Beyond Beauty

There are a Number of Factors to Consider When Matching a Scooter with a Consumer

The thought of owning a scooter, to some, is like having a sleek, hip piece of machinery. These power-operated vehicles may come across as eye candy to consumers, but providers should help them to see the devices for what they really are — pieces of medical equipment.

When it comes to scooters, one size does not fit all. There are certain features that make end-users with specific conditions more comfortable. For this reason, the functionality of a scooter is key when recommending a purchase. In this piece, we’ll break the scooter apart by looking at the different functionalities and features of tillers, styles of seats, driving/steering controls, three-wheel models versus four-wheel models (not to mention five-wheel models), and bariatric considerations.

How Will They Drive It?
There are a number of different styles of tillers, including the popular Delta style, which has a wrap-around design. Cy Corgan, national sales director of retail mobility at Pride Mobility Products, says the company offers a variety of tillers, all of which are adjustable in some form. Research conducted by the company shows that the Delta tiller is the most preferred by consumers.

“We have implemented the Delta tiller as the design that reduces the strain on the upper extremities,” he says. “Individuals with hand-dexterity issues, for example, also find the Delta tiller easier to operate, and it allows for one-hand operation from either the left or right side. If the person has an amputation, arthritis or some sort of hand-dexterity problem, it allows them to operate the scooter from either the right or left side of the scooter.”

Golden Technologies also offers Delta tillers on select models of scooters. Patricia O’Brien, communications manager of Golden Technologies, says that she’s also found that this style of tiller, because of its wrap-around handle, offers users with arthritis, carpal tunnel syndrome and other hand strength issues an easier way to maneuver their scooters.

DuWayne Kramer, president of PaceSaver/Leisure-Lift, says one of the nice features his company offers is having left-hand thumb bar control, right-hand thumb bar control, thumb-bar extensions and fingertip controls on its scooters. Kramer has found that the thumb controls work well for those consumers who may be paralyzed on one side of their bodies. The company also has shorter or longer tillers to fit a person’s physical characteristics.
“All of our scooter tillers can be adjusted to be as close to the user as needed, so they can reach the handles comfortably without having to stretch or reach too far,” O’Brien affirmed of Golden’s features.

Kramer, does, however, warn that if a person is unable to drive a scooter safely, then the vehicle type may not be right for him or her.
“I think all these special hand-controls are fine,” he says. “But you need to be able to be safe with it because if you’re accidentally driving somewhere and hit a ramp on an angle and you don’t have good hand control, that tiller can get jerked out of your hand. And then you’re going to fall over.”

Because it is very typical that people in scooters are dealing with a variety of medical conditions, they must be properly fitted, says Jim Ernst, product manager at PaceSaver/Leisure-Lift.
“We constantly see that somebody will get a scooter, then they’ll find out later that it wasn’t properly prescribed and sized for them,” Ernst says. “It’s not what people think — that it’s a one-size fits all.”

Sitting Pretty
Having an accommodating seat is imperative to ensuring a good scooter purchase.
Ernst says that the width, depth and back height of scooter seats are fitted to a patient much like a wheelchair’s. Custom seat heights and custom formations are available as well. Having an adjustable seat and back helps to fit the seat to the person and prevent decubitus ulcers.

A popular form of seating offered at PaceSaver/Leisure-Lift is cane seating. Cane seating consists of a pressure point cushion and multiple adjustments of the seat and back, providing a custom fit for medical needs. Different cushions can be put into a cane seating system as well as adjusting width and depth. Other seating options include adjustable-height arms, removable arms and narrow arms, which allow people who need extra-wide scooters to still be able to get through doors. Kramer believes adjustable heights and armrests are needed for someone sitting in a chair all day because those adjustments can alleviate shoulder pressure.

Those suffering from hip problems could most benefit from reclining and fixed-angle seat backs that are fingertip adjustable. Special backs can also be built onto a seat to accommodate varying heights.

Pride also offers reclining back seats. The recline function helps consumers to open up their hip angle to combat either a limited range of motion or pain, says Corgan, and can assist in proper positioning: “It can promote gravity-assisted positioning for improved sitting balance.”
Captain’s seats are appropriate for patients who, despite their diagnoses, have intact sensation and the ability to effectively manually weight shift for pressure management. Corgan says captain’s seating is best for part-time users and also for those who are using the scooter to get from one point to the next due to limited ambulation, mobility impairment or a respiratory compromise.

“We do have different styles of seats on a scooter, and a lot of that is really dependent on the end-users’ preference of what’s comfortable for them,” he says.
Standard scooter seats at Golden have a fixed recline, where the angle of the backrest can be set to the user’s comfort. O’Brien says Golden’s captain’s seats can recline back manually while users are in the seat. These seats are offered for those who need a higher back support and a headrest. In addition to these features, Golden also has a stadium-style seat without the headrest, which is standard for most of its scooters, along with several scooter seats with height-adjustable armrests.

