HELPFUL PRODUCTS FOR OLDER PERSONS: Wheelchairs and Scooters

Table of Contents:

Introduction

As we grow older, important daily activities, like walking, dressing, bathing, cooking, and eating, may become increasingly difficult to manage alone. Many of us depend on helpful products or devices to help carry out these activities.

Wheelchairs are used by people with impaired mobility and reduced strength. As we age, we may require a wheelchair because of chronic conditions like arthritis, stroke, or fractured hips.

The 1990 census reported nearly one and one-half million Americans used a wheelchair. As our population ages, this number grows larger. Today, older Americans use more wheelchairs than any other age group.

As the number of people using wheelchairs grows, so the dimensions, characteristics, and kinds of wheelchairs are becoming more diverse. There now exist many wheelchair designs that were not available twenty years ago. Unfortunately, many people are not aware of the wide variety of wheelchairs to fit different needs. Many people only know about the standard, heavy-duty wheelchair.

People often order their wheelchairs directly from manufacturers or distributors, without consulting a healthcare specialist. Many pick up wheelchairs from garage sales, or receive them as gifts from well-meaning friends or relatives. Unfortunately, this can lead to a poor “fit” between the user and the wheelchair. To avoid this, it is very important to consult with an expert, such as a physical or occupational therapist, before selecting a wheelchair.

Selecting a Wheelchair

Buying a wheelchair is a significant decision. People often use wheelchairs for many years, so it is important that the wheelchair be comfortable. Poorly fitting chairs can cause bruises, pressure ulcers, poor posture, and other problems. Situations sometimes make it necessary to get a wheelchair immediately. If this is the case, you should not buy a chair in haste, but instead consider borrowing or renting a chair for the short-term.

Buying a wheelchair can be an overwhelming process. There are hundreds of makes and models of wheelchairs, with hundreds of accompanying options and accessories. Even physicians, clinicians, and distributors may find the choices staggering. Physical or occupational therapists are your best guides for the selection process. The therapist will give you an in-depth evaluation to help choose a wheelchair appropriate for your needs.

The therapist will consider your physical abilities, the hours per day you will be in the wheelchair, and the kinds of surfaces over which your chair will roll. To ensure that you are happy and comfortable in your new wheelchair, it is important to let the therapist know your personal preferences. This guidebook will help in preparing you as an “informed” consumer.

In the evaluation, the therapist will take your seated body measurements. These measurements determine the height and depth of the wheelchair’s armrests, seat, and back.

The therapist may use a pressure mapping system to determine where pressure points may cause sores on your body and take steps to ease this stress. Relieving this pressure increases comfort and decreases tissue trauma. Special air (a) and foam (b) cushions, alternating pressure pads, and gel pads are often necessary to prevent pressure sores.

The therapist may also use a “seating simulator,” which positions you in various positions in space, to determine the most appropriate seating position and angle. Correct positioning in a seat is extremely important for comfort and health.

a. Air pressure relief cushion. b. Foam cushion.

The Parts of a Wheelchair

Wheelchairs come in hundreds of varieties, but their basic design remains the same: a seat with two side frames joined by a cross brace.

Most wheelchair frames are built using tubular steel or aluminum. Many frames fold (a) for easy storage and transportation. Rigid, non-folding frame chairs are more maneuverable, but harder to store and transport. They may also be less comfortable on rough terrain.

The wheelchair’s seat, back, arms, and leg and foot rests provide support to the body. Armrests may be short, for ease in pulling up to a desk, or longer to support the entire arm. Some arms are detachable or swing out of the way. This makes transfers and transporting the chair easier. Foot and legrests support the legs for comfort or medical reasons. To improve maneuverability, some footrests are removable or swing (b) under the seat. The height, depth, and angle are usually adjustable. A wheelchair supplier should be able to adjust the chair to your measurements. Be sure you know how to make adjustments and how to work mechanisms like folding the chair and swinging away the legrests.

The wheels drive and steer the chair. Tire materials affect the wheelchair’s rolling resistance. Generally, pneumatic tires (inflated like bicycle tires) are better for outside use. Solid tires (rubber or polymer) work better on carpeted floors. Pneumatic tires generally give a more comfortable ride but require more maintenance than solid tires. A pneumatic tire that is low on air will make it much harder to push the wheelchair.

a. Folding wheelchair.

