Blog/News

Thank you John,

Thank you for such a comprehensive report and sound clinical reasoning to support the provision.

Case Manager - Stokes Case Management

Thanks John for making this part of getting new chair so easy. I love it - it's so whizzy! Going up Lane was much easier.

Getting the right wheelchair can be tough – there are a million options available and each manufacturer is going to tell you that their model is perfect for your child!  What makes it even more difficult is that one wheelchair isn’t going to be ideal in all situations.  A wheelchair which is great getting around a classroom, isn’t going to be ideal negotiating a muddy sports field or the soft sand at the beach.

This article will give you an idea on what options are available and their various benefits and drawbacks. Its not meant to provide a pathway for you to go out and seek the perfect wheelchair for your child, more to give you a better understanding of the wheelchair market and allow you to make better, more informed choices.  You’ll also be able to ask more questions of the person prescribing the wheelchair, whether that be the NHS wheelchair service or a retailer. 

Every NHS wheelchair service will have specific criteria for them to provide your child with equipment.  There are typically a certain number of hours or days the wheelchair needs to be used for, and whether it is for inside and/or outside use.  Most services will only provide for permanent disabilities, rather than a specific short-term need.

If you choose to purchase your own wheelchair, choose a retailer that has experience selling the type of wheelchair you’re looking for – don’t let your child become their guinea pig!  They should be able to show you a range of options and take into account the specific nature of your child’s ability. 

There are also charities who may be able to provide financial assistance for the purchase of a wheelchair.  Each charity tends to have a certain target market and cover a specific geographical area.  Get in touch if you’d like to know more.

Manual Transit Wheelchairs

In most cases, these are the most basic of wheelchairs.  The small wheels at the back enable you to push your child, however they will not be able to self-propel (or push) themselves.  Most transit wheelchairs will fold, so they can be stored easily in the boot of any car.  Cushions and other products can be added for comfort, pressure relief or to provide positioning. 

Manual Self-Propelling Wheelchairs

Self-propelling wheelchairs are designed to give your child the opportunity to independently self-propel.  The rear wheels are large enough so they can be reached easily.  Self-propelling isn’t easy though and a lot of kids will not have the strength or coordination to mobilise everywhere themselves.  Its hard work and little arms just aren’t built for it!  The large wheels aren’t just for self-propelling, they also make the wheelchair easier to push than a transit wheelchair, especially over rougher ground.  The larger wheels roll over bumps much more easily.  Most self-propelling wheelchairs can be stored easily in the boot of any car.  Cushions and other products can be added for comfort, pressure relief or to provide positioning. 

Active User Self-Propelling Wheelchairs

These are still considered self-propelling wheelchairs, but they are easier to self-propel than the more standard self-propelling wheelchairs described above.  Being easier to self-propel is achieved through two differences – they’re normally lighter in weight, and they have a lot of adjustment available so that an efficient position and weight distribution for self-propelling can be achieved.  The most important adjustment is rear wheel position – moving the rear wheel forward on the frame makes the chair more efficient to self-propel through better weight distribution, and also moves the wheel so that the shoulders are in a stronger position.   Seat height is also important.  On the pink chair below there is a lot of overlap of the wheel above the cushion (compared to the more basic self-propelling chair above.  This means there is more wheel that the child can reach. 

Active user wheelchairs used by children are also fitted with push handles – so that you can give them a helping hand when they need it.  Like the more basic wheelchairs above, active user wheelchairs can be fitted with cushions and other equipment to improve comfort, pressure relief or positioning. 

Active user wheelchairs are always more expensive than more standard wheelchairs.  NHS wheelchair services will typically have quite strict criteria on who they prescribe active user wheelchairs to.  Being a full-time user (rather than someone who walks as well) as well as being able to independently self-propel for most of their mobility, are the main criteria most services will work to. 

Tilt in Space Wheelchairs

Tilt in space tips the seating of the wheelchair backwards (imagine tipping a dining chair onto its back legs) and allows gravity to ‘push’ the upper body of the user against the backrest of the wheelchair.  This enables a child with reduced sitting balance to maintain a sitting position, but with reduced muscular effort.  Tilt in space also helps with pressure relief by re-distributing weight bearing from the cushion to the backrest.  For users using a hoist to transfer to their wheelchair, tilt in space can make this transfer easier, allowing the angle of the seating to match that of the child in their hoisted position.  For other users, tilt in space enables them to adjust their own position, using gravity to assist them slide back over the cushion.

