The chair is also like a pair of shoes -- there are distinct styles for special purposes, such as tennis or rugged trail use. If the fit isn't just right the user can't get comfortable and therefore can't achieve maximum function. Selecting the right chair, especially for a first-time wheelchair user, can be confusing. It's always a good idea to work with an occupational therapist (OT) who has experience with various kinds of wheelchairs. Many people choose their first chair because it was the one the insurance company was willing to pay for. The second one, though, is often selected because of styling, performance or other features.
•	The Pivot Dual Lever Drive replaces the quick-release rear wheels of any manual wheelchair; the Pivot comes with five levels of effort.
•	The Wijit Wheelchair lets the user push half as much as they usually do with a conventional wheelchair.
Twenty years or so ago, the power chair market was limited to just a few brands and models. Innovation has expanded the choices toward lighter, more powerful and much faster chairs. Most power chairs have rear-wheel drive, but mid-wheel and front-wheel drives have grabbed a share of the market. These are easier to turn and are quite nimble in tight spaces. There are models that are rugged and off-road ready; there are models that fold for travel; there are power chairs that can be customized for the most complex needs of people with paralysis. The right choice for each user is based on much more than style.
Need a new chair? You'll need to work with your funding sources, your OT and seating specialists, and your rehab supplier to get the best chair for your needs, and to defend your choice in the event of a reimbursement denial. To be sure, reimbursement is a key issue for all durable medical equipment purchases, especially for high-ticket items such as power chairs (which can cost more than a fully loaded Honda). The power-mobility industry has been the target of federal investigations into Medicare fraud.
Absorbent glass mat (AGM) batteries, like gel units, don't require maintenance and are fine for flying. They are very rugged, hold a charge better and last twice as long as standard lead-acid batteries. They are also the most expensive. Wheelchair batteries are sometimes the same as those used in the boating industry. If you pay for your own batteries out-of-pocket, you might save money by purchasing marine deep-cycle batteries. Be sure and check with your chair manufacturer's specifications.
A rider's range will increase dramatically using the assist, saving personal energy and wear and tear on the rotator cuffs. What's more, the chair doesn't look like a beefed-up power unit: It looks more or less “normal.” SmartDrive is a newer power assist option for manual chairs. This is a portable drive wheel (11 pounds) that pretty easily hooks on to the base of the chair; a battery fits under the seat.
Another option, this one without batteries or motors, MagicWheels, two-gear wheelchair wheels that have a lower gear for hills when you need it, with a click of the hub, at about a third the cost of power assist units. If users emphasize the potential increased health benefits of power assist devices (saving the shoulders), many insurance companies will cover them, including Medicare.
For a list of available cushions and seating systems see AbleData or USA TechGuide, which offers reviews of many wheelchair-related products. It's best to work with a seating and positioning expert to pick the right product.
One type of chair, called “tilt in space,” changes a person's orientation while maintaining fixed hip, knee and ankle angles. In effect, the whole seat tilts. The other chair option is a recline system, which basically changes the seat-to-back angle, flattening out the back of the chair and, in some cases, raising the legs to form a flat surface. A tilt system redistributes pressure from the buttocks and posterior thighs to the posterior trunk and head. The system maintains posture and prevents sheering (the friction on tissues from dragging across a surface). A drawback: If a user sits at a workstation, for example, the tilt requires that he or she move back from the table to avoid hitting it with the knees or footrests.
If you are looking for more information on wheelchairs or have a specific question, our information specialists are available business weekdays, Monday through Friday, toll-free at 800-539-7309 from 9:00 am to 5:00 pm ET. Additionally, the Reeve Foundation maintains fact sheets on wheelchairs with additional resources from trusted Reeve Foundation sources. Check out our repository of fact sheets on hundreds of topics ranging from state resources to secondary complications of paralysis.
•	USA TechGuide is a guide to wheelchairs and ¬assistive technology, including numerous reviews of mobility gear. Sponsored by United Spinal Association.
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