By Kevin Lockette, PT
Selecting a manual wheelchair is much like buying a car. There are numerous manufacturers, models, and options. And like purchasing an automobile, what you ultimately select reflects your needs, preferences/style, and budget. The goal of this article is to walk you through the matrix of options while highlighting some of the unique features and chairs that are on the market.
For reimbursement purposes, Medicare classifies similar wheelchairs in categories called "K-codes." This classification system is useful as well when sorting out your options because all the chairs in each class have similar characteristics.
Before we start on the specific classes of wheelchairs, it is important to keep in mind the multiple considerations that will ultimately dictate your selection of a particular wheelchair. Considerations include the strength, range of motion, orthopedic status, muscular tone, and cardiopulmonary status of your client. Other considerations include the potential for change in function or size, need for an adjustable or modular frame, the method of—arms, legs, or both—propulsion, positioning needs and environmental needs that will dictate types of tires, casters, etc.
Below is a general overview of the different classes of self-propelled, manual wheelchair frames. The accessory options available are quite extensive and too large to address here.
K0001—STANDARD WHEELCHAIR
Source: Palmetto GBA. Available at: www.palmettogba.com. Accessed September 6, 2005.
Appropriate Clients (K0001): The client is typically able to propel a "standard" weight wheelchair and is without functional or postural compromise or is dependent in mobility. This client also does not require any modifications or atypical dimensions in the frame in order to self-propel the wheelchair or perform transfers in and out of the wheelchair.
K0002—STANDARD HEMI WHEELCHAIR This class is the same as the K0001 with the exception of having a lower seat to floor height and shorter footplate extension tubes. The seat to floor height in this category is typically 17 to 18 inches, which often is not low enough for many clients for foot propulsion.
Appropriate Clients (K0002): This class is the same as the K0001 with the exception of having a lower seat to floor height and shorter footplate extension tubes to accommodate a client that is of shorter physical stature or a client who needs a lower seat to floor height to use their feet for propulsion.
K0003—LIGHTWEIGHT WHEELCHAIR The K0003 class has more sizes available, but is still limited. The standard seat width is 16 or 18 inches. However, most chairs in this class have 20-inch seat width and 18-inch seat depth available. There are few if any frame modifications or adjustments in this class. There are more options and accessories, but they are still limited. These chairs weigh less than 36 pounds without front riggings with an average around 28 pounds. This class has a standard seat to floor height range of 19 to 21 inches.
Appropriate Clients (K0003): The client for this class may be unable to propel the weight of a standard wheelchair due to upper and/or lower extremity weakness, low endurance or cardiopulmonary issues, pain, spasticity, and/or decreased ROM, but is able to propel in a lightweight chair of this class. The body dimensions of the clients are accommodated by the standard wheelchair dimensions. Clients that are appropriate for this class of wheelchair do not have significant deformities or spasticity and typically do not have a condition that is progressive in nature because there is little adjustability to accommodate any type of physical or functional change.
K0004—LIGHTWEIGHT WHEELCHAIR The K0004 class has more sizes, options, and accessories, as well as minimal frame adjustments, including a minimal adjustable axle plate. The standard seat width is 14 inches, 16 inches, or 18 inches. However, most chairs in this class have 20-inch seat width and 18-inch seat depth available. These chairs weigh less than 34 pounds without front riggings with an average around 26 pounds. This class has greater seat to floor options with available dimensions of 17 to 21 inches.
Appropriate Clients (K0004): The client for this class may be unable to propel the weight of a standard and lightweight wheelchair (K0003) due to upper and/or lower extremity weakness, low endurance or cardiopulmonary issues, pain, spasticity, and/or decreased ROM, but is able to propel in a lightweight chair of this class. The body dimensions of the clients may require chair dimensions and adjustability that you cannot find in the K0003 class such as greater or lesser seat to floor height, and higher back height other than standard due to poor balance postural control, abnormal tone, and/or other orthopedic issues. As in the K0003 class, clients that are appropriate for this class of wheelchair do not have significant deformities or spasticity and typically do not have a condition that is progressive in nature.
K0005—CUSTOM LIGHTWEIGHT AND ULTRA LIGHTWEIGHT WHEELCHAIR The K0005 class has more sizes, options, and accessories, as well as many frame styles and adjustments, including adjustable axle plates, folding and rigid options, modular options, and different suspensions. The axle plate can be adjusted to a great extent allowing for ultimate customization in the wheelchair setup, which can also aid in injury prevention. There is much more adjustment in caster housing with greater options for angle of seat. There are greater options in caster sizes to be tailored for the user. For example, micro-size castors can be used for a much tighter turning radius for sports or tight work areas or wider casters can be used to accommodate more difficult terrain. These chairs offer adjustable back angles with an example of +3° (squeeze) to –15° (to accommodate for lack of hip flexion). More back height options are available in this class—low, medium, and tall.
The standard seat width is 14 inches,16 inches, or 18 inches. However, most chairs in this class have 20-inch seat width and 18-inch seat depth available. These chairs weigh less than 30 pounds without front riggings and can go down as low as 17 to 18 pounds for the titanium frames. This class has greater seat to floor options with available dimensions of 17 to 21 inches. This class of chairs is more expensive and requires meticulous documentation and rationale for coverage by third-party payors.
Folding and Rigid Frame Options: The K0005 class of chairs is the only class that allows for the rigid frame option. It is appropriate then, to spend a little time on when or why you would choose one over the other. A rigid frame is typically for a client who has been a wheelchair user for a considerable amount of time and knows exactly what they want and need. It is fairly typical for paraplegics to select a rigid over other diagnoses. Rigid frames are more durable, more energy efficient, and lighter. The drawback of the rigid frame is that it does not easily accommodate changes in the client's status or size. Lastly, rigid frames may be more difficult to transport depending on the vehicle.
Appropriate Clients (K0005): In regard to appropriateness for clients, this class has some of the same advantages of the K0004 class with the added benefit of a much lighter wheelchair with a wide range of adjustments that may allow for greater accommodation of deformities and for greater independence on all terrains. Due to the adjustability, this class of wheelchairs is the most appropriate of the manual wheelchairs for clients with dynamic and/or progressive disorders.
FINAL CONSIDERATIONS
www.sportaid.com www.wheelchairs.com www.spinlife.com www.caremedical.com www.mobilityeng.com www.thewheelchairsite.com
Kevin Lockette, PT, is president and owner of Ohana Pacific Rehab Services LLC, with clinics in Honolulu and Kailua, Hawaii.
