Powered wheelchairs

  • Introduction
  • Provision of equipment
  • Identifying your needs
  • Choosing a wheelchair for your body shape and size
  • Powered wheelchairs
  • Introduction

    The aim of this Information Sheet is to provide some basic information and suggestions if you are considering getting a powered wheelchair. It looks at:

    • your personal circumstances
    • the various categories of powered wheelchairs
    • the practical and legal requirements when owning a powered wheelchair
    • safety factors and insurance
    • a number of accessories that might be useful to you.

    If you have very particular requirements you are advised to seek a professional assessment and advice.

    The wide range of battery-powered vehicles currently available for the disability market is divided into two main categories: powered wheelchairs, and mobility scooters. The information in this Information Sheet covers powered wheelchairs only. For information on mobility scooters, see the Assist Ireland Information Sheet Mobility scooters.

    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 online, 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 offer an equipment hire service on Assist Ireland.

    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. Contact Revenue's Central Repayments Office to request Form VAT 61a (see Useful Addresses), or you can apply online for a VAT refund using eRepayments in Revenue's myAccount service.

    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.

    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.

    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.

    Identifying your needs

    For someone who requires a wheelchair all or much of the time, you should access a full seating assessment from an occupational therapist or physiotherapist skilled in this area of work. If you have specialist needs it is vital that you have a professional assessment in order to get the correct chair and seating.

    Even if you do not require a professional assessment, it is important to recognise what your requirements are, in order to get the right powered wheelchair to help you in your circumstances.

    There are a number of factors about yourself to consider including:

    • Your mobility – this is your ability to move around. It includes walking, sitting down and standing up, and adjusting or moving your body within the chair. Depending on your level of ability, you will need to consider how you will get in and out of the chair. Are you able to walk short distances? Are you able to stand up and sit down safely? Will you need to transfer, perhaps using a transfer board? Does the chair have removable armrests allowing you to do this? Are you usually hoisted? Will the chair enable your hoist to move close enough to the chair to enable this?
    • Your tolerance – this is the length of time you can tolerate doing something, e.g. standing, walking or sitting.
    • Your balance – this is your ability to remain steady, when standing or seated and especially when moving between the two.
    • Your posture – this is the position in which you hold your body. When using a powered wheelchair, you need to be able to maintain a comfortable, stable, safe and supported seated position. You may need special cushions or support to provide comfort and help you to maintain your position.
    • Your body height and weight – if you are a very tall or large person you will need to look for a wheelchair that is appropriate and safe for you. Measure and record your height and weight accurately and check manufacturers’ details. A tall person will need a chair which can support longer legs, a longer spine and possibly bigger feet. It is important that your limbs and body are fully supported when in the chair. It is important for a large person to have a chair which is designed and made for their body weight and size so as to maintain the correct balance and stability in the chair, to prevent discomfort and pressure areas and to ensure the chair does not break.
    • Your skin condition – is your skin on any potential pressure points intact and healthy? The relevant pressure points might be the bony prominences of your bottom and hips, the base of your spine and the back of your knees. Any areas upon which you lean without relieving the pressure has the potential to develop a pressure ulcer, such as your shoulder blades and elbows or forearms (Stockton and Flynn 2009). If you are going to spend significant time in the chair and if you find it difficult to relieve the pressure on these areas by shifting around, you must have suitable pressure relief cushioning.
    • Your sight, perception, memory and cognitive ability – if you are losing your visual, perceptual, memory or cognitive abilities, it is unlikely that a powered wheelchair is appropriate for you.

    All of the above can be affected by many things including age, tiredness, a medical or physical condition and medicines.

    Consider how all these factors will be affected by, and will affect, your use of the wheelchair.

    If you have a condition which is deteriorating, you may wish to take account of your possible future needs at this earlier stage. You also need to take into account the needs of any person who will be helping you, including carrying out basic maintenance tasks, e.g. charging the batteries. Their level of ability and safety need to be considered.

    Dementia

    Dementia can affect a person in many ways, including memory, concentration, judgement, vision, planning or problem-solving. It is a progressive disorder and those affected may not have insight into their illness. You may not be able to make a realistic judgement about your ability to use a scooter safely.

