Choosing the right wheelchair for your child can be tough, as there are a million wheelchairs for kids available and each manufacturer is going to tell you that their model is the best. What makes this even more difficult is that one wheelchair isn’t going to be ideal in all situations. A wheelchair may be great for getting around a classroom, but that same chair won’t be ideal for negotiating a muddy sports field or the soft sand at the beach.

This article will give you an idea on what options are available and their various benefits and drawbacks. Its not meant to provide a pathway for you to go out and seek the perfect wheelchair for your child, more to give you a better understanding of the wheelchair market and allow you to make better, more informed choices.  You’ll also be able to ask more questions of the person prescribing the wheelchair, whether that be the NHS wheelchair service or a retailer. 

Every NHS wheelchair service will have specific criteria for them to provide your child with equipment.  There are typically a certain number of hours or days the wheelchair needs to be used for, and whether it is for inside and/or outside use.  Most services will only provide for permanent disabilities, rather than a specific short-term need.

If you choose to purchase your own wheelchair, choose a retailer that has experience selling the type of wheelchair you’re looking for – don’t let your child become their guinea pig!  They should be able to show you a range of options and take into account the specific nature of your child’s ability. 

There are also charities who may be able to provide financial assistance for the purchase of a wheelchair.  Each charity tends to have a certain target market and cover a specific geographical area.  Get in touch if you’d like to know more.

Manual Transit Wheelchairs for Kids

In most cases, these are the most basic of wheelchairs.  The small wheels at the back enable you to push your child, however they will not be able to self-propel (or push) themselves.  Most transit wheelchairs will fold, so they can be stored easily in the boot of any car.  Cushions and other products can be added for comfort, pressure relief or to provide positioning.

Manual Self-Propelling Kid’s Wheelchairs

Self-propelling wheelchairs are designed to give your child the opportunity to independently self-propel.  The rear wheels are large enough so they can be reached easily.  Self-propelling isn’t easy though and a lot of kids will not have the strength or coordination to mobilise everywhere themselves.  Its hard work and little arms just aren’t built for it!  The large wheels aren’t just for self-propelling, they also make the wheelchair easier to push than a transit wheelchair, especially over rougher ground.  The larger wheels roll over bumps much more easily.  Most self-propelling wheelchairs can be stored easily in the boot of any car.  Cushions and other products can be added for comfort, pressure relief or to provide positioning. 

Active User Self-Propelling Kid’s Wheelchairs

These are still considered self-propelling wheelchairs, but they are easier to self-propel than the more standard self-propelling wheelchairs described above.  Being easier to self-propel is achieved through two differences – they’re normally lighter in weight, and they have a lot of adjustment available so that an efficient position and weight distribution for self-propelling can be achieved.  The most important adjustment is rear wheel position – moving the rear wheel forward on the frame makes the chair more efficient to self-propel through better weight distribution, and also moves the wheel so that the shoulders are in a stronger position.   Seat height is also important.  On the pink chair below there is a lot of overlap of the wheel above the cushion (compared to the more basic self-propelling chair above.  This means there is more wheel that the child can reach. 

Active user wheelchairs used by children are also fitted with push handles – so that you can give them a helping hand when they need it.  Like the more basic wheelchairs above, active user wheelchairs can be fitted with cushions and other equipment to improve comfort, pressure relief or positioning. 

Active user wheelchairs are always more expensive than more standard wheelchairs.  NHS wheelchair services will typically have quite strict criteria on who they prescribe active user wheelchairs to.  Being a full-time user (rather than someone who walks as well) as well as being able to independently self-propel for most of their mobility, are the main criteria most services will work to. 

Tilt in Space Wheelchairs for Kids

Tilt in space tips the seating of the wheelchair backwards (imagine tipping a dining chair onto its back legs) and allows gravity to ‘push’ the upper body of the user against the backrest of the wheelchair.  This enables a child with reduced sitting balance to maintain a sitting position, but with reduced muscular effort.  Tilt in space also helps with pressure relief by re-distributing weight bearing from the cushion to the backrest.  For users using a hoist to transfer to their wheelchair, tilt in space can make this transfer easier, allowing the angle of the seating to match that of the child in their hoisted position.  For other users, tilt in space enables them to adjust their own position, using gravity to assist them slide back over the cushion.

