Reinventing the wheel: form, function, and your first wheelchair

[kaberett]

The proximate impetus to write this is that I'm trying to get back into the swing of technical, information-dense long-form writing. The motivation with respect to content, however, is that there's a whole lot of information about all this stuff and I found it utterly overwhelming when I was first seriously looking at mobility aids, especially in a cultural context that is hellbent on insisting that it's far more important that we look "normal" than that we be comfortable or capable. Form over function, as applied to people, is something that makes me particularly cross. Ergo.

The focus of this guide is manual wheelchairs for everyday active independent use by people who can stand and walk to some extent.

Contents

• Orientation

  • Price points
    
  • There are lots of correct choices
  
  

• Decisions

  • Materials
    
  • Frame
    
  • Footplates
    
  • Wheels
    
  • Seating
    
  • Additional features
  
  

• Process

  • Measurements
    
  • Acquisition
  
  

• Recommendations

  • Accessories
    
  • Aspirational
  
  

• End notes

Orientation: price points

This section is about the cost of new wheelchairs. Buying new is not the only option: if you buy second-hand, you'll be able to spend £300 or less on a chair that would set you back over £2000 if new. (For more discussion on this, see Process: Acquisition.)

The first thing you should know is that wheelchairs are expensive. The cheapest ones available are the type the NHS fobs you off with if you don't go into your appointment with Wheelchair Services knowing how to argue, and are the kind you'll find in supermarkets: steel, folding, immovable armrests, swing footplates. They're about £300 new, they weigh a tonne, and they are absolutely not designed for solo active use: it's assumed you'll have someone pushing you, or at worst that you'll be using it in the kind of environment a supermarket provides; that is to say, on completely smooth, completely level, completely dry polished surfaces. In general, I very strongly suggest that people not buy them: if you're wanting to do any kind of active solo use you are much better off spending this amount of money on something decent second- or third-hand via eBay (see Acquisition). I can't self-propel more than about 20m at once in these on anything approaching realistic terrain, and even that much makes an utter mess of my RSI; they're deliberately set up so that it's almost impossible to pop a wheelie in them without actually breaking them, which makes it functionally impossible to get over small lips or up small kerbs (and that does include most dropped kerbs) independently. I'm much better off walking with sticks under all circumstances where I want any degree of independence. They are *sometimes* better than walking if I have someone to push me, but firstly even then they're so wobbly/creaky/jarring that they mess my hips and lower back up something dreadful, and secondly I utterly loathe having other people push me because it's incredibly intimate and vulnerable.

The next price point for new chairs is around £2000. For this, you'll get a partially customised-to-you fit and set-up; good lateral stability; lightness; manoeuverability; and the possibility for actual comfort.

From around £5000 you can start getting a fully customised frame. I've no experience with this; most people won't need one; it is probably worth waiting until your second chair, when you'll have a better idea of what you want.


These prices are for frame + standard wheels only. You can get a lot more expensive a lot more quickly with add-ons (discussed variously in Decisions and Recommendations); the one thing you really do need to budget for is seating. If you are intending to use a chair for anything more than very brief transfers, you will need a proper supportive cushion; my chair cushions cost around £350. This is discussed in more detail in the relevant subsection.

Orientation: there are lots of correct choices

Chairs are pretty much endlessly customisable. The key point is this: provided you get something in approximately the right size that's not made out of steel, you'll be pretty well sorted. Everything from there on up is a bonus; it's completely fine to decide you can't handle the decision-making, and go with what a friend or vendor recommends. To this end, I'll be stating my preferences very plainly throughout this document.

If at all possible, find a local friend in approximately your size, tell them you're looking into getting a chair, and ask them if they'd mind you sitting in theirs for half an hour to get an impression. (Be more careful about approaching strangers on this, but the first time I met davidgillon, at WorldCon, I let him try mine out. Once we've got chairs, a lot of us tend to the slightly evangelical - and quite a lot of us end up with more than one, and are willing to loan out our secondary chair while Wheelchair Services drag their feet, build time estimates increase, and you get comfortable with the idea that a chair will make a massive positive difference to your life.) What that will do straight off is give you an idea of what measurements mean, and what your preferences are in terms of a lot of the decision points below.

If you can't manage this, then everything's still fine. If you're buying from a physical vendor, they'll have you try out a bunch of different chairs and seating set-ups and will help you make decisions that way. It'll take longer than if you go in knowing what you're after, but there are lots of correct choices and you'll be absolutely fine.

Decisions: materials

To first approximation, you've got three options, which get more expensive as they get lighter: aluminium, titanium, and carbon fibre. The key thing to bear in mind when deciding which material to go for is what all else you're going to want to put on the chair: if you're aiming for something incredibly stripped-down, with ultra-light wheels and minimal seating (half-back, light cushion), then carbon fibre makes more sense than it does if you're sticking with heavy wheels and so on. My main chair is aluminium (it has 20kg of wheels and 5kg of seating on it); my dance chair is titanium & set up with light wheels: it weighs about 6kg all in.

There's the obvious exception to this - that you're wanting overall light as possible but for some reason need a specific heavy component, so you're trying to shave as much weight as possible off everything else - but I trust you to know if that's your situation.

Decisions: frame

Traditionally, you've had two basic choices on this one.

Folding wheelchairs are generally heavier and slightly more expensive, all other factors being equal; they generally provide a slightly less easy/comfortable ride, because the fact that they're folding reduces the lateral stability meaning some of the push you're putting into the wheels is going into sideways motion rather than all of it going forward; but they're a lot more convenient, in that you can fit them into most car boots, through awkward narrow gaps, and in that space behind the door where people are least likely to trip over it.

