Considerations About Mobility and ALS #
- Mobility in ALS changes as the condition progresses and the individual experiences lower extremity weakness and balance impairment.
- The OT must ensure that the client is recommended the most appropriate mobility device, as well as consider equipment as a strategy for energy conservation.
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It is not recommended to go through the Assistive Devices Program (ADP) for a walker, manual wheelchair, or basic power wheelchair, as clients’ symptoms will progress. These equipment can be obtained from the ALS Canada Equipment Program and can be used for as long as the client requires them. Generally, clients should save ADP funding for a Type 3 power base wheelchair with power seating (tilt, recline, and elevating legrests).
Walking and Ambulation Aids #
- For canes, clients will need to purchase from a home healthcare store.
- For walkers (rollator walkers and 2-wheeled walkers), OTs can assist clients to access the ALS Canada Equipment Program .
- Assess for possible footdrop and recommend appropriate support (see Footdrop)
- Provide education and strategies for fall prevention (client handout)
- Provide recommendations for a medical alert system with fall detection, especially if clients live alone and experience regular falls and difficulty getting up on their own.
Medical Alert Systems with Fall Detection #
| Bedford | https://bedfordmedicalalert.ca/ |
| Lifeline | https://www.lifeline.ca/en/ |
| Galaxy | https://www.galaxymedicalalert.com/ |
| Life Assure | https://www.lifeassure.com/information/?info=medical-alert-canada |
| Apple Watch (ensure there’s fall detection) | https://www.apple.com/ca/watch/ |
Bedford #
Bedford Medical Alert’s Dedicated Care Responders are on call 24/7. They address client needs when a medical alert signal is received from a button push, a fall that has been detected, or any number of other monitored life safety events. Even if you are unable to speak, your emergency signal will bring your information up on the Care Responder’s screen, so Bedford can initiate actions to help.
Lifeline #
Lifeline is an easy-to-use personal response service that lets you summon help any time of the day or night – even if you can’t speak. All you have to do is press your Personal Help Button, worn on a wristband or pendant, and a trained Personal Response Associate will ensure you get help fast.
Galaxy #
Galaxy Medical Alert Systems Monitoring Center operates at the highest standards and is backed by industry leading certifications.
Our Emergency Medical Technicians are trained and certified experts in the medical industry. Rest assured that during an emergency, you or your loved one will be taken care of by knowledgeable and experienced medical professionals.
Life Assure #
Lifeline is an easy-to-use personal response service that lets you summon help any time of the day or night – even if you can’t speak. All you have to do is press your Personal Help Button, worn on a wristband or pendant, and a trained Personal Response Associate will ensure you get help fast.
Apple Watch #
If Apple Watch SE or Apple Watch Series 4 or later detects a hard fall while you’re wearing your watch, it taps you on the wrist, sounds an alarm, and displays an alert. You can choose to contact emergency services or dismiss the alert by pressing the Digital Crown, tapping Close in the upper-left corner, or tapping “I’m OK.”
Transport and Manual Wheelchairs #
- Transport, manual wheelchairs (type 2 or 3), and manual tilt wheelchairs (type 5) can be accessed from the ALS Canada Equipment Program . Proper measurements and seating recommendations need to be done by the OT.
- If the client is ambulatory, consider recommending transport wheelchairs for energy conservation, such as going to appointments or long-distance mobility.
Scooters #
- If clients do not have postural weakness and can transfer independently, they may consider a scooter for outdoor mobility. OTs can assist clients in obtaining a scooter from the ALS Canada Equipment Program .
Considerations for Scooters #
- 3-wheeled scooters are smaller and compact, but less stable
- 4-wheeled scooters are larger, but more stable
- Although scooters are available through the ALS Canada Equipment Program, they are popular items, especially during the spring/summer months. Clients may not be able to receive a scooter for a couple of months, and may need follow-up once they receive the scooter.
Power Wheelchair (non-tilt) #
- If clients do not have postural weakness and do not require tilt for support or repositioning, they may consider a power wheelchair (non-tilt), which is available from the ALS Canada Equipment Program . Proper measurements and seating recommendations need to be done by the OT.
- Add yellow blurb – titled “Considerations”
- If the client does not intend to use the power wheelchair for indoor mobility, they can consider using it for independent outdoor mobility.
