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Pushrim-activated power-assist wheelchair

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The manual wheelchair is often thought of as an inefficient means of transportation. Often individuals who utilize manual wheelchairs for an extended amount of time will develop shoulder injuries which may present as pain and general weakness (1). Other factors that make propelling manual wheelchairs difficult are low cardiopulmonary reserves, insufficient arm strength or range of motion, fatigue due to overexertion, and the inability to maintain the posture that is needed for propulsion (1,2).

In the past ambulatory options for this particular population consisted of the need for an assistant to push the individual, powered scooters, or electric-powered wheelchairs (2). This being said, many wheelchair users don’t want to rely on an assistant to push them and would prefer to maintain their independence. Independence is another reason why many individuals who use wheelchairs don’t want to switch over to a powered wheelchair. They often believe that it makes them appear to be more conspicuous. Often it is felt that the powered wheelchair is more bulky and more difficult to maneuver, not to mention the need for special modifications that need to be made to the users automobile to transport the heavier piece of equipment.

Recently the pushrim-activated power-assist wheelchair (PAPAW) has been developed and is considered to fall somewhere in the middle between manual and powered devices. It has its own strengths and weaknesses and its grounds for purchase would be based on the user’s clinical presentation and preference. The wheels for a PAPAW can be purchased from a handful of companies, and many of them can be fit to most manual wheelchairs. Most of the systems consist of a battery or two and as many motors that provide an additional power boost when an external torque, provided by the user, is applied to the rim of the wheel.


Advantages to using a PAPAW are numerous and include the patient's ability to maintain their desired level of independence in a manual type device. The PAPAW is also lighter and less bulky and easier to transport (wheels detach easily) than a powered wheelchair. Users may also find that it is simpler to transverse hills, ramps, and other rough terrain such as thick carpet, ramps and curb cuts (1). The PAPAW may be used as a manual wheelchair when turned off as needed and the wheels can also be retrofitted to several types of manual wheelchairs. Studies show that the PAPAW reduces the energy demand placed on the user during propulsion (1,2). They also have shown that individuals rated the ergonomics favorably when compared to their manual wheelchairs (2).


Disadvantages to using a PAPAW include transportation issues such as it takes longer to transfer to and from the vehicle than a manual wheelchair (2). They are also very costly and average around $6,000.00 for the wheels, not including the manual chair they attach to. The PAPAW is also heavier than a manual wheelchair and requires charging of the batteries to make use of the system.

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  • 1. Algood D, Cooper RA, Fitzgerald SG, Cooper R, Boninger ML. Effect of a pushrim-activated power-assist wheelchair on the functional capabilities of persons with tetraplegia. Arch Phys Med Rehabil 2004;86:380-386.
  • 2. Cooper RA, Fitzgerald SG, Boninger ML, Prins K, Rentschler AJ, Arva J, O'Connor J. Evaluation of a pushrim-activated, power-assisted wheelchair. Arch Phys Med Rehabil 2001;82:702-708.