Editor's Note

Bad Metaphors

When I fell in my garage at the end of January, my first, terrible thought was that I’d broken my ankle. (My second thought was that I’d broken my ankle during complex rehab show season. See? Priorities!)

badage rollIn the long moment I lay sprawled on the concrete, I thought of surgery and an orthopaedic boot. I thought of physical therapy and crutches or a knee scooter. After hobbling inside, I reached for an ACE bandage.

Thankfully, my ankle was badly sprained. But what if it had been broken? My doctor would have prescribed more than an ACE bandage. I would have been referred to a podiatrist or orthopaedic specialist. There could have been surgery and PT afterward. Follow-up visits. Prescription meds.

Even people without medical degrees would have understood: “She broke her ankle. That’s serious, and she needs specialized care.” I don’t think they would have said, “But you could buy a car with what ankle surgery costs!”

So why do complex power wheelchairs so often provoke that comment?

“That’s what a car costs!” people say when they hear the price of a complex rehab power chair. Or when they see two power chairs — the first one with a captain’s seat and no power positioning; the second with tilt, recline, elevating/articulating legrests, advanced suspension, and highly programmable electronics — they call that second chair, the one configured for a client with muscular dystrophy, a “Cadillac.”

They call a chair with sip-and-puff for a client with C3 quadriplegia a Cadillac, too. That metaphor implies that a more complex chair, one that can be reconfigured to keep pace as its user with ALS rapidly progresses, is full of frivolous bells and whistles that are purely luxury items.

Criticizing a complex rehab power chair because it costs more than a standard power chair is as silly as criticizing surgery because it costs more than an ACE bandage. If we were to treat a complex fracture with Advil and ice, what would the outcome likely be? Would we be surprised if later on, the patient needed more expansive surgeries, hospitalizations and therapies because the situation wasn’t handled properly from the start?

There is absolutely a need for standard power chairs, just as there is a need for ACE bandages and ice packs. But comparing standard to complex power chairs purely on price, as if they were equivalent interventions, isn’t just inaccurate. It’s dangerous. Ask anyone who’s had to fight to retain or regain access to complex rehab technology (CRT).

Admittedly, I’ve spent weeks with my foot wrapped and elevated, which has made me crankier than usual (and given me too much time to read sketchy social media posts about Cadillacs). But I am so, so over that tired old metaphor. CRT is medical equipment, and it’s innovation at the highest assistive technology levels. CRT is not a luxury. It’s an utter necessity, worth every penny.


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