Informed Consumer's Guide to Wheelchair Selection
A wheelchair can be a wonderful liberator. Someone 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 the body and the world around it. Like shoes, a proper fit is essential if a person is to maximize her/his potential and feel comfortable moving around in the world; like a car, design factors should take into account one's personal needs and interests.
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. Also included are suggested reading materials that can be used to help determine what kind of wheelchair most accurately meets one's individual needs. Finally, if you are newly- injured, you are probably working with an occupational therapist who may have personal experience with specific wheelchairs. This kind of professional knowledge and experience can also be very helpful in assisting you to select the best chair for you.
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 wheelchair propelled by arm strength, or what is called a manual wheelchair. Some people are unable to propel a wheelchair with their own arm strength and may prefer--or require--a wheelchair powered by batteries. Powered wheelchairs come in several basic styles: The traditional style is similar in appearance to the standard manual wheelchair and has been reinforced to tolerate the added weight of the power and control systems, the platform-model powered chair which consists of a seating platform atop a powered base, a round-based powered chair (Hoveround) which emerged on the market in 1993, and three- and four-wheeled scooters.
Everyday Lightweights. The most commonly used everyday wheelchair for active chair users is a lightweight manual wheelchair. Sports 'n Spokes, a publication dedicated to sports and recreation for wheelers, conducts an annual survey of lightweight wheelchairs. In its 1993 survey, twenty everyday wheelchairs were listed, with weights varying from a low of 12 pounds to a high of 45 pounds (including wheels), depending upon the type of material used for the frame and the configuration of the chair. Some frames alone now weigh as little as under five pounds!
The options available to today's lightweight wheelchair user are many, allowing one to select a wheelchair that meets the individual's functional needs and personal design preferences. Further information is provided under the heading, "The Selection Process."
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, as well.
Sports wheelchairs have continued to become more specialized as wheelchair athletes have become more sophisticated and successful over the years. Most serious athletes have chairs that they use specifically for sports, and separate chairs to use for everyday mobility. 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. Sports chairs listed in the Sports 'n Spokes Lightweight Wheelchair Survey vary from 14 to 25 pounds including wheels.
The most common wheelchair in use prior to the late 1980's was a standard adult wheelchair, a heavy, difficult to maneuver chair, generally available only in an institutional-looking metallic finish. Most standard wheelchairs require a considerable amount of energy to propel, thus making them less practical than a lightweight wheelchair for everyday use for most people.
Because the needs of wheelchair users vary considerably, some individuals require specialized wheelchair designs developed to address their particular needs. People who have had their lower limbs amputated, for example, 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 therefore 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 and easy to use chair. 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.
For a more detailed discussion of the various types of manual wheelchairs, see ABLEDATA Fact Sheet on Manual Wheelchairs.
Because their bodies are growing and changing, choosing chairs for children and adolescents requires consideration of factors not a part of the adult wheelchair selection process. One of these is the frequency with which a chair must be changed or replaced: Because of the high cost of replacing a chair, and because insurance providers often place limitations on the frequency of chair replacement, purchasing a new chair each year can be financially prohibitive, if not impossible. 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. (See also ABLEDATA Fact Sheet on Wheelchairs for Children.)
People who use powered wheelchairs generally have limited strength in their arms, and thus need to use an external power source to enable them to get around. Powered wheelchairs use either gel cell or wet cell batteries that must be re-charged on a regular basis. A powered wheelchair usually is significantly heavier than a manual wheelchair to accommodate both the weight of the battery and the weight of additional adaptive equipment, such as body supports or respiratory equipment.
Today's powered wheelchairs tend to follow one of several design trends. 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. A new design, introduced in 1993, utilizes a round platform base (Hoveround) with a seating system affixed to it. Finally, several manufacturers offer power pack attachments which allow manual wheelchairs to be converted to powered chairs. (For more detailed information, see ABLEDATA Fact Sheet on Powered Wheelchairs.)
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 and overall profile than many wheelchairs, 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. (See the ABLEDATA Fact Sheet on Scooters.)
The Selection Process
The wheelchair selection process includes several distinct steps:
- Deciding the level of assistance necessary.
- Determining how the wheelchair will be used.
- Selecting the appropriate chair that meets all of the needs outlined in the first two steps.
Anyone choosing a wheelchair for the first time should consider working closely with a wheelchair prescriber, such as an occupational or physical therapist, to help determining how much assistance the wheelchair should provide. While some individuals with quadriplegia, for example, can only use powered wheelchairs, others may find that they are able to use a manual wheelchair or a powered scooter. These alternatives generally are less expensive and may more appropriately fit the individual's lifestyle.
It also is important to determine how the wheelchair will be used. Will it be used indoors, outdoors, and during transport in a van or car? Some people keep a manual wheelchair in their homes, but travel to work or other outside activities in a powered scooter. For many manual wheelchair users, the ability to fold a wheelchair or take it apart easily for travelling in a car is of utmost importance.
Once an individual's needs have been determined, the next step is to choose the "right" chair. New wheelchair users may wish to talk with current chair users about their likes and dislikes. There is nothing like practical experience to provide feedback on specific features that may be desirable, as well as those that should be avoided. Prescribers may also be another source of information, since they often receive feedback from previous clients.
Finally, many written resources on wheelchairs are now available (see below), and ABLEDATA, the premier assistive technology information database, provides up-to-date information on products for people with disabilities, and is a good source for information on specific wheelchairs.
Funding for wheelchairs or other assistive devices is dependent upon an individual's eligibility for medical, social services, income support or vocational assistance from any of a number of different resources. The ABLEDATA Informed Consumer's Guide on Funding Assistive Technology is available to answer questions about funding resources.
