1.1. My Wheelchair Guide: A Manual Wheelchair Mobile App

My Wheelchair Guide

United Spinal Association and the Department of Rehabilitation Science and Technology at the University of Pittsburgh have co-developed a new app that informs and encourages consumers and their families to play an active role in acquiring, using, and maintaining their manual wheelchairs and handling health issues related to wheelchair use. My Wheelchair Guide mobile app makes choosing the right wheelchair easier and more efficient. Now, all the necessary tools and resources to guide you through wheelchair selection, delivery and maintenance are at your fingertips. This comprehensive app covers the entire process of getting a wheelchair, providing practical information to evaluate your needs, wants, and concerns from beginning to end. Learn more about the app at the above link. Supplemental Information can be found here:  My_Wheelchair_Guide_Supplemental_Information.pdf (unitedspinal.org). 

1.2. Locating a Wheelchair Supplier- Medicare

Medicare.gov, the official U.S. government site for Medicare, offers the following Directory to locate Suppliers: Medicare Supplier Directory.

• The directory defaults to search within 10 miles of the zip code entered.  Once you receive your search results, you may need to modify your search by expanding the mileage on the "Distance" field on the right side of the page. 
• The supplier directory helps you find information about suppliers throughout the U.S. Although CMS and its contractors work hard to provide accurate and complete information, occasional errors may occur. Neither the U.S. Government nor CMS assumes any legal liability for the accuracy, completeness, or usefulness of any information, product, or process disclosed in the supplier directory, or represents that use of such information, product, or process wouldn’t infringe on privately owned rights.
• You can also select the  "Medicare assignment" check box to show only suppliers who always accept the Medicare-approved amount as payment in full for all claims for the product category.

1.3. Tips for Choosing the Right Wheelchair

The SCI Forum video "Tips for Choosing the Right Wheelchair" has been posted on the Northwest Regional Spinal Cord Injury System website.

 

For people with spinal cord injuries (SCI), having the right wheelchair is critically important for independence and health. How do you make the right decisions about this expensive, vital piece of equipment? Our speaker, Jennifer Hastings, PhD, PT, NCS is a nationally respected provider, researcher and educator in wheelchair seating for people with SCI. She discusses the principles of seating for maintaining optimal health after spinal cord injury, the relationship between seating and skin health, and how and when pressure mapping may be useful. She also provides resources for finding a wheelchair seating expert.

1.4. Surviving the wheelchair clinic

A large number of questions we receive are from people who are in the process of looking for a new wheelchair. Many of these people are doing their homework by gathering information, talking to other wheelchair users and providers and indulging in a fair amount of investigation prior to making a decision.

Still, there is more to it than looking at pretty pictures of wheelchairs or reading slick manufacturers ads. There is the process itself, the evaluation process. This is where the people in the know and you get together and start making some decisions on the type of ride you will have to live with.

If you are paying for your own wheelchair, you certainly have the option of going it solo. If your wheels are being funded by one of the customary sources such as Medicare/Medicaid, insurers, or the Department of Veterans Affairs, you will likely need to undergo an evaluation. This is where you will need all the help you can get. Being in the right place with the right people makes all the difference in this process.

First, locate a facility or clinic that can handle your needs. Turn your radar on and scan your area for a clinic or evaluator who has experience with your specific disability. If you have to travel to a clinic or center that specializes in your disability, do it. The time you spend in traveling is nothing compared to the time you will spend trying to make things right later on.

When you locate a clinic, call and ask some questions. Start by asking how many evaluations they have done on individuals with your disability. Hearing things like "You're my first" or "I've never done this before" is not what you want to hear. Ask around and talk to other wheelers who have been through the process.

It is not enough to put yourself in the hands of people who know wheelchairs. You need to find those who also know something about and understand your specific disability. Find the most experienced and knowledgeable people you can to help you with your evaluation.

If you're headed for a vendor's facility or clinic for your evaluation, put the eyeball out when you get there. Check out what other people are riding, especially the new chairs. Spotting the new chairs isn't tough. They're shiny, don't have dings or bent leg rests and have nice new looking upholstery or covers. If there is a line of new chairs sitting there waiting for delivery to users, check them out also.

If the chairs you are seeing are all alike, same manufacturer or same model, then you don't belong there. You have taken a wrong turn and have stumbled into "Cozycorners," a place where the staff has become very comfortable with one brand or model of wheelchair, or worse, "Vendorville," a place where a particular vendor is dominating the selection of wheelchairs. Either way, you need to be on the first wheelchair heading out of town. Limiting the arsenal and the choices also serves to limit the opportunity for good results.

At some point you will be face to face with the clinic team or wheelchair specialist. This is your one shot to be heard, so make sure you are. Don't be shy; get those questions and concerns out there. You should be a player in this process.

The clinic staff is there to help guide you to a successful outcome, so give them the information that they will need to get you there. Remember, opinions are just that, a conclusion reached by someone based on information that may be assumed or real, facts that may be accurate or bogus, mixed in with some mindsets and prejudices. Politely offer accurate information on your situation, correct people when they are wrong or make assumptions, and steer them back on track when they stray.

