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A wheelchair isn't just a wheelchair anymore. A generation ago, the word "wheelchair" conjured up the image of a boxy, shiny steel frame and vinyl upholstery. There would have been little or no discussion of finding the proper fit for a wheelchair, either. If a child needed a chair, little attention was paid to the fact that he or she was growing; the solution was simply to order a larger chair and let the child "grow into" it. No longer! Now there are almost as many wheelchair styles, colors, and options available as there are children to use them.
Many manufacturers offer models specifically designed to meet the changing needs of children, while others offer both child and adult models of chairs in their product lines. This fact sheet will explore the special considerations in selecting wheelchairs for children, or pediatric wheelchairs, and the many kinds of chairs and alternatives available to meet those requirements.
Click on the links below for more information and specifics:
1. Selecting a Wheelchair - The Basics
The first consideration in selecting the appropriate chair is the child's needs based on his or her age, disabilities, and abilities. Professional wheelchair prescribers, such as physical or occupational therapists and physicians, make some of the initial decisions of the selection process. They determine how much support the chair must provide, how it will be propelled, and what special features and adaptations are needed. Decisions such as these determine whether the child uses a manual chair, powered chair or a wheelchair alternative, and whether special seating systems or supports are needed.
Children and their parents must actively participate in the selection process. These individuals are most aware of the environment and circumstances in which the wheelchair will be used. They can best answer important questions such as-
- Will it be used primarily indoors or outdoors?
- Will it be used for play, in the home, in school, or in a combination of settings?
- Will the chair need to be transported? If so, how will it be transported - in a van, a car, or by some form of public transportation?
- Are there stairs or other barriers to be considered?
The answers to these questions help determine the best chair for the child.
Finally, the child's personal tastes and interests should also be considered. A wheelchair is not simply something a child needs to use; it is an extension of his or her personality. Being comfortable with a chair is more than how it feels to the body; it must also feel comfortable to the personality. Depending upon their age, children should be actively involved in selecting the style, color, and features of their chairs from among the options available to them.
2. Wheelchair Components
Wheelchairs are available in two basic types: manual and powered. Both types have some common components, including frames, seating systems, upholstery, brakes, wheels and tyres, footrests, and armrests.
- Wheelchair frames are made of a variety of materials, including stainless steel, chrome, aluminum, aircraft aluminum, titanium, chrome alloys, and other lightweight composite materials. The materials used in the frame determine the wheelchair's strength and capacity. The development of newer materials such as titanium and composites has allowed for lighter weight frames than the traditional stainless steel. Regardless of the materials used, frames are generally available in folding and rigid styles. Folding frames utilize a crossbrace system that allows the wheelchair to be collapsed for storage or transport. Rigid frame chairs do not fold, but many have quick-release wheels and/or axles to allow the wheels to be removed easily for storage and travel. Children's wheelchairs often come with a variety of color options for frames, which may include bright neon colors and patterns as well as solid primary colors and the traditional chrome finish.
- Seating Systems
- Seating systems are frequently selected separately from the wheelchair itself, although some wheelchairs include seating or posture support systems. If the seating system is ordered separately from the chair, it is essential to ensure the frame is compatible with the seating system being considered. Seating must also fit the child. Typically, children's wheelchair seats are 10 to 14 inches wide. Seat width and length (depth) may be fixed or adjustable. Some models come in one seating size, while many allow the purchaser to choose from a range of seat widths and depths. Some chairs also provide growth capability, enabling the chair seat to be adjusted within a specified width and/or depth range to accommodate growth.
- Upholstery must be rugged enough to withstand daily use and a variety of weather conditions. A number of materials are currently available, including nylon, velour, polyester, vinyl, and leather. Like frames, upholstery can be found in a variety of colors and styles to meet individual preferences.
