“Of approximately 25,000 veterans with spinal cord injury, about
18,000 are treated in the VA's 20 spinal cord injury centers and other
facilities of the VA medical care system. It is critical that VA clinical
practitioners have the most comprehensive knowledge in the wheelchair
selection process in order to make the best prescription. This clinical
supplement will assist the physician and his team in making the most
appropriate wheelchair prescription.’

Joseph E. Binard, MD, FRCS (C)
Director, Spinal Cord Injury Service

“'The Department of Veterans Affairs is the largest procurer of
wheelchairs in the United States. As the director of the service
responsible for the issuance of these devices, it is my concern that every
veteran is evaluated to assess his/her individual needs. It is critical that
each person receive the right wheelchair from the onset. | believe that
this supplement will improve the quality of the wheelchair selection
process.""

Frederick Downs, Jr.
Director, Prosthetics & Sensory Aids Service

“Consumers have been a major force in the development of improved
wheelchairs. Sports chairs, Sports ‘N Spokes, wheelchair games, etc., have
been dramatic forces in the improvement of wheelchair mobility. The
Paralyzed Veterans of America (PVA) has also been a leader in the
development of wheelchair standards. PVA, along with the VA
Rehabilitation Research and Development Service, and other organizations,
has sponsored significant research on wheelchairs. Now it imperative that
VA clinical practice make the best possible wheelchairs available to
veterans in accordance with their unique individual needs. | endorse this
publication as a step towards this goal.’’

Victor McCoy
Associate Executive Director,
Paralyzed Veterans of America

v


EDITORIALS

“The Department of Veterans Affairs (VA) is proud of the continuing
efforts of the Rehabilitation Research and Development Service to
provide better wheelchairs to veterans. Lighter, stronger and more
adaptable wheelchairs have been developed which can greatly improve
the mobility of the physically impaired. This publication provides
information to the clinician about wheelchair prescription. It will be a
valuable tool for enhancing the quality of life for the disabled.’’

John A. Gronvall, MD
Chief Medical Director

“The significant number of advances in wheelchair technology in
recent years pose a challenge to clinicians in keeping abreast of the latest
developments in wheelchair prescription. This Clinical Supplement to the
VA Journal of Rehabilitation Research and Development, prepared by the
Office of Technology Transfer, provides the clinician with a valuable aid to
assist in providing disabled veterans with mobility aids which best meet
their individual needs."’

David H. Law
ACMD for Clinical Services (Acting)

“The VA is deeply committed to making the best possible
wheelchairs available to veterans who have served their country.
Aggressive investment in research and development along with the
initiative of veterans service organizations have resulted in development
of chairs which are far superior to those available only a few years ago.
Now we face the challenge of evaluating chairs and seeing that
appropriate chairs are properly fitted to veterans in need. | pledge that a
major commitment of my offices will be to see modern wheelchair
standards adopted by the VA and an aggressive VA program of
wheelchair evaluation implemented."’

Margaret J. Giannini, MD

Deputy ACMD for Rehabilitation and Prosthetics
Director, Rehabilitation Research and Development
Service



Samuel Robert McFarland
1941 - 1989

We take pride in dedicating Clinical Supplement No. 2 to Samuel McFarland, who
served as Director of the Rehabilitation Engineering Program at the National
Rehabilitation Hospital in Washington, DC, and Director of the Rehabilitation
Engineering Center on Evaluation of Rehabilitation Technology, funded by the National
Institute on Disability and Rehabilitation Research.

Mr. McFarland began his career at Southwest Research Institute in San Antonio,
Texas in 1969. His work focused on the design of innovative new products for
disabling conditions such as deaf-blindness, quadriplegia, and mental retardation. His
work involved the transfer of engineering and scientific technology to the medical and
rehabilitation field, as it related to the home, vehicle, and worksite. He participated in
the development of performance standards for automobile adaptive devices and
wheelchairs, and played a role in the development of the Unistick vehicle controller.