Powered Wheelchairs for Kids

Powerchairs have batteries and electric motors that remove the physical effort involved in self-propelling (or pushing from behind) a manual wheelchair.  For those children who are unable to self-propel a manual wheelchair, a powerchair can be the difference between them being able to independently mobilise or not.  Powerchairs are typically controlled with a joystick mounted on the armrest (as in the picture below), but other means are available such as a joystick mounted for use with the chin, foot or head.  Switches of almost any shape and size can also be used instead of the joystick.  A single switch is all that is necessary to control every function on the powerchair. 

Some manual wheelchair users also benefit by having a powerchair.  A powerchair will enable them to move faster and further, greater for when they’re wanting to keep up with others! 

Powerchairs have their drawbacks though – they’re typically very big and heavy (100kg plus), so can’t be lifted into the back of a car.  Many powerchair users have a wheelchair accessible van (WAV) that they’re able to drive into.  Most powerchairs are crash tested, meaning the child is able to stay seated in the wheelchair when travelling in a vehicle. 

Kerbs (or lack of dropped kerbs) can also be a problem.  Most powerchairs have difficulty getting up anything more than a 3” kerb. 

Accessories/Specialist Uses

There are loads of accessories available to pimp a wheelchair!  The list is endless, but here a some of the more commonly requested options, just don’t expect to see these on the NHS list!

Manual wheelchairs can be turned into powered devices by adding a powered front wheel.  This means the wheelchair can be used as a manual wheelchair indoors for example, and then the powered device can be fitted (less than a minute) when travelling outdoors.

Other devices provide powered assistance to normal self-propelling, the motor and batteries being stored inside the wheel itself.

Other wheelchairs are made specifically for off-road use. Most of these tend to be powerchairs, but manual ones are available too.  The trickiest terrain for almost any wheelchair is loose sand, but there are chairs designed specifically for that too, and they’re available to hire at some UK beaches.

Kid’s Wheelchair Guidance from Silver Fern

If you’re struggling to work out where to start, drop us a line.  We’re happy to offer advice over the phone.  Alternatively, our website has information on our assessment process and what to expect from our involvement.

There are many places where you can get a wheelchair, such as the NHS and certain charities. However, your options may be different depending on your circumstances. Here are the main places where you can find a wheelchair, as well as some important details that you should know before making your decision.

Places to Get a Wheelchair

NHS

• Many people who need permanent use of a wheelchair will be eligible for equipment from the NHS. Your GP will be able to point you in the direction of your local wheelchair service. The criteria for receiving NHS equipment varies from service to service. In general, full time, permanent wheelchair users will always be eligible. Most NHS wheelchair services require a referral from a health professional (GP, consultant, nurse, physiotherapist, occupational therapist etc). They will assess what equipment is needed and prescribe accordingly from a range of equipment available to them. 
• NHS wheelchair service staff are often made up of a mix of occupational therapists, physiotherapists, rehab engineers and clinical scientists. There will also be support staff in administration and clinical roles.

Privately

• Everyone has the option of purchasing their own equipment. Some retailers are members of the British Healthcare Trades Association, however membership is not mandatory. Retailers will decide with you which is the best equipment for you to purchase, based on your wheelchair needs, and your budget. Some will employ occupational therapists or physiotherapists to provide a more clinical approach.  Some retailers will have a limited range of wheelchairs, focusing more on other equipment such as beds or riser-recliners. Speak to them to determine if they can support your wheelchair needs.
• Having a clinical assessment prior to purchasing a wheelchair can also be useful. This ensures all needs, future and present, of the user are taken into account prior to purchasing equipment. A clinical assessment will involve evaluation of posture, pressure relief, technical assessment of any current equipment and the environment any equipment will be used in. The clinician, normally and occupational therapist or physiotherapist will make recommendations for adjustment or additions to the existing wheelchair or will work with the user to determine the best wheelchair for them to purchase.

Finance

• Some retailers will offer finance, enabling the wheelchair to be paid in monthly instalments over a period of time.

Charity

• Charity funding can be available to some wheelchair users. Many charities will have specific requirements or conditions that need to be met, before they support the purchase of a wheelchair. Most will only support the purchase of equipment that cannot be funded through a NHS wheelchair service.

Motability

• The Motability scheme enables specific disability benefits to fund the lease of a powerchair. Motability has agreements with specific wheelchair retailers to provide the equipment. The leases are typically 3 years and include repairs and maintenance. 

