Dizzy? Don’t Wait. Why Early Treatment for Dizziness MATTERS.

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, AIB-VRC

Owner: Healthy Aging Physical Therapy

I’ve been meaning to write this for a while.

As a physical therapist, I’ve met so many patients - especially older adults - who are frustrated, scared, and worn out from trying to get help for their dizziness. Many have already been to the ER or seen their primary care doctor. They’ve had bloodwork, imaging, and hours spent waiting, only to leave with a discharge summary (and costly bill…) that says "vertigo" and a prescription for meclizine (which, by the way, is often the worst thing you can do for vertigo!). 

Dizziness can be hard to describe, hard to diagnose, and hard to treat without the right tools. And most healthcare providers, despite their best intentions, do not have the training to effectively treat dizziness. Causes of dizziness in older adults can range from simple ‘plumming’ issues like Benign Paroxysmal Positional Vertigo (BPPV) to complex, multifactorial dizziness that can really limit an individual's ability to live their lives the way they want to and can lead to a cascade of other problems, both physical and emotional, down the road. Fortunately, truly dangerous causes of vertigo are actually pretty rare, and vestibular therapists like myself are trained to screen for them - and can do so, right at home. 

Last week, I completed an advanced Vestibular Rehabilitation course through the University of Pittsburgh’s Department of Physical Therapy - a detailed update on the science of dizziness, its causes, and effective treatments. It gave me the final nudge to write this, because the truth is:

Dizziness is common - but TREATABLE!

What is the Most Common Cause of Dizziness?

You may be surprised to learn that one of the most common causes of dizziness in older adults is BPPV (benign paroxysmal positional vertigo) - and it’s often misdiagnosed or missed altogether.

In fact:

• Dizziness is one of the top 3 reasons older adults seek emergency care.

• It accounts for ~10% of all ER visits in people over 65.

• Approximately 40% of dizziness in older adults can be attributed to BPPV - and many go undiagnosed for years.

BPPV is caused by tiny calcium carbonate crystals in your inner ear - called otoconia - that get dislodged and move into the wrong part of your vestibular system. This sends confusing signals to your brain, causing that awful spinning sensation when you move your head a certain way.

But here’s the key:
BPPV is both benign and highly treatable. (Really  - it’s in the name!)

Using a gentle series of head movements called canalith repositioning maneuvers, we can move the crystals back to where they belong, most often in just 1 or 2 sessions.

What If It’s Not BPPV?

That’s okay too. Vestibular therapists are trained to assess and treat a wide range of dizziness causes - including vestibular hypofunction, central dizziness, post-concussion syndrome, cervicogenic dizziness, and more.

Treatment often includes a combination of:

• Vestibular exercises designed to retrain the brain and inner ear to work together again. These may include gaze stabilization exercises (teaching your eyes to stay steady while your head moves), habituation exercises (gradual exposure to movements that trigger symptoms to reduce sensitivity), and substitution strategies that help your body use other senses like vision or proprioception to compensate for balance loss.

• Balance training that challenges your body safely to improve stability, confidence, and coordination. This may include:

• Standing on uneven surfaces

• Practicing turning or head movements during walking

• Dual-task activities to mimic real-world situations (like walking while talking or carrying something)

• Education is one of the most powerful parts of therapy. As vestibular specialists, we help you:

• Understand why you're dizzy

• Identify what makes your symptoms worse

• Learn how to gradually return to daily activities

• Build confidence to move again (because the fear of dizziness can often be just as limiting as the dizziness itself)

We also spend time helping you avoid common pitfalls - like over-relying on meclizine or stopping movement altogether, which can actually make symptoms worse over time.

We don’t just guess - we test.
Using clinical tools and evidence-based screening, we assess your vestibular system, visual tracking, balance strategies, gait, and postural control. From there, we create a personalized plan that meets your needs and goals.

Vestibular rehabilitation therapy (VRT) is the gold standard for managing most non-life-threatening vestibular disorders, and it has strong research support behind it.

Isn’t Dizziness Just a Normal Part of Getting Older?

One of the most harmful misconceptions I hear from patients is they brush off dizziness as part of aging, or are told by well-meaning healthcare providers to simply drink more water.  But dizziness is not a normal part of aging, and when it goes untreated, it can trigger a cascade of issues that affect nearly every aspect of a person’s health. People often start avoiding certain movements or situations that provoke symptoms, which leads to reduced physical activity, progressive muscle weakness, and worsening balance. This in turn increases the risk of falls, leads to  social withdrawal, and contributes to emotional challenges like anxiety and depression.

