Manual-Wheelchair Basics

Choosing a Chair and Using It

Do It Right!

Most people with spinal cord injury (SCI) use a wheelchair for primary mobility. Although some individuals may have similar injuries and basic needs, they also have unique needs that should be addressed when selecting the proper wheelchair. One of the biggest mistakes is not learning how to select the proper one. Do not simply order off the Internet or from your local vendor.

A Team Approach

Any time you need a wheelchair, selecting it should be a team effort with you as team captain. It is your wheelchair, so it is your responsibility to make choices.

A doctor is your second team member. He or she writes the prescription for your wheelchair that essentially justifies the specific type and options you need. A physical or occupational therapist is another essential team member. Your therapist evaluates your unique needs, suggests the proper equipment to meet them, and provides your doctor with the justification for that equipment.

Finally, you and your therapist need to choose a vendor. A good wheelchair vendor should be able to show you a selection of wheelchairs and answer questions about each one’s pros and cons. Plus, the vendor should be able to suggest wheelchair options and adjustments that best fit your needs.

The Selection Process

You need to be as informed as possible. Search the Internet, read wheelchair reviews, and get as much information as you can.

There are many aspects of your life to consider when selecting a wheelchair, and your therapist and vendor are there to advise you. Your goal is to select the wheelchair that best fits your needs based on your:

Goals. What wheelchair and options can help you best meet your goals?

Overall Health. Consider your posture, body weight, pain type/severity, spasticity severity, bladder and bowel management, and pressure ulcer history.

Function. The proper equipment can often make your life easier and enhance your daily living activities despite limited communication, mobility, strength, range-of-motion, balance, ability to transfer, endurance, and energy level.

Environment. Consider a wheelchair that fits more easily into your environment instead of modifying your living space to fit your wheelchair.

Finances. Chances are you will have to pay at least some portion of the wheelchair’s costs. Always get the most “bang” for your money.

– Transportation. Transferring and lifting the wheelchair into a vehicle are issues for car owners. Power-wheelchair  users usually own vans. People who fly often may prefer an easily collapsible manual chair or a maintenance-free, battery-powered chair.

Caregiver’s role. Most people who need a caregiver use a power chair. Power seat options can often make a caregiver’s job easier.

After you make your wheelchair selection, your therapist and vendor will measure your body. This is important, because any weight or posture changes can greatly impact how the equipment fits your body.

Manual-Wheelchair Types

Manual wheelchairs are user-propelled. This requires users to have good upper-body balance with enough shoulder and arm strength to push hand rims to propel the rear-drive wheels. There are eight types of manual wheelchairs. The lower-end ones are generally big, bulky, and tend to be hard to push and maneuver. Low-end chairs are temporarily used as “loaners” for patients during rehabilitation. People do not usually own low-end wheelchairs unless they are simply unable to afford a better choice. Higher-end types are typically preferred because they are more customized, highly adjustable, and offer a maximum ease of control as well as durability.

The eight types are:

  1. Standard. These wheelchairs are a basic design that has been around for decades. It is not usually tailored to an individual. Instead, it is designed to fit multiple users with a simple sling seat and very limited adjustability.
  2. A standard hemi-wheelchair is for users who require a lower seat height (17–18 inches) because of short stature or to enable them to place their feet on the ground for propulsion.
  3.  A lightweight wheelchair is for people who cannot propel a standard chair in the home but can and do propel a lightweight wheelchair.
  4. A high-strength lightweight wheelchair is for individuals who propel the wheelchair while engaging in frequent activities in the home that cannot be performed in a standard or lightweight chair and/or require a seat width, depth, or height that cannot be accommodated in a standard, lightweight, or hemi-wheelchair, and spends at least two hours per day in the wheelchair.
  5.  An ultralightweight wheelchair is typically for people with paraplegia and quadriplegia who need to adjust the rear axle to get a seat “dump” to improve balance or to propel the wheels.
  6. A heavy-duty wheelchair is for those who weigh more than 250 pounds or have severe spasticity.
  7. An extra-heavy-duty wheelchair is for users who weigh more than 300 pounds.
  8. A tilt-in-space wheelchair can tilt the frame of the wheelchair greater than or equal to 45 degrees from horizontal while maintaining the same back-to-seat angle.

 

Manual-Wheelchair Options

Manual chairs offer various options to help improve users’ independence. Most of these can be fixed or adjustable. Some basic features on most manual chairs include:

Armrests

Wheel Locks

Wheel and Handrim

Casters

Seat/Back Upholstery

Foot Plates

Manual Chair Push-Assist

Push-assist technology bridges the gap between manual and power wheelchairs. It is intended for users who want a manual chair but need assistance in pushing it.

There are currently two types of push-assist devices. One is battery-powered and attaches to the rear wheels. When a user pushes the wheelchair, a sensor monitors the force of the push and helps propel the wheel movement, which reduces the force the user needs to propel the chair.

The second assistive device works much like a two-speed bicycle. The standard rear wheels on the manual wheelchair are replaced by two-geared, battery-free rear wheels. These wheels allow users to shift between gears to make it easier or harder to push the chair, depending on the terrain.

