What types of Mobility Equipment are out there? Who typically uses them?
Stroller Bases
Typical users
Strollers are typically used by children or small adults who:
- Have mild to moderate motor involvement.
- Need minimal positioning.
- Are able to walk, but sometimes need a mobility base to travel long distances, when fatigued, and so forth.
- Have a wheelchair, but want a second mobility base for quick trips around town.
Features
- Lightweight.
- Relatively easy to fold and transport.
- Appearance more acceptable to some than a wheelchair.
- May be less costly than a wheelchair.
- May have positioning systems.
- May have vehicle restraint system, and be crash tested.
- May transport oxygen and ventilators.
Possible drawbacks
- Generally not as durable as a wheelchair.
- Few or no “grow-ability” features that allow it to adapt as user grows.
- Difficult to mount custom lap trays and communication equipment.
- Incompatible tubing and hardware may make it difficult to use with custom seating components.
- If used as a second mobility base, insurance may not pay it.
Standard, upright Manual wheelchairs
Typical users
Standard wheelchairs are usually used by children and adults who:
- May be able to propel their own chair, or may need someone else to do this.
- Have mild to moderate motor involvement.
- Have fair to good head and trunk control.
- Sit quite well with little external support.
- Walk, but need a wheelchair for long distances.
- Use power wheelchairs as their primary mobility base
Features
- Available in lightweight, heavy-duty, and high performance (sport) models.
- May offer commercial/Off-the –shelf positioning products
- Readily accept custom seating systems, lap trays, and communication mounts.
- Offer options for armrests, leg rests, foot plates, push handle height, rear wheels, front casters, tires, anti-tip tubes, wheel locks, and so forth.
- Relatively easy to fold and transport.
- May be “growable,” with adjustable seats and backs.
- May have vehicle restraint systems built into the frame, and have been crash tested.
- May have adjustable axle plate so rear wheels can be moved forward or backwards creating better balance or push points.
- May offer wheels that can be cambered (set so that bases of wheels are closer together than tops, for better performance & maneuvering).
- Offer a wide range of seat-to-floor heights for foot propelling or non-foot propeller heights
- May transport oxygen and ventilators.
Possible drawbacks
- No specific drawbacks as long as wheelchair is carefully chosen to suit its user.
- If the person often travels in a van, be sure there will be enough headroom in the van. To do this, measure the sitting height of the person when sitting in the wheelchair using the recommended cushion.
Tilt-in-space Wheelchairs
Typical users
Tilt-in-space wheelchairs are often used by children and adults who have:
- Progressive medical conditions.
- Moderate to Poor head and trunk control.
- Limitations in range of motion.
- Fluctuating muscle tone.
- Pain or pressure while sitting.
- Developing curvature of the spine (scoliosis or kyphosis).
- Limited ability to sit upright.
- Weakness, lack of endurance.
- Seizure or sleep disorders.
- A need for custom contoured seating inserts, so the seat continues to fit well when the chair is tilted to relieve pressure.
Features
- Seat and back angle remain constant at up to 45 degrees tilt.
- May be “growable,” with adjustable seats and backs.
- May have vehicle restraint systems built into the frame, and may have been crash tested.
- May transport oxygen and ventilators.
- Often offer commercial positioning such as cushions, backrests, headrests, lateral supports, hip guides, footplates/boxes. Most of these must be ordered separately.
- Often offer a recline option and or elevating legrests that when combined present the user in the supine position. This position emulates ones bed possibly reducing the number of transfers from chair-to-bed.
- Often readily accept custom seating systems, lap trays, and communication mounts.
- Offer options for armrests, leg rests, foot plates, push handle height, rear wheels, front casters, tires, anti-tip tubes, wheel locks, and so forth.
Possible drawbacks
- Not as easy to transport; cumbersome to fold if at all, and do not fold up into as small a package as an upright manual wheelchair.
- Overall chair length may be greater than a standard upright model.
- If the person often travels in a van, check to be sure there will be enough headroom in the van. To do this, measure the sitting height of the person when he or she is using the recommended cushion and sitting in the wheelchair
Reclining wheelchairs
Typical users
Reclining wheelchairs are typically used by children and adults with:
- Moderate to severe motor involvement; progressive conditions.
- Poor head and trunk control.
- Low muscle tone in upper body.
- Limitations in range of motion, especially hips.
- Pain or pressure while sitting.
- Developing curvature of the spine (scoliosis or kyphosis).
- Limited ability to sit upright.
- Weakness, lack of endurance.
- Seizure or sleep disorders
Features
- Seat remains parallel to the floor; back reclines up to 90 degrees.
- Makes it easier to provide personal care, such as catheterization or diaper changing.
- May transport oxygen and ventilators.
- Available with commercial positioning seating systems.
- Often readily accept seating systems, custom lap trays, communication mounts.
- Often offer options for arm rests, leg rests, foot plates, push handle height, rear wheels, front casters, tires, antitip tubes, wheel locks, and so forth.
- Consider the “smart legs” option if elevating leg rests are needed that can be raised; these will extend as they elevate.
Possible drawbacks
- Not a good choice for people who use custom contoured seating inserts, for the contours will not fit well when the back is reclined.
- More cumbersome to breakdown for transporting in an automobile than an upright manual wheelchair.
- Overall length is often greater than a standard upright chair.
