Clinically Speaking

Choosing the Correct Power Base for Your Consumer

One of the biggest challenges therapists and providers have is matching the correct power base to a consumer’s needs. The team needs to consider the activities of daily life the person will use the power base for and what environments and challenges the wheelchair must overcome in order to meet the everyday use of the consumer.

One of the worst outcomes from evaluations are consumers becoming dissatisfied with their power wheelchairs because the chairs don’t meet their needs, don’t fit into the transportation they use or don’t fit through the many different doors they must go through on a daily basis. It is very easy to miss one of these important factors.

We need to be very thorough in every evaluation we perform to be sure that all the consumer’s needs are explored and evaluated. The best approach to evaluation for a power base is to educate consumers so they alone or with their team can make an educated decision on which power base meets their needs the best.

There are many things to educate consumers on throughout the evaluation process. The list includes drive-wheel configuration, accessories and seating components that are needed to meet their needs. Each of these items is impacted by the environmental and functional needs the individual has.

Drive-Wheel Configuration

Each drive-wheel configuration comes with its own set of advantages and disadvantages. Consumers will often decide what is an advantage or disadvantage specifically to where they use the wheelchair.

For instance, if consumers have a fully accessible house with a very open concept floor plan, then turning radius may not be an advantage or disadvantage for them because any of the drivewheel configurations will work in their home environment. But as the evaluator, we really have to examine things with a broader view. Although their home environments may be very accessible and easy to maneuver around, what happens when they go out into the community?

When evaluating for drive-wheel configuration, we need to look at consumers’ multiple environments, including inside their homes and all of the other environments where the wheelchairs will be used. These environments may include home, indoors and outdoors, work, school, the grocery store, mall, vehicle used for transportation (private and public), and other locations they may venture into. Many of these environments may have different types of terrain the wheelchair must handle as well.

In order to look at each drive-wheel configuration during an evaluation, the evaluator must have a good knowledge of what the pros and cons are of each.

Front-Wheel Drive

This drive-wheel configuration is known for having a tight turning radius for maneuvering around corners, but consumers must be aware of the rear part of the wheelchair because it needs to swing as they are making the corner. Front-wheel drive also climbs obstacles very well because the larger drive wheel is in the front of the wheelchair.

If consumers have tight hamstrings and their legs need to be positioned tight to the seating and wheelbase, front-wheel drive is ideal because this drive-wheel configuration does not have front caster wheels, allowing for greater ease with positioning the legs closer to the power base. If you have a person whose center of gravity needs to be positioned forward on the wheelbase, front-wheel drive can be a very stable platform because his or her weight is being placed over the drive wheels, which will assist with traction while driving.

Mid-Wheel Drive

This drive-wheel configuration is known to be useful for consumers with very tight spaces in their homes and who have the need for good maneuverability. A mid-wheel drive power wheelchair can turn in a 360° circle using only the footprint of the wheelchair (from the consumer’s feet to the rear caster wheels). This allows maneuverability in very tight, confined spaces.

This drive-wheel configuration tends to be very intuitive for individuals who have previously been ambulatory, because the midwheel drive wheelchairs drive much like we walk. These days it is very common to have a six-wheels-on-the-ground design, as that provides the consumer with very good stability while driving. When it comes to outdoor use, mid-wheel drive tends to track across a side slope very well, as the drive wheel is in the center of the power base.

Rear-Wheel Drive

This drive-wheel configuration is best known for having tracking at higher speeds. These power bases will track very straight with the least amount of fishtailing of any of the power bases. This drivewheel configuration also handles aggressive terrain very well due to its larger front caster wheels. For stability in a power base, rearwheel drive provides very good stability. Many users who drive with non-proportional input devices find rear-wheel drive the easiest to control, so it can be very much a personal preference.

Again, each drive-wheel configuration has its own advantages. Many of the advantages and disadvantages need to be discussed with the consumer for the consumer to make the best-educated decision as to what drive-wheel configuration is most important to his or her daily routine.

In addition to drive-wheel configuration, manufacturers offer different components to their power bases to enhance their performance.

Some of these additional features include suspension, higherspeed motors, tracking technology, larger caster wheels and electronics. Each of these additional features lends to the overall performance of the power base and will be more important to some consumers than others.

And What Will Happen in the Future?

When choosing a power wheelchair base with a consumer, we not only need to consider the environment and what the drivewheel configuration provides, but also what the consumer’s future may hold in store.

Is his or her diagnosis progressive, or is he or she expected to remain stable? These factors will influence decisions regarding expandable or non-expandable electronics and whether the power base may need to accept a power seating system for positioning, pressure management and management of other medical needs.

Choosing the correct mobility base is a very big decision, and whatever is chosen must meet the consumer’s needs for many years to come. It is a decision that we as therapists and ATPs have influence over, but our true job should always be not to decide for consumers, but to be sure they have been properly educated in order to make the best informed decisions for themselves.

This article originally appeared in the March 2013 issue of Mobility Management.

About the Author

Jay Doherty, OTR, ATP, is the clinical education manager for Pride Mobility Products Corp., Exeter, Pa. Jay can be reached via e-mail at jdoherty@pridemobility.com or by calling (800) 800-8586.

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