Refining Your Manual Wheelchair


MOBILITY & SEATING

The right equipment and accessories to customize your ride.

“These days there is a plethora of wheelchair accessories to refine your chair and improve your life. Here are my favorites and why I prefer them.”

NEW MOBILITY Senior Correspondent Bob Vogel is our go-to expert on many topics, including mobility products such as cushions and wheelchair add-ons. A para who writes from Sacramento, California, when he’s not trying out new gear, he’ll likely be sailing, scuba diving, mountain handcycling or playing in the water with his service dog, Killy.

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Bob Vogel

Choosing the right chair and accessories has been crucial for my mobility, health and self-esteem since my rehab days as a T10 para back in the mid 1980s. My first vital refinement to my ride was something that literally saved my butt — switching cushions after my nightly mirror-skin-check revealed the early stages of a pressure sore. I had initially requested a ROHO cushion suggested by my SCI peers, but it was nixed by my physical therapist, and I was sent home on a block of memory foam with a cover. Despite constant weight shifts, I soon developed a tiny ischial sore. I stayed off my butt and successfully advocated for the cushion that had been recommended by my peers. The sore healed and, thanks to using proper cushions and extreme vigilance, I haven’t had one since.

These days there is a plethora of wheelchair accessories to refine your chair and improve your life. Here’s a list of my favorites and why.

Cushions

The most important wheelchair accessories are proper cushions. There is a wide range of excellent cushions on the market. With help from a seating specialist, pressure mapping and mirror-skin-check, you’ll find the right one for you.

For me, choosing the right cushion has become more important as years go by because I’ve developed a slight curve in my spine — my left ischium is lower than the right — and despite putting on a few pounds, my butt is skin and bones.

The waterproof ROHO Quadtro Select is great for drip-drying in between scuba dives.
The waterproof ROHO Quadtro Select is great for drip-drying in between scuba dives.

My primary cushion of choice is a high-profile ROHO Quadtro Select by Permobil. The key to this cushion is that the air cells are divided into four quadrants controlled by two “memory-control” buttons. The green button opens the memory valve so air can flow between quadrants, enabling a custom fit. I push it, then lean back and to my left to create a deeper immersion for my left ischium, which helps protect my skin and compensates for my spinal curve. Pushing the red button locks the quadrants’ “memory” into place. I’ve used this cushion for over a decade, and nightly checks confirm zero redness or hot spots.

Because ROHOs are made from high-quality neoprene, they are waterproof. This makes cleaning a breeze and is a bonus when I hop in my chair after a swim with the dogs or drip-dry between dives on scuba trips. My back-up cushion is also a Quadtro, and I use it on my car seat. Additionally, I have a two-chamber custom ROHO on my handcycle.

My other wheelchair cushion is a Custom 2 Cushion by Ride Designs. The company uses a unique computer scanning system to create a custom-shaped, breathable, lightweight cushion that protects my skin by offloading pressure from sensitive areas. The cushion also provides outstanding postural support, putting my spine into a straighter position to help alleviate my lower back pain. This is especially important to me on long days when I’m working at the computer, as sitting for long periods with minimal movement can cause back pain. Using the Custom 2 Cushion reduces this pain.

Also, I learned early on that the Custom 2 provides so much postural support at the hips that I need to do a weight shift and move my butt sideways prior to leaning to the side to pick things up off the floor. Failure to do so puts a lot of strain on the few functioning lumbar discs I have below my rods, which go from T6 to L2.

Another important skin protection accessory is the ROHO adaptor pad, a 9.75-by-13.5-inch cushion made of one-inch closed cells that easily fits into a daypack and, since there’s no air valve, doesn’t need adjustment. I use the adaptor pad to protect my skin on shower benches and airline aisle chairs, and I drape it over the edge of bathtubs for transfers.

Last but not least for protecting my butt is the Vicair AllRounder 02, a waterproof cushion that attaches with leg and waist straps like a climbing harness. It is great skin protection when I’m sailing, off-road mountain biking — especially when I decide to get off my handcycle and go for a swim — or going upstairs at friend’s houses, stair by stair on my butt. Sunrise Medical also offers an excellent wearable cushion, the Jay Protector.

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CUSHION MSRP COVERED BY MEDICARE
Jay Protector $235 No
ROHO Quadtro Select $482 Yes
ROHO Custom $654 Check with Provider
ROHO Adapter Pad $120 No
Ride Custom 2 $1,614 Yes

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Position and Protection

As soon as I had the opportunity to try out my first pair of rigid side guards, I was hooked. Now, they are an integral part of my chair as they enable a snug fit in my wheelchair. Case in point: I wear a 34-inch pants waist, and I fit perfectly into a 14-inch-wide chair.