In fact, dizziness and anxiety are closely linked; research shows that the brain regions responsible for balance and emotional regulation are deeply connected. So yes, while dizziness can make you feel anxious, anxiety can actually make you feel dizzy! It’s a real, bi-directional cycle that many people find themselves stuck inW.

That’s why early treatment is so critical. A 2023 study of over 800,000 adults found that individuals who received physical therapy within three months of reporting dizziness were 86% less likely to fall in the following year. That’s an extraordinary impact, and a clear message that getting help early matters. Don’t wait to see if it goes away. There’s effective treatment available, and it can make all the difference.

The Benefits of At-Home Vestibular Care

When you're experiencing dizziness, just getting to a clinic can feel overwhelming, dangerous or impossible. You may be facing challenges like driving, navigating stairs, fatigue, or simply not having someone available to accompany you. BPPV treatment may leave you feeling dizzy for an hour or so after they are complete, so getting home from the clinic may be an unexpected challenge as well.  That’s why we bring expert vestibular care directly to you. At Healthy Aging Physical Therapy, we provide outpatient-at-home vestibular rehabilitation—a safe, effective, and personalized approach that addresses dizziness, vertigo, and balance issues in the comfort of your own home. Our team includes certified vestibular and concussion specialists, Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist,  and Jessie Jamieson, PTA, both trained through the American Institute of Balance. When dizziness is your primary concern, you’ll be evaluated by one of our vestibular-trained clinicians to ensure an accurate diagnosis and targeted treatment plan from the start.

You may also receive care by a member of our larger, collaborative team of physical and occupational therapists who have  advanced training in fall prevention, Parkinson’s Disease, orthopedic rehabilitation, chronic pain, arthritis, and post-injury recovery. That means you won’t just be treated for your dizziness - you’ll be cared for as a whole person. With at-home vestibular care from a specialized and holistic team, you can feel secure knowing you're in good hands every step of the way.

Ready to Get Steady?

Dizziness doesn't have to take away your confidence, your safety, or your ability to live life on your terms. With the right treatment, delivered by a specialized team in the comfort of your own home, you can get back to doing the things you love without the fear of falling.

At Healthy Aging Physical Therapy, we provide outpatient-at-home vestibular rehabilitation covered by Medicare Part B, BCBS and most Medicare Advantage Plans. That means you get the same expert care you'd receive in a clinic, without ever having to leave home. From your first evaluation to personalized vestibular and balance therapy, you’ll be supported every step of the way by a team who understands the unique needs of older adults.

To request a Vestibular Therapy Consultation, you can:

📞 Call us at (617) 398 - 4508
📠 Ask your doctor to fax us referral to (781) 262 3337
🌐 Or click the button below to register as a new patient and we’ll call you from there to schedule your appointment.

References

• Marmor et al. (2023). Use of Physical Therapy and Subsequent Falls Among Patients With Dizziness in the US.
   JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2023.2840

• Pauwels et al. (2023). Gait and Falls in BPPV: A Systematic Review and Meta-analysis.
   J Neurol Phys Ther. https://doi.org/10.1097/NPT.0000000000000438

• Dunlap et al. (2021). Fear Avoidance Beliefs and Disability in Vestibular Disorders.
   Phys Ther. https://doi.org/10.1093/ptj/pzab147

• Metz & Bryce (2024). Including BPPV Screening in Falls Clinics.
   J Laryngol Otol. https://doi.org/10.1017/S0022215123002049

• Agrawal et al. (2009). Vestibular Dysfunction and Fall Risk in US Adults.
   Arch Intern Med. https://doi.org/10.1001/archinternmed.2009.66

• McDonnell MN & Hillier SL. (2015). Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.
   Cochrane Database Syst Rev. (1):CD005397.
   https://doi.org/10.1002/14651858.CD005397.pub4

• Bhattacharyya N et al. (2008). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (BPPV).
   Otolaryngol Head Neck Surg.
   https://doi.org/10.1016/j.otohns.2008.08.022

• Oghalai JS et al. (2000). The Dizziness Handicap Inventory: BPPV and Older Adults.
   Otolaryngol Head Neck Surg.
   (Referenced for prevalence data; original article not available online, but frequently cited in clinical literature)

The Science of Socialization

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

Owner: Healthy Aging Physical Therapy

Earlier this month, I returned from a very special trip: a full week away in Sedona with my best friends — my college roommates. Since meeting back at ‘the turn of the century’ (how ridiculous does that sound ?1?), our lives have taken us in many different directions: new careers, marriages, divorces, losses, love, babies, teenagers (😫) moves across states - even moves across oceans! And like many adult friendships, the day-to-day demands of life often mean that we go far too long without seeing each other face to face.

