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Spinal Cord Injury Update

Summer 2008: Volume 17, Number 3

 

Choosing a Wheelchair:

Thoughts from a physical therapist after attending the 2008 International Seating Symposium

By Debra Glazer, PT, MPH sillouette of man in wheelchair

 

When I first became a physical therapist 15 years ago, there were very few seating and mobility products to choose from. Things have changed tremendously since then, and this was never more apparent to me than when I walked into the massive convention halls at the International Seating Symposium (ISS) in Vancouver, BC last March. Hundreds of vendors, from large manufacturers to small start-ups, filled three rooms that were each the size of a football field. Thanks to new materials and engineering advances, the choices now are plentiful, and also somewhat overwhelming.

The new consumer

There also has been a parallel shift in the consumer’s role in choosing a wheelchair. In the past, the clinician made the choice based on the patient’s injury level: C6-C7 and above would get a power wheelchair; T1 or below would get a manual one. Consumers were not consulted in these medical decisions. Today they are active participants in deciding what wheelchair is best for their body and lifestyle; some even invent new products to meet their specific needs.

More wheelchair users today are choosing to “blend” features from both manual and power technologies to develop a chair that enables them to conserve energy, avoid overuse of joints and fit their lifestyle. Some people with low-level tetraplegia choose manual wheelchairs to fit their office environments but make sure they get assistance with transfers at home to protect their shoulders. College students with paraplegia sometimes choose to use power wheelchairs to get around campus and switch to manual chairs for the tighter spaces of the dorm.

Shoulder and wrist pain

According to Kendra Betz, MSPT, ATP, a conference speaker and nationally recognized wheelchair seating expert, there is ample research evidence showing that people who use manual wheelchairs are at risk for shoulder and elbow pathology and repetitive strain injury of the wrist and hand. The reason for these problems, however, is still being debated. Are they due to improper push technique or to wheelchairs that are incorrectly configured to the client’s anatomy? Are therapists too often recommending standard lightweight wheelchairs when ultra-light models might be a better choice? Which does more damage over time, pushing or transferring? Why do only some people get shoulder problems?

Most clinicians would agree that the way an individual propels a wheelchair in clinic is probably very different from the way he or she pushes uphill on a city sidewalk. If a person’s lifestyle regularly leads to poor wheelchair technique, a power wheelchair or hybrid device might be a better choice, such as a power-assist or electric manual wheelchair with a small, removable motor. Hybrids are lighter, less expensive and much easier to transport than traditional power wheelchairs. On the other hand, they are heavier than standard manual chairs and harder to push when using manual mode. Another option is the two-gear manual wheel, which allows the user to shift to a lower gear to help with hills.

Considerations

In the end, choosing a wheelchair is usually a trade-off. To make the best choice possible, clinicians and consumers will need to carefully consider all of these factors:

Parting thoughts

I did not find a “right” answer to the manual-versus-power debate, but I did learn about many new options in wheelchair technology that I can pass on to my patients.

Meanwhile, the most important take-home message hasn’t changed: thinking through everything ahead of time, before buying a wheelchair, will help you make the best choice for your physical and lifestyle needs.

References