WHEELCHAIR PRESCRIPTION

Dr. Srutarshi Ghosh

• Wheelchairs and seating systems allow
individuals with mobility impairments to
actively participate at home, work,
school, and the community.
• The quality of life of an individual is
reflective of the overall effectiveness of
the wheelchair and seating system when
considering activities of daily living (ADL)
• Wheelchair and its components are
fundamental for altering the interaction a
person with a mobility limitation has with the
environment
• The multidisciplinary team of rehabilitation
professionals considers not only the
individual and the wheelchair but also the
activities, context, policies, and personal
assistance associated with the technology
 Team
• Patient
• Rehabilitation engineer
• Occupational therapist
• Physical therapist
• Rehabilitation technology supplier
• Speech and language pathologist
• Rehabilitation physician
• The most important team member is the patient.
The opinions and desires of the patient are critical
to a successful fitting but must be assessed in terms
of their level of knowledge and insight
• Some patients have been using a wheelchair for
years and know exactly what they are looking for.
For these individuals, team members act to provide
unbiased information.
• A novice patient may have little knowledge of what
is available and the trade-offs of each decision. For
this individual,the team will need to be more
directive. The family and caregiver should also
provide input
• Detailed history to be taken: To understand the
abilities and intentions of the intended user and
potential caregivers to ensure that the wheelchair
will be accepted and used properly.
• Specific personal environmental details are
important examination items include strength and
range of motion. For individuals with chronic
arthritis problems, the examination should
document the painful, swollen, or malaligned joints.
When no strength deficit is seen, it is important to
document issues with coordination, tone, and
proprioception.
 The delivery process: components
• The referral
• Assessment
• Equipment recommendation and selection
• Funding and procurement
• Fitting
• Training
• follow-up
• maintenance, and repairs
• outcome measurement
• REFERRAL: once the need is established, an individual
should be referred to a multidisciplinary team that can
properly assess and provide personalized help
• INITIAL ASSESSMENT : Medical Variables
-Age
-Sex
-If the underlying condition is progressive or has a highly
variable presentation
-Pain, obesity, cardiopulmonary or musculoskeletal
problems, genitourinary or gastrointestinal issues,
alterations in mental status, overall cognitive capacity,
and risk for falls.
-Potential risks and secondary injuries, such as pressure
ulcers, postural deformities, or upper limb repetitive
strain injuries
 Physical and Functional Variables
• Physical-motor assessment of strength, range of
motion, coordination, balance, posture, tone,
contractures, endurance, sitting posture, trunk
stability, cognition, perception
• Use of external orthoses.
• Observed performance of ADLs that are reported as
essential by the patient or his/her family or
caregiver. These include self-care, reaching,
accessing surfaces at various heights, transferring to
various surfaces, and functional mobility
• Functional mobility should be assessed in the
user’s home and community
• Ambulation should be assessed from the
perspective of the surfaces and distances
encountered in a routine day and whether walking
or pushing a manual wheelchair is safe and
efficient.
• The amount of stress applied to the upper limbs
must be taken into account, as it can lead to
repetitive strain injuries.
• There is no evidence that upper limb strength correlates with the ability to propel
manual wheelchairs, especially in the context of patients with cardiac or
pulmonary impairments, arthritis, multiple sclerosis, or cerebral palsy.
• Obtaining proper positioning while seated and
determining the necessary componentry to ensure
such positioning requires observation of a patient’s
posture both while seated and while on a therapy
mat table, to assess postural alignment and joint
range of motion.
• Assessment of pelvic alignment is crucial because
the pelvis serves as the base of all seating support.
• An obliquity of the pelvis to one side needs to be
accommodated or corrected (if possible) to prevent
leaning of the trunk or development of spinal
deformities superiorly.
• Spinal deformities need to be accommodated in the
design of the backrest, to allow the user to tolerate
sitting
• The amount of hip flexion available at the user’s
pelvis determines the tolerated seat-to-back angle.