But no matter what else is happening in our lives, we've remained religious about one thing: scheduling our annual girls weekend. Even when it’s just a long weekend over the summer, we’ve kept the tradition alive. This year was the first time we carved out a full week — and let me tell you, it was pure magic.

More than the hikes, the incredible views, or the late nights laughing until we cried, what made it so meaningful was simply the connection. That feeling of being truly known, truly supported, and truly in the moment with people who have walked beside you through all of life’s changes. And it reminded me how critical — and how scientifically essential — social connection is for our health.

What Happens Inside Your Body When You Connect

When we connect meaningfully with others, it’s not just a "nice feeling" — our bodies actually respond biologically:

• Oxytocin, sometimes called the “bonding hormone,” is released, promoting feelings of trust, belonging, and relaxation.

• Levels of cortisol, our main stress hormone, decrease when we engage in positive social interaction, helping reduce inflammation and boost immune function.

• Dopamine and serotonin — the "feel good" neurotransmitters — increase, improving mood, energy, and even pain tolerance.

• Meaningful social interaction can even lower blood pressure and support cardiovascular health over time.

In short, connection is not just emotional — it’s chemical. Your brain and body are wired to thrive on human interaction.
(Source: Harvard Health Publishing, 2021; National Institutes of Health, 2022)

How Our Social Networks Change Over Time

It’s also normal that how and when we socialize evolves throughout life:

• As children, friendships are constant and casual, woven into daily school and playtime.

• In adolescence, friendships intensify, shaping identity and emotional development.

• As new parents, social circles often shrink, with focus centered on caregiving and family demands.

• In midlife and later adulthood, social opportunities can decline as retirement, relocation, health issues, or caregiving responsibilities arise.

Without mindful effort, social isolation can sneak up, making connection even more critical as we age.

Why Socialization Matters for Healthy Aging

We often think about diet and exercise as the pillars of healthy aging (and they are), but strong social connections are just as essential to long-term health and well-being. In fact, research shows:

• More than one-third of adults over age 45 report feeling lonely, and nearly one-fourth of adults over age 65 are considered socially isolated.

• Loneliness is often considered as harmful as smoking 15 cigarettes a day and raises the risk of heart disease by 29% and stroke by 32%.

• Social isolation significantly increases the risk of premature death from all causes, comparable to risks posed by smoking, obesity, and physical inactivity.

• Older adults with strong social ties have better cognitive health, lower depression and anxiety rates, and stronger physical health overall.

(Source: National Academies of Sciences, Engineering, and Medicine, 2020)

The simple truth is: connection heals. It protects, energizes, and helps us live not just longer — but better.

Small Steps to Build (or Rebuild) Your Social Connections

If you’re feeling the need for more connection in your life — you're not alone. And it’s never too late to take steps to strengthen your social well-being:

• Reach out to an old friend you haven't spoken to in a while.

• Join a local class or club that sparks your interest — fitness, art, volunteering, book clubs, or travel groups.

• Explore virtual communities if distance or transportation is a barrier.

• Schedule regular get-togethers, even if just for a coffee or walk.

• Be open to making new friends — every stage of life can bring new connections.

Just like exercising your body or eating nourishing food, tending to your social life is an important part of caring for your health.

As I was reminded during my week in Sedona, it’s not about where you go — it’s about the people you walk beside. Connection is a vital ingredient in the recipe for healthy aging — and one of the most joyful, too.