- Brakes on manual chairs are usually wheel locks applied manually as "parking brakes". Several styles are available, but most brakes are applied by toggling with a pushing or pulling motion. Brakes can be mounted at different heights depending on the user's needs, and brake lever extensions and other modifications are often available. Powered chairs usually feature electromechanical and/or dynamic brakes. Dynamic brakes engage when the chair is not powered in forward or reverse motion. Chairs with push-handles often have attendant brakes as well as wheel locks that can be used by the person sitting in the chair.
- Wheels and Tyres
- Wheels and tyres are available in a variety of types and styles. Most wheelchairs use a four-wheel system comprised of two large wheels with tyres in the back and two smaller casters in the front. Wheels are generally aluminum or molded composites. The most common rear wheel is 24 inches in diameter, but other wheel sizes are available. Most chairs are equipped with pneumatic tyres, but several other types are also available. Tyre options include mag (oversized width) tyres, off-road tyres, steel-reinforced radial tyres, semi-pneumatic tyres (a combination of solid rubber and air-filled tubing), and solid tyres (tyres without air space or tubes). These tyres are extra-cost options on most chairs. A typical caster is 8 inches in diameter with solid or pneumatic tyres. Some manufacturers offer smaller casters for specialized use.
- Footrests are usually incorporated into the frame of a rigid frame chair. Folding chairs offer a range of options including fixed, detachable, swing-away, or elevating legrests, or legrests featuring a combination of these elements.
- Armrests are generally available in full- and desk-length styles, and may be detachable, height-adjustable, flip-up, have a combination of features, or be fixed. Some chairs, especially lightweight or sports models, are designed to be used without armrests.
- Controls (Powered Chairs and Scooters)
- Powered chairs generally include as a standard feature a manually controlled joystick to regulate the chair's speed and direction. However, most manufacturers offer customized control options to accommodate the varied abilities of the user, including sip-n-puff systems, head and chin switches, push-button controls, trackballs, and tillers. Many chairs also have programmable control features which allow the user or a dealer to adjust or set the chair's speed and control limits as the user's abilities change. There are also manufacturers who do not make wheelchairs, but who offer specialized control systems for powered wheelchairs, including voice-activated controls. When purchasing controls and switches from a source other than the chair's manufacturer, it is essential to determine that the selected control is compatible with the chair.
- Drive System (Powered Chairs and Scooters)
- The drive system refers to the means by which power is delivered to the chair's wheels. Standard drive systems include gear drive, direct drive, and belt drive. The type of drive system affects the power available to propel the chair and the amount and type of maintenance the chair requires. Batteries (Powered Chairs and Scooters)
- are a determining factor in the range and power of a powered chair. Generally, the larger the chair's batteries, the greater the power and the longer the chair's range between charges. Many chairs require two rechargeable 12-volt batteries. Most wheelchairs utilize U1, group 22 or 24 batteries, although other batteries are also used. More manufacturers are designing chairs around the group 24 battery because it affords a longer range. The type of battery required is also an important consideration in terms of safety, maintenance, and transport. Powered chairs may utilize lead acid, gel cell, or sealed wet batteries. Gel cell batteries require the least maintenance and have less danger of leaking than do the other battery types. Gel cell batteries are also required by a number of airlines when transporting powered chairs.
3. Types of Wheelchairs and Wheelchair Alternatives
- Manual Wheelchairs
Manual wheelchairs are available in several types and styles for children. Most are propelled by the user's arm, but some chairs with a lower, or hemi, frame are designed to be propelled by the user's legs. Manual chairs range in price from approximately R1 500.00 for a basic chair to more than R35 000.00 for a customized lightweight chair, with the average price range being R12 000.00 to R28 000.00 Price is affected by the number and kinds of options selected and any custom or individualized modifications.
Most manual wheelchairs for children fall into one or more of the following basic categories:
- Standard/Everyday Wheelchairs
Standard/Everyday chairs are the more traditional wheelchair styles featuring a folding crossbrace frame, swing-away and/or elevating footrests, fixed or detachable armrests, and a mid-level or high back with push handles to allow someone other than the child to propel the chair. Frequently these chairs are also available with a variety of standard and optional features and custom modifications.