Rigid wheelchairs are lighter, more comfortable, and slightly less convenient. Some models have a back that folds down, which makes it easier to fit them in car boots; quick-release wheels and very minimalist frames mean that it's possible to whip the wheels off and drop the frame on a carseat in a way that isn't generally possible with folding chairs. You're pretty much stuck with the width, though, which can lead to Entertainment; I took the Caledonian Sleeper recently and got my dance chair (a 14" RGK) into a standard sleeper berth by taking off both the wheels then feeding it sideways through the doorway, wobbling it along the bends to get it in. An interesting (and unusual) option here is the Icon A1, a rigid wheelchair that's designed to let you change the geometry (including the width!) as your body and needs change.

And then as of fairly recently there's the hybrids. In the process of writing this up I've just discovered that RGK are doing a rigid chair that folds in utterly non-traditional ways to the point of FITTING IN AIRLINE OVERHEAD LOCKERS holy crap I want three, um, where was I, right, okay, this is astonishingly innovative and elegant design and is not at all how normal folding-to-rigid works, in that it looks to be laterally rigid but folding everything else up, which immediately gets rid of a lot of the problems with folding chairs.

-- okay that unintended advertising break aside, the more trad version of fold-to-rigid chairs has the back fold down and the chair fold along the centre line, giving you something much narrower and smaller. What "fold-to-rigid" means is that the chair's been engineered such that once folded out it locks into place and gives you lateral rigidity; there are basically two of these on the market, the Küschall Champion (my main chair) and the Quickie Xenon family. I like my Champion: it's got more moving parts and thus more that can break (it's no fun at all if you manage to shear the bolt in the crossbar), but it's holding up well to some honestly pretty rough use, nothing's gone wrong that can't be fixed, and it's a good comfortable ride. Relatively recently on the market are two fold-to-rigid chairs by Progeo: the Yoga (yes, I know, sorry), and the Tekna Advance, which has a similar mechanism to the Quickie Xenon.


The guiding questions for this section boil down to: does your life contain any particularly awkward doorways? Do you have sufficient storage space to keep a chair out at all times? And how much time do you spend travelling by car or taxi? (My Champion I can fit into the boot of any taxi, because it folds; with the RGK, the dance chair, I'm more likely to need to specifically request a saloon car or big black cab, which can add significantly to waiting times.)

Decisions: footplates

As in, the bit your feet rest on. Something to think about in addition to style is position: you can have the downpipes at 70 degrees or 90 degrees (the latter means your legs are more tucked in and you've consequently got a smaller turning circle; you might find the former more comfortable; this one's super personal), and you can then choose whether the footplate (if you have one) is mounted "forward" or "backward" relative to its supports (roughly speaking, a forward mount means your feet stick out more and your turning circle's slightly larger).

None. Something that doesn't get talked about much and doesn't really fit into the general public's idea of How Wheelchairs Work is that you can totally foot-propel -- that is, you can propel yourself not by pushing on your wheels with your hands but by walking your feet along the ground while seated. It's good to know going in if this is what you're likely to want, because it means you'll want a smaller height between the floor & the seat than if you were intending to have a footrest in place. You're also likely to want a shorter cushion length and a minimal seat angle, to let you maximise your propelling efficiency.

Separate; folding. Make it marginally easier to sit down & stand up - you can kick them out the way for that part of the process - and mean foot propelling's still reasonably easy should you decide you want it. More moving parts meaning more likely to develop Problems, and by my understanding they have a tendency to wander a bit. Also means you're more restricted in where your feet can be relative to each other without falling down a gap. (There's also the option here of swing-away, where footplates and support structures fold round to the side to give you even more space to stand/sit; most high-end chairs don't offer swing-away as an option, to the best of my knowledge, because of how much weight they add. Nonetheless, if you do get swing-away you can get footplate variants that allow you to keep a leg elevated; again, this increases weight and decreases manoueverability.)

Single; fixed. This is what I've got on all my chairs and is my strong preference. In addition to meaning I can move my feet whereever, which is a significant bonus to me in terms of comfort, it's an additional surface to dump bags on if I then steady them between my feet or calves. A single fixed footplate is required if you want to add on a Freewheel (see Recommendations: Aspirational).

Decisions: wheels

You're going to have two sets of wheels, front casters and rear wheels.

Front casters

The main thing to decide here is what diameter you want. Standard sizes are 3", 4" and 5"; rarely 6". The trade-off is that smaller diameters give you greater manoeuverability and a smaller turning circle, but they're also more prone to things like catching on uneven paving slabs or in ruts (they can't just roll over the top as easily: a jump that wouldn't bother a 5" caster is a much greater proportion of the diameter of a 3" caster) and tripping you up, requiring keeping a much more careful eye on where you're going. I suggest starting with 5" and moving down as you get comfortable - this is something that can be changed trivially as and when you wear out bearings and need to swap them out anyway. I have 4" casters on my chairs and manage to throw myself forwards out of the dance chair about once a week if I'm travelling in unfamiliar places (so am less familiar with the surfaces), particularly if for example I'm bimbling along at a fair clip and chatting to someone.

There's various high-tech options here, but unless you're putting together a sports chair or going for Frog Legs (see Recommendations: Aspirational) this isn't something you need to think about further.

Rear wheels

Wheelchair rear wheels are fundamentally the same thing as higher-end bicycle wheels, with the addition of holes in the rim to bolt the pushrim onto. The standard diameter is 24"; if you're especially tall, you might want 25" or 26" wheels. Conversely, if you're particularly short you might want to go down to 22". There's an increasing variety on the market, from Spinergy Spox (the standard lighweight wheel) through to the Loopwheel (integral suspension!), which I haven't tried but about which I hear good things.