The small wheels in front of the chair are called “casters.” Larger casters give a more comfortable ride and clear obstacles more easily. Small casters give better maneuverability, but are easily caught in cracks and rough terrain.

Handrims and brakes provide control. Handrims, used to drive the chair, are mounted outside the back wheel. Brakes are now required on all wheelchairs. There are many types of brakes available for power wheelchairs and scooters, but all of them have parking brakes that lock automatically when the power fails or the joystick is in the neutral position.

Wheelchair anti-tipping devices can be added to the front or back of a wheelchair to prevent tipping forward or backward (c).

Because people have different needs, there are numerous wheelchair designs to adapt to all surfaces and circumstances.

b. Swing-away footrests are helpful for maneuvering through tight spaces. c. Antitipping devices ensure that the wheelchair will not tip backward during operation.

Recline and Tilt

The therapist may recommend a tilt and recline system (a) for pressure relief and postural relief. Postural relief refers to having different positions to choose from during the day. Choice of posture is based on physiology, comfort and activity, like reclining to rest or sitting upright to eat.

Recline refers to changing the angle of the seat to the chair’s back. A reclining back can help people who need a change of position because of poor head and trunk control, circulation problems, or respiratory problems. Some people also use a reclining wheelchair to help with transfers. Reclining frames are available in either manual systems, which an attendant operates, or power systems, which the user can operate.

Although helpful in many situations, the posture changes resulting from a reclining back may cause other problems. Some people have difficulty readjusting to an upright posture after reclining, and this could result in sitting in a slumped position. Also, the back of the chair moves separately from the person’s back. This can cause discomfort due to friction. A reclining back should be chosen with caution.

a. A reclining wheelchair may be helpful if you need to change position due to poor postural control, pressure problems, or respiratory problems.

Tilt refers to tilting the back and seat backwards. The angle of the seat and back stays the same, but the angle of the seat, back and floor changes. By tilting, the pressure is born on your back instead of just your buttocks. A tilt system can help people who cannot sit upright for long periods, have poor postural control, or who often sleep in the chair. Tilting can also help with circulation and muscle tone.

Both manual and power tilt systems are available. To activate manually, an attendant squeezes a trigger or steps on a release. In a power tilt-in-space system, the whole unit tilts on the wheelchair and maintains hip and knee angles. All seating angles are custom preset. To change position, a switch changes the tilt of the entire system.

Tilt systems can have both positive and negative effects. Choosing a tilt frame requires careful professional assessment.

Some people benefit from a combination of tilt and recline systems, which offers more options for postural relief. Just as someone may cross or uncross his legs or lean forwards or backwards, a wheelchair user may want to tilt, recline, or both tilt and recline. Tilt and recline add complexity and cost to wheelchairs. Insurance companies and other third party payors require good justification to purchase a chair with these features. Again, a thorough assessment is very important when selecting a tilt or recline system.

Types of Wheelchairs

Manual Chairs

As the most frequently prescribed wheelchair, the rear wheel drive chair is often called the “standard wheelchair” (a). The framework consists of two vertical tubes and two horizontal tubes. Standard chairs are heavy, usually weighing over forty pounds. Standard chairs usually have a push handle that reaches to hip level of the attendant for pushing. They also have a “tipping lever” that the attendant can step on to tip the chair backward, for ease in manipulating curbs.

People who need to transport or store their wheelchairs might prefer lightweight wheelchairs. These lightweight chairs are as much as thirty pounds lighter than the typical standard chair. Many people find they prefer lightweight chairs because they require less strength and energy to move.

a. The standard wheelchair is the wheelchair most often prescribed.

Ultralight chairs weigh only about 25 pounds. They are often called “sport chairs,” but many people who do not participate in sports find them useful. The components are the same as a standard chair, except the backrest is usually lower, and it may not have push-handles. Ultralights are usually more expensive than standard chairs.

Power Chairs

Power wheelchairs require much less physical strength to drive than manual chairs. They provide independence for people who are unable to propel themselves in manual chairs. Since these wheelchairs have to carry heavy batteries and power systems, the frames are generally sturdier than manual chair frames. Because of extra equipment, power chairs may be a bit wider. They are harder to maneuver in tight spaces. They are very heavy and do not fold. Most power chairs will require a van for transportation.

