462

Evaluation of Selected Ultralight Manual Wheelchairs

Using A1\JSI/RESNA Standards
Rory A. Cooper, PhD, Michael L. Boninger, MD, Andrew Rentschler, BS
ABSTRACT. Cooper RA, Boninger ML, Rentschler A.
Evaluation of selected ultralight manual wheelchairs using
ANSI/RESNA standards. Arch Phys Med Rehabil 1999;80:
W HEN SELECTING a manual wheelchair, value and
quality should be assessed. Clinical considerations in
determining wheelchair choice include fit, ease of propulsion,
462-7. ease of transfers, ability to load in a motor vehicle, maneuver-
ability, and aesthetics.le4These factors are influenced by the
Objectives: To provide data for clinicians and wheelchair design of the wheelchair and the processesused in its manufac-
users to compare the durability, strength, stability, and cost
turer. In addition, clinicians must justify the cost effectiveness
effectiveness of four different ultralight wheelchair models, and of their choice of wheelchair. Currently, clinicians rely heavily
to compare the results of this study with those published for on experience and the advice of durable medical equipment
lightweight wheelchairs.
dealers, who are often experts on reimbursement. In the current
Design: Standards testing and cost-effectiveness analysis of
four wheelchair models from different manufacturers (12 health care environment it is becoming increasingly difficult to
receive authorization for what many clinicians and consumers
wheelchairs total).
would consider the most appropriate wheelchair. This is
Results: There were significant differences (p 5 .05) in the
fatigue life and value (equivalent cycles per dollar) among the because there is a paucity of data concerned with the objective
ultralight wheelchairs tested. There was also a significant evaluation and comparison of wheelchairs. Clinicians, there-
difference (p 5 .05) in rearward stability tilt angle for the least fore, are faced with a potentially serious problem in this era of
and most stable configurations. There were no differences in evidence-based practice.
forward and lateral stability. The ultralight wheelchairs Wheelchair standards provide a means of assessing the
(1,009,108 cycles) had significantly (p 5 .05) higher fatigue quality and value of products, and are a useful tool for
lives than previously reported for lightweight wheelchairs comparing products. Armed with the type of information
(187,370 cycles). The lightweight wheelchairs had a mean provided by wheelchair standardstesting, clinicians and consum-
value of 210 cycles per dollar compared to 673 cycles per dollar ers may be able to justify their assessmentof the products that
for the ultralight wheelchairs. The difference in value for the are most appropriate. Wheelchair standards also provide a
lightweight and ultralight wheelchairs was statistically signifi- means of assessing the qualities of wheelchairs with which
cant (p 5 .OS). people may not be intimately familiar. Most countries apply the
Conclusion: There were differences in the fatigue life and International Organization for Standardization (ISO) standards
value among the four models of ultralight manual wheelchairs for wheelchairs. The IS0 7176 standards are the series for both
tested. This indicates that ultralight manual wheelchairs are not manual- and electric-powered wheelchairs5-* The American
all of equal quality. The fatigue life and value of the ultralight National Standards Institute (ANSI) and the Rehabilitation
manual wheelchairs were significantly higher than those previ- Engineering and Assistive Technology Society of North America
ously reported for lightweight manual wheelchairs. This indi- (RBSNA) standards are mostly consistent with the IS0 stan-
cates that ultralight wheelchairs may be of higher quality than dards. ANSI-RESNA and IS0 wheelchair standards are com-
lightweight manual wheelchairs. Clinicians and consumers prised of test methods that have been developed through years
should seriously consider selecting an ultralight manual wheel- of laboratory validation and multinational arbitration.5,7g8
chair to meet their wheelchair mobility needs. ANSI/RESNA test results of selected electric-powered wheel-
0 1999 by the American Congress of Rehabilitation Medi- chairs have been published.g However, cost analyses were not
cine and the American Academy of Physical Medicine and done in that study, and the products were donated by manufac-
Rehabilitation turers on a self-selected basis. Cooper and associateslo pub-
lished the first study that compared the life-cycle costs of
rehabilitation (ie, ultralight) manual wheelchairs to depot
manual wheelchairs. Although their report did not include
From the Department of Rehabilitation Science and Technology and Department of wheelchair names, it did reveal that ultralight wheelchairs
Bioengineering, University of Pittsburgh (Dr. Cooper, Dr. Boninger, Mr. Rentschler);
the Division of Physical Medicine and Rehabilitation, University of Pittsburgh
lasted about 13.2 times longer during the ANSURESNA fatigue
Medical Center Health Systems (Dr. Cooper, Dr. Boninger, Mr. Rentschler); and the tests than did depot wheelchairs. They also found that depot
Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Health Care wheelchairs cost about 3.4 times as much to operate as
System (Drs. Cooper, Boninger), Pittsburgh, PA. ultralight wheelchairs. In a follow-up study, Cooper and
Submitted for publication July 9, 1998. Accepted in revised form October 27, 1998.
Supported in part by the US Department of Veterans Affairs, Rehabilitation
colleagues” reported on the results of testing selected light-
Research and Development Service (BSOS-RC), the Paralyzed Veterans of America, weight wheelchairs (Everest & Jennings EZ Lite, Invacare
the Eastern Paralyzed Veterans of America, and the US Department of Education, Rolls 2000, Quickie Breezy). That team reported that there
Rehabilitation Services Administration (H129E50008). were no significant differences in the life-cycle costs or fatigue
No commercial party having a direct financial interest in the results of the research
supporting this article has or will confer a benefit upon the authors or upon any
life among the three lightweight wheelchairs. They revealed,
organization with which the authors are associated. however, that the fatigue life previously reported for the
Reprint requests to Rory A. Cooper, PhD, Human Engineering Research Laborato- ultralight wheelchairs was significantly greater than that of
ries (151.Rl), VA Pittsburgh Health Care System, 7180 Highland Drive, Pittsburgh, lightweight wheelchairs. Moreover, there was stratification of
PA 15206.
0 1999 by the American Congress of Rehabilitation Medicine and the American
life-cycle cost, with the ultralight wheelchairs costing 3.4 times
Academy of Physical Medicine and Rehabilitation less to operate than depot wheelchairs and 2.3 times less to
0003-9993/99/8004-5123$3.00/O operate than lightweight wheelchairs.

