Choosing a Powered Wheelchair

INTRODUCTION

People tend to think about purchasing a powered wheelchair when they can no longer manage their standard manual wheelchair. First, however, it may be worth considering the range of active user wheelchairs that are available. These are manual wheelchairs that are lightweight and have large propelling wheels on an adjustable axle, so that the position of the wheelchair user within the chair can be adjusted to optimise their propelling and manoeuvring potential. A wheelchair user who may, previously, have found propelling a standard wheelchair too difficult may find that the reduced effort needed to propel an active user wheelchair is sufficient to regain independent mobility. The relative lightness of these wheelchairs, especially over powered wheelchairs, is an advantage if the chair has to be lifted and transported in and out of a car boot. For further details on active user wheelchairs refer to the Assist Ireland Information Sheet ‘Choosing an Active User Wheelchair’.

The wide range of battery-powered vehicles currently available for the disability market is divided into three main categories: powered wheelchairs, scooters, and buggies. The advice in this Information Sheet covers powered wheelchairs only. For information on scooters and buggies, see the Assist Ireland Information Sheet ‘Choosing a Scooter or Buggy’.

For up-to-date information on specific products and suppliers in Ireland, visit the ‘Products Directory' and 'Suppliers’ section of the Assist Ireland online database (www.assistireland.ie).The information in this resource can also be accessed using the telephone support service on 0761 07 9200 during office hours, or by emailing support@assistireland.ie.

The information contained in this document is strictly for information purposes only. There are hazards with all equipment and the suitability of any solution is totally dependent on the individual. It is strongly recommended to seek professional advice and assistance before you consider buying any type of equipment mentioned in this Information Sheet.

PROVISION OF EQUIPMENT

Medical Card Holders

Equipment for people with disabilities, sometimes referred to as aids and appliances, is usually supplied free of charge to medical card holders. The card holder must first be assessed by a suitably qualified therapist who can recommend and prescribe the most appropriate equipment.

Long Term Illness Card Holders

People who have one of the conditions listed as qualifying under the Department of Health’s Long Term Illness Scheme may be eligible to receive items of equipment, essential for the primary condition, free of charge. Assessment by the relevant professional is required.

Hospital Treatment

People in hospital may have aids and appliances provided free of charge when they are prescribed as part of in-hospital treatment in a public hospital.

Health Insurance Schemes

The main companies offering private health insurance in Ireland are:

  • Voluntary Health Insurance (VHI)
  • Irish Life Health
  • Laya Healthcare
  • GloHealth

Some policies provide members with cover for a limited number of aids and appliances under their out-patient schemes. A list of approved appliances is available on request. A claim for the reimbursement (part or full) will be subject to a member’s out-patient excess. Medical certification is usually necessary. Contact your health insurance company’s Customer Services to check if a particular appliance is covered by your policy.

Some employers have their own special health insurance schemes which provide cover for their employees. The employee’s family is also often covered. Check with the employer to see what, if any, equipment is covered under the scheme.

ASSESSMENT

Depending on the type of equipment required, a qualified therapist will assess the individual and make a recommendation to the body responsible for the provision of the equipment or to the person or agency who has requested the assessment. Generally the following applies, but the assessment process and provision may vary in different parts of the country.

  • Occupational therapists will assess for aids to daily living – these include wheelchairs, mobility aids, specialised chairs, bath, shower and toilet aids, stairlifts, hoists etc
  • Physiotherapists will assess for movement, strength and balance training equipment, walking aids and exercise devices
  • Speech and language therapists will assess for communication, speech therapy, and training aids
  • Other relevant therapists and specialists may also be involved in carrying out assessments, depending on the equipment or appliance required.

All the different therapists described above are based in hospitals, community care areas, and with various voluntary agencies. For more information, contact the Community Care section of your Health Services Executive area or the relevant hospital department as appropriate.

SHORT TERM LOAN/HIRE

Private hire

Quite a variety of equipment, including wheelchairs, hospital beds, hoists and a variety of walking aids, can be hired for daily, weekly or monthly periods. Many of the companies and voluntary organisations that provide this service can be found in the Golden Pages under ‘Disabled Persons Products & Services'’, or your local public health nurse or community occupational therapist. A number of private hire firms make daily/weekly/monthly hire charges, which may vary in amount and in the conditions attached.You will also find a list of companies which have an equipment hire service on Assist Ireland in the 'Information' section.

Before you choose to hire, consider the following:

  • Does the company provide a delivery and/or collection service and, if so, are there any additional charges?
  • Does the company ask for a deposit and is it refundable?
  • If hiring long term, is the vehicle subject to a six-monthly service and, if so, will a replacement wheelchair be supplied in the meantime?
  • Who is responsible for maintenance if you have a puncture, for example?
  • If you are hiring for holiday use, are you permitted to take the vehicle overseas? Are there additional charges, and/or an increase in the deposit needed?
  • Are you obliged to take out insurance? Is this included in the price, and what does the insurance cover?
  • When hiring a wheelchair, make sure you understand how to operate it and feel confident using it; and make sure you receive instructions on how to charge the batteries (if required) and carry out other simple maintenance.