- Ensure that the home is accessible for a power wheelchair, if the client is planning to use it indoors.
- Ensure that clients have a place to store the power wheelchair and charge it daily.
- It is not recommended to go through the Assistive Devices Program for a power wheelchair (non-tilt), as clients’ symptoms will progress and may need alternative access and seating. Generally, clients should save funding for a Type 3 power base wheelchair from ADP.
Considerations for Power Wheelchair (non-tilt) #
- If the client does not intend to use the power wheelchair for indoor mobility, they can consider using it for independent outdoor mobility.
- Ensure that the home is accessible for a power wheelchair, if the client is planning to use it indoors.
- Ensure that clients have a place to store the power wheelchair and charge it daily.
Portable Power Wheelchair #
Some clients may have questions and want to consider portable power wheelchairs. Portable power wheelchairs may be appropriate for clients who are still ambulatory but have decreased endurance due to shortness of breath or fatigue. However, OTs need to carefully review the advantages and disadvantages with clients, as well as address some considerations before recommending it to clients.
Advantages #
- Compact and portable
- Can be used indoors, easy to transport in a car – no need for accessible mobility.
Disadvantages #
- Not appropriate for long-term mobility solution.
- Does not provide postural support or head support.
- Cannot be customized for postural support, pressure relief, or adapted for power seating or alternative drive access.
- Not funded by the ADP
Examples of Brands #
| Fold-A-Wheel | Fold-A-Wheel |
| EZ-Lite Cruiser | EZ-Lite Cruiser |
| Travel Buggy | Travel Buggy |
| Whill | Whill |
| Easy Fold | Easy Fold |
| Pride Mobility | Pride Mobility |
| Golden Technology | Golden Technology |
Considerations for Portable Power Wheelchairs #
- Check ALS Canada Equipment Program, although these items are very rarely donated or available in the equipment pool.
- These devices should not be considered if the client will be spending all day in the wheelchair or if they are unable to reposition themselves independently.
- These devices may not be appropriate if the client is experiencing rapidly progressive changes in their hands.
- Insurance may cover the device. Check with the insurance about funding periods.
- Generally clients should save funding from insurance for a Type 3 power base wheelchair from ADP.
- Discuss the option of renting with the vendor.
Power wheelchair (Type 3 power base) #
Some clients with ALS may wish to maintain their independence with mobility and inquire about being able to drive a power wheelchair if they begin to experience weakness their hands and trunk. A power wheelchair (type 3 power base) with power tilt, recline, and elevating legrests would be appropriate to recommend to clients.
These power wheelchairs are not available through the ALS Canada Equipment Program . They are only available through the Central Equipment Pool (operated and managed by Motion). These devices are funded by the Assistive Devices Program (ADP) . Client will need have a wheelchair and seating assessment completed by an ADP Authorizer.
An application to the Assistive Devices Program for a power tilt wheelchair with power tilt and power elevating legrests is appropriate if it is foreseen that the client will use it for at least 6 months.
Considerations when prescribing a power wheelchair (Type 3 power base) #
- Must go through the vendor Motion (CEP)
- Consider alternative drive access methods including head array system or single switch scanning, if the client does not have reliable hand function.
- Although these recommendations are not covered by ADP, consider in the prescription:
- Attendant care – allows caregivers to assist with safely moving the client’s powers wheelchair if client has become fatigued while using it
- Power seat elevation – allows client to move vertically in space and improve quality of life to be able to reach for items or have a conversation with family and friends at eye level
- Insurance may provide coverage for items not covered by ADP.
- The OT needs to ensure to discuss home accessibility and transportation with a power wheelchair. See Accessible Transportation section for more details.
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This is specialized equipment requiring experience to prescribe. You are encouraged to consult the neuromuscular clinic OT or PT treating your patient before ordering if you do not have significant experience in these specialized areas.
Sources & Further Reading #
- A Guide to Amyotrophic Lateral Sclerosis (ALS)
(page 47) - ALS Canada Equipment Program
- Comprehensive Rehabilitative Care Across the Spectrum of Amyotrophic Lateral Sclerosis
(“I want to continue to work, take care of my children, go on a trip. What can you do to make this possible?”) - “Power Wheelchair Prescription, Utilization, Satisfaction, and Cost for Patients With Amyotrophic Lateral Sclerosis” Ward et al. 2010
