Powered Wheelchairs
Decisions, decisions! Today a person selecting a wheelchair faces many decisions. Do I want or need a manual chair or a powered wheelchair? If I decide I need a powered wheelchair, what kind of chair do I want? What special features might I need or want? How much speed do I need from my chair? What other factors should I consider in deciding which chair is best for me? This ABLEDATA Fact Sheet is designed to explore the special considerations in powered wheelchair selection and the various options available to meet the needs of powered chair users.
Until 1993, there were two basic styles of powered wheelchairs on the market: The traditional style and the platform-model powered chair. The traditional-style chair, the most common design in use today, is similar in appearance to a standard everyday wheelchair and is reinforced to tolerate the extra weight of a power and control system. These chairs usually are powered by a battery attached behind or underneath the seat of the wheelchair. The platform-model powered chair consists of a seating platform located atop a power base. A variation on the power base concept is a chair that includes built-in lifts to allow the user to raise and lower the seating platform. In 1993, a round-based powered chair called the Hoveround emerged on the market, effectively creating a new classification of powered chair.
Selecting a Powered Wheelchair
A powered wheelchair must be selected carefully in order to ensure it not only meets the needs of the individual who will use it but also represents good value for the money being invested in it. A 1993 report prepared by the Rehabilitation Engineering Center at the National Rehabilitation Hospital entitled Evaluating Powered Wheelchairs suggests that the powered wheelchair selection process include evaluation of the individual's physical status, functional capabilities, and usage requirements. Physical considerations include posture, strength, sensation, visual acuity and perception, and the ability to learn how to use the wheelchair safely. A functional evaluation should include actual use of the wheelchair in everyday settings; an evaluation of the individual's ability to get in and out of the wheelchair; and the ability to perform needed activities from the wheelchair.
While the person's physical capabilities and functional capacity clearly are important factors to consider, it also is essential that the wheelchair selected "fits" the individual's lifestyle. For example, if it is to be used both in the home and at work (or school) both environments must be architecturally accessible. If the person cannot get into the bathroom using a particular wheelchair, that chair is not a practical alternative for that individual. Transportation to and from various settings also is an important consideration: Is a van available to transport the individual in the chair, or is it necessary for the chair to fold or disassemble in order to be carried in an automobile trunk?
Another important consideration, and one that has not received much attention until recently, is personal style. Because powered wheelchairs generally are used by people with severe disabilities, function has traditionally been stressed over style. However, consumer demand for improved appearance of powered wheelchairs has led to an effort on the part of manufacturers to develop aesthetically appealing powered wheelchairs, some in a selection of colors, and most with more streamlined designs.
Wheelchair Components
Basic powered wheelchair components have many similarities to those found on manual chairs. However, others such as controllers, batteries, and drive systems are unique to powered wheelchairs.
Power Wheelchair Frames
Many traditional-style models utilize the traditional cross-brace frame which allows the chair to be folded or collapsed for storage and transport once the batteries have been removed. Other traditional models and some power base chairs disassemble for transport. A number of chairs, however, are designed to be transported while carrying the user; consequently, they do not fold or disassemble.
One of the biggest breakthroughs in wheelchair technology has been the development of new, lighter-weight materials for wheelchair frames and some of these materials are now being used for powered wheelchairs. Traditional-style chairs now have frames made of steel, cold-rolled steel, tubular steel, chrome-moly, and aluminum. Power base chairs may have aluminum, stainless steel, cold-rolled steel, flat steel, tubular steel, or steel frames. The type of material used to construct the frame affects the weight of the frame, and therefore the overall weight of the wheelchair. The type of frame material also can affect the wheelchair's overall strength. While some of the materials used may result in powered chairs being relatively lighter weight than they have been in the past, it should be noted that powered chairs are still considerably heavier than manual wheelchairs, with weights ranging from 85 pounds to more than 300 pounds.
