Power Wheelchair or Scooter?
There is a Post-Polio Institute rule of thumb, or more correctly a rule of arms and legs:
If you’re wearing a short-leg brace you need to use a cane;
if you're wearing a long-leg brace, you need to use two forearm crutches;
if you have two braces, you need a wheelchair.
Obviously, there are lots of polio survivors with and without braces who need a wheelchair. But, after 35 years of experience, I no longer recommend either manual wheelchairs or scooters for polio survivors. If your arms are weak and your shoulders hurt too much to use crutches, you shouldn’t be using a manual wheelchair...or a scooter. Both put tremendous physical stress on polio-damaged, overworked neurons, muscles and joints. The wheelchair requires that you propel yourself using your arms. You steer the scooter using your arms and shoulders to move a "T-bar" tiller that turns the front wheel while you use your hands to squeeze levers that make the scooter move. What’s more, the tiller forces you to lean forward in the seat, putting you in a forward flexed position that causes neck and back pain.
On the other hand, there is the power wheelchair. Steered by a joystick, like those used for video games, power wheelchairs have a knob attached next to one of the arm rests. The joystick allows you to steer with only one hand -- or even just your fingers -- with arms at your sides and shoulders relaxed while sitting with “painless posture.” Also, the new power chairs have mid-wheel drive, instead of the old rear wheel motors, that allow the chair to turn in its own space, make it smaller and very maneuverable.
Power chairs can be fitted with special rigid backs that have adjustable foam inserts to provide the right amount of lumbar curve to insure proper posture. If you have trunk weakness or scoliosis, you can get a back made from custom-formed foam to cradle and hold your body in place. And if you have upper back or neck pain or muscle weakness, you can order a shoulder-high or head-high back, or an additional head rest, that will allow your muscles to be supported and relaxed while driving.
Power chairs can also accommodate custom seat cushions. If one butt cheek is smaller than the other, or if you have scoliosis and your upper body tilts, an adjustable cushion that has separate inflatable air bladders or foam inserts of different heights and firmness can lift one side of your pelvis and balance your body. Those with leg swelling can get manual or electric elevating leg rests. You can even get a special power seat riser to allow you to reach high cupboards and chairs whose backs recline and allow you to take your two, daily, 15-minute rests breaks (or even a nap) without leaving the comfort of your custom-designed chair.
Now that you know power wheelchairs are the way to go, how do you get Medicare or your insurance company to pay? Medicare and most insurance companies use the Medicare rule:
You are eligible for a power chair “only if you need it in your home” and “your arms are either too weak or you have too much pain to propel the manual chair.” Your doctor and a physical therapist need to fill out the Certificate of Medical Necessity and write a separate letter of medical necessity for the power chair.
Your doctor and therapist need to clearly document, on the form and in the letter, your actual physical condition, including
1) leg and arm muscle weakness/pain that prevent you from using use crutches or a manual wheelchair;
2) if you are unable to walk more than ten to twenty feet and need to use a power wheelchair at all times inside the house;
3) if you are unsafe and more likely fall;
4) if your PPS symptoms are progressing and will get worse without the power wheelchair.
If your power chair has already been denied and you are filing an appeal, it is helpful to get the name of the Medicare or insurance company doctor who will be reviewing the denial and have your own doctor give him or her a call and directly send the doctor the form and letter.
A personal doctor-to- doctor chat with the medical director of the insurance company can often get you the chair. In any case, it is important to play by the rules in order to obtain a power wheelchair under Medicare regulations or your own health insurer/HMO policy.