Types of Wheelchairs and Wheelchair Alternatives

Manual Wheelchairs

Manual wheelchairs are available in several types and styles for children. Most are propelled using arm strength, but some chairs with a lower, or hemi, frame are designed to be propelled using leg strength. Manual chairs range in price from approximately $1,000 for a basic chair to more than $5,000 for a customized lightweight chair, with the average price range being $1,800 to $3,800. 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:

Small child wheelchairs

Small child wheelchairs are generally designed for under six years of age, or those with similar height and weight. Some small child models are scaled-down versions of a standard chair, while other models address specific concerns. Small child chairs are frequently available with a selection of options, accessories, and custom modifications.

Child/Junior/Growing chairs

Child/Junior/Growing chairs are designed for children ages six years and over. They are designed to meet the needs of children as they change and grow. Because 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 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 changing situations. In some 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 or Sports chairs

Lightweight or Sports chairs refer to the lighter weight of the frame. Originally developed for racing, these chairs have become increasingly popular as daily use chairs because they offer a sportier appearance and promote independence. While some manufacturers offer chairs specifically designed for racing many lightweight versions designed for general use are available. Many of these chairs utilize a rigid frame with a folding back and quick-release wheels for transport and storage, although some manufacturers also offer folding models. In addition, these chairs are used without armrests and have a low back. Lightweight chairs typically weigh less than 30 pounds without legrests and/or wheels. Many, if not most, wheelchair manufacturers offer one or more lightweight or sports models for children. Some models have folding frames, some have rigid frames, and a few offer a choice of frame styles.

Standard/Everyday Chairs

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 wide variety optional features and custom modifications.

Specialty Chairs

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 an amputee or person with paralysis on one side to propel a wheelchair with one hand, while others offer an optional hemi frame. Specially designed chairs may meet other needs. For instance, a child who needs or wants to stand may be interested in a manual wheelchair equipped with a lift to raise the user to a standing position. Similarly, several offer reclining chairs for those who cannot remain upright for sustained periods or who need to change position regularily without leaving their chair. Still other chairs allow the user to pursue specific interests such as racing or wheelchair sports. Others allow the user to better manage in his or her environment. For example, the Lightweight Wheelie Chair from Accumec Corp. positions the wheels in a forward position, allowing the user to do wheelies, a feature of particular use on rough terrain or in negotiating curbs and steps.

Powered Kids Wheelchairs

Another innovation in the wheelchair market is the availability of powered wheelchairs for children. Until recently it was 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, however, 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.

Powered chair selection requires attention to the considerations discussed at the start of this fact sheet, as well as to those unique to powered chairs. First, it is necessary to determine whether a powered wheelchair is the best option for the child's particular needs. A child who requires independent mobility but is unable to propel a manual chair is a candidate for a powered chair. However, it is also necessary to consider such physical and developmental factors as posture, coordination, and visual perception. 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 accessible - free of barriers and having sufficiently wide doorways and halls. Because of their weight and design, powered chairs generally cannot be tipped or lifted to negotiate steps or other barriers. Hallways must be sufficiently wide to accommodate the larger turning radius of powered chairs, as well. Also, because powered chairs 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, or its maximum distance per battery charge. Finally, cost is a major consideration: powered chairs are rarely priced at less than $3,500 and may cost $12,000 or more, depending upon options and custom modifications.

Powered chairs generally use joystick controllers, although other options such as switches, head or foot controls, and sip-n-puff systems are available to accommodate various abilities. Regardless of the type of controller used, powered chairs fall into two basic categories:

The more 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 also offer the convenience of folding or disassembly for transport. Frequently this is accomplished with a crossbrace frame that allows the chair to be collapsed once the batteries have been removed. Others such as the Electro-Lite (Damaco, Inc./Freedom on Wheels) are specifically designed to be lightweight and easily transportable. The folding frame is constructed of aircraft aluminum, and the power unit disassembles into components that weigh less than 22 pounds each. Finally, some manufacturers offer models with the choice of a rigid or a folding frame. The Zippie P500 by Quickie Designs is similar to the traditional powered chair but is designed to grow with the user. The chair features a programmable controller that adjusts to meet the child's abilities and a range of other adjustments which allow the chair to change with the child; an optional growth kit is also available.

