What’s so hard about choosing a wheelchair? I can just choose one that looks good to me, or chooses based on the cost of the wheelchair right? In the end, aren’t all wheelchairs basically alike? No, they’re definitely not. Wheelchairs are highly customizable, and they have to be; wheelchair users have diverse characteristics and a range of needs that must be met.
Wheelchairs have at least as many variations as any other consumer product, and getting the right fit is even more important than with any of those other purchases. Wheelchairs fit and feel very different from person to person, and they have major differences in how they respond to users and what they enable users to do.
People who use wheelchairs are not a homogenous group! They vary in many ways:
- Age: very young children, elderly adults, and everyone in between.
- Body type: well-muscled athletes, to very slim or very overweight users, to just plain average sized people use wheelchairs.
- Cost of a wheelchair: wheelchairs do vary in cost significantly.
- Diagnosis or reasons for using the wheelchair: although many people assume that everyone who uses a wheelchair is paralyzed, this isn’t accurate. Some users are paralyzed, either partially or throughout large portions of their bodies; others are missing limbs, or have a very poor balance that keeps them from walking effectively; still others just can’t manage walking because they lack endurance or strength.
- Gender: boys and girls, men and women
- Locations: users who mostly use their wheelchair at home have many different needs than users who need to travel outdoors on rugged terrain.
- Needs: different users want to do different activities in their wheelchairs; some people just need to get around a little or sit comfortably, while others intend to take part in everything life throws at them, along with some new activities, without exception.
- Preference: yes, just like anything else, sometimes users or a product just like one brand or feature more than others, and this is true for wheelchairs, too.
The vast differences that exist between wheelchair users and their goals and needs mean that there are almost endless possible combinations of users and mobility equipment. Often, it’s also important to factor in the needs and preferences of healthcare providers, caregivers, spouses, children, or other family members, making the process even more complex. The challenge is determining which type of wheelchair is ideal for each user.
This is why shopping for a wheelchair can be overwhelming, especially for first-time buyers. It’s easy to feel overwhelmed by all of the options. In fact, for many first time buyers, who are already feeling overwhelmed by the need to use a wheelchair at all, the shopping and buying process adds a whole new layer of stress. For most people, getting around using a wheelchair wasn’t part of the plan; it may not be the most exciting or fun shopping trip. And no one likes to spend a lot of money, so the cost of the wheelchair can also make the shopping experience less amusing.
The information in this guide is here to help you through the process. Our goal is to provide as much information about the wheelchair selection process as possible to help you be an empowered consumer. We also think that when consumers know more than it is easier for them to see themselves as clients who are purchasing products and services.
Self-Evaluation: The Wheelchair Shopping Process
Before you get too far down the road in your wheelchair shopping process, it is important for you to think over the following critical questions and answer them as honestly and completely as you can. Some of these may benefit from input from your family members, close friends, or caregivers. Here are the questions:
- Where will I use my wheelchair most? Inside? Outside? In dense, urban areas or sparsely populated places?
- Where will I use my wheelchair occasionally? Will I be vacationing? Traveling for work? Playing sports? Where are some places I might go sometimes, even if they’re not on the daily schedule?
- What are my everyday activities? What are some everyday things that I haven’t done for a while that I want or need to get back to? What are some new things I’d like to try?
- How will I be transporting myself and my wheelchair from place to place? Is there more than one mode of transportation I’ll be using? Do I have a backup plan?
- How many hours will I be in the wheelchair each day and night? Will this vary?
- How will I transfer from the wheelchair? Will I need help?
- If I need help generally with my wheelchair who will provide it? What wheelchair features are important to them?
- How will I navigate my wheelchair around my house, yard, and neighborhood? What kind of terrain, surfaces, and inclines are there?
- How much continuous charge am I likely to need in a day (for power chair users) without stopping to charge? Will this depend on the day?
- Do I have specific physical or mental needs that will need to be addressed somehow by my chair? What are they? For example, will I need to use a seeing-eye dog alongside my chair? Or will I need to take special care to avoid pressure sores?
- How will I manage the cost of a wheelchair?
Think these questions through ahead of time so you can approach the shopping process with more answers than questions. Self-evaluation isn’t always easy, but it’s easier if you take your time with it and do it in advance before others are waiting for an answer.
