Tuesday, May 29, 2012

Wheelchair lessons

To my M.S.-accessorized companions on the Neurological Highway, who may be perhaps facing further accessorizing with a walker/transport chair/wheelchair... some musings on my travels with it/them last weekend.

I normally use a "translator," a walker/transport chair that's a walker (when I'm doing well) or a transport chair (when I'm not). As an experiment, at the Yale reunion I borrowed a standard push-it-with-your-arms big-wheel wheelchair, just to see what the differences in being relegated to a different device would be like. Your mileage may vary (as the saying goes), but for those of you who may find yourself needing to avail yourself of such devices, here's what I learned about the differences between them.

First, the translator in "walker mode" is vastly superior in locations that are only vaguely ADA'ed, or not-really-at-all ADA'ed. Some of the biggest impediments to my passage were one-to-two-inch "steps," sometimes as high as four to five inches. If you're still "walking" (if we can call it that), you can "step over" big lumpy things, and avoid divots/pot holes. In restaurants that haven't really left enough room between tables for wheelchairs, you can partially collapse the walker so it's wide enough to use but not as narrow as you'd "squish" it to fit into the back of a car, and you can thread your way through the tables. Of course, that doesn't work for anything in "wheelchair mode," but the translator at its widest is still is a little narrower than the push-it-yourself wheelchair—and width is a major inconvenience when you're trying to wend your way through a not-well-planned restaurant.

If you're stuck in transport chair/wheelchair mode, the ride is much smoother with the big wheels. The smaller wheels of the transport chair get stuck in, and stopped by, everything. Sidewalk-to-street wheelchair ramps are often very poorly executed, with huge gaps or lifts or gulches between the concrete of the sidewalk and the asphalt of the street, and the smaller wheels of the transport chair always get stuck. Always. The wheelchairs often have "step on it to pop a wheelie" pedals that enable a person pushing you to lift the front wheels over anything, and that's a great feature, but if you're by yourself, you obviously can't use them.

In both kinds of chairs, going backwards often works better. In any chair, that puts the larger wheels first, which often solves problems.

If you're wheeling yourself in a wheelchair, get gloves. Otherwise, your hands will get very dirty. Or scraped, or something else unpleasant.

And the motorized versions? I love them. I have one at school, I drive all over the place in it. But it's no good when the incline gets too steep (it really isn't designed to go "up hills"), they can get stuck in the mud and/or spin out, and more importantly: they're heavy. Nasty heavy. My translator is light and collapsible enough that my 14-year-old students can pick it up and toss it in the back of the truck. You can't just tuck one of those motorized suckers into the back seat of a car, or the back of a truck, you really need a device that attaches to the back of your vehicle that it rides on. They'll tell you that you can take it apart, and you can, but it's nasty inconvenient. You want convenience? You want a translator.

And speaking of off-roading: You want the translator in "walker" mode. Doesn't matter how bumpy the lawn (or whatever) is; as long as you can keep everything upright and on solid ground, you're fine. Big wheel chairs can sink into soft ground or otherwise get stuck; translator in walker mode, you can just lift up, reposition it, and keep going.

Don't use a wheelchair as a wheeled walker. My translator has bicycle-style brakes on its handles, and those are massively convenient; if you need to stop your forward motion for whatever reason, you can do it. And, if you're unloading it from your car and you want to make sure it doesn't get away from you (which it almost did, once, from me), you can. The big-wheel wheelchairs are not walkers. Something happens while you're "walker-ing" with it and you want it stop—you can't make it. It has brakes, but you can't reach them, and you're going to keep rolling forward until you hit something. Not good.

And in terms of what it "costs," energy-wise: Well, you're sure to get your cardio with the big-wheel wheelchair. Right now, I "walk" really crappy if I have to use shoes, but great in just stocking feet—the latter isn't always an option, especially on public streets covered in hot asphalt, mud, or medical waste—using shoes exhausts me very quickly. I went about as slowly wheelchairing myself as I did "walking," but that'd speed up if all I was doing was wheelchairing; practice makes perfect, as the saying goes. Even with no practice, I found myself tired but not significantly so after a day with the wheelchair. Using the translator as a walker, without shoes I can "walk" all day, but with shoes, I tire profoundly, and quickly.

