Jim LeBrecht chose to use a power chair in order to alleviate his shoulder pain. Since then, he’s come to appreciate the benefits of a power chair over a manual, such as effortlessly climbing hills.

Jim LeBrecht chose to use a power chair in order to alleviate his shoulder pain. Since then, he’s come to appreciate the benefits of a power chair over a manual, such as effortlessly climbing hills.

When you can use a manual chair, it may feel like surrender to switch to a power chair instead. But wheeling should be freeing, not energy-sapping, injury-inflicting, or painful, as Patty Kunze, Jim LeBrecht, and Phil Pangrazio discovered.

In her T3-4 SCI from an auto accident in 2009, Patty Kunze’s right arm and hand were fractured, so her shoulder had to be frozen during the recovery process. Pushing a manual chair proved painful. Physical therapy did not help, and further diagnostics revealed some arthritis.

Although Kunze, who was 48 at the time, dearly wanted to use a manual wheelchair, it was clear she would need to use a power chair. “I would go down kicking and screaming if I could, but the pain won out,” she says. A trained nurse, she also hoped to use a manual standing chair, knowing the value of load-bearing on her legs, but her therapists would not approve it. She felt a sense of defeat and reluctantly accepted that a power chair was the only way forward.

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But once she was in her Permobil C300, Kunze discovered the benefits of power. “I found a new freedom I didn’t know could exist since my SCI,” she says. It was easy to board her adapted van, and the elevation feature brought kitchen shelves within reach. Her sadness about having to embrace power fell away.

Kunze’s initial resistance to power had a great deal to do with not wanting to look “more disabled.” But once she made the switch, “My shoulders thanked me, and I didn’t care what the public thought,” she says.

For Jim LeBrecht, embracing power was a much slower process. Born in 1956 with spina bifida, he began pushing a manual chair at the age of 2, and throughout the years he had put his upper body to work in a number of ways. A theater sound engineer since his college days, LeBrecht often carried his body into seating areas or up backstage catwalks. He played wheelchair tennis, did improvisational dance and rode handcycles. “I’ve had times in my life where I felt pain, but then I recovered,” he says. “Until it got to a point where I couldn’t stop the pain.”

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An X-ray revealed that LeBrecht had a rotator cuff muscle tear in his shoulder, a common injury for manual wheelchair users. “I was thinking that the longer I use my shoulders and arms as much as possible, the better shape I’ll be in,” says LeBrecht. But he did lasting damage each time he hurt his shoulder, even though he thought he had recovered. He was unwilling to undergo surgery, given the months of absolute dependency and danger of pressure sores it would entail. “The risks of the recovery process and the percentage chance of it really taking were just not good enough,” he says.

The only answer remaining was a move to power. LeBrecht came to appreciate the benefits of a power chair over a manual one, especially since he lives in a hilly neighborhood in Berkeley, California. “I just couldn’t go out in my neighborhood in a manual chair,” he says.

Energy Preservation

Switching to a power chair gave Phil Pangrazio more energy for work.

Switching to a power chair gave Phil Pangrazio more energy for work.

The switch to power is not always about accommodating an injury. For Phil Pangrazio, CEO of Ability 360 in Phoenix, Arizona, it had everything to do with preserving his energy. Injured in 1979 at C6-7, Pangrazio used a manual chair until 2005, when the pace of his work made it hard to get through a busy day without being seriously fatigued. “I knew if I was going to keep doing what I was doing that I needed my energy,” he says. He admits that not using a power chair was a matter of pride. “If you’re in that ‘super quad’ category like me, where you’ve got enough physical ability to push a manual wheelchair, you’re going to do it.”

Using a power chair instead was also a matter of comfort. “It is just easier to sit in a power chair all day long than in a manual,” he says.  Manuals are primarily designed for mobility, as upright posture and firm contact with the back of the chair is key to being able to make the most of your available strength and balance. A tradeoff of efficiency over comfort has to be made with a manual chair.

The power chair can have a more reclined back, which supports your upper body weight, making you more comfortable. And given that an adjustable reclining feature is common to many models, you get more control over what feels best over the course of a day. You feel more stable and secure.