• Inferiorly, the degree of knee extension available
while the user’s hips are flexed is an important
indicator of hamstring mobility, as they cross both
the knee and hip joints.
• Tight hamstrings, which are common in many
wheelchair users, can therefore significantly
affect foot positioning.
• It is important that excessive tension not be
placed on the hamstrings as this can be
painful and pull the pelvis into a posterior tilt
• It is also necessary to respect a person’s
preference for different seated postures
 Environmental variables
• A thorough assessment and survey of the home is
almost always warranted
• A home assessment is often needed to ensure that
the device will be usable, especially when there are
stairs, narrow doorways, and hallways, or other
tight spaces to be negotiated.
• The assessment involves taking mobility devices to
the home, surveying the environment for
accessibility, and having the user get into the device
to maneuver within the spaces he or she uses in a
typical day.
• The home assessment should also involve
having the wheelchair user complete specific
mobility-related tasks such as transferring to
and from various surfaces, including
• those used for bathing and toileting
• reaching for objects, which may be necessary
for activities such as dressing and grooming
• and pulling up to tables or work surfaces, which
may be necessary for feeding and meal
preparation
• The home assessment should also involve having
the wheelchair user complete specific mobility-
related tasks such as transferring to and from
various surfaces, including those used for bathing
and toileting; reaching for objects, which may be
necessary for activities such as dressing and
grooming; and pulling up to tables or work surfaces,
which may be necessary for feeding and meal
preparation
• Surfaces, terrains, and distances the user will
encounter on a daily basis also need to be factored
into the prescription and decision-making process.
• Social environmental assessment includes the
roles, interests, responsibilities, and occupation
important to the user.
• These roles may include being a parent, spouse,
worker, homemaker, student, or community
volunteer.
• The level of available assistance that the user has
from others needs to be assessed from the
perspective of the user.
• The physical capacity and health of the user’s
caregivers also need to be assessed
 Aesthetics
• Wheelchairs are extremely personal and intimate
devices for children and adults alike and act as an
extension of one’s own body
• For many users, a wheelchair can also be a vehicle
for self-expression, it is an extension of his or her
body.
• An aesthetically pleasing wheelchair is more likely
to be used and gains positive attention from peers
and from the community as a whole.
 Transportation Variables
• An important consideration is whether the make
of wheelchair permits greater transportability of
within a standard motor vehicle.
• The feasibility of equipment assembly and
disassembly by the user or the user’s caregiver,
needs to be carefully assessed.
• Portability can come at the cost of durability and
may compromise the capabilities of a device to
negotiate uneven or soft surfaces
• First hand experience of patient/caregiver before
finalisation
• Most active users prefer some seat angle or dump.
Dump is achieved by tilting the seat down toward
the backrest, thus the end closest to the backrest is
lower than the front of the cushion.
• Dump allows the user to fit more securely in the
chair, increasing the user’s trunk stability and
making the chair more responsive to the user’s
body movements.
• The seat height is dependent on the total body
length of the user. Users with longer leg lengths will
require higher seat heights
• Seat depth is determined from the length of the
upper legs.
• Generally, no more than a 75 mm (3 in.) gap should
be between the front of the seat and the back of
the knees when the person is in the wheelchair.
• This will help ensure broad distribution of the trunk weight over the buttocks and upper legs, without
placing undue pressure behind the knee. Some gap is required to allow the user some freedom to adjust
his or her position.

• Seat width is determined from the width of the

person’s hips, the intended use, and whether the
person prefers to use side guards.
• Generally, the wheelchair should be as narrow as
possible; thus, a chair about 1 in. wider than the
user’s hips is desirable.
• The pelvis should be stabilized on a cushion that
provides postural support as well as optimal
pressure distribution.
• The cushion should be mounted onto a hard
surface that maintains its position, as opposed to
placing it directly onto a sling upholstery seat
Basic Structural Components
• measurement.
 Seating principles
• Ideal sitting position :knees at 90 degrees of flexion, hips at
90 degrees of flexion, and elbows at 90 degrees of flexion.