Tyres. You've got the option of solid or pneumatic. Solid are rubber all the way through, heavy, more uncomfortable (they have less give), impossible to puncture, and don't need topping up. Pneumatic are much lighter, more comfortable, more maintenance, and run the risk of punctures. There's also the option on gel-filled, which give you some suspension, are intermediate in weight, and are self-sealing for minor punctures but very messy for major ones. I prefer pneumatic; as with the wheels themselves, you're looking at market overlap with high-end bicycle parts. I use Schwalbe Marathon Plus tyres on my chair -- they're sort of the default, not least because they're Kevlar lined -- and I've not had a puncture yet. (Bear in mind that wheelchair wheels tend to be a slightly unusual size relative to bike wheels -- 24"x1" is standard -- so you're likely to need to order replacement tyres & inners in to your local bike shop, rather than their just being in stock.)

Pushrims. Whatever wheels you get will probably come with standard pushrims attached. These are of middling diameter and are usually aluminium, though there are some impressive engineering feats going on here -- particularly the Surge handrims, which have an oval (rather than circular) cross-section that some folk find more ergonomic, and which have textured surfaces to increase pushing efficiency. If you're wanting to make modifications, things to consider are:

• how many attachment points are there? (More attachment points means you're more likely to hit your hands on them while pushing.)
  
• what diameter do you need? (I prefer larger-diameter pushrims, because they require a looser hand position and set my RSI off less.)
  
• do you want a coating or cover on them? (Rubberised or silicone coatings/covers mean that the pushrims are less slippery in the wet and less cold in winter; I've acquired aftermarket slip-on covers for my main chair.)
  
• are you putting together an ultra-light chair? (If so, look into titanium or carbon fibre instead of aluminium.)
  
• do you actually want push rims at all? (some wheelchair users prefer to grasp the tyre/wheel rim directly; this reduces weight but makes for much dirtier and more calloused hands)

Weight. As with most other things on a chair, you've got a choice of materials and weights. Aluminium-steel wheels are weaker, so require more spokes, and are consequently heavier. Titanium and carbon-fibre wheels are stronger, lighter, and more expensive; the most popular brand so far as I can tell are Spinergy Spox range. At the bottom end, these will set you back in the vicinity of £200 each when new; I got mine second-hand with the dance chair.

Camber. This is how much the wheels deviate from vertical, when looked at edge-on. Sports chairs in particular tend to have fairly high amounts of camber, because greater camber gives greater lateral stability i.e. you're less likely to tip over sideways when executing tight turns while moving quickly, or on heavily sloped surfaces; it also makes pushing more ergonomic, and makes turns quicker. This is frequently adjustable at home, so you may be able to think about it later. The downside to higher cambers is that they make your wheelbase wider, so you've more restricted options when it comes to navigating narrow gaps; and because of the way the wheels make contact with the ground, you have less traction and get uneven tyre wear (unless you've got specialist tyres, which -- naturally -- cost more).

Decisions: seating

Cushions

Wheelchairs are not designed to be used with bare canvas as seating for anything more than very short transfers. The primary risk is developing pressure sores via long periods sat on hard surfaces; the secondary risk is that you'll be bloody uncomfortable without any shock absorbance; and, fundamentally, wheelchairs are set up assuming you'll be sat on a couple of inches of cushion, so if you're not the wheels will be in the wrong place relative to your hands/arms/shoulder and you'll do yourself a mischief that way.

Options range from £30 blocks of memory foam to specifically engineered multi-layered cushions that go for £350. (Wheelchair Services can be made to give you a voucher for seating on top of the voucher for the frame, if you're in the UK.) The Jay series of cushions are what I have (Jay Easy Visco and Jay Easy); I like them.

Back rests

Back rests are significantly more optional: here, bare canvas is a potentially viable option, and is what your chair will come with. The trade-offs you make here are range-of-motion against supportiveness.

Height. The taller the back, the more your shoulder motion is restricted but the more support you get. If you're not generally dealing with fatigue and do not generally benefit from having your upper body supported, you probably want a backrest that comes to your mid-back, just below your ribcage: enough to stop you slipping off backwards, but give you full range of motion in your upper body (and makes it easier to reach behind you, and so on). This is the kind of back I have on my dance chair; it's good for short trips and situations where it's okay if I get out and lie on the floor for a bit, but I can't use it e.g. at conferences where I have to be On and processing information and making appropriate social body language for twelve hours. My main chair has a back that comes up to my shoulders: this means I can't reach back as far and my pushing motion is more restricted, but it also means that I can sit up pretty much indefinitely. (The much-shorter back on my dance chair also means that I can duck under tree branches and barriers in a way I can't in my main chair: my effective height can be reduced by leaning my torso forward onto my legs. This is often more pleasant than doing the slalom through a roped-off corridor.)

Depth. The back on my main chair is a Jay J3 wheelchair back with deep contouring, i.e. it provides significant lateral support (restricting my motion from side to side) as well as providing straightforward back support. Again, the trade-off's range of movement versus fatigue; the back on my dance chair is very shallow.

Headrest. I have one on my main chair: it attaches to the backrest via a metal stem. Again, I've gone for deep rather than shallow contouring: my main chair is set up to minimise fatigue, which means minimising the amount of work I have to do to support my upper body and neck.

Decisions: additional features

There's lots of little tweaks you can make to customise the chair for your use-case. I've bundled them all together here, approximately alphabetically. Many of these are modifiable after-market, as you go along.

Anti-tips

How "tippy" a chair is (how high its centre of gravity is located) is important in that it determines how easy it is to do a wheelie -- and getting up and down kerbs, or over small bumps, requires you to do wheelies. The trade-off for tippiness (which can in many cases be adjusted) is ease-of-wheelie against risk-of-falling: the tippier the chair the easier manouevers are, but it is correspondingly easier to overbalance (particularly if you've put a heavy bag on your back) and fall over backwards. In practice I've only tipped out of my dance chair backwards twice (compared to catapaulting myself out of it forwards much more frequently); once you've established familiarty with your chair you're unlikely to fall this way.