The Healthy Aging Difference: How Our Team Culture Transforms Patient Care

Written by: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

Owner: Healthy Aging Physical Therapy

Not our hands…or our sweaters 🙃

Why I Call our Staff my 'Team'

When I first started hiring therapists to join me at Healthy Aging Physical Therapy, I had a vision for something different. I never wanted a traditional workplace with a rigid hierarchy where a boss dictates orders and employees follow along. That just didn’t sit right with me (also, seemed kinda lonely…). Instead, I imagined a co-op-style environment—one where we all work together, share responsibilities, and create a thriving ecosystem of care, both for our patients and for one another.

I wanted to create an environment without closed-door meetings or red tape, with a culture of transparency and kindness where we could work together through challenges and also celebrate our wins. While I didn't know exactly what I was doing in many ways, I felt pretty clear in this path, and I’ve found that this philosophy has shaped how we operate and led to strength in our reputation. We all contribute to both our wins and our challenges, and that philosophy has shaped everything about how we operate.

From the very start, I made conscious decisions to build a workplace culture that reflects this team-oriented approach:

• Our meetings aren’t “Staff Meetings” — they’re Team Meetings because we all have a seat at the table. We meet not only to review updates and discuss patient care but also to review practice finances as a team so we are all on the same page. We take turns teaching each other—sharing responsibilities for monthly in-services and journal reviews.

• Our 1:1 meetings aren’t “Performance Reviews” — they’re Mentorship Meetings, focused on growth, not judgment. They’ve become a time to check in, to see how things are going both professionally and personally, and set goals together to move forward over the next year.

• Our compensation model isn’t based on traditional raises (which are often either absent or so small they barely feel meaningful in healthcare). Instead, we have a profit-sharing bonus model where all disciplines (therapists, trainers, office managers) share equally in our collective success—because we’ve worked equally hard to get there.

• I support and encourage co-treats, shadowing, and other learning opportunities as paid time so we can learn from each other, improving patient care and learning from our best resources — our own teammates.

Over the past five years, these intentional choices have evolved into a culture that I am so grateful for—one that I can feel in every interaction with our team and our patients. But what’s even more incredible is that this culture isn’t just a feeling anymore. It’s showing up in tangible, objective ways, and I see it every single day in the way our team steps up for each other and our patients.

Here are just a few ways I've seen this team-oriented culture manifest:

• Leveraging Each Other’s Strengths – Our clinicians actively seek each other out for consults and co-treats, ensuring that every patient gets the benefit of multiple perspectives. Some of our therapists are ortho rock stars, while others (ahem…me) are more specialized in neurorehab, wheelchairs, and vestibular therapy. Instead of staying in our silos, we share our knowledge so that we all grow professionally — and our patients receive the best possible care.

• Going Beyond Patient Care – I often overhear (or 'over-read' in our chats and emails) that our therapists go above and beyond their typical duties. Our therapists frequently step in to help with office tasks and phone calls, and they take the time to care for their patients in ways beyond the duties of therapy. Whether it's taking the time to water their plants each week, bringing holiday-themed decor to use for balance activities, or spending those extra few minutes to really get to know their to patients, these are the skills you don't learn in school — but they are the qualities that make the Healthy Aging experience so special.

• Sharing Knowledge – Whether it's helping a teammate learn to write a letter of medical necessity, sharing resources, or meeting up for a “pizza and transfers” party, our therapists share their time and knowledge because they want to improve their skills for their patients and learn from each other.

• Supporting Each Other in Good Times and Bad – Whether it’s celebrating a wedding, a new baby, or supporting a team member struggling, I've seen our therapists organize gifts and care packages. They cheer each other on when someone earns a new certification or reports a 'win' with a patient. Small gestures like this make a big impact and reinforce that we are more than coworkers—we are a team that genuinely cares about each other.

• Stepping Up When It Matters – When someone on our team is sick or on vacation, others jump in to cover patients outside of their usual territories. There’s no grumbling, no reluctance — just a shared commitment to making sure our patients receive consistent care.

What This Means for Our Patients

All of this translates into amazing patient care. When a team operates with trust, collaboration, and mutual support and respect, this gets passed on to the patient experience. They receive more comprehensive, well-rounded treatment, benefitting from a group of clinicians who are constantly learning from and helping each other. I say it all the time, and I truly mean it—happy therapists = happy patients.

While our model is rooted in 1:1 patient-centered care, what many don't realize is that behind that '1' is 18 teammates working together to encourage their success. And that’s what makes Healthy Aging Physical Therapy different. And the results speak for themselves — just take a look at some of our recent testimonials and reviews from our Healthy Aging community!