Another powered chair option for the pediatric wheelchair user is the powered base with an affixed seating system. This type of wheelchair is a more modular chair and 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.

Scooters

Manufacturers are also beginning to produce three-wheeled carts, also known as scooters, for children. With a price range of approximately $1,500 to $3,500, 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. However, it should be noted that some wheelchair lifts are not designed for use with scooters, nor are wheelchair tie-downs in public transportation.

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, tail lights, and horns.

Strollers

For very young children or those who cannot or do not need to propel themselves in a wheelchair, a stroller may be a suitable alternative. Many models fold for while others feature quick-release axles to allow easy removal of the wheels. Depending upon the manufacturer, a choice of upholstery, frame and upholstery colors, and accessories may be available. Strollers are available to meet a wide range of needs. Models similar to conventional strollers are available, as are all-terrain strollers such as the Kid-Kart line manufactured by Kid Kart,Inc. These strollers feature ball bearings, pneumatic tires similar to those found on standard wheelchairs, and a lower center of gravity. Both the conventional and all-terrain strollers fold for transport and storage, and offer a range of options such as canopies and footboxes or footplates.

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 two-wheel stroller, a child safety car seat, a high chair, or a combination of these. The Kelly Plus by Ortho-Kinetics features a frame that accommodates a modular seating system, allowing the seat to be changed as the child grows. The Spectrum Pediatric by Scott Designs features a unique aluminum frame that fits together similarly to an erector set, allowing the stroller to be converted to a wheelchair for use by older children. Convertible and modular strollers also may be equipped with a variety of standard features and options including trays, canopies, harnesses, and supports.

Strollers are also available for older and larger children. Convaid's Therapy Stroller 4M Cruiser is designed for children aged 4 to 13 years of age and weighing up to 125 pounds. In addition to its Junior Cruiser 4J designed for children ages 1 to 5, Convaid offers a range of products for older or larger children, including the Standard Cruiser 4M for children ages 4 to 10, the Standard Cruiser 4MX for children ages 5 to 12, and the Teen Cruiser 4T for people 8 years of age through adult. The Cruisers are also available in Transport models which have been crash tested for bus and van tie-down. Other Convaid models for larger or older users are the Standard and Teen EZ Rider and the Standard and Teen Shuttles. Similarly, Preston offers its Carrie Rovers in Junior and Small Adult models.

Finally, strollers for specialized uses are also offered. Roleez Wheel Systems manufactures the All Terrain Fun Wheeler for use on beaches and other terrain where a conventional stroller or wheelchair would have difficulty. This rickshaw-style will work well for large children or small adults weighing 125 pounds and up, and features patented oversized pneumatic plastic tires that conform to the terrain and roll easily in sand, mud, or gravel. The wheels have no metal parts, so they are completely submersible. The unit disassembles for transport and storage. The company's Sport Wheeler is a three-wheeled model with the same patented wheel system that can be pushed from behind or is available in a manual, self-propelled unit using special handrims. The company also offers wheel kits designed to be attached to standard, non-folding beach and pool chairs, converting them to push-style or pull-style all-terrain strollers.

Funding Sources

No matter what type of wheeled mobility assistance is chosen, it is always a major investment. Assistance with finances is dependent upon available medical insurance and/or eligibility for medical or social services or income support available from a variety of sources. Some of the common sources for funding of Children's wheelchairs in Ontario:

• Assistive Devices Program (Ministry of Health),
• Easter Seals,
• Community Service Clubs,
• Private Insurance Plans,
• Children's Aid Societies (For their wards only),
• School Boards (For products needed at school)
• and occasionally, Church Groups.