Finding the Best Wheelchair for Your Needs
by Jen Mundl
The Assistive Technology
column last month concentrated on what to address when choosing a
mobility aid. This month provides further in-depth information regarding
finding an appropriate mobility aid to meet specific needs.
A wheelchair or mobility aid is medically necessary for individuals
with physical limitations when ambulation is difficult or impossible.
It is a liberator! Most people with a spinal cord injury can get
around as quickly in a wheelchair as someone else can walking. For
an older person with arthritis, a wheelchair can provide access to
the world outside the home. For an active sportsperson, a wheelchair
is the means to participate in marathons, basketball, and tennis.
In some respects, a wheelchair is much like an automobile or a pair
of shoes. It provides the interface between our body and the world
around us.
Selecting the appropriate
chair, however—particularly for
a first-time wheelchair user—can be a bewildering task, due
to the variety of options available. The purpose of this guide is
to provide the reader with general information about wheelchairs,
and to describe the major kinds of wheeled mobility options in the
marketplace today. Finally, if you are newly-injured, you should
work with a physical therapist and vendor who have personal experience
with specific wheelchairs.
Types of Wheelchairs
Wheelchairs
come in many sizes, shapes, and varieties to meet the diverse needs
of a multitude of users with differing levels of physical function
and varying interests. People with considerable upper body strength
often prefer to use a manual wheelchair propelled by arm strength.
Powered Mobility
Powered wheelchairs
come in several basic styles:
• Traditionally they are similar in appearance to the standard
manual wheelchair except for being reinforced to tolerate the added
weight of the motors, batteries control system.
• Platform-model powered chairs consist of a seating platform
atop a powered base.
• Three- and four-wheeled scooters.
People who use powered wheelchairs generally have limited strength
in their arms and need to use an external power source to enable
them to get around. Powered wheelchairs use either a gel cell or
a wet cell battery that must be re-charged on a regular basis. A
powered wheelchair usually is significantly heavier than a manual
wheelchair. This is to accommodate both the weight of the battery
and the weight of additional adaptive equipment that might be needed,
such as body supports or respiratory equipment.
The most traditional design for a powered wheelchair is that of
a reinforced standard-looking wheelchair frame with a battery mounted
under or behind the seat. Another design being used by some manufacturers
today is a more stylized seating unit on a pedestal mounted atop
a power platform. Finally, several manufacturers offer power pack
attachments which allow manual wheelchairs to be converted to powered
chairs.
An alternative to either a
manual or powered wheelchair is a scooter, or three- or four-wheeled
cart. Some people like scooters because they prefer to use a form
of mobility that does not look like a wheelchair. Others use them
because they provide power but often are not as expensive as regular
four-wheeled power wheelchairs. Scooters also have a narrower wheelbase
making them more maneuverable. A scooter operates much like a golf
cart. The user sits in a chair-style seat normally contoured to fit
the body. The scooter is propelled through use of a steering mechanism
located in front of the user, as if s/he were riding a bicycle.
Manual
Wheelchairs
• Lightweight Chairs. The most commonly used everyday
wheelchair for active chair users is a lightweight manual wheelchair.
In a Spokes & Spikes
survey, 20 everyday wheelchairs were reviewed showing average weights
varying 10 pounds to 45 pounds (including wheels).
• Sports Lightweights. Lightweight wheelchairs originally were
developed and sold for use in sports, such as basketball, tennis, and
road racing. In fact, earlier references to lightweight wheelchairs
refer to such chairs as “sports wheelchairs.” As wheelchair
users were exposed to the lighter-weight chairs, however, they began
to realize the “sports” chairs took less energy to propel
and were therefore easier to use on an everyday basis. Chairs designed
specifically for road racing, for example, have only three wheels,
with the front wheel extended out from the body to allow for maximum
use of aerodynamics.
Sports chairs designed for use by tennis players,
basketball players, and other athletes, however, have become the
everyday wheelchair of choice for many non-athletic wheelchair
users who simply prefer the sportier look and comparatively low
weight of a sports chair.
Specialty Wheelchairs
People
who have had their lower limbs amputated may have a different center
of gravity than someone who has a spinal cord injury. A person
who has had a stroke may have use of only one arm and may be unable
to propel a wheelchair by turning the wheels on both sides of the
chair. A person of large stature may require an oversized chair or
one that has been reinforced to handle the additional weight of the
individual. Consequently, there are specialized wheelchair configurations
available to meet almost any individual need.
Nursing Home/Institutional
Wheelchairs
Nursing home residents often
require assistance in mobility. If a nursing home resident is generally
capable of independent mobility, s/he may wish to use a wheelchair
that will allow the fullest measure of independence to be maintained.
Thus, it would be important to select a relatively lightweight chair
that is easy to use. The selection criteria for the chair would be
similar to that used in choosing a chair for a more active user.
Many nursing home residents, however, require considerable assistance
with activities of daily living, including mobility. Wheelchairs
designed for institutional use generally are much less expensive
than chairs for active users. Consequently, it often is more cost
effective to use an inexpensive chair designed for institutional
use if the individual is unable to benefit from the independence
afforded by a more expensive wheelchair designed for active, independent
wheelchair users.
Growth chairs or chairs with growth kits offer an alternative by allowing
adjustments to be made in the existing chair to accommodate a growing
child. This may include utilizing replaceable components or designing
the chair with features that can be converted from a smaller size to
a larger size. Manufacturers are also responding to the needs of children
in having chairs that fit more easily into their environment and social
situations. This may be accomplished with a more streamlined appearance
and/or a selection of upholstery and/or frame colors.
Freedom and Movement
Freedom
to move around one’s environment independently is something
many take for granted. This article introduced several options for
assisted mobility. In most cases, a medical professional will need
to write a letter of medical necessity for a mobility aid to be covered.
Most insurance companies and medical assistance allow for a new wheelchair
every five years. There are many accessories available that should
be included in the preauthorization letter. Consider all needs for
mobility and discuss likes and dislikes with current wheelchair users
and the medical supply vendors.
