10 Things to consider when choosing a manual wheelchair
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Supporting a person to select the right manual wheelchair to meet their needs can be challenging, especially as there are so many options out there. We need to consider a number of factors that are individual to the wheelchair user when trying to narrow down options. This blog will discuss some considerations to be made when determining what the most suitable manual wheelchair might be for someone. And for the purpose of this blog’s title, we will keep it to 10 points.
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Top 10 Considerations
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1. Goal: Firstly, we need to consider what the overarching goals of the person are, and what’s important to them from a functional and participation perspective. For example, the goal may be getting a job, and a new manual wheelchair will allow a person to achieve independent mobility so they can travel to and move freely around their workplace. The wheelchair must be a facilitator of goal achievement and forms one part of a bigger strategy to support a person’s work towards achieving their desired outcomes.
2. Location: As part of the assessment process, we need to consider the environments where someone might be using the wheelchair (for example, home, school, work, and leisure activities) and the associated access and terrain around these locations. We also need to consider the way a person interacts with others and their environment at these locations (for example, the heights of tables, cupboards, circulation spaces, and facilities).
3. Travel: Thinking about how a person travels to and within the community (and not just the most common way, but all ways)- if this looks like independent vehicle travel, assisted vehicle travel (is a support person lifting the wheelchair into the boot of the car?) or public transport- may influence certain choices when it comes to wheelchair prescription.
4. Regularity and Support: How often someone uses their wheelchair and in what situations that might occur will help dictate priorities. We might often describe a wheelchair user as full-time or part-time. How someone propels their wheelchair- independently, with supervision, occasionally assisted or fully assisted- adds more factors to consider, in particular, if a support person is assisting. Transfers in and out of the wheelchair, as well as between what surfaces they transfer, such as the car seat, toilet, bed or any alternate seating options must be thought about including if any additional equipment or assistance is required to facilitate the transfer.
5. Skin Integrity: Considering skin integrity and various factors associated with someone’s risk of pressure injury, especially if high, always needs to be at the forefront of our minds. As mentioned already, there are often compromises when it comes to wheelchair prescription. For example, a certain cushion may offer high-pressure relieving properties, but if that cushion doesn’t also offer the level of postural support the person requires and they find themselves sliding down the seat, then it is unlikely to facilitate goal achievement.
6. Posture: Completing a Mechanical Assessment Tool (MAT) evaluation is a good way to determine what’s possible for someone’s posture when it comes to wheelchair prescription. Again, we must refer back to the person’s goals. Adding a number of postural supports to a wheelchair can result in optimal upright positioning, but if it makes the wheelchair too heavy and difficult for the user to self-propel, then we are unlikely to achieve what’s important to the person.
7. Configuration: Manual wheelchairs can come in a number of different configurations- tilt in space (with varying degrees of tilt), folding frame (in the traditional sense with a cross brace), and rigid frame. The type of frame and the way it’s configured impacts the overall weight of the wheelchair, which is important for a multitude of reasons for both the user and their supports. Examples of things to consider when configuring a wheelchair include dimensions- seat width and depth and floor-to-seat heights- armrests, push handles, rear-wheel type, footplate type and the list goes on.
8. Features: To a certain extent, we can think about the base frame of a wheelchair as a separate entity to the seating. When it comes to a scripted wheelchair, piecing together various components and how they might support goal achievement should be completed in collaboration with the wheelchair user +/- their supports. Seating can include the cushion, back support, head support, lateral supports (trunk and thigh), as well as accessories such as pelvic belts, upper and lower extremity supports, trays, and communication mounts.
9. Trial: Please consider supporting the wheelchair user to trial the proposed wheelchair in the closest configuration and seating that will likely form the final script. Trials are one of the best ways to determine whether the wheelchair will support goal achievement. If there were aspects that didn’t work about the trial wheelchair, changes can easily be made prior to order, which is not so easy to make once the new wheelchair has been delivered.
10. Integration: The final point to conclude our list of 10 things to consider when choosing a manual wheelchair, is that support doesn’t conclude once the new wheelchair is delivered. In order to successfully embed the new product as part of holistic goal achievement and reduce the risk of Assistive Technology abandonment, ongoing support must be provided to facilitate the person’s integration of the wheelchair into their daily life, routines and across all environments.
About the author
Hannah is the Assistive Technology Clinical Excellence Lead at KEO Care. Hannah has been a physiotherapist for over ten years with experience in multiple settings across Melbourne and interstate. Hannah enjoys working in the community as she feel it’s where she can make the greatest positive impact on people’s lives. Hannah has a passion for all things assistive technology, with experience at both the prescriber and supplier level of equipment prescription. Hannah enjoys collaborating with people to embed successful assistive technology solutions to support them achieve their individual goals.