However, it's possible to set your chair up with anti-tips (or anti-tippers). This is an additional small wheel (or pair of small wheels) that are engaged once you wheelie past a certain point, and catch you to prevent you going any further. As ever, the trade-off is in weight and cost (and manoueverability): no anti-tips is lightest and cheapest while giving you the most flexibility. Other options are having one anti-tip (slightly less stable/strong) or two (stronger, more stable, heaviest, most expensive).

I have no anti-tips on my dance chair, and e-motion anti-tips (see Reccommendations: Aspirational) on my main chair.

Arm rests

The very short version of my take on this is: no.

The slightly longer and more nuanced one is: absolutely do not get fixed arm rests; all they're good for is forcing you to hold your shoulders out at extension when you're pushing, restricting your range of motion, and getting in the way. If you have a chair with arm rests on, try taking them off and seeing how much of a difference it makes to how much pain you're in and how tired you get.

It is possible to get fold-away/swing-away arm rests, that can be flipped back while you're moving and flipped down while you're stationary. I still abhor the things; their primary purpose, as best I can tell, is to provide lateral stability, in exchange for higher cost and weight, restriction of motion, and increased difficulty getting up close to desks and tables. That's a job your seating should be doing, and doing much less obtrusively. Nonetheless, I do know people who have and like them; if you're acquiring a new chair, your vendor should be able to provide you more advice. I'm informed that they come much more into their own for people who don't walk substantially, but that's not something I have much experience with (yet).

Clothes/mud guards/fenders

Clothes guards are solid dividers that sit in between the edge of the seat cushion and the wheels, reducing the amount of dirt and damage your clothes suffer. Mud guards follow the same general principle, but have a top lip that sits above the tyre itself, which helps prevent looser clothing from coming into contact with tyres and also protects you from spray coming off wheels, particularly in damp weather. In terms of materials, titanium and carbon fibre are most common.

I have a strong preference for mud guards over clothes guards; they do preclude propulsion by grasping the wheel directly, but I've found clothes guards don't quite do a good enough job of keeping my trousers clean and in any case I prefer using pushrims.

Brakes

Wheelchair brakes are not used to help you slow down (you press your hands against the pushrims for that) -- they're designed to keep you stationary while parked (for example, while on public transport, or while sat anywhere where you don't have a perfectly level surface). With that in mind, you've got two main choices for format.

Push brakes. These are the most common: you have a solid bar that by default sits an inch or two away from your tyre, with a vertical handle that you push to bring it into contact with the tyre and lock it there. These are simple, require relatively little manual dexterity or maintenance, and can be very light; they run the risk of you bashing your hands into them while you're propelling, and possibly catching finger or especially thumb nails. I have these on my main chair and they're perfectly fine.

Scissor brakes. These fold away completely underneath your seat when not in use, so you absolutely cannot bash your hands against them or apply them accidentally while moving through awkward narrow spaces. They also have more moving parts and are generally a bit more finicky. I have them on the dance chair, and I like them perfectly well, but not enough to buy a set for the main chair too.

Hub and disc brakes. I don't know a great deal about these, and they are expensive -- but they can also be world-changing. ADI brakes are some of the best known; these substantially reduce the amount of strain on your hands and arms by providing bike-style braking.

Caster-cap clocks

There are caps above the bearing mechanisms for your front casters. These are normally covered by plain plastic caps, but you might well get offered the option of having an analogue clock set into one of them (for the price of £75 or so, naturally). The reason I'm mentioning them here is because I didn't, at the time I was putting in the order for my first chair, understand the point of them; their purpose is to prevent you having to stop moving in order to look at a watch or phone, and to allow you to avoid wearing a watch (if, like me, doing so aggravates your RSI). These can be added aftermarket if you decide that you want one in your life. I haven't, so far.

Leg strap

If you have one, this goes between the downpipes, behind your calves; they're adjustable in length. As a walker (i.e. someone who can walk) I was initially sort of baffled, but turn out to like the one on my main chair: it is nice that my feet can't slip backwards off the footplate, particularly when I'm using the chair's unofficial recline-in-space function (see Reccommendations: Aspirational). They're usually a free option when getting a chair and are trivially removable (they're essentially a strip of fabric with a couple of bits of velcro sewn on), so I'd suggest opting in and then removing it from the chair if it turns out you don't like it.

Push handles

If you are expecting to be doing mostly self-propulsion, the principal reason to have handles on your chair is so you've got something to sling a backpack over without risking the upholstery. The secondary reason is that it makes them marginally easier to haul up and down stairs, should that be a thing you end up needing to do.

If you are not expecting to be doing mostly self-propulsion, you probably care a bit about the comfort of your assistant(s), so might want to ask their input.

In either case you should be aware that if you're out alone and you have handles visible, people will grab hold of you and start shunting you around without first asking -- when you're going up the ramps onto trains, yes, but also total strangers who've decided you look like you're having trouble with a slope and the polite thing to do is walk up behind you unannounced and start pushing.

If your handles aren't visible, the number of people who do this drops significantly. You can achieve this by always having a bag on; by getting fold-down handles (I have these on my main chair); or by getting handles that you can remove and stow away (the handles on my dance chair unscrew and can get tucked into a bag if I'm not using them).

Another point, particularly if you're expecting to want other people to push you, is that handles can be height-adjustable. My dance chair's aren't; my main chair's are, but it takes a bit of fiddling round with Allen keys. It's worth asking for: it makes pushing much more ergonomic. The market also contains a variety of push handles that are height-adjustable without needing any tools -- "continuous height adjustment" is probably the keyword you want to look for.

