If you’ve experienced a spinal cord injury (SCI), the correct choice in wheelchair is very important. Finding just the right chair can take time and professional consultation with an occupational therapist. In this article, we discuss the considerations to keep in mind when choosing just the right wheelchair to suit your needs after an SCI. Read on to learn more.
What are Your Choices in Wheelchairs?
These days, SCI does not mean the end of activity, and there are many different types of wheelchairs to choose from, and many people own more than one. Depending upon the level of your SCI and your own personal preferences and activities, you might have a basic manual chair and a basic electric wheelchair, or you might have only a very lightweight sports chair, or a 3 wheeled scooter or a wide variety of other choices.
Should You Choose a Manual or Power Wheelchair?
Basically, a manual wheelchair is more suitable for a person who has some upper body strength and the ability to propel the chair by hand, but everyone needs some sort of manual chair as a backup and a spare.
If your SCI has resulted in tetraplegia/quadriplegia (lack of body strength and the inability to use your limbs) you will need an electric wheelchair, which you can propel through the use of a small amount of hand movement, speech or even lip or eye movement or breath.
What about manual wheelchairs?
In the old days, manual wheelchairs were big, ugly and awkward, but today there are many different styles and types of manual chairs that are easy to maneuver and provide a smooth, comfortable ride. You can choose between a very stable, rigid type or one that can be easily folded and put in the trunk or back seat of a car.
Light, modern manual wheelchairs can be very easy and even fun to drive. You can think of your manual chair as you would a bicycle and customize it with exactly the tires you need for your everyday and recreational activities. Add lever drive propulsion to move about quickly and easily!
If your SCI is below C6 level, you can probably use a manual wheelchair. Even though you may feel that you’d like the ease of a power chair, the manual chair is probably the better choice in terms of your own independence, variety of experience and health and well-being. With a lightweight, portable manual wheelchair, you can go more places, do more things and get good exercise while you’re at it. Just be sure you choose the right chair to avoid repetitive use injuries from constantly propelling your chair.
Keep These Considerations in Mind
Choose a chair that is the right weight for you. An ultra-light manual wheelchair is typically under 30 pounds. In fact, some that are made of aluminum or Titanium can weigh less than 20 pounds. A standard light weight wheelchair is typically under 34 pounds.
It’s best to choose the lightest manual wheelchair you can get by with. Ultra-light chairs offer the most freedom and adjustability. This type of chair can move about quickly and easily and can maneuver narrow passages with greater efficiency.
An ultra-light chair is the perfect choice for an active, young person with an SCI, but it can also be a good choice for an older person. Everyone and every chair is different.
Get the right type of frame. You can choose from a folding frame or a rigid frame. A folding frame is handy if you will need to transfer into vehicles as either passenger or driver and then fold up the chair and stow it.
Rigid frames tend to be more maneuverable when in use, but if you need to, you can break down a rigid chair by folding the back rest down and taking off the wheels. Clearly your choice here will depend a great deal on whether you’ll be getting around under your own steam or riding or driving in a vehicle much of the time.
Choose the right components for your chair.
You’ll need:
Footrests to support your lower legs and your feet. These may be swing-away, folding or fixed. Talk with your OT, observe and try out all three types to determine what will work best for you.
Armrests may or may not be necessary. There are lots of choices, and your choice will depend upon how much strength and mobility you have in your arms and how much support you need. Choose from:
… or just go without if you are very active, have good upper body strength and mobility and want to be able to propel your chair without reaching over your armrests.
Brakes/wheel locks keep your chair from running away with you or scooting out from under you when you park on a slope or want to transfer out of your chair.
Your brakes may be positioned high or low on your chair. They may or may not be retractable. You may want to have them push or pull activated. This all depends upon your own abilities.
There are even some very nimble folks with SCI who opt not to have brakes because they may get in the way of propulsion and add a bit to the weight of the chair. Instead, these daring souls simply control their wheels by hand. This is a potentially risky decision, but it is your decision to make. Talk it over with your OT, and realistically consider all situations in which you may find yourself when making this choice.
Just as with a car or bicycle, you’ll need good tires. There are three choices in wheelchair tires:
Your backrest gives you support and keeps you from falling out the back of the chair. A sling backrest is classic, but an adjustable tension backrest will give you better support. Additionally, as the name implies, you can adjust it to suit your needs from one activity to another or with the passage of time as your own strengths and abilities improve.
A rigid backrest gives very good support, but if being able to collapse your chair easily is important to you, this may not be the best choice.
Other things to consider when choosing a back rest are height and weight - both yours and that of the back rest. If you are taller and heavier, you will need a higher and sturdier back rest.
Higher back rests give more support, so the level of your SCI and your own upper body strength should be taken into consideration when choosing the height of your back rest.
Generally speaking, when choosing materials for any component of your manual wheelchair, including your backrest, it’s smarter to choose the lightest weight material that will get the job done safely.
Your cushion should provide comfort and support. Choose a light weight cushion that will help you stay firmly and safely positioned in your chair. It should provide good air circulation and pressure relief to help prevent pressure sores.
There are many different types of cushions, and it’s always a good idea to discuss your choices with your OT, observe and talk to others and remember that your need in seat cushions may change depending on your chosen activity and changes in your ability level.
The push rims of your wheels affect your ability to propel yourself. You can choose from many different shapes and coatings to give you the best grip and the best fit. Your choice in push rims helps you move along with the greatest of ease while preventing injuries to your hands and arms.