Arch Phys Med Rehabil Vol 80, April 1999

 EVALUATION OF ULTRALIGHT WHEELCHAIRS, Cooper 463

The purpose of this study was to collect and compare the down. In addition, all wheelchairs were inspected at least every
results of ANSI-RESNA wheelchair standards tests for four of 10,000 double-drum cycles and 300 curb-drops. The double-
the most commonly used ultralight manual wheelchair models. drum and curb-drop cycles chosen are those described in IS0
A lightweight wheelchair is defined as a manual wheelchair 7176-08.12 This standard includes static strength tests for the
with minimal adjustments designed for individual or institu- armrests, anti-tip levers, push handles, hand grips, and foot-
tional use. An ultralight wheelchair is defined as an adjustable rests. Static strength is tested using a constant force or weight,
manual wheelchair designed for an individual’s use as a the value of which is prescribed in the standard. Static strength
long-term mobility aid. Although the names “ultralight” and is tested using a constant force or weight, the value of which is
“lightweight” imply a difference in weight, this is not necessar- prescribed in the standard. Static strength load values are
ily the case in practice. The four models of wheelchairs selected expected to be seen infrequently by the wheelchair components.
(Vision Epic,a Action XTRA,b Kuschall 1000,Cand Quickie IId) The standard also includes impact strength tests for the seat,
were from four different manufacturers (Everest & Jennings, backrest, wheels, casters, pushrims, and armrests. During the
Invacare, Kuschall, and Sunrise Medical), who are among the impact tests the wheelchair is also dropped from one meter
largest wheelchair manufacturers in the world. It was hypoth- unloaded, and ten centimeters loaded with a loo-kg dummy.
esized that: (1) the total equivalent number of cycles would not Impact strength tests shocks that the wheelchair may experience
be significantly different for the four models of wheelchairs infrequently during normal and foreseeable use. For the pur-
tested; (2) the cost per total equivalent cycle would not be pose of comparison of fatigue-life and life-cycle cost, we used
significantly different for the four models; (3) the static stability the following formula to compute the equivalent number of
results would not be significantly different in any orientation for cycles:
the four models; (4) the total equivalent number of cycles for
the ultralight wheelchairs would not be significantly different Equivalent Cycles = (Double-Drum Tester Cycles)
from our previously published data for lightweight wheelchairs; + 30 . (Curb-Drop Tester Drops)
and (5) the cost per total equivalent cycle for the ultralight
wheelchairs would not be significantly different from our This equation is based on the ratio for the double-drum
previously published data for lightweight wheelchairs. cycles and curb-drop drops in ANWRESNA wheelchair stan-
This line of research provides purchasers, payers, consumers, dard, part 8. In order to determine relative operational cost per
and manufacturers with information about the quality and value equivalent test cycle, the total number of equivalent cycles until
of commonly used manual wheelchairs. Evidence-based prac- a Class III failure occurred was divided by the initial purchase
tice mandates decision making regarding the purchase or price. This yields a parameter that we refer to as value that has
prescription of wheelchairs, which is based on comparative units of cycles per dollar. The value is an estimate of life-cycle
quantitative data. This report also examined life-cycle cost for costs for each wheelchair’s useful life span (ie, the wheelchairs
the four models of ultralight manual wheelchairs tested. Life- had little or no value after testing). Only common bolts that
cycle cost provides information regarding the approximate cost failed (ie, bolts available from a typical hardware store) were
to operate the wheelchair during its useful life, which is replaced during testing. Three bolt failures (ie, any combination
expected to be about 5 years. The use of life-cycle cost rather that added to three) were considered a Class III failure.
than purchase price may help clinicians, consumers, and payers Maintenance costs were not used when determining dollars per
to make wiser choices when selecting manual wheelchairs. equivalent cycle. This was done because minimal maintenance
costs were incurred during this study.
METHODS All wheelchairs were loaded with loo-kg ANSI/RESNA
This study consisted of three components: (1) testing of 12 wheelchair test dummies, as was appr0priate.j The test wheel-
common ultralight wheelchairs using ANSI-RESNA standards; chairs, described in table 1, were ordered and purchased
(2) comparing the fatigue life of four different models of through US Department of Veterans Affairs medical centers.
ultralight wheelchairs; and (3) comparing the life-cycle cost of This precluded the wheelchair manufacturers from becoming
four different models of ultralight wheelchairs. The selected aware of our intentions before testing. All wheelchairs were
ultralight wheelchairs commonly purchased by the VA and ordered to the same dimensional specifications using the default
other third-party providers were tested. All the wheelchairs features (eg, caster type, wheel type, or tire type) on the
were folding models. The ANSI-RESNA tests were conducted manufacturer’s order form. The dimensions were chosen to be
in the order prescribed by the standards. Double-drum and the most commonly purchased size reported by the manufactur-
curb-drop testing were the last tests to which the wheelchairs ers. Dimensions were verified before testing according to IS0
were subjected.w A double-drum tester is simply two rollers 7176-07 using an ANWRESNA reference loader gage.5
with lZmm-high slats attached to each. The front roller turns All wheelchairs of like model used identical components. All
7% faster than the rear to avoid exciting harmonics. The rear wheelchairs used 203~mm (&inch) polyurethane solid caster
rollers turn at an equivalent speed of Im/sec. The wheelchair is tires, swing-away legrests, 610~mm (24-inch) rear wheels with
balanced over the rollers with a swing-arm attached to the pneumatic tires, and sling-type upholstery. None of the wheel-
wheelchair’s rear axles to provide stability. A double-drum chairs came with a seat cushion. Rated tire pressure was
cycle is defined as one revolution of the rear roller. The maintained for the pneumatic tires throughout the testing. The
curb-drop tester is a device that lifts the wheelchair 5cm and cost of each wheelchair (per unit) was: $1,845 (Everest &
allows it to free-fall to a hard surface. Each wheelchair was Jennings Vision Epic); $1,250 (Invacare Action XTRA); $2,015
planned to be tested for at least 200,000 cycles on the (Kuschall 1000); and $1,900 (Sunrise Medical Quickie II). The
double-drum tester, If the wheelchair completed 200,000 cycles mass of the wheelchairs and their primary removable compo-
without a Class III failure, it was transferred to the curb-drop nents are presented in table 2. All of these wheelchairs have
tester for 6,666 drops. This process was repeated until the cross-brace folding frames and were made from welded,
wheelchair experienced a Class III failure. A Class III failure is 6061-T6 aluminum tubing. The welds were made using tung-
defined as permanent damage, deformation, or failure that sten inert gas or similar methods. All welded joints were
significantly affects the ability to operate the wheelchair. Our mitered.
test machines were instrumented to detect failures and power- A balanced randomization was used for determining testing

