At onset of disability, if you want the best wheelchair that money can buy, make sure that you get run over by a bus.
As ridiculous as that advice sounds, it’s seemingly true. What my extreme example eludes to is that not only does the type of health insurance one has determine the quality of the wheelchair one receives, but so does how one incurs disability in the first place.
As discussed by Dr. Fabrisia Ambrosio of the University of Pittsburgh in a recent article, those who experience disability due to sudden trauma, such as spinal cord injury, receive higher-end wheelchairs from the start than those with non-traumatic injury disabilities, including multiple sclerosis or muscular dystrophy, to name a few. And, in my professional experience, this assertion absolutely proves true, with ramifications not only toward one’s initial wheelchair, but also potentially affecting every subsequent wheelchair one ever receives throughout life.
The fact is, a traumatic injury is a hot-rush, non-stop ticket to the heart of our healthcare system. A spinal cord injury, for example, dictates a linear path from a trauma unit through advanced rehab, where, along the way, most patients go through state-of-the-art rehabilitation programs like those of Kessler, Shepherd, Craig, and Casa Colina rehab centers. And, it’s during rehabilitation that the best-of-the-best clinicians fit patients with cream-of-the-crop wheelchair technology, with newly-injured individuals leaving in among the most advanced manual and power wheelchairs.
However, those with progressive disabilities, such as multiple sclerosis, are far less likely to go through such an intensive rehabilitation program, never receiving such focused, all-encompassed healthcare, such as that geared toward traumatic injury. As a result, wheelchairs for those with progressive disabilities are fitted and prescribe on a more throttled scale, by local therapists and providers who may not have the cumulative resources and experience of advanced rehab centers. Further, toward progressive disabilities, therapists and providers, as required by most insurers, often only assess one’s needs in the immediate, prescribing and funding wheelchairs that aren’t of the most advanced technology, even though one’s condition may become more involved, where in several months or years, a much higher-end wheelchair may be needed.
In this way, during the fitting and funding of first wheelchairs, traumatic injury patients typically have access to higher-end mobility technology over those with progressive disabilities. However, such inequities don’t stop at the issuance of one’s first wheelchair.
Many insurers use the level of one’s current wheelchair as historic precedent for one’s next wheelchair, meaning that what you have is what you get, unless there’s a dramatic change in condition that warrants higher-end technology. The consequence is that if one is initially issued a lower-end wheelchair, one is likely to receive the same type of wheelchair at the time of replacement if there’s no change in condition, keeping one in a funding cycle of low-end mobility products.
Surely, hindsight is 20/20, and there’s nothing that any of us, as wheelchair users, can do to change our own first wheelchairs. However, as members of the disabled community, it’s vital that we look to help others new to disability. If you encounter someone about to get fitted for his or her first wheelchair, take a few minutes to point him or her in the right directions, toward consumer sites on the web, toward an outpatient seating clinic at a rehab center, toward the knowledge that everyone should ideally have when selecting a first wheelchair. In fact, your timely advice could affect the quality of wheelchair that he or she receives for decades to come.