- Child/Junior/Growing Wheelchairs
Child/Junior/Growing wheelchairs are designed to meet the needs of children as they change and grow. Because of the high cost of replacing a chair, and because insurance providers often place limitations on how frequently chairs may be replaced, purchasing a new chair each year can be financially prohibitive, if not impossible. Growth chairs or chairs with growth kits allow adjustments to be made in the existing chair to accommodate a growing child. This may include utilizing replaceable components or designing the chair with features that can be converted from a smaller size to a larger size. More manufacturers are also responding to the needs of children in having chairs that fit more easily into their environment and social situations. In some chairs this is accomplished by a more streamlined appearance, while others provide a selection of upholstery and/or frame colors. Depending upon the manufacturer, color choice may be a standard feature of the chair or it may be an option offered at an extra charge.
- Lightweight Wheelchairs
Lightweight wheelchairs have frames made of lighter materials such as aluminum, titanium, or chrome. Originally developed for racing and wheelchair sports, these chairs have become increasingly popular as daily use chairs because they offer a sportier appearance and independence of movement with minimum effort, and are easier to transport. Lightweight chairs typically weigh less than 30 pounds without legrests and/or wheels. Some models have folding frames, some have rigid frames, and a few offer a choice of frame styles.
- Sport Wheelchairs
Sport wheelchairs come in a variety of configurations designed for specific sporting activities. For example, one model designed for the use in wheelchair contact sports such as wheelchair rugby or football features a wide front-end "hammer-head" made of aluminum tubing. Other popular sport configurations include racing and basketball chairs. All-terrain chairs have rugged frame and wheels that can roll safely over many unpaved and irregular surfaces. Many sport wheelchair manufacturers offer custom design, including custom children's sizes.
- Standing Wheelchairs
A child who needs or wants assistance to stand may be interested in a standing wheelchair, a manual or powered wheelchair equipped with a power lift to raise the child to a standing position. Some mobile standing frames (frames for holding a child upright, equipped with caster wheels) are available with a standing wheelchair option that includes a seat and big wheels for propulsion.
Wheelchairs Reclining wheelchairs and tilt-in-space wheelchairs are available for children unable to sit upright for sustained periods or who need to change position without leaving their chair. In a reclining chair, the back reclines independently of the rest of the seating system, while in a tilt-in-space chair the back, seat, and leg rests all move together, allowing the child to tilt back without losing balance. These features are available separately, or, in some models, together.
- Transport Wheelchairs
Transport wheelchairs are designed to be pushed by a parent or attendant. They have push handles, with brake controls located within the attendant's reach. On some models, the brakes are located on the rear wheels to enable a caregiver to toggle them using a foot. Other specialty chairs meet specific needs of the user. In some cases, these needs are met by special modifications to a basic chair; for example, some wheelchair models offer the option of specially modified wheel/axle drives to allow a child who is an amputee or who has paralysis on one side to propel a wheelchair with one hand, while others offer an optional hemi frame. Wheelchairs of all the types listed above may be available in transit models equipped to be tied down safely in buses or vans. For more information on manual wheelchairs, including models for adults as well as children, see Fact Sheet on Manual Wheelchairs.
- Standard/Everyday Wheelchairs
- Powered Wheelchairs
- It was once thought that children lacked the necessary skills to use a powered chair, and that using a powered chair might inhibit the development of other skills. More current research indicates – as with any other new skill - supervised practice enables children to operate powered chairs successfully and that for some children, using these chairs is actually a benefit in conserving energy and increasing self-esteem for the development of other skills.
- Two Types of Powered Wheelchairs
Powered chairs fall into two basic categories - traditional and modular. The traditional style looks much like a standard/everyday chair, and generally incorporates a drive system with a battery beneath or behind the seat. These traditional-style pediatric models offer features similar to those found on manual wheelchairs such as desk- or full-length armrests and swing-away detachable legrests, and an array of options and custom modifications. Some models are lightweight, including lightweight sports chairs with power options, and others are designed to grow with the child.