All of Pride’s scooters come standard with a swivel function, making it more convenient for the consumer to turn to the side when at a table or counter. A few models come with sliders. This option allows for more or less leg room, which is similar to the function you’d find in your car that enables you to slide back and forth. Pride also offers a power seat option, which provides the user with the ability to raise the seat up in order to reach an elevated area. For instance, if a person is at a bank, they can rise to the level of the counter for convenience.

For people with skin sensitivity or rheumatoid arthritis, PaceSaver/Leisure Lift offers velvet seats that are breathable. A soft vinyl is available for those with incontinence issues. This type of user will also need something with several inches of foam that will aid in keeping pressure down.
“When you look at a seat, look at it in terms of pressure reduction and keeping patients cool and comfortable,” Kramer says. “The main thing is trying to prevent them from getting pressure sores.”

For incontinence and spills, Pride has durable vinyl, which resists spills and allows for easy clean-up.

Steer Consumers in the Right Direction

After determining which seat works best, providers must then help customers make a decision on the type of driving control systems that will best suit their lifestyles. Scooter manufacturers offer a variety of options. PaceSaver/Leisure-Lift has programmable controllers. The company offers an acceleration program, where consumers can have more acceleration at the beginning or end when pushing the throttle or have it evenly distributed. This system includes acceleration, deceleration, and maximum speed along with full-speed roll back — so if an end-user is on a ramp and rolls backward, the scooter doesn’t “run away.”

Different steering controls offered include the Delta tiller and adjustable-height tiller. The dealer can program a scooter so that it won’t go beyond a certain speed, and there’s also a governor switch to adjust speed when in tight situations.

It’s important for the dealers to work alongside the clinician to set the speed according to the person’s capability.
“It all comes down to evaluating a scooter just like you would any other piece of medical equipment,” Ernst says.

Pride is in the process of moving many of its products to the wraparound-style tiller that allows for operation from either the right or left side, depending on dexterity. All of their scooters come equipped with speed knobs that patients can adjust. Pride does offer advanced set speed control at the request of an assisted-living or long-term-care facility that is concerned about the safety of the individual operating the scooter as well as the other individuals at the facility that may interact with that person on the scooter.

“A long-term-care assisted-living facility may say that (they) don’t want the mobility device to run any faster than two miles per hour, and we will then preset it so again it’s safe for the individual and safe for those who would be interacting with that individual around them,” Corgan says.

Picking the Magic Number: Three, Four or Five
In the world of scooters, consumers can currently choose a three-, a four- or a five-wheel model. The choice is typically made according to the use or overall goal of the scooter.

One of the differences between three-and four-wheel models that consumers will notice is the ability to turn in tight spaces. Three-wheel scooters can turn in a tighter area than a four-wheel scooter, but many people feel that a four-wheel scooter is more stable.
“That’s not necessarily the case,” O’Brien says. “It’s all in how you drive it.” Golden also offers a Liteway scooter with a unique feature called the “jockey wheel” on the front, which is two wheels, a few inches apart, on a shorter axle. This design gives you the stability of a four-wheel model with a tighter turning radius of a three-wheel model.

Pride offers both three- and four-wheel scooters in a variety of styles. A three-wheel scooter is typically more maneuverable than a four-wheel scooter. A four-wheel scooter typically does have added stability with its wider stance, and is typically used outdoors because of its larger turning radius as opposed to a three-wheel scooter. The type of model that best suits the person is contingent upon their living conditions.

“Can they operate a scooter safely in their environment to actually conduct their daily living exercises?” Corgan asked.
PaceSaver/Leisure-Lift offers three types of scooters: three-wheel, four-wheel and a five-wheel model. The five-wheel model, called the Fusion, gives the best indoor maneuverability with a good turning radius, Kramer says. “You have excellent outdoor capabilities, and you’re going to go up and down 12° ramps at the RESNA-rated system,” he says. “Certainly you’re getting a much bigger scooter, much more powerful.” This scooter gives consumers the options of being able to use the scooter indoors and yet have the capability to safely use it outdoors.

The Make-Up of a Heavy-Duty Scooter
When dealing with bariatric customers, it becomes even more important to choose the right scooter features. The seat must be large enough to give the back and seat support that bariatric patients will need, particularly if they use the scooter full-time, O’Brien says. A person who is 400 or 500 lbs. is probably going to be 36" around, so these people need greater seat width and depth, and they themselves are either apple or pear shaped, Kramer says. Typically, they will have a lot of posterior redundant tissue, so when a seat is designed for them, there needs to be a big gap in the back so that it doesn’t push them forward in the seat.

