How to Choose the Right Wheelchair

Picking the right (most suitable) wheelchair is not always an easy thing to do.

Thanks to Mark Hanzel for contributing this article to Hamilton Spinal Injury Lawyers. Mark was rendered paraplegic after being hit on his bicycle 16 years ago in Ottawa. Today he, his wife and 2 kids lives in Austin, Texas and is a speaker and regular contributor to educational publications.

A quick summary from Hamilton spinal cord injury lawyers:

If you thought buying a new vehicle or bicycle pre-injury was difficult, wait until it’s time that you start shopping for a wheelchair! It can be an overwhelming task. It is a purchase you need to definitely research before you buy, consult with experts (your doctor, your occupational therapist, your physical therapist), talk with other people already in wheelchairs, talk with wheelchair retailers and rehab centers. I would highly recommend working with your Hamilton spinal injury lawyer and occupational therapist together to find the perfect fit for you, comfort wise and cost wise.

You are going to have to make your decision for your primary chair by process of elimination in some ways. You may acquire additional specialty wheelchairs over time for different purposes – for example, what is your need for your wheelchair: Permanent or temporary? How is your upper body strength? Are you a paraplegic or quadriplegic? Do you need to look at weight or size restrictions? Do you want to buy new or used?

Keep in mind that this is a very expensive purchase that must last spinal cord injury victims for many years. Your insurance or accident benefits carrier won’t be overly excited to pay for a new one on a regular basis.  Also remember – your needs in wheelchairs will change over time. Most wheelchairs, like everything else, have a limited lifespan.  Wheelchairs are very expensive because they must be custom manufactured from specialty materials such as titanium. Each individual requiring a wheelchair needs to be measured and it is very important to be sure to purchase a wheelchair that fits you. In order to help you with your purchase, I have put together extensive checklists below.

Wheelchair Accessories

One accessory you must purchase when you purchase a wheelchair is a wheelchair cushion. Many different types and styles are available. Each different type of cushion has its advantages and disadvantages. You will have to figure out what works best for you in terms of postural support, your skin condition, your mobility requirments, your height and your weight. Wheelchair cushions, no matter if foam, gel or air floatation,  increase sitting comfort will help prevent pressure sores. It is also possible to purchase additional optional accessories for wheelchairs like bags, backpacks, trays, cup holders, etc.

New or Used?

You can purchase a brand new wheelchair or you can purchase a used chair. If you purchase a new chair, you will most likely be purchasing it through a medical supply store or similar retail store. Many people actually now buy their wheelchairs off the internet. The disadvantages to purchasing a wheelchair you cannot see before you buy are that it may not fit you, it may have something wrong with it you could not tell because you could not personally inspect it before purchase. You may not get exactly what you paid for. You may not get your purchase at all. If you purchase a new wheelchair off the Internet, make sure you buy it from a reputable Canadian accessibility and mobility store.

Different Types of Wheelchairs – What’s best for you?

There are several different types of wheelchairs:

1. Standard Manual Wheelchairs: for use less than four hours a day.

2. Lightweight Wheelchairs: for use with air, cruise, train, or ground transportation
3. Transport Wheelchairs: for use to transport someone to and from the house or around the mall.
4. Extra Wide/Heavy Duty Wheelchairs: for use with large or obese individuals
5. Shower Wheelchairs: for use during personal hygiene care and made of rust- free materials
6. Reclining Wheelchairs: for use as a more comfortable chair or for more specialized needs such as for individuals who cannot pressure release manually
7. Pediatric Wheelchairs: for use by children, young adults, or very small adults
8. Power Wheelchairs: specialized wheelchairs operated by battery power with some form of controller operated by the wheelchair occupant
9. Standing Wheelchairs: very specialized wheelchairs that allow the occupant to stand up
10. Scooters: small specialized powered transport devices used best inside and around the home
11. Dedicated Specialty Sports Wheelchairs: specialized lightweight manual wheelchairs for individuals to participate in wheelchair sports such as basketball and
12. Specialized Outdoor Sports Wheelchairs: specialized manual wheelchairs for individuals to use on all terrains for sports such as hunting or fishing

