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Power Move: Rethinking the Many Proactive Possibilities for Power Assist

man doing wheelie in wheelchair

MAN IN WHEELCHAIR: ISTOCKPHOTO.COM/NATASHAFEDOROVA

What will it take to change the conversation about power assist?

Power assist has long been considered an intervention to call on once damage has been done, after manual wheelchair users have strained and stressed shoulders, arms, wrists, and hands after years of self-propelling. Power assist, as past thinking goes, is for middle age. Or it’s for college campuses, Disney World, and extraordinary adventures. And certainly, it can be.

But can power assist be more?

POWER-ASSIST APPLICATIONS CLOSER TO HOME

Curtis Merring, OTR, MOT, is Director of Product Marketing for Permobil Americas. While power-assist devices are often equated with wide-open spaces such as shopping malls or airports, Merring sees plenty of other applications.

“Power assist is not just for active people,” he said. “It really is opening up more functional activities across the board.”

In fact, Merring said, there are plenty of power-assist applications much closer to home.

For example: “If someone lives on a hill, and they just want to carry their groceries from the bottom of the driveway to the top of the driveway. Another example is people who are foot propellers, traditionally people with hemiplegia, whether that’s from stroke or CP [cerebral palsy]. Maybe they are in their home, but they can’t get over a threshold. They can’t go from linoleum to carpet. Now they hit a little [power-assist] boost on their button on the side of their chair, and they get over that threshold.”

POWER ASSIST’S RIPPLE EFFECT

But power assist’s value goes beyond just getting a wheelchair user from point A to point B more efficiently. Merring pointed out that when consumers use power assist throughout the day, they’re conserving energy that can then be used on other activities of daily living.

“I can’t really stop the number of times someone needs to transfer,” Merring pointed out. “They need to go to the toilet, they need to go to their bed, they need to go to their chair. I can’t really change the environment: People who are in manual chairs are going to just sit lower than most people, so when they reach, they inherently have to reach above 90° to be able to reach things. Where does most shoulder impingement happen? Above 90°. But I can’t change all those environments.

“What’s the one thing I can change? How many times somebody has to push.”

Power assist’s ripple effects could even impact the type of primary mobility device, Merring added. “Here’s one scenario, that you can no longer get over those thresholds or it’s hard for you to get from one room to another,” he explained. “So you would [change] to a power chair. But a lot of people get to the point that if they can’t get from room to room or they can’t carry things or it gets to be too much for the family, they start to consider: Do we need to go to assisted living? Do we need go to longterm care?

“But I can give you a mobility aid within your home — it’s the same thing as a cane or walker or wheelchair, a power assist or a power chair. It’s just another one of those opportunities for a therapist and a provider and the user to think about: If I were to implement this, what are some things that I could keep doing? What more can I get out of my daily mobility activity that keeps me in the home, that keeps me safe and keeps me active as much as possible, whether it’s going over the threshold or going to Disney World?”

PICK YOUR POWER ASSIST

The number of power-assist devices on the market continues to grow (see sidebar), as does power assist’s functionality, adjustability and customizability.

That gives seating and wheeled mobility clinicians more options when choosing the best system for each client. Alber, for example, currently has four power-assist devices: SMOOV one (active user), twion (medium active user), the newly launched e-motion M25 (medium active user), and the e-fix (low active user).

Bill Russell, Alber’s Director of Sales, said, “One of the things that we train all of our reps to do: If you’re called in to do a SMOOV evaluation, don’t just take the SMOOV in with you. You need plan B and C. Somebody may want or think the SMOOV is the right product for them, but you can find out they don’t have the strength or the hand function to be able to steer or stop a system like the SMOOV.

“We can come in with four different products in one eval if we need to, and we can determine which product is best suited for that person. They get a chance to try them all, they get a chance to determine along with the therapist and the ATP to make that right choice. This is something they have to live with for the next five years. I’ve talked to way too many people that were told, ‘This is the product you need’ or ‘This is the product you get.’ And they find out that in the places they want to use it, it doesn’t work for them, and now they don’t have any recourse to get another product.”

