Many low-level quadriplegics have sufficient arm strength to push a chair, perhaps aided by handrims with knobs which are easier to grasp than rims alone. Some of these riders use a manual wheelchair at all times, while others switch between manual and power wheelchairs, depending on distance, surface, whether they might need to be lifted up stairs, load the chair into a car, and other such criteria. You might use a power wheelchair to go to and from work, but use a manual wheelchair at home and at the office. College students often use a power wheelchair on campus, where they often need to travel considerable distances over hilly terrain. A blend of the two types could be the ideal strategy for your mobility. It is an approach that does not waste your energy or overuse your body.
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For manual wheelchairs, there are many choices that affect how easy it is to push the wheelchair, and how well it will coast so you don’t have to push as much. Proper maintenance is crucial, especially keeping the tires inflated and the frame tight. Modern adjustable wheelchairs require some attention to axle position, seat angle, back height, and other features that also influence the ease of wheeling. Lighter wheelchairs require less force to push, so those on the cusp should take the overall weight of the chair into account in their selection process.
Manual Wheelchairs
- Require adequate strength and balance to propel
- More fatiguing for distances and going up slopes
- For those with sufficient tone and balance, can contribute to aerobic and muscular health
- Easier to transport
- Rider can be lifted up stairs while in the chair
- Lower maintenance risk from fewer parts
- Not dependent on charging or potential failure of batteries
- Typically narrower and easier to make precise movements in small spaces
Powered Wheelchairs
- Allows those with little strength and stamina to travel distances
- Can contribute to weakening without a supplemental exercise program
- Much heavier and more difficult to transport
- Higher maintenance risk due to greater complexity
- More costly to purchase and service
- Great sophistication in programming of controls
- Variety of types – mid/front/rear-wheel drives – for personal preferences and terrain
- Can include tilt and/or recline systems for pressure relief if rider is unable to lift their own body
A new trend beginning to appear is the concept of "power-assist," in which motors and programmed sensors are added to a manual wheelchair. The system supplement the pushing of the wheels in order to reduce the amount of physical exertion required to push the chair. This holds some promise for the abovementioned borderline quadriplegic who might be able to continue to use a manual chair without risk of straining their shoulder tissues.
Pneumatic Wheelchair Tires
These are commonly made of rubber and require an inner tube which is filled with air to a recommended pressure (pounds per square inch or psi). If you want higher performance, a combined tube and tire (e.g. sew-up) or a Kevlar® (material used to make bulletproof vests) tire with a high-pressure tube (e.g., 180 psi) may be more desirable. Pneumatic tires are widely used on most manual and power wheelchairs because they are generally lighter, shock-absorbing and offer good traction on most terrain types.
While pneumatic wheelchair tires are the most popular kind, they require the highest degree of maintenance. This is because the air insert consists of a thin liner that can be easily punctured by thorns, nails or other sharp objects that penetrate through the wheelchair tire. With these tires, you must always be prepared for encountering a flat-tire, especially if you spend a lot of time outdoors. You can learn to change your own tire, or you can go to a local bike-shop, attendant or friend who is familiar with bike and/or wheelchair maintenance. In addition, you must keep a close eye on maintaining the appropriate pressure level since air tends to leak out of the pneumatic tires over time. Wheelchair Tires need to be replaced when the tread on the tires have become worn or cracked. If the inner air tubes have been punctured, they can be reused if you patch the tear with a "patch kit" but should be replaced every couple months to reduce the incidence of flats due to wear.
Puncture-Proof Wheelchair Tires
These are made of rubber or plastic (e.g., usually polyurethane). The rubber puncture-proof wheelchair tires are similar to the pneumatic kind, but the inner tube consists of a solid material such as foam, plastic or rubber. These wheelchair tires are essentially flat-free and require less maintenance then the pneumatic rubber tires. However, a single solid insert is generally heavier by an average of 1.5 times that of a single pneumatic insert. The combined difference in weight between having two pneumatic inserts and two solid inserts is approximately two to four pounds depending on the material. While this doesn’t seem like very much, this additional weight can have a significant impact when it comes to transporting and propelling the wheelchair. They are also stiffer (not as shock-absorbing) and tend not to grip the ground as well. These features may adversely affect the performance of your wheelchair if you spend time outdoors in slippery conditions, if you commonly travel up and down inclined surfaces and/or if you propel upon rough and/or rocky terrain.
Replacing a solid insert can be very difficult to do on your own and should be taken to an authorized service center. Unfortunately servicing a wheelchair can be expensive. Most wheelchair dealers will charge by the hour and the cost ranges from $30 to $50 per hour. Changing a wheelchair tire with a solid insert takes a little longer than a pneumatic insert so you can expect the cost for service to be higher. Bicycle shops can also provide repair or installation services on most wheelchair wheels and tires and are generally more economical. Labor costs are around $5 to $10 to change an insert.
There are also puncture-proof wheelchair tires that consist of a solid plastic (no inserts). These tires are generally the least expensive but are also low performance, greatly reducing your comfort and can become damaged rather easily. Solid plastic tires are commonly found on depot (hospital) wheelchairs that are designed for indoor usage.
New technologies have enabled puncture-proof wheelchair tires to become more lightweight and comfortable for the user while still providing for longer wear times. These tires typically are constructed of a semi-pneumatic foam and/or rubber combination and come in various tread designs and sizes.
Pneumatic tires and tubes are the most inexpensive combination to purchase. For a standard 24" x 1 3/8" or 1 1/4" tire (most common rear tire size for self-propelling manual wheelchairs) prices range from $10 to $45 per tire and mostly depends on the materials they’re made of. The more inexpensive tires are made of a lower grade rubber with simple wire reinforcing bead (holds the tire inside the rim edges). The more expensive tires are made out of a higher quality rubber while reinforcing on the sidewalls and bead is made out of a Kevlar® material. Tires with heavy tread and high-pressure tires tend to be more expensive also. The costs of pneumatic tubes also depend on material. A standard rubber tube can cost anywhere from $3 to $7. A pneumatic tube consisting of a higher-grade lighter-weight material such as latex is around $20 each. The solid and semi-pneumatic tires and inserts are in the range of $10 to $50 each. In general, puncture-proof inserts made of hard plastic are cheaper than those made of foam.
Wheelchair Tires are available in many different tread designs and widths to accommodate almost any type of terrain, as well as your mobility needs. Treads range from very smooth to extremely knobby, such as those typically seen on high performance mountain bikes. The smoother the tread and the skinnier the tire, the less rolling resistance you will have. The lesser the resistance, the lesser the force or energy that is required to push your wheelchair. If you spend a majority of time indoors, a smooth to lightly treaded skinny tire is most desirable. However, if you spend a lot of time outdoors, a wider tire with a medium knobby tread is more appropriate so you have better traction on rough surfaces. There are special tread designs and widths available for traversing over snow, dirt, turf and grass.
Power wheelchair users tend to have medium treads and thicker tires on all the wheels to accommodate many different surfaces and the weight of the wheelchair/user. Smooth treads aren’t a consideration since rolling resistance is not a problem when the wheelchair is powered with electronics verses "human" power.
The most common rear tire diameters for manual wheelchairs are 22, 24, and 26 inches for adults. Tire sizes for child wheelchairs and power wheelchairs are smaller. Many manual wheelchairs are equipped to support only a couple different wheel diameters. The most appropriate diameter is determined by how long your arms are and how high (or low) you sit in your chair. You should be able to easily reach the entire upper half of the pushrim without bending forward, without hunching your shoulders, and without flexing your elbow too far outward.
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