Wheelchair and the Home

Wheelchairs are like cars in one way. They require routine maintenance and they do break down. I found a general set of issues to consider in the selection of a wheelchair by Diability awareness speaker Gary Karp, who has written many books on spinal cord injury and related issues:

1. How wide are your doors—main entry, kitchen, bedrooms, bathrooms, etc.?
2. Are there tight angles to negotiate, such as a hallway that turns sharply at the bedroom door?
3. How large is the bathroom? Will it be possible to wheel your chair alongside the bathtub, or must you face it directly? Is the door smaller than the others in your house? Will you be able to close the door once inside with your wheelchair?
4. What is the knee clearance of the tables and desks you will deal with at home and at work if you work?
5. How high are cabinets and shelves you might need to reach?
6. Is the terrain around your home paved? If not, what kind of surface is it? Is it level?
7. What are the surfaces where you will do most of your wheeling? Carpet, tile, concrete, packed soil?
8. If you drive, do you have a car, or a van? Two or four doors?
9. What is the size of the trunk in the family car?
10. What kind of public transportation might you use?
11. What kind of hobbies or activities do you participate in that might affect the type of chair you use?
12. If you like to “hang out” at your best friend’s house, can you fit through those doors?
13. Is the appearance of your chair important to you or are you only interested in functionality? Do you want something sporty? Eye-catching?
14. What is your preferred level of exercise? Do you get lots of exercise or are you less inclined to exercise?

Manual Wheelchairs

One consideration in the selection of a manual wheelchair is who will be propelling the chair. Is the injured person going to be propelling the chair or is the person going to have someone pushing the chair all the time? This is a major factor in the choice of a manual chair. Chairs that the injured person will propel have very large wheels in the back of the wheelchair and small wheels in the front. Chairs that another person typically propels have four small wheels.  In selcting a manual wheelchair, consider the following:

1. What is the frame type? –  Rigid or folding frame. Rigid frames cannot be folded. Folding frames can obviously be folded.
2. How is the upholstery? – You must consider the type of upholstery you want on the wheelchair. Bear in mind you may be dealing with extreme heat, extreme cold, rain, snow in Hamilton, and everything in-between.

3. How is the braking systems? –  Braking systems on manual wheelchairs consist of stopping the back wheels with your hands. However, there are different types of parking brakes.
4. There are different types of wheelchair tires now: sold tires, semi-pneumatic tires, and radial tires. There are also mag wheels and off road wheels. All wheels other than what is standard with a particular chair come with extra cost.
5. Consider the Casters: Casters in front vary in size and composition (pneumatic, sold rubber, plastic, or a combination).
6. Footrests: Footrests can be incorporated into the frame of the chair as part of the design or they can swivel, flip up, or be removed.
7. Armrests: Some wheelchairs have no armrests. Armrests are helpful if the person has difficulty with upper body balance while seated. Armrests are an important consideration when dealing with the height of counters, desks, and tables.

Manual Wheelchairs – Steering and Pushing

The strength in your upper body is something you will have to build up over time. It is important to use proper pushing techniques because using a manual wheelchair puts abnormal stress on your wrists, arms, and shoulders. This can lead to carpal tunnel syndrome in the wrists and elbow and shoulder joints wearing out. To learn the proper technique for pushing a manual wheelchair, talk to your rehabilitation hospital.

Power Assist Wheelchairs

These wheelchairs still have to be moved by hand. The power assist feature is controlled by a joystick and is used for going up a hill and for additional braking down a hill. The drawback to these wheelchairs is the batteries are even more expensive than batteries for power chairs and have about half the charge range, meaning  they need to be recharged more often. Powered wheelchairs are the way to go for the quadriplegic or tetraplegic spinal cord injury survivor who does not have sufficient control or strength in the upper body for a manual chair. Many advances have been made in powered wheelchairs in recent years.  Here is a quick list of the some of the variety of choices available in powered wheelchairs:

1. Rear Wheel Drive: power is behind the person so the person feels as if he or she is being pushed from behind.

2. Front Wheel Drive: power is in front of the person so the person feels as if he or she is being pulled from the front.
   3. Mid Wheel Drive: power is under the person. This option has the smallest turning radius. I have also had front wheel drive recommended to me for small turning radius.
3. Retracting or Stationary Armrests
4. Foot Plate Options
5. Front Casters Tires
6. Manual or Power Lift, Recline, or Both
   8.  Manual or Power Elevating Leg Rests.

