Wheelchair Accessories

We all know that wheelchairs aren't as simple as they used to be. Just take a look at the basic wheelchair order form. Pages of information, multiple options, and those great reference numbers that try to explain the best way to encounter a chair without encountering a problem—or so they say! While you might have an idea of what the chair looks like in your head, by the time you weed through the order form your head is spinning. Although the order form may overwhelm you at first glance, you soon realize the reason for the complexity: the ever growing number of accessories.

So what does it all mean? It all depends upon how you define accessory. Many people consider an accessory as a "want" vs. a "need," or a luxury upgrade. This is not always the case. Take for example, armrests. Armrests are not always a part of the base package on many frames, but definitely a "need" for some clients. I think of an accessory as anything with an up-charge, or anything not included in the base package price. It may be a want (like a custom paint job) or a need (like an armrest). So many accessories to choose from might make the selection process cumbersome and often costly, but accessories provide unique clients with realistic options that will help to maximize performance and function. Get beyond the luxury items or "want" accessories and look closely at how accessory options impact the client.

Wants Needs
Paint up-charges
Back packs
Cup holders
Under lighting on power bases
Light-up casters
Wheel locks
Arm rests
Positioning devices
Tire and caster options
Seat cushions
Safety devices

Wheel and Tire Options
The combination of the appropriate wheel and tire can have an impact on durability, ease of propulsion and efficiency. While clients tend to make wheel choices based on appearance, according to one survey, the type and weight of the wheel will impact the quality of the push and the forces needed to initiate propulsion. Combined with an appropriate tire, it will help to minimize rolling resistance, reduce fatigue and minimize impact on the upper extremity. This is a documented fact and can be quantified with clinical tools such as the Smartwheel. While there is less perceived maintenance with a mag wheel, the client may benefit functionally from a lightweight aluminum or fiber spoke option. It may make a difference between assisted or independent propulsion.

Front Casters Size and width impact ability to move over certain surfaces and may impact the positioning options for the lower extremities.

Safety Devices
Options such as anti-tippers, wheel locks and seat belts may be necessary in many cases. Look carefully at your application and be sure you are not limiting the clients' functional potential. Recognize that these accessories are often the first things to be altered or removed with more active users. The chair should be safe, but allow the user to take normal risks (for example, complete wheelies needed to go up and or down a curb).

Back Supports
Whether it is tension-adjustable upholstery, a carbon fiber shell, or a full height, solid back, this accessory should be considered carefully. If properly selected, the appropriate back support can prevent postural deformity and help maintain appropriate shoulder and trunk position relative to the wheel.

Seat Cushions
Oddly enough, this item is often considered an accessory. However, this author is of the belief that everybody should sit on something. For pressure relief, comfort, postural support, or all of the above, the seated surface provides a base of support for all seated functions. One size, or brand, does not fit all and the selection will impact chair configuration and other component interfacing. Cushion selection should be made carefully and not become an afterthought.

Positioning Devices
Lateral trunk supports, pelvic positioning belts, abductor wedges; the list could go on and on. Many clients truly "need" a variety of options, but be sure that they are not inadvertently restricting functional movement. And remember, there is a difference between a positioning device and a safety device.

While we can document medical need for most of these items, don't forget the plethora of so called "want" items. Some clients may want a more expensive cantilever frame, and it may actually mean they are now independent in pulling the chair into the car. Other items are really luxury upgrades, but don't rule out the importance of the "cool factor" and its impact on the client. Light up casters, neon lighting, and custom paint jobs are as important to many clients as the ride characteristics of the frame or the skin protection of the seat cushion. Consider accessories a necessary evil. Understand your options, know the impact each choice will have on the performance of the mobility system, and recognize the importance to the client. Accessories are an important way that we can help clients maximize function and allow clients to maintain their unique style. We have options every day—how we dress, which pair of shoes we wear; imagine if all that was gone and we all looked the same. It would make life simple, that's true, but also a little mundane.

Sidebar:
TRI Quality Inc. Helps U.S. Marine Corps

By Norma Bargstadt

In November of 2004 my son-in-law, a pilot in the U.S. Marine Corp. returned to Iraq for his 2nd tour. I asked him what he least looked forward to other than being away from his family for another six to seven months and his reply was, "the uncomfortable long flights." He said he had cut an old piece of foam to sit on the metal pilot's seat. The following day I ask my employer, Otmar Weber, president of Tri Quality Inc. if we could design a cushion using our rehab knowledge, foams and specialty fabrics (breathable) to allow comfort during these intense flights. We then requested measurements with cutouts to not interfere with the pilot's ejection lever and the cushion was completed and personalized with his "Call Sign." Upon receiving the cushion in Iraq the other pilots became envious and ask him to e-mail Tri Quality and see if they could each purchase a personalized cushion and what the cost would be. Otmar was pleased to donate the materials and time to furnish each of the 15 additional pilots with like, quality custom cushions. Not only can Tri Quality/NuTec design customized seating systems for the wheelchair industry but can make life more tolerable for our fighter pilots flying their long missions over in Iraq.

This article originally appeared in the April 2005 issue of HME Business.

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