Understanding Choices in Manual Wheelchairs

There is no one perfect wheelchair that is right for everyone. Many factors exist that differentiate wheelchair models within the same category of wheelchair. When we understand some of the choices and the clinical implications of those choices, we can begin to see the value in understanding why several models of wheelchairs exist in the same category, even from the same manufacturer. This month, Clinical Corner will review some of the factors to consider that differentiate models of wheelchairs to allow for an optimal selection to be made with a client.

Before we begin on the factors to consider when selecting a model of a wheelchair within a category, let’s have a review of manual mobility. Clinical Corner has addressed manual mobility many times over the years as there is much to know about manual wheelchairs. For a review on any of the topics, click on the title for a link to the article.

• Manual Mobility: The Basics - This article provides an introduction to generic classification of manual wheelchairs. The categories of manual wheelchairs include transport, standard, folding, rigid, and tilt.
• Manual Wheelchair Prescription: Beginning with the Future in Mind - This article reviews the need to consider the potential for a client to change in size or function within a typical funding cycle and how the design of a folding frame wheelchair may help to meet their changing needs.
• Centre of Gravity and Manual Wheelchairs - This article reviews horizontal rear wheel position and the associated effects on rolling resistance and maneuverability.
• More on Rear Wheel Position and Standard Manual Wheelchairs - This article discusses the implication of back support selection and accompanying hardware when prescribing a standard wheelchair for an individual who self-propels.
• Vertical Rear Wheel Position in Manual Wheelchairs - This article reviews the vertical position of the rear wheel of a manual wheelchair and its effects on seat-to-floor height, orientation-in-space, and rear wheel access.
• Rolling Resistance in Manual Wheelchairs - This article explains rolling resistance and the factors that contribute to rolling resistance in a manual wheelchair.
• Front Caster Position in Manual Wheelchairs - This article reviews the effect of caster housing position on anterior stability, rolling resistance, maneuverability, and the potential for caster-footplate interference.
• More on Rear Wheels of Manual Wheelchairs: Lateral Position and Camber - The effects of the lateral position and the degree of camber on the rear wheel on lateral stability, maneuverability, access to the handrim, and environmental access are discussed.
• Maneuverability in Manual Wheelchairs: Which Fork to Use? - This article reviews the different choices of fork selection and the effects on turning efficiency and performance.
• The Weight Factor of Manual Wheelchairs - While weight is not the only factor that must be considered when prescribing seating and a wheelchair, this article reviews the factors that contribute to the overall weight of a system and how this influences rolling resistance and ability to transport a wheelchair.
• Taking a Second Look - This article looks at adult learning theory and why it is considered best practice to understand both new and "old" technologies.
• Enhancing Rigidity in Folding Wheelchairs - Rigidity in a manual wheelchair allows for greater efficiency of propulsion. This article describes several factors that contribute to rigidity in a folding frame wheelchair.
• The Science of Manual Tilt Mechanisms - This article reviews the various mechanisms of tilt wheelchairs and the associated effects of displacement of centre of gravity when moving in or out of tilt.
• Tilt Wheelchairs 2.0 - This article reviews the multiple factors to consider that differentiate various models of tilt wheelchairs.
• More on Wheelchair Transit Safety Standards - This article explains the similarities and differences between RESNA WC19 and ISO 7176-19 for occupied transit.

Differentiating Products

With so many models of wheelchairs existing in one category, even from only one manufacturer, how do we differentiate them? Let's start with standard wheelchairs. Sometimes it is the available configurations on a certain model of a standard wheelchair that help to make the appropriate selection. For example, if a specific low seat-to-floor height is required, it may be available on one model, but not another model. Some models also differ on the options that are available, such as the types of leg supports, casters and rear wheels. This may guide the selection towards a certain model of wheelchair that has the required option available. In addition, some models of standard wheelchairs have quick-release axles, while others do not. Some standard wheelchairs accommodate one-arm drives while other do not. These choices may help in the decision of selecting one wheelchair over another. Lastly, the position of the fixed axle may influence the selection. For example, while many standard wheelchairs have the fixed axle position at the rear frame of the wheelchair, some models have a centre of gravity offset, which makes the wheelchair easier to propel.

When differentiating between models of folding wheelchairs, even within one manufacturer's product line-up, it is important to consider the configuration choices available. For example, some models will have more options available than others. If a particular option is required, it may influence the wheelchair selection to a particular model that has the choice available. Different frame choices exist in folding wheelchairs. The choice of box frame or modular fame will affect the available seat-to-floor height range as well as the ability to accommodate any future change in size or function. Another deciding factor may be the weight capacity of the wheelchair. Not all models of folding wheelchairs have the same weight capacity. Another consideration is a transit option if the client is going to remain seated in their wheelchair while in transit. Another distinction between some models of manual wheelchairs is whether they have been crash tested for occupied transit and if they are complaint with RESNA WC19 or ISO 7176-19.

Summary

There is never going to be one model of wheelchair that is right for every client. Manufacturers recognize this and often provide several models of wheelchairs within a category to meet the various needs and demands of clients. This allows for optimizing both fit and function for a client through the selection of an appropriate model of wheelchair. How we choose between models of wheelchairs goes back to the assessment and then matching the goals of seating and mobility with the choices that are available.