At the end of the evaluation, be sure to ask that a copy of the clinic notes be mailed or emailed to you. These represent the official findings of the clinic and they can make or break you. You may have to go to a particular person or special office to request these, and will probably be charged a couple of bucks for making the facility do some extra work. It's worth the extra effort and cost to get a look at them. Expect to wait a number of days or weeks before you receive them, that's normal. If you notice any surprises in the notes, call the clinic and discuss it with them.

Your new wheelchair will be as good as the company you keep in the clinic. You're likely to run into all levels of experience and knowledge there. Hopefully, you will come before a team comprised of people with varied expertise that may include therapists, vendors (providers), and even an occasional doctor. You may meet a rookie in there; don't let that bother you. Everyone started as a rookie. As long as the rookie is part of a team, you're okay. They have lots of energy and will probably have as many questions as you do; they keep the pros from turning rigid and opinionated. Anyway, the old pros like to strut their skills off in front of the rookies; that'll work for you.

Go with the flow. You may be asked to do certain things or go to certain places or clinics, maybe more than once on different days. You may be asked similar questions several times or be giving out information that you know is somewhere on some form that you handed in. Just do it! It's a good sign when team members confirm and reconfirm information. Don't jeopardize the evaluation by being in a rush to get a new chair. The evaluation, especially if your situation is intricate or involved, may take more than one visit. In order to help you, the clinic team may need a great amount of information about you and your condition.

You are doing yourself a tremendous service by jumping through the hoops.

Whenever necessary let the clinic team do their homework. There may be times when a clinic member may need to seek technical or clinical advice, look up things, call manufacturers, or confer with another staff member. Do not take this as a sign of rampant ignorance. It is not. There are hundreds of wheelchairs out there and thousands of accessories and aftermarket products. No one knows them all. Take it as a good sign when someone goes searching for information or guidance. They are doing it on your behalf.

There should be some logic to the choices. When certain chairs or chair components are recommended, there should be a good reason why that choice was made. For example, you would like a set of those small roller-blade casters on your new chair. I don't blame you. They're pretty cool looking, and some of them even flash colors when they roll. The clinic decides that you need a more conventional or a larger caster. At this point make it your business to ask why that decision was made. They should be able to give you a logical answer, something like this: "It appears that you live on the moon where there is a great deal of rough terrain. The small casters will get caught on the rough areas making it difficult for you to push the chair and possibly causing the wheelchair to tip over resulting in you falling from the wheelchair onto the jagged basalt rock surface and sustaining serious injuries. The larger casters would make negotiating rough terrain easier and safer." Sounds reasonable, doesn't it? You don't have to be an expert or old hand at it to recognize "reasonable".

You should be able to get an explanation for every option and every configuration decided on. Each feature and component selection should be discussed with you for your input. By the time it's all over, you should have a very clear picture of the chair in your mind.

Get prepped for it. Make sure that you go into this with lots of information at hand, in head, on list, or in mobil device. Information about your disability, your functional ability, your likes, dislikes and experiences with different wheelchairs, your home/community/work environment, recreational pursuits, your means of transportation, caregiver concerns, and questions about chairs and components you have researched on your own. Information that will give the clinic insights into who you are and what you do. It is very important that you are treated as a unique individual with unique needs.

Be sure to share the anxiety and bring people who know and understand your daily habits and wheelchair needs along to the clinic. There is no such thing as "they are not allowed in". If you want them in they are in. The concerns of caregivers, a spouse, family members or close friends may not be those that are at the top of your list. Often their concerns are related to weight of the wheelchair, portability, maintenance, ease of pushing chair and user, and compatibility with other home equipment. Nonetheless, they should be fielded in the clinic.

Trial the wheelchair. This one can be tough. If your needs are involved and require things like an odd sized chair, specialty controls, an array of positioning devices or custom components, then trialing a precisely configured wheelchair may not be possible. Locating a "demo" wheelchair with all the right customization is hardly ever possible. Neither clinics or suppliers keep that many differently configured wheelchairs around. It's just not possible. They may be able to find something that is close so regrettably that may have to do. The more common assembly line models should not be a problem.

If you are lucky enough to be supplied with a trial wheelchair then really trial it. Talk the clinic or supplier into letting you use it for a few days in your real world and not just trialing it once around the corridor or showroom. Pound the hell out of it and make sure to cruise all of your regular haunts. Use it in conjunction with your other home equipment to determine compatibility. Run it through all your doorways and living areas. Cruise your regular community paths and make your regular stops. Remember what worked for you and what didn't so that you can discuss the trial later on and adjust for findings.

Set high standards for the outcome but temper it with realities as they arise.

Relax, cooperate, be firm when you have to be, take control as needed, have patience, cross your fingers and slip a rabbit's foot into your pocket, and things should work out. Now that's one heck of a disclaimer, isn't it?

