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Wheelchair 101 - wheelchairs
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Wheelchair 101

By November 20, 2016Uncategorized

self-propelled-wheelchairWheelchair Basics

People aren’t “confined” to their wheelchairs. In fact, their wheels actually liberate them. A paralyzed individual can get around just as fast in a wheelchair as anyone else can who is able to walk. Wheelchairs provide people with access to shopping and working as well as any other traveling outside of their homes.

A wheelchair in some ways is like a bike: there are many styles and designs to choose from including racing models, lightweights and imports. The chair is similar to a pair of shoes as well – there are distinctive styles for specialized purposes like rugged trail use or tennis. If it isn’t the right fit, then the user won’t be able to achieve maximum function or get completely comfortable.

Choosing the right chair can be quite confusing, particularly for those who are using a wheelchair for the first time. Working with an occupational therapist (OT) with extensive experience with different types of wheelchairs is always a good idea.

Many individuals select their first wheelchair based on the fact that it was the one that their insurance company said they would pay for. However, the second one is frequently chosen based on its performance, styling and other features preferred by the user.

Manual Wheelchairs

Typically individuals who have upper body strength use a manual chair. Of course it gets propelled by the user pushing his or her arms forward while their hands are gripping the wheel rims.

Just over one generation ago, a standard wheelchair was a chrome-plated giant weighing more than 50 pounds. Today’s standard wheel chair weighs half that or less and is available in every color imaginable.

The modern chair has been designed to provide superior performance – today’s chair is a lot easier to push and rides truer than yesteryear’s clunkers. The lightweights, whether a folding frame or rigid frame, are also much easier to lift into and out of a vehicle.

In general, a rigid frame (one that doesn’t fold up) will transfer more of the energy of a rider into forward motion compared to a folding unit. However, the main advantage provided by a folding chair is its portability; there are some folding units that will even fit in an airplane’s overhead bin.

Chair makers in recent years have added on a suspension system as an extra option, which considerably smooths the ride. The trade-off for this improvement in ride quality is a higher price and weight (a couple of pounds are added by the shocks).

Aftermarket products (such as Frog Legs) are available as well for providing the front forks with added suspension. They are quite popular and Medicare has approved them for reimbursement. Another important innovation has been utilizing super-light titanium for wheelchair frames. It is better for one’s shoulders when the wheelchair is light. The leader is in the U.S. is Ti.

There are many different options for tires and wheels as well, including innovations for high style, off-road traction and performance. The company Spinergy has developed a higher performance wheelchair rim line. They stay true and are lightweight. Recently the company introduced an innovative push rim. FlexRim, which is a kind of soft rubber, provides a bridge between the tire and rim, which allows for a low impact, easier push that helps to protect the arms and hands from impact.

Alternatives for propulsion: It isn’t necessary to push the wheel rim in order to make your chair go. The market also has a few lever-driver chairs that are available. They claim that your shoulders won’t get damaged the way they might when pushing a standard rim.

The quick-release rear wheels on manual wheelchairs can be replaced with the Pivot Dual Lever Drive. The Pivot has comes with five effort levels.

The Wijit Wheelchair allows the user to push half that they normally would when a conventional wheelchair is used.

Power Chairs

An individual who is unable push might need to have a scooter or wheelchair that is powered by batteries and and electric motor and controlled with a joystick.

There are several basic styles of power chairs. The traditional style has the appearance of a standard issue wheelchair that has been beefed up, in addition to the extra bulk from the control and motor systems as well as the batteries. There are platform-model power chairs available as well that have a captain’s chair or ordinary-looking seat on top of the power base. When it comes to scooters, they are available in four- and three-wheel configurations, and are mostly used by individuals not needing them on a full-time basis.

Twenty or so years ago the power chair market only had a couple of models and brands available. The choices have been expanded due to innovation towards more powerful, lighter and much faster chairs. A majority of power chairs come with rear-wheel drive, but front-wheel and mid-wheel drives have been taking increasing shares of the market. It is easier to turn them and in tight spaces they are very nimble.

There are also off-road ready and rugged models that are available, along with models that fold for traveling. In addition, power chairs are available that can be customized to meet even the most complex needs of individuals with paralysis. When it comes to the best choice for a user, is definitely based on a lot more than just style.

Having a power chair configured and fitted to one’s individual needs required expert assistance, from a reputable medical supplier or OT. How can you locate a good supplied? Read active gear forums online, ask an OT or other people you know.

Do you need a wheelchair? You will need to work with your rehab supplier, seating specialist and funding sources in order to find the chair that suits your needs the best, and for defending your choice in case your reimbursement is denied.

