility devices. We have found that providing “scooter clinics” for residents of care facilities offers the opportunity for clients to obtain the information they need.

Our experience has shown the hands-on environment of the clinics to be helpful, both for residents who already own a scooter and for those who wish to learn about them. In today’s health care, there is such a strong emphasis on aging in place, and the availability of assistive technology such as scooters allows people to maintain independence and mobility longer. That has made the clinics well-attended and increasingly relevant for residents.

Within the clinic format, an evaluation and assessment process determines if a scooter or other mobility device is appropriate for the individual. Clinic staffing generally consists of a physical or occupational therapist, a physiatrist, and a representative from one or more of the companies that manufacture scooters and assistive devices. These representatives can be helpful in training participants and demonstrating the benefits of the devices.

Utilizing a wide range of screening tools, therapists look at gross and fine motor ability, range of motion, sitting tolerance, balance, strength, cognitive ability, judgment, visual acuity, and perception. Instruction and practice in driving rules and safety standards are followed by a “driving” test that helps ensure safety and competency.

If the individual performs test procedures adequately (eg, stopping, turning, parallel parking, weaving through cones, proper acceleration/deceleration, steering, maneuvering in and out of elevators, rooms, chapel, patio, etc), a “driver’s license” is issued. The clinic setting provides the opportunity to evaluate whether the participant operates the vehicle safely. The goal is to ensure safe access for clients to their environment using the most appropriate mobility device. Those who pass the test sign an agreement stating that they have been told the rules and regulations and will obey the facility’s driving rules and speed limits. Drivers who do not follow the rules can be given “tickets.” Periodical reevaluations are critical to maintaining safety and ensuring continued ability to operate the scooter. This is especially important for persons with progressive conditions.

We have found that participation in the sessions has been enthusiastic wherever we have offered the clinics. In general, people are so much more aware of what they will be facing as they age and have demonstrated a growing interest in utilizing whatever assistance is available to them.

IMPROVING THE QUALITY OF LIFE
Scooters clearly have the ability to enhance quality of life for the elderly, as well as for individuals with debilitating non-age-related conditions. They provide an opportunity to move around in the community in ways that would otherwise not be possible, allowing more enjoyment of activities such as going to amusement parks, shopping, and social events.

The keys to ensuring opportunities for this increased independence lie in providing education to those who are likely to benefit, as well as offering comprehensive evaluations, setting parameters for appropriateness and safety, and providing reevaluations to ensure continued compliance.

In our work, it has been very obvious that people tend to identify themselves by their mobility, and regaining some of that ability accomplishes many goals. We have seen the results numerous times, for example, with a resident who is depressed because he or she cannot take part in activities anymore, and the dramatic transformation in attitude and self-confidence that takes place after mobility is renewed.

Knowledgeable rehabilitation professionals can help to ensure that those who stand to benefit most from motorized scooters have the opportunity to take advantage of this option.

Kathleen Drab, MS, OTR/L, is vice president of operations at RehabWorks, Langhorne, Pa, and Sandy Sisenwain, COTA, is an occupational therapist with RehabWorks, Pittsburgh.

REFERENCES
  1. Abledata. Abledata Fact Sheet No. 26. April 1996. Available at: www.abledata.com/text2/scooters.htm. Accessed February 13, 2004.
  2. Kay HS, Kang T, LaPlante MP, Disability Statistics Center. Mobility Device Use in the United States. Washington, DC: US Department of Education, National Institute of Disability and Rehabilitation Research; June 2000. Available at: http://dsc.ucsf.edu/publication.php. Accessed February 12, 2004.
  3. The National Parkinson Foundation Inc. Motorized scooters & user safety. Available at: www.parkinson.org/motor_scooter.htm. Accessed February 12, 2004.

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
Classifieds
Calendar
Consumer Resources
Media Kit
Advertiser Index
EAB
Reprints
Submit an Article
Home     |     News     |     Buyer's Guide     |     Features     |     Products     |     Education     |     Archives

ADDITIONAL ONLINE RESOURCES

Allied Healthcare
Medical Education
24X7mag
Clinical Lab Products (CLP)
Orthodontic Products
The Hearing Industry Resource
Rehab Management 		Physical Therapy Products
Plastic Surgery Products
Imaging Economics
RT Magazine
Sleep Review 		medCME
Practice Growth
Practice Builders
powered by:
Copyright © 2009 Ascend Media LLC | Rehab Management | All Rights Reserved.
Privacy Policy | Terms of Service