Using a manual mobility device of today is not only about propelling the chair, but also living within the chair.

That includes transfers in and out of the chair, going up and down curbs and other obstacles, dressing and toileting using the chair, and being physically comfortable and supported in the chair for many hours a day. It includes being comfortable and confident with how you look to yourself and others while seated in your chair.

It also means going through a process of learning necessary skills to function proficiently in the chair. How much practice is needed to become proficient in a wheelchair? Even with all the technology we have available, there is still a learning curve to developing the skills to be completely independent in the manual wheelchair of the 21st century.

It puzzles me that during rehabilitation, a person who had an amputation and receives a new prosthetic limb gets training daily on how to walk on that limb… but someone who will be a full-time wheelchair user seldom receives that same daily instruction on how to use this device.

Even cane and crutch ambulators get more training than wheelchair users get.

Why Wheelchair Skills Matter

Having proficient wheelchair skills can help rebuild self-esteem after an injury, or even after time spent in a chair that really is not designed for independence. Skills in a modern-day wheelchair will also build confidence in the user to take on more worldly challenges.

I’m not speaking of playing sports necessarily, but taking on the roles of work, school, family, and all the other things our able-bodied counterparts do every day. With better mobility, there is very little a person cannot do.

We cannot listen to the well-intentioned naysayers all around us because they will, many times, hold us back from a challenge. They want to help protect us, but at the same time they may not allow us successes.

Today we see far more people on the streets and in the malls using modern-day wheelchairs. Many of these folks are also gainfully employed. In the past, before independence was practical and achievable, many full-time chair users were content to receive a government disability payment every month for their financial support, and many others also soon realized that this subsidy would doom them to a poverty-level existence at best. Although the unemployment level for people with mobility issues is high, it has dropped in relative terms from past years partly because of increased self-esteem and confidence. That is what today’s wheeled prosthetic can provide.

Is There a Wheelchair Bias?

Getting the best tailored fit of today’s manual chair can be quite a challenge, though. We are dealing with insurance companies that, for the most part, do not understand that providing the consumer a complex, customized wheelchair is best for everyone involved: user, therapist, dealer and the insurance company itself.

How many times do they buy a prosthetic limb or a set of braces, only to see them stand in the closet because of a lack of functionality or discomfort? Then the user tries to get a decent wheelchair to use, and can’t because of cost.

The irony is that the cost of the limb or set of braces is usually 10 times the cost of the high-quality chair. Is this a subtle bias because the user is standing upright with a prosthetic as opposed to sitting in a wheeled prosthetic?

Many users are much more functional in a chair than on their feet today. I once used braces and crutches and was pretty good with that setup, but not nearly as “functional” as I am in a chair. What is the goal here? Is it to stand, or is it to have optimal function in a chairfriendly world?

Since the Americans with Disabilities Act was passed, the environment is much more user friendly for us all. Universal design has become more the norm, and it benefits everyone ambulating or wheeling through life. Shouldn’t the outcome for rehabilitation be to function as independently as possible? As far as I know, there isn’t any requirement that one be on his or her feet to do this.

So why not in the future focus on one’s ability rather than disability? As we see daily, and have seen in the recent past, many people who use wheeled mobility independently have unique abilities. In today’s world, many chair users have gone far beyond expectations, based upon old-world thinking, and the rehabilitation outcome is far more positive than ever before. This seems to be a model for the newer chair user to aspire to, and a model for the rehabilitation professional to bring to clinic.