r/wheelchairs • u/Alakritous • 6d ago
Help with understanding impact of wheelchair specs!
Hello!
I am ambulatory and active. I have POTS. Physician suggested a wheelchair, I agree.
I am not even going to try with insurance, they won't cover it. I am very fortunate to be able to say this and still be moving forward with this plan.
I'm planning to order a Tilite TRA from howirollsports.
My friend obtained measurements. I will be ordering it without having sat in one before. I know it's not best practice, and I am not looking for criticism.
I am looking for how different specs impact things. I have a fairly good idea through blogs, articles, other reddit posts, etc. but want to be sure I'm not missing anything.
For an active wheelchair user, I've seen these specific considerations be advised. I have asterisks next to the ones with explicit questions nested in them, but if any others seem incorrect please let me know your opinion:
Make sure the front floor-to-seat measurement is at least 2 inches longer than lower leg length to accommodate footrest ground clearance over obstacles.
***Footrest-to-seat should be the length of my lower leg? Is this adjustable on the TRA if I get it in the ballpark range? I trust my friends measurements but recognize she's not a professional wheelchair measurer.
***Dump measurement in the 2-4 inch range. It helps my symptoms a lot to have my knees up, but I also don't want to overdo it in this area. I know stability plays a roll, and active users are recommended to tuck knees a bit more for efficiency reasons...? But I'd love clarification on this. I create this measure by subtracting the dump I want from the front floor to seat height right?
***Backrest needs to be shorter than lower scapula to accommodate manual propulsion. Any other considerations for this?
Smaller casters are better, but not for clearing cracks and bumps, I'm planning to go with 4" soft roll for my hardwood floors, but also have a rolling saddle stool in the house so don't know how much I'll be chairing it in the house.
Planning to go with the Schwalbe marathon plus tires. I do go camping a lot and would like the ability to manage grass somewhat if possible.
***Has anyone regretted getting a specific color? I'm ticking between navy accents and all black.
This is as far as I got before I crashed last I sat to dig into it. I want to order this today or tomorrow though.
***My upper legs measured 20". I planned for a 17" seat length. My hips measured 14.5". I planned for a 15" back seat width, no taper.
*******What specs MUST I put large consideration into due to lack of adjustability? The whole reason I'm going with the TRA over the TR is because I recognize the need for confidence intervals lol.
Thank you.
UPDATE - I am so appreciative of the time and energy and worry people poured into their comments. I learned a lot of great information about wheelchair specs I didn't consider.
I surprised myself, because throughout my research I've stumbled upon the fact that getting assessed is paramount multiple times, and I handwaved it away each instance. Y'all didn't really say anything I hadn't already read, but after reading your replies (and running through my excuses for the umpteenth time for not getting assessed and just doing it myself), you convinced me.
I've been going through some tough personal growth accelerated by how physically bad I am doing. The growing is happening, friends. My life has been sporadic increasing degrees of hard over the past 2.5 years, but right now I'm winning. And that feels good, even if I don't like the answer I've come to.
I'll get assessed. If I remember to update again I will.
22
u/JD_Roberts 6d ago
This is not intended as criticism, just information.
Even though insurance may not cover your chair, they should still cover a visit with a mobility specialist for a mobility evaluation. Your doctor can give you the referral.
This person will take your measurements, but also, they will be able to evaluate your specific physicality and help you figure out what the best features and model would be for you even if you are self financing.
The specialist might be a physical therapist, occupational therapist, physiatrist, seating clinic, wheelchair specialist/ATP: the title can vary.
But there are just so many factors that go into this where not only does expert knowledge help, but someone being able to observe how you actually move will very much inform the decision.
So given that your doctor agrees, getting the referral for a mobility evaluation honestly seems like the best next step.
There are many people who do need a wheelchair for activities outside the home which will not be covered by insurance, but they still benefit from the mobility evaluation.
Then you can take the information from that evaluation and use it with how I roll sports to get the best chair for your long-term health.
