THIS PAPER is intended for people using, or planning to use, power wheelchairs. It is said that "knowledge is power" and this is especially true for power wheelchair users because of the many safety issues. The power wheelchair user who knows about and understands the various safety issues will enjoy more varied uses of his power wheelchair than the person who must limit his uses out of fear of being injured in situations he may not fully understand. In this paper, we list, discuss and explain many of the power wheelchair safety issues, including the user's safe transportation in the power wheelchair, in a wheelchair van - as passenger or driver.
Folding, Light-Weight power wheelchair models (for indoor use) are often similar in appearance to manual wheelchairs ... except for the presence of two small electric motors and a detachable tray with one or two rechargeable batteries. These wheelchairs are usually compact for indoor use and have small, self-pivoting wheels (casters) in front. Most of these power wheelchair models are controlled by the user's hand with a small control stick. Quadriplegics unable to use a hand for steering and control may be equipped with a mouth- or breath- control device. These foldable power wheelchair models are usually purchased because they can be folded for storage, for transport in a car or car-trunk, or for transport on a train or airplane. The small-wheels-in-front design enhances maneuverability indoors, in small apartments and tight quarters. Having casters in front makes these wheelchairs very dangerous to use outdoors where one or both wheels can suddenly be turned sharply by encountering a crack in the pavement, a rock, a bump, a drop-off, or a sideways incline. These wheelchair models usually do NOT have electric elevating legrests, backs or headrests which are desired or needed by some wheelchair users.
Light-Weight "Power-Assisted" wheelchair models are usually similar to folding manual wheelchairs and are manually propelled in similar ways. These wheelchair models do have a battery plus one or two motors for propulsion assistance. Typically, the user is a paraplegic or quadriparetic person who desires to manually propel himself as much as possible for the exercise and resulting health benefits. The power assist feature is enabled and used to climb inclines or for extended distance travel, when the user tires or has insufficient arm strength and so desires to use the power assist feature. These wheelchair models are often lighter-weight than the folding power wheelchair models discussed above because the intermittent power use allows for smaller battery and motor sizes.
Non-Folding, Stand-Up power wheelchair models (primarily for indoor use) are sometimes used by people, unable to stand unaided, so that they can be stood up by the wheelchair for household chores or to converse face-to-face with non-handicapped people who are also standing. Generally, these models do not rely on swiveling front casters so that they are less maneuverable in small apartments (tight quarters) than conventional folding wheelchairs with casters. When in the elevated position, this type wheelchair has a very high center-of-gravity and can easily topple over. For this reason, the user of a "stand-up" power wheelchair should never put himself in the stand-up position when outdoors or even indoors, on cracked, rough or broken flooring indoors. Stand-up wheelchairs are safe only on perfectly flat and smooth flooring, and only if the user is properly strapped to the seat and seat back. These wheelchair models sometimes have electric elevation of legrests, back or headrest, often helpful for quadriparetics or quadriplegics.
Combination "Indoor-Outdoor" power wheelchair models are often purchased by people able to have and use only a single power wheelchair. Lack of storage space or limited finances can prevent the safer option: a person's owning two power wheelchair models - one for optimum indoor use - and another for optimum outdoor use. Typically, the "Combination I/O" power wheelchair compromises both functions and performs poorly at each function due to various unavoidable safety limitations. Outdoor safety requirements usually require that large, powered wheels be in front. These "combo" wheelchairs are probably most useful and safe when used (1) outdoors, on pavements and sidewalks in urban and suburban areas - not on grass or soil in rural areas; and (2) indoors, in nursing homes, assisted living facilities or apartments with wider halls and doorways that facilitate the wheelchair with bigger turning radius and maneuvering space requirements. These wheelchair models sometimes have electric elevation of legrests, back or headrest, often helpful for quadriparetics or quadriplegics.
Outdoor power wheelchair models were developed many years ago for use by people living in mostly rural countries such as Sweden. Very efficient outdoors, most have large diameter wheels in front to climb with ... and steering may be accomplished, depending on design: (1) by rotating a rear-wheel dolly ...or (2) by powering one of the large front wheels while braking the other. Many such power wheelchair models are able to safely climb grades of as much as 40%; climb curbs and, sometimes, climb outdoor stairs as seen in front of a courthouse or public building. (They do NOT climb stairs indoors due to the smaller steps and steeper grades.) These wheelchairs weigh as much as 400 to 500 pounds, less the user - or up to 650 lbs. or more with the user. If they break down, a tow truck has to be called because of the weight. They sometimes can be used indoors in hotels, hospitals, nursing homes, or public buildings ... which all have wide corridors and strong weight-bearing floors. Generally, these power wheelchairs are not safe or practical for use in an apartment. These wheelchair models sometimes have electric elevation of legrests, back or headrest, often helpful for quadriparetics or quadriplegics. A few have optional elevating seats or stand-up features.
