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.

May Staff Meeting Updates

Did you know that HAPT meets monthly to review patient cases and provide feedback and ideas, as well as for in-services and education? (Ten heads ARE better than one!) As much as I love learning, I love teaching even more, so thought I'd share a few lessons learned with you.

This month we were lucky enough to have two great presentations. First, Dahlia Cohen, Registered Dietician, spoke to us about Nutrition in Parkinson's Disease. We learned that weight management, in particular keeping weight ON, is a big issue for people with Parkinson's Disease. Not only are there changes in taste, swallowing and digestion that can be problematic, but due to the extra movement and muscle resistance that occurs in movement disorders, individuals with PD are often burning way more calories than normal during the day. This creates an energy deficit and this leads to weight loss. How can we help our patients with this problem? Here are a few ideas Dahlia gave us:

• Encourage 3 meals a day + 3 Nutrient Dense snacks (like greek yogurt, or nuts).
  

•  Make sure to get adequate amounts of protein throughout the day. Your body can only digest about 30 grams at one sitting, so one big steak at dinner won't cut it. Try adding in smaller amounts, more frequently, making sure to time around your meds (levodopa competes with protein for receptor access, so it can make your meds less effective if taken with protein!). Protein is best eaten 30 minutes before taking levadopa or 60-90 minutes after taking meds.

•  Don't forget your fiber! We need 25-30 grams of fiber/day for optimal digestion and bowel management, and constipation is even more common in PD because gastrointestinal motility is slowed. Adding in green vegetables, whole grains and beans to your daily diet is helpful, and supplementing if needed with something like Metamucil can be helpful when needed.

After we finished learning about what to take in, we talked about 'how it comes out' with our staff PT, Katie Moulison. Katie just finished a great course in Pelvic Health and shared some helpful considerations for working with individuals who may be experiencing incontinence as they age. Here are some helpful take home messages:

•  Incontinence is common, but not a normal part of aging and there is a lot we can do about it. Wondering if how often you wake at night to 'go' is normal? Normal nocturia (peeing at night) is waking 0-1 times to get up. If it's more often than that, it can disrupt sleep cycles, leave you more tired during the day and lead to increased risk of falls.

•  Dehydration, constipation and bladder irritants are all common causes of increased frequency, urgency, nocturia and leakage (PS. the acronym FUNL can help you remember what to ask your patients about!). 

•  If you're wondering about your own bladder habits, or trying to help a patient problem-solve their incontinence troubles, start by keeping a Bladder Diary and share it with a pelvic health specialist to get their take. There may be some simple strategies we can try to make it better!

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

How NOT to Fall on the Ice this Winter

It’s Black Ice Season here in Boston and time for me to share my best tips for how NOT to fall on the ice.

But before I do, I have to share my #1, Hands-down, favorite video on the internet. This came across my feed years ago, and I still watch it every so often just because it cracks me up every time. I don’t know if it’s the dad’s laugh, or the fact that I so relate to spending hours waiting in pick up lines outside of schools, but it is absolute gold. Don’t worry, no teens were harmed in the making of this film.

Now, onto the good stuff. What is the best way to avoid taking a digger on the ice this season? Here are my Top 5 Tips to Keep You on Your Feet (and off your rear!) this Winter:

1) Invest in a pair of Ice Cleats:

These come in various brands, shapes and sizes, but a good pair of ice cleats can be your best friend. They are generally mesh and can wrap around whatever shoes or boots you are wearing to give you better traction on the ice. I typically recommend Yak Tracks (See on Amazon here), but LL-Bean also sells their own version (LL Bean Stabilizers), as does REI and other Outdoor stores.

2) Ice-Proof your Cane:

Whether you use a cane on a regular basis or not, it can be a helpful tool in the winter, especially if you add on an Ice-Tip (See Vive Ice Tip on Amazon here). Another great alternative is a hiking pole, and these generally come with a set of tips for various conditions as well (this one is the kind I typically use). Having something to ‘grab’ the ground with, in case of a slip, can be the difference between a ‘phew’ and a hard landing.