• All measurements should be taken on a smooth, level
surface such as a mat. The patient should be seated or
supported in a neutral, upright posture. Patients who do
not have sufficient control to sit upright will require
assistance . Seating measurements should not be taken in a
wheelchair, as the support surfaces of the wheelchair
components do not allow for accurate measurement.
• Proper positioning of the pelvis and trunk provides a stable
base for the upper limbs. An unstable base may lead to
upper limb overuse and injury. Without proper base
positioning, the head and neck will not be well aligned with
the spine
 Seating Surface
• Important for stability, comfort, • ease of propulsion,
and skin integrity.
– There are two 2 types of seats:
1. Vinyl sling seat: easy to fold, easy to clean, and
lightweight.
– Disadvantages: the sling nature of the seat does not
provide sufficient support and promotes a posterior
pelvic tilt, hip internal rotation and adduction.
This in turn sets a patient up for a
 collapsed trunk with subsequent
 head forward flexion,
 neck hyperextension, and
 a protracted and elevated shoulder girdle.
2. Solid seat: firm but provides better postural
control.
– Disadvantages: slightly heavier and can make the
chair more difficult to fold.

 Patients should not sit directly on either type of

seat. All patients should use some type of cushion.
• One way to provide a lighter weight yet supportive
seating surface is to place a solid seat insert under
the cushion to provide a level base of support for
the wheelchair seat cushion. A solid insert can
come in a lightweight wood, such as applewood, a
wood covered in vinyl, or hard plastic.
 Seat Width
Measure across the widest point of the hips (with clothing and
any braces or orthosis).
– For patients who use a manual wheelchair as their primary
means of mobility, the seat width should be the same as their
hip width to maximize their wheel access.
At times, for functional purposes, the wheelchair seat width may be up to 1 inch
greater than the patient’s measured hip width. This extra space can be essential for
patients to be more independent with their activities of daily living, such as dressing in
their wheelchair orperforming bladder management in their wheelchair.
– For patients who use a power wheelchair as their primary means of mobility, the seat width
can be < 1 inch wider than their hip width. However, it is important to rememberthe risk of
scoliosis and utilize hip guides to ensure maximum alignment is maintained in the pelvis.
 If the wheelchair is too narrow, transfers will be more difficult
and the patient is more likely to develop a pressure sore on
the greater trochanters.
 Conversely, if the seat is too wide, truncal support is
compromised, leading to scoliosis, back pain, and difficulty
with wheelchair propulsion
 Seat Depth
Determined by sitting the patient on a mat and
positioning his hips in as neutral position as possible.
Measure from the dorsal buttocks to the popliteal fossa
and subtract 1/2 inch from this measurement.
 If the backrest is cushioned, the thickness of the
cushion must be considered.
Also, if a client is going to be propelling the manual
wheelchair with foot/feet, 1–2inches are usually
subtracted and the cushion is beveled back to allow his
knee adequate flexion to propel the wheelchair.
If the seat depth is too shallow, there is decreased
distribution on the femurs and as a result, there will be
increased pressure on the ischial tuberosities.
 Seat Height
Measure the patient’s lower leg length from the bottom of
the heel of the shoe to the posterior thigh. Subtract the
height of the compressed seat cushion from the
measurement, and then add 3–4 inches to allow for adequate
leg rest clearance.
• For the cushion height, it is important to consider the material: air, foam, or
gel and the amount of compression that occurs when the patient is seated
on it. Foam cushions compress to 1/2 their normal size; therefore, the
cushion height that is subtracted is the “compressed” cushion height.
• Variations on seat height measurements occur in the foot drive, or
hemiplegic chair, which is designed with the seat closer to the floor to allow
the unaffected leg to propel the chair.Measure patient’s lower leg length (as
directed above) and subtract the height of the “compressed” seat cushion
only. This will allow the patient’s leg foot to rest comfortably flat on the
floor, which is essential for the patient to get an adequate leverage heel
strike for foot propulsion.