Shopmobility

A Shopmobility scheme operates in Liffey Valley Shopping Centre in Clondalkin, Blanchardstown Shopping Centre in Dublin 15, Mahon Point Shopping Centre in Cork, Dundrum Town Centre in Dublin 14 and Whitewater Shopping Centre in Newbridge, Co Kildare. This scheme enables anyone to get the loan of a manual wheelchair, a powered wheelchair or a powered scooter while shopping. This is a free service and helpful for anyone who finds shopping a tiring experience. To avail of this service, you must have two pieces of identification with you including photo ID. It is advisable to ring beforehand, particularly coming up to a holiday period or bank holiday weekend.

Some other shopping centres also have manual wheelchairs that they loan out to customers. Contact Customer Services of the shopping centre to check on the availability of this service.

PURCHASE OF EQUIPMENT

Private Purchase of Equipment

Private purchase may be necessary if the user is not eligible to obtain the necessary equipment from the local area health services. Some people may also choose to buy privately because they want the wider choice of equipment available on the private market.

The purchaser has the option of:

  • personally funding the cost of the equipment
  • applying to charities/benevolent funds etc for funding
  • buying second-hand
  • checking with your health insurance company, if a member, to see if, or what, reimbursement is available.

Private Purchase – Applying for a VAT Refund

VAT paid on certain equipment which is privately purchased for use by a person with a disability can be reclaimed from Revenue. The relief applies to VAT on the purchase of goods which are aids and appliances designed to assist a disabled person to overcome a disability in the performance of their daily functions. Most aids to daily living and communication aids are included. Goods designed for leisure purposes are not. An invoice clearly stating the VAT content of the total amount paid must be included with the application. Form VAT 61a is available from Revenue or can be downloaded from their website (see Useful Addresses).

Private Occupational Therapists

Occupational therapists in private practice can carry out assessments in the home or workplace, and if home modifications are being considered, provide a report detailing the recommendations. It is important to ensure the therapist is experienced in relation to your particular needs. Make sure to discuss fees before engaging anyone’s services, and also check what the assessment fee includes (or does not include). The profession’s representative body, the Association of Occupational Therapists in Ireland (AOTI), keeps a list of contact details of member occupational therapists working in private practice in Ireland. This list is available from the AOTI (see Useful Addresses).

Private Physiotherapists

Physiotherapists can assess for movement, strength and balance training equipment, walking aids and exercise devices and recommend accordingly. If you wish to consult a physiotherapist you can go directly to your local chartered physiotherapist or ask your GP to refer you. It is important to ensure the therapist you consult is experienced in relation to your particular needs. Chartered physiotherapists work in hospitals and in the community where treatment is covered under the public health service. They also work in private practice and can be contacted through the profession’s representative body, the Irish Society of Chartered Physiotherapists (see Useful Addresses), or through the Golden Pages.

Funding from charitable sources

If you have little or no disposable income, but do not have a medical card, you could consider applying to a local charity, benevolent fund or occupational fund for financial assistance. Some such organisations have budgets for exceptional cases or needs and requests will be dealt with in confidence.

Second-hand equipment

Buying second-hand can be a cheaper way of finding a solution to your mobility difficulties but, since choice is more limited, you must make sure that you do not compromise on your essential requirements. Also check that what you are buying is in good working order. You do have certain consumer rights when buying second-hand; for example, the seller must accurately describe the product he/she is selling; and you should be made fully aware of any faults that need attention. If possible, obtain a written description of the product from the seller before you buy so that, should you find any faults, you can get your money back more easily.

There are basically two sources of second-hand equipment: equipment retailers and private individuals.

Buying from a mobility equipment retailer

Some commercial suppliers of wheelchairs also buy unwanted vehicles, recondition them, and then offer them for sale with a short guarantee of, for example, three months. Buying second-hand from a retailer is generally more expensive than buying from a private individual, but the wheelchair is likely to have been serviced and should be in reasonable working order.

Buying from a private individual

Some mainstream magazines and several disability organisations publish journals that contain advertisements for second-hand equipment. If you are buying second-hand from a private individual, you must make sure that the powered wheelchair has been regularly maintained, and that you also receive accompanying literature, for example a care manual; and that you receive instructions on how to control and steer the wheelchair. You will also need to find the local company able to service your wheelchair and carry out future repairs.

POWERED WHEELCHAIRS

Powered wheelchairs can be described as:

Indoor use only

  • For indoor use
  • Small turning circle
  • Could be used on a level patio area or in a small, level garden
  • Short distance range

Indoor and outdoor use

  • For indoor use
  • For outdoor use over standard terrain
  • Over low kerbs
  • Short/medium distance range

Outdoor use only

  • Limited indoor use
  • Outdoor use including uneven ground
  • Kerb climbing up to 10cm
  • Medium to long distance range

The wheelchairs that can be used both indoors and outdoors tend to be the most popular types because they are more versatile. Wheelchairs usually have to be taken indoors for storage and maintenance so the overall size and manoeuvrability of an indoor/outdoor wheelchair suits most people.

PRELIMINARY CONSIDERATIONS

Before you proceed, you must be clear in your mind what you want the wheelchair for. If you need it to improve your indoor mobility, you must have level or ramped access into your home. Doorways must be wide enough to accommodate the wheelchair width and there must be enough space within rooms to enable you to turn your wheelchair around. It may be necessary to do some un-cluttering of your home environment to ensure routes through your home are unimpeded. You will need to compare the size and turning circle of the wheelchairs you are looking at.