    Many people in the early stages of dementia can still travel independently in a powered wheelchair, if they are already familiar with using one. You should use familiar routes and carry relevant identity documents with you when alone, should you get lost. A GPS tracking system can be considered - more information about this can be read in Equipment to help with memory and safety. Introducing a powered wheelchair as a new item to someone who already has dementia should not be considered.

    If they already using a powered chair, it can be difficult to decide when you should stop. Some indicators might be:

    • becoming less confident or repeatedly confused about the controls
    • repeatedly getting lost
    • forgetting the purpose of the trip
    • becoming less aware of safety precautions.

    The guidance on when to give up driving a car can be useful and applied to the use of a powered wheelchair. If a person has early dementia, when sufficient skills are retained and progression is slow, driving may still be allowed, but subject to review.

    When a person displays poor short-term memory, disorientation, lack of insight and judgement, they are likely to be considered unfit to drive (Medical Fitness to Drive Guidelines, Road Safety Authority, p75, April 2016).

    Your eyesight

    It is important that you can see well enough to be able to judge distances, recognise obstacles and hazards, and be able to see pedestrians and other road users. If poor eyesight were taken as a contributory factor in an incident, it could make you liable for a compensation claim.

    Vision can change with age and it is recommended that you have regular sight tests. You should have a minimum visual acuity of 6/24.

    If you are eligible to be registered as severely sight impaired (blind), you should not drive a mobility vehicle as this would put yourself and others at risk. If you are eligible to be registered as visually impaired, you should speak to your optometrist or doctor.

    Getting in and out of the chair

    As mentioned above, your remaining level of mobility may dictate how you get in and out of the chair and which features you may need as part of the chair. If you can still walk short distances and can stand up and sit down, you will be able to manage getting in and out of the chair without assistance.

    Many lightweight chairs have features such as flip-up armrests and a swivel seat to make transfers easier. Some chairs have a height-adjustable seat or seat height options and removable armrests. This may be useful to you if you slide transfer, perhaps to and from a car or the bed.

    Every chair will have footplates which either swivel or flip-up out of the way. It is important that you take the time to move the footplates out of the way before you get in or out of the chair. If not, they become a trip hazard or you run the risk of tipping the chair should you put your whole weight upon them.

    If you require a hoist to be transferred in and out of the chair, you need to ensure that your hoist and the chair that you choose will work together. The base of the hoist will need to span the overall width of the chair, or be able to move underneath it, getting close enough to correctly position you into the seat.

    Your mobility requirements

    Consider where you want your powered wheelchair to take you:

    • Do you want to use the chair indoors, outdoors or both?
    • How far might you want to travel? Check the range of the chair.
    • Will you be using the chair all day? Check the battery life of the chair.
    • What is your local area like? Are there wide pavements? Will you have to go up and down kerbs? How does the chair cope with kerbs?
    • Might you need to travel on the road? If yes, you will need a Class 3 category of chair (see below).

    The answers to these questions will guide you in choosing what type of powered wheelchair is best for you. Your personal health requirements will guide you in the features you need to look for.

    Choosing a wheelchair for your body shape and size

    A wheelchair should add to your freedom and independence; it should enable your comfort and well-being, not limit your body movement or cause pain or pressure sores.

    If your body shape allows, you want to preserve and support good posture by:

    • keeping your head, neck and spine aligned
    • keeping your pelvis, hips and knees aligned
    • choosing suitable support cushioning.

    Avoid creating pressure points or limiting your movement within the chair by:

    • ensuring that the chair seat, back and shoulder rests are the right size for you
    • allowing for some space either side of your bottom and thighs
    • avoiding the use of lumpy cushions or wearing any bulky clothes which create pressure points when you are seated in the chair
    • choosing an appropriate pressure relieving cushion.

    A wheelchair is a bulky object and can be longer than it is wide. A powered chair also carries batteries which add significantly to its weight and possibly its dimensions. It is designed to be as safe and balanced as possible, especially when moving over uneven or sloped surfaces.

    It may also be designed to accommodate a person’s individual body size, shape or requirements - e.g. when a person loses a lower limb, their centre of balance changes, even when seated. This means the balance of the chair has to be adjusted to prevent it tipping. If you have significant personal requirements in terms of your body size, shape or mobility you are advised to seek professional assessment and advice.