Today’s power-assist lineups also vary greatly in appearance. The e-motion and twion from Alber; the QUICKIE Xtender from Sunrise Medical; and the NaviOne from Yamaha are in-wheel systems. Alber’s SMOOV one, Permobil’s SmartDrive MX2+, and Spinergy’s ZX-1 attach and detach to the backs of manual wheelchairs. Batec and Cheelcare devices attach to the front of the wheelchair and have a decidedly powersports appearance.

Having more choices could help to overcome power-assist reluctance, especially among younger wheelchair users.

“There’s certainly part of the psychology, that some people are resistant to it. I think in the past, it’s been this antiquated thinking that pushing a manual chair keeps you in shape and keeps you healthy. Yes, you’re going to expend calories to move yourself. But there’s a huge trade-off. You should never look at your wheelchair and your mobility as an exercise device. You should look at it as your mobility device, as how you get from point A to point B. If you want to exercise, go to a gym, lift weights, work your arms and shoulders.

“Going to power assist — changing out wheels or looking at the SMOOV — I think has really changed people’s thinking of what power assist can do for them. It’s not a full-time product all the time. They can use it as needed, and some of these products permit them to use them when they want to and when they need to.”

POWER ASSIST AS A PROACTIVE RECOMMENDATION

As an occupational therapist, Merring said he absolutely sees opportunities to recommend power assist proactively, before injuries and pain set in.

“As soon as I determined that you needed a manual wheelchair, I determined that you most likely need a power-assist also, of some sort,” Merring said, describing a clinic scenario. “There’s lots of opportunities for power-assist integration. It’s another tool in the toolbox now. I keep learning more as I work with it, too. Light bulbs keep coming on.”

Medicare’s funding policy is one of the challenges potentially blocking more proactive prescription of power assist.

“There are some financial hurdles,” Merring acknowledged. “Power assist is a capped rental. It’s well funded and understood to be a medically necessary device, but it is a capped rental.

“That is something we talk about every day, and we need the whole industry to be saying, Is this really the best approach? Is this what our users need, or should this be funded the way a manual wheelchair is and a power wheelchair is? It would really help [funding sources] to save money in the long run if they took a proactive approach versus a reactive approach.”

He cites the number of injuries to manual wheelchair users as another reason to think more proactively about power assist.

“I have to rule out that a walker doesn’t work, a cane doesn’t work, a K0004 manual chair doesn’t work,” Merring said, in explaining the documentation process. “I rule in the K0005 [ultralightweight] manual chair. [Power assist] is the same thing, the same idea: I want this person to be as functional and independent as possible without pain and suffering in their shoulders, knowing that the data says 75 percent of people in six months are going to complain of shoulder pain.”

As for Medicare’s current capped rental policy, “It would make 100-percent sense that we would not think of this as a temporary device. We’ve identified a progressive nature or a stable, static need. How does this fall into this [capped rental] category?”

Mike Salvi, Director of Manual Mobility & Seating for Invacare Corp., agrees that proactively investing in power assist can pay dividends later. “I just listened to a video of one of our end users who can do more because he has power assist and can do the things that he wants to do,” Salvi said. “He described how he didn’t want to go out with friends sometimes because he was embarrassed to have to ask for help up a hill. He worried that if he got fatigued at the end of the night, he was going to need help. He was looking for a home, and he was looking for homes closer to public transportation.

“Then he got a power-assist device that gave him the confidence to say, ‘I can look farther out for a home because I can have more access now. I’m not afraid to go to the grocery store by myself; I can keep up with my kids.’ It’s not just about helping to prevent injury; it’s about saving your energy for the things you want to do. Take more joy out of your day.”

This article originally appeared in the May/June 2021 issue of Mobility Management.

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