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Manual vs. power wheelchair dilemma

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How do you figure out which type of wheelchair to choose, especially if insurance only covers one? Is the only criteria for a power chair weakness of the arms or problems with fatigue? NO!

Many factors need to be considered when deciding between manual and power wheelchairs. Physical condition, functional abilities, environmental issues and transportation options need to be evaluated closely when making a decision that will impact the ability to maneuver at home and in the community for many years to come. Weighing the pro and cons of the above factors assists in making the final decision.

Weakness of the upper extremities that prevent the ability to independently propel a manual wheelchair certainly leads to a power wheelchair consideration. But what about pain, arthritis, carpal tunnel syndrome, RSD or any other condition that affects the upper extremities? Any disease process that limits endurance or causes fatigue, such as COPD or multiple sclerosis, can impair the ability to propel a manual wheelchair.

Think about the activities that have to be performed throughout the entire day. Is there enough energy left to perform the task(s) that is required once you propel the wheelchair to that location-especially at nine o'clock at night? Do you still have the attention span to listen to a lecture if you just spent 20 minutes pushing up a hill to get to the classroom? Can weight shifts be performed independently and adequately throughout the day in the manual wheelchair? Does a powered seating system need to be considered to avoid the potential for skin breakdown? If driving, can you transfer into a car seat and load the wheelchair independently, if necessary?

What is the home and community environment like? Can you safely propel the wheelchair up the ramp into the home? Are curb cuts negotiable with the manual wheelchair? Is the terrain around the home level, or on a tree farm? Can you push the manual wheelchair on the area around the home? Is the driveway paved or gravel? The workplace needs to be considered, also. Pushing around a warehouse is different than negotiating around office cubicles. There is a similar concern with schools or colleges. Can a wheelchair user propel a manual wheelchair around campus in a timely fashion to attend classes on time? Can the hilly terrain be negotiated with the manual wheelchair?

Transportation can be a huge roadblock to powered mobility - if it is a priority. What activities are performed each day/week/month that are outside of the home environment that require transportation? Either the user or someone else can load most manual wheelchairs into a car. Not many, if any, power wheelchairs are easily disassembled to be transported in a car. A vehicle that can accommodate a power wheelchair can be a huge expense, not to mention the modifications or loading devices. Investigating public transportation options may be an alternative to purchasing a vehicle.

The choice between a manual and power mobility is simple in some instances. In others, it will take consideration of all the above factors to determine which type of wheelchair best meets most of an individual's needs.

Oh, and don't forget personal preference. Some people are quite appropriate for a power wheelchair and just don't want one. In the end, personal preference usually wins. You can always consider power assist wheels as a compromise, but that's a whole other topic.

Author: Chris Maurer, MPT, ATP
Affiliation: Shepherd Center, Atlanta, GA

Center for Assistive Technology and Environmental Access, Georgia Institute of Technology

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