    Measuring for your chair

    You should not be ‘squeezed’ into the chair, but have enough space to move within the seat, to rotate your upper body if possible and move your arms. Yet you also need to be supported, especially if you find maintaining your posture tiring and difficult.

    You will need help to gain accurate measurements of yourself. Make sure you are seated comfortably and well-supported, with your back as straight as possible and with your hips at 90 degrees (a right angle) and your feet flat on the floor. Wear your normal clothing and shoes. If you have complex seating needs, you may have to adapt these measurements, but you are then advised to seek professional advice.

    Measure and record these distances (in centimetres). You may not use all of them, depending on the level of support you require from your chair:

    (a) Seat width (not the overall width of the chair) – the distance between the widest part of your hips or thighs, plus 2cm either side. The seat/backrest width should give you enough room for winter-weight clothing, but not be so big that it causes you to lean sideways to find support. This is particularly important if you have poor upper body strength and control. So if, when seated, the widest part of your bottom or hips measured 42cm across, you should be looking for a chair seat with a width of approximately 46cm (18”).

    (b) Seat depth - the distance between the back of your bottom to the back of your knee, minus 2cm. If you have a discrepancy in your leg length, take the measurement from the shorter leg. So if, when seated, the distance between the back of your bottom and the back of your knee is 46cm, you should be looking for a chair seat with a depth of 44cm at most (17.5”). If you choose a larger depth it will cut into the back of your knee.

    (c) Arm rest height – the distance between the seat and your elbow when bent at an approximate right angle (as if resting on the chair arm). Make sure you are not leaning to one side.

    (d) Lower leg length and seat height - the vertical distance between the back of the knee to the heel of the shoe. This gives the distance from the wheelchair seat to the footplates. Add 4cm to give the total seat height from floor to seat.

    (e) Back width - the widest distance across the back, just below the armpit. If your back is very much broader than your hips/thighs and you need back support at a higher level, you may have to consider having a wider chair, or a more specialist back rest.

    (f) Back rest height – this will depend on how much support is required. For people with good body strength, a shorter back rest will be necessary. Take the following measurement according to the level of support you require:

    • The vertical distance between the seat surface to bottom of the scapula (shoulder blade), if you are able to sit comfortably with minimal back support.
    • The vertical distance between the seat surface and the top of the shoulder, if you need support all the way up your spine.
    • The vertical distance between the seat surface to the bump on the back of the head, if you require head support also.

    Image of wheelchair measurements

    Image of wheelchair measurements

    Powered wheelchairs

    Powered wheelchairs are divided into a number of categories. Some are designed for use indoors only and are portable enough to fit in the boot of a car. Others are for outdoor use only - these are generally larger and heavier. Some are designed for both indoor and outdoor use.

    Powered wheelchairs and scooters are classified as ‘invalid carriages’ in road traffic regulations and generally categorised as either:

    • Class 2 products which can only be used on the pavement (except where these is no pavement) and have a maximum speed of 4mph.
    • or Class 3 products which can travel up to 8mph on the road, although must only be driven at 4mph on pavements. When driven on the road, they must obey all requirements and regulations as other road users.

    The differences in weight and power (and thereby speed) of the two enable them to access different environments, but also have different legal requirements for the driver.

    Class 2:

      Image of a Class 2 powered wheelchair height=
    • are generally smaller, lighter and less powerful
    • can be designed for indoor and/or outdoor use. If for indoor use, they will have limited outdoor use and less distance range
    • some can be dismantled or folded for transporting
    • cannot be used on the road (except where there is no pavement or to cross the road)
    • outdoor models have the ability to climb kerbs
    • have a top speed of 4mph (6.44 km/hour)

    Class 3:

      Image of a Class 3 powered wheelchair height=
    • are generally bigger, heavier and more powerful
    • are not for indoor use
    • can be used on the road
    • have a longer distance range
    • cannot be dismantled
    • have a number of additional safety requirements to allow road use
    • have a top speed of 4mph (6.44 km/hour) off the road and 8mph (12.9 km/hour) on the road

    Insurance

    You do not have to have insurance for your wheelchair, but it is highly recommended that you do. Third party insurance will cover you for other people making a claim against you if you are involved in an accident or cause some damage. Other policies will also insure against injuries to yourself and loss or damage of your scooter.

