Wheelchairs

This page covers:

• Types of wheelchairs and their uses
• Seating and positioning for proper support
• Indoor vs outdoor considerations
• Wheelchair add-ons and accessories
• Getting properly assessed for a wheelchair
• Understanding personal wheelchair budgets
• Care and maintenance of your wheelchair

What is the problem?

For adults with Cerebral Palsy, finding the right wheelchair can be challenging. There are many considerations including comfort, functionality, support, and cost. Using inappropriate equipment can lead to pain, fatigue, and mobility limitations.

Approximately 75,000 young people in the UK need to use a wheelchair, and many adults with CP either continue using wheelchairs throughout their lives or begin using them later as they experience changes in their mobility. Many cannot access equipment that fully meets their needs through their local wheelchair services.

The right wheelchair should provide appropriate postural support, be comfortable for extended use, and enable you to participate in the activities that matter to you. However, finding this ideal match requires navigating a complex system of assessments, funding options, and technical specifications.

Types of Wheelchairs

Wheelchairs come in various designs to suit different needs:

Manual wheelchairs:
• Self-propelling: Designed for users who can move themselves using the large rear wheels
• Transit/attendant-propelled: Designed to be pushed by someone else
• Rigid frame: Lighter and more efficient for self-propulsion, but doesn’t fold
• Folding frame: More portable for transport but heavier and less efficient for self-propulsion

Powered wheelchairs:
• Controlled by joystick or alternative controls
• Provide independence for people who cannot self-propel
• Available with various seating options and positioning features
• Generally designed for all-day use

Scooters:
• Controlled by a tiller (steering column)
• Designed mainly for outdoor use
• Less manoeuvrable indoors than powered wheelchairs
• Generally intended for occasional rather than all-day use

Wheelchair Features and Considerations

When choosing a wheelchair, consider these important aspects:

Seating and Positioning

Proper seating and positioning are crucial for comfort, health, and function:

• Cushions: Different materials (foam, gel, air) provide varying levels of pressure relief and positioning support
• Backrest: Height and contour should support your specific postural needs
• Headrest: May be needed for proper head and neck support
• Lateral supports: Help maintain upright posture for those with trunk control challenges
• Leg guides/Thigh supports: Help maintain proper leg positioning

Your body needs at least three points of reference to feel stable in a wheelchair. Your seat bones (ischial tuberosities) provide two points, while your feet on footrests or armrests for your arms provide the third. Without these stabilising points, your body will try to find stability by leaning, which can lead to fixed posture problems over time.

Pressure Management

For wheelchair users who spend extended time sitting, pressure management is essential:

• Pressure mapping can identify potential problem areas
• The right cushion can help distribute pressure evenly
• Regular pressure relief movements are important
• Make sure cushions are used correctly and placed in their covers the right way

Indoor vs Outdoor Use

Different environments require different wheelchair features:

• Indoor use: Prioritise manoeuvrability, compact size, and tight turning radius
• Outdoor use: Consider ground clearance, wheel size, and stability
• All-terrain needs: Specialised wheelchairs or add-ons can help navigate rough surfaces

Remember that smaller front casters (the small wheels at the front) make a wheelchair more efficient indoors but struggle with outdoor terrain. Larger front wheels handle rougher ground better but make the chair less manoeuvrable indoors.

“It’s getting that compromise between the indoor and outdoor. You want to fit the chair for 97% of the time and struggle for the 3%, not the other way around.”
– Lee Warner, Better Mobility

Wheelchair Add-ons and Power Assistance

Modern wheelchairs can be enhanced with various add-ons:

• Power add-ons: Devices like SmartDrive attach to manual wheelchairs and provide power assistance
• Front attachments: Options like the Triride lift front casters off the ground and add power, improving outdoor capability
• Specialised wheels: Products like Loopwheels provide built-in suspension to reduce vibration

These options can help preserve your shoulders and reduce fatigue, especially if you self-propel over long distances or across uneven terrain.

How do we manage it?

Getting a Wheelchair Assessment

A proper wheelchair assessment is essential to ensure your wheelchair meets your unique needs:

• Work with experienced professionals who understand your specific requirements
• Be clear about your daily activities and lifestyle needs
• Consider your home environment, transport requirements, and activity patterns
• Be honest about your capabilities and needs

During an assessment, professionals will evaluate:

• Your body measurements and posture
• How you transfer in and out of the chair
• Your propulsion abilities
• Your home and work environments
• Your transportation requirements

Understanding Your Wheelchair Service

Get to know your local wheelchair service:

• Find out who runs your wheelchair service (NHS or contracted provider)
• Know their contact details and location
• Understand their repair contract information
• Learn their assessment criteria
• Keep all wheelchair documentation together
• Document all communications if you have ongoing issues

Personal Wheelchair Budgets

In England, Personal Wheelchair Budgets (PWBs) provide more choice over wheelchair provision. There are three main types:

• Notional: Accept the wheelchair offered by the wheelchair service
• Notional with top-up: Accept the wheelchair service chair but pay extra for additional features
• Third-party: Receive the value of the wheelchair you would have been entitled to as a contribution toward a privately purchased wheelchair

When considering a top-up, remember that the actual cost to the wheelchair service is often much lower than retail price. Ask what the service is paying for the equipment, not what the retail price would be.

Maintenance and Care

Proper maintenance helps your wheelchair perform better and last longer:

• Regularly check tyre pressure on pneumatic (air-filled) tyres
• Keep caster bearings free of hair and debris
• Tighten screws and fasteners regularly
• Check positioning equipment regularly
• Schedule professional maintenance

Rest and Equipment

The right equipment can help reduce fatigue and improve comfort:

• Ensure that seating is properly adjusted to support good posture
• Consider power assistance if manual propulsion is causing fatigue
• Make sure footplates are at the correct height to reduce pressure on sitting bones
• Position armrests at the right height to support arms without raising shoulders
• Consider the weight of the wheelchair and components, especially if you transfer it yourself