In Praise of the Manual Wheelchair

In our February issue, we talked about manual wheelchair propulsion and the physical toll it can take on manual chair users over their lifetimes. The article discussed frequency of pushing, the anatomy of the shoulder joint, the way in which manual chair users push the wheel, and lifestyle/environmental issues as possible causes for shoulder pain and injury.

Marty Ball, VP of sales for manual chair manufacturer TiLite, was concerned that the story would “serve only to drive more people to power chairs, and more therapists to be wary of prescribing manual chairs for those who can use them properly.” A long-time manual wheelchair user himself, Ball offers his opinion on manual wheelchair propulsion, along with personal insight into the propulsion experience.

If we look at the chairs of yesteryear, there are a few glaring issues that have been found to cause the independent user upper-body stress.

Let’s take the 50-pound-plus chair I grew up with. One factor, of course, is the weight. When we use a wheelchair, we don’t ordinarily just sustain momentum. We start, stop, turn, reverse, etc. Each time we overcome inertia (start to move), we put a level of stress on upper-body joints, especially the shoulders. If we spend all day in our chair, we do this many hundreds of times, causing tendons and muscles to tire.

It has been determined that from the day we start to use a manual chair, we begin the process of wearing out the shoulders. In those older-style chairs, the drivewheel axle was placed in a rearward position on the frame for stability. With the drivewheels behind the shoulders, it meant that we only had access to the front portion of the wheel for propelling, which caused us to strike the wheel many more times than we do in today’s multi-adjustable wheel positions.

In order to reduce the number of wheel strikes, we would “overreach” rearward to achieve a longer stroke, thus hyperextending our shoulders. Pulling through the arc of the wheel, moving a 50-lb.-plus chair with shoulders under stress, over and over again, could only accelerate the stresses on that shoulder.

We have since found that by moving the drivewheel forward to gain more range in propelling the wheels, we put far less strain on the shoulders. Additionally, we have reduced the weight of the wheelchair significantly, to less than half the weight of the earlier steel-chair models. The combination of these factors — and the customization of body mechanics, body position, advanced designs customized to the user — have reduced the wearing of joints, tearing of tendons and fatigue, and have prolonged independence.

Contributing Factors Besides the Chair
I’ve always been one who wants and tries to live as full a life as possible. In earlier days, there was no Americans with Disabilities Act, little accessibility, and fewer users to attempt to pursue life independently from a wheelchair. My view of life is that as far as I know we come through here but once, so let’s live life to its fullest. And so I do.

With little access to places I wanted to go in earlier days, I made it a point to get there anyway, sometimes doing transfers that were not supposed to be possible. Getting on smaller aircraft then meant that one had to crawl on or off the plane, so I did. There were no aisle chairs yet. But we always seemed to get wherever we wanted, not thinking about the wear and tear on our bodies.

In those early days too, there was great emphasis on brace- and crutch-walking during rehab. Looking back on that, I feel it was something that did great damage to my shoulders. That being said, walking for therapy is one thing, but expecting to brace-walk for function was not in the cards for any higher-level injury. We are getting CLOSER to seeing the futility of functional walking using braces and forearm crutches in this century.

The Benefits of Manual Chair Mobility
The benefits of using manual wheelchairs are many and varied. If I had agreed to use a power chair for daily mobility instead of a manual one, there would have been many activities in my life that would have gone unlived. My entire sports career would never have been, and all the enjoyment I experienced there, along with the many lifelong friends as well. That was about 40 years of my life and led me to the business career I continue to enjoy.

All travel would have had to be modified because of the size and weight of a power chair. My home, my automobile and international visits with friends could not have happened either, without compromise. And then there is the image issue. Many of us who have grown up using a manual chair will be faced with the prospect of switching to power at some point. Our entire image of ourselves will change along with our level of independence. Now that there are manual chairs that work along with us as we deteriorate, we can continue to maintain independence in a manual chair for many more years. The transfers are going to be the hardest part down that road.

Since earlier days of manual wheelchairs, when they were mostly cold-rolled steel, 50-lb.-plus behemoths, technology has allowed us to significantly improve mobility through varied materials and better geometry options. We who used the older-style chairs had to stress our bodies far more in those days than we do today. Unfortunately, there are still many chairs using some of the older technology, which for some users negates the possibility of better mobility as well as a more independent lifestyle.

When the chair user is forced to use one of the less advanced chairs, there will be more stress on the upper-body joints because of the poorer drivewheel position and weight of the chair. The shoulders take more punishment when trying to propel a maladjusted or non-adjusted heavy wheelchair.

In addition, there will be the problem of body transfers to and from the chair. It is not always possible to put the chair in the most convenient position when making a transfer, so unusual twisting and weight-bearing positions are sometimes the result and can cause stress to the shoulders, as well as wrists and elbows. The real world offers far more demanding transfer techniques than the trials at the rehab center, and chair choice can better facilitate less stressful transfers, as well. The 180-degree transfers are much harder and stressful than 90-degree ones. A little practice will help the user learn the best transfer style for himself or herself.

This article originally appeared in the June 2008 issue of Mobility Management.

About the Author

Marty Ball is the VP of sales for TiLite, based in Kennewick, Wash.

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