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 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.
• 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.
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.