Wheelchair Basics – Manual Wheelchairs
Choosing the perfect chair, particularly for a first-time shopper and new wheelchair user, can be overwhelming, or at least confusing. If you have access to an occupational therapist (OT), definitely use that person’s skill and experience to your advantage They can help you discern the differences between the many types of wheelchairs.
Those who have enough upper body strength to port themselves typically use a manual wheelchair. This just means any chair propelled by forward pushing of the arms with the hands grabbing the rims of the wheels. There are many, many kinds of sub-types of manual wheelchairs.
Not so long ago, the standard manual wheelchair was a heavy, chrome-plated machine that weighed around 50 pounds—not so easy to push around. Today’s manual wheelchair is so much different! On average, modern manual wheelchairs are less than half that weight, in many styles and colors, to boot.
Modern manual wheelchairs benefit from modern ergonomic design. They feel more comfortable and move with much greater ease. They are designed for high performance, not just getting from point A to point B. They also make use of better materials, such as the super-light titanium that is often used in manual wheelchair frames. Lightweight wheelchairs are better for the shoulders of the people who push them, and titanium is definitely the most popular lightweight material in the U.S. Modern manual wheelchairs are also built for active lifestyles, especially the lightweight wheelchairs, with folding or rigid frames, which are so much easier to lift in and out of vehicles.
Speaking of rigid frames and folding frames, here is the primary difference. As you may guess based on the basic physics of things, rigid frames are easier to push, making more of your energy by transferring it into forwarding motion. Folding frames have the obvious advantage of being more portable, though, which for many users makes up for that lost forward energy; some even fit in the plane’s overhead bin.
This rigid/folding frame comparison introduces a concept that is present throughout the wheelchair discussion: there is always a tradeoff. In almost every circumstance, a benefit comes with a tradeoff. For example, some wheelchairs now come with suspension systems. These offer a much smoother ride—that’s the benefit. The tradeoff, though, is that the suspension system adds a little weight (usually just a few pounds, but every pound counts when you’re pushing!) and price (just like a car, adding options tends to inflate the price.
Aftermarket products for manual wheelchairs
Thanks to the innovations brought to market by various inventors—many of them wheelchair users or family members of wheelchair users—there are many aftermarket products for use with manual wheelchairs. These innovations can add to the total cost of the wheelchair but are often well worth it. Frog Legs are a product you can buy to install on the front forks of your manual wheelchair in order to add suspension and a smoother ride. Medicare will reimburse you for this purchase; these are quite popular.
There are also plenty of aftermarket choices for tires and wheels out there, including products for off-road traction, performance, and style. Spinergy offers a line of high-performance wheelchair rims. They stay true without warping and are very light. They also offer a truly innovative soft rubber push rim, the FlexRim. This rim bridges the gap between the tire and the rim, making it easier to propel with less force and lower impact while protecting the arms and hands.
Or, if your shoulders are already a problem (or you just want to make sure they never become one), there are aftermarket propulsion alternatives that let you move your chair without pushing on the rims at all. Lever-driven chairs are the most common alternative, easier on the shoulders than standard rim pushing.
Wheelchair Basics – Power Wheelchairs
Tip: Language and optics matter. Remember, avoid saying that a person is “confined” to a wheelchair; in fact, they are more independent because of their wheelchair. With a wheelchair, people have meaningful access—to play, work, travel, and almost anything else they want or need. A person in a wheelchair usually gets around just as quickly as any walking person can.
Now, let’s get back to our wheelchair breakdown, and look at more wheelchairs.
If you think that seemed like a lot of variation, get ready because there is a whole lot more variety in the realm of electric wheelchairs, also known as power wheelchairs and motorized wheelchairs. Anyone who can’t propel a manual wheelchair might need a power wheelchair or electric scooter powered by a motor and batteries. Most are controlled by joysticks, but there are many alternatives there, too, which we’ll cover a bit later on.
Motorized wheelchairs are made in several basic styles. The traditional style of power wheelchair looks very much like a manual wheelchair with some extras added onto it, including the control systems, the batteries, and the motor. There are also platform-model electric wheelchairs that have a power base on the bottom and a fairly ordinary-looking captain’s chair or seat fixed on top.