A modular powered chair option for the pediatric wheelchair user is the powered base with an affixed seating system. This type of wheelchair may allow a greater choice in seating systems and powered features. Some chairs of this type allow the seat to be raised to various heights above the floor or to be lowered to floor level, while others offer power reclining and tilt-in-space features. Some chairs also offer a choice of bucket, flat, padded, or sling backs and seats.
Like manual wheelchairs, powered wheelchairs of all types may be available in transit models equipped to be tied down safely in buses or vans.
- Selecting a Powered Wheelchair
Cost is a major consideration when deciding if a powered chair is appropriate for a child. Powered chairs are rarely priced at less than R13 000.00 and may cost R80 000.00 or more, depending upon options and custom modifications.
When selecting a powered chair, consideration should be given to the issues discussed earlier in this fact sheet (see "Selecting a Wheelchair – The Basics"); however, there are several additional concerns that are unique to powered chairs. First, it is necessary to determine whether a powered wheelchair is the best option for the child's particular needs and abilities. A child who requires independent mobility but is unable to propel a manual chair is a candidate for a powered chair. Physical and developmental factors such as posture, coordination, and visual perception should also be taken into account.
In addition, it is essential to evaluate the environment in which the child will use the chair. While architectural accessibility is a concern for any wheelchair user, the concern is even greater with powered chairs; the environment in which a powered chair is to be used must be totally accessible and free of barriers. Because of their weight and design, powered chairs generally cannot be tipped or lifted to negotiate steps or other barriers. Halls and doorways must be sufficiently wide to accommodate the larger turning radius of powered chairs. Some chairs may be most appropriate for indoor use, and others for outdoor use.
Because powered chairs are very heavy and may not fold or conveniently break down, the means by which the chair will be transported must be given special consideration. Other factors to consider are the types of batteries and charger used and whether they are included with the chair; the speed of the chair; and its maximum range per battery charge.
- Two Types of Powered Wheelchairs
For very young children or older children who cannot propel themselves in a wheelchair, a stroller may be a suitable alternative. Models similar to conventional strollers are available, as well as all-terrain strollers, beach strollers with balloon wheels, and adolescent strollers. Many models fold for transport or storage, or feature quick-release axles to allow easy removal of the wheels. Depending upon the manufacturer, positioning supports may be available, as well as a choice of upholstery, frame and upholstery colors, and accessories such as canopies or umbrellas.
Convertible strollers or strollers with modular seating systems allow for more varied use. Some manufacturers offer strollers that convert to a sitting chair, a backpack frame, a child safety car seat, a high chair, or a combination of these. Convertible and modular strollers also may be equipped with a variety of standard features and options including trays, canopies, harnesses, and supports.
Scooters are powered three-wheeled carts with seats. They are available in smaller sizes for children and small adults. These are not to be confused with recreational scooter boards. With a price range of approximately R13 000.00 to R25 000.00, these are somewhat less expensive alternatives to manual or powered wheelchairs, but not all wheelchair users will be able to use scooters. Scooters generally require good upper body strength and arm function; users should also be able to support themselves in an upright, seated position for extended periods. A scooter is an especially useful alternative for children with some walking ability who need to extend their range of mobility. Wheelchair tie-downs in public transportation are not designed for use with scooters, nor are some wheelchair lifts.
Scooters have some similarity in appearance and operation to a golf cart. A seat is mounted on the chassis with a steering column positioned in front of the user. The steering column, or tiller, includes controls for the speed and direction of the vehicle; other controls may also be mounted on the tiller, or they may be located on a dashboard. Some users feel that these mobility aids have the advantage of being more aesthetically pleasing than some wheelchairs, and they may offer greater speed and distance range than some powered chairs. Most scooters have a narrower wheelbase and narrower overall width than powered chairs, affording greater maneuverability. Most models also disassemble into components for transport. Scooters generally offer such optional features as carrying baskets, crutch or cane holders, powered seat lifts, seat belts, and padded seats and armrests. Some models also offer key-lock starters, headlights taillights and horns.