In some ways, choosing a wheelchair is not very different from selecting a microwave oven, refrigerator or a central air conditioning unit. You want it to function as advertised, come equipped with the special features you want or need and be in your price range. However, wheelchairs are different from other consumer products because of the role they play in people’s lives, so it’s important to choose one that takes a host of factors into consideration. Here are some tips on how to buy a wheelchair.
Times are tight and insurance companies are more restrictive about allowing replacement chairs, so choosing one you can live with until the next allowable replacement date is important. Insurers are also starting to require a comprehensive evaluation process before allowing coverage. A thorough evaluation is good for everybody. Users make informed choices which can avoid secondary issues caused by an incompatible chair – like shoulder or pelvic position and pressure problems – and insurance companies are happier about covering their share of wheelchair costs.
Likely sources of insurance include private insurance, Medicare/Medicaid, the Veteran’s Administration or vocational rehabilitation.
If for some reason you don’t meet the insurance criteria for a wheelchair, you might think about purchasing one secondhand. You could pay about 50 percent less than the original price. You also might be able to deduct the expense as an out-of-pocket cost on your taxes, as long as you spend a certain percentage of your income on medical expenses. Speak with a tax attorney to be sure you understand what the threshold is in your state.
If you don’t want to wait for insurance authorization – and if you can afford it – you can make a private pay purchase, which will speed up the process and give you access to a wider selection of wheelchair options. Private pay purchases can often be made at less than the manufacturer’s suggested retail price.
Where and How You Will Use the Wheelchair
Just as you’d bone up on microwave oven makes and models before making a purchase, you should research wheelchair options carefully. That includes giving some serious thought to what your needs are, so you should think about what you do every day, where you go and what the challenges are.
In the home: Start with basic things like getting in the chair and then getting out. Do you know how high the seat is from the floor? What about the height of your bed? Can the chair’s armrests and foot supports be moved out of the way so they don’t obstruct your movement into or out of the chair? What about the width? Will the chair make it through your doorways?
Something else to think about is your floor covering: Is it thick carpet, tile, aluminum or wood? These will impact the speed and ease with which you move around your home.
Around town: Getting around town poses its own of unique challenges. Do you have enough stamina and are your arms and legs strong enough to get you where you want to go? If strength and stamina are issues, you probably want to think about a manual chair with power assist wheels, a powered wheelchair or even a scooter. Scooters are not technically wheelchairs, but they are included in the broader category known as wheeled mobility devices.
Another consideration is terrain – will you have access to sidewalks and, if not, what other vehicles use the road you’ll be traveling on? Cars, trucks, scooters and even bicycles are potential hazards, so you’ll need a wheelchair suitable for a faster pace and crowded conditions.
On the trail or at the mall: If you plan to be a regular on walking trails or at parks, be sure to take note of pathway conditions. Will you be traveling over grass or gravel? If you like to go to the mall, you’ll have access to finished floors and very wide entranceways. Traveling uphill will be more tiring than going downhill, and the downhill journey can be dangerous if you don’t have the arm strength to control the speed. You’ll choose different chairs, tires, wheels and chair bases depending on how and where you plan to spend your time.
Transportation: Transportation options vary depending on where you live, and that’ll influence your choice of device. It’s a lot easier to take a mobility wheelchair on public transportation today – buses and subways are more wheeled mobility-device friendly than ever – but of course, that’s no help if the bus or subway isn’t going your way.
Owning your own car gives you the most flexibility, but there are some factors to consider. You’ll want a wheelchair than can fit into the car, for example. Does the chair fold? Is there room in the trunk to store the chair? If it fits in the trunk, are you then able to get to the car door? Vans or minivans that have been modified to include a ramp or lift are other options, although expensive ones.
Manual: Manual wheelchairs require a fair amount of upper body strength to operate because the occupant must use their arms to spin the large wheels in the back that propel the chair. These chairs are usually constructed of steel or aluminum, generally weigh less than 40 pounds and can support up to 250 pounds.
Using your arms to drive a wheelchair can be great exercise and can improve strength and endurance, but this type of wheelchair is probably not right for someone with breathing issues or high blood pressure.
Heavy-duty manual: Heavy-duty chairs are made of extra-strong steel frames and provide a durable, reliable source of transportation for patients weighing up to 550 pounds.
Lightweight manual: This is a great alternative for someone who has trouble operating a traditional manual chair. They’re usually about 27–35 pounds and don’t require as much effort or strength to move as a traditional, full-sized manual wheelchair.
