What you should know about wheelchairs & power wheelchairs - A little guide

If your personal expectations exceed the co-payment of the health insurance fund and you pay a large share of the costs out of your own pocket, remember: In this case, the maintenance of the wheelchair is usually no longer covered by the health insurance fund. As soon as you have paid for the majority of the wheelchair, you are the owner and have to pay for the maintenance yourself. It is important to clarify this in advance so that you know who is responsible for which costs and who is the owner in the end.  In such a case, you may be able to apply for so-called "mixed financing". In this case, the health insurance pays for what is medically necessary, and you pay for the rest. If something is broken, you usually go directly to the dealer who provided you with the wheelchair.

Finding a suitable wheelchair - the very first question that helps is the same one that car dealers ask a customer when buying a luxury car: "Are you the driver or the driven? Sounds funny? It isn't. Because if you are a relative who often pushes a wheelchair for a family member, or if someone has to push you all the time, the demands on the vehicle will be different than if you are dependent on the wheelchair yourself, but will mainly move around without help. Therefore: Even before the doctor issues the prescription, you should consider together as precisely as possible which wheelchair is best suited for your purposes. Special needs assessment forms are available for this purpose. It is worthwhile to fill these out very carefully together with the doctor. The more precisely the doctor describes your individual needs, the easier it is for a specialist dealer to recommend and fit you with the best wheelchair. However, the rehab consultant often knows even better what options are available. Therefore, it often makes more sense to first ask the rehabilitation counsellor for an assessment so that he or she can then suggest a prescription for the doctor. The following questions need to be clarified:

• What should the wheelchair be used for? In other words: Only for long outdoor journeys? Only for moving around in the flat? Do you only sit in the wheelchair from time to time, or all day long, indoors and outdoors? Does the wheelchair often have to be transported in the car? Are you pushed?
• Do you need special accessories that differ from the standard model?
• How individually does the wheelchair need to be adapted for you? Would you like to be able to change certain things on the wheelchair yourself in everyday life, depending on the situation?

Admittedly: The choice is large. More than 400 models are available on the market, the accessories are diverse and depend on the manufacturer. But you can narrow down the choice quite well just by determining your exact needs. The first basic question in the selection process is: Mobile with muscle power or power wheelchair?

As with all assistive devices, there is also a wheelchair that is a so-called standard model. It costs around 100 euros and is mainly suitable as a temporary solution - not as a permanent solution, because this model does not offer too much. The standard model is often used in clinics and nursing homes to push patients and residents from A to B (as a push wheelchair) - although there are usually handrims on the wheels.

Due to its weight of around 20 kilograms alone, it is only suitable for home use to a limited extent in the medium term, because transporting it in a car, for example, is cumbersome. The standard wheelchair can also only be adapted moderately well to individual needs. Therefore: If you need the wheelchair for a longer period of time, look around for better alternatives.

Unlike the standard wheelchair, the lightweight wheelchair is not made of steel, but of aluminium and is therefore much easier to transport.  Lightweight wheelchairs include all active wheelchairs, both of which are moved with your own muscle power. A simple lightweight wheelchair starts at around 250 euros. Mind you, it starts at that! Because an individual active wheelchair can easily cost up to 6,000 euros.

A lightweight push rim wheelchair is the most common variant of the so-called active wheelchair or adaptive wheelchair. Both terms are used synonymously. The handrims - or handrims - are used to propel the wheelchair with muscle power. The push rim wheelchair is also available as a so-called one-hand drive. In this case, the wheels can be moved separately, each with one hand. In this way, one wheel can be controlled by the other. Such wheelchairs are used in sports, for example. Often, these wheelchairs are adapted very individually - depending on the type of use and the respective impairment. For example, if one half of the body can no longer be moved properly. You can also find such wheelchairs under the term "sports wheelchair". The so-called "tricycle wheelchair" is a wheelchair without footrests. This means that you can also move around with tripping steps. This is especially useful indoors.

The multifunctional wheelchair is also called a nursing wheelchair. It is intended for people who have severe limitations and can therefore hardly move under their own power. As a rule, it therefore falls under the category of a push wheelchair. The multifunctional wheelchair often has handrims like an active wheelchair, but it is much heavier, so the patient can hardly or not at all move under his own power and needs a helper. Due to its weight, a multifunctional wheelchair is only suitable to a limited extent for outdoor use. A large excursion with it will be rather difficult.

With this type of wheelchair, you can have different sitting positions adjusted, and all movable elements - i.e. headrest, footrests, levers for the controls and also the armrests - can be very easily individually adjusted. A wheelchair like this is especially good if the user spends longer periods of time in the wheelchair, but may no longer be able to change his or her sitting position on his or her own. To avoid pressure sores (decubiti) on the body, the wheelchair user must be positioned appropriately. This is possible with a multifunctional wheelchair for relatives or caregivers.

The seat of multifunctional wheelchairs is usually well padded because of the risk of decubitus. Armrests and leg supports can also be upholstered.

The health insurance fund will only pay for a power wheelchair if it is medically necessary. For an electric wheelchair, the doctor must certify that you have a permanent severe walking disability and that your arms can no longer be moved to the extent that would be necessary for a wheelchair with manual drive. If this means that certain basic needs can no longer be met without the power wheelchair and no one is permanently available to push a manual wheelchair, then a power wheelchair is your aid of choice.

