Gary J. Gilberti, CRTS

It was a crisp fall day in western Pennsylvania—the year was 1975. My classmate Sean put on his helmet and ran onto a high school football field as he had done many times before.

As a star defensive back, he was known for his toughness and aggressiveness in spite of his lack of size. Sean had no idea that as he lowered his head to tackle a much larger receiver, he would crush several vertebrae and be unable to move anything below his shoulders. Sean was now a quadriplegic.

After a year of rehabilitation, and major renovations to make the 100-year-old campus buildings wheelchair accessible, he returned to school. None of his classmates had ever experienced someone with a spinal cord injury. All were amazed by his “electric” wheelchair, how he was able to navigate the campus and once again participate in class.

Everyone knew Sean was approaching, since we could hear his chair as he traveled through the halls. We could hear the whining sound of the motors, the clicking of the massive control box on the back of the chair, and the microswitch joystick, which made it difficult for him to accurately steer the chair. It had large rear wheels and belts that often slipped in the least bit of rain or morning dew when he rode across campus.

Even his backup manual wheelchair was a monster—a stainless steel behemoth that friends would push around when his electric chair was not working—which was often. His seating was nothing more than a foam cushion and plywood back with foam and sheepskin covering it. By today’s standards, Sean’s equipment was crude and antiquated. But at that time, and to him, it was cutting-edge technology that allowed him to be back with his friends and back in school.

Sean was the first person I had encountered who used what we now call rehab and assistive technology. Most of us only knew wheelchairs as those things we saw in the drugstore window or at nursing homes. Although this was years before I would enter the rehabilitation industry, I was intrigued by the technology and how it enabled someone with a severe injury to return to a reasonably normal life.

I was unaware that there was an entire field dedicated to providing specialized mobility products for people like Sean. Nor did I even think that I would find myself in the middle of that industry working to provide mobility and seating products to people like him.

The Whine Has Aged Well
In those 30 years, mobility products have evolved by leaps and bounds. Many old school rehabilitation technology specialists (RTSs) could probably identify the make and model of Sean’s chair just by the whine of the motors. Those who were in this industry before the term “RTS” even existed remember electronics that were adjusted by turning a screwdriver and not a plug-in programmer. Electronics were anything but plug and play. Controllers had relays, and joysticks had gimbals or microswitches.

Back then, manual wheelchairs weighed 50 or 60 pounds and had stainless steel frames, not high-strength aluminum or titanium. We went to the hardware store to get brackets to mount our seating components that we just upholstered in our shop.

As the technology evolved, we were introduced to “power bases.” They were lauded as the all-terrain vehicles of the wheelchair field and provided us with the first ability to really work with a modular system. Finally, users could go wherever they wanted. Gone were the belts, as direct drive motors became the new wave. Wider, but smaller tires provided traction on multiple surfaces. Modular electronics meant the ability to interface specialty controls without ordering aftermarket systems.

Modular frames made it possible to mount a variety of seats and systems on the same base without altering the width of the chair. Proportional joystick controls allowed users to drive diagonally, not just north, south, east, and west—and they could even control the speed in those directions. Functions such as acceleration, deceleration, reverse speed, turning speed, and balance all became adjustable through a keypad.

Three-wheeled “scooters” appeared on the market and became an avenue of assistance for those with mild disabilities. Those that needed just a little help in getting around could do so without buying a big, bulky power wheelchair. Scooters offered some level of portability to those who wanted to travel or to be active outside their home.

In the 1980s we were introduced to modular “ultralight” manual chairs in multiple colors and sizes. Wheels became removable via “quick release” axles, and frames could be either rigid or folding. No longer did we have to wait 8 weeks or more for the frame to be custom welded. The chairs were generally in the 30-pound range, easier to push, and easier to place in and out of a vehicle. Those “travel chairs” were being replaced by lighter, more modular tilt-in-space frames.

A New World
New materials such as aluminum, titanium, nylon fabrics, and composite plastics made the chairs portable and maneuverable. Suddenly, people were playing tennis, basketball, and quad rugby in their chairs. Racing chairs, mono-skis, water skis, and quad rugby chairs signaled that a whole new world of mobility was opening up. Sean would be first in line to try these products.

Somewhere along the way, manufacturers decided that drive wheels of power chairs should be mounted on the front. This design had been used in early manual chairs and on power chairs built in Europe, but not in the United States until the 1980s. The front-wheel-drive chairs allowed for greater maneuverability and tighter turning. More power options became available such as seat elevators, standing frames, tilt, and recline—all on the same chair. All of those improvements gave chair users the ability to be more mobile and more independent.

The mid-wheel revolution took place in the early 1990s, and the world of “consumer power” was born. A complete line of products was targeted at those lesser involved clients or “endurance users.” As funding sources chose to stop paying for scooters, these became the product of choice for those clients. This also spawned a delivery model that allowed greater access products for the general public and greater awareness of mobility options.

Today’s World
If Sean were to roll into a rehabilitation technology supplier today, his options would be endless—front-wheel drive, mid-wheel drive, rear-wheel drive, tilt, recline, standing, elevating, joystick, chin controls, sip-n-puff, colors galore, gel cushions, air cushions, contoured seating, and more. For the most part, chairs are made to tighter specifications and are tested rigorously to hold up under real life conditions.

Manufacturers have looked to other industries to find technologies that can be applied to rehabilitation and mobility. Motor and electronic technologies are being imported from the auto industry much like our first ultralight wheelchairs were fabricated from materials used in hang gliders and racing bikes. Manufacturers continue to look overseas to reduce the design and manufacturing costs of these products and make them more affordable.

The technology in the mobility industry will continue to evolve, but the rate of that evolution depends on our ability to preserve reimbursement. Many of the advancements that we have seen were the result of a favorable payor environment. As that payor system continues to change, we will be forced to do more with less. The mobility technology will have to be even more reliable and more functional for less money. Let’s hope that the options available 30 years from now will make 2005 seem as primitive as 1975 seems today. DP

Gary J. Gilberti, CRTS, is president of Chesapeake Rehab Equipment Inc, Baltimore. He can be reached via e-mail: ggilberti@chesrehab.com.