Ultra-light manual: Ultra-light manual wheelchairs are extremely easy to maneuver. They are made of super strong high-tech composites and fibers, and are excellent choices for very active people.
Manual companion chairs. Companion chairs, also known as attendant or transport chairs, are similar to conventional wheelchairs but with an emphasis on ease of caregiver handling, convenience and short-distance travel. The frame is also similar, constructed around lightweight steel or aluminum tubing with a cloth fabric seat. A big advantage of companion chairs is they are often portable, so they can be folded and easily stored in the back seat or trunk of a car.
A distinguishing feature of companion or transport chairs is the rear wheels, which are much smaller than conventional manual wheelchairs, and sometimes the same size as the front wheels. Since they usually weigh between 15–20 pounds, companion chairs are relatively easy to transport. They are less expensive than traditional manual chairs, with prices that start at less than $100.
Comfort is still important for riders, even though companion chairs are not designed for all-day use. Selecting the right seat is a must for obvious reasons. Most seats are 19 inches wide, although 22 and 24 inches are available. You can add a cushion or pad for additional comfort. Footrests, adjustable seats backs, removable arms, padded armrests, attendant-operated hand brakes, nonskid footplates and back pockets are only some of many other features that are available.
Dependent/transport mobility bases. These are designed to be pushed from behind by a caregiver and often function like a stroller. They are easy to fold for storage in a car or van, and provide mobility similar to that of a lightweight wheelchair. Many people use the transport chair as a backup to their primary chair – easily folded and stored when it’s not needed – but at the ready if your primary chair breaks down.
Specialty positioning bases. These dependent mobility devices allow you to change position by adjusting the seating system, the backrest or both. Although they are not easy to transport, they do provide comfortable, all-day seating for people who cannot self-propel or operate a power wheelchair.
Popping a Wheelie With a Manual Wheelchair
If you’re an active manual wheelchair rider, you’re probably familiar with the art of balancing the chair on the back wheels, which is called doing a wheelie. This skill dramatically improves the rider’s ability to get over curbs and travel across soft, uneven surfaces like grass and gravel without getting stuck. Chairs that have adjustable rear wheels need to be fitted to the rider’s needs so a balance can be struck between having the ability to pop a wheelie and the stability required to prevent the chair from tipping over.
The power chair has evolved greatly from its humble beginning as a manual wheelchair with a motor, battery and joystick added. Today most power chairs have two major components – the power base, which contains the motor, wheels, batteries and control module, and the seat.
Most power wheelchair manufacturers offer rear-wheel, mid-wheel and front-wheel drive chairs. Choose carefully, because the drive placement impacts your comfort and how the chair functions.
For example, front-wheel drive allows for a very tight tuning radius, but it can fishtail and be tough to propel in a straight line, particularly on uneven surfaces. A rear-wheel drive delivers a steady, more stable driving experience, but can be more difficult to operate in tight spaces because it has a larger turning radius. A mid-wheel drive chair has a small turning radius that is great for indoor use, but it’s probably not what you’d want to use outdoors.
The best way to choose a power base that’s best for you is to go for a test drive. Most people quickly realize which drive wheel placement is most comfortable to them.
Scooters are a great power mobility option for people who have trouble walking, and they have the added psychological benefit of not looking like a wheelchair. They usually have three wheels, although four-wheel scooters are also available. Steering is accomplished via a tiller and the seat is mounted on a platform that acts as a footrest.
The three-wheel design has a longer turning radius compared to a traditional wheelchair, so it’s not as convenient for indoor use. Most scooters are equipped with a swivel seat, which makes it easier to move from a sitting to standing position. The scooter is not as stable as a power wheelchair for outdoor use, especially for high-speed turns.
One of the most important factors you should consider when choosing a power wheelchair is your medical condition. While some power chairs can be easily adjusted to accommodate changes in your physical condition, scooters are limited in their adaptability. For example, you have to be able to use the tiller. There are some alternatives (see below), but they’re rare. Also, the ability to change seating options is limited with scooters, which can be a problem if you have poor balance.
Power Wheelchair Seating
Seating options on a power wheelchair start with basic automotive style seats, and then work up to more advanced seating that may tilt, recline and elevate the leg rests. In some cases, they offer features that support standing. Seating that lowers to the floor is available on some models, allowing children to participate in activities with their friends.