The advantage of a power wheelchair is that you can cover longer distances without any problems. However, an electric wheelchair can usually only travel at speeds of up to six kilometres per hour, i.e. at a slow walking pace. Electric scooters, on the other hand, are somewhat faster and can travel at speeds of up to 20 kilometres per hour. However, such electric scooters (or also senior citizens' scooters) are only allowed in public spaces if they are registered with the registration office and also insured accordingly. Electric scooters are also considered aids and you can apply for them at the health insurance fund. But be careful: As a rule, the insurance companies only approve the rental costs for an electric scooter - the vehicle remains the property of the medical supply company. Other solutions must be negotiated individually with the health insurance fund.

Caution: It is important to think carefully about where and how the power wheelchair is to be used. There are very big differences - especially when it comes to whether the power wheelchair is used indoors or outdoors.

Five basic measurements are important for the optimal fitting of your wheelchair:

• Back height (RH)
• Lower leg length (USL)
• Seat width (SB)
• Seat depth (ST)
• Seat height (SH)

Correct measuring is so elementary because a wheelchair user spends most of his or her time sitting. This also affects communication with others - who in many life situations speak to the wheelchair user from above. For this reason alone, it is essential to design the sitting position as optimally as possible. After all, if you don't feel comfortable anyway and sit slouched, crooked and uncomfortable in the wheelchair, you can't appear confident to the outside world either. Apart from that, the influence of sitting for a long time on the entire body with bones and ligaments has to be taken into account: If the extremities are no longer moved, these important structures increasingly degrade.  

Back height (RH): The back height determines the height of the backrest. It should end below the shoulder blades so that you still have enough freedom of movement to be able to use the handrims well if necessary. The more freedom of movement you need, the lower the backrest should be.

Lower leg length (USL): The lower leg length is measured from the back of the knee to the sole, with the knee at a 90 degree angle. This measurement is important because it determines the height of the footboard. If this measurement is not taken correctly, the legs will either be too bent or it will feel like you are sliding off the seat.

Seat width: The length from the outer edge to the outer edge of the frame in the case of a rigid frame or the cross braces in the case of a folding frame is the seat width. You have to make sure that there is some space next to the pelvis so that nothing rubs or gets squashed. Keep in mind that a very wide wheelchair may not fit through every door. Especially at home, narrow passages can be a problem - especially if there are handrims on the outside of the wheels.

Seat depth (ST): The correct seat depth is important for a good sitting posture. In addition, the body weight is only distributed optimally over the seat surface if the seat depth is correct - this minimises the risk of pressure points developing on the buttocks and legs. Make sure that the backs of your knees are a few centimetres away from the front edge of the seat.

Seat height (SH): Properly measured, the footrest should end up about three centimetres off the ground and your palms should be directly over the centre of the wheel with your arms hanging down. The optimum seat height is different at the front and rear of the seat and is measured from the ground to the front and rear seat tube, respectively, depending on the frame. This seat slope is necessary so that you can sit stably and move the wheelchair forward by yourself without any problems.

Of course, you can also borrow or rent a wheelchair if necessary. This is especially useful if your own wheelchair is being repaired or you need a different model temporarily - for example, when you are on holiday. It is best to ask at the medical supply store, where you can usually get competent information on terms and conditions. Sometimes you can even rent a wheelchair for your holiday directly from the travel provider.

If you have to climb stairs at home and are permanently dependent on a wheelchair, you can get advice from an expert on the subject of wheelchair lifts. There is the so-called platform lift for indoors and the lift for outdoors. If you want to install a platform lift inside the house, you need enough space in the stairwell. It should be at least 80 centimetres so that the fold-out platform does not touch anything and the wheelchair can fit comfortably. You have to calculate about 7,000 euros upwards for the installation of such a lift system - for lift systems from 9,000 euros. However, this measure falls under the heading of barrier-free conversion and is subsidised by the health insurance fund with up to 4,000 euros if you have a care degree.

One more thing: If you need a wheelchair, you also need to get into it. So don't forget to think carefully about how you can transfer, for example, from the bed to the wheelchair or from the wheelchair to the car seat. There are also special training opportunities for relatives to learn the correct hand grips for this. If you do not know the correct grips, you can damage your back and possibly risk a serious fall. You should also remember that not every day is the same. If today the repositioning works well in one way, then tomorrow it can be different again. Therefore, it is important to talk to each other every time you need a second person to help you move. How do we want to do this now? Are you ready? Can you do it today - or should we try something else?

There are also practical aids that make transferring much easier, for example, a sliding board or a turntable. It's best to ask the medical supply store directly.

Gloves, anti-tip wheels, tray, bag, blanket, footmuff or rain cape, rear-view mirror, drink holder, bell - even lamps and smartphone holders: you can buy a whole range of wheelchair accessories depending on the model and your needs.

Especially if you spend a lot of time outdoors with the wheelchair, you should remember: If you move, you don't get cold as quickly. But if you are only sitting and possibly being pushed, you will get cold more quickly. So a blanket and footmuff are a must, especially in the colder months of the year.

The right seat cushion also deserves a lot of attention. If you find that the seat is too hard in the long run or that the seat height is uncomfortable in some situations, you can choose from a variety of seat cushions. A discussion with your doctor or, even better, the rehab consultant at the medical supply store can be helpful. In case of doubt, the expert knows best which cushion will provide ideal relief for your body.