A well selected, feature matched power wheelchair can provide more than just independent mobility. The chair provides postural support, the ability to interact with the environment, can decrease caregiver burden, and more.
Selecting a power wheelchair is an individual decision, as each person has unique abilities and desires. Team Gleason recommends that people living with ALS trial multiple wheelchairs, especially in their home environment when possible, as Medicare will typically only fund one wheelchair every five years.
Learn about the Grant Process
Team Gleason has a limited number of grants available each month for the seat elevator feature on the power wheelchair. Grants are available for chairs that have not yet been ordered and that are from one of the major wheelchair manufacturers, including Invacare, Permobil, Quantum, and Sunrise.
In addition to the application Team Gleason will need the following information:
- Contact information for the Durable Medical Equipment company that the power wheelchair is being purchased through
- The quote number from Invacare, Permobil, Quantum, or Sunrise
- Proof of and/or a copy of the denial for the seat elevator feature (note: if your insurance considers the seat elevator a non-covered item, a copy of your policy stating this will suffice)
- During the process, you will be asked to provide a rationale for why this equipment is being requested, this will be used when determining who will be awarded the available grants, so be sure to provide sufficient rationale for the request.
- Once the application and necessary documentation have been submitted to Team Gleason, a member of Team Gleason will contact you via email to schedule a time for a call. (note: every applicant must schedule an appointment for a call to be considered for a grant). The conversation will include an overview of Team Gleason, some questions about the equipment being requested, and a review of the remainder of the process. You will also be able to ask any questions you may have about this grant or any other program services offered through Team Gleason.
Grants are reviewed by the Technology and Equipment team. If approved, the wheelchair vendor can expect an email from the wheelchair manufacturer alerting them that the request has been approved along with a revised quote.
It is important to note that Team Gleason can only disperse grants for chairs that have not been ordered, does not provide assistance for wheelchair copays, and cannot provide assistance with other wheelchair items.
A power wheelchair is made up of multiple parts, each of which is modifiable to meet the individual’s needs. In general, this includes the wheelbase, drive controls, and the seating system.
Wheelbase
The wheelbase includes the wheels, the motor, and the battery. There are three primary designs, each with specific advantages and disadvantages:
- Mid-Wheel Drive – the drive wheel is in the middle of the chair.
- Benefits – A Mid-Wheel drive tends to offer a tighter turning radius. Additionally, the axis of rotation is directly under the person, which often makes more “cognitive sense.”
- Weaknesses: A mid-wheel drive chair has four casters (two in the front and two in back). The front casters can cause issues when traversing obstacles. All casters must be pointed in the same direction when driving, so there is a “fishtailing” feel when changing directions.
- Front-Wheel Drive – the drive wheels are in the front of the chair.
- Benefits – There tends to be a better ability to climb obstacles, better outdoor maneuverability, and the ability to get closer to objects as no front casters.
- Weaknesses – The axis of turning is in front of the person, which may require a cognitive shift. There is also typically a slightly larger turning radius.
- Rear Wheel Drive – these are not as common as the other two
- Benefits – Provides good speed and outdoor control.
- Weaknesses – Has the largest turning radius.
Alternative Drive Controls
The drive control provides a way to operate the power wheelchair. Traditionally, the drive control includes a joystick and several buttons for power, mode, and seating functions. Alternative drive controls allow an end-user to drive their power chair when the traditional joystick is not a viable option. Many different alternative drive controls exist to allow for a range of physical abilities, including:
• Proportional Joystick – Proportional joysticks that require less force are great for users experiencing muscle weakness, or who only have fine control of a single finger. These can also be used to operate a power wheelchair with the chin, foot, etc.
• Head Array – Head arrays are built into the wheelchair’s headrest and allow a user to drive their power wheelchair with movements from the neck. When a user makes contact with the left side of the headrest, for example, the wheelchair will turn left. Head arrays are highly adjustable and are often used with a switch to toggle between forward/reverse, as well as control different speed profiles, and chair functions.
• Eye Tracking Drive Systems – Steve successfully challenged Microsoft during an annual hackathon to create an interface that would allow people who are physically disabled to navigate their power wheelchairs with their eyes. After several years, this technology is finally available commercially and allows the end-user to combine a computer, a supported eye-gaze bar, and their wheelchair to create a virtual joystick. This alteration requires modifications to the wheelchair, so please reach out to the durable medical equipment company that provided your wheelchair to learn more. Team Gleason helped foster the development of technology that allows a person to navigate and control their power wheelchair with their eyes.
Another option is to include an attendant control. An attendant control provides a joystick on the back of the chair that can be used by a caregiver. This can be important in many situations, including crowded environments, tight corners, ramps, and during times of fatigue.
Seating System
The seating system includes several items, such as the back, the headrest, the armrests, the cushions, and the adjustable seating functions. Each of the above can be customized to fit the person.
