Clinically Speaking

Ultralights: The Journey So Far & What’s Up Next

With due respect to the interviewees in Laurie Watanabe’s article “Clash of the Titans” (MM March 2010), I feel compelled to add a few thoughts of my own. I feel I have enough experience as a consumer, a two-time athletic Hall of Famer, and an industry person for 32 years who is likely the only person around who has used all of the materials wheelchairs have been made of.

Before Space-Age Metals

Briefly, my first wheelchair was made of wood! I was a product of the polio era who was never expected to function independently. Very few did in the ‘40s, unless the damage from the disease was very minimal. There was still no vaccine then, and the prognosis for severe paralytic cases was institutionalization.

Fortunately for me, my father would have none of that pity stuff, so I was encouraged to continue to try functioning with braces and crutches, or to use a wheelchair. Wooden chairs were about 70 pounds then, as was I, and a new kind of chair that folded and was made of cold rolled steel had just been introduced. It was only in the neighborhood of 55 pounds.

So three years later, I was allowed to return home to my family as long as I continued to use my heavy, steel leg braces. Heavy, steel folding wheelchairs were the only chairs around until creative athletes began to build their own style of chairs, or modify the folding ones. Twenty years later, after playing basketball in those clunkers, I saw the first chair that made sense: the Quadra chair being used by Jeff Minnebraker, recreation department head from Rancho Los Amigos Hospital, Downey, Calif. That was the beginning of the current ultralight wheelchair era, and the emergence of independence for wheelchair users.

In Defense of Titanium

We’ve come a long way, baby, and now even the academics have become quite involved in trying to construct a more perfect answer to wheeled mobility.

Technology has led us away from the “Everest & Jennings era” and brought us to the “Clash of the Titans” era. Personally, I have spent time with a number of manufacturers of wheelchairs, after a brief four years as a provider. Industry total: 32 years. My focus has been to bring better daily mobility to those who need it. During time with Motion Designs, Küschall, Medical Composite Technology, Invacare Corp., E&J, and TiSport LLC, I worked with many, sold many, and used many different frame materials.

In my opinion, it is the outcome that is most important when offering someone a new wheelchair. At my age it is even more critical than it has ever been to have the most functional manual daily wheelchair. As a chair user — and I applaud both Josh Anderson (TiLite) and Jim Black (Top End) for their contributions to the “Clash” — I believe the disabled consumer and the academics each have their place in the discussion of materials. But in the end, the consumer is the only one who can say with conviction that one chair can perform better than another. As smart as some designers or engineers are, unless they are disabled wheelchair users, they cannot feel the little nuances felt by full-time, long-term users.

Oh yes, weight is one important component of performance, but there are others as well. Tom Whelan (Sunrise Medical) pointed out that hydroforming has recently been employed in the construction of some wheelchairs, but is only done with aluminum. It is also only done when constructing a modular frame. Titanium can be “double butted” for lighter construction, which is quite similar to the method Tom speaks of. But technology has allowed our industry to offer individually designed and manufactured “made-to-measure” chairs rather than modular-only frames.

Because of this, we are closer to the chair of today being more like a prosthetic, and fitting the consumer better than ever before. In addition to going more toward a chair conformed to one’s body, a frame with fewer pieces, a frame with fewer holes in it, we have also created a more durable piece of equipment.

In another area of the “Clash” article, it was mentioned that a user typically wouldn’t expect to use a chair for 10 years because of emerging technologies, but he or she would like not to have frame or component failures either, which can happen at any time. Wheelchair durability is a major factor when someone leads an active life. Titanium is a non-corrosive material, so will not “rust” or otherwise corrode during its lifetime. In addition, a better-fit, custom-measured chair can be designed to offer less strain on the upper-body joints, tendons, and muscles and hopefully offer a greater manual chair lifetime to the user.

Jim Black makes a very good point when he speaks about the chair components, such as casters, drive wheels, seating
components, tires, etc. The modern wheelchair of today offers many choices to complete the whole package; it’s not just frame. So Jim’s point is very well taken. But we start with the frame, choose and add the component parts, adjust or manufacture to the user’s particular size, lifestyle, and method of wheeling and sitting, teach some basic skills of energy efficiency, wheeling techniques, and encourage practice, practice, practice!

Another thought came over me while sitting here typing out this note. I know of no user who has ever returned from a titanium to an aluminum chair, all other things being equal (well fit, similar components, etc.).

Putting the Consumer First

Cost is an issue, of course. Should we users settle, or compromise our mobility because of cost? There is a movement to change the general perception of the more active, even the potentially active wheelchair user. In fact many consumers (made) their annual visit to Congress in April (at the CELA event) to point out that rather than see high-end wheelchairs as something that “costs” taxpayers, they are an investment in the human potential a mobility-impaired person has.

If we can give the chair user back his or her independence, we can assure them of full participation in life again. All the things many people take for granted are possible for the chair user, too, given the proper chair and guidance. Self-esteem is regained, recreational pursuits are within reach, family life is enhanced, and employment is a very distinct possibility. Imagine that, someone who uses a wheelchair working and paying taxes.

So taking this thought to the next level, better reimbursement could actually pay for itself. Many other programs to assist in finding employment are already in existence, so now let’s see today’s user of fine, functional, attractive wheeled mobility equipment taking advantage of it all. Go take on life!

This article originally appeared in the June 2010 issue of Mobility Management.

About the Author

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

In Support of Upper-Extremity Positioning