Ziggi Landsman
VP of Assistive Technology
United Spinal Association

1.5. A guide to wheelchair selection

By Jean Minkel, MA, PT

A United Spinal Association TechGuide publication


  How you get around has a big impact on what things you can do and where you can go.

Being able to take even a couple of steps, can be a huge advantage to getting around in your home. Some people are able to use the tight bathroom environment to their advantage, holding on to the sink, walls or grab bars. Counters may offer some support when standing or walking in the kitchen.

Once you get to the front door of your home, however, there are no walls for support and your lifestyle might require long distance mobility to do the things you want to do – shopping, visiting family friends, going to school or work.

Many people who have lived with a disability for a long time, have found that careful consideration of what is the best way to get around has been a key to their independence. For some people the solutions have included multiple devices - different environments, different devices - a manual wheelchair in the home, a scooter for work and even a handcycle for exercise.

Mobility Assistance Equipment comes in many forms, shapes and sizes. The options include:

• Assistive Devices for Ambulation – items to help you when walking – cane, crutches, and walkers
• Manual wheelchair – including chair with moveable wheels to improve your ability to self-propel as well as chairs designed to be pushed by someone else.
• Power Assist Devices – devices added to manual wheelchairs to make it easier for the wheelchair rider to get around.
• Scooters – three wheeled (some are available with 4 wheels) devices with a tiller for steering, which help in getting around, but do not look like a wheelchair.Power Wheelchairs – Front wheel, Mid wheel and Rear wheel drive options, controlled through a joystick or an alternate control device and available with multiple seating options including power seating.

Be an informed consumer. Ask other users about their own experiences. Ask lots of questions.

Very often mobility assistance equipment is purchased through a third party payer for example – medical insurance, Medicare/Medicaid, VA, or vocational rehabilitation. Each payer has their own set of "coverage criteria" and a system for purchasing. As you explore the mobility options available, keep in mind all of these products can be purchased directly by you. If you have the resources, your private pay purchase can offer you greater selection, at less than manufacturer's suggested retail price (MSRP) in a more timely fashion – no need to wait for "authorization".

As you explore options, you may find it helpful to consult with a health care provider with experience in mobility devices. There are Occupational and Physical Therapists (OTs and PTs) who specialize in assistive technology. There are suppliers, Rehab Technology Suppliers (CRTS®), who specialize in individualized fitting and service of the devices. Ask other users, they are often a great source of information of the people in your local area who may be able to help you.

"My physical functioning was unchanged, just my mind and my world had finally opened up. With the scooter, I could get around again. And I loved the freedom." 1 In her recent book, When Walking Fails Dr. Lisa Lezonni eloquently articulates the challenges faced by persons for whom the "acceptable" method of mobility, upright walking, is less than functional. Dr. Lezonni speaks from personal experience as a woman with Multiple Sclerosis (MS) who after many years of assisted ambulation, first with one cane and then with two canes, decided to try a scooter.

Adding a wheeled mobility device to your mobility options is a lot like looking for a new car.

There are so many options and many choices, how can you begin to make an informed decision. To be really satisfied over time, requires you do some homework up front. There is no one best chair. The best choice is the product (or products) that allows you to go where you want to go, when you want to go! To achieve that goal you really need to consider the environments where you will be using the device and what things you will be doing. Some users have no choice about using a chair, it is the only form of mobility available to them. For others, a wheelchair may be "augmented mobility", allowing for longer distance travel, without fatigue or fear of falling.

Options to think about. Do your homework!

Mobility Needs – A careful consideration of what things you want to be able to do, while using the device, will assist you in focusing on your choices. As noted earlier, like a car purchasing decision, you may need to prioritize your functions to identify the key features your need in a mobility assistance device. You may come to the conclusion that more than one device is, ultimately, what is needed. Many users have come to this conclusion and achieve their mobility goals by adding different devices to their options over time. Meet your top priority needs first. Overtime you can purchase different items to meet your needs in different environments.

An important first consideration is where are you having the most trouble getting around. If ambulation, even with an assistive device like a cane or a walker, is not an option, then you will be a full-time wheelchair rider. If walking around your home or other small spaces is functional, then you may only be looking for a device to increase your community mobility or a device to allow you access to a recreational / leisure activity.

You need to think of the chair in each of your environments, home, community, and for work/school/volunteering activities.

