Polio Place

Many of us who had polio used canes, wheelchairs and bracing on our path to recovery and gradually were able to relinquish them. Others of us have developed different chronic conditions that have managed just fine until now without mobility equipment. But as we get older our bodies change, our symptoms escalate and daily activities use so much more energy that we don’t have the get-up-and-go to do what we have to do, much less enjoy the fun stuff. When walking becomes difficult, we have to compromise, reduce activities or eliminate them.

For many years a long leg brace and forearm crutch allowed me to walk wherever I wanted as long as there were benches or seats available for frequent rests. But it took a lot of effort and energy. I was always very fearful of falling and kept my eyes focused downward to spot potential hazards. Most public outings were difficult but mall shopping was especially precarious due to sheer congestion and because shoppers move quickly, are preoccupied with looking at merchandise and don’t watch where they are going. As my legs grew weaker my balance deteriorated and eventually I curtailed most non-essential activities.

Enter the scooter. How has it helped me? Let me count the ways. Life is much richer. I have more energy, less pain, and can enjoy fun outings with friends. I can go where I want to go and park wherever a space is available. No more driving around looking for accessible parking close to the building entrance. Distance is no longer a challenge. I’m not fearful of falling so I can enjoy looking around my environment instead of watching out for hazards. The biggest surprise is that interactions with able-bodied people are much more positive than when I walked. People make eye contact, smile, and often initiate conversation. When I used to walk in public I had to concentrate on not letting people jostle me. This self-absorption is not conducive to friendly interactions with others.

Why Not Just Canes or Crutches?
Elsewhere I discuss the use of canes and crutches. These aids may be all that is needed for people with temporary, short-term disabilities. But the chronic symptoms that most of us experience are not going away. If anything they will progress. Canes or crutches may suit your needs when you’re at home or need to walk very short distances, but …

Walking depletes energy very quickly.Using crutches or canes can cause compression of nerves in the neck area (thoracic outlet syndrome) or wrist (carpal tunnel syndrome). The resulting pain, numbness or weakness can eventually affect the function of your entire upper extremity. Without functional arms it is almost impossible to be independent in daily activities. Preserving your arms needs to be your top priority. Using a power scooter for distances may prolong your over-all function by preventing overuse of both your legs and arms.   

Manual Wheelchairs
The upside is that they are portable, lightweight and easy to fit into most automobile trunks or the back seat of most cars. The downside is that we don’t live in a level or smooth world. Pushing the combined weight of your chair and body on uneven surfaces, inclines, and even carpet covered floors for prolonged periods may lead to the same problems as using canes and crutches - pain and increasing weakness of the shoulder muscles. We don’t gain anything if we conserve our legs by overworking our arms. I have a manual wheelchair which I use when someone is accompanying me and can act as a pusher. All other times I use a power scooter for navigating distances.

If you opt for a manual wheelchair, purchase the lightest weight you can find. The costs can vary from $400 to about $4,000. High priced models are lighter in weight and have more features, such as quick-release axles which allow the wheels to pop off easily for placing in a car. The lightest models weigh less than 27 lbs. and as little as 18 lbs. with the wheels removed

For transporting inside a car, a two-door vehicle allows more room for loading a wheelchair into the back seat. Rooftop carriers are also available for folding chairs, and if you can do a little lifting and walking, an external carrier attached to a trailer hitch may work for you. 

Power Wheelchair or Scooter?
Although I recommend getting input from many sources before purchasing big ticket items like wheelchairs and scooters, I want to provide you with enough background knowledge so you will know what questions to ask. As with any new subject, sometimes we aren’t aware of what we don’t know and a little advance information can help you to formulate some questions.

You need to anticipate what your physical condition will be in the future. A power scooter requires enough leg and trunk strength to transfer on and off the seat. You also need adequate trunk balance, arm strength to reach forward to the tiller and hand strength to operate the tiller. If you are experiencing increasing weakness in any of these areas, consider purchasing a power wheelchair.

When choosing a scooter, safety issues are the top priority. Be sure the base is very sturdy and can’t be tipped over easily. Four-wheel scooters give greater stability for outdoor use but have a larger turning radius which makes them inappropriate for use in small spaces. Three-wheel scooters can be very safe if they are large and heavy enough and have a sturdy base which can’t be tipped over easily. The brakes should lock automatically as soon as you let up on the lever (no hand brakes.) Small lightweight travel scooters have pros and cons. The upside is that they can be transported easily; the individual components can be stored in the trunk of a car. The downside is their instability. A lady I know suffered a broken hip when her lightweight travel scooter overturned on uneven ground at a county fair.

Consider the type of terrain you’ll encounter. You may think now that you’ll only use the scooter at home or in the malls but that can change. What if your future vacation plans include sightseeing on uneven terrain or even cobblestones? Find a 3-wheel model that works well outside as well as indoors. This requires large enough wheels to go over rough ground and enough power for going up inclines. With a rear drive scooter, the weight of the user is over the drive wheels which gives better traction and more power. Most scooters have two 12-volt batteries; a model with one battery is appropriate only for indoor use with a lightweight person. Before you make a decision, test models in various situations and on different surfaces.