    Powered wheelchairs for children

    It is important that your child receives a full formal seating and wheelchair assessment to ensure that they receive the most suitable chair to meet their needs. As with an adult, the child’s health and level of ability must be considered before obtaining a powered chair.

    In order to be safe in a powered chair, your child will need to be able to:

    • understand the meaning of 'stop' and 'go'
    • follow simple instructions and respond to commands such as 'slow down' or 'let's go faster'
    • pay attention to tasks without losing concentration
    • react in a timely manner
    • plan what they want to do.

    Your child will also require:

    • arm and hand control or competence in switch use
    • visual skills and adequate hearing
    • motivation, attentiveness and persistence
    • cause and effect association (e.g. knowing that pushing joystick engages wheelchair in motion).

    Training and safety for children

    Children who receive a wheelchair from a wheelchair service will receive basic training in the safe use of the wheelchair and to allow children to reach their full potential with wheelchair skills.

    Practical considerations

    Storage

    Your powered wheelchair will need to be stored in a secure, dry place, with access to a power source for battery charging. You need to ensure that it is not a trip hazard or a fire hazard (by blocking escape routes) for yourself or anyone else whilst it is stored.

    If you need to store your chair outside, you are advised to get a waterproof cover for it or to use a storage shed. Consider the need for level or ramped access to the storage and accessibility to a power socket for charging the chair batteries.

    If you live in a communal property, such as a council or housing association flat, sheltered housing or a care home, you must seek advice and permission in relation to storing and charging your chair. They are not usually allowed to be stored in corridors or stairwells as they could cause an obstruction or be a trip hazard.

    You may have space for a powered chair in your personal flat/room, or there may be an allocated room/space for storage. In any situation check that it is not a hazard to yourself or any other person.

    Batteries

    All powered wheelchair batteries are 12 volt and are usually fitted in pairs giving a 24 volt output. It is recommended that you replace both at the same time when required.

    There are three main types of battery:

    • lead acid
    • gel cell
    • AGM.

    Check with your manufacturer or supplier which type of battery your chair has and how best to charge and maintain it. Ensure you are provided with the manufacturer’s instructions, especially if you are purchasing a second hand mobility scooter.

    The batteries will need replacing after 12 to 18 months depending on their type and use. Always ensure that new batteries are suitable for your chair in terms of type, size and weight. Your supplier or your local council will be able to advise you how to dispose of old batteries.

    If you can store your wheelchair close to a power socket it makes charging easier. They will need to be charged using an ordinary electric socket, although some chairs will allow you to remove the batteries and charge them elsewhere. Batteries can be heavy, so consider who will lift and carry them if required.

    Establish a regular charging routine. How often you need to charge the batteries will depend on how frequently and how much you use the chair. It will also depend upon the terrain you drive over, the weight your chair is carrying, the age of the batteries etc. If you use it daily, then overnight charging will be required. If you use the chair less often, weekly charging may be sufficient. Charge the battery regularly, even if you do not use the chair for an extended period of time. Avoid letting the batteries run completely flat and always fully charge them. Always use the proper charging cable.

    Servicing and maintaining your powered wheelchair

    There are a number of things that you can do to maintain your chair:

    • Keep it dry. If you store it outside, get a waterproof storage cover for it
    • Keep it clean. Wash or wipe off any significant amounts of mud or dirt. Try to avoid driving over really wet, dirty or gritty areas.
    • Check the tyres. If your chair has pneumatic tyres, ensure these are kept at optimal pressure (check the manufacturer's advice). Check the tyres for wear and tear. At some point they may need replacing.
    • Check the lights. If you have a road-going chair, your lights must be in working order.

    A regular service will ensure that your wheelchair is safe, both for you and for those around you, especially if you use your chair on the road. It will also keep it in good working order for longer.

    It is advised that you get your chair serviced every 12 months as a minimum, more often if it gets heavy usage. Check the manufacturer’s instructions. Your supplier will also be able to advise you on this.

    Getting your chair into a car

    Some of the lighter wheelchairs are able to fit into a car, enabling you to take it with you when you travel. Your chair may have a fold-down backrest or removable footrests etc. The chairs are heavy to lift, so there are a range of options for getting them into a vehicle, including ramps, lifts and hoists.

    RIDC (the Research Institute of Disabled Consumers in the UK) has produced some information on getting a wheelchair into a car.