For any durable medical equipment purchase, reimbursement is definitely an important issue, particularly for an item like a power chair (which may cost more than a Honda that is fully loaded). The power-mobility industry has been targeted for Medicare fraud by federal investigators.

A 2011 government report stated that 80 percent of power wheelchair Medicare claims didn’t meet its coverage requirements and that Medicare shouldn’t have paid for them. Medicare has made changes to some of its reimbursement rules to try to curtail fraud. The disability community has put up much resistance to this in addition to the choice-limiting competitive bidding system.

Batteries

A critical issue for users of power chairs is battery life. If the power source is not managed properly it can lead to annoying or sticky situations, especially if you happen to be far away from home.

It is important for power chair batteries to be deep-cycle 24-volt, that can be discharged for long period of time, as opposed to the 12-volt car battery that is used for short power bursts. There are several sizes of deep-cycle units that are available: e.g. Group-27, Group-24 and Group-22. The larger that the group number is, the more power the battery stores and the larger it is.

There are three different kinds of batteries used in wheelchairs:

“Wet” or lead-acid batteries generate electrical energy whenever sulfuric acid and lead interact. The battery cells must be filled up with distilled water periodically, perhaps once per month. The lower cost is the major advantage offered by a wet-cell battery. The major disadvantage is that special handling might be required, especially whenever you fly.

There is no liquid to top off or spill with gel batteries. They cost ore than wet batteries, but have a longer life cycle and a lot better for flying on airplanes.

Like gel units, absorbent glass mat (AGM) batteries, work fine for flying and don’t require maintenance. They last twice as long compared to standard lead-acid batteries, hold a charge much better, and are quite rugged.

Sometimes wheelchair batteries are the same ones that are used for boats. If you are paying for batteries out of your own pocket, you may be able to save some money through buying marine deep-cycle batteries. Make sure you check your wheelchair manufacturer’s specifications first.

Power Assist

You can trick-up a standard lightweight manual with a powerful, small motor attached to the wheel units or base of the chair. Whenever the assist is turned on, when the hand rim is pushed forward it provides the chair with a strong boost.

The Xtender is available in two versions on some Quickie models, one increases the force that is applied to the hand rims by 3 times and the other that boosts it by 1.5 times.

A fair amount of weight is added to the chair by the assist hubs (from 38 to nearly 50 pounds) as well added expense ($5,000 – $8,000). However, the advantages are great, particularly for lower-level quad as well as anyone who has achy shoulders who won’t need to struggle trying to get up steep hills any longer.

The range of the rider will increase significantly when the assist is used, saving a lot of wear and tear on your rotator cuffs as well as personal energy. The chair also doesn’t resemble a beefed-up power chair. It basically looks normal.

There is a newer power assist option called SmartDrive for manual chairs. It is an 11 pound portable drive wheel that hooks up fairly easily to the base of the chair and the battery fits underneath the seat.

MagicWheels is another option that doesn’t have a motor or batteries. They are two-gear wheelchair wheels with a lower gear to use when you need to on hills, by just a click on the hub. They only cost around a third of the price of a power assist units.

Many insurance companies, including Medicare, will cover them if the user emphasizes the possible increased health benefits like saving the shoulders that power assist devices provide.

Chairs for Kids

Children’s bodies are constantly changing and growing, which means that their chairs need to be replaced or adjusted more frequently compared to adult chairs. Chairs are not exactly cheap and quite often limitations are placed on replacement by insurance providers, so adjustable chairs are offered by most manufacturers for accommodating growing children.

Quite often wheelchair companies provide chairs for children that don’t have a “medical” appearance. They updated looks frequently offer different frame colors, cooler upholstery and more streamlined designs.

Colours offers the Chumpe and Little Dipper. The Invacare Orbit and Sunrise Quickie Zipper are made for younger wheelchair users who like riding in style.

Positioning and Seating

Individuals who live with paralysis are at great risk for getting pressure sore, so the usually need to have special seating systems and cushions to provide some relief to the skin.

There are several different types of cushion materials. They each have benefits for specific kinds of users: liquid (e.g gel), foam or air, a variety that has moving parts and is more dynamic.

There isn’t one product that can do the job for everyone. Having the proper cushion can prevent pressure sores, offer correct positioning and provide comfort. However, it still won’t meet every users specific criteria.

An ambulatory individuals who uses a wheelchair only for shopping will not have the same needs that a high-level quad does who needs to spend eighteen hours a day in their power chair. That is why it is very important to completely understand what your requirements are and choose the cushion that is most appropriate for you, after weighing the pros and cons of various styles.