Indoor Stair-Climbing power wheelchair models have been developed and tested over the past thirty years. The developers and manufacturers have generally been unable to obtain product liability insurance coverage and, thus, have not been able to market many of these products. Recently, the U.S. FDA approved yet another stair-climbing power wheelchair which has some very interesting and attractive design features. This stair-climber, as others before it, was designed for use in private homes and apartments as well as in public buildings. The earlier models, by other designers, were primarily for stair-climbing and were rather poor performers for general wheelchair use. The recently approved model appears to perform well in most wheelchair functions, as well as in climbing and descending stairs in private homes, in public buildings, and outdoors. These wheelchair models may or may not have electric elevation of legrests, back or headrest, often helpful for quadriparetics or quadriplegics.
A BASIC DANGER OF STAIR-CLIMBING in a wheelchair is the fact that, if an occupied stair-climbing wheelchair falls down a flight of stairs (it could fall from near the top of a 32-step stairway) then serious injury or death to the user is the likely. Others in the area may also be injured or killed.
Each person considering the use of a stair-climbing power wheelchair should think about a lot of different variables, all of which interact with each other. These are just a few of the most significant of these important variables: (1) Does user have firm and immediate manual control of steering, braking and other wheelchair controls? Examples: a paraplegic YES; a quadriplegic NO; users with MS or CP: variable - MAYBE - to what degree? (2) Does user have sharp eyesight for spotting objects or defects on steps? (3) Does user have engineering training or hobby experience in mechanics? If not, can user understand the dynamics of stair-climbing and learn to observe, analyze and think - before climbing stairs? (4) Are the stairs to be climbed in the user's home? Are they stairs he has climbed and descended in the wheelchair time and time before? Or, is it a new staircase not previously accessed? (5) Has the user visually inspected the stairs before attempting to climb or descend them, for the presence of toys, clothing, and wet or damaged areas? Any of these or other items could cause the wheelchair to fall. (6) Has the wheelchair user had someone else visually inspect the stairs for clutter, wet spots or damage before attempting to climb or descend? (7) Has the wheelchair user been trained to climb and descend a particular flight of stairs by a professional such as the wheelchair engineer, or a therapist or a mobility trainer? (8) Does the wheelchair user regularly climb or descend a new (to him) stairway on his own? Or does he always have another experienced person evaluate the new stairway, first? (9) Who is the first person to try climbing or descending a new stairway, in the power wheelchair? The wheelchair user? Or, his therapist, engineer or other proxy?
Age & Health Factors can be very significant to safety, both in preventing - and in surviving accidents. Examples: (1) Young paraplegic with normal upper body functions and strength. This fast moving person, with good eyesight, may well maneuver fast and vigorously enough to prevent an accident. Even if his wheelchair turns over or falls over an embankment, the person has the highest chance of surviving with minimal injuries. Or, (2) an elderly paraplegic, or a wheelchair user of any age with upper body weakness and impaired movement abilities, is less likely to prevent an accident or fall at the last moment and is much more likely to suffer serious injuries or death in a fall, collision or accident.
Wheelchair Control Methods are also very significant to safety. Most power wheelchairs are controlled solely by the user, without intervention by computers, terrain monitors gyroscopes or autopilots. These power wheelchair models require, for safety, that the user quickly sense, recognize and react to each and every situation, as it arises. The young, healthy paraplegic will usually meet these requirements most rapidly and effectively. The power wheelchair user with weak and/or slow-moving hand responses is more likely to have accidents and may be more severely injured. An ALTERNATIVE is available in some more costly power wheelchair models. This is the addition of computer-controlled systems that constantly monitor and correct for: wheelchair position and attitude; forward terrain variations; up and own stairway variations; user commands; and overall wheelchair performance. In theory, these power wheelchairs are much safer to operate than those without computer oversight. In practice, however, these power wheelchairs are sometimes more dangerous than non-computer wheelchairs. Serious accidents sometimes result from sensing or computer system failures. The failures may be subtle ones not recognized by the wheelchair user. Or, they can be in the form of a sudden, unexpected total failure of the wheelchair computer system, which may result in an accident when occurring at a critical time. Disregarding cost factors and considering safety issues alone, it is difficult to recommend the use of power wheelchairs that have - or that lack- computer monitoring and control capabilities. This type decision is best made with advice, on an individual basis, by each patient's physician, therapist or mobility trainer. A "Dead-Man's" safety control to automatically stop and brake the wheelchair if the user should let go of the wheelchair control stick or slump in his seat, can protect against accidents due to sudden loss of manual control or due to fainting or seizure. This feature is highly recommended and was included in most power wheelchairs dispensed by this Institute.
USERS of Power Wheelchairs - DISABILITY CATEGORIES & SAFETY RISKS as summarized below, do not include the added hazards of navigating a power wheelchair with poor vision or with susceptibility to fainting or unexpected seizures. It is assumed that all wheelchair users are strapped in for safety. Two straps should be used: one, down, lap to chair - and the other higher up, securing the upper body to the backrest of the wheelchair. The power wheelchair user must be secured both ways for maximum safety.
SAFETY - INFORMATION ... for Users of Power Wheelchairs