The big-wheel wheelchairs have their advantages in specific situations. I like using them in museums; my wife and I look at things at completely different paces, so we can each look at things the way we each want to, and then she pushes me to the "next stop." They've got a wonderful turning radius—they spin in place, the transport chair can't. The ride is significantly smoother, they're much better when the roads/paths aren't really ADA'ed properly. But if you can walk at all, you want the translator.

Electric's the choice for distance and speed, but definitely not for off-roading! A good choice if you can leave it in the place you're going to use it daily, but if you want to transport it so it can transport you, you'll either need special equipment to facilitate that, or a very strong helper. And don't forget to keep it charged, and you may very well have to replace the battery more often than you like.

So that's that. The people who sell you this stuff will tell you certain things, medicos that prescribe them or teach their use will tell you other things, but you don't really understand them until you use them. By yourself. Without help.

And of course, my prayer for you is that you won't require these things daily... but I was very surprised by how easy it was to get used to them, and damn! They are wonderfully helpful. One can't wall-walk everywhere, convenient as that may at times be. And no matter what you may (or with luck, may not) need for transportation assistance... good luck!


Katja said...

This is a great comparison between different mobility aids. One thing I'd add is that any standard manual wheelchair (big wheeled push it yourself wheelchair) that you borrow is going to be bigger, heavier, wider, more uncomfortable and harder to push than a manual wheelchair that is properly fitted for you. Think of it as grabbing some random shoes (that are large enough for the largest person who might need them) off a rack and trying to walk around in them all day.

So if you find yourself using a manual wheelchair occasionally , it may be worth investigating having your doctor write a prescription, getting a seating evaluation, and purchasing your own lighter weight, appropriately sized chair.

Muffie said...

Robert, this is spot on! Your assessments are so accurate -- and I've experienced them all. Suffice it to say, though, we're still in much better shape than countries across the pond. It's all pretty much non-accessible. Thanks for the excellent evaluation.

Robert Parker said...

Katja: Well said. The one I borrowed was one of the clunky, old, WICKED heavy models that have been around forever. I understand that the new ones are still heavier than the translators, but not as heavy as the old "Ironside"-era models.

They may actually be heavier than 19th-century wheelchairs the theater has rented from prop shops.

Katja said...

Exactly. The chair you borrowed probably weighed on the order of 60 lbs. By contrast, my chair weighs about 22 lbs with wheels and cushion.

Those big clunky chairs, for some reason, are called 'depot wheelchairs'.

Robert Parker said...

"Depot" wheelchairs? Perhaps because you'd find them at Home Depot? Home of clunky equipment of ALL kinds...

Katja said...

Here we go, from "Rehabilitation Engineering Applied to Mobility and Manipulation", by Rory A. Cooper:

"7.2.1 Depot (institutional) wheelchair

"The depot or institutional wheelchair is essentially the same wheelchair that was issued to veterans in the 1940s. The wheelchairs may be a bit lighter, but the basic frame is unchanged. Depot wheelchairs are intended for institutional use where several people may use the same wheelchair. These wheelchairs are typically used in airports, hospitals, and nursing care facilities. Generally, they are inappropriate for active people who use wheelchairs for personal mobility (figure 7.2). Depot wheelchairs are designed to be inexpensive, accommodate large variations in body size, to be low-maintenance, and to be attendant-propelled. Hence, they are generally heavier and their performance is limited."

Robert Parker said...

Katja: Thanks, that explains a lot.

Basically indestructable rather than user-friendly. Proof, as ever, that "one size fits all" really means "one size fits all badly."

"Inappropriate for active people who use wheelchairs for personal mobility"... well, I must say, I do feel better about disliking it so much. Informative, it indeed was. If anyone needs motivation to keep out of those devices, just use one for a day... Oh, yes, you'll be motivated, all right. (Grumble...)

Katja said...

The sad thing is that so many people, on the cusp of needing a wheelchair (or some other mobility aid) do use one for a day, and come away from the experience swearing that they'll never use a wheelchair, that a wheelchair is utterly impractical - completely unaware that something much better by the same name is out there and could be helpful to them.