Aluminum, once the industry standard, got a big challenge when titanium wheelchairs entered the market in the mid ’90s — and justifiably so. Titanium chairs soon became synonymous with “ultralight” and pushed the envelope of what is possible. But chairs made out of the aerospace metal also came with higher price tags. In time titanium chairs pushed manufacturers and engineers to advance aluminum chairs to the point where their weight is now on par with titanium. With weight no longer an issue, what are the advantages of titanium, and do they justify a higher price tag?
To answer the question, let’s first revisit the basics. Pure titanium is brittle; its superior qualities are achieved when combined with other metals to form titanium alloys. Grade 9 seamless aircraft-grade titanium has proven to be the best for wheelchair applications. Titanium is heavier than aluminum, but twice as strong. Because of titanium’s high strength, you can make a chair with thinner-walled tubing, using less material. Thus, lightness and strength are combined.
Alan Ludovici, vice president of engineering for TiLite, the pioneering titanium wheelchair manufacturer, explains that working with titanium requires precision and unique design and manufacturing skills. He says titanium has very good “memory” and is difficult to bend, so the bends have to be exact. Once titanium is bent into a shape for a chair, the memory keeps it in that shape. The fit of titanium parts needs to be precise in order to achieve a good weld. “At TiLite we have a process called ‘zero gap tolerance,'” he says, “meaning that all the parts of a frame have to fit together so perfectly that they are water tight — before they are sent to our welders.”
Ludovici explains that welding titanium is another unique skill. The weld has to be done at precise temperatures in an oxygen-free environment, which is achieved by pumping argon gas around the surface during the welding process. The welder has to stop at regular intervals to prevent the weld from getting too hot.
When it comes to the advantages that titanium chairs offer, Marty Ball, vice president of sales for TiLite, runs down a list. “Titanium doesn’t fatigue, doesn’t corrode, and is extremely scratch-resistant, so it stays looking nice. If it does scratch, the scratches can usually be buffed out with a Scotch-Brite pad. It keeps its shape and has a subtle shock absorbing quality to it.”
Ball’s job keeps him traveling, and by default, testing many of titanium’s properties on his list. In a typical week his chair gets jammed into the cargo holds of airliners, crammed into the trunks of taxis and accidentally flipped onto the pavement when he’s transferring into unfamiliar rental cars. “Despite all the travel, my chair looks good, rolls straight and true, and I’ve never had a broken Ti chair,” he says. “Once I was sitting in seat 1A, and I watched my chair roll off the jetway and drop 20 feet onto the pavement. I had to wait to get to my destination in Atlanta to see what happened. When I got there, the chair was fine.”
A titanium frame not only stays looking good but lasts indefinitely, says Ball. “Most metals, including steel and aluminum, are subject to ‘work fatigue,'” he says. “It’s like when you take a coat hanger and bend it back and forth again and again and it fatigues and breaks. This doesn’t happen with titanium. It maintains its molecular strength forever. That’s why Lockheed Martin and Boeing use it for hydraulic lines in their aircraft.”
Ball says the importance of a frame’s appearance and durability is coming into play for more consumers. “The trend is for funding sources to be tighter, unfortunately, so you want a chair that is still good looking and functional five, six, seven or more years down the road.”
As important as all these factors are, Ball says fit is critical. “You have to look at the whole picture — not just weight or material. A wheelchair should fit a person like an orthosis [a fitted brace]. That’s why we custom-make our chairs for each client. One of the ways to find out if a manufacturer does custom chairs is to look at the measuring options on an order form.”
The only downside to titanium as a material is the price, Ball says. “Right now it costs about 10 times more than aluminum per foot. But we don’t charge 10 times more for a chair.” Because of tighter funding, TiLite started offering its complete line of chairs in aluminum as well as titanium. “Some funding sources just flat out refused to pay for titanium, and we wanted to offer the same level of customization and high quality to those who may not have access to titanium chairs,” says Ball. “Although we have a complete line of aluminum chairs, we are still selling a lot more titanium chairs than aluminum.”
What Do Users Say?
Josh Sharpe, a Social Security supervisor from Navarre, Fla., is in his 15th year as a T9 para. Sharpe has been styling around in Invacare’s Top End Terminator Titanium for eight years. “I live near the ocean, so it has seen its share of salt water. I’m constantly loading it in and out of my vehicle, plus I race handcycles and go on a lot of adventures, so the chair gets stuffed into the bellies of planes quite a bit. After eight years, it is still in great shape. The only thing I’ve replaced on it are tires, casters and upholstery.” Sharp is a veteran, but his injury isn’t service connected. He got his chair covered through standard VA entitlement. “I’ve had an aluminum chair before, and it was a good chair, but I prefer the durability and smoother ride of titanium.”