There are a number of seating functions that allow the chair to be moved in different ways. These movements can allow for positional changes, increase comfort throughout the day, allow for pressure relief, allowing for safer and easier transfer, and allow for increased access and social interaction.
These features include:
• Power Elevating Legs –elevates the footplates. This can help reduce edema and improve circulation. It can also be used for positional changes.
• Recline – seat to back angle increase/decreases. Recline can be a greater pressure reduction than tilt (61% decrease in pressure at full recline), but when used without tilt, there is a potential risk of shear and loss of position.
• Tilt – the seat to back angle remains consistent. Tilt provides pressure relief, postural stability, improved sitting tolerance, and a position of rest.
• Power Seat Elevation – elevates the whole seat, which can assist in transfers, functional reach, reduction of pain from having to “lookup” at people, and provides social and emotional benefits (looking people in the eyes)
• There are also Anterior tilt and standing options, which are situationally important.
Cushions – Cushions help prevent pressure injuries (i.e. pressure sores/ulcers), maintain proper posture, and therefore are a key component of a power chair.
Frequently Asked Questions
I am living with ALS and have Medicare. How do I go about getting a power wheelchair?
A: To acquire a power wheelchair through Medicare, the following must be completed:
- A face to face exam by your neurologist or primary care physician. During the face to face examination, your doctor will determine if a power wheelchair is reasonable and necessary for you and write a prescription.
- A power wheelchair evaluation: This is usually done by either a Physical Therapist (PT) or Occupational Therapist (OT), oftentimes done with assistance from an Assistive Technology Professional (ATP) from the Durable Medical Equipment (DME) supplier who will order and deliver the wheelchair to the end user. A thorough wheelchair evaluation for an individual with ALS should include trials of multiple power chairs in the user’s home environment, simulation of proper positioning supports, measurements of the end user’s body, and a proper cushion and backrest to maximize pressure distribution for each user.
- The DME supplier will submit the necessary documentation to Medicare for pre-authorization. After pre-authorization is completed, the end-user will be notified of the estimated copay amount before the chair can be ordered. Medicare will cover 80% of a covered power wheelchair, and the end-user is responsible for the remaining 20% and all non-covered items. Medicare will not fund a power chair if the end-user is in a facility, nursing home, receiving hospice, etc. Keep in mind that the wheelchair provider CANNOT place the order for the power chair without your authorization.
- Make sure that all of your questions are answered about the product and you are content with the options presented to you during the evaluation BEFORE placing the order for the chair. Medicare will pay for one power wheelchair every five years.
- Currently, Medicare does not cover seat elevators. If you are requesting assistance from Team Gleason for a seat elevator grant, this must be submitted to Team Gleason prior to placing the order for the chair.
Does Team Gleason assist financially with power chair copays?
A: No, Team Gleason does not assist financially with power chair copays.
I was told by my provider that Medicare denied my power adjustable seat height seat elevator and that I must pay out of pocket for this feature. Can Team Gleason help me?
A: Medicare does not pay for power adjustable seat height features as they are deemed by CMS to be “not medically necessary” and used for “convenience.” Team Gleason has partnerships in place with Invacare, Permobil, Quantum, and Sunrise to help issue grants for seat elevators. If the chair has already been ordered, Team Gleason cannot provide assistance for the seat elevator portion.
How do I apply for seat elevator or attendant control grants for the power chair that I am going to order?
A: Grants are available for new chairs that have not yet been ordered. These power chairs must be in quote form. NOTE: If the order for your power chair has already been placed, Team Gleason will be unable to assist with grants. The process for obtaining assistance with additional power chair features are as follows:
What are some companies that manufacture wheelchairs and wheelchair accessories?
A: There are a number of companies that manufacture wheelchairs and wheelchair accessories
- Adaptive Switch Labs - Adaptive Switch Labs (ASL) designs and produces equipment that allows individuals to access their environments and wheelchair controls.
- Body Point - Body point manufactures a range of products that primarily assist with postural support and positioning.
- Invacare - Invacare provides a range of home health equipment, including power wheelchairs, manual wheelchairs, beds, and transfer equipment.
- Motion Concepts - Motion Concepts produces a range of power wheelchairs.
- Permobil - Permobil produces a range of manual wheelchairs, power wheelchairs, and seating and positioning options.
- Quantum - Quantum Rehab produces a range of power wheelchairs and seating and positioning options.
- Symmetric Designs - Symmetric Designs manufacturers the Savant Headrest, a custom, moldable gel support for the head.
- Stealth Products - Stealth Products designs and produces equipment that provides postural support, positioning, and that allows individuals to control their wheelchair through alternative methods.
- Sunrise Medical - Sunrise produces a range of manual wheelchairs, power wheelchairs, and seating and positioning options.
How do returns work?
A: Team Gleason cannot accept wheelchairs. Please contact your local ALS Chapter or Muscular Dystrophy Association to pay it forward to others in need.