• Home – critical features of the wheelchair will effect your ability to transfer (getting in and out of the chair). What is the height of the seat from the floor? How does that height compare to your bed, for example? How do the armrests or foot supports move out of the way, to make your transfer easier? What is the overall width of the chair, will it fit through your doorways?
• Community – How do you want to travel in the community? Do you need to fold the walker when riding in the car? If you are using your arms or your legs to propel a manual wheelchair, will you get too tired, just getting to the store or to visit friends? Would a power option (power assist wheels, power chair or scooter) provide more efficient (you will be less tired) method of getting around? Are there sidewalks and curbcuts where you want to travel, or are you "sharing the road" with cars and truck? Do you want to be in the great outdoors – trails, grass, gravel or are you a "mall walker" – smooth finished floors, wide open doorways. Your choice of tires, wheels and type of base can make a world of difference getting around the store versus hitting the trail.
• Transportation – Where you live and what are your transportation options will have great impact on your device choices. Public transportation – bus or subway are increasingly accessible for passengers using a wheeled mobility device, providing you want to go where the bus is going. Private transportation (owning your own vehicle) gives you the most flexibility and freedom, when relying on a wheelchair to get around. However, fitting your wheeled mobility device into the car will present a series of questions. Can the chair fold? Can you store it in the trunk or within the car? Can you get it in the trunk and then walk to the car door? Many wheeled mobility device users find a van or a minivan, especially one adapted with a ramp or a lift are the real key to independent mobility. Modified vans are expensive and for many people, just not an option.

Options for ambulation aids:

• Cane or walking stick – The key is to get the cane fitted to be the right height. Ideally when you hang your arm by your side, your hand should hang just over the top of the cane, your wrist lining up with the very top of the cane. An adjustable cane is easiest to use when seeking the right height. Once you have established the height, if you are a long time user, you may choose to use a non-adjustable (cut to your specific height) cane or even a walking stick – to add a little style. When you grasp the top of the cane, your elbow should bend about 30 degrees. If you are using a cane because of weakness on one side of your body, place the cane in the hand of the stronger (opposite) side.
• Crutches - There are basically two type of crutch styles – under the arm (axcillary) or cuffed to the forearm (Lofstrand or Canadian crutches). A proper fit and some instruction on safe use is important. Seek the assistance of a health care provider when first using crutches. Long time crutch users have found the style tip (rubber tip on the bottom of the crutch) and the grip style for your hand can add to overall comfort for long term use.
• Walkers – Walkers now come in many styles – pick-up walker (no wheels), Sliders with little skis or tennis balls on the rear legs, or rollator walkers with 4 wheels. Some walkers are three wheeled – triangular in shape (offering a little less support but not as bulky). 4 wheeled walkers come designed for primarily indoor use with 4 little wheels or much more robust walkers with 4 larger wheels, a full basket and even a fold down seat.

Styles of wheelchairs and scooters

Broadly speaking there are three categories of products that are referred to as "wheeled mobility devices" – Manual wheelchairs, Scooters and Power Wheelchairs. As mentioned previously, many long-time wheelchair users have several of types of chairs – each chair functions differently in different environments, together they provide functional mobility for the person. Initially most people only purchase one device, but they hang on to that device later on and find "niche" uses.

Manual Wheelchairs- Manual wheelchairs are designed for two very different purposes –to be pushed by someone other than the rider or to provide self-prolusion by the rider.

Dependent/Transport mobility bases, not designed for self-prolusion often have small rear wheels and may look and function much like a stroller. For transport purposes, these chairs often fold compactly to store in the trunk of a car and provide "light duty" mobility. You may find a transport chair is a convenient "back-up" to your primary chair, easily folded when not needed, but readily available if your chair breaks down.

Specialty Positioning bases are dependent mobility devices that allow for changes in positioning by tilting the seating system or reclining the backrest or both. These devices are not easy to transport, but are designed to provide comfortable, full day seating for the user, who is not able to propel or operate a power wheelchair.

Self-propelling manual wheelchairs are equipped with a large wheel used for propelling. Riders self-propel using either both arms, both legs or one arm/one leg. If you are using your leg(s) for propulsion, then the seat to floor height is a critical feature to insure maximum mobility.

The most active manual wheelchair riders are able to balance the chair just on the back wheels. This is called, "doing a wheelie". The ability to do a wheelie significantly improves environmental access for the wheelchair rider. By "popping a wheelie" you can negotiate a high threshold, get over a 2" curb and, if able to ride in a wheelie, cross soft terrain like grass and gravel, without the front casters getting stuck and stopping the person in their tracks. Manual chairs with adjustable rear wheels (able to move the rear wheel forward and backward on the frame) need to be fitted to the user to get the best combination of "tippiness" (ease of popping a wheelie) and stability (not tipping over when just pushing on the wheels). If you have good balance and want to learn to do a wheelie, ask for training from your PT or OT.

Scooters

Scooters provide power mobility, but have the distinct advantage of "not looking like a wheelchair." For many people who have experienced difficulty with walking, a scooter is a great benefit to "restore" mobility. Scooters are most often 3-wheeled devices (4-wheeled scooters are also available), equipped with a tiller for steering and a seat mount on a platform, which serves as a footrest.

If you have even a limited ability to walk, there may be some good transportation options, such as using a lift into the trunk of car, when using a scooter. For children, who may be walking only limited distances, a scooter can provide "a cool" option to make longer distances to the cafeteria or recess much more feasible. Functionally the three-wheel design creates a longer turning radius, when operating indoors as compared to a traditional wheelchair. However, most scooters come with a swivel seat, allowing easier transfers from sitting to the standing position. Outside, the scooter will not be a stable as a power chair, especially when turning the scooter at high speed. Exercise good judgment and slow down when turning or traveling on unfamiliar ground.

