ALS is a devastating diagnosis. It tends to be diagnosis by omission of other issues and often by the time this happens, mobility has been affected. When that becomes the case, there is a need to discuss a mobility solution – generally a power wheelchair.
With many ALS patients, the immediacy of their condition drives them to use of a “loaner” chair provided through their ALS clinic and often in partnership with a Complex Rehab Technology (CRT) provider.
A loaner chair is just that – on loan to the patient for a temporary period. The benefit of loaner chairs are that they are able to provide a short-term mobility solution on demand in an effort to retain as much independence as possible. With this approach, a mobility solution is quickly provided that allows the patient to remain mobile, get a feel for nuances of the equipment, work with a therapist on transfers, arrange the house, understand what parts of a chair they may or may not like, and identify specific needs to be included on a customized final product. The patient may not realize many of these things until spending time in a loaner chair - and it is far easier to change configuration up front vs. after a custom chair is delivered.
As positive as it is initially for most ALS patients to take advantage of a loaner chair, it is not customized to that individual and should not be viewed as final solution for the patient’s needs. A loaner chair is pulled from a common pool of available chairs, based on a first come first served basis. It is a “best available fit” approach vs. a custom configured approach. There is no fitting, positioning, sizing and set up of drive controls. The clinic and/or CRT provider will get as close as possible, but there are usually compromises with this approach. This potentially impacts how long a patient can spend in the chair daily, the ease of independent movements, how the chair works in the home, and other basic challenges.
A loaner chair program is by design a stop gap to a final chair. A loaner chair has benefits as noted, and it can be tempting to try to stay with it indefinitely. However, there are typically limited available resources and by staying in a loaner chair too long, a patient is not only potentially restricting this benefit to others, but may be limiting his/her own mobility and creating associated health issues from sub-optimized seating configurations.
Ultimately, any patient that has medical needs that have necessitated a loaner chair, should be fitted for an individually configured wheelchair. The goal of this is to find an optimized mobility product and configuration that best accommodates the patient, maximizes comfort and safety, and allows for as much independence for as long as possible. A proper evaluation should be conducted by a clinical team which includes an OT or PT, M.D., as well as an equipment provider who is a certified Assistive Technology Professional (ATP).
Inappropriately applied seating can lead to significant posture and comfort issues and results in more serious health conditions such as pressure injuries, digestive issues and breathing trouble.
So while the loaner chair approach most certainly has its place with an ALS patient, it should be viewed as a temporary solution and the patient should move quickly to begin the process of an individually configured mobility solution that best meets their specific needs.