Power Wheelchair Upholstery
Upholstery for wheelchairs must withstand daily use in all kinds of weather. Consequently, manufacturers provide a variety of options to users, ranging from cloth to new synthetic fabrics to leather. Many manufacturers also offer a selection of upholstery colors, ranging from black to neon, to allow for individual selection and differing tastes among consumers.
Seating System
Seating systems are sold separately from the wheelchairs themselves, as seating must be chosen on an individual basis. It is important when selecting a wheelchair or a seating system to ensure that the two components are compatible. Power base chairs, because of their more modular construction, frequently feature customized chair-style seating systems.
Power Wheelchair Brakes
Most powered chairs utilize a dynamic braking system in which the motor and brakes work together to slow and stop the chair when the joystick or other controller is released, and which automatically engages the brakes when the power is off or when the chair is not being powered in a forward or reverse motion with the controller. Traditional-style chairs frequently also have "parking brakes" (wheel locks) similar to those found on manual chairs which are available in several different designs and can be mounted at various heights to maximize convenience for the user.
Power Wheelchair Wheels/Tires
Traditional-style chairs generally use the standard four-wheel configuration, with two large wheels at the back and two smaller ones (casters) at the front. The standard tire used for the rear wheels on most wheelchairs is a pneumatic tire, for which the standard sizes are 20 or 24 inches. Smaller and larger sizes, however, also are used as are solid and semi-pneumatic tires. Casters, too, vary in size (generally ranging from six to eight inches in diameter, although smaller sizes are also used) and composition (pneumatic, solid rubber, plastic, or a combination of these). Power base chairs typically use four wheels of the same size, usually 8 to 10 inches in diameter. These chairs may have pneumatic, semi-pneumatic, or solid tires.
Power Wheelchair Footrests
A variety of footrest assemblies are available on both types of wheelchairs. They may be a rigid single unit, 90 degree-90 degree platforms, folding, flip-up, detachable, adjustable length, hemi- height, or have a combination of features.
Power Wheelchair Armrests
Armrests also come in several styles or with a combination of features. They may be full- or desk-length, or wraparound, and they may be fixed, removable, pivoting, and/or adjustable height.
Powr Wheelchair Controls
Powered chairs generally include as a standard feature a manually controlled joystick to regulate the chair's speed and direction. However, most manufacturers offer customized control options to accommodate the varied abilities of the user, including sip-n-puff systems, head and chin switches, push-button controls, trackballs, and tillers. Many chairs also have programmable control features which allow the user or a dealer to adjust or set the chair's speed and control limits as the user's abilities change. There are also manufacturers who do not make wheelchairs, but who offer specialized control systems for powered wheelchairs, including voice-activated controls. When purchasing controls and switches from a source other than the chair's manufacturer, it is essential to determine that the selected control is compatible with the chair.
Power Wheelchair Drive System
The drive system refers to the means by which power is delivered to the chair's wheels. Standard drive systems include gear drive, direct drive, and belt drive. The type of drive system affects the power available to propel the chair and the amount and type of maintenance the chair requires.
Power Wheelchair Batteries
Batteries are a determining factor in the range and power of a powered chair. Generally, the larger the chair's batteries, the greater the power and the longer the chair's range between charges. Many chairs require two rechargeable 12-volt batteries. Most wheelchairs utilize U1, group 22 or 24 batteries, although other batteries are also used. More manufacturers are designing chairs around the group 24 battery because it affords a longer range. The type of battery required is also an important consideration in terms of safety, maintenance, and transport. Powered chairs may utilize lead acid, gel cell, or sealed wet batteries. Gel cell batteries require the least maintenance and have less danger of leaking than do the other battery types. Gel cell batteries are also required by a number of airlines when transporting powered chairs.
When purchasing a powered wheelchair, the user also should consider whether batteries and the battery charger are included with the chair or whether they are extra-cost items. Another consideration is the range or distance a chair can travel between charges. Although factors such as the user's weight, additional powered features, speed, and the type of terrain on which the chair is used will effect the range, a maximum distance can be determined; that may be as few as 7 miles or as many as 40 miles. It is important that the chair's performance meet the user's needs and expectations.