An important consideration when considering a scooter is how stable is your medical condition. Unlike many power chairs which can be adjusted and re-configured with changes in your physical status, scooters are not nearly as flexible. You will need to be able to use the tiller to steer (you can not change the drive controller). Changing seating options, if your sitting balance is poor, is much more limited in a scooter than compared to a power chair.

Power Wheelchairs

Historically, the power chair was simply a manual wheelchair equipped with motors, batteries and a joystick. Today the power chair is a dramatically different design. Most power chairs, today, are designed to have two major components, the power base (containing the motors, wheels, batteries and control module) and the seating component. Each component (power base and seat) are offered with a wide variety of options. The following is just a general list of options you may want to consider

Power Base – The most obvious difference in power bases is the position of the drive wheel. Power wheelchair manufacturers now offer three types of "drives" – rear wheel, mid wheel and front wheel drive chairs. The placement of the drive wheel has a significant impact on "how" the chair moves. Each method has its advantages and disadvantages in both indoor and outdoor driving conditions. Your best bet is to arrange for a test drive, ideally with three different chairs, each with a different drive wheel position. Riders quickly identify the drive wheel placement, which feels most comfortable to control. Once a particular drive wheel placement has been chosen, there are several different models (from different manufacturers) from which to choose.

Wheelchair Seating

There are many options available when looking at seating on a power chair. The options range from fairly simple automotive style seats, often referred to as "Captain's seats" to very sophisticated power seating which may tilt, recline, elevate your leg rests and some seats even provide a standing feature. For children, there is even a power-seating feature that lowers the entire seat down to the floor to participate in peer-to peer activities.

Determining your seating needs requires a good look at your sitting balance (do you need external support to use both your hands) and your risk for pressure sores (do you need a mechanical method of taking weight off your buttock). If you have had "pressure sores" or you have trouble sitting up (over the edge of the bed for example), you should work with a health care provider to determine the seating options to best meet your needs.

Many power chair and scooter riders are able to use the standard controls, which come on the chair, the joystick or the tiller. For those who are unable to use the standard controls, several manufacturers now offer "alternate controls". These alternate controls replace the joystick and use other voluntary movements to allow the person to operate the chair.

• Examples include Sip "n Puff, which uses a straw and the person's sips and puffs to control the direction of the chair or head arrays – a series of switches mounted into the headrest which allow head movements to operate the chair. If you are in need of an alternate control system, you will need to be evaluated by a seating team, a supplier and a therapist who specialize in customized assistive technology solutions.

Power Assist

A new technology is now available which offers hybrid or "cross-over" products, between traditional manual and power wheelchairs. The power-assist systems are equipped with new wheels (the larger rear wheel for a manual wheelchair) that are battery operated and designed to increase the number of revolutions the wheel makes with just one push on the rim.The goal is to increase the efficiency of manual propulsion while reducing the amount of effort the rider must put into the wheels.

Add-on power systems are designed to give power chair operation, while mounted onto a manual wheelchair base. With a quick release system, these add-on power systems are more easily transportable than traditional power chairs, but do not have the long-term performance or durability of traditional power chairs.

Wheelchair type advantages and disadvantages:

	Advantages	Disadvantages
Manual Wheelchairs	1. Lighter in weight 2. Greater reliability 3. Easier to transport 4. Less expensive 5. Provides a level of exercise 6. Easier to overcome accessibility problems	Self-Propulsion: 1. Possible secondary complications (sore shoulders, wrists and elbows) after long-term use. 2. Requires physical effort to be mobile
Scooters	1. Aesthetics, does not look like a wheelchair. 2. Increases mobility range without increased exertion 3. Swivel seat may allow for easier transfers in and out of the seat.	1. More complicated to transport in a car than a manual chair. 2. Needs charging 3. Less flexible to modify to changing physical conditions than a power chair.
Power Wheelchairs	1. Greatest mobility range with least exertion. 2. Easier to modify over time, if needed. 3. Available with power seating options – tilt and/or recline.	1. More Expensive. 2. More difficult to transport. 3. Less reliable than manual wheelchairs.

The Internet has opened a great opportunity for product exploration before ever going to a wheelchair clinic or a medical store showroom. Each manufacturer has a website describing their own product line. Major manufacturers include Invacare, Permobile, Pride Mobility and Sunrise Medical. Other valuable resources include:

• www.usatechguide.org – large database of available products by category and wheelchair user reviews.
• www.wheelchairjunkie.com – consumer direct information regarding commercial products and a wheelchair users forum.
• www.resna.org – provides a directory of therapists (Assistive technology Practitioners (ATP) and Suppliers (ATS) who specialize in rehab products.
• www.nrrts.org – list of suppliers by state specializing in rehabilitation products.

