For many individuals, a standard joystick provides a safe and effective way to reach their goals. However, for others, the flexibility and customization of alternative drive controls are essential. This additional flexibility and individualized options become especially important for people whose needs and goals may change and evolve over time. Early discussions about potential future needs and alternative drive controls help ensure an individual's wheelchair system can be modified as needed and create a power mobility system that has both immediate impact and long-term adaptability.
How do we make sure the drive control and the wheelchair it's paired with are not only a good match for each other, but also for the person who will be using them? Let's look at a couple of key features of both and why they matter.
Drive Wheel Configuration
Drive wheel configuration can influence stability, maneuverability, and how the chair responds to the drive inputs you give. All of these are important to consider with any drive control, but when using an alternative drive control, there are some additional things to think about as well.
Front-Wheel Drive
Front-wheel drive chairs have their drive wheel at the front and two caster wheels at the rear of the base. A big benefit of this configuration, especially for alternative controls users, is that with only two caster wheels on the ground, there is less "caster whip" when changing directions. It also means that direction changes are initiated more directly from the drive wheel instead of the casters. This can make the chair's response when transitioning from forward to reverse or initiating a turn more predictable and efficient.
Front-drive powerchairs also tend to deliver a smoother ride on uneven terrain or bumps. This can be important for maintaining consistent access to switches and drive controls. Front-wheel drive bases have a larger turning radius than mid-wheel drives, and for some users, they find specific scenarios require more awareness of the wheelchair's position in space. Overall, front-wheel drive can be very effective for alternative controls in terms of predictable handling and efficiency in multiple environments.
Mid-Wheel Drive
Mid-wheel drive chairs have their drive wheel in the middle and four caster wheels, two at the front and two at the rear of the base. Mid-wheel drive wheelchairs are known for having a tight 360 degree turning radius, which can be helpful with turning in space by limiting the amount of back-and-forth maneuvering needed.
Many mid-wheel drive users also like that the chair pivots around where they are seated, making it feel more natural and intuitive. For individuals using alternative controls who primarily navigate indoors or in small spaces, a mid-wheel drive base might allow them to drive more safely and efficiently.
Additional Considerations for Drive Wheel Positioning
When trialing mid and front wheel drive power wheelchairs, it is important to think about the type of alternative control being used, especially when thinking ahead for an individual whose needs may change over time. For switch (non-proportional) controls, a front-wheel configuration with more predictable handling during direction changes and control in varied environments may be preferred. For proportional drive controls, the choice between mid-wheel and front-wheel drive might depend more on where the wheelchair will be used and what feels comfortable to the person. The programming options for these controls make them adaptable to either drive wheel style.
Tracking technology, and whether it's included based on the drive wheel configuration or the manufacturer's electronics should also be considered. When equipped with tracking technology, alternative drive control users can drive more efficiently, requiring less correction, which results in reduced fatigue and increased safety and confidence.
Electronics and User Interface
The wheelchair's control system, which includes the electronics, display, and user interface, allows access to all the wheelchair's capabilities. It determines not only how someone drives, but also how they access all the other features of their power chair, from changing speeds to accessing their seat functions and controlling their phone through the wheelchair's Bluetooth. Today's wheelchair electronics have evolved into more configurable platforms that can be programmed to work with virtually any alternative control method.
Choosing electronics with a customizable user interface and programming flexibility allows for individualized setup, including personalized driving parameters and multiple drive profiles. Additionally, it enables setting different access methods for switching between driving and other wheelchair functions, matching the drive control's characteristics and personal needs or preferences. Flexible programming allows the ability to adjust these settings when adding additional wheelchair functions, changing from one type of drive control to another, or giving someone the ability to use more than one type of drive control at a time.
Positioning and Mounting
Unlike standard joystick options, which usually have limited mounting options, alternative controls provide flexibility and adjustability in their placement, allowing them to be positioned in various locations, such as the head, chin, or foot. They can also be repositioned as a person's abilities or goals change over time.
A good mounting system allows the drive control to be placed precisely where the user can best access it consistently and reliably. Whenever possible, select drive control hardware that can be repositioned or repurposed. Mounting systems with interchangeable parts can allow a joystick to be used in a different location or switches to be reconfigured into a new drive control setup, ensuring that the user always has optimal access.
Customization and Integration
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The best alternative drive solutions are built with change in mind. They offer adjustable mounting, flexible components that can be used for multiple functions, positioning supports that can be adjusted to maintain access, and expandable electronics with customizable access for different wheelchair functions. A modular approach enables gradual upgrades or reconfigurations when needed, making the transition smoother. When quick changes are required, adapting rather than replacing components often reduces the time and funding requests involved.
Making sure these different components work together is also essential, especially since parts might come from various manufacturers. Good collaboration between users, manufacturer representatives, suppliers, and clinicians helps ensure that multiple technologies and types of equipment can work together.
Support for ongoing modifications needs to be both physical and technological. Offering programming and user interface options that can adapt to users with changing goals and needs is vital. And if a new drive control is required, the electronics should easily support the change.
Planning should also go beyond the wheelchair itself to include access to other assistive technologies like communication devices, phones, computers, and environmental controls. By designing a wheelchair system with all a person's goals in mind, we can help maximize their independence and access outside of mobility alone.
Sarah Lusto PT,MSPT, ATC, ATP
Regional Clinical Education Manager
Sarah Lusto PT,MSPT, ATC, ATP is a physical therapist and the Regional Clinical Education Manager for Permobil in the Mountain Region. Prior to joining Permobil in 2021, Sarah worked at the Kessler Institute for Rehabilitation where she gained extensive experience in neuro rehabilitation. At Kessler, she served as the inpatient wheelchair team lead and a member of the outpatient wheelchair clinic. She has lectured for numerous Occupational Therapy, Physical Therapy, and Medical Residency Programs and was a faculty member for Kessler’s PT Neuroresidency program. She has also presented at ASCIP and the International Seating Symposium. Sarah is a current member of RESNA and the APTA Assistive Technology/Seating & Wheeled Mobility SIG.
You can contact Sarah at sarah.lusto@permobil.com
David Miller, MA, OTR/L, ATP/SMS
Regional Clinical Education Manager
David Miller, MA, OTR/L, ATP/SMS is an occupational therapist and is the Regional Clinical Education Manager for Permobil in the Pacific Southwest and Hawaii. David joined Permobil in 2021 and prior to this time, practiced as a seating mobility specialist for over 25 years, providing complex rehabilitation solutions for pediatrics and adults at Helen Hayes Hospital Center for Rehabilitation Technology in New York. In addition, David worked at New York University Langone Health wheelchair clinic and private consultant. David is a member of RESNA and has presented at the International Seating Symposium, Medtrade, and frequently lectures to clinicians, students, and rehabilitation technology suppliers.
You can contact David at david.miller@permobil.com