If you are intending to use the wheelchair outside, bear in mind that handling the wheelchair over uneven ground, passing pedestrians and crossing roads, requires a fair amount of confidence. You must look at the distance you intend to travel and the routes you will be taking to get an idea of what you will be requiring your wheelchair to do.

In addition to the ability to handle the controls you must also:

  • be able to judge distances and widths (to safely manoeuvre the wheelchair between doorways and through busy streets)
  • have reasonable eyesight
  • be aware of your responsibilities as a wheelchair user.

You will need a secure and waterproof place in which to store your powered wheelchair, close to a power point to charge its batteries. If you are keeping your vehicle in your home, make sure access is possible. It may be necessary for you to install an access ramp leading into your home. Once indoors, ensure the vehicle is not going to obstruct essential circulation space. If you live in a block of flats and plan to keep your wheelchair in a shared hallway, ask permission of other residents and your landlord, and inform the local fire officer to ensure that the wheelchair will not cause a hazard in a fire emergency.

TRY BEFORE YOU BUY

Powered wheelchairs are expensive so it is essential that you do not rush into buying a vehicle that you later find is not entirely suitable.

Before buying, it is strongly recommended that you seek the advice of an occupational therapist on the suitability of the wheelchair to your needs. It is recommended you try out a range of different powered wheelchairs from different suppliers if possible.

If the wheelchair is being provided by the health services, the occupational therapist and wheelchair service provider will be able to assist you in selecting the most suitable wheelchair for you.

You can arrange to visit a supplier’s showroom (if they have one). Contact details of suppliers can be found under ‘Disabled Persons Products & Services’ in the Golden Pages and some may have a website with details of their products and services which you can view online.

Sometimes suppliers organise exhibitions of different types of equipment in various locations around the country allowing people to see and try equipment. These exhibitions are often advertised in the local paper or on local radio. You can also request to be put on a supplier’s mailing list so you will be notified if there is an event being held in your area.

Some companies will give equipment for a try-out period before purchase. Enquiries should also be made about maintenance (if it will be required), maintenance contracts (if relevant) and whether a user manual is provided with the equipment (essential).

When purchasing from any supplier, it is important to remember that it is their business to sell. There may be several suppliers of that particular piece of equipment or different manufacturers of the same type of equipment, so always shop around.

HOME DEMONSTRATIONS

Some suppliers of powered wheelchairs can arrange a home demonstration service, which allows users to try out the vehicle in their home environment.

A home visit is always useful. Before a final decision to buy is made, check that:

  • the vehicle can be manoeuvred over thresholds, through doorways and over terrain where you are likely to be using it.
  • you sit in the wheelchair and drive it - do not allow the sales representative alone to take control.
  • you have a third impartial person with you to give advice and offer another opinion.

Although you hope there will be no need to question the integrity of the sales representative, a minority may try to take advantage of your vulnerability. Take your time over making any decision to buy. Do not buy from anyone exerting pressure on you to buy their product. You must give yourself an opportunity to think things through independently.

BEFORE YOU COMMIT TO BUYING

Check the following:

  • What is the delivery time?
  • Will the powered wheelchair arrive ready assembled?
  • What guarantee is available?
  • What after-care service is offered?
  • How much is the company's call out charge?
  • Will spare parts be brought to the home?
  • If the powered wheelchair has to be taken away for repairs, will a loan vehicle be offered?
  • If the same vehicle can be supplied direct from the manufacturer or from other retailers, how do prices compare?

You must be certain that:

  • you have the necessary skills to handle a powered wheelchair
  • the wheelchair is capable of doing what you require of it
  • your home environment can accommodate your wheelchair.

WHAT DOES THE USER NEED?

A STABLE SEATING BASE

Wheelchair users must feel secure and supported within their wheelchair seat so that they can then focus on the task of driving and steering their wheelchair. Correct positioning will also make everyday tasks, such as reading, writing and feeding, easier to achieve. As a general rule, the seat should have a level base and be wide enough to accommodate outdoor clothing if necessary, but not so wide that the user is forced to sit asymmetrically in order to feel supported. If the seat is too narrow, it will be uncomfortable and increase the risk of pressure sores.

If the wheelchair user has poor sitting balance or his/her disability causes postural asymmetry or variation in muscle tone, a more supportive seat unit with trunk and pelvic supports may be necessary.

A VEHICLE THAT IS EASY TO STEER

The joystick control of standard powered wheelchairs does not require much effort to use, although adjusting to the sensitivity of joystick steering may take a little while to master. As a general rule, better control is achieved by placing the control in the V between the thumb and the index finger, rather than grasping the joystick itself.

The majority of controls are programmable so can be altered to accommodate less refined movements. If using a joystick is impossible, alternative switches are available.

A VEHICLE THAT MAKES TRANSFERRING EASY

You must be able to transfer in and out of your wheelchair safely and, if possible, independently. Features such as flip-up/swing-away footrests, detachable or fold-down armrests and flip-back kerb riders will give you closer access to the wheelchair. Powered wheelchairs can only be moved manually when the motors are disengaged (i.e. the chair is put into free wheel) so, unlike a manual wheelchair, a powered wheelchair cannot be pulled up to you to get it close for transfer. So, make sure there is room around the wheelchair to position yourself close to it. Although a powered wheelchair should not move during transfers, a parking brake is often provided for added security.