Conculsion
In closing, the purchase of a wheeled mobility device is not a simple purchase. Much like the car, there are aesthetic considerations, what image do you want to project? Also like a car, what functions do you need to accomplish, may influence your selection. Many a "soccer mom" would love the 2-seater, convertible roadster, too bad there is no room for the kids. Function often wins out.

Both the image of ourselves and the functions we need to perform as a part of our everyday lives change over time. Over time you may have different priorities and thus "move" from one type of mobility device to another. Always do your homework. Ask others about function, reliability, personal experiences of people with similar needs as your own. With routine maintenance and a little tender loving care, your mobility device can provide years of mobility.

Get out there. Talk to other riders, they are a great source of information. Check out the options which can take YOU where you want to GO!

 

References:
1. Iezzoni LI. When walking fails. JAMA. 1996;276:1609-1613.
2. Hokenberry, J.: Moving Violations, Hyperion, New York, 1995
3. .Karp, G. Life on Wheels: For the Active Wheelchair User, O'Reilly & Associates, Sebastopol, CA. 1999.
4. Bates PS, Spencer JC, Young ME, Rintala D. Assistive technology and the newly disabled adult: Adaptation to wheelchair use. American Journal of Occupational Therapy, 1993, 47, 1014-1021.
5. Axelson P, Chesney D, Minkel J, Perr A. The Manual Wheelchair Training Guide. Minden, NV PAX Press, 1998.
6. Axelson P, Chesney D, Minkel J, Perr A. The Power Wheelchair Training Guide. Minden, NV PAX Press, 2001.

7. Denison I, Shaw J, Zuyderhoff R, Wheelchair Selection Manual: The Effect of Components on Manual Wheelchair Performance Vancouver, BC BC Rehab, 1994 (604) 321-3231 x762

*Jean L. Minkel, MA, PT is an educator and master clinician widely recognized for her expertise in assistive technology. She currently directs Minkel Consulting, a company providing educational and consulting services to clinicians, consumers, manufacturers and payers. She is the author and director of the videotape series: Spending or Investing: Funding Assistive Technology and co-author of the book A Guide to Wheelchair Selection and The Manual Wheelchair Training Guide. Ms. Minkel has over a decade of experience in seating and mobility service delivery to clients of all ages. She has lectured extensively in the United States, Canada, Europe and China.

Copyright United Spinal Association
Reproduction of all or any part of this document is forbidden.
Contact zlandsman@unitedspinal.org if you would like to reproduce all or part of this content.

 

1.6. Your Second Power Chair: What You Need, How To Get It

Your Second Power Chair: What You Need, How To Get It

Article from New Mobility November 2014

1.7. Power (Assist) to the People

Power (Assist) to the People
An article by Alan Troop in New Mobility magazine for July, 2002. Power Assist - the latest thing in wheelchair design - gives wheelers new options, energy and fun.

2.1. United Spinal Wheelchair Reviews & Views Project

United Spinal Wheelchair Reviews & Views Project: This resource provides wheelchair reviews from users, caregivers and clinical staff, along with readily available information, which can help with the wheelchair selection process. View the wheelchair entries or post a non-technical review on a wheelchair that you are familiar with.

2.2. Choosing a Wheelchair

Article from the Northwest Regional Spinal Cord Injury System:

Choosing a Wheelchair
Finding a wheelchair that fits the physical, lifestyle and financial needs of the user begins with a thorough seating evaluation by a clinician who specializes in seating and positioning and who can guide the consumer through this often confusing and time-consuming process.

2.3. Getting the Right Wheelchair: What the Spinal Cord Injury Consumer Needs to Know

From the Model Systems Knowledge Translation Center:

Getting the Right Wheelchair: What the Spinal Cord Injury Consumer Needs to Know
Your wheelchair is an important part of your life, so you want to make sure you end up with the right wheelchair that fits your body, preferences, activities and lifestyle.

2.4. The Manual Wheelchair: What the Spinal Cord Injury Consumer Needs to Know

The wheelchair is a complex piece of equipment that has been extensively engineered and studied. Most individuals with SCI become wheelchair experts because doing so increases their chances of getting a wheelchair that truly meets their needs. However, there are numerous options when considering a manual wheelchair, so it is critical to get help. While it is not possible to teach you all there is to know in a single handout, this factsheet from the Model Systems Knowledge Translation Center includes some of the most important information.

2.5. The Power Wheelchair: What the Spinal Cord Injury Consumer Needs to Know

The wheelchair is a complex piece of equipment that has been extensively engineered and studied. Most individuals with SCI become wheelchair experts because doing so increases their chances of getting a wheelchair that truly meets their needs. However, power wheelchairs are technologically advanced and have many components, so it is critical to get help when purchasing a new chair. While it is not possible to teach you all there is to know in a single handout, this factsheet from the Model Systems Knowledge Translation Center includes some of the most important information.

 

2.6. Switching to a Power Chair

A pamphlet from Craig Hospital that reviews decisions one faces when considering changing from a manual chair to a power chair.