In addition to enabling a snug fit, rigid side guards help keep you centered in your chair, and protect clothing from dirt, water, and “wheel wear.” Also, they help prevent side-to-side movement, which may reduce tissue shear, thus helping avoid skin breakdown. In a perfect world, side guards should be ordered as an on-chair accessory. However, they can be added and easily installed on many chairs. MSRP prices start around $120 a pair — but you can often get them for less when you order through an online company such as Sportaid or DME Hub.

Bob Vogel plays fetch with his dogs before going for a swim. With his FreeWheel, the high grass is not a barrier.
Bob Vogel plays fetch with his dogs before going for a swim. With his FreeWheel, the high grass is not a barrier.

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More Efficient Propulsion

Switching to an ergonomic hand rim helps add pushing and stopping power, and can alleviate hand and wrist strain. There are quite a few good push rim options.

Some wheelers with limited hand function are fans of RibGrips. These are ergonomic wheelchair hand rim covers made out of soft rib discs that provide good traction and wear resistance with an MSRP of $149.99.

My push rims of choice are TC (for Tactical Control) hand rims by Spinergy. TC rims have an embossed texture surface, kind of like a small diamond plate, which is a secret of their performance. They provide great traction for pushing, good braking power on downhills, are easy on the hands and don’t cause friction heating. Also, they’re lightweight — 1.1 pounds for a 6-tab 24-inch rim. They don’t leave marks on skin or clothing, are easy to clean and are made of stainless steel, which is significantly tougher and more scratch-resistant than aluminum push rims.

After two years of pushing my TC rims, they still look new. And I have yet to have a hand-slicing bur appear on the rim, something that happens all too often when aluminum push rims brush a rock, curb or fall during car transfers. The MSRP is $399 per pair.

Another push rim option to consider, especially if wrist or hand pain is an issue, is the Natural Fit Surge LT, recently purchased by Permobil. The key to the Surge LT is an oval shape that provides a wider area to grab, which is easier on the wrist, fingers and thumb, and provides a greater surface area for easy braking. At the top of an LT rim is a Gription Strip — a rubber strip for superior pushing traction with minimal effort. Made out of aluminum, LT rims weigh 1.25 pound per rim and MSRP is $340 per pair.

A towel and ROHO Adaptor Pad draped over sharp edge shower door tracks protects skin during transfers.
A towel and ROHO Adaptor Pad draped over sharp edge shower door tracks protects skin during transfers.

Protecting Shoulders

An essential accessory for extending the life of my aging shoulders has been the SmartDrive power assist by Permobil. Weighing 12.5 pounds, the SmartDrive quick-connects onto the back of a rigid or folding chair and provides propulsion, with a driving range of 12.3 miles.

The SmartDrive saved my shoulders the week it was unveiled. In 2012, I was working an annual international trade show held at a hotel and venue notoriously known for what seems like miles of sand-like padded carpeted surfaces. That was tough enough when I first attended as a young supercrip, but that year, experiencing my first serious twinges of shoulder arthritis and rotator cuff irritation, I feared my shoulders would be cooked. Fortunately, I was given a SmartDrive demo for the duration of the show. I was hooked and have used a SmartDrive ever since.

The SmartDrive has three control options. The first is a push button mounted on your chair that you push to start and stop. The second is a PushTracker wristband that communicates with the motor via BlueTooth. You double-tap to accelerate, tap again when the desired speed is reached and double-tap to stop. The third option is the new PushTracker E2, which, in addition to controlling the SmartDrive, is a multi-functional device that’s similar to a combination of a FitBit and SmartWatch.

The SmartDrive enables me to take my dogs on long walks and the top speed of 5.5 mph is plenty fast to keep the pups at a steady trot while we head to town to check the mail or grab some groceries. It is also great for racing through airports with a lapful of luggage and, when removed, fits into the overhead compartment of airliners.

Although I worked at keeping my shoulder muscles balanced and stretched, I feel that if the SmartDrive had been available 20 years earlier, my shoulders wouldn’t be nearing their expiration date. As a physical therapist (or anybody into fitness or building muscle) will tell you, it is important to provide a day or two of rest to let broken-down muscle fibers recuperate and rebuild. Unfortunately, without devices like the SmartDrive, our shoulders and arms never get this time, thus start to develop irritations that lead to weakened areas, injury and breakdown. I predict wheelchair users who are incorporating the SmartDrive into their wheeling lives at an early stage are going to get many more years or decades of mileage out of their shoulders. MSRP $7,131, Medicare approved.