Want to Join our Team? We’re always in search of amazing Physical and Occupational Therapists, and Personal Trainers ready to do things differently. Check out our Careers page to learn more, or submit your application by clicking below!

PIVOT! The Key to Moving Forward in Health, Wellness, and Life

Written By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

Owner: Healthy Aging Physical Therapy

"PIVOT! PIVOT!"

Lately, my kids have been watching Friends from the beginning, and as a ’90s girl myself, it’s been a total nostalgia trip. The quotes, the scenes, the moments that were so ingrained in my younger years are suddenly playing in the background of my house again. And of course, one of my all-time favorites - and probably yours too - is the Pivot scene.

You know the one. Ross, Chandler, and Rachel are attempting to move a couch up a narrow staircase, and as they get wedged in the corner, Ross repeatedly shouts "PIVOT! PIVOT!" in sheer desperation. The couch, of course, is going nowhere.

And as hilarious as that scene is, it also got me thinking - sometimes in life, we feel just as stuck. Whether it’s our health, our habits, our work, or something deeply personal, we often find ourselves wedged in a corner, unsure how to move forward. But just like Ross (though hopefully with a little more success), the solution is often simple: We have to pivot.

Why Pivoting is Essential

We tend to believe that change is impossible or overwhelming. Maybe it’s because we see others seemingly doing so much better, or because we’ve tried before and failed. Maybe we tell ourselves the odds are stacked against us.

But here’s the thing: we don’t have to see the climb the whole staircase - we just have to take the first step.

A pivot isn’t about a massive overhaul. It’s not about solving everything at once. It’s about shifting direction just enough to create momentum. And once we start moving, it becomes easier to make the next best choice, climb that next step - make our way towards the top.

Getting Patients to Pivot

As physical and occupational therapists, the hardest thing we face isn’t learning the latest new technique or mastering clinical documentation. It’s getting our patients to make changes - getting them to pivot toward better health.

We all know how easy it is to get stuck. We get set in our habits, convinced that things are unchangeable, too difficult, or simply not worth the effort. Our patients often feel the same way. When we encourage them to move more, to push past their comfort zones, or to try a new approach to managing pain, we’re often met with resistance. And honestly? We get it. Change is hard. But change is also necessary.

The key is not expecting someone to change everything all at once - it’s helping them take just one step. They don’t need to see the whole staircase. They just need to find where they can pivot in a way that makes sense for their life and circumstances.

How the Therapy Profession Has Pivoted

The role of the physical and occupational therapist has changed dramatically over the years. When I, and many of my colleagues, went to school, therapy education was focused on fixing. The emphasis was on what we, the clinician, could do to the patient - through our hands, through mobilization, through guiding patients through movement patterns. Most of the continuing education available after graduation were in specific manual therapy techniques or skilled handling techniques - designed to help people recover movement after an injury or a stroke. We were trained to believe that if we just applied the right technique, the body would heal.

But then science evolved. And guess what? It turns out, long-term improvements in movement, strength, or in pain reduction don’t come from what we do to a patient. They come from what the patient does for themselves.

The research is clear: Passive interventions - where the clinician is doing all the work - do not lead to long-term improvements in pain or function. What does work? Movement. Nutrition. Stress Management. Sleep. The things we put into our bodies. The activities we do with them. The rest we need to make sure that they get. And most importantly - the habits we build and maintain.

So, as science has changed, so have we. The field of rehabilitation has had to pivot. And as individual therapists, we’ve had to pivot with it. Because it doesn’t help anyone to keep doing the same thing that doesn’t work (isn’t that the definition of insanity?).

We've had to shift from focusing on what we can do to a patient to what we can empower a patient to do for themselves.

And science supports this shift - research like the OPTIMAL Theory (Wulf & Lewthwaite, 2016) highlights that people improve more when they:

• Believe they can improve (Enhanced Expectancies). Patients need to experience small wins to build confidence in their ability to change.

• Have control over their choices (Autonomy Support). When patients feel like they have control over their own care (rather than being told what to do), they are more likely to follow through.

• Focus on meaningful goals (External Focus of Attention). Instead of instructing a patient to “activate their glutes,” we might tell them to “push the floor away” or “root down and rise up, like a tree.”

It turns out, progress isn’t just about prescribing the perfect exercise - it’s about creating the right conditions for motivation, autonomy, and confidence to grow.

