What You Should Know About the First Wheelchair
Getting mobile is important in a child’s development, and picking the right chair needs to be an informed decision.
by Louise Kinross*
Reprinted with Permission**
Natalie Walker did some reading before purchasing a first wheelchair for her son, Caelan, at age 2. She had even found a picture of a cute, compact, low-to-the-ground wheelchair she thought would be perfect for Caelan, who has a cognitive and physical disability. Natalie found she was mistaken:
"When I showed it to our occupational therapist, she immediately said it wasn't appropriate, because it wouldn’t bring Caelan to eye-level with things around him. Then we learned he would need a special seating insert to position him properly, and that there were lots of other options to consider. We didn’t realize it was such a complex process and that there were so many components to think about."
Buying a first wheelchair can be "as complicated as buying a car," says Gloria Leibel, a physical therapist who prescribes assistive devices at Bloorview MacMillan Centre in Toronto, Ontario, Canada. "There are so many different options that it can be very confusing for parents," explains Leibel. "It’s also not a family-friendly process because funding rules differ depending on where you live."
Add to that the painful emotions a first wheelchair can trigger for some parents, and it can be an overwhelming experience.
It is helpful to focus not so much on how your child is moving—whether walking or wheeling—but on the fact that your child will be able to move, Leibel says. "Children learn through moving, and movement is critical to their development. Using a wheelchair means your child won’t miss out on all the cognitive learning and social interaction that goes along with exploring the environment."
Because there are so many options to consider, it is important "to find the right match in a therapist who can walk you through the process," says Mary Dishart, whose son, Matthew, 16, had his first wheelchair at age 4. That will be an occupational therapist or physical therapist.
After an initial meeting with your therapist, "the assessment to determine the type of wheelchair should be a team approach with the family, therapist, and wheelchair vendor," Leibel says. "That allows you to discuss all of the options with the vendor." If possible, ask the vendor for a two-week trial of a chair you are considering, and have your child maneuver it in different settings.
Depending on their needs, most children get their first wheelchair between the ages of 2 and 4. While the multitude of options can be confusing, the choices allow you to tailor the chair to your child’s individual needs. "Traditionally, people tried to match a child to an existing chair," Leibel says. "Today, we’ve come so far with different features that we should be matching the chair to the child."
The first step in your purchase is to make a list of your child’s and family’s needs. As most children typically use a manual chair as their first wheelchair, consider the following questions:
Will your child self-propel or be pushed?
Whether your child wheels independently or is pushed will determine the height and type of wheels, as well as the weight of the chair. For example, if you have a tiny 2-year-old who can self-propel, you may want to consider a frame that allows the large wheels to be put closer to the front, where small arms can more easily reach them. The wheels will need to be relatively small and the frame low, so that the child is at eye-level with other toddlers. And the frame needs to be light enough to be maneuvered by a young child. If you will be pushing your child in the wheelchair, your needs—including your height, and where you will be pushing the child—come into play.
Will the chair be rigid, folding, or tilt?
There are three types of frames to choose from, each with advantages and disadvantages. First consider your transportation needs. If the chair needs to fit in the trunk of a car, it must fold up easily and fit in a tight space. Foldable chairs have more flexible frames, giving them a smoother ride on slightly uneven surfaces (all four wheels stay on the ground). They can also be adjusted to "grow" with a child. However, they are generally heavier than rigid frames, which perform better on hard surfaces. Who will lift the chair, how often, and what weight can be managed? These are all questions to consider in choosing a rigid or folding frame. If your child is unable to sit upright due to low tone, seizures or other problems, a chair with a frame that tilts back is required.
Do you need maneuverability or stability?
If your child has good trunk control and will use the chair for sports, you will need one that is easy to maneuver, with a tight turning radius and ability to tip. That is because active riders like to tip the chair, with a small shift of weight, into a wheelie. On the other hand, children with poor trunk control usually feel more secure in a stable chair, with a broader base of support and lower center of gravity. Stability is also essential for children who rock or make other self-stimulating movements that could accidentally tip over a chair. A rocking feature is available on some chairs for teens and adults.