Special Powered Wheelchair Features
Powered chairs may offer specialized powered features to meet the user's needs, either as customization or options on a standard chair or as a chair designed specifically for a particular purpose. Among the available features are elevating and lowering seats, and reclining and/or tilt-in-space seats. Specialized chairs have the capacity to raise the user to a standing position, to negotiate stairs, or to be used as a lift or in transferring.
Power Wheelchair Standards (USA)
The American National Standards Institute (ANSI) recently approved a complete set of 18 standards for wheelchairs. These standards provide for standard methods of disclosing information and standard testing methods to measure a chair's strength, "tip-ability," turning radius, and other important criteria. The standards were developed by a committee that included rehabilitation engineers, manufacturers, consumers, and therapists from RESNA, a professional association that promotes the use of assistive technology by people with disabilities. The standards themselves are highly technical documents. However, summary documents are available from RESNA, 1700 North Moore Street, Suite 1540, Arlington, VA 22209; (703) 524-6686. Also available from RESNA is the complete set of standards for $180, or individual standards for $15 each.
Comparative Power Wheelchair Information
Until recently, it has been difficult to find comparative product information about wheelchairs. While organizations like Consumers Union regularly test and report upon consumer products that are directed toward the general marketplace, little comparative testing has been done on products for small market items such as powered wheelchairs. Consequently, a wheelchair purchaser has been dependent upon anecdotal reports from other wheelchair purchasers or upon the experience of individuals who have prescribed a number of different wheelchairs over a period of time. In recent years, however, a concerted effort has been made to develop useful comparative information about wheelchairs.
The Rehabilitation Engineering Center at the National Rehabilitation Hospital (NRH) conducted a comprehensive comparative study of ten powered wheelchairs, using the ANSI/RESNA wheelchair standards test methods. Included in this study were wheelchairs from the following manufacturers: Damaco; Everest & Jennings International; Fortress Scientific; Invacare Corporation; Permobil Inc.; Redman Inc.; and 21st Century Scientific Inc. This is one of the first studies conducted in which standardized test methods have been used to compare performance and safety factors of powered wheelchairs. While the ten chairs tested represent only a fraction of the total number of powered wheelchairs available on the market, the results of this study, as well as the explanatory information included with the description of each test, make this an essential resource for powered wheelchair selection criteria. Copies of the study are available for $6.05 from NARIC, 1010 Wayne Ave., Suite 800, Silver Spring, MD 20910, 800/346-2742 or 301/562-2400.
Paraplegia News conducted a survey of powered wheelchairs in its April 1993 issue, where specific characteristics of wheelchairs were compared using the ANSI/RESNA standards. The article provides comparative product information on more than thirty powered wheelchairs currently on the market. Back issues of the magazine sometimes are available; so are reprints of specific articles. Readers who are interested in receiving a copy of this publication should call Paralyzed Veterans of America (PVA) Publications for availability. Their telephone number is 602/224-0500.
Homecare Magazine and TeamRehab Reports also publish an annual "Wheelchair Focus" that provides similar comparative information. It is published once a year (also in the spring) and can be ordered through Miramar Publishing at 800/543-4116 or 213/337-1041.
Power Wheelchair Funding Sources
Anyone who has purchased or is considering the purchase of a powered wheelchair should be aware of the expense of buying and maintaining them. The purchase price of a powered wheelchair rarely is less than $4,500; for the more deluxe models or those with specialized adaptations, the price can exceed $12,000 and be as high as $20,000 or more. Thus, a powered wheelchair is a major financial investment. Like any major financial decision, purchase of a powered wheelchair should be undertaken with the utmost care to ensure the product meets the needs of the individual who will be using it. In Ontario, some of the common sources of funding are The Assistive Devices Program (Ministry of Health), Ontario Disability Support Program, March of Dimes, MS Society, Local Community Service Clubs, Private Extended Health Plans, Department of Veteran's Affairs and Non-Insured Health Benefits (First Nations Members).