This is why Healthy Aging Physical Therapy does things differently.

How We Help Patients Pivot Toward Better Health

At Healthy Aging Physical Therapy, we don’t set goals for our patients - we set them with our patients.

✔️ Every patient fills out a self-assessment survey to help them identify what truly matters in their daily life.
✔️ We don’t just hand out exercises; we help our patients work through barriers that might get in the way of making lasting change.
✔️ We recognize that every patient is a whole person - not just a broken arm or a leg, or a back in pain. Every patient has a personal history, experiences, and individual challenges that impact their health and their sense of self-efficacy - or lack of it.
✔️ We take the time to understand our patients - their goals, their fears, and what drives them - because we know that real progress only happens when it’s meaningful to the person doing the work.

And let’s be honest - it’s not all unicorns and rainbows. We work with older adults. Many of them have 80+ years of experience, opinion, and habits that are sitting right there with them. That’s a lot of lived experience to navigate! But that’s why we take the time to build trust, to have real conversations, and to help our patients figure out where they can pivot to make the next best choice for themselves.

Final Thoughts: The Power of Small Shifts

At the end of the day, therapy (just like life) isn’t about finding a magic fix - it’s about making small, meaningful shifts in the right direction.

The next time you feel stuck - whether in your health, your career, or your personal life - channel your inner Ross Geller. Take a deep breath, assess the situation, and find your next best move.

Just remember: you don’t have to move the whole couch at once. You just have to pivot.

Wheelchairs 101: Understanding Wheelchair Options, Coverage and the Acquisition Process

Written By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist

Owner: Healthy Aging Physical Therapy

As a physical therapist, I have had the privilege of working with many individuals who rely on wheelchairs to maintain their independence and quality of life.  The reasons for needing a wheelchair are as diverse as wheelchair users themselves, and a well-matched chair can make a world of difference. From those with new spinal cord injuries who require an agile, lightweight manual chair to take the place of walking in the setting of traumatic paralysis, to the patient who has had a stroke and now needs a specialized ‘hemi-chair’ designed for propulsion with one side of the body, each journey is unique.

While many people initially see a wheelchair as a step back, I often see it as a step forward. A wheelchair can open doors to independence, freedom of mobility, and a reduced reliance on caregivers. Although I sometimes encounter hesitation or pushback when bringing up the idea of a wheelchair, I frequently find that once the process is complete, my patients experience newfound freedom and vastly improved quality of life.

In my current practice, I most often work with patients with neurodegenerative diseases, like multiple sclerosis (MS) or Parkinson’s Disease, who can still ambulate part of the time but may need a wheelchair with custom features, like the ability to tilt-in-space, elevate seat height or powered mobility, to manage fatigue, enable longer-distance mobility, support posture in the presence of kyphosis and scoliosis and maintain independence in their daily tasks. Most recently, I had the opportunity to help my own mother obtain a custom power wheelchair. After living with Parkinson’s disease (PD) for 20 years, her postural impairments began affecting her ability to breathe, function, and manage back pain. The chair provided her with much-needed relief and now allows her to access her facility’s dining room even during periods when walking is too difficult due to ‘off times’ and back pain.

(PS: You’ll see some pictures from my mom’s assessment and fitting throughout the blog - special thanks to Derek Logan, PT, ATP from REQ for your help with this process!)

No two reasons for needing a wheelchair are the same. This is why a thorough assessment by a knowledgeable therapist, in collaboration with a skilled vendor, is essential to finding the best solution for each individual’s needs. At Healthy Aging Physical Therapy, we frequently provide wheelchair assessment training in conjunction with a variety of local vendors and I’d like to take this opportunity to shed some light on what this typically entails.

Wheelchairs, Scooters and Powered Mobility Options

When it comes to mobility devices, there are many options to consider. The choice between a standard wheelchair, a custom manual or power chair, or a scooter depends on the user’s specific functional and medical needs. Each type of mobility aid comes with its own set of features, costs, and considerations.

Scooters

Scooters are three - or four-wheeled motorized devices for individuals who can sit upright and operate controls but require assistance for longer distances due to weakness or cardiopulmonary conditions. Scooters are an excellent choice for those with some mobility but who experience fatigue with walking. They are often not covered by insurance and usually require an out-of-pocket investment ranging from $800 to $3,000. Many scooters can break down or fold up for transportation and can be tried at local durable medical equipment vendors and pharmacies.

