POLIO TIPS AND TECHNIQUES: The Right Chair

By Dr. Richard L. Bruno

We at the Post-Polio Institute have a rule of thumb, or more correctly a rule of arms and legs: If you’re wearing a short- leg brace you need to use a cane; if you’re wearing a long- leg brace, you need to use two forearm crutches; if you have two braces, you need a wheelchair.

Obviously, there are lots of polio survivors with and without braces who need a wheelchair. But, after 25 years of experience, we no longer recommend either manual wheelchairs or scooters for polio survivors. If your arms are too weak and your shoulders hurt too much to use forearm crutches, you shouldn’t be using a manual wheelchair or a scooter. Both put tremendous physical stress on polio- damaged, overworked neurons, muscles, and joints. The wheelchair requires that you propel yourself using your arms. You steer the scooter by using your arms and shoulders to move a “T-bar” tiller that turns the front wheel while you use your hands to squeeze levers make the scooter move. What’s more, the tiller forces you to lean forward in the seat, putting you in a forward flexed position that causes neck and back pain.

On the other hand (no pun intended) is the power wheelchair, which is steered by a joystick, like those used for video games, a knob attached next to one of the arm rests. The joystick allows you to steer with only one hand-or even just your fingers-with arms at your sides and shoulders relaxed while sitting with painless posture. Also, the new power chairs have mid-wheel drive, instead of the old rear wheel motors, that allow the chair to turn in its own space, make it smaller and very maneuverable.

Power chairs can be fitted with special rigid backs that have adjustable foam inserts to provide the right amount of lumbar curve to insure proper posture. If you have trunk weakness or scoliosis, you can get a back made from custom-formed foam to cradle and hold your body in place. And if you have upper back or neck pain or muscle weakness, you can order a shoulder-high or head-high back, or an additional head rest, that will allow your muscles to be supported and relaxed while driving.

Power chairs can also accommodate customized seat cushions. If one butt cheek is smaller than the other, or if you have scoliosis and your upper body tilts, an adjustable cushion, that has separate inflatable air bladders or foam inserts of different heights and firmness, can lift one side of your pelvis and balance your body. Those with leg swelling can get manual or electric elevating leg rests. You can even get a special power seat riser to allow you to reach high cupboards and chairs whose backs recline and allow you to take your two, daily, 15-minute rest breaks (or even a nap) without leaving the comfort of your custom-designed chair.

Now that you know power wheelchairs are the way to go, how do you get Medicare or your insurance company to pay? Medicare and most insurance companies use the Medicare rule: You are eligible to get a power chair only if you need it in your home. If you are eligible under the rules, your doctor needs to fill out a Certificate of Medical Necessity and write a letter of medical necessity. It is helpful for your doctor to make it clear that 1) your legs and arms are too weak and painful for you to use crutches or a manual wheelchair; 2) you are unable to walk more than 10 to 20 feet; 3) you need to use a power wheelchair at all times inside the house; and 4) your PPS symptoms are progressing and will get worse without the power wheelchair, making you unsafe and likely to fall.

If you feel your power chair is wrongly denied and you are filing an appeal, it is often helpful to get the name of the Medicare or insurance doctor who will be reviewing the denial and have your own doctor give him or her a call and send him or her the paperwork. A personal doctor- to-doctor chat can often get you the chair.

Dr. Richard L. Bruno is chairperson of the International Post- Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. His e-book, How to STOP Being Vampire Bait: Your Personal Stress Annihilation Program, is available from rbruno@unitedspinal.org.