The joystick is the most common method of steering the chair. Besides basic steering, the interface between the wheelchair driver and the power system allows speed control and braking. Other interfaces include head controls, voice activated controls, and sip and puff controls.

Power chairs differ in speed, climbing ability, and in how far they can travel on a charged battery. Good suspension systems on power chairs can make a driver more comfortable by absorbing shocks and reducing vibrations. Batteries require frequent maintenance. Your wheelchair supplier should explain how and when to charge the batteries. With regular use, a battery should last a minimum of one year before replacement may be necessary. As wheelchair batteries differ from car batteries, buy the batteries only from a wheelchair supplier.

Scooters

Three wheelers, also known as scooters (b), resemble a horizontal platform with three wheels. Scooters are useful for people who can walk short distances but need help for long distances. Most scooters have rear wheel drive and front wheel steering.

Scooters are good for traveling over most indoor and outdoor surfaces. Scooters provide a very comfortable ride because they absorb shock. Most can achieve speeds up to 4 miles per hour. Many have seats that rotate for easy entry and exit. Scooters are steered with a handlebar, steering wheel, joystick, or push-button controls. Some scooters disassemble easily for transportation in the trunk of a vehicle. When selecting a scooter, check if you can lift the largest, heaviest part when disassembled. This may help determine how transportable it is for you.

b. Three wheeled scooter.

Specialty Chairs

Many wheelchair designs are for people with special circumstances, such as hemiplegia or an amputated leg.

Amputee Wheelchairs: When a person has a leg amputated, the center of gravity changes. Even when using a prosthesis, there may be an imbalance because of weight differences between the person’s leg and the prosthesis. When a person with an amputated leg sits in a wheelchair, there is less weight than normal in the front of the chair. Amputee wheelchairs (c) compensate for just such a condition by situating the rear axle and large wheels farther back.

c. Amputee chairs have been modified to compensate for a change in the center of gravity.

Hemiplegic Drive: Persons with hemiplegia or the use of only one arm have difficulty steering a wheelchair. Hemiplegic drive wheelchairs compensate for this either by having two handrims on one side, or by connecting the handrims so that the chair can be steered with one hand. Lower seat heights allow some people to “drive” the chair with the unaffected foot.

Standers: Some full-time wheelchair users who cannot stand unassisted use frames for support in a standing position. Standing can improve bowel and bladder flow, provide pressure relief, and offer the social benefit of being able to stand face to face with one’s peers. Some standers are fixed in place. Others include wheels to move around while standing. Wheeled standers come in both manual and powered models. Standing has major effects on a person’s body and balance. Not everyone will be able to manage it. Consult your physician and rehabilitation specialist if you are considering a stander.

Wheelchair Accessibility in Your Home

Wheelchair users may need to make some changes in the home to accommodate for their wheelchair. Power wheelchairs, in particular, may require adaptations.

You can rearrange commonly used items by moving them to within easy reach, perhaps by adding and using a low shelf. Baskets and pegboards situated within wheelchair reach are also great for storing commonly used items.

The kitchen can be modified with cut-out spaces under the sink (a) for the wheelchair to roll under. Faucet controls at the front or side of the sink are easier to use and reach. Similarly, ovens should have controls at the front or side of the oven. Doors that open sideways instead of downwards are easiest to use on appliances like ovens (b), dishwashers, and washing machines. Counter tops should also be at a lower level, with low cabinets that are accessible to reach from the wheelchair. Roll-out shelves and lazy susans are also helpful.

a. Your wheelchair can easily roll under the cut-out space under the sink. b. An wall-mounted oven with a side-opening door is easiest to reach. Photo courtesy of Gaggenau.

A licensed contractor, preferably one familiar with wheelchair accessibility can help you make changes that you might have difficulty doing on your own. A contractor should always be involved when making structural changes to your house, like ramps.

Accessories

Many wheelchair accessories are available to customize chairs for comfort and convenience.

Lap trays (a) come in a variety of styles, and are made from wood or plastic. Some are padded to protect the user’s arm, a feature which many people find more comfortable. Different mechanisms are used to fasten the lap tray to the wheelchair; some use plastic guides that fit over the arms, some use Velcro straps. A “half-lapboard” is available that fastens to one wheelchair arm, and takes up less space directly in front of the user. Kits are available for all the parts necessary to build your own laptray from a board. Weight of the lapboard is an important feature to consider, as you may attach it and remove it several times a day. An alternative to lap trays are lap desks. They provide a surface for writing or working, but do not attach to the wheelchair; rather, they sit in your lap, supported by your legs.