    Tyres

    When considering which chair to buy, look at the tyres used on the various models.

    Larger tyres tend to give a more comfortable ride as they cope better with lumps and bumps. Tyres for powered wheelchairs may be pneumatic (with an inner tube filled with air) or puncture-free (with solid or foam inserts). Pneumatic tyres tend to give more comfort and weigh less, but will puncture. Solid, puncture-free tyres are increasingly provided.

    If you were to get a puncture, is this something you or your carer could cope with?

    The tyres will need replacing when they wear down or if damaged. Heavy-duty tyres are available.

    Controls

    There are numerous control systems for wheelchairs. The one you need will be dependent on the amount of movement, strength and control you have. Most systems have a separate power button on the control unit and adjustable sensitivity.

    • The most common control system is a joystick mounted on one of the armrests. This requires you to have reasonable arm control, grip and strength to manage, but gives you optimum manoeuvrability. Mini or compact joysticks require less movement and force from the user. There are a variety of options in the grip design of the actual joystick and it does not have to be controlled with the hand, for example, the joystick could be set up to be controlled by the chin. It is worth trying different options if you have difficulty gripping things.
    • Finger control systems consist of a small box with a hole in the top for your finger. They work in a similar way to a joystick, but you move your finger in the direction you wish to move.
    • Touchpads, like touch-sensitive computer screens, use touch or movement across the screen (not pressure) to initiate travel. These may be suitable for someone with very poor grip or strength, but not for a person with a significant tremor.
    • Switches can be used in a variety of ways and positioned close to the hand or head. Some use touch, others proximity. By activating particular switches, the chosen direction of travel is selected.
    • Other systems are more specialist, such as sip and puff controls for those who have no function in their body. The user sucks and blows through a mouthpiece. The difference between suck and blow and the difference in the strength of the suck or blow can be used to control the chair.
    • The joysticks and finger control systems are proportional - the more you move the joystick/your finger, the faster the wheelchair moves. Other systems, like switches, are not. The propulsion stops when the pressure is released from the switch.

    Footrests

    The footrests on a powered chair should be used at all times when in the chair, but should be moved out of the way when transferring in and out of the chair.

    Footplates may be in pairs, which usually swivel to the side and flip up out of the way, or there may be one single plate which flips up against the chair.

    Your feet should not ‘dangle’ but be supported by the footplates, preventing all the weight of your legs being carried on the back of your thighs. The footrests should not be so high that all your weight is tipped backwards through your bottom and the base of your spine. You are aiming to keep your hips and knees at right angles, spreading the weight of your lower body equally across all the body surfaces which touch the chair.

    The footrests should be at least 4cm clear of the ground.

    Elevating leg rests

    Elevating leg rests support the lower leg in a raised position. The leg rest is supplied in place of a footrest. Care should be taken when mobilising or pushing a wheelchair with the user’s legs raised, as it can make the legs and feet quite vulnerable to being knocked.

    Armrests

    Most wheelchairs can accommodate a choice of armrest designs. They can be full length or desk style (shorter). They may be height adjustable. Some are detachable, fold up and down or swing away.

    If you have good torso strength and stability, you may prefer to have less support and use shorter armrests. This can give more freedom of movement in the upper body and arms. It also means you can move the wheelchair closer in to tables and desks. If you have less upper body stability, you are better getting good support from the armrests.

    The arms rests should support your forearms without the need for you to hunch your shoulders or lean to the side. They should be padded, so not causing pressure points along your forearms.

    Consider how you will be getting in and out of the chair. Will you need a full-length armrest to support yourself as you sit into the chair or up from the chair? Do you need removable or movable armrests if you transfer sideways in/out of the chair?

    Look at the manufacturer’s website or ask the supplier for information on what options are available.

    Wheel drive

    Like a car, a powered wheelchair can have front- or rear-wheel drive. There are also centre and mid-wheel drive options.

    • Front-wheel drive chairs in effect pull the chair over the ground. They are very stable, but can be difficult to steer. Over steering can cause the rear of the chair to spin round at higher speeds
    • Mid-wheel and centre-wheel drive chairs are very manoeuvrable as the chair is almost turning on its axis
    • Rear wheel drive chairs, the most common, tend to have more power and thereby more speed. They are also very stable.

