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Vol. 5, No 3 May/June 1997 |
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The “Wheel Deal”:
Wheelchair Considerations
(Part I)
Nancy Chipman Ranalli, PT
Chief Physical Therapist
Easter Seal Rehabilitation Center
Wheelchairs and seating systems are some of the most expensive purchases of durable medical equipment a consumer may make. In these times of decreasing insurance coverage for equipment, it is important that the wheelchair serve the needs of the consumer for several years, barring any major changes in the person’s physical status or need to transition from a manual to a power wheelchair. One way to be sure the equipment is appropriate is to have a thorough assessment by qualified professionals, (physical therapist, occupational therapist, rehabilitation engineer) who are able to assist with the decision-making process.
There are many aspects of the wheelchair and seating system to consider. A few of the more common items are outlined in the following article. In addition to the physical aspects of the components and chair specifications, other questions should be answered before the wheelchair is ordered. Information about how the chair will be transported, how the consumer will transfer into/out of the wheelchair, how the chair will be maneuvered in the home/community, and whether the home/worksite is accessible to the particular equipment are important considerations.
POWER VS. MANUAL WHEELCHAIRS
Whether a power or a manual wheelchair is chosen depends upon the needs and abilities of the consumer. Manual wheelchairs are most often prescribed for someone who is unable to walk functional distances and can either use his/her arms to propel the wheelchair, or is unable to independently drive a power wheelchair. Power wheelchairs are often recommended for those who are unable to propel a manual wheelchair for functional distances, but are able to safely and independently drive a power wheelchair. Various forms of joysticks can be set up to allow a person with minimal movement of the arm/hand to independently maneuver a power wheelchair. Three or four-wheeled scooters are another option that some people choose.
TILT-IN-SPACE VS. RECLINE
Some people who use wheelchairs require assistance to change position in the wheelchair to prevent pressure sores. Tilt-in-space and reclining wheelchairs are two methods that can accomplish this goals. In a tilt-in-space wheelchair, the user is able to maintain the proper seated position, while the entire seat is tilted back on the frame to change the person’s orientation in space. It is similar to leaning the wheelchair back on the antitippers (“wheelie bars”) for pressure relief, but much easier on the consumer or caregiver. A reclining wheelchair is one in which the back reclines so that the person moves from a sitting position to more of a reclining position, much like what happens in a recliner at home. There are advantages and disadvantages to both type of systems, so if pressure relief is a concern, be sure to discuss these options fully during the evaluation. Tilt-in-space and recline are available on manual or power wheelchairs, and can be operated either mechanically or manually.
WHEELCHAIR COMPONENTS
Besides the type of chair, each chair comes with a variety of options. When you finish ordering a wheelchair, you may feel like you just ordered a new car! The rear wheels and casters (front wheels) can be air-filled (as with a bicycle tire), solid, or air with a solid filler. Air tires (pneumatic) tend to give a more comfortable ride, but require more maintenance than solid tires. It is also important to note that the rear tires and casters do not need to be the same type of tire. Each type of tire has its advantages and disadvantages, so be sure to discuss the tire selection during the evaluation.
The arm rests and leg rests are other components that can be variable. The armrests can be adjustable height or fixed height, removable or fixed, or desk-length or full-length. Generally, removable armrests are recommended because they allow the most flexibility with transfers. Desk-length arms will allow the consumer to get closer to desks/table, but full-length arms will provide more support for a person’s arms or for a lap tray. The legrest can be swing-away, removable or fixed, elevating or standard, and the hanger angle can be 70, 80 or 90 degrees. Swing-away legrests can swing to the side and/or be removed to allow for easier transfers. The angle at which the footrests hang should be considered especially when there are restrictions in range of motion, or when tone/spasms present a problem. For most consumers, a 70 degree legrest hanger is appropriate.
TRANSFERS
Another concern when ordering a chair for the first time, or a replacement for a current wheelchair, is the ease of either maintaining or improving the current method of transferring. For example, if the wheelchair/seating system being considered provides total positioning and tilt-in-space ability, can the caregivers still easily and safely transfer the consumer, or do the new components interfere with the transfer process? In another scenario, now that the legrests and armrests are removable, are transfers made easier, and more independently?
ACCESSIBILITY
Finally, the ease of maneuvering the wheelchair into and within the home, relatives’/friends’ homes, school or work needs to be considered. If the wheelchair is going to be larger or longer, will it still fit in the bathroom, bedroom, or hallways? If the change has been from a manual wheelchair to a power wheelchair, is there room to maneuver it safely? Is there a ramp to allow access into the building?
This article touched on only a few of the many options available when ordering a new wheelchair. Although there are many decisions to be made regarding the wheelchair purchase, and the evaluation may take quite a while, it is in the consumer’s best interest to take this time in the initial stages to insure that the most appropriate wheelchair is purchased and to prevent problems with the wheelchair once it is delivered. Getting assistance from professionals who understand wheelchairs, as well as seating and positioning, will allow the consumer to make more informed decisions and to order a wheelchair that meets all of his/her needs.
Part II of this article will appear in the July/Aug issue of the AT Messenger.