Arm trays provide support for one’s arm. Like lap trays, they come in a variety of styles, and use different types of mechanisms to attach to the wheelchair arms. Wheelchair armrest pads offer another alternative for providing more comfort for your arms.

Wheelchair pushing gloves provide extra traction in pushing a wheelchair, and also help protect the hands.

Transfer boards are typically made of wood or plastic. They make it possible for a wheelchair user to move from the wheelchair to another seat or bed without standing (b).

a. Laptrays and cup-holders put things within reach. b. Transfer boards can be used for sliding from the wheelchair to a bed, couch, chair or toilet.

Portable wheelchair ramps are available that can be set up easily and provide a safe bridge over steps and curbs.

Safety flags are available to make you and your chair more visible to drivers, should you use your wheelchair while crossing streets.

If your wheelchair is going to remain outside, perhaps next to your car, wheelchair covers are available to provide protection from the weather.

If you find that your wheelchair runs into walls occasionally, one company sells a kit that provides plastic and rubber bumpers and guards that can be attached to the wheelchair, providing protection for the walls.

Other wheelchair accessories include seatbelts (c) attachable umbrellas, ashtrays, shopping bags, caddies, side pouches, bags (d), brake lock extensions, and mounting clamps for accessories, lights, and cleaning systems.

Although accessories help to customize wheelchairs for better comfort and convenience, adding too many accessories can interfere with the performance of a standard or powered chair. Add only accessories that are necessary and avoid those that may limit a chair’s accessibility or maneuverability.

c. Seatbelts can help in remaining in a comfortable, safe position. d. Tote bags and baskets carry and organize belongings.

Wheelchair Transport

In most cases a person using a wheelchair who transfers from the wheelchair to a car seat, will want to take the wheelchair along. There are wheelchair carriers available that attach to the back of a car or van, to the top, or assist with getting the wheelchair inside the car (a) or trunk. The selection of a wheelchair carrier will depend on one’s ability to walk the short distance from the back of a car and the availability of other persons to assist. There are wheelchair carriers available for persons who get about in a car completely independently, yet are not able to walk. For users of powered wheelchairs who have specially equipped vans, lifts like the one pictured below are available.

a. Powered wheelchair lifts are available for vans and other vehicles and make it possible for a wheelchair user to get in and out of a vehicle.

Further Information

The American Association of Retired Persons (AARP) published a consumer report on manual wheelchairs, which includes product comparisons. For a free copy of the Product Report: Wheelchairs, call 1-800-424-3410 or write to:

AARP Fulfillment
601 E Street NW
Washington, DC 20049

Physical therapists can help you choose a wheelchair that fits your needs. Contact the American Physical Therapy Association for a list of physical therapists in your area.

American Physical Therapy Association
1111 North Fairfax Street, Suite 200
Alexandria, VA 22314-1488

Phone: 1-800-999-APTA (2782)

Occupational therapists are trained to assess home environments, including wheelchair accessibility. They can make helpful recommendations to make daily tasks easier and increase home safety. Contact the American Occupational Therapy Association for a list of occupational therapists who work in your region.

American Occupational Therapy Association, Inc.
4720 Montgomery Lane, P.O. Box 31220
Bethesda, MD 20824-1220

Phone: (301) 652-2682

Project LINK is a free, national information service that mails catalogs and other product literature from companies that make or sell helpful products. Since no names or addresses are released to companies, the confidentiality of the consumer is protected. To join Project LINK, call: (Voice/TT) 1-800-628-2281 or 716-829-3141, or write to:

Project LINK
Center for Assistive Technology
University at Buffalo
515 Kimball Tower
Buffalo, NY 14214-3079

The Rehabilitation Engineering Research Center on Aging offers a number of videos, pamphlets, and articles on assistive technology, some directed at health care professionals, and others designed for consumers. To receive a free product catalog, call 1-800-628-2281.

Technical Assistance Programs in most states, provide a variety of assistive technology services. RESNA is a national association that provides information and technical assistance to these state programs. For information on the Technical Assistance Program in your state, call (703) 524-6686 or TTY: (703)524-6639, or write to:

RESNA – Technical Assistance Project
1700 North Moore Street, Suite 1540
Arlington, VA 22209-1903