Decades ago, the market for motorized wheelchairs was limited. There were only a few models and brands to choose from, and anyone whose needs weren’t fairly standard often had to improvise on their own or make do. Demand and innovation have opened up this market and the number of choices now available is vastly expanded, with an emphasis on much faster, lighter, and more powerful electric wheelchairs.
Most power wheelchairs are still rear-wheel drive models, but both front-wheel and mid-wheel drive motorized wheelchair models, agile in tight spaces and easier to turn, have captured a share of the market. There are electric wheelchair models that specifically designed for off-road use, rugged and ready for action. There are motorized wheelchair models that can actually fold for travel. There are power wheelchairs that can be customized in almost any way you can think of, to meet even the most complex needs of people coping with all kinds of spinal cord injuries and paralysis. The bottom line is that so much more than looks and style go into making the right choice for each user.
Getting an electric wheelchair configured and fitted to meet every need often demands expert help. If you do have access to advice from an OT, make use of it! If not, choose only a reputable durable medical supply house. If you’re seeking reimbursement for your purchases, you may have to defend your purchasing decisions, so make sure you’ve noted the reasons behind your decisions.
Battery life is central to motorized wheelchair users. Mismanaging your power source can be annoying or even dangerous, particularly when you’re far from home.
Power wheelchairs use 24-volt “deep-cycle” batteries, which are discharged, meaning they spend their power, gradually over long periods, unlike, say, a 12-volt car battery that discharges short bursts of power for ignition. Deep-cycle batteries come in multiple sizes, and the larger their group number, the more power they hold. Group-27, Group-24, and Group-22 are some of the most common sizes.
There are three kinds of electric wheelchair batteries: lead acid batteries, gel batteries, and absorbent glass mat (AGM) batteries.
Lead acid batteries, also sometimes called “wet” batteries, are the most common type—or at least they once were—because of their low cost. They contain lead and sulfuric acid which interact to create electrical energy. These wet battery cells need to be filled with distilled water periodically, around once a month usually. The obvious advantage of lead-acid batteries is simply their lower cost. Their primary disadvantage is that they demand special handling, particularly during air travel.
Gel batteries are a more modern alternative, and like so much cutting edge technology, they are more expensive. On the other hand, they offer a longer life cycle, easier air travel, and no liquid to top off or spill.
AGM batteries are the best of the bunch when it comes to holding a charge and lasting. They don’t need maintenance and can fly safely, but are the most expensive battery of the three types.
Seating and Positioning
Everyone wants and needs to be comfortable, so seating in a motorized wheelchair is important. However, people with paralysis are at high risk for pressure sores, so for these wheelchair users, seating and positioning are even more critical. They typically require special seating systems and cushions to provide relief for their skin.
There are a few basic types of cushion material, and each one has benefits for some users: air, foam or gel/liquid. No one material does it all for everyone, and that’s why there are choices; remember, just because something works for one person doesn’t mean it will work for you. Keep looking until you find what works best for your specific needs. A person who is still ambulatory but uses a chair in some situations doesn’t have the same needs as someone with quadriplegia who spends basically all of their waking time in a power wheelchair.
Foam is the least costly cushion material. It also has the benefit of being lightweight, and it doesn’t lose air or leak. On the downside, foam does wear out, and over time it loses its compression.
Many air flotation cushions use a rubber bladder of air to provide evenly distributed support. These cushions work well but leak, especially over time. They also demand adjustments at different altitudes. Other air cushions use multiple permanently sealed cells of air. You can then adjust them by opening up the liner and adding or removing air cells. These too can leak but are usually sturdier.
Gel cushions are filled with a gel that is slow-flowing and adjusts to movement, protecting the skin. They are somewhat heavy, but still effective and popular.
There are also dynamic cushions that make use of custom engineering and sometimes air pumps to adjust to users. This is a great solution for active users who are in danger of getting pressure sores.
Tilt and recline
Another way to fight pressure sores is by using a tilting power wheelchair or a reclining electric wheelchair. These kinds of motorized wheelchairs can reduce the risk of pressure sores by distributing pressure more evenly. They can also improve sitting tolerance and increase comfort.