If you can manage a standing transfer, look at the position of the kerb riders. A centrally positioned device can get in the way.

If transferring independently is difficult, a carer should not help to lift you manually as this will put him/her at risk of injury. A range of equipment is available to help with transfers such as sliding boards and rotating discs, or if necessary, use a hoist. For advice on moving and handling issues consult the occupational therapist through your local health centre.

A VEHICLE THAT IS EASY TO MANOEUVRE

A few wheelchairs are designed primarily for indoor use and tend to be smaller and more manoeuvrable. Check that the chosen powered wheelchair will:

  • go through doorways and over thresholds,
  • manoeuvre on floor surfaces,
  • make tight turns from hallways into living rooms,
  • manoeuvre backwards, if necessary, e.g. reversing out of the toilet,
  • go down shop aisles etc.

You may find that a powered wheelchair does not adjust immediately to a change in direction because the castors need a split second to swivel round.

Wheelchairs that can move around easily inside tend not to be as efficient outdoors - coping with longer distances, steep or uneven ground. You may have difficulty in finding a wheelchair that meets all your requirements, although newer designs incorporate mid-wheel drive to give a smaller turning circle. You may have to make compromises and/or continue to use a manual wheelchair for some activities.

Vehicles designed purely for outdoor use usually have very wide turning circles and wide/deep treaded tyres for easier movement over rough or soft ground.

A STABLE VEHICLE

Over flat, even ground all powered vehicles are stable. However, a user with a lower limb amputation, especially a high level or double amputation, should choose carefully because the lack of weight at the front may affect the centre of gravity and could cause the vehicle to tip backwards especially when climbing kerbs. Check with the manufacturers about weighting the front end. Stability can also be decreased if your wheelchair backrest is reclined or your wheelchair seat tilts backwards (tilt-in-space).

FREEDOM OF TRAVEL

Powered vehicles allow the user to travel quite long distances without too much personal effort. Although many vehicles have a good distance/range per battery charge - some even travelling up to 30 to 40km (25 miles) - to cover these distances more travelling time is required. Powered vehicles are not replacements for cars. It could take a minimum of four hours to cover 25km (16 miles) in a pavement-only vehicle.

A VEHICLE THAT IS EASY TO TRANSPORT

Although most manufacturers claim that their powered wheelchairs can be dismantled and folded for transporting, it is not something that can be done easily and should only be undertaken in emergencies or occasionally (e.g. when travelling on holiday). Bear in mind that if you transport the wheelchair somewhere and then bring it back again, this will involve lifting the components at least four times, assembling and disassembling them. It is not a task that can usually be undertaken by wheelchair users themselves because it requires flexibility (to reach catches, plugs etc); strength (to lift the component parts); and standing/walking stability.

Most powered wheelchairs have a folding frame that can be folded once the batteries have been removed. Wheelchairs tend to have two 12 volt batteries each weighing approximately 10kg. A few wheelchairs can also have detachable motors. The frame itself will not fold down as compactly as the frame of a manual wheelchair and will be heavier to lift. The wheelchair supplier will be able to tell you how much each component part weighs; the heaviest component can be from about 12kg to 35kg. Remember that a bag of sugar weighs only 1kg.

If you do need to transport your wheelchair on a regular basis a few solutions will avoid the need to lift it. If you have an estate car, and the backrest of your wheelchair folds down, an assistant may be able to drive the wheelchair, unoccupied, into the back of the car via ramps. Also wheelchair hoists can be fitted to the back of a car to lift component parts or the whole vehicle into a car; or a wheelchair can be transported on a rack or trailer.

A VEHICLE THAT MEETS THE ASSISTANT'S NEEDS

Powered wheelchairs with dual or attendant control enable someone else to control the wheelchair from the back. Controls are sited on the right or left pushing handle of the wheelchair to suit the requirements of the assistant. Dual controls not only enable users to be independent when they want to be, but also make it possible for someone else to help when the need arises.

The comfort and mobility needs of the wheelchair occupant are of paramount importance, but if the assistant has to undertake routine maintenance, such as pumping up tyres and putting the wheelchair on charge, and dismantling and assembling the wheelchair then he/she must be involved in the selection process to make sure the tasks required are manageable.

WHEELCHAIR FEATURES TO CONSIDER

FRAME

A rigid frame is stronger than a folding frame but may make transporting the wheelchair more difficult. A folding frame generally operates once the wheelchair batteries have been removed.

Wheelchair with large front wheels for outdoor use

WHEELS/TYRES

Wheelchairs with smaller wheels are generally easier to drive in confined spaces; larger wheels are better over uneven ground. Some models have the same size wheels both front and rear, while others may have smaller wheels in front and larger rear wheels. A few wheelchairs, primarily designed for outdoor use, have large drive wheels at the front to made outdoor terrain and kerbs easier to negotiate.

The drive wheels are those to which the motor directs its power. Rear wheel drive provides better grip and power when driving over uneven or slippery ground, especially as the weight of the user is directly over these wheels.

Front wheel drive provides better manoeuvrability.

