Your Choice - A Manual or Power Wheelchair?

Some users are on the "cusp" of being able to use a manual wheelchair full-time. Here is some criteria for choosing.

Many low-level quadriplegics have sufficient arm strength to push a chair, perhaps aided by handrims with knobs which are easier to grasp than rims alone. Some of these riders use a manual chair at all times, while others switch between manual and power chairs, depending on distance, surface, whether they might need to be lifted up stairs, load the chair into a car, and other such criteria. You might use a power chair to go to and from work, but use a manual chair at home and at the office. College students often use a power chair on campus, where they often need to travel considerable distances over hilly terrain. A blend of the two types could be the ideal strategy for your mobility. It is an approach that does not waste your energy or overuse your body.

For manual wheelchairs, there are many choices that affect how easy it is to push the chair, and how well it will coast so you don’t have to push as much. Proper maintenance is crucial, especially keeping the tires inflated and the frame tight. Modern adjustable wheelchairs require some attention to axle position, seat angle, back height, and other features that also influence the ease of wheeling. Lighter wheelchairs require less force to push, so those on the cusp should take the overall weight of the chair into account in their selection process.

This woman who experiences deterioration of her spine and hips finds she needs one of each:

Continuous use of my arms for moving the chair will only aggravate the problems in my shoulders, but wheeling short distances in my home would help to maintain my ability to move manually.

The power chair is the better method for outdoors because once I'm used to controlling the chair, it would actually be safer. I live in a rural area with no sidewalks and few of the places I would be going are level. Using the power chair would mean greater independence.

There have been some interesting efforts at a "best of both worlds" solution. The Roll-Aid is a motorized unit that attaches to a manual, folding wheelchair. You roll over it until the steering/control arm is between your legs, and the Roll-Aid will attach itself to your chair, allowing you to drive it like a scooter, steering with two hands rather than using a single joystick as with most power chairs.

The Quickie P200 model (now the P222) revolutionized power chairs in a variety of ways. One of its unique characteristics is that the basic chair unit can be lifted off of the motor module, and then manual wheels can be attached. One user of the P200 offers an example of its versatility:

My wife and I have found this to be very handy when we arrive somewhere and find steps barring our access. We switch my chair to manual and together roll me backwards up the steps.

There are advantages and disadvantages in either case:

Manual Chairs

• Require adequate strength and balance to propel
• More fatiguing for distances and going up slopes
• For those with sufficient tone and balance, can contribute to aerobic and muscular health
• Easier to transport
• Rider can be lifted up stairs while in the chair
• Lower maintenance risk from fewer parts
• Not dependent on charging or potential failure of batteries
• Typically narrower and easier to make precise movements in small spaces

Powered Chairs

• Allows those with little strength and stamina to travel distances
• Can contribute to weakening without a supplemental exercise program
• Much heavier and more difficult to transport
• Higher maintenance risk due to greater complexity
• More costly to purchase and service
• Great sophistication in programming of controls
• Variety of types – mid/front/rear-wheel drives – for personal preferences and terrain
• Can include tilt and/or recline systems for pressure relief if rider is unable to lift their own body

A new trend beginning to appear is the concept of "power-assist," in which motors and programmed sensors are added to a manual wheelchair. The system supplement the pushing of the wheels in order to reduce the amount of physical exertion required to push the chair. This holds some promise for the abovementioned borderline quadriplegic who might be able to continue to use a manual chair without risk of straining their shoulder tissues.