Extras and special circumstance features you may also wish or need to add include:
Set your chair up to suit yourself and your needs. Once you’ve taken possession of your chair, you’ll need to be sure that everything is set up correctly for your comfort and safety.
Be sure the seat fits right. To prevent pressure sores, you need to be certain that the seat is not too narrow. To prevent sliding around, you need to be certain that the seat is not too wide.
Correct seat slope will help keep you stable in your chair. The back of your seat should be just a bit lower than the front so that your knees are slightly raised. This will help keep you from sliding around (or out!)
Be sure the seat is set at the right height for you. When you sit in your chair, you should be able to easily access the push rims. When you let your hands hang down, the tips of your fingers should be just below the axle of the chair.
Ease of transferring is also dependent on the height and the slope of the seat. You’ll need to practice this to determine the seat height that will best enable your transfers.
The rear axle of your chair should be positioned as far forward as it can be without causing the chair to tip backwards. A forward positioned rear axle facilitates intentional tipping or popping a wheelie (e.g. to hop over a high threshold or up a low step). It also makes it easier for someone else to push your chair when needed.
Rear wheel camber refers to the tilt of your chair’s wheels. The tops should tilt in toward you slightly with the bottoms of the wheels a bit splayed. This arrangement gives you a broader base and more support and stability. It also makes propelling easier on your hands and arms. You have to get this tilt just right, though. Too much makes your chair too wide and limits your ability to maneuver and access narrow passages.
[https://pubmed.ncbi.nlm.nih.gov/10159861/]
Learn How to Get Around
Now that you have your chair all set up, you’ll want to work closely with your OT to learn how to propel yourself quickly, efficiently and with the least chance of injury. Generally speaking, you should use smooth, long strokes to move forward, and your hands should fall below your push rims for a brief rest between strokes.
As you grow stronger and more capable at propulsion, work with your OT to learn how to pop a wheelie so that you can easily navigate over rough terrain, curbs and other challenges.
It is also possible to add power assist to a manual wheelchair. This creates a nice hybrid that maintains the light, flexible profile of a manual wheelchair with a little extra oomph to help you manage challenging situations, such as hills.
A power assisted wheelchair is a good choice if you can manage a manual chair, but you need a little boost from time to time. This type of chair is a little heavier and a bit more cumbersome than a standard, manual wheelchair, but it is a lot easier to maneuver and transport than a full power chair.
What About Power Wheelchairs?
If your SCI is higher than C6, you may need to use a power wheelchair. Additionally, you may occasionally need to rest your arms and shoulders from using your manual chair. Alternately, you may simply want to have a power wheelchair for some occasions and activities. There’s a lot to recommend power chairs, and luckily there are lots of choices you can make.
Power wheelchairs are also available in a wide variety of designs. From basic, standard wheelchairs to three or four wheel scooter varieties, you will surely be able to find/customize one that precisely fits your everyday and recreational needs.
As with your manual chair, your choice in power wheelchairs will depend in great part upon your own strengths, abilities and needs and the activities, environments and challenges you will encounter.
Here are the components you should consider when thinking of choosing a power wheelchair:
The seat is attached atop the base.
Some power wheelchairs are equipped with elevating seats that can make it easier to transfer. Still others can actually help you stand upright. This can be very helpful when you need to reach something that is above your shoulder height. If you have very good use of your arms, you’ll want to retain that ability. This type of chair can help your avoid shoulder injury caused by reaching up and undue stretching.
Each of these offers a different level and type of support, weight and pressure distribution. Other attributes to consider when choosing a material for your backrests and cushions include:
When making your choices, you’ll need to weigh your personal preferences and needs. One thing you will not need to consider is the weight of the cushion because this is not as critical as it is when choosing a cushion for a manual wheelchair.
In fact, the heavier, more costly pressure reducing cushions are usually better when using a power chair than would be an inexpensive foam cushion. The thinking is that, if you are using a power chair, you will probably be in the same position for your entire day, so pressure sore prevention is more important than lightness or thrift.
What about Tilt-in-Space and Reclining Wheelchairs?
Tilt in Space and reclining wheelchairs are excellent for providing comfort, managing posture and relieving pressure. Furthermore, they make it easier for your assistant to help with personal care.
When you sit in a reclining wheelchair, you get a good stretch to your hip flexors. This position also makes it easier for your caregiver to help you transfer and/or to attend to toileting and catheters.
The tilt-in-space feature allows the chair to tilt back while keeping the angle between the backrest and the seat constant. If you are not able to transfer yourself or shift your weight on your own, this type of chair allows you to tilt back without the possibility of shifting yourself in a way that could be injurious.
Your Wheelchair is a Tool for Your Use
To make the most of your life after SCI, it’s very important to make a wise choice in wheelchairs. Though you may feel like resisting the entire subject when you are in rehab, the fact is, you should pay close attention to the choices you are offered and the advice of your OT. It’s also smart to watch other wheelchair users around you. Observe their abilities and challenges and ask questions. All of this will give you valuable information to help you make the best possible choice for greater comfort, safety, ability and independence.
Whether you want to engage in off road activities like wheelchair hiking or you just need to be able to get around at work, on your school campus or at home, there is a chair for you that offers just the right maneuverability, suspension, comfort and safety levels. The key to making the right choices lies in working closely with your occupational therapist to determine exactly what you want to do and can reasonably do and what features are necessary to manifest your wishes.
Resource :
SCI Model System Consumer Information guide Getting the Right http://uwmsktc.washington.edu/sites/uwmsktc/files/files/wheelchairs.pdf
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