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What kind of adaptive equipment can make life with SCI easier, and how do we find it?

There are all kinds of adaptive equipment designed to make life with SCI easier, some designed to make the survivor more self-sufficient, others designed to make everyday activities easier and more enjoyable for the survivor.

Mobility

When one things of adaptive equipment for the SCI survivor, the wheelchair is most likely the first piece of equipment that comes to mind. A wheelchair allows the survivor to go just about anywhere an ambulatory person can, in the same amount of time or even faster. With a good wheelchair, the survivor can easily go to work, go grocery shopping, or go out to dinner with friends. There are even specialized wheelchairs that allow the survivor to pursue competitive sports such as tennis and basketball.

Depending upon the specific needs of the person, there are a wide variety of chairs to choose from that feature different styles, weights, and performance ability. A person who is interested in navigating rugged trails, for example, will have much different needs than someone who is navigating city streets.

Wheelchairs can be manual or power. If you have upper body strength and movement, a manual chair, which is propelled forward by the arms, might be the ideal choice. Most manual wheelchairs are very light in weight, and come in a variety of styles and colors. You’ll have a choice between a rigid frame or a folding frame, which are easier to transfer in and out of cars. Power wheelchairs are ideal for quadriplegics without upper body strength, and are also relatively light considering their additional weight of motors and batteries. Many also come in mid-wheel and front-wheel drive to make them more maneuverable. Power wheelchairs also come in a wide variety of styles and colors. Three- and four-wheel scooters are also an option for those who don’t require a chair at all times.

In addition to manual and power chairs, there are also several hybrid-type chairs available. These chairs are essentially standard manual chairs who have been outfitted with a powerful motor designed to give the chair a boost when needed, such as when going up hills.

There are also a wide variety of specialty chairs, from sleek racing chairs designed for maximum speed to “standing” chairs that position the rider in an upright position, allowing them to stand eye to eye with others when they want to.

The wide variety of choice in wheelchairs can be absolutely overwhelming, so we suggest that you speak with your Occupational Therapist about which type and style of chair will best suit your needs. If you require a power chair you’ll also want some help navigating Medicare, as they have become increasingly picky about which chairs they’ll cover. Don’t make the mistake of choosing the first chair they cover. You’ll be much happier with your chair and will save money in the long run if you choose the right chair the first time around! Here’s a list of questions to ask yourself to get you started on finding the perfect chair:

1. Will I be able to propel the wheelchair myself?
2. What is my environment like, and where will I be using the wheelchair most?
3. Will I need to transport the wheelchair?
4. Will I need to get the wheelchair in and out of tight spaces?
5. Do I want to use the wheelchair for any sports, and if so which ones?
6. Does my situation warrant seating options like tilt and recline?

Braces and Orthoses

Braces and orthoses are used for both positioning the limbs, as well as increasing function. A wrist-hand orthosis transfers force from the wrist to the fingers, allowing the survivor to grasp objects. The ankle-foot orthosis can assist some survivors with incomplete injuries with the swing phase of the stride, allowing the foot to more effectively clear the ground. The knee-ankle-foot orthosis stabilizes the knee and ankle, allowing SCI survivors, generally L3 and above, to “walk” with the use of crutches. With the weight of the survivor’s body resting on the crutches, he or she “swings” his or her legs forward at the hip level.

One of the newest technologies to come on the scene is the Parastep. Most beneficial to those with T4 to T12 injuries, the Parastep is a high-tech device that allows the user to walk by sending electrical impulses to the leg muscles. Parastep comprises a walker, a keypad, and a set of surface electrodes. The surface electrodes are attached to the quadriceps, gluteal muscles, and peroneal nerve. Holding onto the walker, the survivor uses the keypad to send electrical impulses to the electrodes, which “fire” the muscles. Done in the correct order, this creates a type of walking gait. While some people do use the Parastep for the simple purpose of walking short distances, many others use it for exercise. The Parastep is costly, but Medicare will pay for it for qualified people, and sometimes it’s covered by insurance. You can learn more about the Parastep by visiting the Sigmedics website, www.sigmedics.com.