Vogel transfers to a sling seat wearable cushion to protect his skin while sailing.

Vogel transfers to the Vicair AllRounder O2 sling seat wearable cushion to protect his skin while sailing.

Vogel transfers to a sling seat wearable cushion to protect his skin while sailing.

Smoother, Faster, Safer

Another accessory that has become indispensable for me is the FreeWheel, a 12-inch bicycle wheel that quick-connects to rigid and folding wheelchairs. The magic of the FreeWheel is that it lifts the front casters a bit off the ground and extends the wheelbase length, which makes the chair super-stable in front and provides the smooth, terrain-absorbing ride of a bicycle tire.

I originally got a FreeWheel for going on off-road trails, sand, gravel and snow. It certainly excels in these environments — especially when you need a push from a nondisabled person, which can cause your front casters to dig into soft terrain and you to fly out of your chair and face plant. The FreeWheel doesn’t dig in, hence no more flipping forward into the slush, sand or mud — a friendly push to the back of your chair powers the FreeWheel right through.

What really surprised me about the FreeWheel is the outstanding ride and reduced rolling resistance it provides in urban environments. Along with my SmartDrive, the FreeWheel is my go-to attachment when I head out the front door. The FreeWheel relieves the worry of catching casters on cracks or uneven pavement or that high-speed caster flutter. As for high speed, Killy, my service dog, loves that it’s so stable I can let him flat-out run. A friend recently paced us with his car at 20mph and the ride felt smooth and stable.

I wish the FreeWheel had been invented earlier because it would have prevented my two separate femur fractures, both caused by catching my casters on something and flipping forward. MSRP is $659 and it is generally a cash item, one that lasts and lasts. I’ve had mine since 2012, and it still works like new.

Last but not least, the FreeWheel is a must have for anybody with an infant or child who is still young enough to ride in their lap. I wish it had been available when my daughter, Sarah, was young. It would have certainly made the late-night pushes across the carpet to change diapers easier. Not to mention, it would have prevented the several times my casters caught, flipping Sarah and me forward, requiring Hollywood stuntman-type aerial moves in order to land on my back with Sarah softly on my stomach.

Most of the items in this article can be found at a discount in the online retailers in the resources list.

Resources 
• DME Hub: dmehub.net
• FreeWheel: gofreewheel.com
• Jay Protector: sunrisemedical.com/seating-positioning/jay/wheelchair-cushions/protector
• RibGrips: ribgrips.com
• Ride Designs: ridedesigns.com
• ROHO by Permobil: permobilus.com/products/seating-and-positioning-by-roho/
• SmartDrive by Permobil: permobilus.com/products/tilite-manual-wheelchairs-smartdrive-power-assist/smart-drive/
• Spinergy: spinergy.com
• Sportaid: sportaid.com
• Natural Fit Surge LT by Permobil: sportaid.com/the-surge-wheelchair-handrims.html
• Vicair AllRounder O2: vicair.com/product/activity-cushion-vicair-allrounder-o2/


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4 Comments
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Dwight Dukes
Dwight Dukes
3 years ago

Hello I’m interested in talking to someone who can help me with information or can give me some insight into someone on the Tallahassee Florida area about a provider that can help me with a little weight wheelchair.

Jim Felakos
Jim Felakos
3 years ago

I love my Freewheel and have also found it transformative. I live in New York, and it is great at going over lousy sidewalks & bad curb ramps. Makes small jumps much easier, like hopping a curb or across the gap getting on a subway. My speed is also about doubled. I got it after about twenty years in a chair and wish it had been invented earlier.

I primarily got it when my boys were starting to walk so I could go onto the grass in parks with them and it is great for that.

My younger boy spent a couple years riding around in my lap. We did get tossed out of my chair once due to the Freewheel’s hook getting caught on a metal basement access door that was too proud of the sidewalk. I have since trimmed he hook on the back of the footplate so it is not as close to the ground. A dremel or hack saw does the trick

PATRICIA VAN-DYKE
PATRICIA VAN-DYKE
3 years ago

Great article. I have a smart drive that weighs 25 pounds.consequently it just sits in my room. No one can lift it to put it on my chair.I would like one of the lighter ones but, the insurance won’t pay for it.
My shoulders are shot.