In choosing a manual wheelchair for a user, clinical considerations sometimes take a backseat to the cold, hard realities of cost. Third-party payors, of course, insist on that. But satisfying payor whims should not necessarily force you to take a one-size-fits-all approach to manual wheelchair inventorying.

According to some experts, it can actually work to your financial advantage to carry the widest possible variety of wheelchair types, styles, and features because doing so will make you the most popular supplier in town in the eyes of referring clinicians.

“A mistake I see a lot of HME dealers make is they stock only those wheelchairs they know they can get paid for,” says assistive technology veteran Jean Minkel, MA, PT, of Minkel Consulting in New Windsor, NY. “An HME dealer can afford to look at a wheelchair as a commodity item only if he or she is going to be selling to the limited segment of the market that has very benign mobility needs, such as the person recovering from an orthopedic injury. The advantage of inventorying appropriately is that it opens the door to the HME dealer who wants to form good, strong, mutually beneficial relationships with the rehab community.”

And it is not all that difficult to swing that door wide. As Minkel points out, physiatrists, physical therapists, occupational therapists, and other clinicians who make referrals for manual wheelchairs by and large do not like taking out a wrench and going to work on equipment. “They love that there is someone they can turn to who can handle that end of it for them,” she says.

Rory A. Cooper, PhD, chairman of the Department of Rehabilitation Science and Technology at the University of Pittsburgh, shares Minkel’s belief in the value of HME dealers working cohesively with clinicians to ensure manual wheelchair users receive the optimal piece of hardware.

“As a dealer, you should make an effort to become part of a team,” he says. “If you take a team approach and provide good-quality product and good-quality service, everything should work out just fine. You’ll turn a fair dollar on the sale and, at the same time, you’ll have satisfied partners wanting to keep working with you in the future—and wanting to do everything in their power to keep you successful. Because, once you’re part of the team, they’ll see you as a very worthwhile partner who deserves their ongoing support.”

Getting the Right Fit
Were this a more equitable world, each manual wheelchair user would own more than one such mobility aid, says Mark R. Schmeler, MS, OTR/L, ATP, director of the Center for Assistive Technology at the University of Pittsburgh Medical Center.

“You wouldn’t try to sell a customer on the idea that there’s just one type, style, and size of shoe for all occasions and purposes,” he says. “Well, the same holds true for manual wheelchairs. There isn’t a single type, style, and size for all users. You’ve got different needs and different applications. One type, style, and size of wheelchair isn’t going to begin to cover them.”

Many dealers err by making the one chair they carry a basic type. Durable to the hilt, basic wheelchairs unfortunately are often so heavy that most users find them difficult to self-propel, Schmeler says.

“The drawback to these—besides offering zero adjustability—is that they’re designed to accommodate the body of an average-sized adult male, which is actually an atypical user,” he says. “Further, we have research that shows people develop repetitive-strain injuries in their upper extremities when they use a basic manual wheelchair continually throughout the day over the course of time. In addition to pain, these users are prone to developing postural deformities and pressure sores.”

Ideally, says Schmeler, an HME dealer should stock a variety of product from the following other categories of manual wheelchairs:

• Lightweight wheelchairs. Not nearly as heavy as a basic wheelchair, this type is often utilized in hospital rehab settings. It affords some adjustability, and it is usually foldable—a plus if it must be stowed in the trunk of a car for users who commute to and from school, work, or shopping. Users can safely spend 4 hours a day in one of these, Schmeler says.

• Ultra-lightweight wheelchairs. Affording superior adjustability, these present the least amount of rolling resistance and so are considered desirable in situations where strain on the user’s body must be held to a minimum. Within the ultra-lightweight arena are two subcategories: modular and rigid-frame chairs.

Modular ultra-lights permit swapping out of the greatest number of components when attempting to customize a chair. “You can change the wheels, casters, armrests, back supports, angles, and more,” Schmeler says. “Modular ultra-lights are particularly good for helping first-time users from the spinal cord injury population discover what configurations are going to work best in their individual situations.”

Rigid-frame ultra-lights, meanwhile, are very durable. They are easiest of all to propel because the rigidity minimizes loss of energy during propulsion. “Welded titanium frames, which deliver ultimate performance from the chair, are preferred for use by very active lifestylers,” Schmeler says.

How to Match Them
Carrying the right selection is only the starting point when providing manual wheelchairs. Schmeler and others say you also need to ensure that each wheelchair is matched correctly to each user’s needs. Here are a few suggestions concerning how to do it:

• Become thoroughly knowledgeable about equipment options and applications. You are expected to be the source authority on available products, so it is important you keep up with the marketplace and are able to inform your consumers and clinician partners about every feature and benefit of those products, Schmeler says.

• Spend time with the customer. Ask questions about current mobility skills to help you develop a context for identifying the most appropriate chair. “Questions to ask include things like, ‘Can you pop a wheelie, are you able to push across carpeting, are you able to self-propel up an acceptable ramp?’” Minkel says.

• Never let the user test-propel in the showroom if all you have is easily traversed linoleum. Absenting a dedicated test area with a variety of surfaces in your shop, take the consumer out to the parking lot and direct him or her to try propelling down the curb cut, across the lot, and over to a car. “You’ll see the functional demands of the chair change completely during that test drive over the various surfaces,” Minkel says.

• Use teleconferencing technology to partner with busy clinicians. You have joined a clinical team, but not everyone can arrange their schedules for a face-to-face meeting to work out the various issues of matching the user to the right chair. No problem. Simply set up a teleconference using desktop squawk boxes, wireless picture phones, or Internet Web cams hooked to your laptop computer.

“Teleconferencing would be one way that each member of the team could see the client and one another during a meeting,” says Rory A. Cooper. “Saving steps and frustration is what it’s all about.”

Rich Smith is a contributing writer for Dealer/ Provider.