Wheels 101 Part 1

Good evening all! Lets start by debunking the hugely ignorant myth that wheelchairs are only for the paralyzed, people with neurological disorders like multiple sclerosis, or the unfortunate soul who was unlucky enough to break both their legs at once. There are a multitude of reasons people use wheelchairs. Some people are full time users, part time, or situation specific. Personally if I had a functional chair right now I would fall into the part time category. I can make my way through the house or short distances like from the parking lot into the doctors office on crutches or a cane. I’m slow, less steady, but it’s doable. Grocery shopping, pickups at the pharmacy or any social engagements I need a chair to be even marginally functional on my own.

Mobility is a huge hurdle for many types of illness. From the pain of diabetic neuropathy to the lack of endurance caused by pericardial effusion yet there is a distinct lack of understanding and compassion for these needs. These aids aren’t cheap and depending on your personal needs can cost several thousand dollars. If your medical team isn’t supportive of the needs and willing to write you a prescription it can eliminate the possibility of successful functioning. This is my current hurdle trying to convey that while I don’t want to be in a chair I do want to be functional and its a compromise I’m willing to accept.

So lets have a run down of some of the broad categories of adaptive wheels and accessories!

Types of wheelchairs –

Hospital – This is likely the kind of chair most people are familiar with. Higher back, solid arms, adjustable/elevating foot rests.

Pro’s of these chairs is that they are easily available somewhat affordable (more so second hand) and they typically fold into a more transport friendly shape.

Con’s are that they are often heavy to lift when transporting generally around 40 pounds. You must remove the leg pieces to fold the chair so there are additional pieces to transport, high backs makes turning and reaching items difficult as do the locked position arm rests, the arm rests also interfere with the ability to easily reach the rims for propulsion.

Rigid – This type of chair is what you will often see with paraplegics. A solid frame no crossbars for compact folding, stationary foot rest often accompanied by a strap to secure the limbs, no armrest or they have a fold away option, and adjustable height on the back.

Pro’s these chairs are often already lightweight under 25 pounds, very sturdy solid base for uneven terrain, easy access to rims for propulsion, quick release wheels, adjustable back makes reaching behind you easier, and they often have more build in padding as they are designed to be lived in.

Con’s since they have a solid base often the only folding you’ll be able to achieve is the ability of the backrest to fold flat down onto the seat for transport which is not all vehicle friendly which is a special challenge if you don’t drive or have a vehicle designed for your needs. Propulsion uphill or overlong distance can be challenging without an electric or gear driven assist and depending on the chair they may not have customization options to make comfortable accommodations for height, weight, and other medical devices like IV poles.

Sport – Now these are some sexy hardware! The main features of sport chairs are an elongated base for more stability and balance and tilted wheels to prevent tipping.

Pro’s while not your average everyday chair they do have excellent qualities that suit particular environments better such very uneven terrain (think gravel and dirt paths), very stable to withstand extensive upper body movement such as playing sports, very low back for extended range of motion, more options for seat adjustments, extra easy grip rim options for rapid movement (think pivot turns), and attachments like FreeWheel which let you go all terrain and up curbs with ease.

Con’s price can be of issue depending on what accessories you choose as they are often not covered as a necessity by insurance. Elongated frame plus accessories means more to disassemble to transport.

Ultra-Light – In this category we have begun to see some excellent versatility from the compact folding Ti-Lite Aero X to the more conventional Quickie 7R some of which are under 20 pounds fully assembled!

Pro’s a really excellent choice especially for those who do not drive as they are lighter for others to lift into their vehicles, also depending on model such as the Aero they can fold flat enough to fit behind the seat without needing to remove the wheels. They often have more versatility in customization on the go such as the back and foot rests that can be adjusted while your in the chair.

Con’s as I said not all ultra-lights will fold up as compact as you’d wish for but they are still significantly lighter than standard rigid chairs. Due to the light frames you have less accessory options such as neck support, IV pole, and storage packs.