Process: measurements

If you're buying new, you don't need to worry about this (unless, as in my case, your back is deceptively narrow, or something): your vendor will make sure things fit.

If you're buying second-hand, there's some key numbers it's good to have in mind to determine whether a chair will be comfortable enough to be worth buying. Wheelchair manufacturers often provide guides with pictures to these measurements.

The most important one is seat width. If your anatomy is such that your hips are wider than your shoulders, you want this to be as narrow as possible while remaining comfortable to sit in, because every extra inch that you give the seating is an extra inch that you've got to reach out sideways in order to self-propel. If your shoulders are wider than your hips, you can have more room without having a negative impact, but you absolutely want to avoid your seat being wider than your shoulders. Again, it's for the best if you can try sitting in a friend's chair to calibrate, but for reference: when seated and wearing typical trousers, placing the tape measure right up against the bend between my hips and my thighs, I measure across my lap as being approximately 15"; my dance chair is 14" across and definitely snug but not impossible.

Secondary is seat depth, which is also commonly listed for second-hand chairs. This is how far it is from the back (or the backrest) to the front edge of the seat (or seat cushion). Ideally you want this to be a fairly close match for the distance between the back of your hips and the back edge of your knee/calf when seated; you don't want it to be significantly larger; smaller is workable, but runs the risk that you'll end up having to work harder to push yourself because of where your shoulders are positioned relative to the wheels.

One final number to keep an eye out for is the height from the floor to the bottom of the seat. Bearing in mind that you'll be adding a couple of inches' height with your seat cushion, and that footplate height is typically adjustable across a range of several inches, you want this number to be very similar to the distance from your knee to your heel if you'll be foot-propelling and can remove the foot plate/rests, or a little longer if you'll be propelling manually (so you've a few inches' clearance between the footplate and the ground).

This is not a comprensive guide to measurements; it's a very quick-and-dirty overview. Detailed guides are available for free online.

Process: acquisition

I acquired my main chair via local Wheelchair Service and my dance chair via eBay. This is not intended to be a guide to navigating Wheelchair Services in the UK; the very short version is that your GP should fill out a basic form to refer you if you ask, and you will then have to do a lot of self-advocacy about how the basic £300 model isn't adequate for your needs (for example, you need a lightweight chair because of RSI or fatigue; you need a chair without arm-rests for reasons of RSI and manoueverability; and so on). However, once you have a voucher, Wheelchair Services can either procure the chair for you, or you can choose a vendor; I did the latter.

In the UK, the best places to go that I'm aware of are EPC Wheelchairs (my vendor), Gerald Simonds, and RGK (if you are after a custom-fit titanium chair). A lot of places say they do mobility aids and wheelchairs, and actually only offer things akin to the £300 basic model I can't use; you want a place that stocks the high-end brands. Invacare, Kueschall, Quickie, RGK, and TiLite are all brands that should be carried.

If you're getting a new chair, you'll be measured up, asked to choose from a dizzying array of options (most of which are covered above), and then you'll have to wait for some time while the chair is built; once it's been delivered to your vendor you'll go in for a tune-up and handover. This is the most expensive option, and takes the most time from the point of ordering; it's also the one that's going to get you the best and most comfortable possible fit. However, an awful lot can be done with seating after the fact, so it's not necessary to go all-new (semi-)custom-build for a comfortable chair.

In terms of buying second-hand, you've got a very great many choices.

Every vendor I listed (and most others you can find) will sell ex-demo models at up to 25% off list price. The worst they'll have had is a bunch of people sit in them and maybe being banged around the showroom a little; if you're very keen on having something approximately-new, and one comes up in exactly your size, knowing the chair's full history can be very helpful when it comes to interacting with manufacturers for spare parts and the like.

Additionally, several vendors have Classified sections: here's EPC's, for example.

Where I've always ended up, though, is eBay. I picked up my RGK (over £2000 new) with Spinergy Spox (the £200/each version) for £500 all in; I've helped someone else acquire a TiLite ZRA (over £2000 new) for £300 (no cushion; standard wheels). You need to know the range of seat widths and depths that you're comfortable with; you need to make sure you're using a search string that filters out the £300-new heavy-as-sin models ("titanium wheelchair" is where I usually start, but you can also use brand names per the list above); and from there you've got a selection of ex-demo models, refits, and - in essence - classified ads. You will under almost all circumstances have to travel to collect, and you'll need to get lucky with timings, but provided you can be relatively flexible with your requirements this is an excellent way to pick up a chair at a price point an order of magnitude below where you'd otherwise have to pay.

Recommendations: accessories

My "congratulations, you've got a wheelchair" starter kit comprises a pair of wheelchair gloves, a spare inner tube, and a loan of my hex wrenches. Chairs take tinkering and tune-ups and maintenance, and there's a bunch of little things you can do to make yourself more comfortable: herewith recommendations.

Hex wrenches. I have the imperial and metric Bondhus fold-up GorillaGrip allen wrenches; does all the sizes I need, and chunky enough that my hands cope reasonably well.

Adjustable spanner. Or a full set of spanners, but having an adjustable one in my repair kit makes life easier, given that I don't need it for anything seriously heavy-duty.

Tyre levers. If you're intending to change tyres and fix punctures yourself. I usually have tyre levers, a spare inner, and a small hand-pump on me in case of punctures; I haven't actually ever yet had a puncture, but I don't want to have to rely on working out where the nearest bike shop is, and especially I can't rely on them having 24x1" inner tubes in.

A track or floor pump. One that can get up to 120psi, which not all do: I keep my tyres at around 100, and self-propelling gets noticeably more difficult once they drop below 80psi. Track pumps make pumping up tyres much faster, much less tedious, and much easier on the hands and wrists.

A Black Box. Black Boxes are storage bags that sling underneath your seat; I strongly recommend them.