    Converting a manual chair to a powered chair

    It is possible to obtain a power pack which attaches to a manual chair, in effect adding a motor.

    They are fitted very easily and offer a full conversion to a powered chair with a joystick, or giving a level of assistance, which takes some of the strain out of manually driving a chair, or for the carer pushing. You can still choose to manually drive your chair for periods, even when they are fitted.

    Most manual chairs can be fitted with a powerpack. Depending on the drive mechanism, some units required particular wheels to be fitted to your chair and some require an anti-tipping mechanism adding.

    Cushioning and support when seated

    Most standard powered wheelchairs will come with a padded seat or a basic seat cushion. If you are using your chair much of the day, this may not offer enough pressure relief, even for someone who has good skin condition. You are advised to consider obtaining a cushion which offers an element of pressure relief. Look at the manufacturer’s information or ask your supplier.

    When you are seated in the chair, aim to keep your body as aligned as possible and not leaning to one side.

    Moulded cushions can help to maintain the hips and pelvis in good alignment. You can obtain chair inserts and cushioning which offer support at particular points if required. If you struggle to maintain an upright posture, you may benefit from support around your torso. Look for a backrest or cushion which is shaped, curving around your back and slightly under your arms at the back.

    There are a range of cushions, backrests and mouldable supports that fit into a wheelchair leaving the existing seat and backrest in place. If you need active support, look for an insert that is more rigid, although it will need a soft outer covering. If you just want comfort, look for a soft padded insert or cushion.

    It may help you to maintain an upright posture if you have a belt or harness, which also adds an element of safety. You can have a lap strap, or hip belt, as you would wear in an aeroplane, or a higher strap across your tummy. These can be padded for extra comfort. More support can be given by a chest harness which secures you around your torso and over your shoulders. You can also add a crotch strap. You are advised to seek professional advice before you use a full harness, as they can create pressure points and distort a person’s posture if poorly fitted.

    If you have complex positioning needs, seek the advice of a seating specialist.

    Portable ramps

    You may need ramps to be able to enter or leave your home when on your wheelchair. You can choose whether to create a permanent ramp or to use portable ones.

    Ensure that the ramps can bridge the change in levels adequately, without creating too steep a slope and check the weight capacity of the ramps. Check that the ramps can accommodate the width of your wheelchair and the combined weight of the wheelchair and your body.

    As a general rule most ramp manufacturers recommend a gradient no steeper than 1:12 for independent use and 1:10 for assisted use. A simple calculation for finding out the right ramp length is to multiple the height by the ratio, i.e. if working on a 1:12 ratio multiply the height of step by 12 to give you the minimum length of ramp, e.g. 6 inch step x 12 = 72 inches (6ft ramp).

    Reclining and tilt in space powered wheelchairs

    Image of Reclining and tilt in space powered wheelchairPowered wheelchairs are available which have the ability to recline or tilt in space. These would help someone who has weak upper body strength or experiences back and/or hip pain and needs to rest. These are two separate movement mechanisms. The reclining chairs have a back which reclines, but the seat remains static. Elevating leg rests may be required to make this a comfortable option. Tilt in space chairs tilt the back and seat backwards as one unit, keeping the same angle at the hips, knees and ankles.

    When either of these mechanisms is used, the chair becomes very long and not very manoeuvrable. Consider what space will be required when used inside. Look to see how these mechanisms are operated. Can they be used by the person in the wheelchair, or will help be required? Can they be operated when the user is in the chair?

    Elevating seats and sit-to-stand mechanisms

    Powered wheelchairs with elevating seats and sit-to-stand mechanisms are also available. Again, these are aimed at people who are full-time wheelchair users.

    Wheelchairs with an elevating seat have a battery-operated, pneumatic or gas lift mechanism, operated from the wheelchair controls. This raises and lowers the level of the seat without changing the user’s posture, enabling the user to access higher levels or be at eye level with other people. Care must be taken to ensure that the user's feet or footrests do not become trapped under furniture as the seat rises up. Some models can be driven at a reduced speed with the seat fully elevated.

