With so many wheelchairs on the market, it can be hard to determine what the best option might be for a customer, especially when there might only be one or two differences between choices. Would aluminum or carbon fiber better suit a buyer’s needs? What about a folding or rigid chair? HomeCare spoke to Alli Speight, director of clinical education of Motion U at Motion Composites, who gave us a crash course on key components that can impact manual wheelchair performance and insight into which wheelchairs might be right for certain customers.
HOMECARE: What’s the difference between materials? Is there a preferred material or does it depend on usage? How do you know which is best?
Alli Speight: Common materials used in high-end manual wheelchairs include aluminum, titanium and carbon fiber. Each is lightweight and strong, making them suitable for manual wheelchair construction. Within each material category, there are different grades or manufacturing techniques, each offering specific benefits or potential drawbacks—what is ideal is often dependent on the user’s individual needs. One of the most critical factors in manual wheelchair design is a material’s strength-to-weight ratio, which reflects how much strength a material offers relative to its weight. All three materials are durable and meet industry standards for safety and performance, but they vary significantly in this ratio: aluminum has
a lower strength-to-weight ratio, titanium is higher and carbon fiber currently offers the highest strength-to-weight ratio available. Each material also brings additional properties. For example, aluminum is more budget-friendly, titanium offers excellent impact resistance and carbon fiber has inherent vibration dampening and a near-infinite fatigue life. Ultimately, material selection should be based on both clinical needs and budget or funding availability to determine the most appropriate choice for the user.
HC: How about rigid vs. folding? Is there a reason to not get a chair that folds?
Speight: Folding wheelchairs are by far the most commonly used globally, often due to funding limitations rather than clinical preference. In best practice manual wheelchair selection, we prioritize lightweight construction and configurability—that is, how well the chair can be tailored to an individual user. Rigid wheelchairs are generally lighter because they lack the additional hardware required for folding mechanisms. They also tend to be more customizable, offering independent adjustment of key angles (e.g., seat-to-back, front end). Rigid frames also often allow for more adjustability as needs change over time. However, rigid chairs typically do not have swing-away footrests, which can pose challenges for some users during transfers. As with all wheelchair decisions, individual needs, abilities and goals must guide equipment selection.
HC: It seems there’s been a growth in bariatric options. Besides weight, what else should people consider—for users and for home medical equipment (HME) providers in terms of inventory?
Speight: The growth in bariatric wheelchair options reflects rising demand. It’s important to match not just the user’s width and depth, but also the chair’s weight capacity. While many manual wheelchairs may look similar, each manufacturer has unique engineering designs. Within a single manufacturer, models can differ in weight capacity, adjustability and accessory options. For users who will rely on a wheelchair for more than six months, a lightweight, fully customizable option is typically recommended. For the short term, a stock wheelchair may be appropriate—provided it still meets the user’s needs for fit and safety. HME providers should be able to distinguish when stock equipment is sufficient versus when a custom configuration is warranted. If the provider doesn’t offer sales and fittings for custom wheelchairs, they should maintain a strong referral network. A poorly chosen wheelchair can lead to physical injury, social isolation and economic hardship—so getting it right is critical.
HC: Are people generally choosing between lightweight vs. stability or is it more complex than that?
Speight: It’s more nuanced. While lightweight frames improve propulsion and reduce fatigue, increased adjustability—such as movable rear wheels or back angles—can allow for proper setup but can add weight. Eliminating these adjustments during manufacturing results in lighter frames, but also reduces flexibility for future changes. Two core principles in ultralightweight wheelchair prescription are: 1—make the chair as light as possible, and 2—position the rear wheels as far forward as possible without compromising safety. Bringing the wheels forward improves efficiency but can make the chair less stable (aka “tippy”). Rearward positioning enhances stability but at the cost of biomechanics and propulsion efficiency. The goal is to select a model that balances current and future adjustability needs while minimizing weight.
HC: Does the choice of wheels, tires and hand rims make a difference? What factors should people consider?
Speight: Absolutely. Components such as wheels, tires and hand rims are critical in customizing a wheelchair for both performance and user comfort. For those who self-propel, the hand rims are their main point of contact—so selecting the correct material, size and positioning directly impacts independence and upper extremity health. Rear wheels, tires and casters influence rolling resistance and therefore the user’s propulsion efficiency. Pneumatic (air-filled) tires are the lightest and most efficient but require maintenance. Solid tires are heavier and less efficient but offer low maintenance. Similarly, the width and size of casters can affect how the chair performs on different surfaces and during maneuvers. Rear wheels are often one of the first components users choose to upgrade, as they can significantly enhance ride quality and propulsion efficiency.
HC: When is a patient eligible for a custom wheelchair? Is that reimbursable?
Speight: Custom wheelchairs are typically considered when a user is expected to need the equipment for more than six months. Eligibility for funding varies depending on location and funding sources, so it’s important to assess each case individually. A common misconception is that eligibility for an ultralightweight wheelchair depends on a specific diagnosis, but that’s not true. Instead, funding is based on clinical need. Collaboration between a registered occupational or physical therapist, the durable medical equipment provider, and—where required—a certified assistive technology professional helps determine funding eligibility and explore alternative funding sources if needed.
HC: Does it ultimately come down to what insurance will cover, or can HME providers help patients explore more options?
Speight: While many key options and accessories have standard, no-cost options, upgrades often depend on the policies of the specific funding source. That said, clients usually have the opportunity to self-fund features that aren’t covered. While this isn’t feasible for everyone, it’s important that it be presented as an option. Ultimately, it should be up to the end user or their caregivers to decide whether a feature is worth the investment. Providers play a key role in this process by offering clear, knowledgeable guidance so clients can make fully informed decisions.