• If the seat height is too high for this patient, he will be
constantly sliding out of the wheelchair as he attempts to
propel it with his unaffected leg and arm.
 Back Support Height
• The wheelchair back support height can vary
depending on the capabilities and support needs of
the patient.
• In general, the backrest should be high enough to
provide good trunk support, but not inhibit
movement. For patients who will be utilizing their
arms for propulsion, the height of the back support
should be just below the inferior angle of the
scapula. The scapula should not hang over the
chair.
• If the backrest is too high, it may interfere with
shoulder movement. If it is too low, it will not
provide adequate trunk stability
• Measure the distance from the bottom of the
buttocks to the inferior angle of the scapula.
• Then add the “compressed” wheelchair cushion
height to get the true back support height
measurement
• If the patient has good trunk control and can propel a wheelchair, the
back support can be lower than the just under the inferior angle of
the scapula. The only caution is to make sure that the client is not
hyperextending his back over the back support for stability.
• If the patient has no upper extremity strength and poor trunk control,
the measurement is first taken by a measuring the client from the
bottom of the buttocks to the spine of the scapula. Again, the
compressed wheelchair cushion height is added
• The back support does not need to be higher than the patient’s
shoulder and should be just under his shoulder at the spine of the
scapula. This client will also need to have a headrest for adequate
support.
Head Support
• Measure from the bottom of the buttocks to the
top of the cranium. Then add the height of the
“compressed” seat cushion to determine the “top
of the headrest” position. This is adjusted down by
2–4 inches depending on the patient’s support
preference.
Footrest Height
• Measure the distance from the patient’s heel of
their shoe to the under surface of the thigh at the
popliteal fossa. Footrests are usually adjustable and
should have approximately 2 inches of clearance
from the floor
Back Support
 Recline and Tilt-in-Space Mechanisms
• The most important reasons for a tilt and recline
seating system is to perform adequate weight shifts
and to minimize risk of skin breakdown. Other
reasons may include
• Poor sitting balance,
• Poor endurance,
• Orthostasis,
• Fluctuating respiratory status needs, or
• Otherwise need to be able to adjust the backrest.
 Recliner Wheelchair
• A reclining back support is a back
support that can be easily
repositioned incrementally in a
posterior direction from an upright
to varied reclined positions. The
seat of the wheelchair stays in the
same position relative to the floor
while the back support is
adjustable.
• A recliner can be a semi-recliner
that stops at 120 degrees or a full
recliner that stops at 180 degrees.
• A manual wheelchair with a
reclining back is at minimum 3”
longer than a standard wheelchair
and is more difficult for a patient
to propel.
 Power Recliner Advantages:

• Independent pressure relief.

• Can assist in orthostatic episodes.
• Allows for passive range of motion (PROM) of hip and
knee – however is not a substitutefor a PROM
program.
• Easier to perform catheterization
• Can help mobilize secretion.
• Can maintain items on laptray during a weight shift.
• Can maintain position under table or desk during
“pressure relief”.
• Can transport in car with a large trunk.
 Power Recliner Disadvantages:
• May result in shear forces and shearing
pressure sores.
• Can increase spasticity due to the hip position
change.
• Increased turning radius
• Patient does not maintain “ideal” seated
position after several weight shifts
 Tilt-in-Space System
• The entire seat and back are tilted
back as a single unit.
• The angle of the seat and back
itself does not change. The
patient/user remains in thesame
position, but orientation in space
changes.
• This allows pressure to be
redistributed from the seating
surface to the back support. Since
there is no movement of the back
away from the seat, shear forces
are kept to a minimum.
• In order to redistribute sufficient
pressure, the system must tilt at
least 45 degrees. Most systems
allow 45–60 degrees of tilt
 Tilt-in-Space Advantages

• Independent pressure relief

• Can assist in orthostatic episodes.
• Minimizes shear.
• Diminishes effects of spasticity during position changes.
• Maintains seating position during weight shifts.
• Helps mobilize secretions.