Powered Wheelchairs

Powerchairs have batteries and electric motors that remove the physical effort involved in self-propelling (or pushing from behind) a manual wheelchair.  For those children who are unable to self-propel a manual wheelchair, a powerchair can be the difference between them being able to independently mobilise or not.  Powerchairs are typically controlled with a joystick mounted on the armrest (as in the picture below), but other means are available such as a joystick mounted for use with the chin, foot or head.  Switches of almost any shape and size can also be used instead of the joystick.  A single switch is all that is necessary to control every function on the powerchair. 

Some manual wheelchair users also benefit by having a powerchair.  A powerchair will enable them to move faster and further, greater for when they’re wanting to keep up with others! 

Powerchairs have their drawbacks though – they’re typically very big and heavy (100kg plus), so can’t be lifted into the back of a car.  Many powerchair users have a wheelchair accessible van (WAV) that they’re able to drive into.  Most powerchairs are crash tested, meaning the child is able to stay seated in the wheelchair when travelling in a vehicle. 

Kerbs (or lack of dropped kerbs) can also be a problem.  Most powerchairs have difficulty getting up anything more than a 3” kerb. 

Accessories/Specialist Uses

There are loads of accessories available to pimp a wheelchair!  The list is endless, but here a some of the more commonly requested options, just don’t expect to see these on the NHS list!

Manual wheelchairs can be turned into powered devices by adding a powered front wheel.  This means the wheelchair can be used as a manual wheelchair indoors for example, and then the powered device can be fitted (less than a minute) when travelling outdoors.

Other devices provide powered assistance to normal self-propelling, the motor and batteries being stored inside the wheel itself.

Other wheelchairs are made specifically for off-road use.  Most of these tend to be powerchairs, but manual ones are available too.  The trickiest terrain for almost any wheelchair is loose sand, but there are chairs designed specifically for that too, and they’re available to hire at some UK beaches.

Summary

If you’re struggling to work out where to start, drop us a line.  We’re happy to offer advice over the phone.  Alternatively, our website has information on our assessment process and what to expect from our involvement.

We're serious about data security as Silver Fern Therapy.  To help us maintain our high standards, we've started using online forms to collect data from our referrers and patients.  To date, we have the following forms set up for online completion:  

- Referral information including patient details

- Consent for treatment and data processing

- Consent for photography

- Consent for sharing patient records

- COVID-19 home visit risk assessment

- Telehealth consent form

If you're asked to complete one of these forms, you'll receive a link that looks like this one: https://mysilverferntherapy.co.uk/3ccef. This one happens to be to our privacy policy (if you're interested).  

The forms are integrated into our online patient management software system - Power Diary.  This means that once the form is completed, the data is automatically saved into the individual patient record, with no additional handling.  This takes away a job for us, but more importantly keeps that data as secure as possible.  The data entered into the forms is secured using 256bit SSL technology.  

If you'd like to know more about the security features that Power Diary uses, have a read of their website here:  https://www.powerdiary.com/uk/security. 

We're pleased to be working with Somerset Mobility & Stairlifts, providing their clinical wheelchair and seating assessments.  See the details here about what we can provide alongside their service.

Very pleased to be featured in this article in THIIS Magazine.  At the start of the first lockdown, I had a chat with Stuart Barrow from Promoting Independence who writes a regular column.  

You can see the full article here:  https://thiis.co.uk/the-ots-perspective-how-a-specialist-occupational-therapist-can-help-you-with-wheelchair-assessments/

The chair is a great success for which a very big thank you to you. The carers are managing to sit him correctly and several people have commented on his posture being so much better. I've sent a letter today to TPG thanking them for introducing us to you and to emphasise what a good job you did, so hopefully you'll get more referrals. Thank you again for everything. We'll be in touch if there are any future issues. God bless you, JG

What level of service can I expect after I receive my wheelchair?

NHS

• Equipment from the NHS is maintained and repaired at no cost to the user. If the user changes in any way where different equipment may be required, they can be re-assessed.