Arch Phys Med Rehabil Vol 80, April 1999

464 EVALUATION OF ULTRALIGHT WHEELCHAIRS, Cooper

Table 1: Model, Manufacturer, and Critical Dimensions for Wheelchairs Tested

Seat Seat Seat Seat Backrest Backrest Backrest Overall Overall Overall
Manufacturer/ Angle Depth Width Height Angle Height Width Width Length Height
Model (7 (mm) (mm) (mm) (7 (mm) (mm) (mm) (mm) (mm)

lnvacare
Action XTRA 1 9 430 410 500 11 400 400 635 1050 910
Action XTRA 2 8 430 410 500 11 400 400 635 1050 910
Action XTRA 3 7 430 410 500 9 400 400 635 1050 910
Kuschall
Champion 1000 1 7 470 400 500 9 340 350 635 980 855
Champion 1000 2 11 470 400 500 9 420 350 635 980 890
Champion 1000 3 8 470 400 500 11 340 350 638 980 855
Everest&Jennings
Vision Epic 1 8 450 410 460 IO 415 340 660 1010 930
Vision Epic 2 9 450 410 460 IO 415 340 660 1010 930
Vision Epic 3 8 450 410 460 IO 415 340 660 1010 930
Sunrise Medical
Quickie II 1 IO 450 400 510 9 450 400 630 1010 930
Quickie II 2 IO 450 400 510 9 450 400 630 1010 940
Quickie II 3 IO 450 400 510 9 450 400 630 1010 940

order for each of the 12 wheelchairs. Multiple analysis of RESULTS

variance (MANOVA) and analysis of variance (ANOVA) with The results were categorized into four areas: (1) static and
levels of significance of p < .05 were used to test the five impact strength testing, (2) fatigue testing, (3) life-cycle
hypotheses stated for this study. The Fisher post hoc analysis analysis; and (4) static stability testing. All but one of the
was used to determine significant interactions. The small wheelchairs passed all sections of the static and impact strength
sample and cell size were clearly limitations to the statistical portions of IS0 7176-08: Static, Impact and Fatigue Testing
analysis. However, the cells were balanced, and this was a large Standard.12 Only the Kuschall Champion 1000 failed the
sample for this type of study considering the cost of the handgrip pullout test for one chair (Champion 1000 3). The
wheelchairs, the length of time required to test to failure, and results of fatigue testing for the wheelchairs are presented in
the complexity of collecting the data. The use of MANOVA and table 3 and figure 1. The equivalent cycles were calculated from
ANOVA implies the assumption that the variables chosen for equation (1). Analysis of variance revealed that there were
analysis can be represented by a normal distribution. significant differences (p 5 .05) in the equivalent cycles among
The 12 test wheelchairs were also evaluated using other the models of ultralight wheelchairs tested. Our results show
pertinent components of ANSI-RESNA wheelchair standards.5 that the Champion 1000 wheelchairs endured significantly
These tests include Static Stability (part Ol), Effectiveness of more equivalent cycles than both the Vision Epic and the
Brakes (part 03), Static Strength Testing (part OS),and Impact Quickie II wheelchairs. In addition, the Action XTRA wheel-
Strength Testing (part OS).The static and impact strength tests chairs lasted significantly more equivalent cycles than did the
are pass/fail, whereas the other tests are disclosure. All tests Vision Epic. There were no other significant differences in
were performed by thoroughly trained and experienced wheel- equivalent cycles before Class III failure among the other test
chair testing engineers.
wheelchairs. The Champion 1000 had the highest number of
equivalent cycles on average (1,830,026), whereas the Vision
Table 2: Mass of Wheelchair and Primary Components Epic had the lowest mean number of equivalent cycles (430,409).
Figure 2 presents the results of the life-cycle cost analysis for
Total Mass of Mass of Mass of
Manufacturer/ Mass Footrest Armrest Rear Wheel
the wheelchair models tested. Analysis of variance showed that
Model (kq) (kn) ka) (kn) there were significant differences in the value among the
ultralight wheelchairs tested. The Fisher post-hoc analysis
lnvacare showed that there were significant differences between the
Action XTRA 1 15.9 0.8 .45 2.5
value for the Action XTRA and the Champion 1000, Vision
Action XTRA 2 15.9 0.8 .45 2.5
Epic, and Quickie II. There were also significant differences in
Action XTRA 3 15.9 0.8 .45 2.5
value between the Champion 1000 and the Vision Epic, and
Kuschall
Quickie II. The Action XTRA had the highest value (1,290
Champion 1000 1 15.1 0.7 .45 2.4
cycles per dollar) among the ultralight wheelchairs tested. The
Champion 1000 2 15.1 0.7 .45 2.4
Vision Epic had the lowest value (237 cycles per dollar).
Champion 1000 3 15.1 0.7 .45 2.4
The results of the static stability testing are given in table 4.
Everest&Jennings
For all tests, the surface of the incline test plane was in
Vision Epic 1 15.1 0.7 .45 2.2
compliance with ANSI-RESNA wheelchair standards.5All the
Vision Epic 2 15.1 0.7 .45 2.2
2.2
ultralight wheelchairs were tested in their least and most stable
Vision Epic 3 15.1 0.7 .45
configurations. Ultralight wheelchairs have adjustability to
Sunrise Medical
Quickie II 1
accommodate the needs of their users. With the rear wheels
15.2 0.7 .45 2.5
Quickie II 2 0.7
locked and unlocked, there were statistically significant
15.2 .45 2.5
(p < .05) differences in the rearward tilt angle between the
Quickie II 3 15.2 0.7 .45 2.5
least and most stable positions. Both the Vision Epic and the