A recent wheelchair development is a six-wheel base with the drive wheels positioned centrally to give a smaller turning circle.

All powered wheelchairs are fitted with a free-wheel facility to disengage the motors so that the wheelchair can be pushed in an emergency situation. A powered wheelchair is heavy to push and manoeuvre manually.

There are different types of tyres including:

  • pneumatic tyres that must be inflated regularly to maintain air pressure and checked for punctures. They give a smoother, more comfortable ride and better traction on kerbs, slopes and rough ground than other types of tyre. Punctures can be repaired in a similar way to bicycle tyre punctures. If this task is too difficult to manage at home, a local cycle shop or mobility vehicle retailer should be able to carry out the repair.
  • solid tyres which do not puncture or need inflating and may make it easier to manoeuvre on some surfaces.
  • puncture-proof tyres which are a compromise between solid and pneumatic tyres. They are made of an open cell rubber compound to help with shock absorption.
  • deep tread pneumatic tyres which provide increased grip and stability on slopes, muddy grass and rough or uneven ground.

FOOTRESTS

  • Detachable footrests can be completely removed and therefore lessen the weight of the unit if the wheelchair needs to be transported. In some circumstances, it might also provide better access during assisted transfers on and off the wheelchair. However, make sure that the footrests do not become mislaid.
  • Swing-away footrests can be swung out of the way to give better access to the wheelchair seat during transfers.
  • One-piece footrests provide a greater area of support for feet and may allow the user to move his/her feet around. Some may not be detachable and may interfere with transfers.
  • Elevating footrests are available for people who need to have their legs raised, or for those who have stiffness in their knees. Addition of elevating legrests tends to increase the overall length of the chair which in turn may affect manoeuvrability.
  • Height-adjustable footrests make it possible to accommodate the leg length of the user. However, footrests that are positioned very low can make contact with the ground when going up hills, over uneven ground or when negotiating kerbs. It may be necessary for someone with long legs to look for footrests that are angled further outwards.
  • Angle-adjustable footrests are a useful feature for people whose legs tend to kick out in a spasm. The angle of the footplates can be altered to a position that may lessen spasm.
  • In addition, wheelchair footplates can generally be hinged upwards; heel loops to help keep the feet on the footplate and a calf strap across the footplate hangers to prevent the legs slipping backwards may be available.

ARMRESTS

Armrests define the width of the seat, help the user to feel more secure and provide support for the elbows. There is a range of different styles to choose from.

  • Full-length armrests run the full length of the seat from back to front and provide more substantial support particularly when the user wishes to stand up or sit down. They often include an attachment for a tray. However, they can prevent a close approach to a table.
  • Desk-style armrests are shorter in length and allow access to work surface, but do not offer as much arm support and may not be suitable for people who need to push down on the armrest to help them stand up.
  • Adjustable height armrests provide maximum support and comfort.
  • Detachable armrests reduce the size/weight of wheelchair and can make storage and transportation and sideways transfers on and off the wheelchair seat easier. However, as they are removable they can be mislaid.
  • Fold-up/fold-down/swing-away armrests may be more convenient for someone who needs to transfer sideways.

BACKRESTS

The height of the backrest is often a matter of personal preference but, as a minimum, it should be high enough to stabilise the lower back. Very low backrests are not common in powered wheelchairs because powered wheelchair users tend to require more adequate back support. The backrest height generally reaches shoulder blade level or beyond.

  • Folding backrests - reduce the overall size of the wheelchair which makes storage and transporting easier; can help when positioning slings for assisted transfers.
  • Non-folding backrests provide firmer back support and secure attachment for more supportive backrest systems.
  • Semi or fully reclining backrests can either be reclined manually by an assistant and some can be adjusted electrically by the user.

SEAT

It is vital that the user is accurately assessed for the correct seat size and style as this has a direct impact on posture and comfort. Remember to allow room for outdoor clothing if you will be using the wheelchair outside.

A slung seat and backrest are standard features, but some powered wheelchairs can have a more substantial seat unit that is padded and/or contoured to give additional comfort and increase shock absorption. It is not generally advisable to sit on only a slung seat as this will not provide sufficient comfort. As a minimum, the wheelchair seat should be fitted with a foam cushion, or a cushion with higher pressure reducing properties if the user is vulnerable to pressure sores. For more information on pressure relief, see the Assist Ireland Information Sheet ‘Choosing Pressure Relief Equipment’.

Some people may require more support than that provided by a standard wheelchair seat. A range of seating systems is sold separately and usually an occupational therapist or physiotherapist is involved in the selection process to find the most suitable system. The seating system must be compatible with the wheelchair chassis.

BRAKES

All powered wheelchairs have brakes that automatically come on when the user lets go of the joystick or accelerating control.

Some models have the option of a hand brake, which rests on the tyres when stationary (tyre pressures must therefore be kept firm). This provides extra security.

WHEELCHAIR CONTROLS

Wheelchair control console

Wheelchairs are fitted with a control console that will generally include:

  • an on/off switch or key,
  • a control to drive and steer the wheelchair (usually a joystick),
  • switches or a dial to limit speed,
  • a horn,
  • switches for lights or indicators,
  • a battery level indicator.