Environmental Control

Every survivor who wants to be independent must learn to deal with everyday home activities that they took for granted before the accident. There is a wide variety of environmental control technologies designed to make home life easier for the SCI victim. This technology gives the person more control over their living space, allowing them to do things like turn on lights, open doors, answer the phone, and control the temperature.

Many of these technologies are “hands-free,” allowing the survivor to control his or her environment by using puffs of air, voice, head movement, or even blinking. In addition, the home can generally be outfitted so that it operates off of one remote control unit.

Computing and Communicating

The computer is one of the best technologies available to people with SCI. In fact, today’s computer technology allows someone who is disabled to work, shop, communicate with friends, take online classes, play video games, or just surf the Web with relative ease. Again, for hands-free computing there are plenty of options, including technology that allows you to operate your computer and software with head motions, puffs of air, blinking, and voice commands.

Home and Work Accessibility

Making the home and work space accessible depends upon taking a good look around, deciding exactly where needs must be met, and then designing the space in question accordingly. Ramps, strategically placed grab bars, height-appropriate sinks and counters, widened doors, and remote control devices discussed above that make it easier to control the environment are all considerations when planning your home and work space. Some of these modifications are quite simple and can be done by the do-it-yourselfer, while others are more complex and require the use of an architect. There are architects that specialize in home modifications for paralysis victims; many of these employ something called “Universal Design,” which allows the disabled and the able bodied to enjoy a space that is functional and comfortable to both.

Driving

Most of us don’t spend a lot of time thinking about how much freedom the ability to drive gives us. We just hop in the car anytime we need to go from place A to place B without really thinking about it. But take that ability away, and all of us a sudden it becomes all too evident how integral driving is to our independence.

While driving in most cases requires the use of hands and feet, thanks to adaptive vehicles and driving equipment, even quadriplegics with very limited upper body control can manage their own vehicles. Modifications are varied and depend upon the needs of the person. There are hand controls that allow braking and acceleration for those with no lower body control, easy-touch pads for ignition and shifting, and joysticks and spinner knobs for those who have limited upper body movement. Because the controls of a modified vehicle are completely different than those in a standard vehicle, the survivor will need to learn how to manipulate these controls.

But before you get behind the wheel there are a few steps you’ll have to take. The first step is to contact the Association for Driver Rehabilitation Specialists. Start by logging on to their website,www.driver-ed.org, or give them a buzz at 800.290.2344. In addition to lots of information and educational material, this organization has experts on staff who specialize in adaptive driving and modified vehicles. These specialists will be able to evaluate you to determine whether driving is a possibility, and if it is they’ll suggest equipment and adaptations best designed to suit your particular needs.

The final step is to get a new license from your state. Just like those applying for a license for the first time, you’ll need to schedule an on-road driver’s test. While everyone, regardless of disability, can apply to be tested, that doesn’t mean that the state has to grant you a license. In some cases, they may give you a restricted license depending upon your particular disabilities and the modifications that are required.

Once you know what modifications are necessary and your state license has been approved, it’s time to find a vehicle that suits your needs. You basically have two choices here. You can either adapt your current vehicle, or you can buy a new one. If it’s possible to go the former route you’ll definitely save money during a time when you’ll need as much as possible. Just make sure the dealer you choose has plenty of experience making the modifications you require, and be sure to ask the vehicle modification expert you’ve been working with to do a detailed inspection of the vehicle before you start rolling.

Regardless of whether you modify your current vehicle or by a brand-new adaptive vehicle, the costs will vary greatly. Expect to spend anywhere from $5,000 (for the most minor modification in a already-owned vehicle) to $80,000 (for a brand new highly modified vehicle). Either way, getting a modified vehicle isn’t cheap.

Luckily, you may not have to completely foot the bill on your own. The specialists at the Association for Driver Rehabilitation Specialists can give you plenty of advice on how to finance your modifications. Or try contacting the division in your state that deals with vocational services. There’s a chance your insurance carrier might cover vehicle modifications, but if not you have other choices like grant programs. Lots of manufacturers also have policies that reimburse you for part or all of your modifications, so be sure to ask.

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