2.7. RERC on Wheeled Mobility

RERC on Wheeled Mobility
The Rehabilitation Engineering Research Center on Wheeled Mobility conducts research as well as develops and evaluates data on wheelchair selection, seating, postural measures and wheelchair technology. This web site also has information on wheelchair standards.

2.8. WheelchairJunkie.com

WheelchairJunkie.com
An Internet site that provides unbiased, honest news and reviews of wheelchairs and a message board for user to help user, the unbiased "Consumer Reports" of wheelchairs and accessories.

3.1. Non-Medicaid Wheelchair Assistance programs

A few states also have programs for Medicaid-ineligible seniors that provide a variety of financial supports with the aim of keeping the individuals off of Medicaid. These programs vary quite a bit from state to state. But we’ve identified the following programs as having a broad enough charter or specific enough objective where their benefits can apply to individuals in need of home medical equipment and assistive technology. Click on the program names to learn more.

4.1. Safe Wheelchair Transfer Training Course (online) and Infographics

The University of Pittsburgh Spinal Cord Injury Model System and the American Institute for Research in collaboration with the Model Systems Knowledge Translation Center have developed resources to educate consumers on safe wheelchair transfer techniques. 

Transfers are critical to independence for wheelchair users. Unfortunately, they also put higher stress on the arms and shoulders. Learning the correct way to transfer can reduce the risk of developing pain or sustaining injuries. This self-paced direct-to-user training program on independent transfers is now available for manual and power wheelchair users: Safe Wheelchair Transfer Training.

Please also see the following related infographics, created by the collaborative team indicated above: 

• Safe and Independent Manual Wheelchair Transfers
• Safe and Independent Power Wheelchair Transfers

4.2. Ultralight Wheelchair Skills: From Rehab to Real World

 

Ultralight Wheelchair Skills: From Rehab to Real World

 

Presented on November 8, 2011 at Harborview Medical Center, Seattle, WA as part of the Northwest Regional Spinal Cord Injury System's SCI Forum presentations

Learn the skills you need to successfully navigate your ultralight manual wheelchair in a variety of situations and environments so you can more fully participate in the activities you enjoy. In this video, physical therapist Elisa Smith, DPT, of Harborview Medical Center provides practical tips and explanations for learning and perfecting wheelchair skills, including wheelies for curbs and maneuvering in small spaces, on gravel roads, up and down hills, and more. Wheelchair users with spinal cord injuries are shown demonstrating several of these skills.
Click here to read the written report.

The Empowerment Project Videos

 

Wheelchair Skills Video Series

Learn proper techniques for performing manual wheelchair skills and managing different kinds of terrain so you can be as independent as possible in your life. These short videos will show you how.

• Video 1: Introduction to Wheelchair Skills
• Video 2: Wheelie in Place
• Video 3: Wheelie Pop-Ups
• Video 4: Forward in a Wheelie
• Video 5: Grass to Sidewalk
• Video 6: Turning in Tight Spaces
• Video 7: Wheeling Across Grass
• Video 8: Managing Potholes
• Video 9: Crossing Raised Obstacles
• Video 10: Down a Ramp in a Wheelie
• Video 11: Curbs and Steps

4.3. Safe Transfer Technique

Safe Transfer Technique (2009) - Transferring in and out of your wheelchair puts high stress on your arms and shoulders. This publication authored by Michael L. Boninger, MD, in collaboration with the Model Systems Knowledge Translation Center, discusses the correct way to transfer. 

 

 

4.4. Wheelchair Skills Program

This website deals with the Wheelchair Skills Program (WSP) developed by Dalhousie University in Halifax, Nova Scotia. The WSP includes the Wheelchair Skills Test (WST), the questionnaire version of the WST (WST-Q) and the Wheelchair Skills Training Program (WSTP). It is used to assess and train wheelchair users and/or their caregivers and clinicians. Also available in French, Bosnian, Chinese, and Farsi.

4.5. Power Wheelchair Mobility

Power Wheelchair Mobility

By Dave Colescott, PT

Presented on November 8, 2011 at Harborview Medical Center, Seattle, WA

Learn the skills you need to successfully navigate your power wheelchair in a variety of situations so you can more fully participate in the activities you enjoy. In this presentation, Dave Colescott, PT, of Harborview Medical Center, provides practical tips and guidelines for learning power wheelchair skills, starting with proper positioning and progressing to maneuvering safely in a variety of environments, including mud, snow, crossing tracks and climbing obstacles.

5.1. Wheelchair Maintenance Online Training Courses and Infographics for Consumers

These courses were developed by the University of Pittsburgh Spinal Cord Injury Model System and the American Institute for Research in collaboration with the Model Systems Knowledge Translation Center. Their self-paced direct-to-user training programs on independent transfers and wheelchair maintenance are now available.