Arch Phys Med Rehabil Vol 80, April 1999

 EVALUATION OF ULTRALIGHT WHEELCHAIRS, Cooper 465

Table 3: Fatigue Test Results for Selected Ultralight Wheelchairs

Manufacturer/ Double- Curb-Drop Total Equivalent

Model Drum Cvcles Drows Cvcles Class III Failure

lnvacare
Action XTRA 1 600,000 17,168 1 ,I 15,092 Frame, left front along bolt hole
Action XTRA 2 923,947 26,664 1,723,947 Frame, right front along bolt hole
Action XTRA 3 1 ,ooo,ooo 33,330 2,000,000 Frame, right front along bolt hole
Kuschall
Champion 1000 1 1,200,000 39,996 2,400,OOO Left, top castor to frame bolt failed 3 times
Champion 1000 2 890,159 26,664 1,690,079 Right, rear wheel bearing failed 3 times
Champion 1000 3 800,000 19,998 1,400,000 Left, lower castor to frame bolt failed 3 times
Everest&Jennings
Vision Epic 1 197,313 0 197,313 Left castor stem failed 3 times
Vision Epic 2 396,744 6,666 596,744 Left castor stem failed 3 times
Vision Epic 3 297,169 6,666 497,169 Right castor stem failed 3 times
Sunrise Medical
Quickie II 1 200,000 6,666 400,000 Frame, front left, weld b/w seat/footrest
Quickie II 1 288,952 6,666 488,952 Right castor stem failed 3 times
Quickie II 3 400,000 6,666 600,000 Right castor stem failed 3 times