Ana Acton, from Nevada City, Calif., is executive director of FREED Center for Independent Living. Acton is in her 19th year as a T12-L1 para. “I’ve had a TiLite TR for the past eight years and it has been a phenomenal wheelchair. The only things I’ve changed are tires and bearings,” she says. “I’m hard on chairs. I live in the countryside, I ride horses, and race downhill mountain chairs. The chair is constantly in and out of my car. I’ve done a ton of traveling with this wheelchair. I’ve flown to Washington, D.C., multiple times and to Japan seven times. The chair still looks great and doesn’t have any scratches. While traveling, especially to Japan, I was glad I had a titanium frame chair that was tough and less likely to get crushed.”
Like many wheelers, Acton is experiencing the effects of funding cutbacks. Eight years ago her insurance, Medicare (primary) and Blue Cross (secondary), funded her TiLite chair with no problem. “I got my physical therapist to write a letter of medical necessity saying I needed a titanium chair because it’s lightweight and high performance and will help prevent shoulder injuries,” she says. “The chair has held up fine, but since I’ve had it for eight years, I figured the time had come to try and get a new chair. So I had my physical therapist write the same type of letter of medical necessity again. But this time I’ve run into a wall when it comes to getting them to pay for a titanium chair. I finally got the insurance to agree to pay for an aluminum chair, but I like my titanium so much, and it has been so tough, I’m going to call my insurance company and see if I can get another TiLite TR chair funded. If it turns out there’s no way I qualify for a titanium chair, there are still some cool aluminum chairs out there.”
To say that Brad Morgan is tough on chairs is an understatement. Morgan, a research consultant from Central City, S.D., has been a T11-12 para for 23 years. “I’m brutal on chairs. I jump off loading docks in my chair. Remember the shots in New Mobility that Chris Benson took of the longhaired guy jumping his chair off a bridge abutment into the water? That’s me.” The chair that has held up to all of this abuse is a Quickie GPV Titanium that Morgan used for 16 years. “I drive a pickup truck and throw the chair in the bed of the truck. It’s a good thing the chair is so light. I don’t think my shoulder would have survived throwing a heavier chair. One time the chair flew out of the truck at highway speeds and all it got was one scratch in the frame. It has taken an incredible beating. Everything on the chair has been replaced but the frame.”
Morgan’s previous chair was the same Quickie model in aluminum. “I lived and worked in the city and spent all day wheeling on the sidewalks, and the constant ka-pok ka-pok going over the cracks all day was wearing,” says Morgan. “One of the first things I noticed when I got titanium was the ride. It has subtle shock absorption, which smoothed everything out. I also like that titanium doesn’t hold the cold like aluminum does. When I come in from a cold winter day, the frame is room temperature almost instantly.”
After 16 years, one of the backrest tubes on Morgan’s chair finally broke. He wanted to get the exact same chair, but Quickie no longer makes that particular model. The good news is he got a TiLite TR covered under South Dakota’s Medicare/Medicaid program.
The Real Winner
“When it comes to getting a titanium chair covered under Medicaid, different states have different rules, so it pays to ask,” says Mala Aaronson, a certified rehab technology supplier for National Seating and Mobility in Boston, Mass. Having worked as an occupational therapist for almost a decade before switching to the dealer side for the past 17 years, Aaronson knows the ins and outs of wheelchair funding, fit and performance.
“In Massachusetts I always have success getting titanium chairs approved for my clients on Medicaid. From a dealer standpoint, it is difficult because a titanium chair has a lower profit margin,” says Aaronson. “I’m in this for my clients, and I’m very fortunate that I work for a dealer that supports me to do the best thing for my client, and if we are going to make a little less money on the chair, they still support me. In the long run this makes us more money because the clients are happy and they refer more business to us.”
About the benefits of titanium, Aaronson says a lot can be learned by talking with the people who do the repairs. “We have a huge facility, and I work closely with my repair guys. I have never seen a broken titanium frame,” she says. “We have worked hard to educate our Medicaid people that with a titanium chair, they will spend less in terms of repairs over the life of the chair.”
Aaronson’s clients tell her that titanium gives them the subtle quiet ride reported by other wheelers. “My clients that have switched from aluminum chairs to titanium come in and say the chair rides smoother, and at the end of the day, they just feel better. I’ve never had a consumer in a titanium chair come in for their next chair and say, ‘I didn’t feel enough of a difference to spend the extra money for a titanium chair.’ They always want another titanium chair.”
Aaronson seconds Ball’s statement about the importance of fit. “It’s the most important thing. A chair should fit so well that it is like a prosthetic for your body and responds to your movement.”
Titanium chairs have raised the bar for the entire wheelchair industry, which has resulted in improved chairs in both titanium and aluminum. In the end, the clear winner is the wheelchair user.