The tiller (the handlebar that operates the scooter) is operated by gripping a lever with the fingers or pushing it with the thumb. See if you can maintain this action without fatiguing your muscles if you will be driving your scooter for considerable distances. Be sure to check out how the tiller moves forward (for easy access on and off) and backward (for driving). Many models require two hands to release and move the tiller. This can be difficult if you have one-sided weakness and is very inconvenient if you are carrying something in one arm and need to push the tiller away. If your finger strength is limited you won’t want turning knobs or push buttons for release mechanisms. When shopping for a new scooter, the first thing I look for is a tiller that moves back and forth easily when pushed with either hand.

Pay attention to the arm rests. Can you reach the tiller easily while your elbow is supported on the armrest? If not, your shoulder muscles will become fatigued. The arm rests should flip up out of the way to make transferring easier.

Another component to consider is the seat. Most models feature swivel seats that can be locked in four different positions. I found that bucket seats were difficult for me but some people prefer them. You might want to consider an elevating seat; this upgrade costs extra but comes in handy when objects are out of reach or you need more leg room.

Most scooter models have a built-in battery charger. If you go away from home frequently you won’t want to be burdened carrying an external charger. I used to travel overseas every year, so I had a dual voltage battery charger installed in my scooter. It just took a twist with a screwdriver to change the voltage from 110 to 220.

Transporting a Scooter
Although a scooter can be taken apart for storing in a car trunk, the individual components are too heavy for a person with a disability. Even removing the seat is difficult unless you have good balance and strong arm and trunk muscles. If you want to go out-and-about independently you’ll need a lift or ramp that you can operate yourself.

The easiest solution is to have an external scooter lift attached to the rear of a car. A platform rests on the ground, you drive onto the platform and secure the scooter, then the platform is elevated with an electric motor. This type of carrier has several disadvantages. The scooter is exposed to the weather. The added length of the car is more prone to being rear-ended. The extra weight at the back can affect the steering and cause “bottoming out” when going over bumps and dips in the road.

Ramps and crane-type lifts do not require the scooter to be dismantled but you do need a minivan for these. If you can walk a few steps a crane-type lift is much less costly than a electric ramp but does require bending to attach the hook to the docking device. It does not require any vehicle modifications, simply installation.

A crane-type lift such as the Bruno Curbsider has an arm that swings outward, and a strap with a hook at the bottom that is lowered and fitted onto the docking device under the seat of the scooter. The scooter is then raised and swung inside the minivan. The user does all this by standing in back and pushing buttons on a hand-held control; the only work required is gently guiding the scooter in or out of the vehicle. The Bruno Curbsider gives you a choice between lowering the scooter in back of the vehicle or onto a sidewalk. This is a convenient feature when you have to park at a curb instead of a parking lot.

I bought a typical 7-seat minivan, had the middle seat removed and the back seat pushed forward to the middle position. This leaves lots of room in back for the scooter, luggage, stroller, or groceries.

If walking isn’t an option, an electric ramp allows the user to remain on the scooter at all times as long as the van has secure tie-downs. Ramps can be rear-door, side-door, or under-the-floor. Other modifications may be needed, such as a lowered floor or raised top. Be sure the ramp can be operated manually in case of a power failure.

Power Wheelchairs
Choices! Choices! Do you want maneuverability indoors or traction and curb-climbing ability outside? Tight-turning radius? Good suspension system for a smooth ride? Need a tilt or recline system for pressure relief? Need good trunk support or special seating? All power wheelchairs are controlled by a “joystick” which requires minimal hand or arm motion—other than that the choices seem almost endless. It all depends on your physical needs as well as lifestyle choices.

Power wheelchairs can range in price from $3,000 to $12,000 or more depending on the custom features you require. Speed and durability increase along with the price. Light-duty power chairs costing $3,000 - $4,000 may be adequate for an adult weighing less than 175 lbs. A person weighing between 175 and 250 lbs. would require a mid-price chair, which can also accommodate a wider range of seating and control options.

Some of your other decisions will involve direct drive vs. belt drive, and placement of the wheels. Mid-wheel drive is most maneuverable, but front wheel drive negotiates downramps better.

Because of the diversity of options, seek input from as many sources as possible. Check with a physical or occupational therapist at a rehabilitation center. Visit dealers who carry different brands of power chairs and try out different models. Search the internet. Talk to others who use the same type of mobility equipment you are thinking of purchasing. Read disability magazines. If you belong to a support group, use it as a resource.

Do the same amount of research to explore your transportation options. Outfitting a van or minivan to match your specific needs is expensive and you will be living with your decisions for a long time.

© 1999-2008 Grace R. Young
Courtesy of Diane Young and Sharon Lark.