Power Wheelchair Mobility Bases
Typical users
Typical users of Power Wheelchairs are children and adults who want independent mobility and are available for ages 2 years old and up. Advances in technology mean that a suitable controller or switches can be used even when a person has severe physical limitations.
However, these chairs are powerful vehicles. It is important that their users have good judgment and maturity, to ensure the safety of themselves and others.
Power chairs are now available in:
- Rear wheel drive: The power is behind the person, so that it feels as if the chair is being pushed from behind.
- Front wheel drive: The power is in front of the person so that if feels as if the chair is being pulled.
- Mid wheel drive: The power is under the person. This offers the smallest turning radius, a plus in small homes, offices, and other places where space is tight.
Power wheelchairs offer many options for type of headrests, armrests, leg rests, foot plates, rear wheels, front casters, tires, and so forth. They can also be ordered with:
- Manual or power tilt, recline, or both
- Manual or power elevating leg rests
- Retracting armrests
- Standing Capabilities
- Power Seat Elevation
Alternate controls for reduced dexterity such as:
Proportional Drive Controls
Standard Joystick – This is a drive control found standard on electric wheelchairs. Power buttons, speed control, profile select, and sometimes seat function controls are often all in included. Input devices such as a mode select and remote power can usually be added.
Stand Alone Joystick – This joystick operates the same as a standard but only offers the ability to drive the wheelchair. Power, speed, profile, and mode all must be controlled by an enhanced display or by remote operation. The benefit of this drive control is that it is smaller than a standard joystick and can be mounted wherever needed. Chin drive, footdrive, and mid mount are just a few locations available. Numerous joystick handles can be fitted to allow optimal contact and control of the joystick.
Mini Joystick – This joystick is the size of a human thumb and requires minimal pressure and excursion to operate the wheelchair. Typically, this device is uses as chin and/or mouth operation or finger operation. The negatives to this system are that since minimum movements are used, the speed and direction can be difficult to control.
Proportional Head Control – This joystick is similar to a standalone joystick but mounts onto the headrest. Pressure on the headrest controls the speed and direction of the wheelchair. There are two issues to be aware of on this system. First, in order to operate this joystick in reverse, a separate switch must be mounted to toggle between reverse and forward directions. Secondly, when used in conjunction with tilt in space, the drive function must be disengaged to allow the user to use the headrest as a rest and not a drive control.
Touch Drive – Similar to the mouse pad on a laptop, this is a great option for those with poor hand control but with good gross hand or finger movements. This technology is very intuitive since most users are familiar with a mouse pad.
Finger Steering – Operates by determining the position of the users finger in a box with an opening for finger insertion. This drive control requires good finger dexterity and movement.
Magitek – A tilt sensor is attached to the users head, foot, hand or other part of the body with controlled movement. “Tilting” the sensor in the correlating direction and range drives the wheelchair.
Non-Proportional
Head Array – This is a very common alternative drive control mostly for quadriplegics with good head control. This device recognizes the position of the head using proximity switches mounted in the headrest. It allows for 4 direction steering plus veering and additional switches can be added.
Switch Joystick – A non-proportional joystick can be used for clients with reduced motor skills. This type of joystick is similar to a standalone joystick in appearance however usually only travels in 8 directions and profiled speeds.
Multifunction switches – Examples of this type of drive control are a wafer board, laptray with proximity switches, and a 4 button switch. Again, these are non-proportional and only allow travel in a minimum amount of directions.
Scanner – This technology uses either an audible tone or display that indicates to the user which direction the chair will travel. A single function switch is needed to “scan” the system until the desired direction has been chosen. A switch is activated to initiate wheelchair movement in the selected direction.
Game Controller Adapter – Frequently, there are wheelchair users that can play video games but have a difficult time driving their wheelchair. This technology duplicates the functions of the game controller to drive the wheelchair by using the D-pad on an actual game controller to drive the wheelchair.
Sip n Puff – Sip n Puff is an older technology that is frequently overlooked. Typically, this type of drive control is used when there is no functional control of the body. A straw is attached to a module, the client then “sips” or “puffs” for directional control of the wheelchair. This technology requires good respiratory function and frequent maintenance.
Scooters
Typical users
Typical users of scooters are children and adults who:
- Are looking for a means of mobility to increase their independence.
- Have good head and upper body control
- Have sufficient range of motion and coordination to reach and operate the controllers; usually a push or pull action of thumb or fingers is needed.
- Can usually transfer independently
- Require less external support.
Considerations for power chairs and scooters
- Power wheelchair & Scooter technology is changing very rapidly. It is important to test drive the product and try out its controllers before buying the chair or scooter. An experienced therapist can be very helpful in this process. It is also a good idea to ask other users if they are satisfied with their wheelchairs and vendors.
- If the chair will be used by a child, or by a person with a progressive condition, it is important to ask if it is adaptable and “growable.” That is, can it be adapted to meet the person’s changing physical requirements for seating or size, can tilt or recline features or different controllers be added in the future — or will you need a completely new wheelchair?
- Due to the size and weight of most scooters and power wheelchairs, transporting them usually requires a van with a ramp or lift.
- Will it fit on Public Transportation i.e., bus, skytrain, Handy Dart, Sea Bus etc.
- Not all insurance companies will pay for scooters; check with your insurance carrier.
