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.”