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Choosing Wheelchairs for Kids by: Maricon Williams Take a Team Approach Before Buying No parent should try to choose a chair for their child all by themselves,' says Chris Seiberlich. 'It's not that they aren't qualified to make decisions, but there are too many to be made by any one person. You have to think about a huge spectrum of issues. Seiberlich is a physical therapist at Children's Clinics for Rehabilitative Services in Tucson , Ariz. She and her partner, Kimberly Becerril, an occupational therapist, are discussing how to choose and properly fit a wheelchair. 'For instance,' Becerril says, 'one of the most fundamental issues in choosing a chair is transportation. How will the chair be moved from home to school? If the answer is in the back of a station wagon, then a power chair is out. Even with a van, a power chair is going to need a ramp, because it's too heavy to lift in. A lot of our kids would benefit from a power chair, but unless the transportation issue can be solved, it won't be the right choice.' Becerril knows a number of children who have power chairs who leave them at school, and use a manual chair at home. 'During the process of choosing a chair, we do a lot of transfer analysis,' Seiberlich says. 'We want to know who's going to be doing them (transfers), and we want the parents to demonstrate how they're doing them. We can suggest ways to make it easier, such as use of a transfer board, or a Hoyer lift in appropriate situations. 'Most parents who've never seen a board are surprised by what a difference they can make,' she adds. 'Still, if they are lifting the child and the chair several times a day, they are at a big risk for developing back problems. We had one mother with bruises all over her legs from constantly lifting the chair. Choosing a lighter chair, and one with some removable hardware, can make a big difference.' Seiberlich and Becerril note that they can't make all the decisions regarding the choice of a chair, either. 'We want the involvement of those people who see the child on a regular basis,' Becerril says. 'That means the parents, of course, because they know the child best. But we also want the school involved, especially the teacher or therapist who sees the child daily functioning outside the home. The issues at school can be quite different from those at home.' Becerril says that they also want the chair supplier involved, to tell them what's available. 'We'll describe the need, and the supplier can describe what they have to meet it. We can make mistakes if we do it ourselves, but if we have the whole team, we can cover all the bases.' Lifestyle and Environment What's the right style of chair? While this will depend on individual needs and preferences, Becerril offers some important guidelines. 'Lots of kids want the sports frame look: It's got a low profile and looks great. However, these frames are rigid: they can't be folded, and they can't grow with the child. So we wouldn't recommend one of these at least until they are finished growing. Even then, the transportation issue remains a problem.' Seiberlich adds, 'We also would never recommend a chair without removable armrests or footrests. One of our clients who got a chair with rigid footrests went from independent transfers to requiring two people to move him. Luckily, we were able to recycle the chair to someone for whom it made more sense.' When it's time to choose individual components, Seiberlich and Becerril want to hear about lifestyle, terrain and environment. 'We can choose the wheels based on how rough the ground is around the home,' Seiberlich says. 'Here in the desert, we recommend airless inserts. One good cactus spine and you've got a flat! Back East, we've got to consider the mud, the snow and the rain.' 'We also want to know about the inside of the home: Will an otherwise ideal chair have trouble getting through narrow doorways? If so, and there's no money to redo the home, we've got to change our thinking,' Becerril says. Social and educational factors come into play here as well. 'Is the chair appropriate for the school setting?' Seiberlich says. 'For instance, does the height of the chair put the child above or below classmates? Can we make small changes to get it looking more streamlined, if that's what the child wants? If we can think of these things up front, it can save a lot of time and expense later on.' Growing With the Child Both the X-shaped cross brace (black) and the front frame sections (blue) can be replaced as a child grows. And expense is a huge issue: A manual wheelchair with custom seating can cost $'5
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