Quickie II were statically unstable with their least stable wheelchair models (EZ Lite, Invacare Rolls 2000 LT, and
adjustments when occupied by the loo-kg test dummy on a Quickie Breezy).
level surface. There were no statistically significant (p < .05)
differences in either lateral or forward stability between the DISCUSSION
least and most stable positions. All manual wheelchairs are not alike. There are substantial
The results from the ultralight wheelchairs tested in this differences in features and adjustments.‘” The results of this
study were compared to the results for nine lightweight study showed that there are differences in durability and
wheelchairs, previously reported.” Analysis of variance re- life-cycle costs among ultralight manual wheelchairs. The
vealed significant differences (p = .007) among the equivalent Action XTRA had the highest value (equivalent cycles per
cycles for lightweight and ultralight wheelchairs. The ultralight dollar). The Vision Epic had about 5.5 times higher life-cycle
wheelchairs lasted on average 1,009,108 cycles, whereas the cost than did the Action XTRA. Another way to view cost is to
lightweight wheelchairs had a mean equivalent of 187,370 examine the sale price necessary to yield equal value. The
cycles. The Fisher post-hoc analysis revealed significant differ- Action XTRA has a suggested retail price of $1,250 and a value
ences (p 5 .05) in equivalent cycles between the Action XTRA of 1,290 equivalent cycles per dollar. To achieve the same
and the Champion 1000 when compared to all three models of value, the other wheelchairs would need to sell for the
lightweight wheelchairs (EZ Lite, Rolls 2000 LT, and Breezy).
When value (equivalent cycles per dollar) was compared
among wheelchairs, analysis of variance revealed significant
differences (p = .02) for ultralight and lightweight wheel-
chairs. The lightweight wheelchairs had a mean value of 210 8 t 1290
cycles per dollar compared to 673 cycles per dollar for
ultralight wheelchairs. The Fisher post-hoc analysis showed
that the Action XTRA and the Champion 1000 had significantly
higher value (p 5 .05) than all three of the lightweight

/ Action XTRA 1
Quickie II 1
Action XTRA 2
Action XTRA 3 237 244
Champion 1000 1
r-l IL
E
22
(right side)
Fig 2. Value (equivalent cycles per dollar) for selected wheelchairs.
Black bars represent value for ultralight wheelchairs; white bars
Fig 1. Locations of failures on the test wheelchairs. represent value for lightweight wheelchairs.