    Sit-to-stand mechanisms offer the same benefits but also enable the user to change the angle of their spine, hips and knees - relieving pressure, counteracting joint and muscle stiffness and other health advantages. The person must be held safely within the chair. There is usually a supporting harness and pads around the trunk and knees, which are worn all the time. The stand up mechanism is usually operated by the user from the controls and involves the seat and backrest flattening out to bring the person up to vertical. It is recommended that medical advice is sought before trying one out if the person has not stood for a long time.

    All terrain wheelchairs and powered sports chairs

    All terrain wheelchairs are specifically designed to offer stability, power and comfort in an off-road situation. They generally have more battery and motor power with greater torque strength to power the chair over rough or sloping surfaces. They also have inbuilt suspension. The chairs may be rear, mid or four wheel drive, with chunky high grip tyres for traction. Some chairs come with the option of tilt in space or standing functions.

    There are a limited number of powered chairs specifically designed for sport. As with all terrain chairs, they provide power and stability, but may have additional features, such as leg guards/bumpers for football, or all terrain chairs combined with a standing mechanism to enable golf.

    Accessories

    Walking stick or crutch holders
    Clips are widely available to hold walking sticks, crutches etc. Most combine a clip with a cup to hold the base of the stick or crutch. They attach to wheelchairs with a variety of fastenings including screw clamps or hook and loop Velcro. Some are fitted behind the chair, others to the side. Consider the most appropriate fitting for your chair and your ability to reach to guide your choice. Ensure that the clip element of the holder is big enough for your stick or crutch.

    Drinks holder
    There are a range of cup, bottle and drink holders available. These attach on to the frame of the wheelchair and allow you to carry a drink around with you.

    Wheelchair umbrella
    A wheelchair umbrella clamps to the wheelchair frame and has a flexible handle to enable positioning. Clamps are also available into which a standard umbrella can be fixed.

    Bags
    There are a range of bags available specifically designed to attach to a wheelchair. Most attach to the back of the chair, but others fit to one side, as pannier bags, or under the seat. Consider the design of your chair and your ability to reach the bag when seated in the chair.

    A number of other specific bags and holders are also available, such as ones for carrying mobile phones, wallets or oxygen cylinders.

    Wheelchair outdoor clothing - Wraps, capes, ponchos and macs - When you are sitting in a wheelchair, it is easier to put on or take off and wear an outer layer which is loose fitting. Wraps, capes and ponchos are easy to slip around or over your head. The looser fit across the shoulders and upper arms is more comfortable as you self-propel your chair.

    Large capes and ponchos are available in waterproof fabric, acting like a mac in wet weather. They can be large enough to cover both you and the chair.

    Leg cosy - A leg cosy or zipped sitting bag keeps your legs warm and protected from wet or windy weather. These are designed to be used instead of having a blanket over your legs, as blankets can get caught up in the wheels of your wheelchair.

    Controls and joystick covers
    Image of wheelchair controls coverWaterproof covers are available which keep your hands and the wheelchair controls dry in wet weather. Fitted to the armrest, they are usually made of transparent plastic, or have a transparent section to enable you to see the controls.

    Tables, trays and stands
    Wheelchair tables and trays come in a variety of sizes and designs. Some fit across the whole lap space, attaching to both sides of the chair. Others are a half-lap size, fitted to one side, which flip over to be used/stored at the side.

    Most people would need assistance in fitting a full width wheelchair tray once in the chair. A half-lap size can usually stay in situ, flipped over and stored down the side of the chair

    Most trays have a smooth wipe-clean surface with a raised edge. Some are moulded or have a cut-out circle to accommodate a cup or mug. An increasing number are made of see-through polycarbonate, which enables the user to see what’s in front at floor level. Padded trays are also available.

    Small stands are available which clamp to one side of the wheelchair frame. With a flexible arm, these can hold books or a tablet.

    Charging port
    It is possible to request the installation of a phone/laptop charging port on some models of powered chair, allowing you to easily charge your phone or tablet whilst on the move. Discuss this with the manufacturer or supplier if it is something you need.

    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
      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)
      England
      Tel: 0044 207 289 6111
      Email: info@dlf.org.uk
      Website: www.dlf.org.uk

    • Research Institute for Disabled Consumers (RIDC) (independent research body in UK which produces guides for older and disabled consumers based on professional research - formerly known as RICA)
      England
      Tel: 0044 207 427 2460
      Email: info@ridc.org.uk
      Website: www.ridc.org.uk

Updated: July 2018