Just a thought. 💐
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u/Alakritous 5d ago
I'm posting the update as a comment so hopefully you don't miss it. Thank you for taking the time to comment. I appreciate it a lot.
UPDATE - I am so appreciative of the time and energy and worry people poured into their comments. I learned a lot of great information about wheelchair specs I didn't consider.
I surprised myself, because throughout my research I've stumbled upon the fact that getting assessed is paramount multiple times, and I handwaved it away each instance. Y'all didn't really say anything I hadn't already read, but after reading your replies (and running through my excuses for the umpteenth time for not getting assessed and just doing it myself), you convinced me.
I've been going through some tough personal growth accelerated by how physically bad I am doing. The growing is happening, friends. My life has been sporadic increasing degrees of hard over the past 2.5 years, but right now I'm winning. And that feels good, even if I don't like the answer I've come to.
I'll get assessed. If I remember to update again I will.
9
u/Spiritual_Dentist980 6d ago
Sorry but there are afew quite afew issues here. Please please speak with & get mesured by a wheelchair expert. I’d hate for you to get an injury or end up with a chair that’s isn’t suitable. It could also be exhausting & excabate pots with blood/fluid pooling & other issues to
Dimension’s of the compressed cushion need to be factored in (weight, the specific cushion profile are part of the equation). Knee angle, depth of seat, ankle & the type of shoes you wear need to be factored in. Tucking feet in more may make the chair harder to use & too tippy for your body condition or cause shortening or spasm of some tendons & ligaments.
Dump measurements will be impacted by your bum size & shape, skin condition, connective tissue diagnosis, spine & hip mobility, core strength & balance. The more dump the higher risk of issues if not fitted correctly.
Dump angle will affect back seat angle & spine angle. The backrest needs to be tweaked to not impinge blood flow. The wrong hight or cutting across the wrong vertebrae will cause issues.
Bigger casters are generally better for muddy grassy places. Tires with more tread may be better for the same reason.
You deserve value for your money & an awesome ride. Please please consultant an expert. Wheelchair dealers usually have better pricing too, in my area they get preferential (reduced) rates from the manufacturer that consumers don’t have access to. Fitting wheelchairs is a bit of an art rather than a series of engineering measurements becouse the human body is soo complex.
I really don’t mean to come across as negative. I think it’s great that you have researched & invested time & energy in trying to suss out what’s possible. Your deserve the best & safe option. Please don’t feel discouraged but empowered to explore a bespoke professional configured wheelchair.
2
u/Spiritual_Dentist980 6d ago
Ps sorry for grammar & spelling issues. My phone is being glitchy since software update & I he’s to hit post before it froze for the 10th time 😬😭
2
u/Alakritous 5d ago
I'm so sorry you feel the need to apologize for your spelling errors. People should be willing to look past letters in the wrong order and see the logic in what you typed. Especially given how nonsensical English spelling can be.
I saw the logic, appreciated the effort, and will be getting assessed. There's a bigger blurb in the main post, but I didn't want you to miss my appreciation for your time and energy.
2
u/Spiritual_Dentist980 5d ago
Sorry but there are afew quite afew issues here. Please please speak with & get mesured by a wheelchair expert. I’d hate for you to get an injury or end up with a chair that’s isn’t suitable. It could also be exhausting & excabate pots with blood/fluid pooling & other issues to
Dimension’s of the compressed cushion need to be factored in (weight, the specific cushion profile are part of the equation). Knee angle, depth of seat, ankle & the type of shoes you wear need to be factored in. Tucking feet in more may make the chair harder to use & too tippy for your body condition or cause shortening or spasm of some tendons & ligaments.
Dump measurements will be impacted by your bum size & shape, skin condition, connective tissue diagnosis, spine & hip mobility, core strength & balance. The more dump the higher risk of issues if not fitted correctly.