Arch Phys Med Rehabil Vol 80, April 1999

466 EVALUATION OF ULTRALIGHT WHEELCHAIRS, Cooper

Table 4: Tilt Angle From Static Stability Results for Selected the wheelchair were used to make adjustments. Many ultralight
Ultralight Wheelchairs (All Angles Are in Degrees)
wheelchairs have accessoriesavailable to increase their range
Rearward of adjustments. The static stability results of this study were
Forward: similar to those previously reported.i3*i4
Rear Wheels Rear Wheels Casters
Locked Unlocked Unlocked Lateral Ultralight wheelchairs last longer during fatigue testing and
Manufacturer/ Least Most Least Most Least Most Least Most have lower life-cycle costs than lightweight wheelchairs. Our
Model Stable Stable Stable Stable Stable Stable Stable Stable results showed that ultralight wheelchairs last about 5.4 times as
lnvacare
long as lightweight wheelchairs. The fatigue life results of this
ActionXTRAl 8 15 13 24 20 20 19 20
study were in agreement with those previously published. li The
ActionXTRA2 8 15 13 24 20 20 19 20 ultralight wheelchairs tested in this study lasted on average
ActionXTRA3 8 15 12 24 21 20 19 20 1,009,108 2 782,960 (n = 12) equivalent cycles, whereas other
Kuschall studies have shown lightweight wheelchairs to last 187,370 2
Champion 10001 4 8 8 15 18 18 18 18 153,013 (n = 9) equivalent cycles. The double-drum tester has
Champion 10002 5 8 9 15 18 19 18 18 .254-m diameter drums. Therefore, one cycle of the drums is
Champion10003 5 8 8 14 18 18 18 18 equal to .80m. Applying this information, the ultralight wheel-
Everest&Jennings chairs endured an average of 807km before a Class III failure
Vision Epic 1 0 IO 6 18 20 21 20 20 compared to 150km for the lightweight wheelchairs. Indeed,
Vision Epic 2 0 IO 6 17 20 21 21 20 testing represents rough kilometers that are designed to acceler-
Vision Epic 3 0 IO 6 17 20 21 20 21 ate failures. All the ultralight and lightweight wheelchairs had
Sunrise Medical solid front casters.A comparison of value between the ultralight
Quickie II 1 0 IO 6 17 21 21 20 21 and lightweight wheelchairs showed that the ultralight wheel-
Quickie II 2 0 IO 6 17 21 21 19 21 chairs were significantly higher in value. The lightweight
Quickie II 3 0 IO 6 17 20 20 19 22 wheelchairs cost about 3.2 times more to operate than ultralight
wheelchairs. Cooper” reported a 2.3 times factor for life-cycle
costs between ultralight and lightweight wheelchairs. This
following: $1,418 (Champion 1000); $333 (Vision Epic); and study showed that it is more cost effective to provide long-term
$384 (Quickie II). It is unlikely that Everest & Jennings and wheelchair users with ultralight wheelchairs than lightweight
Sunrise Medical can sell their products at these prices. There- wheelchairs. This is based on a cross-section of seven models of
fore, it would be useful to concentrate on addressing the failures wheelchairs from four major manufacturers. Previous studies
in their designs. have shown that both ultralight and lightweight wheelchairs are
The Kuschall Champion 1000 endured the highest number of more durable and cost effective than depot wheelchairs.‘O~ll
test machine cycles. The Champion 1000 lasted about four This study relied on standardized tests designed to evaluate
times as long as the Vision Epic during fatigue testing. The wheelchairs. These tests are performed on machines using test
Vision Epic and the Quickie II did not fare as well in the fatigue dummies. The performance of wheelchairs on the ANSI/
testing or in the life-cycle cost analysis. Eleven of the 12 RESNA-IS0 tests may vary from actual use. Moreover, there is