Gloves. I've got a strong preference for wheelchair gloves (they give you slightly more grip, particularly in the wet; they mean that the effective pushrim diameter is larger, which mitigates my RSI); and given that the way you brake is by pressing your hands against the rims, this can generate a lot of heat and friction, particularly when going downhill. You might not. Nonetheless, if you're thinking of trying them out I recommend lots of padding on the palm and a full thumb, regardless of whether they're otherwise fingerless. (This sort of thing.)

Water bottle holder. As sold for bikes, which gives you a very wide range of options. You'll probably want a handlebar mount convertor (or similar terminology) to attach it to one of your front downpipes.

Light-up front casters. These are almost entirely for fun: they light up when you move, and give more continuous light the faster you're going. The reason thttp://www.invacare.co.uk/sites/uk/files/product_documents/473df79a13506368cd02c59bb749f3d2e2e62819_Kuschall_Measuring_Guide_2016.pdfhat they're almost entirely for fun is that they make you a lot more visible in the dark, which is frequently no bad thing.

Spoke guards. Plastic covers you can fit to your wheel hub to cover your spokes. They're decorative and they prevent you catching your fingers in the spokes.

Recommendations: aspirational

"Aspirational" because these suddenly get expensive, and apart from the e-motions (largely paid for in my case by a grant) they're on the wishlist.

e-motions. Power-assist wheels, to permit self-propelling where RSI and fatigue are concerns. They have two main settings, configurable on a per-wheel basis (the default is "outside", high sensitivity/high power, and "inside", low sensitivity/lower power), work via some very clever engineering that senses the impulse you provide via the pushrim, and are incredibly heavy (they operate using one battery per wheel, each of which weighs 11kg, which is before you take into account the mass of the mounting plate). The additional upside is that with e-motions, anti-tips are a must -- and specifically the Alber e-motion anti-tips, which are designed to withstand you crashing the full weight of yourself and your chair back onto them with the power assist, which means that unlike evey other set of anti-tips you can lean back on them and stay that way, for recline-in-space functionality. You're not supposed to do this and it's definitely not officially recommended or sanctioned, but it works and it's fab. Several thousand pounds.

SmartDrive. Also a power-assist -- but this set-up is much lighter than eMotions. I've not been able to play around with one so I'm not terribly clear on the other pros and cons, but it's definitely an option worth considering.

Freewheel. The Freewheel is a large-diameter single front caster that you can clip onto the mounting bar of a single footplate on rigid chairs. It makes uneven terrain vastly easier and more comfortable to traverse, it pops on and off so you can sling it onto the carrying frame on your back, and I have been assured that if I ever try one I won't ever want to go back. I have very deliberately not yet tried one. £500.

Frog Legs. A mounting system for front casters I hear excellent things about: they provide suspension and shock absorbance, making bumpy or uneven ground much less uncomfortable. They'll set you back around USD300 the pair, and come with specially-designed front casters.

End notes

• Last updated: September 2018.
  
• Many thanks to Esther in particular for advice that improved and expanded this post.
  
• jesse_the_k has written a number of excellent guides, including how to get your first wheelchair in the USA; and Safer rolling in the city

Comments

[angelofthenorth]

this is brilliantly informative thank you.

[kaberett]

you are very welcome; thank you so much for saying!

[me_and]

Thing that could be clearer: "Orientation: price points" makes it sound like (particularly at a quick skim) I'd be looking at £2k starting for just "the possibility for actual comfort". You've mentioned buying second hand / ex-display elsewhere, but given it's the first section a (potentially stressed, poor, worried) person is gonna be reading, I'd want to make it much clearer that second hand is much cheaper and very viable.

Otherwise yes. Thank you. I found this interesting and informative and (a) I reckon I'm now a lot more clued up than the average TAB person and (b) not looking to get myself a chair for the (hopefully) foreseeable future.

[kaberett]

Thank you! Tweaked that section, and added some more guide numbers to the Acquisition section for buying off eBay. Better?

(<3)

[batdina]

bookmarking for future reading. this is going to be incredibly helpful for me, though I'm hoping not to need it in the immediate short run.

still, thanks!

[kaberett]

Thank you so much for letting me know - and good luck with your mobility. Please do let me know if you have any further questions; I'm very happy to clarify.

[naath]

I assume (without actual evidence) that carbon fiber chairs have the same failure mode as carbon fiber bikes... vis - sudden catastrophic lack of structural integrity with no visible warning signs of impending issues even on careful inspection. I guess bikes are more likely to crash/be dropped?

[kaberett]

Iiiii actually don't know but that's a good point to have flagged up; thank you!

Bikes are perhaps more likely to be dropped, but I certainly throw my chair around a lot (bumping abruptly down kerbs, etc), so this is probably something to bear in mind.

[damerell]

Aluminium fatigue failures can be very abrupt too. Steel is real... also heavy, but I wonder if the situation is exacerbated because all steel wheelchairs are the equivalent of gaspipe bike frames and one could hypothetically have a Reynolds 853 wheelchair.

K: how do you pull a wheelie, anyway?

[ceb]

Thanks for writing this! It may be relevant to my life at some point and it's reassuring to know I'll have a place to start if it is.

[kaberett]

You are very welcome. I am obviously completely happy to let you try sitting in my chairs, provide further tailored advice, etc. <3

[jesse_the_k]

Outstanding essay! I've read at least twenty attempts at this and def the best so far.

Particularly helpful: "all the good choices."

For power chairs, my advice is always: buy second-hand & privately first, so you won't use your insurance benefit until you've some idea what you really want. Does NHS fund second hand equipment (no US insurance does).

[davidgillon]

I've never heard of someone buying second hand via the voucher scheme, which I believe (Kab, feel free to clarify) is set up to go through authorised dealers. What the situation would be for an ex-demo chair or if they'd had a second-hand one part-exchanged I don't know.

