By LeRoy Wm. Nattress, Jr., Ph.D.

(This is the first of three articles that will present different aspects of "Selecting a Wheelchair." In the next issue we will consider wheelchair use and some of the options available that will make your chair more user friendly.)

Independence, the ability to move from place to place on one's own, is a basic human need, desire, something that motivates us. We see this in the lengths taken by a young couple choosing a stroller for their first child, by a child working hard to be worthy of his/her first bike, by the adolescent striving to meet the requirements of a driver's license and earning the right to drive the family car, or a young adult saving his/her hard earned money to buy "wheels" whether it be a car, a motorcycle, or . . . . . These are recognized rights of passage in society as we know and have experienced it. "Wheels" are both fascinating and liberating. They mark the transitions between infancy and childhood, childhood and adolescence, adolescence and adulthood in a society where more formal, ceremonial transitions generally do not exist. They are signs of our maturing, being ready and able to accept new and added responsibilities. "Wheels" are a part of who we are.

As we mature, there comes a time when we are faced with a decision about another set of wheels, wheels which markedly change how we see others, move from place to place, and are viewed by the public. That decision often is not of our choosing, but one forced upon us by circumstances we did not intend. It is the decision to stop struggling to walk, choosing instead to use a wheelchair. Certainly, it is not what we planned, but it is something that permits a level of independence. Note: I will not use the phrase "confined to a wheelchair" or the term "wheelchair bound." A wheelchair is an enabling, not a confining, piece of Durable Medical Equipment (DME).

That said, when faced with a decision to obtain a wheelchair, where should you start? A magazine? A catalog? A showroom? A hospital? A rehabilitation center? Another person who is a wheelchair user? A healthcare professional?

When asked to address the issues surrounding Selecting a Wheelchair a few years ago, I accepted without question having been involved in buying a number of wheelchairs during the past twenty-plus years. However, as I began to research the topic I found that my experience was the exception. I knew what was wanted/needed and where to buy it. For the inexperienced, Selecting a Wheelchair can be a complicated series of decisions.

To begin with, you as a person who will come to depend on it must have a clear idea about how you intend to use a wheelchair. What do you want to accomplish that will be done more easily from a wheelchair? Equally important, what obstacles do you foresee if a wheelchair is part of your life?

Determining how you will use a wheelchair starts with the prescription process. A physician must sign a prescription authorizing your purchase of a wheelchair. Ideally, however, that prescription should be the work of a team of healthcare professionals, including one or more of the following: physical therapist, occupational therapist, seating specialist, and rehabilitation engineer. Each of these professionals will examine you. In the process, they should ask a lot of questions as together you and they work to determine the best type of wheelchair for you.

At the same time, you must find out about the limits of your insurance coverage in relation to the purchase of a wheelchair. As an aside, if you know what you need in a wheelchair, you must become your own advocate to make sure your needs are met--don't let the bureaucracy increase your disability.

The most important decision comes next as you set out to choose where you will buy your wheelchair. Your insurance company will likely refer you to a supplier that's a Preferred Provider. You will want to visit that company, but you should also obtain a list of all of the companies that are on your insurance company's approved list so you can make an informed choice.

As you visit different suppliers, recognize that those who sell wheelchairs, unlike the other healthcare professionals who have worked with you, are not required to meet educational or experience standards--in other words, anyone can open a business and begin selling wheelchairs. This is of particular concern in a competitive market where price is often the determining factor in what your insurance company will approve. What follows are some questions you should find answers to when deciding about doing business with a specific supplier:

1.  Does the supplier have a presence in the community that indicates stability and permanence? Not only should the facility be well kept, wheelchairs should be a prominent part of the business, not a sideline. Also, is the supplier a member of the local Chamber of Commerce and the owner/manager a member of one of the local service clubs, i.e., Rotary, Lions, Kiwanis, etc.? Answers to these questions will not assure competence, but do indicate a measure of credibility.
2.  Do members of the supplier's staff have experience with wheelchairs and have they completed formal training in fitting and servicing wheelchairs? Ask about the specific training and years of experience staff members have had in wheelchair design, options, fitting, and servicing. Also, look for certificates on display that indicate the type and recency of the staff's training. Above all, does the person who will work with you give you a feeling of confidence and competence. Use that sixth sense--intuition.
3.  Is the supplier a member of AAH (the American Association for Homecare) and/or its local affiliate; in California that is either the California Association of Medical Product Suppliers or the California Association for Health Services at Home? This is a sign of the company's commitment to the field. However, membership in these organizations does not indicate that a standard of competence or excellence has been met. Keep in mind the stated purpose of AAHomecare is "to support the passage of essential legislative and regulatory policy, that creates a fair economic environment for providers."
4.  Does the supplier have equipment in stock--an inventory--and will he allow you to try out different chairs, even bring them to your home to determine which one best meets your needs? Take your time--selecting the right wheelchair is every bit as important as selecting an automobile and every car dealer I know will allow you to take a test drive.
5.  Is the supplier able to service and repair wheelchairs on the premises and are "loaner" chairs available if yours is out of service? Since you must depend on your wheelchair to accomplish day-to-day activities, you cannot be without your chair if and when it breaks down. Therefore, the ability to repair a wheelchair locally is essential as is the availability of a "loaner" in case of an emergency. Also, an in-house service department is another indication of the stability and commitment of the supplier to the community.
6.  Does the supplier represent more than one manufacturer? In making a selection, you are looking for choices. This includes not only the variety of designs and options offered by one manufacturer, but also variations made available by competing manufacturers. A supplier who represents only one manufacturer usually does not have the variety of chairs you should have to choose from.
7.  Does the supplier listen to what it is that you, the consumer, want/need in a wheelchair? Yes, you have a prescription for a wheelchair, but you must decide which wheelchair best meets your needs. The supplier should be your guide in making this choice. A major part of such guidance is answering questions and listening to your concerns. The decision you make will affect the quality of your life for years to come. The emphasis is on listening!
8.  In what ways will the supplier stand behind the products he sells? What about warrantees? Watch out for verbal promises and only rely on what is written. In saying this, make sure you read the small print and do not sign anything you do not understand!

Interestingly, in visiting three suppliers to check the accuracy of information in this article, I found, to my surprise, that none of them provided more than a bill of sale and an "Owner's Operator and Maintenance Manual." The manual included both a "Safety Summary" and a "Limited Warrantee." Both should be read carefully before accepting (signing for) delivery of your wheelchair.

There are three statements I have found in contracts that make me uncomfortable. They are:

•  I acknowledge receiving full instruction and have demonstrated my understanding in the proper use, operation, and care of the equipment and/or supplies that have been delivered to me and described above.
  Do not sign a contract containing this statement unless you have been thoroughly trained in the care and use of the wheelchair in question.
•  Any modifications or accessories other than those provided by the manufacturer are at the customers own risk.
  Do not sign a contact containing this statement as any accessory you add to your wheelchair that is not in the manufacturer's catalog may cancel your limited warrantee.
•  Any warrantees from the manufacturer should be taken directly to the manufacturer. We do not back any manufacturer claims as to the quality of the product.
  Do not sign a contract containing this statement as it absolves the local supplier from any responsibility for the wheelchair he is selling you.

Finally, if you are offered a deal that sounds too good to be true, it probably is!

(This article is an updated version of one first printed in Meeting the Challenge Quarterly, (Volume 8, Number 3), Winter 1999, published by the Partnership to Preserve Independent Living for Seniors and Persons with Disabilities, Riverside County, CA)

Dr. Nattress is Senior Program Director, Community Health Systems, Inc., and Executive Director, The Amputee Information Exchange, Inc.