Where will the chair be used?
Will the chair be used at home, at school, or outside? Where your child uses the wheelchair determines the type and size of tires. The best tire for any environment is an air-filled (pneumatic) tire, because it provides the smoothest ride, absorbing the shocks of bumps. However, some families find it difficult to maintain air-filled tires because they need to be monitored and pumped regularly. If a chair will be used primarily indoors, solid tires with an insert that prevents flats are available. For riding over rough outdoor terrain, large tires with a greater surface area and thick treads make for a more comfortable ride.
Will the chair grow with your child?
Adjustable features that will meet your child’s expected rate of growth are critical. An adjustable wheel-axle plate allows you to adjust the seat-to-floor height of the chair, as well as position of the wheels, in relation to your child’s size. Moveable cross braces can provide additional inches to the seat’s width, while extensions for seat rails increase the depth. Some manufacturers offer growth kits with free parts to reconfigure the chair. However, the customer or funding source must pay for the labor required.
How will your child get in and out?
Does the seat height need to be low to the ground to encourage a child’s independence in getting in and out, or higher to aid a parent or caregiver who will lift the child? Swing-away legrests can make independent and standing transfers easier, as they give the child ready access to the ground.
In addition to considering the needs of your child and family, it is helpful to know about some of the key wheelchair parts and associated features.
These are the handles caregivers use to push a wheelchair. There is a variety to choose from, including "antler"-style, which allow a tall person to push a child-sized wheelchair without straining, and removable handles, which can be attached when the child is being pushed and taken away when the child rides independently (so eliminating extra weight).
The legrests position the child’s legs and adjoin the footrests. The angle created between the seat and legrests is critical to providing a proper base of support that allows children to effectively use their arms and hands while seated. This angle usually ranges between 70 and 90 degrees, depending on the child’s needs. Rigid legrests are appropriate if your child transfers by lifting his or her legs over the side of the wheelchair. Swing-away legrests make sense for kids who move forward when getting out and need to easily access the ground.
Footrests, or footplates
These are attached to the legrests and function to position the child’s feet. They are available in standard sizes, "but many children don’t have standard feet," Leibel notes. Adjustable footrests are preferable because they allow the therapist to appropriately angle the plate to the child’s feet. This is particularly important if the child has low tone or wears splints. The positioning of the footrests is also affected by the size of the casters—the small wheels at the front of the wheelchair—because footrests must clear these wheels.
Some children like or need armrests to support their arms, while others find they get in the way when pushing the chair. There are many types of armrests, including those that flip back easily when the child wants to propel the chair, and those that adjust to different heights. Adjustable armrests allow you to position them at the appropriate height for holding an attachable tray, or ensuring your child can get up to, and under, a desk. Proper armrest height is important to prevent shoulder problems.
These connect the wheels to the frame of the chair. They can be adjustable or have a fixed, single point. There are a number of advantages to adjustable axle plates, particularly for children. Adjustable plates allow the wheels of the chair to be moved to a position where a child can most easily reach them, and the seat-to-floor height of the chair to be adjusted as the child grows. They also enable the chair to be properly balanced if a seating system—which changes the child’s center of gravity in the chair—is used.
In closing, Leibel offers parents this advice: "Take your time, be an educated shopper, and ask lots of questions. If possible, get a chair you can 'demo' before making a purchase. One chair won’t meet all of your child’s needs, so you may have to make some compromises. Wheelchairs need to be serviced on a regular basis, so don’t forget to ask the vendor about warranties."
* Louise Kinross is the Communications Coordinator in Family and Community Relations at Bloorview MacMillan, Toronto, Ontario, Canada.
**Reprinted with the expressed consent and approval of Exceptional Parent, a monthly magazine for parents and families of children with disabilities and special health care needs. Subscription cost is $39.95 per year for 12 issues; Call (877) 372-7368. Offices are at 65 East Route 4, River Edge, New Jersey 07661.