“Tilt in space” power wheelchairs change the orientation of the user while maintaining fixed angles for ankles, hips, and knees. Basically, the entire seat tilts and allows for a different vantage point and variation in pressure points, redistributing pressure to the posterior head and trunk and away from the buttocks and posterior thighs. The system prevents sheering and friction and maintains posture. The downside to a tilt system is that if you’re using it at work, for example, you’ll need to move away from the work surface or table so your footrests and knees won’t hit it.
The reclining system essentially changes the angle of the chair’s back to its seat, flattening out the chair’s back. In some cases, even the legs are raised, creating a wholly flat surface. Recline systems open up both the knee and seat-to-back angles, and can make eating, assisting with bladder or bowel programs, and transferring easier since the user is essentially lying down.
In general, the recline provides more pressure relief than does the tilt system but comes with a higher risk of sheer than does the tilt system. For people with edema, elevating the legs can be tremendously beneficial. Both tilt and recline systems demand fitting and prescription by experts who can advise users on seating and positioning.
Standing wheelchairs act, both power wheelchairs and manual wheelchair models, help raise their users to a standing position. I have been well-settled by research that being tall is an advantage in the workplace, at school, and in life generally; standing wheelchairs allow their users this advantage. Some manual wheelchairs can rise to stand with a power assist mechanism. Some electric wheelchairs also have standing mechanisms that make eye-to-eye contact possible. In addition, medical research has shown that standing for at least 30 minutes each day can significantly improve the quality of life for wheelchair users, by improving their ability to straighten their legs, range of motion, circulation, and bowel regularity, and reducing bladder infections, contractions, spasms, and bed sores.
Of course, like anything else, there are also drawbacks to standing wheelchairs. They are heavier than their everyday use counterparts, and they are also more expensive.
Manual Wheelchairs and Power Wheelchairs – A Detailed Comparison
In this section, we have a breakdown of the many different kinds of wheelchairs with some details about each, and where possible, some examples of each type.
Active wheelchairs/Sports wheelchairs
Usually called sports wheelchairs, active wheelchairs are right for users with active, athletic lifestyles, who enjoy getting out, playing sports, and staying on the move. These users need ultra lightweight frames, superior maneuverability, and the right center of gravity for their sports, and for their daily needs.
These power wheelchairs are also called heavy duty wheelchairs, or sometimes extra-wide wheelchairs. They are known for their extra width (often with a maximum seat width of 30”), reinforced cross braces, and an extra weight capacity of at least 300 pounds, up to 550 pounds in many cases and 700 pounds in others.
Ergonomic wheelchairs tend to be foldable wheelchairs that also fit into the ultra lightweight wheelchair category. Their frames are designed to prevent health concerns such as pressure sores and relieve pressure throughout the body. Many also come with anti-microbial cushions.
Folding wheelchairs are any wheelchairs that can be folded for easy transport. Many folding wheelchairs are manual models, but thanks to modern innovations, there are also power wheelchair options that are foldable. For example, the KD smart chair is a lightweight folding wheelchair that is also a power wheelchair option, and it works for many kinds of users.
Heavy duty wheelchairs
Heavy duty wheelchairs range in their capacity from at least 300 pounds up to 700 pounds. These heavy-duty wheelchairs also have component parts that are each tested for durability and heavy-duty reinforced frames. Most heavy duty wheelchairs allow you to choose your seat width, with models offering anything from a seat 20 inches wide up to 30 inches wide. These kinds of heavy duty wheelchairs weigh between 38 and 98 pounds.
Lightweight wheelchairs can make a tremendous difference to manual wheelchair users. Heavy wheelchairs can exacerbate your physical condition and even cause new injuries. Now, over the past 10 to 15 years, lightweight wheelchairs and lightweight folding wheelchairs have dominated the industry, by popular demand. Lightweight wheelchairs usually weigh between 29 and 34 pounds and can accommodate up to 300 pounds. Although they are not as light as ultra lightweight wheelchairs, they are still far more portable than their more traditional cousins.
Pediatric wheelchairs are obviously kids wheelchairs. These might be manual wheelchairs or power wheelchairs, and they can offer assistive technology for all kinds of disorders.
You can read more about reclining wheelchairs in the previous section, but reclining wheelchairs allow users to recline comfortably and safely at incremental angles. Some reclining wheelchairs also have elevating leg rests.
