Wheelchair>>Understanding Manual Wheelchair Options - 1/1/2007
Weaving Through Manual Wheelchair Options
Kevin Lockette PT
Ohana Pacific Rehab
Selecting a manual wheelchair is much like buying a car. There are numerous manufacturers, models and options. What you ultimately select reflects your needs, preferences/style and budget. The goal of this article is to walk you through the matrix of options while highlighting some the unique features and chairs that are on the market.
For reimbursement purposes, Medicare classifies like wheelchairs in categories called “K-codes”. This classification system is useful as well when sorting out your options because all the chairs in each class have similar characteristics.
Before we start on the specific classes of wheelchairs, it is important to keep in mind the multiple considerations that will ultimately dictate your selection on a particular wheelchair. Considerations include the strength, ROM, orthopedic status, muscular tone and cardiopulmonary status of your client. Other considerations include the potential for change in function or size, need for an adjustable or modular frame, the method of propulsion (i.e. Arms, legs or both), positioning needs and environmental needs which will dictate types of tires, casters, etc.
Below is a general overview of the different classes of self-propel manual wheelchair frames. The accessory options available are quite extensive and too large to address for the purposes of this article.
K0001- Standard Wheelchair: This class is your basic institutional wheelchair. There is no frame adjustments or modifications in this class. The wheelchairs are steel frame construction and generally weigh approximately 36 pounds without the front riggings. There is limited size options in this class as well. Seat to floor height is 19 to 21 “.
Appropriate Clients (K0001): The client is typically able to propel a “standard” weight wheelchair and is without functional or postural compromise or is dependent in mobility. This client also does not require any modifications or atypical dimensions in the frame in order to self-propel the wheelchair or perform transfers in and out of the wheelchair.
K0002- Standard Hemi Wheelchair: This class is the same the K0001 with the exception of having a lower seat to floor height and shorter footplate extension tubes. The seat to floor height in this category is typically 17 to 18 inches which often is not low enough for many clients for foot propulsion.
Appropriate Clients (K0002): This class is the same the K0001 with the exception of having a lower seat to floor height and shorter footplate extension tubes to accommodate a client that is of shorter physical stature or for a client who needs a lower seat to floor height to use his or her feet for propulsion.
K0003- Lightweight Wheelchair: This class has more sizes available but is still limited. The standard seat width is 16 or 18”; however, most chairs if this class have 20” seat width and 18” seat depth available. There are few if any frame modifications or adjustments in this class. There are more options and accessories, but still limited. These chairs weigh less than 36 pounds without front riggings with an average around 28 pounds. This class has a standard seat to floor height range of 19 to 21”.
Appropriate Clients (K0003): The client for this class may be unable to propel weight of a standard wheelchair due to upper and/or lower extremity weakness, low endurance or cardiopulmonary issues, pain, spasticity and/or decreased ROM, but is able to propel in a lightweight chair of this class. The body dimensions of the clients are accommodated by the standard wheelchair dimensions. Clients that are appropriate for this class of wheelchair don’t have significant deformities or spasticity and typically do not have a condition that is progressive in nature because there is little adjustability to accommodate any type of changes whether it is physical or a functional change.
K0004- Lightweight Wheelchair: This class has more sizes, options and accessories as well as minimal frame adjustments and including a minimal adjustable axle plate. The standard seat width is 14,16 or 18”; however, most chairs if this class have 20” seat width and 18” seat depth available. These chairs weigh less than 34 pounds without front riggings with an average around 26 pounds. This class has greater seat to floor options with available dimensions of 17 to 21”.
Appropriate Clients (K0004): The client for this class may be unable to propel weight of a standard and lightweight wheelchair (K0003) due to upper and/or lower extremity weakness, low endurance or cardiopulmonary issues, pain, spasticity and/or decreased ROM, but is able to propel in a lightweight chair of this class. The body dimensions of the clients may require chair dimensions and adjustability that you cannot find in the K0003 class such as greater or lesser seat to floor height, higher back height other than standard due to poor balance postural control, abnormal tone and/or other orthopedic issues. As in the K0003 class, Clients that are appropriate for this class of wheelchair don’t have significant deformities or spasticity and typically do not have a condition that is progressive in nature.
K0005- Custom Lightweight and Ultra Lightweight Wheelchair: This class has more sizes, options and accessories as well as many frame styles and adjustments and including adjustable axle plates, folding and rigid options, modular options, different suspensions. The axle plate can be adjusted to a great extent allowing for ultimate customization in the wheelchair set-up, which can also aid in injury prevention. There is much more adjustment in caster housing with greater options for angle of seat. There are greater options in caster sizes to be tailored for the user. For example, micro size castors can be use for a much tighter turning radius for sports or tight work areas or wider casters to accommodate more difficult terrain. These chairs offer adjustable back angles with an example of +3 (squeeze) to –15 degrees (to accommodate for lack of hip flexion). More back height options are available in this class- low,medium and tall.
The standard seat width is 14,16 or 18”; however, most chairs if this class have 20” seat width and 18” seat depth available. These chairs weigh less than 30 pounds without front riggings and can go down as low as 17 to 18 pounds for the Titanium frames. This class has greater seat to floor options with available dimensions of 17 to 21”. This class of chairs is more expensive and requires meticulous documentation and rationale for coverage by third party payers.
Folding and Rigid Frame Options: This class of chairs is the only class that allows for the rigid frame option. It’s appropriate then, to spend a little time on when or why you would choose one over the other. A rigid frame is typically for a client who has been a wheelchair user for a considerable amount of time and knows exactly what he or she wants and needs. It is fairly typical for paraplegics to select a rigid over other diagnoses. Rigid frames are more durable, more energy efficient and lighter. The drawback on the rigid frame is that it does not easily accommodate changes in the client’s status or size. Lastly, rigid frames may be more difficult to transport depending on the vehicle.
Appropriate Clients (K0005): In regards to appropriateness for clients, this class has some of the same advantages of the prior class (K0004) with the added benefit of a much lighter wheelchair with a wide range of adjustments that may allow for greater accommodation of deformities and for greater independence on all terrains. Due to the adjustability, this class of wheelchairs is the most appropriate of the manual wheelchairs for clients with dynamic and/or progressive disorders.
As you can see, there needs to be much thought to the selection of a manual wheelchair taking into account, the client’s physical dimensions, physical needs and function, environment, and lifestyle. There are many resources available and a listing of all of the components for each wheelchair frame on the different manufacturers’ web-sites. Going through the different order forms is a good way to get acquainted with all of the components and what is available as options for each chair. The impact of proper and improper wheelchair prescription can be profound. There are also many different specialty chairs and accessories available including sports specific chairs, beach and water access devices that allow for greater independence with recreation.