Wheelchair Selection: How to choose a new wheelchair

Wheelchair Selection: How to choose a new wheelchair

What's the big deal? Wheelchairs look pretty much alike. Right?
Wrong! It's just not that simple. A wheelchair is much more than "looks." There are as many differences in wheelchairs just as there are differences in cars or microwave ovens or... any consumer product.
With wheelchairs it can be even more important. Wheelchairs have strong differences in how they feel, how they fit, how they respond and what they enable us to do.
There are lots of differences in the people who use wheelchairs too. People who use wheelchairs vary in:

• Age: children, young adults and older adults,
• Gender: boys and girls, men and women
• Body type: every body type from muscular to just average to very thin or very overweight.
• Diagnosis or reason for using a wheelchair: some people are too weak or have too little endurance and can actually still still get up and walk in some situations. Others have paralyzed legs and torsos, missing limbs or poor balance and use a wheelchair all the time.
• Activities they want to do in their wheelchair: some people just what to sit, others want all of life's activities without exceptions.
• Places they will use their wheelchair: some people only use a wheelchair at home which is their primary environment. Other people go travel all around the community. Still others push their wheelchairs to the max using them in rugged environments like dodging potholes on city streets, working on a farm or camping in the woods.
• Preference or just "what they like": the same thing that makes some people like a Ford and others a Chevy.

Because people, their abilities and their needs are so different there are many possible combinations between people and mobility equipment. That's part of the challenge... figuring out which kind of wheelchair or seating system is best for each person. For many consumers, there is even another person who figures into these decisions. If a spouse or child or family member will be assisting the person using the wheelchair their needs may need to be considered in the wheelchair selection decision too.
People who buy or get a wheelchair for the first time are usually overwhelmed by their choices. In fact, they are overwhelmed just by the idea of having to use a wheelchair. Some of their concerns are addressed on the New User page. Usually, a wheelchair is not what people have in mind as a way for moving around in life.
The information you will find on the next few pages is about the process of getting a wheelchair. This page will link to other pages and resources on the Internet. Our goal is to give you as much information about the process of getting a wheelchair as possible so you can be an informed consumer. We think that informed consumers make better choices and better decisions. We also think that when consumers know more that it is easier for them to see themselves as "clients who are purchasing products and services."
Clients are people who hire professionals and then ask them to help solve or correct complicated problems. This way of thinking can be a very helpful model to keep in mind when you are preparing to get a new wheelchair. Wheelchair selection is a complicated process and, especially if you are new at it, you will want expert help. It will be a learning process for you but you will learn something every time you get a new wheelchair. It is also important to realize that regardless of expertise, you have the biggest stake in the end result. You will be using the wheelchair on a daily basis for the next 5 years or so. Because you have strongest interest in a good outcome we would like to help you know what to expect when you get advice from the seating and mobility professionals who will work with you.
The professionals in the wheelchair business are:

• people who evaluate you, your body and your daily living needs,
• people who recommend equipment that matches with your needs,
• people who complete the selling, funding and reimbursement transactions (like your insurance company),
• people who make sure that the delivered equipment is fitted exactly to you, and
• people who design, test and manufacture the wheelchairs that people want and need in their everyday lives.

So if you want to know more about this process keep on reading....

Getting a Wheelchair for the first time!

If you are like most people, you will be depending on the most knowledgeable person you know when you go to get that first wheelchair. This might be your sister who is a nurse, or an occupational or physical therapist, or a friend or spouse, or a salesperson at a durable medical equipment store. New users of wheelchairs usually get their first wheelchair in one of these ways. They get a:

• A loaner or hand-me-down chair from someone they know,
• A rental wheelchair from company that contracts with Medicare or their insurance company,
• A prescription from their doctor which they take to a sales person at a medical supply store, or, if they are fortunate, they go to
• A wheelchair clinic with experienced wheelchair people like OTs, PTs and Rehabilitation Technology Suppliers.

The outcome or the end-result in getting a first wheelchair can have a lot of variation:

• Sometimes people have a good experience.
• Sometimes they don't.
• Sometimes first-timers don't even know what to expect from the experience. (It's hard to have expectations when everything is so new!)
• Sometimes professionals know a lot and are really experts.
• Sometimes professionals know a lot, are really experts and they include YOU in the process.