ultralight wheelchairs exceeded the IS0 fatigue requirements. variation among the usage patterns that affect wheelchair life
Only Vision Epic 1 failed on the double-drum tester. Four of the among wheelchair users. Many wheelchairs are available with a
12 wheelchairs experienced frame failures during the fatigue wide variety of options and adjustments. It was not feasible to
testing. All three of the Action XTRA wheelchairs experienced test all the possible permutations of the wheelchair configura-
frame failures. Most of the wheelchairs experienced multiple tions in this study. There are likely to be different results with
component (eg, bolts, caster stems) failures. Component fail- different configurations. The approach of using standardized
ures can be annoying, and may leave the user stranded. On the test methods and international standards makes comparison of
other hand, component failures can be incorporated into a products tested by different laboratories possible. Test laborato-
product’s design to protect more expensive sub-assemblies.The ries must rigorously follow the standards to minimize the
results of this study suggest that the Action XTRA will be a likelihood that a flaw in the test procedure could skew the data
more reliable wheelchair than the others tested (ie, required no or invalidate comparisons. When applied properly, standards
repairs during fatigue tests). These results suggest that not all can provide useful information about products.
ultralight wheelchairs are of equal quality. Clinicians and
Wheelchair selection can be a challenging process when
consumers should be cautious when ordering wheelchairs and
should make sure that the manufacturer supplies some evidence done properly. There are few quantitative data on the quality of
of the product’s quality. wheelchairs. This makes the selection and justification of
The static stability testing of the selected ultralight wheel- wheelchairs difficult. However, there is an increasing body of
chairs showed that adjustments affect the angle at which the literature related to wheelchair quality. The literature is most
wheelchair will tip. Our results indicate that the greatest abundant in the areas of stability, safety, and durability.15-l9
changes in tip angle are in the rearward direction. The rearward More studies are required to provide sufficient data on the wide
stability (mean F SD) with the wheels unlocked was 8.3” +- variety of products available to consumers and clinicians. It
2.9” for the least stable position and 18.3” 2 3.6” for the most appears clear the ultralight wheelchairs are superior in durabil-
stable position. When the rear wheels were locked, the rearward ity and value (equivalent cycles per dollar) to lightweight
static stability angles changed to 3.0” ? 3.4” for the least stable wheelchairs and, by extension, depot wheelchairs. The trend in
position and 10.5” ? 2.7” for the most stable position. The funding is toward depot and lightweight wheelchairs, yet these
forward stability angles for the ultralight wheelchairs were types of wheelchairs are of poorer quality and are not cost
19.8” 2 1.1” and 20” i- 1.1” for the least and most stable effective. Moreover, lightweight and depot wheelchairs do not
positions, respectfully. The lateral stability tilt angles range incorporate the adjustability included in the design of ultralight
from 19.2” t 0.9” for the least stable position to 19.9” L 1.3” wheelchairs. The adjustability of the wheelchair for the user can
for the most stable position. Only parts originally supplied with increase mobility and, possibly, reduce the risk of secondary