The Price of Power

There’s a learning curve when you switch to power. The added weight and extra speed of a power chair have to be considered in ways that are not the case with a manual.

“My banged up walls and cabinets could tell the story,” says Kunze. And LeBrecht actually broke an elderly woman’s toe when she stepped into his path of travel — but he grants that he could have been going slower.

LeBrecht learned about a Permobil C300 with tilt and elevation available from a family who had lost a member to ALS. He paid just $1,500 for it. But most people are likely to get caught in a very long process of selecting a chair, waiting for delivery and then paying out of pocket for a good share of it.

He got lucky, as the cost of a power chair can be steep, commonly in the tens of thousands, and often wheelchair users have to fight with insurers. To increase your chance of winning those battles, try to find a seating professional and provider willing to advocate for you. And, of course, you need to be sure that the provider you work with is in your funder’s network.

It’s an unfortunate fact that a lot of wheelchair options don’t have insurance codes, which means they have to be paid for out of pocket. As you work through the options on the order forms, be sure you know exactly what a feature will cost you. If it’s important enough to you, you may have to pay for it yourself. Things like specialized chair backs, for instance, with ergonomic adjustment, lumbar support and so on, might be something you will have to choose to fight for, pay for, or just pass on.

So there are upsides and downsides to power. The perks include greater mobility, more comfort and even more flexibility in parking. “It doesn’t matter if I have to park three blocks away downtown for a meeting. Boom. I’m over there with the power chair,” says Pangrazio.

But using power means if you don’t already have an adapted van, you’ll probably have to get one. Van conversions are expensive and hard to get funded outside of Voc Rehab, but you may be able to find a deal on a used lift-equipped van (see Tips for Buying a Used Wheelchair Van, November 2018).

Lastly, keeping that manual chair around is a common strategy. You might still be able get around the house in it, and if your power chair breaks down, you’ll have a handy back-up.

Not Ready for Full Power? Try Assist

Mark RaceMark Race paid attention to the pain in his shoulders. He works for his local independent living center, where he helps people transition back to the community from institutions. After loading his chair into and out of his car 10 or more times a day for years, he’d had enough. “I just couldn’t do it anymore,” says Race, a T3 paraplegic. “I was going to need a shoulder replacement if I didn’t do something different.”

Race rehabbed his shoulder and was fortunate to achieve total return. But he couldn’t go back to what he was doing. So while he’s able to push a manual chair, he started using a Smart Wheel in 2014 for power assist.

Power assist technologies, combined with the modern highly-customized, ultralight manual wheelchair, offer an alternative to a joystick-controlled power chair. They are less expensive and easier to transport. Also they allow you to still burn calories and maintain some strength and range of motion in your upper body.

Race made the case to his insurance company for his Smart Wheel by saying, “Six grand for a Smart Wheel, or 32 grand for a power chair? You make the choice.” They paid.

Putting off Power

Comfort, stability and safety in a manual chair rely on having it very well specified and configured. “An improperly-fitting chair will definitely put you at risk of developing shoulder issues — and fast,” warns Annie Palermo, a physical therapist and researcher at The Miami Project to Cure Paralysis. She says this is because “essentially your shoulders become your hips. They were not evolutionarily made to do that. When you’re putting smaller muscles in charge of propelling your body, they fatigue quicker. And they break down.”

A critical issue is center of gravity — the position of the main wheel axles toward the front or rear of your chair. “If you have to reach too far back for your wheels, you will put wear and tear on your shoulders that can add up over years and cause inflammation,” says Palermo.

In the old days of the ultraheavy Everest & Jennings tanks that many of us used, it was nearly impossible to protect our upper bodies in the long term. A well-specified and maintained modern ultralight wheelchair gives us control over that moment when we make the switch to power. Instead of being forced by chronic pain and injury, we can do it for the greater mobility and independence it has to offer, and at a time of our own choosing.

On the whole, taking care of your arms and shoulders, using a well-configured manual chair, and being extra aware when you engage with disability sports will ward off the day you might be forced into power.

You’ll also want to keep your tires inflated. When they go soft, you have to apply more force and you don’t coast as far. That means more pushes, and more strain, on your tissues over time. Keep those puppies pumped!