Wheelchair maintenance can reduce wheelchair breakdowns, injury, and related consequences, as well as costs for repairs and replacement. Do you know how to maintain your wheelchair? Check out these free resources to keep your wheelchair rolling:

• Power Wheelchair Maintenance Training: This training will teach you how to identify issues with your power wheelchair so you can keep yourself safe and better manage the cost of wheelchair repairs. 
• Manual Wheelchair Maintenance Training: This training will teach you how to identify issues with your manual wheelchair so you can keep yourself safe and better manage the cost of wheelchair repairs.

The following related infographics were also created by the teams mentioned above:

• Know and Maintain Your Folding Manual Wheelchair
• Know and Maintain Your Rigid Manual Wheelchair
• Know and Maintain Your Power Wheelchair

5.2. Wheelchair Maintenance Video with Sunrise Medical

5.3. Maintenance Guide for Users of Manual and Power Wheelchairs

“Maintenance Guide for Users of Manual and Power Wheelchairs" was written by Sara Munera Orozco, MS; Jon Pearlman, PhD; Lynn Worobey, PhD; Michael Boninger, MD and developed in collaboration with the Model Systems Knowledge Translation Center (MSKTC). This resource provides an overview of manual and power wheelchairs and explains the importance of performing maintenance for each. 

6.1. Leveraged Freedom Chair (LFC)

GRIT The Leveraged Freedom Chair (LFC)

Contact: 1-877-345-4748 or email us: info@gogrit.us 

Available currently in India and developing countries in orders of 100 chairs or more. Available in the US and developed countries as well. International shipping is available. Contact us at info@gogrit.us with your ship-to address to request a shipping quote.

GRIT is a social enterprise startup based in Boston, Massachusetts. We believe in a stakeholder driven design process, where the people who use a technology help to design it. We started as the MIT Mobility Lab where we invented the Leveraged Freedom Chair (LFC), a lever-powered all-terrain wheelchair. After four years of testing the LFC in the field, we founded GRIT in 2012 to bring the LFC to market. We help people with disabilities get off-road and on with their lives.

6.2. Free Wheelchair Mission-Manual Only

Free Wheelchair Mission-is a faith-based international aid organization dedicated to providing very basic wheelchairs to those in other, usually third-world countries who have no such mobility options at all. This is the list of countries served.

6.3. Participant Assistive Products

Participant Assistive Products Benefit Corporation — — Wheelchair product provider — — International

Great medical devices can be affordable. Today, 80% of medical devices are designed for only 20% of the people who need them. To fit tighter budgets and rougher environments, our product design process and company structure are different.

Participant is for-profit
company registered as a Benefit Corporation. Here are a few of our commitments
to social impact.

• Our products are evaluated by outside experts to confirm
  that they pass international quality standards.
• We monitor and report the actual efficacy of our products.
  Our participants tell us if we are succeeding!
• Our management is evaluated by our board using
  environmental and social metrics - as are all employees.
• All products have lifecycle impact assessments. We do not
  do ‘planned obsolescence’.
• 5% of our profits are donated to our non-profit partners
  so they can serve more people.
• We all participate in the company's success. All employees
  are owners regardless of where they live.

6.4. Push International

Push International is a non-profit humanitarian organization whose mission is to provide mobility and facilitate sustainable development in the disabled community inside the countries where we work. Collection points are scattered accross several US states and service includes Mexico.

6.5. Reach Out and Care Wheels

Reach Out and Care Wheels
Providing wheelchairs and other mobility products for people in developing countries without regard to political affiliation, religious beliefs or ethnic identity in Nepal, Mexico & the West Bank.

6.6. UCP Wheels for Humanity

UCP Wheels for Humanity's mission is to provide increased self-sufficiency, mobility and education to people with disabilities throughout the world, without regard to political affiliation, religious belief or ethnic identity. Staff and volunteers at UCP Wheels for Humanity collect and refurbish used wheelchairs then individually fit them to impoverished children and adults in developing countries. Project map

6.7. Wheelchair Foundation

The Wheelchair Foundation is a non-profit organization with a goal to provide a free
wheelchair to every child, teen and adult worldwide who needs one, but has no means to acquire one. Countries served

6.8. Whirlwind Wheelchair International

Whirlwind Wheelchair International is a non-profit social enterprise dedicated to improving the lives of people with disabilities in the developing world while also promoting sustainable local economic development in the process. We work to make it possible for every person in the world who needs a high quality wheelchair to obtain one, leading to maximum personal independence and integration into society. By giving wheelchair riders a central role in all aspects of our designs and projects, Whirlwind ensures that our chairs are individually appropriate for each user and his or her respective environment. For thirty years in over 40 countries we have focused on producing durable, low-cost, and highly functional wheelchairs. These chairs give riders the reliable and functional mobility they need to reach their full potential. Our active adult wheelchair design, the RoughRider^®, is used by 25,000 riders traveling over every terrain that only the best of wheelchairs can cross, from muddy village paths to rough pot-holed urban streets.

At this time, Whirlwind has collaborative wheelchair production relationships in the Republic of Georgia, South Africa, Vietnam, Mexico, Canada and China.