Lever Drive – This is an exciting category for me personally and I’m sure many others. These are manual propelled chairs but you don’t propel by the rims! Rio Mobility Pivot being the most notable example though Wijit and Nu-Drive are worth mentioning as well. Two of these lever drive attach to any wheelchair equip with quick release wheel option which gives you versatility without having to buy a whole new chair. Each model has slight differences I’ll profile below.

Pivot offers propulsion on both the push and pull stokes, you brake by pulling the lever handles in towards each other, you can shift between forward/neutral/reverse with the flick of a button, and it also has five gear shift options for ease of navigating up or down hills.

Wijit propels only in the push motion, breaks same as Pivot by pulling the handles together, and you change from forward/neutral/reverse with a turning knob versus the Pivot’s button switch.

Nu-Drive’s main difference is in how it attaches.  Unlike Pivot and Wijit Nu-Drive does not replace your wheels. It attaches to any 24 inch metal spoke wheel in two pieces. The first part the wheel adapter attaches to the inside of the wheels between the spokes, the second part the drive unit snaps onto the hub of the wheel adapter. Much like Wijit you can only propel in the push motion, braking is the same pull in motion, it also uses a dial to switch between forward and neutral with no option for reverse. In Nu-Drive best I can tell from the site you must manually use the wheels hand rims to reverse after placing the gears into the neutral position.

Pro’s excellent for those with hyper-mobility issues such as myself as we are especially prone to the wear and tear of manual chairs. I have subluxed both shoulders, both wrists, multiple fingers, and twisted an elbow in just one day in my manual chair. I went to the beach and grocery shopping that day which makes it a pretty brutal price to pay to be able to get around. Thankfully lever drive greatly reduces the upper body stress as well as reduced need for fine motor dexterity (no more fingers stuck in rims ouch). They also ease prolonged distance as they feed 40% or more power than you supply by pushing the levers meaning less row boat and more coasting. You can still use your rims manually if you wish/need by simply switching into neutral, braking is more intuitive and no more hand burn or worn gloves.  There is certainly a boost to the hygiene factor not having to deal with everything your wheels and rims pick up or splash through on your way, though they do add weight its significantly less than a power chair meaning they are still acceptably easy to transport.

Con’s these attachments aren’t cheap often more than the cost of the wheelchair itself which is a serious investment especially with questionable insurance coverage. There is a learning curve no different than going between driving an automatic verses a stick shift automobile. They are designed fairly intuitive though I admit the tendency to pull back on the levers to reverse is a hard habit to defeat.

Transport – More of an offhand mention are Transport Chairs. These are not user propelled they are strictly as the name implies to be transported in with another pushing the chair from behind.

Pro’s widely available retail and second hand, affordable, lightweight, and compact folding.

Con’s well you’ve got to have someone wheel you around for every little thing meaning zero independence.

Power Assist – Such as the Emotion M15 are a battery powered add on accessory wheel for manual push chairs. They are most often self contained with the battery pack residing inside the wheel hub and motion activated by sensors in the rims.

Pro’s are mainly the reduced stress on the upper body and hands by getting more propel for you push making it less fatiguing to operate.

Con’s also a significant expense at $5,000 and up which may or may not be covered by insurance and the need to stay on top of charging the battery modules.

Full Electric – Most often used my people with severe upper body restrictions or movement disorders. By far the most expensive option but also the easiest to operate generally by a joystick type controller such as Quickie P-222.

Pro’s ease of use requiring minimal dexterity and strength. Much more support for the back, head, and neck. Longer battery life than power assist and you can maintain faster more even speeds than manual chairs.

Con’s these are very heavy equipment over 100 pounds before batteries meaning to be used anywhere outside the home you will need a lift and a vehicle that can accommodate that kind of alternation. Reduced turning radius and wider base makes maneuvering difficult (think between clothing racks in a department store). Maintaining a charged battery can be a chore as well as carrying fully charged back ups in case of a long outing. They are also extremely costly often five times the price of a manual chair. Also as these types of chairs are upholstered they require more in depth maintenance and some hygiene precautions if you suffer from incontinence as they are more difficult to clean than the typical nylon seats of manual chairs you can literally take outside and hose off.

I hope this post has been helpful in evaluating your choices in wheelchair mobility options. Stay tuned for Wheels 101 Part 2 on accessories!