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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.

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.

• 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. 

• Tilt in space wheelchairs can often be fitted with many of the options that other wheelchairs use, however there are some features used more on tilt in space wheelchairs than others.
• Lateral supports are used to control the position of a user’s spine. They are fitted to the backrest and provide support to the outside of the rib cage.  They can have the effect of preventing a user leaning to the side or can even straighten a scoliosis. 
• Elevating legrests are often fitted to control swelling of the legs, however simply elevating the legs achieves very little improvement - the legs continue to remain the lowest part of the body for fluid to accumulate. Combined with tilt in space and recline however, the legs can be raised high enough to encourage a reduction in swelling.  This can be an uncomfortable position, therefore many users will opt to transfer to their bed, where they can comfortably raise their legs whilst lying down.  
• Headrests allow the head to be supported, especially when using tilt in space or recline. In both positions, the users head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
• Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
• Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.

• Drive Type
  • There are three main drive wheel configurations available on powerchairs. Drive wheels are those which are attached to the motors.  The motors control the movement of the powerchair, as well as steering and braking.  Powerchair motors have brakes integrated into them, meaning that when the drive is not engaged in movement, the brakes will be activated. 
  • Rear wheel drive. This is the most common configuration.  A rear wheel drive has four wheels in contact with the ground, with the drive wheels at the back.  Rear wheel drives have the largest turning circle out of three described here when compared against comparable chairs.  They have good traction when ascending slopes because of the additional weight of the user that transfers to the rear wheels when travelling uphill.  The compromise is on descents, where reduced weight over the rear wheels produces less traction and less braking capacity.
  • Mid wheel drive. Most mid wheel drive powerchairs have six wheels in contact with the ground. The front two and rear two are casters and the middle two are larger drive wheels.  The main benefit with mid wheel drive powerchairs is their turning circle which is significantly smaller than a comparable rear wheel or front wheel drive.  Because the drive wheels are located beneath the user and in the centre of the wheelchair, it can turn within its own length.  This is often very useful in small environments such as bathrooms and kitchens where large turning circles and three-point turns create difficulty.
  • Another benefit of mid wheel drive powerchairs is the weight distribution over the drive wheels. The drive wheels will tend to bear most of the weight irrespective of whether the chair is being driven uphill, downhill or on the flat.  This means the drive wheels are likely to have good traction in all scenarios, maintaining control and braking capacity.  However, there needs to be sufficient up/down movement of the front and rear casters, relative to the drive wheels.  This movement enables the drive wheels to maintain contact with the ground.  If there is insufficient movement, the possibility of the drive wheels losing contact with the ground is increased.
  • Front wheel drive. This is the least common configuration.  Like a rear wheel drive, a front wheel drive tends to have four wheels in contact with the ground.  The motors are connected to the larger front wheels.  The turning circle of a front wheel drive is slightly less than a comparable rear wheel drive but will tend to be larger than a mid-wheel drive.  Front wheel drives have good traction going downhill but are likely to have reduced traction when travelling up hill. 

• Controls
  • Most powerchairs are controlled with a joystick. This enables the user to control the powerchair in all directions, combining forward or reverse with left or right to create smooth turning.  When the joystick is returned to centre, the chair stops and the brakes are applied automatically.  Speed is controlled by the amount of movement of the joystick in each direction - the further the joystick is moved, the faster the powerchair will go.  This is called proportional control.  Most joysticks are fitted to the armrest of the wheelchair, allowing the user to control it with their hand or fingers.
  • Joysticks can also be fitted to other parts of the wheelchair, enabling control with other parts of the body. Examples could be the chin, lips, head or foot.  Different sizes or joysticks, and the force required to operate them, are available to tailor the joystick to the part of the body being used.
  • For those who find it difficult or impossible to control a proportional control, switched control is also possible. Switched control allows many different combinations of switches or buttons to be used to enable driving.  At a basic level, one switch can control forward movement only with no access to other directions.  Switches can be added to this to enable control of left, right and reverse.  Most powerchairs will have the option of latched or non-latched switch control.  Latched control allows a button to be pressed once and the chair to continue moving in the direction chosen until another button is pressed.  Non-latched control requires a button to be held down to achieve movement in that direction.  Non-latched control is significantly safer and the most common option. 
  • Switches can also be used to operate a scanner control. A scanner is simply a display screen with a direction indicator.  The indicator will highlight or light up each direction, one at a time, in a predictable rotation, enabling the user to select a direction by pressing a single switch.  Used in non-latched mode, when they release the switch, the indicator will start scanning again, giving the user the opportunity to chose a different direction or continue on the same path.

• Leg rests
  • The most common leg rests fitted to powerchairs are swing away. Each leg rest is fitted to the wheelchair on a hinge mechanism.  When unlocked, the hinge enables the leg rest to rotate out to the side, allowing a clear space in front of the wheelchair for transfers or to enable the user to get very close to something in front of them.  A footrest will normally be attached to the end of each leg rests, allowing individual adjustment of the position of each foot.  However a single footplate, spanning the entire width between the leg rests can also be fitted to some powerchairs. 
  • Centre mount footrests can be fitted to mid wheel and front wheel drive powerchairs. A centre mount footrest is fitted to the front, centre of the seat.  It normally enables the user to sit with their knees bent more than with swing away leg rests.  This position reduces the length of the chair as a whole, allowing it to negotiate smaller spaces.  Centre mount legrests can not normally be fitted to rear wheel drive powerchairs because the space between the front casters is not wide enough to fit the footrest. 
  • For below knee amputees, stump supports can be fitted to the legrests as well. This provides a supportive surface for the stump to rest with their knee straight. 