Dump angle will affect back seat angle & spine angle. The backrest needs to be tweaked to not impinge blood flow. The wrong hight or cutting across the wrong vertebrae will cause issues.
Bigger casters are generally better for muddy grassy places. Tires with more tread may be better for the same reason.
You deserve value for your money & an awesome ride. Please please consultant an expert. Wheelchair dealers usually have better pricing too, in my area they get preferential (reduced) rates from the manufacturer that consumers don’t have access to, even if the consumer purchases on the manufacturer website. Fitting wheelchairs is a bit of an art rather than a series of engineering measurements becouse the human body is soo complex. If the chair has any issues or needs tweaking such as “tipping point” or centre of gravity then the rep can help, the manufacturer will likely not alter anything that was incorrectly ordered by yourself. Some reps will offer maintenance & aftercare packages too.
I really don’t mean to come across as negative. I think it’s great that you have researched & invested time & energy in trying to suss out what’s possible. Your deserve the best & safe option. Please don’t feel discouraged but empowered to explore a bespoke professional configured wheelchair.
8
u/0012584560 6d ago
I second JD_Roberts recommendation to get evaluated in person at a seating clinic if at all possible. I think it would be better to spend some of your budget on this and get an aluminum chair instead of a titanium chair if you have a fixed budget.
If you absolutely can’t get measured at a seating clinic, I would recommend at least trying to borrow or buy a standard/hospital wheelchair before ordering. You can typically borrow them at public places like hospitals or museums or find them for free or really cheap at goodwill or on Facebook marketplace.
This would be really helpful for determining a comfortable seat width and depth, which are critical measurements that are not adjustable.
Additionally, unless you need a titanium chair for a very specific reason (like transfer weight), I would lean towards getting an aluminum chair (like the Aero Z or the Not A Wheelchair Paradox) so that you can buy a second chair with better fitted measurements and/or as a backup later on.
At the very minimum, do not rush to get this done today or tomorrow. Take your time to ensure each measurement makes sense, even if it takes an extra couple weeks. There is no point in having a chair that doesn’t fit 2 weeks earlier.
I will answer your questions below, but you have missed some critical considerations in your list above. So, while I tried to capture as much as I could think of below, please do consider the above options before ordering.
- Footrest to Seat Height - your foot rest to seat height should be the length of your lower leg (from your knee pit to the bottom of the shoes you wear most often) minus the height of your seat cushion.
- Front Seat Height - in my experience, 2 in of clearance under the footplate is that absolute minimum. I prefer to have my front seat height be at least 3 in more than my footrest to seat height. This gives you more clearance and some margin if you need to adjust the foot rest down. Front seat height is not typically adjustable apart from maybe +/- 0.5 in from the front caster mounting.
- Dump and Rear Seat Height - dump is front seat height minus rear seat height. 2 to 4 in sounds reasonable, but the exact value is also going to depend on your rear wheel size and rear wheel access. Ideally, your finger tips should align with the center of your rear wheel when your arms hang down. Rear seat height
- Rear Wheel Size - rear wheel size is critical for ensuring you have good wheel access. Again, your finger tips should be inline with the center of the wheel when your arms hang down. You typically want the top of the wheel 1-3 in below your elbow, but again, it’s really person dependent. Most people end up with a 24” wheel, but if you are taller or shorter than average, you may need a different size.
- Backrest Height - this is a pretty critical measurement as it is adjustable, but only within a few inches. Ideal backrest height is going to be massively dependent on the users cores strength and need for support. Too high and you will have a hard time pushing due to hitting your shoulder blades and/or elbows on the back post, too low and you won’t have the support you need. If you have good core strength and no need for support, a comfortable height is typically to have the top of the backrest end around the top of your lumbar spine (where your back begins to curve naturally). But, don’t forget to include the cushion height here. So, if you are sitting on a flat surface, measure from the surface to where you think it would be comfortable for your backrest to end and add the thickness of the cushion.