• Tighter turning radius
 Tilt-in-Space Disadvantages
• No ROM benefits
• May not offer as much pressure distribution relief as a
recliner to 180 degrees.
• If using a leg bag, urine may run backward in the tilted
position (anti-reflux valve on leg bag tubing can
manage this).
• Difficult to maintain items on a lap tray when tilted
• Need to come away from desk or table to perform
weight shift
• May require a raised door in van secondary to height of
tilt-in-space wheelchair.
• More difficult to perform catheterization
• These systems do not disassemble sufficiently for
transport by car.
 Armrests
• Measurement: Measure arm height from the
buttocks to the bottom of the patient’s bent elbow
at 90 degrees. Then add the height of the
compressed seat cushion to obtain the armrest
height.
• Uses:
Provide appropriate glenohumeral support,
Offer patients a surface to shift their weight when
reaching and functioning from a wheelchair
Help perform “push up” exercises for pressure
relief to prevent pressure ulcer.
 Fixed vs. Removable/Flip Back Armrests
• Fixed armrests are lighter because there are less moving
parts and do not add width to the chair.
• Disadvantage: they are not usually prescribed, as they do not
allow a patient to perform lateral transfers to/from the
wheelchair.
• Removable or flip back style armrests are essential for
patients who are close to being independent with transfers
and that need to perform lateral transfers to/from the
wheelchair.
• Disadvantages: add extra weight. Some removable armrests
also increase the overall width of the wheelchair by 2 inches.
• Variations:
 Wraparound armrests
 Swing-away or flip-up armrests are preferred by active SCI
patients.
 Active, younger patients often prefer no armrests if balance is
not a concern.
 Full Length vs. Desk Length Arm
• Fixed and removable are available.
• The removable desk length arm is the most
commonly prescribed.
• Full length offers more arm support which is
essential to support a laptray or arm trough.
• It is also necessary for upper extremity support
with sit-to-stand transfers to/from the wheelchair.
• Disadvantage: patient will be unable to get close
to tables and desks.
• Desk length armrests allow the patient to better
access tables for feeding and desks.
• Adjustable Height Armrests
• Adjustable height is essential to provide clients with
adequate glenohumeral support. It is available as an
alternative to ordering a fixed custom height.
• Adjustable armrests are heavier than fixed.
• Tubular vs. Standard Armrests
• Tubular arms allow the patient to obtain better
forearm clearance when propelling the wheelchair.
The square edge of the standard armrest pad often
causes forearm bruising with propulsion
 Types of wheel
(1)MAG WHEELS are most common.
• They are one piece
• Cast with metal alloys or metal and plastic to
• Weigh only slightly more than the wire spoke wheel
• Maintenance free
(2)SPOKE WHEELS, similar to a bicycle wheel, are lighter weight.
• Less force needed to propel and has improved shock absorption.
• However, they require more maintenance secondary to bending and
loosening
(3)SPINERGY WHEELS a
• lighter weight than standard spoke wheels.
• more durable
• require less maintenance
• but are more expensive.
Spinergy Wheel
 Adjusting Axle Position type
• Although most wheelchairs are of the
fixed axle variety, in a wheelchair with
an adjustable axle, the wheel axle can
be moved forward to position the
center of gravity underneath the client
to allow for improved rear wheel
access and more efficient wheelchair
propulsion.
• In addition, this forward axle position
facilitates “wheelies”
• Moving the axle posteriorly is essential
in a bilateral amputee patient and with
a reclining back tilt system
• The more posterior the rear • The more anterior the rear
wheels: wheels:
1. The greater the rolling 1. The less the rolling
resistance resistance
2. The more energy required 2. Less energy is required to
for propulsion propel
3. The greater the turning 3. The smaller the turning
radius radius
4. The more stable the chair 4. The less stable the chair
5. The more extension 5. The more maneuverable
needed at the the chair
glenohumeral joint which 6. May relieve shoulder pain
can compromise the with manual propulsion
anterior shoulder joint
 Types of wheel tires
• Solid rubber tires • Pneumatic tires
– Have a very low rolling – They are lighter weight than other
resistance on flat or smooth options.
surfaces. – Provide a smoother, more
– No risk for “flat” tire comfortable ride than solid tires.