3) Walk like a Penguin:

When you’re out there trying to get from Point A to Point B, walk like a penguin! Take wide, short steps and avoid pushing off at the end. Basically, waddle like a penguin! It may seem silly, but it works:

4) Bulletproof Your Balance:

We all know that Prevention is the best Medicine and when it comes to walking around this winter, this is especially true. We all have these automatic fall-prevention reflexes, called Reactive Balance Strategies, that are designed to help us regain our footing after a loss of balance. Whether that is a little ankle rock, bending over at the trunk to lower your center of mass, or getting a foot out there to step and prevent a fall, these need to be practiced to remain effective! If you’ve been having falls, or even find yourself having a lot or near misses, it may be a good time to see a Physical Therapist to work on your balance. Even if you feel like your balance is pretty good, as you age, it’s a good habit to do some regular balance exercises to keep it up to snuff. Check out our Otago Exercise Page for a routine you’d an try at home, or join us at one of our Strong and STEADI sessions if there is one available near you. Looking for 1:1 Balance Training? Contact us today to see if we can help.

4) Stick the Landing:

Slips, trips and falls happen, so if you’re going down, you’re better off knowing how to land. We’ve put a page together with helpful tips on how to land safely to reduce risk of fractures and other injuries and practice this skill often with our patients. If it can mean the difference between a bump or bruise and a hip fracture or head injury, believe me, it’s well worth it. Check out our How to Fall Safely page here.

We hope these tips keep you on your feet and off the ice this winter! Physical Therapists like us are Fall Prevention Experts and we love to help. Read more below to learn about our practice, meet our therapists and find out how to get in touch so we can help you stay safe this winter.

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

How do we RETRAIN the BRAIN?

Ever wonder how to RETRAIN the BRAIN? Read on learn all about the wonderful world of NEUROPLASTICITY….

I asked a patient of mine to do a particular exercise "100 Times a Day" last week. I told him I didn't care if he did it 100 times in a row or if he breaks it up throughout the day, but I told him it was the only thing I wanted him to focus for the week. I walked in today, and not only did he tell me he's done it every day, but that one night he went to bed at 11:30PM, realized he forgot and got OUT OF BED to do his last 25. (Yes, this WAS the highlight of my day!)

Now, this is not something I do all the time, and certainly not an effective way to strengthen a muscle or stretch something tight. But what I wanted to do, is 'retrain' his brain to recognize a movement pattern and perform it better to improve his walking pattern. Did you know it takes an average of 2000 trials for an animal to learn a reward-motivated pattern (like tapping a lever for a treat), and even more for athletes or musicians to master a new motor skill involved with their sport or craft?

Rehab is no different. If we are asking our patients to make changes that we hope become habit, we need to follow the principals of neuroplasticity (neuro-what??! Yes, neuroplasticity is one of my favorite words - no surprise there, right!). Neuroplasticity is the ability for the brain to change - and this change can be positive, like learning a new skill, or negative, like losing a motor pattern like walking, dressing or eating, after experiencing a stroke, brain injury or other neurologic injury.

So what encourages 'positive neuroplasticity' - and how DO we 'retrain the brain?' It's simpler than you may think:

1. Repetition: Back 'in the day,' (aka when I went to grad school), it was thought that we had to complete repetitions in perfect form to retrain the brain properly. This meant lots of hands-on guidance from therapists, and even passive exercise like forced cycling. Fortunately, what the research has shown lately, is that the movement doesn't have to be perfect, but it does have to be repetitive...and INTENSE.

2. Intensity: Like the old adage says, nothing good ever comes easy, and harnessing the power of neuroplasticity is no different. Retraining the brain is just like strengthening a muscle. If I wanted stronger biceps, lifting a one-pound weight over and over is not going to cut it. I'd have to lift something heavier than I can currently handle, to stimulate the muscles to grow STRONGER to be able to manage this new load. The brain is the same. We need to give it a task that requires focus, concentration and demands attention. It needs to be INTENSE to give the brain a good reason to pay attention!