There are several factors to consider when thinking about your seating needs. The first is your sitting balance. If your balance is poor, you may need an external support so you can use both hands. The second is your risk for pressure sores. If you are susceptible to sores, you might need to consider a mechanical method of reducing weight off your bottom. In either of these cases, it’s best to work with a health care professional to decide on the best seating option for you.
Most power chairs are equipped with standard steering controls: a joystick or tiller. For people who cannot use them, there are a few alternatives. One of them is Sip ‘n Puff, which requires the rider to literally sip and puff through a straw to control the direction of the chair. Another option, called head arrays, allows head movements to control the chair through a series of switches mounted into the headrest. If you think you need an alternative control system, be sure you’re evaluated by a therapist who specializes in customized assistive-technology solutions.
Recently, a new hybrid technology has become available that bridges the divide between traditional manual and power wheelchairs. Power-assist systems are equipped with the larger rear wheels typically found on manual chairs, but they are battery powered, which increases the number of revolutions they can make with a single push on the rim. Power-assist systems help increase manual wheelchair efficiency while reducing the amount of work the rider must do to put the wheels in motion.
Another benefit is that these add-on power systems are more easily transported than traditional power chairs. However, they do not provide the long-term durability of traditional power chairs.
Common Wheelchair Injuries
If you’re using a wheelchair frequently, even one that has been thoroughly researched and customized for your needs, injuries can still occur. Some of the more common injuries include blisters, abrasions and lacerations, shoulder pain and carpal tunnel syndrome.
1.Blisters, Abrasions and Lacerations
These are not typically defined as injuries, but since about 18 percent of wheelchair users suffer from one of these at any given time, they are included here. Blisters, of course, are due to the constant rubbing of skin against wheelchair parts, and usually results in the collection of fluid, commonly referred to as pus. You can prevent blisters from occurring by using talcum powder or a lubricant such as petroleum jelly to coat and protect against skin irritation. Gloves can also help.
Abrasions are more severe forms of skin irritation. In these cases, layers of skin are actually torn from the body, exposing blood capillaries and causing localized pain or discomfit. Lacerations are defined as wounds where the skin is irregularly torn. Gloves or plastic wheel-guard covers are commonly used protections against these conditions. Other preventive measures include using armrests and changing the wheel cambers to avoid getting fingers caught in the spokes.
2. Carpal Tunnel Syndrome
Spinal cord injuries can place an inordinate amount of stress on the upper body for wheelchair users, increasing the probability of carpal tunnel syndrome. The frequency of transfers, chair propulsion and other upper body stresses are primary causes of carpal tunnel instability. Treating this condition usually involves rest, immobilization and nonsteroidal anti-inflammatories. If the condition worsens despite these treatments, surgery may be necessary.
Studies have shown the incidence of carpal tunnel syndrome is 27 percent at one to ten years after the injury, 54 percent at 11 to 20 years after injury, around 54 percent at 21 to 30 years and 90 percent at 31 years and up from the time of injury. This indicates a need for periodic checkups with your doctor starting at about five years after the injury has occurred.
3. Rotator Cuff Strain/Shoulder Impingement
The shoulder is one of the most mobile and used joints in the human body, and it is one of the most important for wheelchair users who rely on it to transfer in and out of the chair and to propel it. An injury to the rotator cuff can be painful, make it very difficult to operate a wheelchair and may require minor surgery to repair.
Interesting Facts About Wheelchairs in the U.S.
- There currently about 3.3 million wheelchair users, and the number is growing as baby boomers continue to age
- 1.825 million wheelchair users – more than 55 percent of the total – are age 65 or older
- About 98 percent of public transit buses have wheelchair-accessible ramps
- Wheelchair use is growing by about 2 million new users every year
- More than 11 percent of adult wheelchair users have college degrees versus less than 22 percent of the entire adult population
- Great vacation destinations in the U.S. for wheelchair riders include the Skydeck in Chicago, Silverstrand Beach in Coronado, California, and the National Sports Center for the disabled in Winter Park, Colorado
- The top five cities in the U.S. for wheelchair lifestyles are Seattle; Portland, Oregon; Reno, Nevada; Albuquerque, New Mexico; and Denver.
Make the Right Decision
A quality wheelchair can make a big difference for a rider: It can mean the difference between freedom and confinement. It’s also an investment, maybe a big one, especially if you’re on a fixed budget. Therefore, it’s important to do the research and make the best decision for you. Always consult with a health care professional before acquiring a wheelchair.
Visit the Towson Medical Equipment Co. website for more information about choosing a wheelchair that’s right for you.