Arch Phys Med Rehabil Vol 80, April 1999

 EVALUATION OF ULTRALIGHT WHEELCHAIRS, Cooper 467

disability. It is most appropriate to provide ultralight wheel- wheelchair. Washington, DC: Paralyzed Veterans of America;
chairs to long-term wheelchair users. 1994.
Future studies need to examine depot wheelchairs more 7. Johnson I, Andrich R. European report on wheelchair testing.
closely. There appears to be a trend toward making depot Commission of the Euronean Communities (COMAC BME)
Mobility Restoration for P’aralyzed Persons. Milano, Italy: Ediz:
wheelchairs consumer goods, thus circumventing the prescrip- ioni Pro Juventute: 199 1.
tion process. Many retail stores sell depot wheelchairs directly 8. Roebroeck ME, van der Woude LHV, Rozendal RH. Methodology
to consumers. There is little information about the quality and of consumer evaluation of hand propelled wheelchairs. Commi-
safety of these products. Few studies have focused on the sion of the European Communities (COMAC BME) Evaluation of
testing of electric-powered wheelchairs and scooters. This is Assistive Devices for Paralyzed Persons. Milano, Italy: Edizioni
likely due to the cost and complexity associated with evaluating Pro Juventute; 1987.
electric-powered mobility products. It is important to continue 9. Barnicle K. Evaluating powered wheelchairs, request evaluating
to provide direct product comparisons. As products are intro- assistive technology. Washington (DC): The Rehabilitation Engi-
duced, information must be developed as to their cost and neering Center at The National Rehabilitation Hospital; May 1993.
10. Cooper RA, Robertson RN, Lawrence B, Heil T, Albright SJ,
suitability. With time, sufficient data could be available to a
VanSickle DP, et al. Life-cycle analysis of depot versus rehabilita-
wide variety of consumers to enable them to clearly choose and tion manual wheelchairs. J Rehabil Res Dev 1996:33:45-55.
justify their choice of wheelchair products. 11. Cooper RA, Gonzalez J, Lawrence B, Rentschler A, Boninger ML,
VanSickle DP. Performance of selected lightweight wheelchairs on
CONCLUSION ANSI/RESNA tests. Arch Phys Med Rehabil 1997;78:1138-44.
There are differences in the fatigue life and value (equivalent 12. International Standards Organization. Committee Draft ISOlCD
cycles per dollar) of the four models of ultralight manual 7176-8(E). Wheelchairs-part 8: requirements and test methods
wheelchairs tested. Hence, ultralight manual wheelchairs are for static, impact, and fatigue strength. Zurich, Switzerland:
Technical Committee 173, Subcommittee 1, N 200; December
not all of equal quality. The fatigue life and value of the 1994.
ultralight manual wheelchairs were significantly higher than 13. Cooper RA, Stewart KJ, VanSickle DP. Evaluation of methods for
those previously reported for lightweight manual wheelchairs. determining rearward static stability of manual wheelchairs. J
Therefore, ultralight wheelchairs may be of higher quality than Rehabil Res Dev 1994;31:144-7. -
lightweight manual wheelchairs. Clinicians and consumers 14. Maiaess GG. Kirbv RL. Ackrovd-StolarzSA. Charlebois PB.
should seriously consider selecting an ultralight manual wheel- Influence of seat position on the static and dynamic forward and
chair for meeting their wheelchair mobility needs. rear stability of occupied wheelchairs. Arch Phys Med Rehabil
1993;74:977-82.
Acknowledgments: The authors would like to thank the members 15. Baldwin JD, Thacker JG. Characterization of the dynamic stress
of the working groups of Technical Committee 173, Subcommittee 1 of response of manual and powered wheelchair frames. J Rehabil Res
the International Standards Organization, for their assistance in devel- Dev 1993;30:224-32.
oping the test methods for this research. The authors would also like to 16. Cooper RA, Robertson RN, VanSickle DP, Stewart KJ, Albright
express our thanks to Jess Gonzalez, Dan Woodbury, and Paula SJ. Wheelchair impact response to IS0 test pendulum and IS0
Stankovic for assistance with data collection. standard curb. IEEE Trans Rehabil Eng 1994;2:240-6.
17. Cooper RA. Stability of a wheelchair controlled by a human pilot.
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Arch Phys Med Rehabil Vol 80, April 1999