On some makes of wheelchair the control console can be dropped down, swung away or temporarily repositioned to improve access to the wheelchair seat during transfers.

ON/OFF SWITCH OR KEY

This immobilises the vehicle when it is not being used. A key can be removed for extra security. The controls must be turned off when the user is transferring in and out of the wheelchair to prevent the wheelchair moving should the joystick be accidentally knocked.

JOYSTICK AND ALTERNATIVE CONTROLS

Most chairs have a proportional joystick control that requires minimal hand movement to control speed and direction.

Light, forward touch progresses the wheelchair slowly; pushing the joystick further will increase speed. Direction is controlled by moving the joystick to the left or right; or backwards to drive the wheelchair in reverse. People who do not have a delicate touch can have a joystick that is not proportional in operation. A slight tremor can usually be accommodated by the electronics of a joystick; a more significant tremor may need a more sophisticated control to compensate for it.

Wheelchair with joystick control

The joystick is usually mounted on the left or right armrest. Some are permanently fitted at the factory, while others can be changed to the other side quite easily. Many wheelchairs can also have the option of a joystick mounted at the back to enable an assistant to control the wheelchair. This can replace or be in addition to the armrest joystick. If the wheelchair has dual controls, a switch determines whether the wheelchair user or the assistant is driving the wheelchair.

Alternative controls

Wheelchairs with backrest and tray-mounted controls

Many wheelchair manufacturers can supply alternative controls. These may include a tray-mounted joystick; switches mounted so that other parts of the body can be used to control the wheelchair such as the chin, head or foot; touch sensitive switches; a suck/blow switch etc. These alternative switches make it possible for severely disabled people to control their wheelchairs independently. Centrally mounted controls may help to improve body symmetry and help to promote a stable seating posture.

SPEED LIMITER

Most powered wheelchairs have a speed limiter, which determines the maximum speed to which the wheelchair can accelerate. It may be a simple switch to select a slow/fast speed, or a dial to give a wider and more accurate choice of speed.

HORN

A horn is generally available on all wheelchairs that can be used outside. The horn should be used to warn other pavement/road users that you are there, but the wheelchair user must also show consideration to pedestrians.

SWITCHES FOR LIGHTS AND INDICATORS

Your wheelchair should be fitted with lights and indicators if you plan to use it at night. Switches and/or buttons for the lights and indicators will be sited on the control console.

BATTERY LEVEL INDICATOR

Not all control consoles are fitted with a battery level indicator and one may not be necessary if the wheelchair is to be used only indoors. If you plan to travel further afield, a battery level indicator will ensure that you know that there is sufficient power in the batteries for your journey and will indicate when charging is required.

WHEELCHAIR PERFORMANCE

If you require a wheelchair for outdoor use, first assess your local environment and think about where you are intending to go in your wheelchair. To get an idea of whether the wheelchair you are looking at is going to be suitable, find out what distance it is capable of achieving on a full charge - the range; and how well it can manage on hills - the gradient. Most brochures will have this information in a technical specification section, but this should be used as a general guide only. The figures quoted by the manufacturers in their brochures can be achieved under optimum conditions, and with new batteries on a full charge. They can be affected by:

  • condition of batteries - older, well used batteries will not store as much power,
  • weight of user - the heavier the person the more power will be used,
  • terrain to be covered - climbing hills and kerbs uses up more power,
  • accessories - lights and indicators are powered by the wheelchair batteries,
  • weather - batteries do not perform as well when it is cold,
  • if you are heavier than average (i.e. more than 11 stone/70kg), the distance your wheelchair will cover and its performance on gradients will already be reduced without considering the other factors mentioned above,
  • the technical specifications will also give details of the maximum speed your wheelchair is capable of achieving. This speed can be maintained on level ground and gentle hills but, when climbing a continuous hill, the wheelchair motors may not be able to maintain the same level of thrust as the wheelchair approaches the top of the hill.

NEGOTIATING KERBS

Wheelchair with kerb climbers

A wheelchair without kerb climbers may be able to negotiate a small raise of up to 5cm. With the addition of kerb climbing devices, a higher kerb of at least 10cm can be negotiated. Check with suppliers the recommended maximum height for each wheelchair and the technique you should use to climb and descend kerbs safely.

The three main types of kerb climbers are:

  • side-mounted - a pair of arc-shaped devices fitted to either side of the wheelchair that lift the front wheels of the wheelchair up and onto the kerb. They tend to increase the overall width of the chair. Some styles can be detached (useful for indoor manoeuvrability); some can be flipped back so are less likely to hinder sideways transfers
  • centrally-mounted - wheel or arc-shaped devices are situated between the two front wheels. This is less likely to hinder sideways transfers and will not increase the width of the wheelchair, but may get in the way of standing transfers
  • direct-drive - some chairs have wheels large enough to climb kerbs without special devices. These wheelchairs tend to be larger and have a wider turning circle and therefore are not as easy to manoeuvre in confined spaces.

Sometimes, kerb climbers can be bought and attached to the wheelchair as an accessory so, if the user is not sure whether they will be needed, they can be bought at a later date.