For a cushion, the least expensive material is foam. In addition, it doesn’t lose air or leak, and is very lightweight. Over time, however it loses its compression and wears out.

Air flotation cushions, like the popular ROHO model, offer support through the use of a rubber bladder that has evenly distributed air inside. They do work well but may leak. Whenever you change altitude you will need to adjust the air.

The Vicair Vector is another style of air cushion that works by employing multiple, small air cells that are permanently sealed.  The user can adjust the cushion by using the handy zipper to open the cushion and add or remove air cells. BBD is a single-chamber model that is very popular and provides pressure relief inexpensively. The Jay is an example of a gel cushion. These cushions are quite effective and popular. The provide good skin protection, but the gel filling makes them quite heavy.

Dynamic cushions work by use of an oscillating pump that causes the internal pressure of the cushion to alternate. Aquila is a good example of this type of cushion. The concept behind dynamic cushions is that alternating the pressure of the seating surface can help alleviate damage done by sitting for long periods of time. This type of cushion is heavy because of the pump and the batteries needed to run it. This causes it to be a bit cumbersome for users.

The Ease cushion is also a dynamic, pressure-changing model. Users may find a great deal of benefit from obtaining a cushion that is customized to fit the lines of the body. One such cushion is the Aspen, which is made using a thin plastic shell that is contoured following a mold of the user’s actual silhouette.

If you would like a list of the seating systems and cushions that are available, you can refer to USA TechGuide or AbleData. Both of these publications provide comprehensive reviews of products related to wheelchair use. To get just the right product for your circumstances, you should consult an expert in positioning and seating.

Tilting & Reclining

Some users find that specialized wheelchairs that are designed to distribute pressure more evenly can help reduce chances of developing skin sores. These types of chairs make sitting more comfortable.

One such chair is named “Tilt In Space”. This model changes the user’s orientation while keeping fixed angles of hips, knees and ankles in place. Basically, the entire seat tilts. There are other chairs that can help change orientation by reclining. With this model, the angle of the back can be adjusted in relation to the seat. The chair can actually be flattened out to provide a complete reclining surface. Some chairs can even provide leg elevation.

Tilting systems help by redistributing pressure from the derrière and the backs of the thighs to the head and upper and lower back. With this type of system, posture remains consistent. Additionally, it reduces the risk of damage caused by tissue being dragged across a moving surface. This is known as “sheering”. One problem with this type of system is that it cannot be employed while the user is sitting at his or her work station. Tilting the entire chair back would result in having knees and/or footrests collide with the underside of the work surface.

A reclining system works by opening up the angle between the seat of the chair and the back of the chair. Additionally, those reclining wheelchairs equipped with elevated leg rests open the angle of the knee. Reclining systems are nice for activities such as transferring, dining or simply stretching out for a rest. They are also quite helpful to attendants performing bladder and bowel care programs.

For the most part, reclining systems provide better relief of pressure than tilting systems, but they do present increased sheering risk. Users who suffer from edema are sure to benefit from the ability to elevate their legs. To get either a tilting or reclining chair system, the user must be evaluated and fitted by an expert in positioning and seating. These chairs are available by prescription only.

Standing Chairs

This type of wheelchair can perform all the functions of a standard wheelchair, along with having the ability to assist the user into a standing position. The ability to “gain height” can come in quite handy at home, work, school and in the community.

There are some types of manual wheelchairs that are equipped with power assist that activates the rising mechanism. These power chairs help the user to stand up and communicate with ambulatory people eye-to-eye. For more information, refer to Redman or Permobil.

The main problem with standing wheelchairs is that they are quite expensive. They are also quite heavy and are not a good choice for getting around on a day-to-day basis. Nonetheless, there are physical benefits involved in being able to stand from time-to-time. Standing can improve range of motion and circulation. Being able to stand also helps prevent problems with pressure sores. Additionally, standing has been shown to help reduce instances of muscle contractions and spasms. The reason for this is unclear.

Several years ago, a representative from the Hines VA said that in their experience, patients who were able to stand for half an hour or more every day experienced a significantly better quality of life. These patients had fewer bladder infections and bedsores. They also experienced better bowel regularity and better ability to flex and straighten their legs.

It is also possible to get a standing frame. There are several models offered by EasyStand. There is even one designed for children. There are a few motorized models (e.g. the Stand Aid). There are also some very simple models that just consist of a non-moving frame designed to support a person with paralysis in a standing position.

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