It's hard for wheelchair users to be independent when the rest of the world is set up for people at a standing height, and there are stairs and other obstacles everywhere we look. Fortunately, advances in technology have led to the design of mobility products that can adapt to the world around us, and the latest version should arrive in the marketplace this summer.
|The iBOT's front wheels rotate on top of its rear wheels, lifting the user to a standing person's eye level.|
Freedom for people with disabilities is what Independence Technology, a Johnson & Johnson company, had in mind when the Independence iBOT Mobility System was being developed in 1995.
Recommended by an advisory panel last fall for approval by the Food & Drug Administration, the iBOT has undergone a long and expensive improvement process. After the careful inspection of the device at several medical sites is complete and all paperwork is reviewed and approved, the FDA will make its final decision.
Independence Technology expects a favorable decision that will make the iBOT available to consumers this summer.
The iBOT isn't the first wheelchair that can elevate the user to a higher position, and it isn't the first to use four-wheel drive to tackle uneven surfaces and go over curbs. But it's the first on the market that can climb stairs, and the first to combine all three functions.
How does it work?
Besides using the device like a typical power wheelchair, an iBOT user can make the chair's front wheels rotate on top of its back wheels. The chair then balances on two wheels and puts the user at eye level while still seated — a perfect height for face-to-face conversations with others who are standing. This "standing" feature also enables the user to reach high shelves, cupboards and other spaces beyond the grasp of traditional wheelchair users.
There are other standing wheelchairs on the market, such as the Chairman 2K Stander from Permobil, which has a powered seating system that allows its user to go from sitting to an upright standing position in seconds.
The iBOT goes further by being able to ascend and descend stairs.
The mobility options the iBOT makes possible replace "functions that are lost in advanced neuromuscular diseases, and if technology can restore this, then I am all for it," says Gregory Carter, an MDA clinic director and physical medicine specialist at St. Peter's Hospital in Olympia, Wash.
According to Jay Van Vechten, president of Van Vechten & Company, the public relations firm for Independence Technology, the iBOT is a "revolutionary mobility system that climbs up and down stairs while the occupant's seat remains level." It uses a complex system of sensors, gyroscopes and electronics to simulate human balance.
"The iBOT is designed to let users go wherever they want to go," Van Vechten says. With the ability to switch to four-wheel drive, the iBOT trudges through grass, gravel, sand and just about any uneven terrain the adventurer can conjure up. But, though it's rugged and stable, the iBOT — at 24¾ inches from tire to tire — is narrower and more compact than conventional wheelchairs, Van Vechten says.
Dave Brown, Independence Technology's vice president of Sales and Marketing, explains another unique feature of the iBOT: You don't have to be in it to drive it. The control panel can be removed from its resting place on an armrest, leaving the joystick attached to the iBOT by a 5-foot tether. So, for example, after the user has transferred into a van or SUV, the user or someone else can carefully "drive" the chair up the ramp and into the vehicle.
Is it for you?
The iBOT isn't for everybody. Tested with many different types of users, including people with neuromuscular diseases, the iBOT is recommended for users based on their functional ability to operate the device rather than on specific disabilities, Van Vechten says.
Carter says the iBOT may be useful for some of his neuromuscular patients who have some hand and arm strength. It's better suited to those who have reasonable hand control, which is needed to operate the device, he says.
According to Gary Karp, author of Life on Wheels and Choosing a Wheelchair, those interested in the iBOT should be warned that certain medical conditions may hinder the effectiveness of the device.
"People who are not that stable in their bodies might not do as well," Karp says.
Operating the iBOT requires the user to have good balance, and it isn't designed for people who need specialized seating for stability, Karp says. As of now, the chair offers no special positioning options for seating.
Karp explains that the iBOT "takes someone who has stability and is not affected by sudden movements that might initiate a spastic response."
While the iBOT can be used successfully by people with varying types of disabilities, Van Vechten says the chair doesn't adapt to neuromuscular changes that occur with a progressive disease. It also lacks tilting and reclining capabilities, something many people with neuromuscular diseases find therapeutic.
iBOT users are warned to operate the chair as directed and rely on their common sense to decide which inclines or stairs are too steep to climb safely.
The FDA deems the iBOT a Class 111 medical device and requires a doctor's prescription. A health care professional should assess your ability to operate the device safely and effectively before prescribing it. Independence Technology will also prescreen potential users to ascertain their compatibility with the iBOT. For example, IT wants to be sure iBOT users have use of their arms and can operate a joystick.
The FDA approval is expected to include training and testing requirements.
Is it worth it?
Priced at $29,000, the iBOT offers a new level of freedom that will offset its price, Van Vechten says. He adds that the combined cost of home modifications such as ramps, elevators and lowering kitchen cabinets and bookshelves to accessible heights greatly surpasses the price of the iBOT.
Johnson & Johnson is currently demonstrating the benefits of the iBOT to Medicare, Medicaid and private insurers. The goal is to show these agencies how the iBOT will help improve the lives of people with disabilities and make sure the device is reimbursed at the necessary levels.
When the iBOT reaches the marketplace, Karp advises that buyers talk to various medical experts and ask a lot of questions about all aspects of the chair, including seating and footrest options, battery life and tire function. They need to ask about the typical operation of the iBOT and the full range of accessories that are available so they'll really know whether the chair can be configured to their specific needs.
"I think that some people can get excited about wanting the super-new technology, and they might not be as realistic about whether it supports them well," Karp warns.
Update (November 2003)
After a long and complicated series of safety tests, the Independence iBOT Mobility System was approved by the Food and Drug Administration in August.
The iBOT should be available in certain clinics across the country for $29,000, and a prescription is needed.