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The mobility decision.

THE MOBILITY DECISION

For parents of children with special mobility needs, the 1980s brought good news because so many new products were developed. For example, the integration of computer technology with new developments in wheelchair design has made it possible to control the movements of a powered wheelchair with puffs of air and even voice activated controls. In addition, sometimes the same controls can activate personal computers or electronic environmental controls. Similarly, computer technology has led to significant advances in the design of specialized seating systems.

It is now possible to create, with adjustments and various attachments, a chair uniquely tailored for every child. However, the increasing number of available features has increased the complexity of selecting the proper components, and the choice of one product over another may not be clear-cut. A child's specific health need, such as the need to sit in a reclining position to improve digestion or circulation, may limit the choices. Also, the child's size, weight, and ability to transfer in and out of the chair and to understand and operate controls can all limit choices.

Physicians, therapists and medical equipment dealers who are well-trained, experienced and, importantly, open-minded to the changing product climate are necessary in helping parents select the best mobility aids. However, because today's marketplace contains such a wide variety of products, including many new ones, professionals may be learning about new equipment right along with parents.

When parents are shopping for a wheelchair, they are usually also shopping for the combination of pads and/or cushions that properly position the child to provide correct seating posture in the chair. In addition, if it is a powered chair, the electronics that control and power it must be selected. Accordingly, the chair itself and the seating/positioning system are the two key issues for parents and the clinical team.

MANUAL OR POWER

The decision to select a manual chair instead of a powered model depends on the child's ability to move his or her limbs to propel the chair, the child's physical strength, endurance, and judgment. For example, a child may have the necessary capability to operate a manual chair for an hour or so, but his or her endurance may be insufficient for an entire day. Thus, a critical issue to discuss with the clinical team is whether a manual chair is appropriate or if it is too much work for the child, risking exhaustion and discouragement. On the other hand, with proper encouragement, a lightweight manual chair may be just the thing to stimulate a child's physical development and facilitate the child's active participation in neighborhood life.

SELECTION CHARACTERISTICS

* Dimensions--such as height, width and length from back to front (including push handles and footrests)--determine the ability of the chair to be maneuvered through tight spaces such as doorways, hallways and around corners.

The chair's maneuverability has to be considered in the context of the child's living and educational environments. The chair's ability to fit through small doorways in a child's home is important, as is its utility in typically small rooms like bathrooms. For example, widths of chairs currently available on the market range from 18 3/4 inches to 28 inches. The latter measurement comes very close to the width of a typical door frame with the door opened to a right angle. This makes it very difficult for a child to maneuver a 28 inch chair through the doorway (especially since the 28 inches do not include the child's arms and hands which may be propelling a manual chair). How easily the controls on a powered chair actually maneuver the chair through these areas should also be considered. A small apartment or older house might preclude certain types of powered wheelchairs for indoor use.

* Weight determines how easily a chair can be pushed by the rider and its transportability--how easily a chair can be moved to other locations. Transportability can be a significant challenge for children going back and forth to school and other activities. Fortunately, manufacturers are beginning to address this problem so that specially equipped vans are not always required. Many chairs, even some powered ones, now weigh less than 50 pounds, making transport easier. Some are designed so that in a matter of two or three minutes a manual chair can be disassembled into three pieces and a powered chair into four pieces. For example, on one chair, the largest of these components, the power chair's main frame with its drive system, wheels and casters, weighs less than 50 pounds. These chairs are designed so that all the components can be stored in the trunk of a mid-size car (with room for the car's spare tire). For those who would have trouble lifting these components into a trunk, there are several hydraulic and electric lifts available, which function like cranes and mount either on top of the car, on the bumper, or inside the trunk.

* Durability is related to how well a chair is built. Construction of the chair's frame is extremely important, especially the materials used (aircraft aluminum and coldrolled steel are the strongest), as well as the quality of the welds in the frame. For example, continuous welds in the frame are more durable than "spot welds."

Parents can evaluate durability by examining the warranty. Warranties demonstrate how confident manufacturers are about the durability of their products. Warranties also serve as "insurance" for the consumer against malfunction. Some wheelchair manufacturers are apparently quite confident, as they offer lifetime warranties. Some offer three years, while others offer only a year or six months. Also, parents should find out which components the warranty will cover; the frame, axle, power drive and any electronic parts are the most important considerations.

* Adaptability refers to how easily, inexpensively and extensively chairs can be modified to "grow" with the child. Also, consider if modifications can be easily made to allow for improving or deteriorating posture. For example, are additional parts required to expand the seat width or depth or to accommodate seating systems that the child may need later? In planning ahead, estimate that a pediatric wheelchair can realistically be used for a maximum of six years, due to the limits of the chair's expandability and normal wear and tear.

When choosing a power chair, also consider:

* Maximum and minimum speeds and ease of stopping are key safety concerns. When a powered chair is too fast for the child's ability to steer, it is unsafe. When a chair is too slow, the child may be unable to keep up with other children.

* Battery life between charges (remember, a child may be in a wheelchair as long as 12 hours per day). This will determine how often the battery will need to be charged.

* Climbing angle--the steepest angle of an incline that the chair can climb. It is useful in determining how the chair will perform outdoors on unpaved terrain or loose gravel.

OPTIONS

Specific wheelchairs usually allow for the use of options and accessories--such as various types of armrests, legrests, upholstery, tires, brakes, handrims, headrests, trays, seatbelts, backpacks and antitip devices--depending on the needs and abilities of the chair user.

How the chair user feels about his or her chair is important to the person's willingness to use the chair and to interact with peers who are not wheelchair riders. The look of the chair is important to the child's self-esteem. In that way, this is one reason manufacturers are offering chairs in a variety of frame styles (designed for sports, racing, indoors or outdoors) and colors.

The current variety of wheelchair and seating technologies means that users have greater choices than ever. The challenge is to find the therapeutically correct mobility system and then to be able to pay for it. Parents have an essential role to play for they are their children's ultimate client advocates. They alone are the ones, through all the medical and funding bureaucracies, who are involved throughout the entire process.

Cliff Henke is president of Henke Information Network, an information, research and publicity management firm headquartered in Arcadia, California. He specializes in writing about rehabilitation and home health care.
COPYRIGHT 1990 EP Global Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1990 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes related information; 1990 Wheelchair Guide
Author:Henke, Cliff
Publication:The Exceptional Parent
Date:Mar 1, 1990
Words:1356
Previous Article:Directory of wheelchair manufacturers.
Next Article:Funding to make the wheels turn round.
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