Some reclining wheelchairs like the EZ lite wheelchair are powered models that recline almost completely and can still be operated while reclined. The EZ lite wheelchair can also be folded and is among the lightest of the electric wheelchairs.
Standard wheelchairs are really just standard manual wheelchairs. They are the kind of wheelchair that is most commonly used. These typically weigh between 36 and 42 pounds, feature detachable or fixed armrests, and have a seat width between 16 and 20 inches. Almost all standard wheelchairs can support up to 250 pounds, and many can support up to 300 pounds. Most are constructed with steel frames and are made to be sturdy and durable.
You can read more about standing wheelchairs in the previous section, but standing wheelchairs allow their users to actually rise to a standing position, usually with some kind of powered feature. Most standing wheelchairs come with easy access joystick controllers and the power models can be moved while in a standing position.
You can read more about tilting wheelchairs in the previous section, but tilting wheelchairs can help prevent serious health problems such as pressure sores by allowing their users to tilt their position in the seat so they are more comfortable. The pressure on the user’s bottom and back are significantly reduced as the tilting motion balances the user’s weight.
Transport wheelchairs are lightweight folding wheelchairs that are easy to move around and travel with. They are an ideal solution for anyone searching for smaller rear wheel size and a lightweight portable frame, to allow easier portability. The smaller wheels make them easier to move, but not easier to propel without help; that’s why transport wheelchairs such as the Karman transport chair or the Medline transport wheelchair are designed for use with a caregiver.
Transport wheelchairs typically weigh between 18 and 29 pounds. Most feature fixed armrests, side panels, and swing-leg rests. The transport wheelchair almost always has a folding frame and four caster wheels. You may hear some wheelchairs called “companion wheelchairs” or “rollabouts,” but these are just alternative names for transport wheelchairs such as the Karman transport chair and the Medline transport wheelchair.
Ultra lightweight wheelchairs
Ultra lightweight wheelchairs are just like they sound: the lightest wheelchairs going. They range in weight from 14 to 34 pounds, are not just lightweight, but also durable and foldable in most cases.
Many ultra lightweight wheelchairs come either stock or offer optional adjustable and removable components, like height adjustable frames and swing away footrests.
Wheelchair Sizing and Dimensions
Making sure you have the proper sizing and dimensions for your wheelchair is essential for comfort and healthful use.
Wheelchair seat width
Seat width is the first metric to check. Every person has a specific size need here. 16 inches, 18 inches, and 20 inches are common measurements for most wheelchair models, but heavy duty wheelchairs and bariatric wheelchairs provide up to 30 inches of seat width. Some wheelchairs only provide seat width options of 18 inches, so choose carefully and make sure you have the size that works for you.
Seat depth is just as important as seat width, so check this next. Seat depth is gauged by measuring the wheelchair’s seat from front to back. Find out which seat depth you require by having the user sit straight and then measuring from the back of the user’s pelvis to the back of the shins. Or, if you had a previous chair that was a perfect fit, of course, you can measure that chair and go with that size again.
Seat to floor height
The seat to floor height is just like it sounds. Measure from the floor to the seat and you have it. This keeps the user’s feet from dragging or dangling, although if the user wants to propel with their feet, they should be a little lower than usual.
To find back height, measure from the top of the backrest to the top of the seat. If you need extra back height, you can use accessories to extend the top of the backrest on some wheelchairs.
Armrests are generally either desk length or full length. Desk length armrests make it easier to sit at a desk or table and work. Full-length armrests give extra arm support for those who don’t need to work at a table or other surface. Some wheelchairs provide features such as removable or flip-back arms that make transfers simpler and adjustable height arms.
Leg rests are generally elevating or swing away. Elevating leg rests raise the legs with a calf pad and prevent swelling. Swing-away leg rests allow easier in and out access by rotating to the side. Both kinds of leg rests are removable, and some feature tool-free adjustment of their length.
Some wheelchairs make especially tall or short users more comfortable with an adjustable backrest height.
With a dual axle wheelchair, you may adjust the height of the wheelchair from standard height to a hemi height, which is about 2 inches lower. Hemi height is most commonly used for foot propelling or for users under 5 feet tall.
Quick release wheels
Quick release wheels can be released from the rest of the wheelchair by pressing a button for compact transport or storage. This feature is usually preferred by users who need an ultra-portable option.