A founding member of the Association for the Advancement of Rehabilitation
Technology (RESNA), Mr. McFarland was also a member of the American Society of
Mechanical Engineers, the American National Standards Institute, and the Society of
Automotive Engineers. In April, 1989, he was selected as one of 20 rehabilitation
technology experts from across the country to be a Switzer Scholar.

We commend his achievements in the field of rehabilitation technology. We also
appreciate his extensive contributions to this publication. He authored one of the
articles, he provided technical assistance for the entire text, and his illustrations appear
throughout.

Samuel McFarland was a highly respected, knowledgeable, and devoted
professional. He will be missed.

The Editors
Journal of Rehabilitation Research and Development

vi


WN Department of

Veterans Affairs

Journal of Rehabilitation Research and Development

Clinical Supplement #2

CHOOSING A WHEELCHAIR SYSTEM.

Department of Veterans Affairs
Veterans Health Services and Research Administration
Rehabilitation Research and Development Service
Prosthetics Research and Development Center— Office of Technology Transfer


Acknowledgments

The Editor wishes to thank the following for their contributions as technical reviewers
of this publication: Richard R. Owen, MD, Medical Director, Sister Kenny Institute,
Minneapolis, Minnesota; Theresa Gregorio, MA, OTR, Unit Supervisor, Department of
Occupational Therapy. The Institute for Rehabilitation and Research, Texas Medical Center,
Houston, Texas; Joseph E. Binard, MD, FRCS (C), Director, Spinal Cord Injury Service,
Department of Veterans Affairs, Washington, D.C.

Special acknowledgment is made to the following for their technical assistance in the
development of this publication: Victor McCoy, Associate Executive Director, Paralyzed
Veterans of America, and his technical staff; Frederick Downs, Jr., Director, VA Prosthetics
and Sensory Aids Service; James Mayer, special assistant to the Deputy ACMD for
Rehabilitation and Prosthetics, Department of Veterans Affairs; Robert E. Tooms, MD,
Director, Campbell Clinic, University of Tennessee; Douglas Hobson, PhD; Nigel Shapcott,
PhD, and Elaine Treffler, MA, OTR, Rehabilitation Engineering Center, University of
Tennessee. Acknowledgment is also made to the following for their services on the initial
text draft: Valerie Faith, PhD, editorial consultant; Barbara G. Sambol, VA Office of
Technology Transfer, editorial assistant; Cheryl L. Henretty, VA Rehabilitation Evaluation
Unit, editorial assistant.


WN Department of

Veterans Affairs

CHOOSING A WHEELCHAIR SYSTEM

Journal of Rehabilitation Research and Development
Clinical Supplement #2

Fourth Printing: March 1998

Margaret J. Giannini, M.D.

Deputy ACMD for Rehabilitation and Prosthetics

Director, Rehabilitation Research and Development Service
Veterans Health Services and Research Administration
Department of Veterans Affairs

Seldon P. Todd, Jr., Editor

Tamara T. Sowell, Associate Editor
Holly M. Jellison, Associate Editor
Bobbi Levien, Managing Editor
Delvin A. Wilkes, Circulation

The cover

Design: Holly Jellison
Illustrations: Samuel R. McFarland
Production: Frank Vanni

Address correspondence to: Editor, Journal of Rehabilitation Research and Development,
Office of Technology Transfer (110A1), VA Prosthetics R&D Center, 103 South Gay
Street, Baltimore, Maryland 21202.

The opinions of the authors are their own and not necessarily those of the Department of
Veterans Affairs. Contents of the Journal of Rehabilitation Research and Development
Clinical Supplement #2 include copyrighted material. No portions may be reproduced in any
form without the written permission of the copyright holders.

The mention of specific companies or of certain manufacturer's products does not imply
that they are endorsed or recommended by the Department of Veterans Affairs in
preference to others of a similar nature which are not mentioned. The Department of
Veterans Affairs does not endorse commercial enterprises, commercial products or services.

The Journal of Rehabilitation Research and Development and its supplements are printed on
acid-free paper, as of Volume 25, Number 2 (Spring 1988).