Bruce has published a good post on power chairs: Thanks Bruce for passing on this information on power chairs!

I thought I would relate some of my experiences with power chairs here. I'm a fellow KD'er and I'm currently at the point where I only walk very short distances fully dependent on a walker. In fact my only "walking" is really just standing transfers for someplace to my power chair or back. I spend at about 1/2 my day in my chair. I've owned several chairs from entry level (Jazzy 1103) to the top end (Permobil C300.)

I encourage other KD'ers to look into a bottom end chair and lifts to work with your car or mini-van as soon as you starting having difficulty walking long distances. Been there, done that, and the chair made life much easier. The entry level solutions are Ok if you use the chair occasionally - I used to call it "for distance or duration." Once you need the chair for all occasions the high end chairs are recommended. Keep in mind that if you are using insurance they are going to expect any purchase to last five years before they will kick in for a new chair or upgrade. I do not recommend scooters.

For a KD'er looking at a high end chair the options are pretty set. The biggest choices are over seating and what functions are powered. There are a slew of options dealing with different physical limitations but our needs are pretty simple compared to some.

A high end power chair for a KD'er should be equipped with a three or four way seat positioning system. The critical "way" is an elevating seat to allow for self-transfers. The remaining dimensions help you deal with being in the chair near full time. Get as tall a lift as is available.

Tilt allows you to shift some weight to your back to give your bottom a rest. Tilt is accomplished by tilting the seat pan so the whole "chair" portion tilts.

Recline is just the back moving and the seat pan staying where it is. I use "recline" more for support while leaning forward than back. Typically while pulled up to a table. Another useful time is when in the doctor's office to avoid having to transfer to an exam table. I just tilt back to get my body in the same position. I can also use the elevator to raise myself to the same level as an exam table. (I notice a new chair I am looking at (Permobil M300) has a manual recline which may be OK.

The fourth "way" is elevating leg rests. These are helpful in dealing with the lower leg edema that results from sitting all the time. It was critical for me when I broke my leg a few years ago. There are times slight adjustments are needed that would be impractical with a fixed system.

As noted I am looking for a new chair. Mine is 5+ years old and repairs on these puppies are expensive so a new one is in order. My provider likes the Quantum Rehab Q6 for most of his power chair customers. He's not too big on the Permobil and I'm not certain why. I think it may be that Permobil corporate is the issue with carry, inventory, and training overhead.

I'm hoping I can work something out with my provider as the new Permobil M300 looks like the ticket for me. I have a C300 now and both chairs are similar. They are a good compromise between indoor and outdoor use. (The Q6 is probably a better outdoor chair.) The M300 is an updated design that has and updated controller and goes faster (6mph standard, 7.5 optional ) than the C300 which isn't all that stable at top speed. The M300 has suspension that deals with the issues in Bruce's post and that can handle the higher speeds. The M300 is really a six wheel chair as opposed to the C300 four + two tip over preventers. More importantly the 300's have a lower seat height (17.5 vs 18.5 for the Q6) and a higher lift (8" vs 6/7".) The lower seat allows you to get under tables more easily and helps when the chair is used with a ramp van. I'm right at the limit now on being able to get high enough for self transfers, but I can add a bit with seating when the time comes.

These high end chairs have order forms posted on their web sites that are very confusing, that is where the qualified provider comes in. The MSRP on these high end models cost more than a small car (about $30K) but the actually costs are pretty much determined by Medicare or the insurance companies. For those line items with charge codes the price is pretty much the same across all the makes and models. You are on your own for the options, but I understand there is some trading that goes between the dealer and manufacturer on these items. Your out of pocket is determined by your insurance deductibles and co-pays.

I'd highly suggest you shop around all your local providers and to deal locally. Service can be very important when things go bad. If you buy out of area you may have to wait several days for a first visit from a tech, and often more than one session is required.

I'll report back with my adventures with my new chair purchase. Feel free to post questions.

Bob, thanks for taking the time to share your experiences with our fellow KD'rs. As usual, you are a wealth of knowledge.

Happy Thanksgiving!

I finally looked into several options and wound up replacing my used 2006 Permobil C300 with a 2014 model.

I tried a demo Redman stander and a Permobil C500vs stander and both were too tall in the seat for my Dodge XLT conversion - a new van would have been required. I am 5' 10'' tall and I can fit through the door without bending over in the C300. With the other two chairs I had to duck to get in the door and the driving postilion was too high. Height was also a problem for dining tables.

I really like the concept of the Redman Chief ZRx chair but I couldn't find an easy way to do self transfers - a deal killer. Also no available dealers in my area.

The C500vs was also too tall for the van. A bigger problem was that the insurance folks classify the C500 as a Group IV chair and they wouldn't pay for it for my SBMA needs. I could do the same transfers as used with the C300 so that wasn't an issue.

I gave up on the stander technology and went back to the C300. I didn't really see any competition that matches the C300 for my needs. The insurance company picked up most of the cost - about $3,000 out of pocket for me.

Great indoor and outdoor chair - still highly recommend.

Bob, thanks for the update. I had a similar experience with the C500. It is a nice chair, but it is substantially bigger than the C300. My insurance company also made it more comfortable (affordable) to go with the C300. Good luck with the chair.

Bruce has come up with another excellent post on Power Chairs

I added a reply (with some edits below):

Some suggestions to prepare for insurance coverage:

On every doctor visit have a note made on issues that may be addressed by a powerchair (PC) or some other adaption or action. The insurance company will be looking for conditions that may justify the need for a powerchair.

e.g. If you have leg edema (even minor) have that noted on your record. If reasonable have the Doc enter a recommendation for leg elevation. This will support the elevating footrest option.

Having trunk strength or sitting posture issues/pain support the seat and back tilt option. Back tilt is not as good as seat tilt when the chair is used outside slopes. Make sure you get seat tilt.

When can't get up from a standard height chair document that you need to have a seat height of at least 27" (or whatever) to do a self-transfer. Have it documented that you do not have enough strength to do a side transfer. This will support the seat elevation. This also applies to toileting. For years I was at least able to urinate when out and about using ADA grab rails to stand in front of a toilet. Eventually, that became too difficult and I switched to using a catheter. The elevated seat helps there too to achieve the correct posture.

When doing the powerchair eval appointment mention these same items. Emphasize you expect to be strong enough for a self-transfer and toileting well into the future if you can depend on starting a standing transfer from 27" or so.

There are a lot of used chairs out there too, at or near the copay you may face. The disadvantage of used is lack of coverage for major repairs like a controller or motor. A lot of the used chairs come from the ALS (or similar) community and do not have elevating seats as the patients are not weight bearing so can't do a standing transfer. DO NOT buy a PC without elevating seat unless you cannot stand today. I found I use seat tilt and elevate several times a day. Back tilt (recline) and leg rest elevate I could live without.