A proper wheelchair provides required comfort and necessary support. Transport chair, Geri chair, and electric chair are just some varieties of wheelchairs. With so many types of wheelchairs available in the market, it is crucial for people working in a hospital or a subacute care facility to find a proper wheelchair for thier patients. It becomes more challenging if you work with neuro patients like I do. The reason being, patients with neurological disorders change their presentation frequently due to change in tone and tightness. That is why a proper wheelchair evaluation is important. The aim of this article is to provide you with the basic information regarding different types of wheelchairs and their use.
Five reasons why wheelchair evaluation is important for physical therapists:
- Proper wheelchairs provide proper physical support and comfort
- Wheelchairs help to prevent skin breakdown by allowing right positioning/adaptive devices in the place like lateral support, contoured back, calf support etc.
- Good wheelchairs provide an appropriate sitting position to medically complex and prolonged bedridden patients.
- Comfortable wheelchairs allow socialization by enabling patients to move around. This will enhance the positive psychological state of mind.
- Wheelchairs serve as a means of strength and endurance training once a patient starts propelling the chair manually.
There are a variety of wheelchairs available in the market in different ranges from a transport chair to customized manual chair. There are also highly customized electrical chairs available for high spinal cord injuries or neurological disorders, and for patients who are cognizant but unable to walk.
Various Types of wheelchairs:
A transport chair is the most basic type of standard wheelchair. As the name suggests, transport chair can be used for transportation. These are for people who are unable to go up and down the steps, or walk long distances. Most chairs you see in hospitals, at airports, in communities etc are transport chairs.
Most of the wheelchairs that are sold in your big box retailers and online stores are considered standard wheelchairs. They are lightweight, easily fordable, and allow easy transport. These type of wheelchairs are also very convenient, as they can fit into compact spaces around the house. A Standard wheelchair is a good affordable choice for conditions ranging from short-term disability to those who can not ambulate at all.
High back recliner chair:
This is a standard wheelchair with higher back support and head support. As the name suggests, the back can recline in order to provide some relief after constant sitting upright. This chair is very useful for short-term rehab patients, who are not out of bed for maybe a week or ten days and have some cardiopulmonary or neurological disorder. It can also be used if the patient complains of back pain while in a chair for long period of time or needs to relieve pressure.
The above chairs are for comparatively high functioning individuals. a patient needs to be able to tolerate sitting upright safely and needs to have good trunk control. For example, without any signs and symptoms of orthostatic hypotension or other medical issues like a headache, fainting, nausea or vomiting, high respiration rate etc.
For more complex and physically involved patients, I usually evaluate them for one of the following chairs.
Tilt-n-space chairs give us an option of high customization. These also provide good support. It can recline all the way up to 120 degrees in cases where your patient is unable to tolerate upright sitting safely. Moreover, you can work on sitting tolerance and proper anatomical position gradually with these chairs. Some of these chairs have functions to just recline back or to elevate leg rests etc. In addition, it can be motorized for tilting features if your patient is cognizant to do so.
Geri chairs are highly comfortable chairs for very low functioning individuals. A Geri chair can recline all the way up to 180 degrees and will act like a recliner sofa. This is especially relevant to highly involved patients like those with severe traumatic brain injury, or anoxic brain injury. You can also add lateral support, arm tray, cushion, etc based on your patient’s needs.
Broda chairs are just like Geri chairs but with more cushioning on arms, legs and back areas. Patients with constant tremors or ataxia tend to have good results with these chairs.
This is an automatic power chair, which you can highly customize. Electric wheelchairs can be used in diagnosis like MS, TBI, high SCI, stroke etc. Working with the vendor, the customization of an electric wheelchair is based on a patient’s functional level.
For example, for a patient with good fine motor grasp, we can use a Joy Stick. You can have goal post for the patient with good gross motor control and wrist strength of 4 or above. For high SCI, you can have a head array, or sip and puff etc.
A few less common types of chairs you may have seen/heard about are scoop chairs, barten chairs (for bariatric patients), sports chairs, pediatric chairs etc. I do not talk too much about them here, as they are highly specialized. However, if you have specific questions, you can ask them in the comments section below or using the contact form, and I’ll try to provide you with additional details.
Accessories for Wheelchairs
You can accessorize wheelchairs with regular or elevating leg rests, long or short adjustable armrests, calf support, foot box, etc based on patient’s needs. If a patient has pressure ulcer or is prone to get wounds on his back/sacrum due to prolonged sitting, specialized cushions can be provided. A specialized cushion will alleviate some pressure from constant sitting. You can learn more about these accessories in detail in my post on wheelchair evaluation.
A patient’s physical and cognition level is the main factor that determines the type of the chair. Other factors, like medical complexity, discharge goals, caregiver or available help at home, type of home, and home environment also affect the type of wheelchair a physical therapist is going to recommend.