GOING UP KERBS

Most wheelchairs require a head-on approach to climbing kerbs. If regularly used routes involve frequent kerb climbing, these routes should be tried out before the powered wheelchair is bought. Although kerb climbing can be carried out safely, the driver does need to be competent at handling the wheelchair. It does involve some jolting so good sitting balance is essential, and it may prove too uncomfortable for people with painful joints. If dropped kerbs can be found (even if it means taking a slightly longer route) this might be preferable.

The absolute maximum that a wheelchair can negotiate is 13cm, but it must be remembered that this is under ideal circumstances. The following may influence this:

  • battery charge level - if the power is low, high kerbs will be more difficult,
  • user position - the user may need to move his/her body weight to shift the centre of gravity to assist the manoeuvre,
  • state of the kerb and pavement - if the kerb is uneven or the pavement behind it cracked or slippery with sand, gravel or leaves, then kerb climbing will be more difficult,
  • footrests - kerb climbing will not be possible if the wheelchair footrests are too low as they will touch the ground,
  • anti-tip devices/stabilising wheels - many wheelchairs are fitted with these devices to ensure that the vehicle will not tip backwards or sideways when climbing a high kerb or going down a steep kerb.

GOING DOWN KERBS

Most wheelchairs are designed to go down backwards so that they are leading with their larger wheels. Once down, the wheelchair then needs to be turned through 180 degrees to cross the road - quite time consuming and risky on busy roads. It may be unsafe for users with neck problems to manoeuvre backwards as they may not be able to see oncoming traffic.

BATTERIES AND CHARGERS

Battery powered vehicles operate from either one or two, 12 volt rechargeable batteries which are not interchangeable with cheaper car batteries (used only to start a car engine and not to provide continuous power).

New or newly recharged batteries must not be installed with used ones.

Battery output is measured in ampere hours (ah) and, generally, the larger and heavier the batteries the greater the output capacity and range travelled. A choice of battery capacities is often available when purchasing new vehicles or replacement batteries.

The distance travelled or range from a fully charged battery depends on its ampere rating, age, condition, type and temperature, as well as external factors such as the weight of vehicle and user, terrain covered etc. Batteries in a vehicle stored outdoors at colder temperatures may not maintain their charge as effectively as those stored in a warmer environment.

Remember to include the on-going costs of maintenance and replacement of batteries when budgeting for a powered wheelchair.

TYPES OF BATTERIES

Two main types of battery are available:

  • Lead acid/wet batteries - require checking and topping up with distilled water. They are less commonly used these days because of the inconvenience of topping up; the risk of corrosive spillages; the requirement to charge them in a ventilated area due to the emission of gases during charging; and their unsuitability for air travel. Intending passengers should always contact their airline prior to travel to check the suitability of their battery for carriage.
  • Gel batteries - maintenance free and are so called because their conducting chemicals are suspended in a gel-like substance so no topping up is required. However, they do not last as long as wet batteries and are more expensive to replace.

CHARGING BATTERIES

The following information covers general points to consider regarding the maintenance and charging of batteries.

However, it is advisable to follow the guidelines recommended by the manufacturer.

Ideally, the powered wheelchair needs to be placed beside a mains electricity power socket so that the batteries are charged in situ, usually overnight, using a specified battery charger.

Check that the charging point is easily accessible. Charging of wet batteries should always be done in a well-ventilated room as gases are given off. Although these are not poisonous, they could cause an explosion if ignited by a flame. It is also recommended that batteries are not charged in a room where someone is sleeping.

Remember the following points:

  • Check wet batteries regularly before charging to make sure that water is covering the cells.
  • Always use the right charger for the batteries. Dry batteries have to be charged with a constant charge. Wet batteries may be charged using a constant or cyclic charge. Using the wrong charger will ruin the batteries.
  • Plug the charger into the wheelchair charging point before plugging it into the mains.
  • The battery charger may have a mains and a charging indicator light. Check they are both on.
  • Most chargers have a cut-out and a light indicator which operate when the battery is fully charged.
  • Take care not to overcharge the batteries as this will reduce their overall life. A battery level indicator on your wheelchair control console will indicate when the batteries require charging. Ideally, they should be recharged when the indicator reads 20% to 25% charge. Some chargers charge the batteries very quickly for the first few minutes and then slow down. Overcharging may occur if this type of charger is turned on regularly for short periods. It is much better to leave the batteries to charge overnight.
  • Overcharging causes chemical decay and recharging becomes impossible. New batteries must then be purchased. It takes about three months for the batteries to decay if left uncharged.

But:

  • Vehicles not in use should be charged once a month.
  • Vehicles used infrequently should be charged once a fortnight.
  • Vehicles in constant use should be charged daily. Daily use will increase the life span of the batteries.

General points

  • Do not touch both terminals at once with wet hands or place a metal object across the terminals. Although the shock would not be lethal, a small shock can be quite nasty!
  • Keep the terminals free from corrosion by smearing with petroleum jelly.
  • If replacing the batteries, check that the new ones will fit into the allotted space.

POWERED WHEELCHAIRS WITH SPECIAL FEATURES

Some wheelchairs have special features that allow people to be more independent or provide additional support or comfort. The features available include:

AN ELEVATING SEAT

These wheelchairs are generally used indoors to enable users to reach high level cupboards and shelves, for example. It is usually advised that, for stability, the wheelchair should not be driven with the seat elevated.