“You need more leg room, tummy room and rear room,” Kramer says. “They need more room, period.”
The biggest issue for bariatric patients is getting around the tiller, he adds. It is sometimes hard for them to turn the tiller because of their stomachs, so it’s imperative to give them more seat depth, and this is accomplished through leg room. “What that really means is you’ve got to push them back in the scooter and lengthen the floor pan,” Kramer says.

For a bariatric person, you’ll definitely want a strong frame, Ernst chimed in.
“Some manufacturers take a regular frame and beef it up, Ernst says: “That does not a bariatric scooter make.”
“You need to have an incredibly heavy-duty frame because they’re really hard on their units,” he says. “They’re very heavy. Therefore you’re moving a lot of weight, which is a lot more strain on the components, particularly the frame of the unit, and that’s why you want it as strong as possible.”

They’ll also need stronger controllers, stronger motors and greater efficiency of the unit, Kramer says. Another feature to consider is the tires. If the person’s outside a lot and they’re fairly capable mechanically, then you can use a pneumatic tire. But if they’re not very capable, and can’t keep the tires inflated, their best bet is probably gel tires, says Kramer, whose company also offers custom units for bariatric needs. Foam-filled tires tend to be difficult for bariatric patients, he added.

Extra-long arm-rests and height-adjustable headrests should also be considered for comfort and support of the bariatric patient, says Corgan, whose company offers the Maxima four-wheel scooter for bariatric needs.
“You need to be able to offer longer floor pans, wider and deeper seats and cane seating systems, and all the other different kinds of things you’re going to need for this person,” Kramer stressed. “You’re really talking about a real-need situation. This is not a mall scooter: This is the real thing.”

Determining Whether a Customer’s Right for Any Scooter — Period
With Medicare, there are certain qualifications that need to be met to put a person in a scooter. One is that he/she must be able to transfer safely in and out; another is that he/she must be able to operate the tiller control and have adequate trunk stability to ride in the seat that’s on the scooter, says Paul Komishock, general manager, government relations at Pride. “Some of (the criteria) might even exclude someone from looking at a scooter, depending on the situation.”

“Fit to the patient, fit to the patient, fit to the patient,” Ernst repeated. “Otherwise you’ll be hearing back from your patient: ‘I’m uncomfortable in it, I can’t fit in it. I can’t use it, it wasn’t properly fitted,” Ernst says. It simply “just doesn’t work for what their needs are.”

It really is important for the provider to interact with the consumer and ask them questions of daily living such as how, when and where they’re going to be using the scooter and under what conditions, Corgan says. All of these factors should be considered before closing the deal (see the checklist below).

Selecting the Right Scooter Features

  • For customers with amputations, arthritis, carpal tunnel syndrome or any other hand-dexterity issues, consider recommending a Delta tiller. It allows end-users to operate the scooter with one hand.
  • Having the option of either a left- or a right-hand thumb-bar control is the right choice for someone who’s been paralyzed on one side or the other due to stroke or some other medical condition.
  • For someone who’s really tall or really short, varying lengths of tillers are available. Custom seat heights can also accommodate different heights of people.

  • Pressure relief can be achieved through a pressure point cushion offered in some seating systems.

  • Adjustable-height armrests are available to prevent shoulder pressure.

  • Reclining and fixed-angle seats can be used for those experiencing hip problems.
  • Captain’s seats are great for part-time users to get from point A to point B because of limited ambulation, due to mobility impairment or a respiratory compromise. They also work well for someone who needs higher back support and a headrest.
  • Velvet seats are good for those with rheumatoid arthritis or skin sensitivities.
  • Go for vinyl seats for incontinence and spills. It allows for easy clean-up — mild soap and water.
  • Swivel seats are convenient when approaching a table or counter top.
  • A power seat elevation option allows the seat to rise to reach a higher area.
  • Programmable controllers can help with adjusting acceleration and deceleration options. Scooters can be programmed not to go beyond a certain speed for safety.
  • A governor switch allows consumers to adjust speed when in tight or crowded situations.
  • Three-wheel scooters are typically used indoors, while four-wheel scooters are used outdoors. Five-wheel models, as well as three- or four-wheel models built for versatility, can be used both indoors and outdoors.
  • Bariatric patients typically need more leg, stomach and rear room, so seats should be large enough to give them back support and offer extra depth. The scooter should also avoid pushing the driver forward in the seat.
  • Bariatric patients should also have stronger frames, controllers, motors, extra-long armrests, height-adjustable headrest and sturdy tires.

This article originally appeared in the August 2008 issue of Mobility Management.

In Support of Upper-Extremity Positioning