PS: The above image is from the movie Thelma. If you haven’t seen it yet, stop reading and go watch it:)

Transport Wheelchairs

Transport wheelchairs are often purchased online or at medical supply stores and are the lightest, most easily transportable wheelchairs available. They typically have small wheels and limited seat and lumbar support; this enables them to be light enough to transport easily in and out of the car, but are also not designed for long term use as they do not provide adequate postural support for the user. Transport wheelchairs are not typically covered by insurance (unless you meet the criteria for a standard chair, but cannot self-propel and have a 24/7 caregiver who can assist) and cost anywhere from $100-$300 typically. 

Standard Manual Wheelchairs

Standard manual wheelchairs are the most basic option covered by insurance, and are often used for short-term needs or rental purposes. These chairs are manually propelled and typically cost between $100 and $500. They are ideal for individuals who do not require specialized features and need a temporary mobility solution. Medicare and other insurance plans may cover standard wheelchairs if they are deemed medically necessary, and are often issued during hospital stays in a ‘rent to own’ manner in which the Medicare beneficiary pays a small amount a month for thirteen months and then ‘owns’ the wheelchair.

Custom Manual Wheelchairs

Custom manual wheelchairs are tailored to the user’s specific dimensions and functional requirements. These chairs may include lightweight frames, adjustable seating, and positioning supports to enhance comfort and postural alignment. They are commonly used by individuals with conditions such as spinal cord injuries or neurological disorders. Custom manual wheelchairs generally cost between $1,500 and $5,000, depending on the materials and features. Custom manual wheelchair acquisition requires a wheelchair assessment by a therapist and vendor team, a visit with a doctor who will provide documentation to certify medical necessity, and insurance coverage often requires detailed documentation to justify the need for customization.

Power Wheelchairs

Power wheelchairs are motorized devices designed for individuals who have limited upper body strength or severe postural issues. These chairs can include advanced features such as recline, tilt-in-space, and elevation to address complex needs. Power wheelchairs are best suited for individuals with conditions like MS, Parkinson’s disease, or other impairments that significantly limit strength and mobility. The cost of a power wheelchair can range from $2,000 to over $20,000, depending on the level of customization and technology. Medicare typically covers power wheelchairs, but only after a thorough assessment to establish medical necessity. These assessments need to be provided by a therapist and vendor team, and the individual will also need to visit with their doctor who will need to complete additional paperwork (‘Face to Face’ visit) to support the medical necessity of this device.

Fun Fact: The average custom power chair weighs between 200 and 300 pounds. And, no, you cannot lift it into the trunk of your car!

Beyond Mobility: Other Important Reasons to Consider a Wheelchair

While mobility is often the primary reason for a wheelchair, there are several other important considerations that influence the need for a specific type of chair.

Preventing Skin Breakdown and Pressure Ulcers

For individuals who spend long hours in their wheelchairs, proper seating and support are critical to prevent skin breakdown and pressure ulcers. Specialized cushions, adjustable seat angles, and recline and tilt-in-space features can help individuals redistribute pressure and protect vulnerable areas, ensuring comfort and long-term skin health.

Providing Postural Support

Postural support is essential for individuals with trunk weakness or structural deformities. A well-designed wheelchair can enhance alignment, improving not only comfort but also critical functions like breathing and digestion. For example, we might choose to increase the seat angle (aka ‘seat dump’) and use a contoured seat back to improve pelvic alignment and maintain a healthy posture throughout the day, reducing pain and fatigue.

Enhancing Functional Abilities

Wheelchairs with advanced features can improve functional abilities in daily life. Elevating seat mechanisms, for instance, allow users to reach higher surfaces such as kitchen counters and cabinets, enabling tasks like cooking and cleaning. Additionally, alternative drive options like head controls or adapted joysticks can enable mobility even in users with limited hand function.

Reducing Caregiver Reliance

By addressing mobility and functional needs comprehensively, a wheelchair can reduce reliance on caregivers. This increased independence not only improves the user’s quality of life but also eases the burden on family members and care teams and can improve family dynamics considerably. 

How do I get a Custom Wheelchair?

