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Thanks John for making this part of getting new chair so easy. I love it - it's so whizzy! Going up Lane was much easier.

Getting the right wheelchair can be tough – there are a million options available and each manufacturer is going to tell you that their model is perfect for your child!  What makes it even more difficult is that one wheelchair isn’t going to be ideal in all situations.  A wheelchair which is great getting around a classroom, isn’t going to be ideal 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

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 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 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

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

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.

 

Summary

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.

What level of service can I expect after I receive my wheelchair?

NHS

  • Equipment from the NHS is maintained and repaired at no cost to the user. If the user changes in any way where different equipment may be required, they can be re-assessed.

Privately

  • Every wheelchair will come with a manufacturer's warranty. The length of this warranty period will between manufacturers and even between different parts of one wheelchair.  Explanation of the warranty periods should form part of the buying process.  The manufacturer's warranty covers parts but does not cover the time taken by the retailer to replace the parts.   Ensure the sales agreement stipulates who is responsible for the cost of the time to fit parts covered by the manufacturer's warranty.
  • There are also service packages available from most retailers. These are agreements to replace, repair or fix problems with the wheelchair and can include accidental damage.  They are normally underwritten by an insurance company. 
  • Breakdown insurance cover is also available. This can also include public liability insurance, which provides cover for accidental damage to someone or something else.

 

How long should a wheelchair last?

  • This varies a lot and depends entirely on how the wheelchair is used and in what conditions. Expect to use the wheelchair for three to five years before it needs replacing, but it may last a lot longer if it is not often used or used well within its physical limits.

 

How long does it take to get a wheelchair?

  • Very basic wheelchairs will be available for immediate purchase from a retailer, or immediate issue from an NHS wheelchair service. More complex wheelchairs will take much longer and require several appointments before an order is made.  For complex equipment, it is essential to trial equipment prior to purchase to ensure it works as expected and meets the requirements of the user.  There can sometimes be a delay of several weeks waiting for demonstration equipment to be delivered from a manufacturer.
  • Once a wheelchair is ordered it can take up to 12 weeks for it to be delivered. This depends greatly on the manufacturer and the complexity of the equipment being ordered.  Some equipment can be delivered in a few days.
  • Bariatric wheelchairs can simply be larger versions of standard wheelchairs; however some models can be more specific to heavier users. They can have additional, strengthening framework added to increase the durability and enable greater maximum user weights to be achieved.  Parts with greater strength can also be fitted, such as wheels, backrest, footrests, upholstery and brakes. 
  • Tilt in space wheelchairs can often be fitted with many of the options that other wheelchairs use, however there are some features used more on tilt in space wheelchairs than others.
  • Lateral supports are used to control the position of a user’s spine. They are fitted to the backrest and provide support to the outside of the rib cage.  They can have the effect of preventing a user leaning to the side or can even straighten a scoliosis. 
  • Elevating legrests are often fitted to control swelling of the legs, however simply elevating the legs achieves very little improvement - the legs continue to remain the lowest part of the body for fluid to accumulate. Combined with tilt in space and recline however, the legs can be raised high enough to encourage a reduction in swelling.  This can be an uncomfortable position, therefore many users will opt to transfer to their bed, where they can comfortably raise their legs whilst lying down.  
  • Headrests allow the head to be supported, especially when using tilt in space or recline. In both positions, the users head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
  • Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
  • Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.
  • Standard wheels tend to come with few options, however there are several things to consider.
    • Every wheelchair should have a cushion.  A very basic cushion should be considered a minimum to provide some comfort and pressure relief. 
    • Seat size. Ensure an appropriate seat size.  There shouldn't be much space between the user's hips and the sides or armrests of the wheelchair.  There should be 1-2" space between the back of their knee and the front of the cushion.
    • Backrest height. The backrest should be sufficiently high to prevent the user leaning backwards over the top of the backrest upholstery.
    • Anti-tips. These are two small wheels that protrude close to the ground from the back of the wheelchair.  They prevent the wheelchair tipping over backwards.  This is especially important if the wheelchair is to be used on slopes or if there is any other reason why the wheelchair should be more unstable than normal, such as leg amputees.
    • Headrests allow the head to be supported, especially when using backrest recline. When reclined, the users head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
    • Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
    • Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.
  • Active user wheelchairs are manufactured to be efficient to self-propel, therefore the options available on active user wheelchairs are usually aimed at either being lightweight, or enabling an efficient configuration for self-propelling.
  • Reducing the weight of the chair can be achieved either by reducing the amount of material used or by using a lighter material. For example, many active user chairs have a rigid, non-folding design.  Because a folding mechanism uses a lot of additional frame material, rigid chairs will tend to be lighter.  Another example is the use of 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.
  • 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:
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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. 
    • 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.

This is a very quick overview of the different types of chair available.  It doesn't go into great detail, or include every option - we'll save the detail for later posts!  But if you're wondering what is available in the wheelchair market, this post might be a good start.  If you need any specific detail about any of the chairs, please let us know.

 

Standard Wheelchair

Standard wheelchairs are typically used by people for occasional use.  They come in a range of sizes, but their configuration is often limited.  Standard wheelchairs almost always fold for storage.  Most standard wheelchairs will have a transit option with small rear wheels, designed for the wheelchair user to be pushed by someone else.  They will typically have a self-propelling option as well, with large rear wheels, designed for the wheelchair user to propel themselves, using their arms.

Standard wheelchairs can be fitted with parts and accessories to make them useful for more complex users who use their wheelchairs frequently.  The addition of a contoured cushion, backrest, lateral supports and headrest can enable a standard wheelchair to be used for a more complex, full time user.

 

Active User Wheelchair

Active user wheelchairs are used by people who often use their wheelchairs for all their mobility.  Active user wheelchairs are configured to be efficient to propel by the wheelchair user themselves.  They are typically lighter weight than standard wheelchairs and have more weight distributed over the rear wheels.  The front wheels (casters) of an active user chair are often smaller than standard wheelchairs.  This helps to reduce rolling resistance and make the chair easier to turn.  Active user wheelchairs are configured very precisely for each person.  They therefore have many size and configuration options to tailor the wheelchair to each person and the way that they use the wheelchair.

 

Powered Wheelchair (Powerchairs)

Powerchairs are typically used by people who lack sufficient arm movement or strength to propel a manual wheelchair or are limited by distance or terrain.  Powerchairs have electric motors powered by batteries.  Control of the motors is usually via a joystick on the armrest, however other parts of the body can be used as well.  Powerchairs enable people to mobilise with very minimal effort.  Basic powerchairs are used indoors only and will have a small turning circle to cope with doorways and small spaces.  Larger powerchairs enable outdoor use as well and will cope with hills, rougher terrain and have larger battery capacity.  Some powerchairs are designed for outdoor use only and will cope with off-road terrain.

 

Tilt in space Wheelchair

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 wheelchair user against the backrest of the wheelchair.  This enables the user to maintain a sitting position, but with reduced muscle control.  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 user 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.

 

Bariatric Wheelchair

Obesity is defined by Body Mass Index (BMI) above 30.  Those with a BMI above 40 are considered morbidly obese or bariatric.  Specific wheelchairs, both manual and powered, are available for this weight range.  They will often look like other wheelchairs but have different construction materials or design that provides greater strength.  They will have a size range that is larger than other wheelchairs.

Affiliations

Affiliations

HCPC
RCOT
Institute of Ergonomics & Human Factors
NHS Wales
Posture & Mobility Group
Call us today on 02921 660346