[ludy]

On a related note if you are regular pushing someone else's wheelchair then you aslo need gloves or similar (i wear my wrist protectors "the wrong way round" so there is padding on my palms. Dad wears his cycling gloves)

This is an awesomely comprehensive list which i shall refer back to as and when necessary. Mum's needs are very different to yours because she doesn't self-propell but i'm guessing the points about cushions etc will be useful. (Grump about the Wheelchair service - they assess the chair-user but not their regular pushers. Mum's handles are too low for both me and Dad but apprently adjustable-height handles are not a thing!)

[kaberett]

Adjustable-height handles absolutely are a thing! It's just that - you guessed it - they cost more and consequently rock-bottom chairs mostly don't have them, as far as I'm aware. It's worth taking a quick look at the upholstery supports/handle supports (or take a photo and send it me, or tell me the chair model) but they might well not be at all adjustable, as you say.

Seating concerns absolutely do apply to people who are mostly not self-propelling, yes (if not more so, in that at least self-propelling means you're shifting your weight around a fair bit of necessity!).

[davidgillon]

How did I miss this? It was only when I thought 'Hang on' and went and looked at what you've posted this week that I found it. And ditto on the RGL Tiga tweet, intriguing, even if I was days late in spotting that (tho Phil Craven is not the person to have fronting your videos if you want to impress me, bloody Atos apologist)

Will study at length later.

[kaberett]

I was a little surprised not to have seen you comment! Glad you found it eventually :-)

[davidgillon]

Have now had the chance to read this properly. It's really well put together, I've read several of these and this is by far the most comprehensive. (Now I just need to put this into action).

A few thoughts do occur.

Do take up the option of trying out someone's high-end chair if you get the chance. Kab mentioned I tried theirs at Worldcon, what they didn't mention was that everyone burst out laughing because I was so visibly relieved. The cheap hire-chair I was using meant I was still moving, which I wouldn't have been on crutches, but Kab's chair was so far beyond that it was ridiculous. Just that couple of minutes convinced me to more than double how much I was prepared to spend and I'd already known I needed to spend four figures.

Non-rigid chairs and flexibility. I've quite literally subluxed (partially dislocated) my hip as a result of my current cheap NHS folding chair flexing crossing a kerb-cut. If you have any kind of joint or connective tissue issue, you definitely want a rigid or fold-to-rigid design.

Wheelchair gloves and braking. You brake by pushing against the pushrims, this causes friction, which becomes heat. On a longer or steeper slope, this can be enough heat to hurt, so better it goes into the glove, not your palm!

Back-bags. The Black-Box has definite advantages, but if you have a cheap folder then the x-frame under the seat is likely to block it, which leaves you with a bag slung over the back as your main option*. You can improvise with pretty much any rucksack, but there are plenty of purpose designed ones available cheaply. A couple of things to be aware of: it will bounce off your back as you accelerate and brake, so unless you have a rigid back to the chair, be careful how you pack it. And secondly, the purpose-designed ones don't normally have a carrying strap, which may be a problem if you need to take it off the chair to use as hand-luggage on an aircraft.

* I've taken to using one of the military-styled leg bags instead, if I don't have anything major to carry. Worn on the top of your leg instead of the side it takes wallet,gloves, keys, phone and multi-tool with room to spare.

[davidgillon]

Things that occurred to me after pressing return: gel tyres, hybrid of pneumatic and solid, by filling a hollow tyre with gel. Hybridizes the advantages and disadvantages of both.

Back width can be a similar issue to arm-rests for pushing, I find the back of my NHS clunker is wide enough to interfere with my push motion, so I normally use it with the back folded.

Elevating leg rests. I have at least one friend who uses these regularly, and I've occasionally used them myself on things like airport chairs. These are an alternative to swing-away footrests, going on the same tube mounting, and allow you to keep one or both legs elevated if you can't bend a knee. Obvious disadvantages in having a leg stuck out in front for getting through tight spaces and opening doors. Available as an aftermarket add-on, but only if you have swing-away footrest to start with.

[silveradept]

This is an excellent guide, and should I ever need it, I should hope to refer back to it in the future.

[kaberett]

Thank you kindly for the compliment :-)

[davidgillon]

Raising this here rather than somewhere more recent as the answer may end up being useful for others. Are you aware of any decent all-leather, full-finger wheelchair gloves? My current full-finger pair only have leather on the back of the fingers, and the palm and grip got thoroughly soaked through the other week, which was less than pleasant. All-leather, half-finger designs seem to be everywhere, but I'm specifically looking for something for the winter weather. I've found a pair for £13 on ebay, but I thought I'd check whether any of my wheelie contacts know of anything decent before ordering.

And as I'm here, and I have both my ridiculous chair and a five feet rule to hand, I thought I'd check the size of my castors. I'd presumed they were six inches. Nope. 7.5". Seriously, WTF? I've been using it with the footplates off today and they're so big they're actually hitting my feet at times.

And on the same principle I checked what I'd assumed were 24" wheels. Nope. 22" Argh! No wonder this thing is hard work. *Headdesk* *Headdesk*

[kaberett]

Honestly the way I tend to do this is put a pair of thinsulate gloves on inside the fingerless leather, and just accept that my fingertips are going to get thoroughly sodden; but it might actually be worth putting a pair of normal leather gloves inside a slightly-larger-size fingerless pair, which isn't something I'd really considered before.

Otherwise it bumps the price up a bit, but using the keyword "tactical" (as in "tactical leather gloves") gets you a lot of really heavy-duty durable stuff.

(That's about where my suggestions run out for right now, I think...)

[whisper]

Thankyou, a friend linked me to this guide and it's amazing! It's exactly what I need right now.

