Getting the Right Wheelchair: What the SCI Consumer Needs to Know.
Written by MSKTC Experts
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.
Wheelchair seating technology is a complex and rapidly changing industry, with new types of wheelchairs and components coming on the market all the time. The days of “one size fits all” are long gone. With all the different choices, how do you pick the right one? Many different factors must be considered when making the decision.
Selecting the right clinic is a critical first step. The clinic you select should have a process and the key players in place to assist you with making the right choice. You can call in advance to find out who is part of the team, if they have certification, and how long the process takes. It may be necessary for you to travel to get the best team to work with you on your chair. You would not hesitate to drive a long distance for the right surgeon; your wheelchair selection is equally important.
The right clinic will have a team of individuals to help with wheelchair selection, each of whom has different expertise.
- You: The most important member of the team is you, the wheelchair user. Even if this is your first wheelchair, your opinions and desires are essential in order to make the best selection.
- Family members or caregivers: Individuals you live with or who care for you will also be affected by the wheelchair selection and should provide input.
- Rehabilitation professionals:
- Rehabilitation medicine doctor (called a physiatrist) who understands your overall health situation. The doctor is the one who writes the prescription needed for your insurance to pay for the wheelchair and has ultimate responsibility for determination of medical necessity.
- Occupational or physical therapist who is experienced in wheelchair evaluation and training.
- Qualified wheelchair supplier who works with the therapy and medical team to trial, order and maintain equipment.
- Certification: Many occupational and physical therapists and wheelchair suppliers will have Assistive Technology Practitioner (ATP) certification from RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) indicating they have passed a national examination and credentials check in their specialty. If Medicare is the payer, they require the wheelchair vendor to have at least one ATP-credentialed specialist.
The team needs to consider many factors to ensure that you get the right wheelchair for your body, your health and your care needs.
Time since injury
- Newly injured individuals: If this is your first wheelchair, you will likely need more advice on the technology that will best suit your needs. In addition, you may continue to have physical changes or recovery over the next several months, in which case this first chair may only be temporary. As a result, the team may recommend a rental chair or more frequent follow-ups.
- Long-time injuries: If you have been using a wheelchair for a long time and have developed new problems, such as weakness or pain, you may need to make changes to your current wheelchair seating system.
- Age affects endurance and strength and may be a deciding factor between a manual or power wheelchair.
- Strength and range of motion will determine whether or how much you can push your wheelchair, transfer in and out of your wheelchair, lift and fold your wheelchair, etc.
- Height and weight will affect what size wheelchair you will need.
- Trunk stability: The higher your level of injury, the more unstable you are likely to be, and this requires extra attention to seating and position to enhance stability.
- Functional abilities: Your level and completeness of spinal cord injury will affect how much function you have in your arms and hands and whether you will need a power or manual wheelchair.
- Medical conditions or risks: Conditions such as spasticity, previous pressure sores, or urinary leakage can also affect wheelchair selection and should be discussed with your team.
It is important for the people who care for you to be able to work with your wheelchair, which may include pushing it occasionally or lifting, folding, fixing, cleaning or adjusting the wheelchair.
Your wheelchair is a tool that enables you to do more of what you want in life.
- Home: Is your home carpeted? Are entrances to your home steep? Are there difficult surface conditions that a wheelchair might need to push over, such as gravel or grass? While you may make changes to your home to accommodate a chair, it is also possible that chairs exist that can help you when changes to the home environment are not possible or desired.
- Work: What will you be doing for work, and how does your wheelchair need to fit into that environment? For example, will your wheelchair fit under the conference room table where you meet twice a week?
- Transportation: Will you be driving your own vehicle? Van or car? Will you be taking public transportation? Will someone else be driving you around?
- Leisure activities: Will you spend time outdoors on grass or hiking on trials? Will the wheelchair also be used for sports?
- Personal taste/preferences: For example, some people may prefer a sportier-looking chair or a specific color (but note that something other than the standard color may cost more).
- Insurance coverage: This is often a major consideration when choosing a wheelchair and may limit your choices. However, it is best to choose the optimal chair first, then consider your financing.
- Other financial resources: Local resources to assist in purchasing your chair may be available through organizations such as United Cerebral Palsy or the Multiple Sclerosis Society. Despite their names, these organizations often help people with any disability. Some individuals have fund-raisers through their church or temple.
- History and physical exam by physician, OT, and/or PT, who will use this information to justify (to the insurance company) the wheelchair and seating system you need and to ensure that medical issues are properly addressed.
- Test Drive: You should always test drive the device. Ideally this will occur at the clinic during your visit and later during the home assessment. A good wheelchair clinic should have the ability to get devices for you to test drive during your visit.
- Home assessment: It is best to have a supplier or therapist assess your home to recommend appropriate equipment. Some insurance plans (including Medicare) require this step, and others do not.
- Submission of prescription and documentation: The clinical team will likely need to submit a Letter of Medical Necessity (LMN).
- Delivery, final fitting and wheelchair driving skills training: Ideally the wheelchair will be delivered to the clinic, where the team will make sure that the wheelchair that was ordered is, in fact, what was delivered. In addition, the chair will likely need to be adjusted for the best fit. Finally, the team will train you on how to use the chair properly to avoid injury.
It is important to plan for the possibility that your wheel chair will break down and need repairs. If possible, keep a spare wheelchair on hand. If not, have a plan in place to insure timely repair and the use of a loaner.
Pressure mapping technology is a way of measuring seating pressure and can help a clinician decide which cushion provides the best pressure distribution for a particular individual. A pressure-mapping evaluation of a cushion and seating system can help make sure your skin is protected.
Choosing A Wheelchair: A Guide for Optimal Independence by Gary Karp (Cambridge, Mass: O’Reilly, 1998).
Also in the SCI Model Systems Consumer Information Series on Wheelchairs:
- The Manual Wheelchair: What the SCI Consumer Needs to Know
- The Power Wheelchair: What the SCI Consumer Needs to Know
Our health information content is based on research evidence whenever available and represents the consensus of expert opinion of the SCI Model System directors.
Getting the Right Wheelchair: What the SCI Consumer Needs to Know was developed by Michael L. Boninger, MD, in collaboration with the Model Systems Knowledge Translation Center.
This information is not meant to replace the advice from a medical professional. You should consult your health care provider regarding specific medical concerns or treatment.