The decision about when to acquire a wheelchair is one that you will make with your doctor. A wheelchair will be prescribed for you by your therapist.
There are different types of wheelchairs and wheelchair features that require consideration. Straps may be needed to hold in arms and feet, and a seat belt is also a good idea. A reclining
back can give you added flexibility or comfort. Hand-rim pegs are helpful if you have trouble gripping with your fingers, but have strength in your arms. There are also wheelchairs that have
a double hand rim for operating from one side, useful if you have strength in one side only. Anti-tipping bars may be extended out the front or back to prevent the wheelchair from tipping
forward or backward. A commode attachment is available when you are alone for long periods. Tray- or table-like platforms should be a standard feature that can be attached to your wheelchair.
Folding wheelchairs are useful because they can be put in a car. Ask the professionals who help you with your wheelchair decision about other available features.
For the more advanced stages of ALS, a battery-powered wheelchair may be required. These can be operated using a joystick or other switching devices that can be controlled by almost any
part of the body that you can move.
Getting fitted with a wheelchair requires careful consideration and professional advice. First, your size will determine the appropriate height, depth and width of seat, as well as the height and
width of the back.
You should try different chairs, and ensure that:
- Both feet touch the ground squarely when you are properly seated;
- The foot rests are adjusted so that when your feet are on the rests, the back of your knee is about 3" away from the edge of the seat;
- The back of the seat touches your shoulder blades;
- There is at least 1" space between your hips and the wheelchair on both sides to leave room for bulky clothing, such as an overcoat;
- The arm-rests are at a height which enables your arms to bend naturally.
It is very important that you purchase the right chair. Many factors will have to be considered, such as your physical condition now and in the future, your financial situation and the
availability of financial assistance, your level of help from family and friends, and the sorts of services that your community provides for transportation. A wheelchair is a major purchase,
and if it is going to enhance your life now and in the future, it must be a careful choice.
Manual Chairs
Lightweight manual wheelchairs are often used by people who retain trunk stability and the ability to self-position themselves in the chair. These chairs are light to push and may be easily
transported by car. Because ALS is a degenerative disease, it may be more cost-effective to rent or borrow this type of chair, leaving funds available for other equipment.
Tilt-and-Recline Wheelchairs
A tilt-and-recline wheelchair is usually recommended as a person becomes weaker. Many people with ALS find breathing easier when in a reclining position. This chair positions the body in
ways that use gravity, instead of working against it. The tilt feature allows gravity to pull the hips to the back of the chair to prevent a continual forward sliding movement, which is a common
problem with a reclining chair. The tilt feature also relieves pressure on the ischials and coccyx (tailbone), preventing pressure sores from forming.
No matter what type of chair is used, skin breakdown is more likely to occur if regular repositioning techniques are not used.
Electric Wheelchairs
Electric wheelchairs allow a person to remain mobile and independent for a longer period of time than manual wheelchairs do. A standard electric chair (or scooter if muscles are relatively unimpaired) will increase your outdoor mobility while reducing overall fatigue. Because the progression of the disease will necessitate ongoing changes, borrowing or renting this chair may be more cost-effective than buying it.
As you weaken and more support and better positioning are needed, a scooter will no longer be a viable option. Electric wheelchairs with manual or electric tilt-and-recline functions should be considered. The wheelchair should support your back and head. Specialty backs provide pressure relief and lateral support, which improves stability and positioning. Headrests are available in a variety of sizes and styles.
Some electric chairs can be controlled by using sip-and-puff or rim controls. For many people with ALS, these features significantly prolong independence. Other people do not choose this kind of alternative control as they may not be able to maintain a seal around a straw or have adequate breath control for sip-and-puff, and consistent head movements are needed to drive a chair with head or rim control.
Cushions should be chosen for comfort and pressure relief, as many positions demanded by prolonged wheelchair use can cause skin breakdown. If you can independently reposition every 30 minutes, a high-density foam cushion should be adequate to relieve pressure.
As physical mobility decreases, more pressure-relieving cushions will be necessary. Many people with ALS report that gel cushions are uncomfortable, while air-filled cushions seem to provide more comfort and pressure relief. More than one type of cushion is usually required since no cushion will provide both comfort and relief all the time.