A STAND-UP MECHANISM

These wheelchairs stand the user up to a near vertical position. The seat and backrest flatten out (using either a manual or powered control), and the user is stabilised in a standing position via chest and knee straps. As well as increasing reach, these wheelchairs also enable users to raise themselves to a point where they can communicate more easily with others and may also benefit the health of the user by providing some pressure relief and improvement to circulation and fluid drainage.

A STAIR CLIMBING FACILITY

A few wheelchairs have a special mechanism to negotiate flights of stairs, both up and down. Ascent and descent is controlled by the wheelchair user via a more complex control console.

Wheelchair with wheel clusters for climbing stairs

Although the angle of the seat unit adjusts on the stairway to keep the seat horizontal, users must have good trunk control.

A POWERED RECLINING BACKREST

A reclining backrest is longer and includes a head support section. Backrests that recline manually are commonly available, but can only be operated by an assistant. A powered backrest can be reclined by wheelchair users, increasing their level of independence. A reclining backrest is usually operated in conjunction with elevating leg rests and provides an alternative position for the wheelchair user, useful for resting, pressure reduction and to relieve back pain. The backrest should be returned to an upright position for stability when the wheelchair is driven and to direct the vision of the user forwards.

A TILTING SEAT UNIT

The seat unit in these wheelchairs can be tilted backwards, whilst maintaining a constant angle between the seat and backrest. Like reclining models, the backrests on these styles of wheelchair are longer to provide full-length support for the back and head of the user. The tilting mechanism may be manually operated by an assistant, or powered for independent use. People who have low muscle tone with limited head and trunk control may be better supported in a tilt-in-space wheelchair. It might also be used for resting, for altering weight distribution and to improve comfort. However, users will need to return to the upright position at meal times so that they have better eye contact with other seated people and when driving the wheelchair.

A CAR TRANSFER SYSTEM

Travelling by car if you are an electric wheelchair user can be a problem.

Wheelchair with Car-chair system

The Car-chair system consists of a specially adapted manual or electric wheelchair, which works with a powered lifting unit, that raises the user, and the complete wheelchair into the car into the space previously occupied by the seats of the front passenger or driver. The user remains seated in the wheelchair throughout the transfer.

The Carony system positions the wheelchair user similarly, but the wheelchair seat unit detaches from the wheelchair chassis and the seat alone is transferred into the position of the front passenger or driver.

WHEELCHAIR ACCESSORIES

The majority of manufacturers supply a range of accessories to accompany their wheelchairs. Typically, cushions, trays, bags, wet weather protection is available. Some suppliers sell universal accessories for use with a range of different wheelchairs.

USEFUL ADDRESSES

  • Association of Occupational Therapists of Ireland (AOTI)
    Office 1 & 2
    1st Floor
    Haymarket House
    Smithfield
    Dublin 7
    Tel: 01-874 8136
    Email: info@aoti.ie
    Website: www.aoti.ie

  • Irish Society of Chartered Physiotherapists (ISCP)
    Royal College of Surgeons
    St Stephen's Green
    Dublin 2
    Tel: 01-402 2148
    Fax: 01-402 2160
    Email: info@iscp.ie
    Website: www.iscp.ie

  • VAT (Unregistered) Repayments Section
    Revenue Commissioners
    FREEPOST
    Central Repayments Office
    M: TEK II Building
    Armagh Road
    Monaghan
    Tel: 047 621 000
    LoCall: 1890 60 60 61
    Email: cromon@revenue.ie
    Website: www.revenue.ie

  • Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
    Liffey Valley Shopping Centre
    Quarryvale
    Clondalkin
    Dublin 22
    Tel: 01-620 8731

  • Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
    Mahon Point Shopping Centre
    Mahon
    Cork
    Tel: 021-431 3033

  • Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
    Red Car Park (Level 2M)
    Dundrum Town Centre
    Dundrum
    Dublin 14
    Tel: 01-298 7982
  • Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
    Blanchardstown Shopping Centre
    Red Car Park - Marks and Spencers Entrance
    Blanchardstown
    Dublin 15
    Tel: 01-821 1911

  • Shopmobility(a free service offering manual wheelchairs, powered wheelchairs and scooters to members of the public with limited mobility for periods of up to a day)
    Green Car Park
    Whitewater Shopping Centre
    Cutlery Road
    Newbridge
    Co Kildare
    Tel: 045-450736

  • Irish Wheelchair Association (IWA)
    Áras Chúchulainn
    Blackheath Drive
    Clontarf
    Dublin 3
    Tel: 01-818 6400
    Fax: 01-833 3873
    Email: info@iwa.ie
    Website: www.iwa.ie

  • Disabled Living Foundation (DLF)(UK charity providing advice and information and a comprehensive up-to-date database of disability equipment available in the UK)
    Ground Floor
    Landmark House
    Hammersmith Bridge Road
    London W6 9EJ
    England
    Tel: 0044 207 289 6111
    Email: info@dlf.org.uk
    Website: www.dlf.org.uk

  • Rica(independent research body in UK which produces guides for older and disabled consumers based on professional research)
    G03, The Wenlock
    50-52 Wharf Road
    London
    N1 7EU
    England
    Tel: 0044 207 427 2460
    Fax: 0044 207 427 2468
    Email: mail@rica.org.uk
    Website: www.rica.org.uk