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

(This is the second article that presents different aspects of "Selecting a Wheelchair.")

The purpose of a wheelchair is to increase mobility-allowing a person to move from place to place with greater ease-and to improve quality of life, permitting a person to be more independent. In Part I of this series, we indicated that, after determining how someone will use a wheelchair, the process of selecting a wheelchair begins with choosing a supplier. With that understanding, let us take a step back and consider some of the questions you might ask when determining how you or someone close to you will use a wheelchair. Here are some obvious questions; they should help you formulate other questions based on your unique circumstances.

1.  Will the wheelchair be used indoors, around the home or in a convalescent center; or will it be used at work, a place of employment, or will it be used in a variety of settings as the person's primary means of mobility?
2.  Does the intended user have sufficient upper body strength and hand control to move from place to place without assistance, or should a power wheelchair or scooter be considered?
3.  If the wheelchair is to be used in different settings, how will it be transported from one location to another and who will lift it in and out of the transport vehicle; or must a ramped vehicle or some alternative means for getting it into and out of the vehicle be considered?
4.  Are the hallways and doorways of the home wide enough to accommodate a wheelchair or must the living space be redesigned?
5.  Is the wheelchair user able to transfer independently from the wheelchair to other types of seating--an automobile, bed, and a commode/toilet--or will the user require assistance?
6.  Will the wheelchair user be seated in the wheelchair when eating meals or working at a desk?
7.  Is the wheelchair user's balance something that must be considered, i.e., a person who is a bilateral above-the-knee amputee needs a different chair than one who is a L1-2 paraplegic?
8.  Does the height and/or weight of the wheelchair user necessitate special consideration?
9.  Are there special seating needs-cushions, body positioning and/or support, etc. -and are there possible areas of concern because of skin integrity or incontinence?
10.  Who will pay for the wheelchair and what limitations do that impose?

These and other questions will determine which of the following components and configurations will be most appropriate for the prospective wheelchair user. Therefore, while the physician's prescription may read "One manual wheelchair for Patient X," buying a wheelchair off the showroom floor is likely to be a mistake, leading to disappointment and dissatisfaction. That's why selecting the supplier is so important.

The choices to be made about each wheelchair include:

1) The Frame - Things to consider: Weight and height of the prospective user; corrosion resistance; chair weight and durability; and workmanship-check the weld joints and fastenings. Note: There are two types of frames, the cross-brace that lets you fold the chair for storage or transport and the rigid where the frame is a solid piece and the wheels are removed for storage or transport. If you choose a cross-brace chair, and most of you will, make sure it opens and closes with ease.

2) Upholstery - The two questions I always ask about the upholstery are: 1) does it breathe and 2) is it washable? Also, this is one place you can customize a piece of durable medical equipment, making it a reflection of the user by selecting a color that makes a statement about who you are and how you want to be seen by others.

3) Brakes - In practice, the "braking" of a manual wheelchair is done by the user applying pressure to the wheel rims, dragging one or both feet, or a combination of these efforts-whatever works. Parking brakes lock the chair in position when the user does not want to move. Parking brakes should be selected and positioned for ease of use by the person in the chair.

4) Wheels/Tires - Most wheelchairs are four-wheel vehicles--two large wheels (usually 24") that are fixed and equipped with push rims, and two small wheels that rotate freely. Whether the large wheels are in the rear (the most usual configuration) or in the front, is determined by the needs, i.e., balance, of the user. Recently we have seen a three-wheel vehicle, used in sporting events, in which the two small wheels are replaced by a single caster centered beneath the footrests. Some manufacturers offer pneumatic, solid rubber, radial, and other types of tires, as well a variety of wheels for specific uses, usually sports related.

5) Footrests - As with the other components of a wheelchair, there are a variety of footrests which are available depending on the needs of the user. These include: fixed or rigid (not recommended), elevating, swing away, and removable. Check on the ease of adjusting and otherwise working with the footrests on the chairs you are considering before making a final selection.

6) Armrests - Like footrests, there are a number of designs and configurations to consider, depending on the physical condition of the user and the way in which the chair will be used. Most are removable, which makes transferring and transporting easier. Also, many wheelchairs come with step-down armrests which permit the user to get close to a table or a desk. If one has step-down armrests and wants to use a lap board, simply turn the armrests around so the step is toward the back of the chair and the higher portion is toward the front. In addition, there are at least two types of swing-away designs. The upholstery and padding of the armrests are critical to wheelchair comfort. If needed, one can obtain sheepskin covers for the armrests which adds to the comfort.

7) Manual or Motorized - In some instances it would be advantageous for the user to have both a manual and a motorized chair. However, in today's cost containment-dominated care environment, most payers will approve one or the other. In addition, the medical profession will often discourage purchase of a motorized chair, feeling that without the physical effort required to use the manual chair the patient's strength and physical well-being will deteriorate. There are good arguments on both sides, which we note as we move on. The motorized chair or scooter is the topic for another article.

8) Accessories - this will be discussed in Selecting A Wheelchair - Part III

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For further information about selecting a wheelchair, access the following Web sites: 

http://www.abledata.com (Search for "Product Type." Look for "Wheeled Mobility.")

http://www.spinlife.com

or refer to:

Choosing a Wheelchair: A Guide for Optimal Independence, © 1998, by Gary Karp, published by O'Reilly & Associates, Inc., 101 Morris Street, Sebastopol, CA 95472.

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This is an edited version of an article submitted to the Partnership to Preserve Independent Living for Seniors and Persons with Disabilities on July 3, 2000, for publication in the Summer Issue (Volume 9, Number 1) of Meeting the Challenge Quarterly.

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