– Lack “cushioning” on – The higher the pressure square inch
rougher terrain. Rougher (PSI) the lower the rolling resistance.
ride than a pneumatic tire. – Contain air inner tube and are
– Heavier than pneumatic lightweight.
– The profile of the tire can be highly
textured or smooth.
– The best ride on most surfaces, but
not as good as rubber on smooth
surfaces
• All-terrain tires • Kevlar® tires
– Have a wider tread and – Made of Kevlar® which
are wider overall. is more puncture
– They are air tires and resistance.
require a standard inner – Provide a durable and
tube. smooth ride.
– They are used for – Lower risk of a “flat”
mobility on soft and tire compared to a
sandy terrain and are up standard air tire
to 2-1/2 inches thick.
 Camber
• Camber is the wheel angle against the vertical axis where the
bottom of the wheel is out further than the top of the wheel.
• Camber is available in increments ranging from 2–12 degrees.
• Camber positions the wheel in a better biomechanical
location to the shoulder joint.
• Camber makes the wheelchair easier to propel (especially at
higher speeds), increases stability, and makes it easier to turn.
Camber maximizes lateral stability of the wheelchair.
• The disadvantages are increased overall width of the chair
and up increased tire wear on the inside of the tire. This can
be managed by choosing smaller degrees of camber and
making sure the overall width is less than a standard doorway
(< 28 inches).
 Handrims
• Handrims allow propulsion and control safety
without touching the tire directly to avoid
soiling the hands.
• The larger the diameter of the handrim, the
easier it is to grasp and propel. The concern
with this is the increased weight.
• The standard handrim is the circular
aluminum or steel tube.
• A variation is the one-hand drive chair for
individuals with plexus injury, upper extremity
amputation, or hemiplegia A power wheelchair is
often the best option for this client.
• Another option is the “natural fit handrim.” This
is an oval shaped handrim with a thumb guard
that promotes a more ergonomic wrist and hand
position.Benefits of this more ergonomic
handrim outweigh the increased weight
• well suited for people
who frequently propel
long distances and over
outdoor terrain (e.g., dirt
• drawbacks to using a
lever drive system include
difficulties with
maneuvering in tight
places, transfers, and
transportability.
roadways).
• Antitippers are devices
that attach to the rear of
the wheelchair frame and
usually have adjustable
length tubes with small
wheels at the end
• protect the user from
tipping the wheelchair
backward, but can make
it difficult for the user to
ascend a curb or do
wheelies
 Casters
• Casters are the small front wheels that allow
turning of the wheelchair
• Available in a 2-, 3-, 4-, 5-, 6-, and 8-inch sizes.
• The smaller and narrower the caster, the lighter and
more maneuverable the chair.
• A smaller caster allows a smaller turning radius but
performs poorly on outdoor surfaces and on carpets
• Many patients obtain tremendous benefit from the
increased maneuverability.
• Larger diameter casters make it easier to negotiate
uneven surfaces but may shake or flutter and have
larger turning radii.
The 8-inch diameter caster
• is standard on the basic chair.
• The size is great for uneven indoor and outdoor
surfaces, such as carpet, sidewalks, and grass.
• Disadvantage
• decreased maneuverability
• increased strain on the upper extremity to
perform frequent small adjustments to maneuver
in tight areas indoors,
• 8-inch casters may also be ordered with
pneumatic or semi-pneumatic tires to be used on
rough surfaces or outdoors
• 5- and 6-inch caster sizes tend to be the
average caster sizes that give the combination
of best overall indoor maneuverability and
good outdoor performance.
• Used in many ultra-light chairs and on
children’s chairs.
• Caster placement more posteriorly decreases
the turning radius, decreases stability,
andincreases maneuverability
 Front rigging( footrest+legrest )
• Footrests are measured by taking the distance from
the heel to the under surface of the thigh at the
popliteal fossa. The “compressed” cushion height
should be accounted for.Footrests are usually
adjustable and should have 2 inches of clearance
from the floor.
• Types:
1. Fixed:
2. Swing-away
3. Others
Seat Cushions
• Active manual wheelchair users may not like an
air-filled cushion because it does not provide a
stable base for propulsion
• Solid seat inserts (thin wood boards) are often
inserted into the cushion cover to provide a solid
base for sitting.
• For flexible deformities, the pelvis should sit in as
neutral a position as possible, with the trunk
maintaining a normal degree of lumbar and
cervical lordosis
 Wheelchair propulsive techniques
• Propulsive strokes are generally described in two
phases: when the hand is in contact with the pushrim
applying forces (contact phase), and when the hand is
off the rim and preparing for the next stroke (recovery
phase)
• Four distinct propulsion patterns have been identified,
which are defined by the path the hand takes during
the recovery phase:
• arc,
• semicircular,
• single-looping over, and
• double-looping over
 Powered Wheelchairs
• Basic power wheelchairs have simple electronics, a
standard proportional joystick, and limited seating
options
• They are low cost and low quality
• They are designed for light use on indoor surfaces.
• They are appropriate for limited indoor use for
individuals with a short-term disability who have
good trunk control and do not need specialized
seating.
Basic powered wheelchair
Indoor outdoor powered wheelchair
• Intended for individuals with long-term disabilities
and are designed for indoor surfaces and on
finished surfaces (e.g., sidewalks, driveways, etc.) in
the community.
• These wheelchairs, depending on the model, will
support simple to advanced controllers, a wide
range of input devices (e.g., proportional and
nonproportional), and power seating options.
• Come with either simple seating or rehabilitation
seating.
• Rehabilitation seating allows for the attachment of
modular seating hardware (e.g., backrests,
cushions, laterals, hip guides, and headrests)
Heavy Duty wheelchair
• All-terrain indoor-outdoor power wheelchairs are
for use by people who live in communities without
finished surfaces.
• These wheelchairs usually have more powerful
motors, drive wheel suspensions, large-diameter
drive wheels with heavily treaded tires, or four-
drive wheels for climbing obstacles and traversing
rough terrains
FRONT WHEEL DRIVE REAR WHEEL DRIVE
• The front-wheel drive power wheelchair features
large drive wheels in the front and small pivoting
casters in the rear.
• Of the three drive locations, it has the best
capability to climb forward over small obstacles.
• The overall turning radius is smaller than that of
rear-wheel drive
• tendency for the back of the chair to wander side to
side (“fishtailing”), especially with increased
speeds. This directional instability requires steering
corrections that could make the wheelchair difficult
• Rear-wheel drive is characterized by large drive
wheels in the rear and small pivoting casters in the
front
• The rear-wheel drive power wheelchair steers and
handles predictably, and naturally tracks straight,
making it the most appropriate drive configuration
for high-speed applications.
• Traditionally, rear-wheel drive was preferred by
people who drive with special input devices (chin
joystick, head array, etc.) or have reduced fine
motor coordination (because of its consistent
tracking)
• The Midwheel drive power wheelchair has been
one of the fastest growing power bases in the
wheelchair industry.
• The drive wheels are located near the center of the
power wheelchair, allowing the user to seemingly
turn in place, dramatically increasing indoor
maneuverability.
• among the most effective at both ascending and
descending obstacles for skilled, practiced users.
• A center-wheel drive location enables for a more
compact footprint and a tighter turning radius.
• a possibility of getting “stuck” on the front or rear
casters.
 Input devices

Joystick input
Sip and puff input
Scooters
• Designed to provide intermittent mobility
support for individuals with good arm strength,
trunk balance, and ability to transfer in and out of
the device.
• Scooters are usually equipped with automatic
braking (similar to power wheelchairs) and are
not able to coast.
• Three-wheeled scooters are more common than
four-wheeled scooters which can traverse more
rugged terrain but are large for most indoor
setting
• cost less than a typical power chair