Access to Work

• The employer of people with a disability is legally obliged to make reasonable adjustments to ensure you they not substantially disadvantaged when doing their job. If the help you need they work is not covered by their employer making reasonable adjustments, they may be able to get help from Access to Work.
• They need to have a paid job or be about to start or return to one.
• An Access to Work grant can pay for special equipment, adaptations or services to help do things like answer the phone, go to meetings and getting to and from work.
• They may not get a grant if they already get certain benefits

Getting a Wheelchair

Once you’ve decided where to get a wheelchair from, you will often need to choose your wheelchair type – particularly if you are purchasing your wheelchair privately. A wheelchair prescription can help. Contact Silver Fern Therapy today to discuss your options.

Active user wheelchairs are manufactured for self-propelling. Because of this, active user wheelchairs are usually designed to be lightweight or use an efficient configuration for self-propelling.

Reducing the weight of an active user wheelchair is generally achieved by using less material. For example, many active user wheelchairs have a rigid, non-folding design. This is because a folding mechanism uses a lot of additional frame material, so rigid chairs tend to be lighter. Another option is to use a lightweight material like aluminium, titanium or carbon fibre to construct the frame of the wheelchair, rather than steel. Minimising the presence or weight of any accessories such as push handles, tool kits and back packs also reduces the weight of the chair as a whole.

Active User Wheelchair Features

There are many ways in which an active user wheelchair can be configured to make it efficient, or easier to self-propel. As described above, being lightweight will help with increasing the efficiency of an active user wheelchair, but there are many other considerations:

• Narrow seat size. Having a seat width that is too wide means that excessive shoulder movement is required when self-propelling. A narrow seat width means the wheels are as close as possible, allowing the shoulders to move in their strongest, most efficient position.
• Ideal centre of gravity. Many active user wheelchairs have forward-backward adjustment of the rear wheel position, or can be built with a specific position. It is essential for most active user wheelchairs to have more weight distribution over the rear wheels, than the front casters. The rear wheels are larger, have a larger tyre and therefore roll with less resistance. By moving the position of the rear wheels forward on the frame of the wheelchair, the wheelchair becomes more efficient to roll and to self-propel.  This forward position of the rear wheels has the added benefit of improving the position of the shoulders. They can move with greater strength and efficiency.
• Adjustable seat height. Many active user chairs can be adjusted or configured with specific front and rear seat heights. The rear seat height determines the height of the shoulders above the rear wheels. If the rear seat height is too great, the user is required to straighten their elbows more to reach the rear wheels, reducing the strength and efficiency of the arm and shoulder when self-propelling.
• Ideal backrest height. Excessive height of the backrest restricts movement of the back and shoulders when self-propelling. However, backrest height is important in creating a stable sitting position. Therefore if the backrest is not high enough, self-propelling efficiency is likely to be compromised.
• Specialised brakes. Standard brakes are positioned to be easy to operate and close to the tyre. During forceful self-propelling, the thumb of the user can contact the brake, resulting in injury. Many active user wheelchairs are therefore fitted with brakes that fold away from the tyre when not in use.
• Strong, lightweight wheels. The wheels transfer energy from the user into movement of the wheelchair, therefore they are important in maintaining efficiency of the wheelchair. A well-built, lightweight but strong wheel will transfer a greater proportion of energy than a poorly made, heavy wheel. Being the widest part of a wheelchair, they need to be able to deal with knocks. A strong wheel will be able to deal with those knocks, when they are attached to the wheelchair and when they're not.

Active User Wheelchairs - Pneumatic or Solid Tyres?

The major decision when it comes to tyres is between pneumatic and solid tyres. Pneumatic (air-filled) tyres tend to be lighter than solid tyres.  They also have significantly less rolling resistance, making self-propelling much less difficult. The downside with pneumatic tyres is there possibility of puncturing. This likelihood can be reduced with thicker tyre tread, good maintenance, liquid infills inside the tube and avoiding certain places where puncture might be likely.  Learning to replace a tube or having someone else that can do this can be a very useful skill.

Choosing an Active User Wheelchair

Choosing an active user wheelchair can be challenging when there are so many different features to consider. If you’re looking for expert advice on choosing an active user wheelchair, then contact Silver Fern Therapy today to arrange a wheelchair fitting.