A spinal cord injury changes how your body moves, and the equipment you choose will affect your daily routine for years. Manual and power wheelchairs come in a variety of models and costs. If the mobility aid is poorly matched to the user’s needs, there may be pain in the shoulders or pressure injuries may occur. A good match provides independence at home, at work and in the community. This article outlines how injury affects your options, the different types of devices available, and tips on fitting, funding, and home planning.

Assessing Your Starting Point

Injury Level and Completeness

The level of your injury sets the first limits on what you can operate. Cervical injuries impact the arms and hands as well as the legs, and the condition is known as tetraplegia. Injuries to the thoracic or lumbar regions typically spare arm function and are referred to as paraplegia. For injuries at C5 or higher, a battery-operated wheelchair for adults is often the better option. A manual chair is not the best option for patients with weak upper-body strength, as propelling is difficult and exhausting.

Completeness also matters. An incomplete injury (grade B, C, or D on the ASIA Impairment Scale) may result in some sensation or movement below the injury level. Your rehab team will determine which grade you apply, and that grade should dictate your equipment choice.

How Your Needs Change Over Time

It may be different in the first year as you have time for swelling to subside, strength to return and technique to improve. Your rehabilitation chair might not be the right one for you 9 months later. Some centers would supply a provisional chair for this purpose. If they offer one, try it out and see what you like and dislike before you decide on a permanent one.

A factor is age. Those who have been pushing manually for a long time may develop shoulder issues at 25, and by 45 it may be necessary to alter the set-up. Make an appointment with your therapist at least once a year, and after weight, health, or life changes.

Comparing Device Types

Manual Wheelchairs

For those with good arm and trunk control, an ultra-light, manual chair is a good place to begin. They are made of aluminum or titanium, typically range from 15 to 30 pounds, and may feature a wheel angle, seat height and axle position adjustment. The Consortium for Spinal Cord Medicine suggests using an ultralight chair to support the upper limbs, and a lighter frame reduces the effort required with each push.

Most buyers don’t realize how important rear-wheel position is. Move the axle forward so you need less push, but it will make it easier to tip backward, so anti-tip wheels are recommended until you get a good sense of balance. The average price of a well-designed ultralight model is around $2,500 to $5,000.

Power Wheelchairs and Power-Assist Options

Power chairs are for you if you have poor arm strength, low endurance, or have to travel long distances. The drives can be tailored to one’s skills:

• The standard joystick for people who have hand function
• A chin-operated joystick for limited hand movement
• A head array uses head movement to direct the array.
• For the first time, users without control of their hands and/or head can use a sip-and-puff switch.

Many power seats can also tilt, recline, and elevate the seat. These functions help relieve pressure and access upper shelves and counters.

Power-assist wheels are a mix of manual and powered. The Permobil SmartDrive and the Alber e-motion are motorized systems that fit on a manual chair and help to take the strain of going uphill or over rough terrain. They are good for paraplegics concerned about shoulder wear but have weight and cost drawbacks. Request a sample before ordering.

Fitting and Assessment

Seating and Pressure Care

Skin protection is as important as the frame. Pressure injuries occur when you sit for a long time without realizing you need to move. The most important protection is a cushion. Several types are available, including air, gel, foam, and hybrid, and the best option depends on your body type, skin history, and transfer method.

Your therapist will instruct you to shift your weight every 15-30 minutes. Check your skin daily (either in a mirror or with help from a parent or caregiver). If the cushion has become flat or lost its shape, it provides little cushioning and needs to be replaced.

Working with a Professional Team

A physical or occupational therapist knowledgeable in seating should evaluate you, along with an Assistive Technology Professional (ATP) working under the physical therapist’s direction and certified by the RESNA. Your posture, ROM and skin risk are measured by the therapist. The ATP then compares those results to a specific product and places the order.

Come to the appointment with your usual routine. Discuss how you enter the car, where you go and how far you travel. Come test two or three chairs for a week or more at the showroom, because a showroom test will not usually indicate that a bathroom is too narrow or a door is too heavy.

Practical Planning

Home and Transport

Measure your home before ordering a chair. In public buildings, the Americans with Disabilities Act requires a clear door width of at least 32 inches; many older homes have narrower doors. Most wheelchair users can turn around, so a 60″ turning circle is acceptable for a ramp, which should not exceed a 1:12 rise. When purchasing, keep these in mind:

• The width of all doors you open each day
• Utilizes space in the bathroom and bedroom
• Steps and entrance thresholds
• A safe place to store and charge a power chair

Plan transport needs along with everything else. Drivers who transfer independently can store a folding manual chair in a car. The power chair will most likely need a van with a ramp or lift. Check the lift’s rated capacity before you buy, and make sure the chair’s weight is under the limit.

Funding and Trials

Coverage details vary by plan, so contact your insurance provider early. Medicare Part B covers a power wheelchair only if a face-to-face examination is conducted and documented to show your need; complex rehabilitation chairs often require a specialist evaluation. Private insurers typically use the term “letter of medical necessity.” You can appeal denials, and thorough paperwork from your therapist can support your case.

Sometimes, when coverage is inadequate, state vocational rehabilitation agencies provide funding for employment support equipment. The Christopher & Dana Reeve Foundation’s Paralysis Resource Center can provide information on local programs. You can use equipment from regional spinal cord injury associations, but a professional must fit it before you take it.

Making Your Decision

Selecting a mobility device for spinal cord injury is best done with professional guidance. Start with your injury level, try a few options, protect your skin and shoulders, and make sure the chair fits in your home and vehicle. Check the option annually as your body and situation will evolve. With thoughtful evaluation and planning, you may choose equipment that helps you maintain independence for many years.

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