3. Saliency: PS. It's also got to MATTER. The brain pays more attention to something that it cares about. Picture someone on an assembly line doing the same menial task day in and day out. This is not salient to that person, but making money to feed his or her family may be, so they show up and do it again each day. We've got to choose tasks, and activities that are interesting, motivating and personally relevant to our patients, to encourage neuroplasticity. Whether this means linking an exercise or activity directly to one of their personal goals, or engaging them in activity that they get joy, pride or some other form of satisfaction from participating in, it’s got to MATTER to make a DIFFERENCE.

4. Repetition: See what I did there? (ahh, PT jokes...), but seriously, repetition MATTERS, maybe more than anything on this list. I'm learning as I become a more experienced (/OLDER) clinician to give less, while giving more. Ever been gone to PT and been given 10 pages of exercises only to 'lose them' on the way home, or tuck them away somewhere never to be seen again? (yes, I have too...no judgement here). What if we give them ONE thing to focus on - that hits all these criteria - something intense, meaningful and challenging - and ask them to do it over and over again? THAT'S where the magic is going to happen.

So back to my motivated, compliant, amazing patient above. Guess what? I came back to today, and he was walking BETTER. Five days of specific focus on one activity. It works, guys, I promise...

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

PWR! Moves for Parkinson’s Disease

This post is dedicated to PWR! Moves Mobility, a therapeutic approach both myself and Dr. Allison Leonard are proudly certified in. There are four main Moves we use in PWR! Moves Parkinson's Therapy. Each of them is special in their own way, but all of them work towards a strong, upright posture that lets you MOVE safety and efficiently in ALL of the direction’s life takes you.

You can read about this therapy on our website at https://healthyagingpt.com/pwr and check out some videos of these moves in action. Read on to learn more about each of these Moves and how they can improve your mobility if you are living with Parkinson’s Disease (or other Mobility Disorders!)

All about the PWR! Up...

The PWR! Up is all about ANTIGRAVITY EXTENSION. This move focuses on the STRENGTH and POWER to rise up from sitting, to squat down in standing and to get up and out of bed. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional muscle patterns that involve the glutes, quads, and scapular muscles and is a GREAT exercise for those of you who may feel STUCK in your chairs when you go to rise up.

All about the PWR! Rock...

The PWR! Rock is all about WEIGHT SHIFTING. This move focuses on the ROCKING and REACHING to achieve MOVEMENT outside of the straight plane. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional muscle patterns that strengthen your HIPS and SHOULDERS and is a GREAT exercise for those of you who may feel STUCK when you go to turn around or reverse directions.

All about the PWR! Twist...

The PWR! Twist is all about AXIAL MOBILITY. This move focuses on the SPINAL MOBILITY to achieve ROTATION across your body. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional movement patterns like OPENING AND CLOSING your arms and is a GREAT exercise for those of you who may feel STUCK when you go to roll over in bed or put on your shirt or coat.

All about the PWR! Step...

The PWR! Step is all about TRANSITIONS AND MOBILITY. This move focuses on the STEPPING STRATEGIES to achieve WALKING and MOBILITY. We practice it in all five postures: sitting, standing, on all-fours, on our bellies in prone and on our backs in supine. It strengthens critical functional movement patterns like STEPPING and TRANSITIONING is a GREAT exercise for those of you who may feel STUCK when you approach a doorway or go to turn to sit in a chair.

Now that you’ve got an intro to the Moves, you can put them together for an entire Home Workout! Check out these great vides from the therapists at Parkinsons Wellness Recovery - the team that created the PWR! Moves Mobility Program.

PWR! Moves Seated Class

PWR! Moves Class - All Postures

PWR! Moves - Standing with Weights

PWR! Moves - Standing with Bands

To request an Free Phone Consultation to see How Healthy Aging PT can help you, click the button below:

To learn more about our Power over Parkinson’s Group Fitness Class, click the button below:

To learn more about BIG/LSVT & PWR! Moves Parkinson’s Therapy, click here the button below: