Power Bases: A Provider's Perspective

Joe Scanlan, ATP, CRTS, specializes in working with ALS patients and pediatric clients at Reliable Medical Supply in Brooklyn Park, Minn. Those specialties give Scanlan an excellent point of view when asked if advances in technology are making it possible for more consumers to successfully operate power wheelchairs.

“Absolutely, especially with our most complex individuals,” he said. “The suspensions and tracking systems that the manufacturers have been developing are just a game changer, with the suspension keeping in contact with the ground and getting better traction when traveling over different terrains.

“At the same time, suspensions are keeping the seat surface consistent, keeping the individual where they need to be within the seating system to remain in contact with their drive control. [Suspensions and tracking systems] are working together: The tracking system is also helping to reduce switch hits to correct the direction when driving on non-level surfaces with switches.”

Maintaining seated stability is vital, Scanlan said. “I was taught that when we’re looking for a switch access point, you want to look for a consistent, non-fatiguing part of the body for driving or for accessing their communications device,” he noted. “But if they only have one consistent, non-fatiguing body part, it’s going to fatigue.”

He recalled a family he worked with whose son has Duchenne muscular dystrophy and recently received a new power chair. “The mother called me and said that with the past power chair, while they were out on their walk, she would have to reposition her son’s hand on the joystick,” Scanlan explained. “She said that when they got the new chair, she didn’t have to [reposition him] once. It’s a good sign manufacturers are going the right way with their suspension systems, because now this young man was able to stay on his driver control and was independent, and they could have an enjoyable walk together.

“Our complex kids in the neuromuscular disease category, or anyone with limited movement, have to stay right on that driver control. And they’re usually using switches of some type or a specialty control. So true tracking has just been a godsend. Hopefully for [clients] who are using switches, people are aware of these tracking systems, because they’re a huge advantage to someone who’s driving with a specialty control.”

The Power Base Decision Tree

Asked how he decides on a power base, Scanlan said, “The first thing I look at is ‘Is this a new client or an existing one?’ Then: Is it a replacement base vs. a new base? Is it an adult vs. a child? If it’s a new client, what do they like to do? What’s their activity level? Are they an outdoor individual or family? Are they working or going to school?”

Next: “Are they in a home, an apartment, or townhome? A rural or an urban setting? What’s the home entry like? Is it a zero entry? Will the home need to be ramped if it’s a new client? Or is there an elevator in the apartment? If it’s a rural setting, are there any paved surfaces outside the home? I’m looking at those environments, and once I get that information, I can start to tell them the pros and cons of each of the three drive-wheel configurations.

“With a rural setting, with front-wheel drive, the first point of impact is that drive wheel. And it just climbs better when you’re going over uneven terrain. I tell the family: You might want to consider front-wheel drive in this scenario because you’ve got uneven terrains in this environment. You are not in an urban setting where most of the surfaces are flat and hard. If it’s a child, I start thinking about being able to keep them interacting in different areas outside the home. That’s when I may consider a base that transitions over uneven surfaces a little bit easier.”

Does he gravitate toward a certain drive-wheel configuration if the client is a child? “It just depends on the child and the input device,” Scanlan said. “If you’re using a head control, it might be a little more intuitive when turning if you don’t have the back end of that front-wheel drive swinging [behind you]. With mid-wheel, when you’re turning, those drive wheels are right under the pelvis and right under the head, depending on your positioning. Equal distance, front and back. So it’s a little more intuitive with the turning. But with some kids, the primary reason they’re getting it is to be out on the playground. Most kids are on different surfaces, and I’ve had clinicians and families tell me: We need a chair that goes on all surfaces effectively.

“Ultimately, it’s trying both and educating the families. Here are the pros and cons. We’ve got a lot of good choices; it’s just what’s going to best meet your needs.”

This article originally appeared in the Sep/Oct 2021 issue of Mobility Management.

In Support of Upper-Extremity Positioning