When you are included in the process, then there is a larger chance that the outcome will be a good one. You are included in the process when you are seen as a "client" (someone who is purchasing a service) and the professionals ask you questions about:

• your goals,
• your needs both today and in the short term future,
• your lifestyle,
• your living environments,
• how you plan to use your wheelchair, and
• how you plan to travel as a driver or a passenger in motor vehicles.

When you as a client experience this kind of evaluation you have had the best situation of all.
So... If this is the kind of experience you had the first time you got a wheelchair, count yourself lucky! (Don't loose their phone number!) When it is time to replace your equipment you will have an excellent resource at your disposal. Spending money for this kind of service might seem like an expense to avoid the next time you get a wheelchair but it can actually be money very well spent. Mobility products and services are more expensive and more complicated today. Insurance companies allow replacement chairs less often so you can be stuck with a poor purchase for a long time. Many insurance companies are starting to recognize the value of a good evaluation and are starting to require it a a condition for purchase. A good evaluation can be a huge saving in time and aggravation. You can often prevent a secondary disability like a shoulder problem, a pelvic position problems or a pressure sore when you have a knowledgeable professional working for you.

The Wheelchair Evaluation Process

Since there is so much to learn about getting a wheelchair for the first time, this is a good place to talk more in depth about that process. There is a whole vocabulary of new words that you will start to hear. And it might be helpful to understand a head of time about some parts of the "service delivery" process. "Service delivery" is health care jargon that refers to the way an organization sets up the processes and procedures they will use to get their services delivered to you. Any time you get involved with an organization it is helpful to know a little something about how service delivery works and how to move around in that system.

We have created a page, Wheelchair and Seating Evaluations, that discusses the evaluation process and in particular:

• The Wheelchair Prescription
• The Wheelchair Evaluation Process
• The Evaluation Team
• The Consumer as the Focus
• The Evaluation Summary
• Letter of Medical Necessity or Justification

But, first do this!

Before you take your wheelchair prescription to an evaluation team it will be important for you to think about o the following important questions. As you come up with answers it may also be important to discuss with them with your family. Here they are:

1. Where will I use my wheelchair most?
2. What will I use my wheelchair occasionally?
3. What kinds of activities that I do (or did) everyday are most important to me to get back to doing?
4. How will I get my wheelchair (and myself) from place to place?
5. How much of the day will I be spending in this wheelchair?
6. How will I transfer from the wheelchair to other surfaces?
7. If I will need help with my wheelchair who will that come from and what features about my wheelchair are important to them?
8. How will I get my wheelchair around my neighborhood or yard? What kind of surfaces or slopes are involved?

If you have thought about these questions ahead of time, then you will approach the evaluation process a little differently than most new consumers. On the other hand, it is important that you have a team that takes the time to listen to you. Good Luck!
Here are some additional resources related to choosing a wheelchair that have been found through searching the WWW.

• Choosing a Wheelchair: A guide for optimal independence - a book by Gary Karp
  • Life on Wheels website
  • Purchase this book online
• Independent Reviews - reviews of different wheelchairs by knowledgeable and "real" end users.
• Informed Consumer's Guide to Wheelchair Selection - from ABLEDATA but written in 1994.
• Slide show "Development of consumer-based criteria for evaluation of assistive devices" - by Batavia and Hammer (a 18 K pdf download file).
• The Wheelchair Selection Guide: How to Use the ANSI/RESNA Wheelchair Standards to Buy a Wheelchair - a book by Axelson, Minkel, & Chesney - read the exerpts posted on WheelchairNet or purchase the entire book.
• Wheelchair Selection - from the Spinal Cord Injury Network at UAB.
• Wheelchair Selection: An ALS patient guide - by Marilyn Trail, OTR, BCN and Peggy Ingels, PT
• Wheelchair Selection and Training: Teaching and Guiding Practitioners and Consumers - a book review of 5 books on wheelchair selection by Brian Dudgeon, PhD.
• Wheelchair evaluation check list and Comparison Matrix - a resource located on WheelchairNet.
• What does it mean if your rehabilitation professional has Certification in Assistive Technology?