The American National Standards Institute (ANSI) recently approved a complete set of standards for wheelchairs. These standards consist of standard methods of disclosing information (example: How do you measure the width of a seat? Inside to inside of each tube, or width of a cushion, or what?); and standard test methods to test a chair's strength, "tip-ability," turning radius, and so forth.
Copies of the standards themselves are available from RESNA for $180 for the complete set. The standards consist of eighteen separate parts, such as standards for brakes, test methods to determine the stability of a wheelchair, standard methods to measure wheelchairs, and so forth. These probably would be of interest only to manufacturers and others who are going to conduct testing themselves, as they are very technical documents. However, there are some good summary documents available that describe the standards for therapists and laypeople.
Invacare, one of the largest wheelchair manufacturers in the United States today, recently began advertising that its wheelchairs had been tested according to these standards. It is expected that other manufacturers also will begin using the standards for testing--and advertising this fact to the public--as consumers and therapists begin to ask for this information. Once standards information becomes more readily available, it can be used by consumers and prescribers to make more informed purchasing decisions.
Available from: RESNA, 1700 N. Moore Street, Suite 1540, Arlington, VA 22209. Telephone: 703/524-6686 Price: $180 for the complete set of eighteen standards; $15 for individual standards.
Beginning at the Beginning . . .
This ABLEDATA "Informed Consumer's Guide" is designed as an introduction to the wheelchair selection process. ABLEDATA also offers more detailed information on the specific types of wheelchairs mentioned here in its fact sheets on Powered Wheelchairs, Manual Wheelchairs, Children's Wheelchairs, and Scooters. Individual copies of the Fact Sheets are available from ABLEDATA.
The ABLEDATA database of assistive technology provides information about and descriptions of more than 31,000 products for people with disabilities. Included are all types of wheelchairs currently available in the United States, as well as information about manufacturers and distributors.
Computer users may also search the database themselves and download the search results using the ABLEDATA Web site, http://www.abledata.com.
Resources and Related Reading
Because of the expanding number of options available, several resources have been developed to assist either an individual select his/her own wheelchair, or to assist a health care provider in selecting the appropriate wheelchair for a client or patient.
- How to Select and Use Manual Wheelchairs, A. Bennett Wilson, Rehabilitation
Press, 1993. Available from: Rehabilitation Press, P.O. Box 380, Topping,
VA 23169. Price: $12.50.
Selection of the most appropriate wheelchair and seating system can be simplified if one has information about factors to consider and products on the market. This guide helps new wheelchair users select a wheelchair with the right dimensions and seating system depending upon the degree of disability, goals of the user, and the environment in which the chair will be used. It also provides information about proper use and maintenance of wheelchairs.
- Wheelchairs: A Prescription Guide, A. Bennett Wilson and Samuel R.
McFarland, Rehabilitation Press, 1986. Available from: Rehabilitation Press,
P.O. Box 380, Topping, VA 23169. Price: $14.95.
This small, straightforward publication addresses in clear language the factors to be considered by people responsible for prescribing wheelchairs. It is filled with illustrations and practical suggestions for making prescription decisions. Although intended primarily for prescribers, the information contained in this guide would be of value to an individual selecting a wheelchair for personal use. The information about manufacturers and product availability is slightly dated because of the swift advances that occurred in the wheelchair industry, but the basic concepts presented remain useful, and up-to-date manufacturer information can be obtained through an ABLEDATA product search.
- Choosing a Wheelchair System, Department of Veterans Affairs, 1990.
Available from: Department of Veterans Affairs, Veterans Health Services and
Research Administration, Washington, DC 20420. Ask for the Clinical Supplement
#2, Journal of Rehabilitation Research and Development, March 1990. Price:
The U.S. Department of Veterans Affairs Rehabilitation Research and Development Service (Rehab R&D) several years ago issued a Clinical Supplement entitled "Choosing a Wheelchair System." This resource was written by people with disabilities who have selected wheelchairs for many years; health care providers who prescribe wheelchairs; and researchers/engineers who participate in the development of new wheelchair designs.
- RESNA Video. Available from: RESNA Third-Party Payor Program, 1700 N. Moore
Street, Suite 1540, Arlington, VA 22209. 703/524-6686. Price: $60.00 plus
RESNA, an association for the advancement of assistive technology, recently published a series of videotapes directed primarily toward organizations or individuals that provide funding for assistive technology. One of the videos in this series, a thirty minute tape entitled Manual Mobility: Finding the Right Wheels, discusses the options to be considered for someone purchasing a manual wheelchair.
- Annual Wheelchair Surveys. Available from: PVA Publications, 2111 East Highland
Avenue, Suite 180, Phoenix, AZ 85016-4702. 602/224-0500. Price: Call for price
- Sports 'n Spokes, a bi-monthly publication for active wheelchair
users, publishes an Annual Survey of Lightweight Wheelchairs in their March/April
issue each year. The most recent survey (March/April 1994) includes a description
of how wheelchairs are tested in order to comply with recently-issued American
National Standards Institute (ANSI) standards. Also included are illustrations
of a variety of everyday, sports, and junior-sized lightweight wheelchairs
from different manufacturers; comparative sizing information; warranty information;
delivery time; and retail price. Back issues of the magazine sometimes are
available; so are reprints of specific articles.
- Homecare Magazine and TeamRehab Reports also publish an annual "Wheelchair Focus" that provides similar comparative information. It is published once a year (also in the spring) and can be ordered through Miramar Publishing. Available from: Miramar Publishing, 6133 Bristol Parkway, P.O. Box 3640, Culver City, CA 90231-3640. 800/543-4116 or 213-337-1041. Price: Call for price and availability.