I have a question, if you don't mind answering; How much do I need to worry about the height of the back on a 2nd hand wheelchair? I mean, is it a thing I can modify freely afterwards (I too need a high, fairly deep one with a headrest), or do I get stuck with whatever comes with the frame?

[kaberett]

I am so glad it's helpful!

The Jay back I use has mounting brackets that attach to the handle posts; this gives you some flexibility in terms of switching it in and out, and how positioning works, and it looks (on my backrest) as though it would be possible to move the mounting pins quite close to the bottom. (Mine's set up so that the backrest attaches to the handle posts about halfway up the height of the backrest, which I suspect gives better stability/less tilting than you'd get if the attachment point was closer to the top or closer to the bottom, but again, there's flexibility here.)

In an absolutely ideal world, you'd probably want to work out what backrest you want or are likely to be able to get (I can very happily recommend the Jay3 but they are pricey), and then look at the technical specs/service manual to see how short a set of handle posts you can get away with. Conversely, with many chairs it's possible to alter the height of the handle posts relatively cheaply as an after-market modification, which again gives you a bit more flexibility -- but in any case, you're very unlikely to be completely stuck with the back height on a chair you pick up second hand.

I really really hope this helps -- if there's anything that's unclear, or that you'd like me to go into more detail on, or if you'd (for example) find it helpful to have some photos of my chair set-up, please let me know and I'll get back to you tomorrow, at which point I'll hopefully be more awake and better at wordsing :-)

[cesy]

Are genuine Black Box bags better than other under-seat bags in some way?

[kaberett]

If your hands are a small/XS and you don't mind the pointless pink or are happy to redye, http://www.ebay.co.uk/itm/Ladies-Women-Wheelchair-Gloves-Mobility-Disability-Full-Thumb-Gloves-Fingerless-/322415018415?var=&hash=item4b116ec1af:m:m0ZXN4oX5gXMwroZdbS5usw maybe?

[dolljoints]

hiya, a friend linked me this guide about a month ago.. i re-read it and started making notes at about midnight today (is 10:17 right now), trying to prepare for wheelchair services..

i don't have access to anyone with a car or anything, so almost every ebay find is completely out of the question.. so i figure i'll try my luck at glasgow's wheelchair services. i've had better luck with physiotherapists and psychiatrists here than in any other city so far, so finger's crossed.. (if anyone has had experience, pls lmk)

i unfortunately don't know anyone i could borrow a spare chair off of.. i used an acquaintance's for a while a few years ago, but it was only in the upstairs of their house, so i didn't get much of an idea of outdoor usage. except once, where i was totally unable to get up a very slight incline, but more importantly it told me that armrests that aren't adjustable are bad (though i think i need *some* at least when at my computer, and my future wheelchair will almost certainly replace my computer chair), most footrests suck, solid tyres suck... etc.

i really hope i luck out and get something amazing, but in the mean time, i'm having to work together with flatmate to get the flat sorted out... because we were forced to move here just before christmas, due to our previous flat being repossessed by landlords for them to live there themselves... and the flat we were moved into has so many things breaking or broken. but the landlords want to look at all the problems all at once, and try to minimise call out fees and stuff... so we have had to unpack and make all the problems accessible. it's taken almost 2 months but we're almost there!

since i know how much of a problem wheelchair services can be, i'm waiting until all of the repairs (strangers coming into our flat... i want to limit it to once a week max, but they might haggle that down because they're terrible. they keep saying they understand and want to work around our issues but have consistently actually done the opposite so far.. the week we moved in some workmen showed up, and 3 showing up 3 days in a row was the fucking worst!!) are done before doing anything with wheelchair services. but at the same time, i know about long waiting lists... but on the other hand, i don't want to be caught out if one pops up before we're done dealing with landlords...

um, uh, i was wondering if you could possibly link me to the online guides you mentioned about dealing with wheelchair services (i intend to have my GP and physiotherapist print off letters describing my problems and my needs, and "unrolling" EDS into EDS, chronic fatigue syndrome, chronic pain syndrome, to make it seem more intimidating, perhaps – my physio was the one who recommended i pursue wheelchair services, at least, after she saw how much of a difference my walking stick has made, but learning that it isn't enough by itself.) and measuring for online buys (i'll keep an eye on them just in case something in glasgow that's not a 15kg folding chair shows up, after all)?

ah, sorry, that's a lot of brackets. um, i'm going to rephrase that! – you mentioned online guides for navigating wheelchair services and self-measuring for buying chairs yourself, but no matter how much i searched online, all i could find was useless guides like "measure your width" and i'm like,, how?? do i include the curvature of my hips and stomach, or try and somehow get a linear measurement from my body? i don't have a wheelchair to tell already... so i was wondering if you had a few you like that you could link? it's totes ok if not of course.

(said friend actually talked to you in the comments a while ago, but i'm not going to namedrop because i've not checked if that's ok to do)

ah jeez i thought i had notes of what to say after i'd opened All Those Tabs but i seem to be drawing a brain blank... uh.. i hope your day is good! and i hope my comment was ok. please lmk if i did anything triggering or just insensitive or anything... um, uh , well bye >.>

[cloudsinvenice]

Here via katzenfabrik; this is an absolutely terrific and very useful post! I've bookmarked and will no doubt recommend it often.

[kaberett]

Thank you so much for saying! I'm delighted it's useful, and please do let me know if you have any questions I might be able to help with.

[glitchesaintshit]

Just wanted to say thanks for writing this up!! I saw you tweet this in reply to someone else recently & even though I'm in the US & it's older info it was still an incredibly valuable read :))) Much appreciated!

[azurelunatic]

Link rot: the Tiga FX is now at https://rgkwheelchairs.com/wheelchairs/daily-wheelchairs/tiga-fx.html