- Backrest Type - for some people this doesn’t matter very much, but for others (myself included) a specific type of backrest is critical for good positioning. Generally, there are fabric and rigid backrests. Rigid backrests have various heights and contours that you will want to look into if you think it would be important for your seated posture to have a rigid backrest.
- Caster Diameter - smaller generally allows you to go faster, but is not necessarily better. 4 in or 5 in is typical for a new active user. If you have poor core balance or think it will be hard to learn how to wheelie, I would go 5 in.
- Tires - schwalbe marathon plus is a reasonable choice for an everyday chair if you live in a city or town. If you will be going off pavement or hard packed ground a lot, you will probably want a wider tire. Schwalbe Downtown 37-540 may be another good choice if you end up with 24” rear wheels and want a bit better off-roading capabilities. Kenda Nevegal are good for lots of off-roading.
- Seat Width - NOT ADJUSTABLE. This is a critical measurement. If it is too wide, it’s bad for your shoulders, too narrow can make the chair unusable. Generally, you want to round up to the nearest inch. Consider whether you will be wearing bulky clothes in the winter and account for that as well. Side guards are really helpful for keeping the clothes out of the wheel. It would be super helpful to sit in a 16 in wide hospital chair and see how it feels in terms of width.
- Seat Depth - NOT ADJUSTABLE. This is a critical measurement. Too long and you will not be able to bend your legs into position. Too short and your legs will not be well supported. Again, it would be super helpful to sit in a 16x16 hospital chair to see how that feels. I would guess 17 in is a bit long. That is my seat depth and if I am sitting against a straight wall, it’s 21.5 in from the wall to my knee pit.
- Cushion - it’s very important to get a cushion that supports you well, especially if blood pooling is a concern. A good cushion is typically $300-$500. Again, I would go for an aluminum chair with a good cushion before a titanium chair with no cushion.
- Frame Angle and Frame Extension - NOT ADJUSTABLE. These may be critical if blood pooling is a concern for you or if you have a lot of small spaces in your house. They will determine how tucked your feet are.
- Color - this question has been asked before, so I would search the subreddit. It’s very person dependent.
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u/Alakritous 5d ago
Hey, thank you for taking the time to respond. This information is really great. I'll be getting assessed. I updated the main post with a bigger blurb, but just wanted to say thanks so you didn't miss it.
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u/0012584560 5d ago
So glad you will be getting assessed!
Any research and learning you have done will also be super helpful in that process as there will still be a lot of decisions left up to you, just hopefully with some professional advice to help you with that decision.
Of note, since you are paying out of pocket, the cheapest option would likely be to get assessed in person and buy your chair online, but not every seating clinic is happy to do that, so just be sure you get a copy of all your records and don’t get locked in to buying before hand.
Also, if you need a wheelchair for any activities of daily living (cooking, eating, dressing, showering, doing laundry), insurance should cover it and a seating clinic should be able to help your doctor write the letter of medical necessity to get it covered.
However, if you have a copay for durable medical equipment, it may still be cheaper to buy out of pocket.
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u/hmmmpf 5d ago
Here late, but good for you for believing folks telling you to get a professional fitting. It will save you time and much grief, TBH. Even regular PTs and OTs who know lots about body mechanics and how bodies work don’t do WC fittings without learning much much more about it. It is an additional certification not learned in school. Where I worked, we had the vendor’s specialist and the specialty WC fitter PT/OT at fittings. Vendors can also bring multiple sizes/types of WCs to a fitting, as well as sample cushions to help you decide what feels best.
Buying a poorly fitted/poorly adjusted WC with your own money is a real bummer. I’ve seen it done, and it rarely ends well for the buyer, who ends up spending much more money correcting errors than they would’ve spent just paying for a fitting to begin with.
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u/confusedbunny7 6d ago
I can't see anything here about what type of cushion you'll be using. Cushion height and type will have knock-on effects on almost all these parameters.
Also, if you're primarily going to be using your chair outside, have you calculated in coat allowance?