Acquiring the right wheelchair is a multi-step process that involves collaboration between the patient, therapist, and vendor. Here is what to expect:

1. Initial Wheelchair Assessment: Your therapist and vendor team will conduct a comprehensive assessment of the individual’s mobility, strength, posture, and functional needs. This evaluation helps determine the type of wheelchair that will best meet the user’s requirements. These can be done in a Wheelchair Clinic or at-home with a provider like Healthy Aging Physical Therapy. You will have the opportunity to trial a chair similar to the one you will likely end up with to see if it would be a good fit.

2. Therapist/Vendor Collaboration: The therapist works closely with the wheelchair vendor to determine the best type of wheelchair for you, and identifies any necessary modifications or adaptations to meet your needs. They then work together to fill out the necessary paperwork and complete a Letter of Medical Necessity.

3. Documentation Submission: The prescribing physician, therapist and vendor provide detailed paperwork, including the assessment findings and justification for medical necessity. This documentation is submitted to Medicare or other insurance providers for approval.

4. Approval and Order Placement: Once the paperwork is approved, the vendor places the order for the wheelchair. Once approved, the equipment is ordered and the wheelchair is prepared for you. For custom manual or power chairs, this step may involve further adjustments and fittings.

5. Delivery and Fitting: Once the wheelchair is ready, your vendor and therapist will meet with you again to deliver the chair and provide any additional modification that may be needed. Things like the arm rest height and head rest position will need to be set for you specificically to ensure the best fit. If there are any larger issues, your vendor may take pieces of the chair back to be adapted as needed. 

6. Wheelchair Training: Now the fun begins! Just like learning to drive a car, learning to drive your new wheelchair will take some practice. Your therapist will work with you to learn to drive it forward, backwards and to turn so you can safely and efficiently navigate your home and community. 

7. Timeline for Custom Chairs: The entire process, from evaluation to delivery, can take anywhere from 6 to 12 weeks if everything goes smoothly. This timeline depends on the complexity of the chair and the speed of approval from insurance providers and can take up to 6 months at times if there are delays along the way.

Will Medicare Pay for my Wheelchair?

Medicare provides coverage for wheelchairs under its Part B Durable Medical Equipment (DME) benefit, but specific criteria must be met. Most commercial plans also have a DME benefit that is typically based on, or similar to, Medicare standards. Coverage is available when a physician prescribes a wheelchair for use in the home due to a medical condition that limits mobility. Here’s an overview of how this coverage typically works:

• Eligibility Requirements: Once you meet with your therapist and vendor team to trial your wheelchair and determine your needs, a physician must then conduct a face-to-face assessment and document the medical necessity of the wheelchair. This documentation is then submitted to Medicare for review.

• Types of Wheelchairs Covered: Medicare covers basic manual chairs (rent to own), custom manual chairs, and power wheelchairs if the features are medically justified.

• Scooters: Medicare may cover scooters in limited circumstances, such as when mobility is restricted both inside and outside the home, but this coverage is less common.

• Costs: For approved devices, Medicare typically covers 80% of the cost, leaving the user responsible for the remaining 20%, either out-of-pocket or through supplemental insurance.

• Modification and Replacement: Generally speaking, Medicare expects your custom chair to last at least 5 years. Should your chair require modifications or repair within that five year time frame, you will need to work with your vendor to fix your current chair in most situations. If modifications are required due to a change in your medical status, they may be covered by medicare, but repairs due to wear and tear may be an out of pocket cost. After five years is up, you may be eligible for a new chair should you demonstrate medical necessity for a new chair at that time. 

Choosing the right wheelchair is a collaborative process that requires a deep understanding of the individual’s needs and goals. By working closely with a skilled therapist and an experienced vendor, users can find a solution that not only meets their medical requirements but also improves their quality of life. Whether it’s a lightweight manual chair for someone with a spinal cord injury or a custom power chair for postural support, the right match makes all the difference. 

At Healthy Aging Physical Therapy, we are proud to offer custom wheelchair assessments in the comfort of your home. This approach can be incredibly beneficial, not only for individuals who may find it difficult to access a clinic but also for tailoring recommendations to fit seamlessly into your living environment. By evaluating how a wheelchair will work within your home - from navigating doorways to accessing essential spaces - we can ensure the best possible outcome for your mobility and independence. If you or someone you know could benefit from an in-home wheelchair assessment, we encourage you to reach out to learn more about how we can help.