Power Wheelchair

Power (electric) wheelchairs are generally used by people who cannot push a manual chair due to limited upper-body strength. Battery-powered motors propel front-, center-, or rear-wheel drive options. Each drive option has particular handling characteristics. For example, people who primarily use their power chair indoors may prefer the tight turning radius of a center-wheel drive. A rear-wheel drive might be preferred for mostly outdoor use. A front-wheel drive might be better for equal amounts of indoor and outdoor use.

Power-wheelchair components include a seat frame of some sort, armrests, footrests, seat, and seat back. Several control types are available for driving a power chair. A joystick control is most common. Chin, head, or mouthstick (the user sips/puffs into a tube located near the mouth) control can be used by people who are unable to use a joystick due to limited hand or arm movement. Other customized control devices are available if needed.

The controller is also used to operate power seating systems. Four options are available that are intended to improve independence in self-care and daily activities:

A tilt seat frame tilts the user backward in the seated position at an angle to change pressure points in order to help prevent pressure ulcers. Tilting the seat can also improve sitting balance.

– A reclining backrest opens the hip angle for users to lie back for pressure relief, resting, or self-catherization.

– An elevating seat lifts a user in the seated position. Elevating can improve reach and enhance the ability to socially interact on a more eye-to-eye level.

– A standing frame lifts the user from a seated to standing position, offering the pressure relief of tilting and reclining along with the same functionality as the seat elevator. Standing may also improve circulation, bladder function, digestion, and respiration but further research is needed to verify such benefits.

Other potential options include swing-away joystick mounts, environmental control technology (inferred/bluetooth operation through controller),flat-free tires, power leg-rest elevation, frame color, high-speed motors, and suspension.

Specialized Wheelchairs

Today, wheelchair users are demanding wheelchairs that are tailor made for specific sports and recreational activities. You can purchase 4-wheeldrivechairs if you are an outdoorsman. Wheelchairs are designed for individualized sports such as basketball, tennis, or racing. If you have a special interest, chances are you can find one that will maximize performance.

Wheelchair Costs

Your “first” wheelchair is likely going to be paid for by private health insurance, Medicare, Medicaid, or an accident settlement. Some insurance will pay for only one chair in your lifetime. Insurance may pay for the full price of the chair or only a percentage.

Medicare and Medicaid will only pay for a new wheelchair that will make you independent in your home. Some private insurers, Medicare, and Medicaid may purchase a new chair every five years but only if there is evidence that (1) your current chair is damaged beyond repair or (2) your physical condition has changed such that you need a different chair.

Even if you provide justification for all your wheelchair needs, your insurance largely dictates the type chair and options you can get. Each insurance provider has guidelines for the type of chair it will supply based on diagnosis, physical condition, and functional abilities. For example, you may be able to justify a need for an elevating seat, but the payer may still decline to pay for it. This means you may need to pay out of pocket or get an external funding source such as vocational rehab to pay any additional costs.

Insurance payment is made for only one wheelchair at a time. In general costs for manual chairs range from the low end of $500 to the high end of $4,000. Power chairs normally range from $5,000 to $30,000. Backup chairs are denied as not medically necessary, but one month’s rental is covered if a patient-owned chair is being repaired.

Your New Wheelchair

Once your vendor has your new wheelchair, do not simply have it delivered to your home. Instead, meet your vendor and therapist for your wheelchair fitting. This allows them to fine-tune the adjustable aspects to fit your needs. The fitting lets you make sure everything is the way you want it before you take the new chair home.

It is essential that you get a seating evaluation as part of your fitting. Not only are there differences between your old and new wheelchairs, but your body is always changing in weight, shape, and posture. Such changes can put you at higher risk for a pressure ulcer. If you get a seating evaluation each time you get a new wheelchair, you may be able to prevent problems.

Read all the warranty information. Many wheelchairs have lifetime warranties on the frame. Do not try to fix something yourself until you check to see if it is covered by the manufacturer’s warranty.

If you have problems with daily activities or discomfort, see your therapist for a re-evaluation. Minor seating adjustments may be needed.

Take care of your chair! Regular maintenance and care are important. Tightening loose screws can prevent major breakdowns later.

Wheelchair “Lemon Laws”

Many states have a law to protect consumers who buy a new wheelchair that turns out to be a “lemon.” If you purchase a wheelchair, you may get a refund or have the wheelchair replaced if it does not conform to the terms of the written warranty and the manufacturer or authorized dealer is unable to repair it after a reasonable number of attempts during the first year.

Conclusion

Over the years, wheelchair technologies have advanced greatly. Today’s chairs have many options, parts, and accessories to make the equipment more functional for you.

(This article is based on InfoSheet #7, developed by Gayle Benson, PT, and updated by Phil Klebine, MA, and Cathy Carver, PT, MS, APT. Published by the Office of Research Service, 205-934-3283 / 934-4642 (TTD) / www.spinalcord.uab.edu.© 2009 Board of Trustees of the University of Alabama; used by permission.)

 

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