• Armrests
  • Most powerchairs are fitted with armrests. They enable the user to rest their arms on a supportive surface, taking away the muscular effort required to maintain the position of their arms.  This also prevents the weight of the arm pulling the upper body of the user forward or sideways.  Most armrests are height adjustable, allowing multiple heights to be achieved. 
  • There are two main types of armrest - single post and flip back. Single post armrests are attached to the side of the seat frame and need to be removed if the user is transferring sideways to or from the wheelchair.  Flip back armrests can be moved without removing them.

• Headrests
  • Headrests allow the head to be supported, especially when using tilt in space or recline. In both positions, the user's head is likely to fall backward with gravity, therefore it is important to support it in a comfortable position.
  • Headrests also provide some safety when travelling in a vehicle whilst seated in the wheelchair, in a similar way the headrest of a standard car seat would do. It is important to note that a wheelchair headrest is not tested to the same criteria as a car seat headrest would.
  • Some users require additional head support to maintain an upright head position, or to maintain their head in a comfortable position. Additional supports and shaping can be added to tailor the support offered by the headrest.

• Powered seat movements.
  • Electric actuators (using the same principles as those used to control the shovel on earth moving equipment) can be fitted to many powered wheelchairs. The actuators are powered and controlled through the main control system of the wheelchair and enable the user to move specified parts of the seat frame.  The commonly fitted actuators are described below.
  • Tilt in space. 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 the user 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 user 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.
  • Recline is an adjustment of the seat to back angle only, in the same way a backrest can be reclined on a car seat.  Recline needs to be used with caution because it can often cause the user to slide forward over the cushion.  However it can be useful for some users to manage pain by enabling them to shift their position.  For other users, it can make hoisted transfers easier, by giving carers more space to insert or remove the sling.  When combined with tilt in space, recline can assist with pressure relief, allowing more weight to be re-distributed from the cushion to the backrest.
  • A riser, as the name suggests, simply raises the seating unit of the wheelchair directly upwards.  For some users, this enables them to complete standing transfers by giving them a higher surface to stand from.  For others, it enables them to reach objects that would normally be too high.
  • Both centre mount and swing away leg rests (described above) can have actuators fitted to control their movement.  A centre mount leg rest often has movement in two planes; elevation which moves the footplate forward, straightening the knees, and a direct up and down movement that changes the distance between the seat surface and the footplate.  Sometimes, these movements can be combined.
  • Swing away leg rests can also have elevation. Some are fitted with an additional feature that extends the length of them slightly whilst they elevate, referred to as articulation.  This prevents the knees of the user being lifted off the cushion during elevation. 
  • Elevating leg rests are often fitted to control swelling of the legs, however simply elevating the legs achieves very little improvement - the legs continue to remain the lowest part of the body for fluid to accumulate. Combined with tilt in space and recline however, the legs can be raised high enough to encourage a reduction in swelling.  This can be an uncomfortable position, therefore many users will opt to transfer to their bed, where they can comfortably raise their legs whilst lying down. 

This is a very quick overview of the different types of chair available.  It doesn't go into great detail, or include every option - we'll save the detail for later posts!  But if you're wondering what is available in the wheelchair market, this post might be a good start.  If you need any specific detail about any of the chairs, please let us know.

Standard Wheelchair

Standard wheelchairs are typically used by people for occasional use.  They come in a range of sizes, but their configuration is often limited.  Standard wheelchairs almost always fold for storage.  Most standard wheelchairs will have a transit option with small rear wheels, designed for the wheelchair user to be pushed by someone else.  They will typically have a self-propelling option as well, with large rear wheels, designed for the wheelchair user to propel themselves, using their arms.

Standard wheelchairs can be fitted with parts and accessories to make them useful for more complex users who use their wheelchairs frequently.  The addition of a contoured cushion, backrest, lateral supports and headrest can enable a standard wheelchair to be used for a more complex, full time user.

Active User Wheelchair

Active user wheelchairs are used by people who often use their wheelchairs for all their mobility.  Active user wheelchairs are configured to be efficient to propel by the wheelchair user themselves.  They are typically lighter weight than standard wheelchairs and have more weight distributed over the rear wheels.  The front wheels (casters) of an active user chair are often smaller than standard wheelchairs.  This helps to reduce rolling resistance and make the chair easier to turn.  Active user wheelchairs are configured very precisely for each person.  They therefore have many size and configuration options to tailor the wheelchair to each person and the way that they use the wheelchair.

Powered Wheelchair (Powerchairs)

Powerchairs are typically used by people who lack sufficient arm movement or strength to propel a manual wheelchair or are limited by distance or terrain.  Powerchairs have electric motors powered by batteries.  Control of the motors is usually via a joystick on the armrest, however other parts of the body can be used as well.  Powerchairs enable people to mobilise with very minimal effort.  Basic powerchairs are used indoors only and will have a small turning circle to cope with doorways and small spaces.  Larger powerchairs enable outdoor use as well and will cope with hills, rougher terrain and have larger battery capacity.  Some powerchairs are designed for outdoor use only and will cope with off-road terrain.

Tilt in space Wheelchair

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 wheelchair user against the backrest of the wheelchair.  This enables the user to maintain a sitting position, but with reduced muscle control.  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 user 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.

Bariatric Wheelchair

Obesity is defined by Body Mass Index (BMI) above 30.  Those with a BMI above 40 are considered morbidly obese or bariatric.  Specific wheelchairs, both manual and powered, are available for this weight range.  They will often look like other wheelchairs but have different construction materials or design that provides greater strength.  They will have a size range that is larger than other wheelchairs.