Our learning objectives are for the participant to be able to list three categories of manual wheelchairs, to identify optimal manual wheelchair configuration for self-propulsion, and to describe optimal self-propulsion stroke to increase efficiency and decrease injury risk.
A manual wheelchair is designed to provide either dependent or independent mobility to a client, as well as to support the seating system itself. A wheelchair can provide mobility, but it is very important to remember that another primary goal of the manual wheelchair is to support the client in a seated position. This means it is supporting some type of seating system, whether it is simply the sling seat that we see in this Figure 1 or if it is more advanced seating system.
Figure 1. Sling seating on a manual wheelchair.
Manual wheelchairs can be used for clients who have no other means of mobility at all, either dependent mobility or independent mobility. This person is unable to use any sort of independent ambulation, augmented mobility or other dependent mobility bases. Manual wheelchairs are also used for clients who can ambulate. A person may be able to ambulate only with a walking aid. Even if they can ambulate, it might be that the client can only walk for short distances, with excessive effort, with excessive fatigue, or with a risk of falling. It is easy to assume both from a funding standpoint and a clinical indicator standpoint that if someone can walk, even not very well or with augmented mobility, that they could never get a manual chair. That is not the case. Many of these people will use manual chairs, but perhaps only under certain circumstances like longer distances.
Back-up Mobility Base
Manual wheelchairs are also used sometimes for clients who primarily use a power wheelchair for their independent mobility, but still need a backup mobility base. There are times where, just like a car, the power wheelchair may not be functioning. If that is the case and it is in the shop for new batteries or some other type of repair or growth modification, the client needs to have some sort of mobility base so that they have supportive seating. We want this person to have postural support in upright position. If a manual chair is a backup to a power chair, it might be pushed by a caregiver.
The manual chair can be used if an accessible vehicle is not available. Power chairs do not fold up and go into the back of your compact car. If the accessible vehicle is broken down, a manual chair can still allow the client to have mobility, even if it is to go to a doctor's appointment. It can also be used if the eventual destination is not accessible.
Let's say this little girl in Figure 2 has an accessible home, but she is going to visit grandma, and grandma's home is not accessible. Getting a power wheelchair up grandma stairs is probably not realistic, but getting a manual chair up the stairs could be accomplished, even if it is not ideal.