Privately

• Every wheelchair will come with a manufacturer's warranty. The length of this warranty period will between manufacturers and even between different parts of one wheelchair.  Explanation of the warranty periods should form part of the buying process.  The manufacturer's warranty covers parts but does not cover the time taken by the retailer to replace the parts.   Ensure the sales agreement stipulates who is responsible for the cost of the time to fit parts covered by the manufacturer's warranty.
• There are also service packages available from most retailers. These are agreements to replace, repair or fix problems with the wheelchair and can include accidental damage.  They are normally underwritten by an insurance company. 
• Breakdown insurance cover is also available. This can also include public liability insurance, which provides cover for accidental damage to someone or something else.

How long should a wheelchair last?

• This varies a lot and depends entirely on how the wheelchair is used and in what conditions. Expect to use the wheelchair for three to five years before it needs replacing, but it may last a lot longer if it is not often used or used well within its physical limits.

How long does it take to get a wheelchair?

• Very basic wheelchairs will be available for immediate purchase from a retailer, or immediate issue from an NHS wheelchair service. More complex wheelchairs will take much longer and require several appointments before an order is made.  For complex equipment, it is essential to trial equipment prior to purchase to ensure it works as expected and meets the requirements of the user.  There can sometimes be a delay of several weeks waiting for demonstration equipment to be delivered from a manufacturer.
• Once a wheelchair is ordered it can take up to 12 weeks for it to be delivered. This depends greatly on the manufacturer and the complexity of the equipment being ordered.  Some equipment can be delivered in a few days.

NHS

• Many people who need permanent use of a wheelchair will be eligible for equipment from the NHS. A list of NHS wheelchair services is available online.  This list is frequently changing however, therefore your GP will be able to point you in the direction of your local wheelchair service.  The criteria for receiving NHS equipment varies from service to service.  In general, full time, permanent wheelchair users will always be eligible.  Most NHS wheelchair services require a referral from a health professional (GP, consultant, nurse, physiotherapist, occupational therapist etc).  They will assess what equipment is needed and prescribe accordingly from a range of equipment available to them. 
• NHS wheelchair service staff are often made up of a mix of occupational therapists, physiotherapists, rehab engineers and clinical scientists. There will also be support staff in administration and clinical roles.

Privately

• Everyone has the option of purchasing their own equipment. Some retailers are members of the British Healthcare Trades Association, however membership is not mandatory.  Retailers will decide with you which is the best equipment for you to purchase, based on your wheelchair needs, and your budget.  Some will employ occupational therapists or physiotherapists to provide a more clinical approach.  Some retailers will have a limited range of wheelchairs, focusing more on other equipment such as beds or riser-recliners.  Speak to them to determine if they can support your wheelchair needs.
• Having a clinical assessment prior to purchasing a wheelchair can also be useful. This ensures all needs, future and present, of the user are taken into account prior to purchasing equipment.  A clinical assessment will involve evaluation of posture, pressure relief, technical assessment of any current equipment and the environment any equipment will be used in.  The clinician, normally and occupational therapist or physiotherapist will make recommendations for adjustment or additions to the existing wheelchair or will work with the user to determine the best wheelchair for them to purchase.

Finance

• Some retailers will offer finance, enabling the wheelchair to be paid in monthly instalments over a period of time.

Charity

• Charity funding can be available to some wheelchair users. Many charities will have specific requirements or conditions that need to be met, before they support the purchase of a wheelchair.  Most will only support the purchase of equipment that cannot be funded through a NHS wheelchair service.

Motability

• The Motability scheme enables specific disability benefits to fund the lease of a powerchair. Motability has agreements with specific wheelchair retailers to provide the equipment.  The leases are typically 3 years and include repairs and maintenance. 

Access to Work

• The employer of people with a disability is legally obliged to make reasonable adjustments to ensure you they not substantially disadvantaged when doing their job. If the help you need they work is not covered by their employer making reasonable adjustments, they may be able to get help from Access to Work.
• They need to have a paid job or be about to start or return to one.
• An Access to Work grant can pay for special equipment, adaptations or services to help do things like answer the phone, go to meetings and getting to and from work.
• They may not get a grant if they already get certain benefits

• Bariatric wheelchairs can simply be larger versions of standard wheelchairs; however some models can be more specific to heavier users. They can have additional, strengthening framework added to increase the durability and enable greater maximum user weights to be achieved.  Parts with greater strength can also be fitted, such as wheels, backrest, footrests, upholstery and brakes.