The controller on a powered wheelchair is an important consideration. A joystick is the typical method of operating a powered wheelchair. If the spinal cord injury survivor does not have sufficient use of his or her arms then another form of controller must be used. Swing away joystick controllers are also available and are better for some situations. Wheelchairs can be controlled through a sipping or puffing breathing system, a system of switches built into the headrest, or by means of a switch and scanner so that a finger tap or toe tap can be used to control movement.

Considerations when Purchasing a Wheelchair

There are several general considerations in the purchase of a powered wheelchair:

1. Where will I be using the wheelchair? Will it be used indoors or outdoors? If the wheelchair will be used outdoors, will there be rough or uneven ground?
2. What is the turning radius of the wheelchair? Will this work in my home?
3. Does the wheelchair have a weight limit?
4. Does the chair accommodate a tilt system?
5. Can I operate the joystick and turn the wheelchair on and off?
6. Will the chair accommodate other types of controls (head control or single switch)?
7. Can I mount a seating system on the wheelchair?
8. Can you modify the wheelchair?  If you are buying a used wheelchair, check with the manufacturer to learn if you can modify the chair at a later date. (The electronics may not be current to be able to install alternative controllers).
9. Can the chair be modofied with different controllers?  If the wheelchair will be used by a child or a person with a condition that will deteriorate, make sure to ask if the chair can be modified accordingly with different controllers or other options.

Conclusion

Over the years and in support groups (yes…I am still in support group meetings) I have heard and read that many people are very frustrated because they have found “the perfect chair” for their needs and they cannot get their insurance company of accident benefits to pay for it. Many provinces have grant programs to assist with paying for wheelchairs. If you can find a local spinal cord injury support group in Hamilton, someone there may also know of other funding programs. Also check with the professionals at the Hamilton Regional Rehabilitation Centre.

Wheelchairs are one of the most common frustrations I have heard discussed in my support group meetings people complain they cannot get their chairs properly repaired or parts of the chair wore out before they thought was a reasonable time.  For any wheelchair you purchase new, the quality and availability of customer service is very important. Talk with retailers, people who have been in chairs for many years, and anyone else you can find to learn about the customer service of the company’s product(s) you are interested in. Someone years ago shared this wheelchair checklist great in helping me get a proper fit into a wheelchair:

1. Your feet are flat on the footrests.
2. Your elbows are comfortably bent on the armrests.
3. Your thighs are parallel with your seat or slightly higher.
4. Your knees are comfortably bent at the edge of the seat.
5. You have a half-inch breathing room between your hips and the sides of the wheelchair.
6. Your bottom is flush with the seat angle of your chair.
7. You are sitting in a balanced position. This doesn’t mean heads up and stomach in, but rather a position where your knees are slightly high and bent and your head is slightly down. This provides better trunk control, reaching ability, and coordination. But make sure you keep up your strengthening exercises, particularly the muscles of the shoulders, girth, neck, and legs. And keep on pressure relieving.
8. Your brakes, control panel, and on/off switches [if you have the latter two] are easy to reach.
9. You can maneuver easily in your chair and can stop when you have to.
10. You feel comfortable.

The above lists are by no means exhaustive. Good luck in finding a chair that fits you comfortably! Buying a wheelchair is an expensive investment and it’s important to no doubt find the right chair that meets your needs and requirements. Expect to pay anywhere from $500.00 to $1000.00 for a good manual wheelchair, and from $3500 to $10,000.00 for a good power wheelchair.  Lso expect to pay anywhere from $50.00 to $100.00 for good cushions, whether air, gel or foam.

I hope this article was informative and I wish you the best of luck finding your suitable wheelchair. Purchasing a suitable wheelchair will no doubt lead to dramatic improvements in your mobility, independence and overall quality of life. Try your best to pick the right one!

*This information has been obtained from our experience and knowledge of spinal cord injury law as well as Medical Peer Reviewed Journals and Medical Studies from SCIRE (Spinal Cord Injury Research Evidence)