CUSTOMERS IN NEED OF POWER WHEELCHAIRS have plenty of options. The variety of models on the market matches the wide variety of riders, their needs and priorities. From basic mobility to high-end rehab, one size does not fit all in power wheelchairs. So how do you match customers and chairs?

The trick, say industry experts, is finding the right combination of features. Does the customer need a midwheel powerbase that gets in and out of tight corners or a rear-wheel-drive chair built for outdoor speed? Each configuration optimizes specific capabilities. One might be more stable, another better at handling obstacles, and yet others may be more maneuverable, flexible or easier to control. User needs and preferences are really what determine which chair is right, the experts say.

Chair selection, however, is often a matter of compromise. One feature may come at the cost of another. By understanding performance traits, home medical equipment providers can play a helpful role in finding the right combination for each customer's needs and desired usage-and minimizing the compromises users have to make.

Below are eight key parameters of power wheelchairs to consider.

Turning Radius A TIGHT TURNING radius, measured in inches, generally is in the high teens to low 20s, manufacturers say. Many agree that midwheel drives do this the best. "Midwheel became an option mostly because consumers said they were not able to get into all areas of their home," says Julie Jacono, senior product manager, power wheelchairs, at Invacare Corp. in Elyria, Ohio. "Midwheel optimizes maneuverability, but it may not be as strong in some of the other areas, such as stability or obstacle handling."

Midwheel is also considered easy to control. "Our midwheel drive chair has a center of balance at the tip of one's nose," explains Dan Meuser, senior vice president, sales and marketing, of Pride Mobility Products in Exeter, Pa. "That's where people's natural coordination has been developed."

Because radius is measured from the center of the drive axle out to the farthest extremity of the chair, turning radius is largely a factor of where the person's feet rest, manufacturers say. "The difference comes in where that person's feet are going to be placed. If they need rigging, then it's going to affect turning radius because their feet are going to be farther away from the chair," says Jacono.

Even a bariatric chair can boast a tight turning radius. "The width of the seat really doesn't have any impact on the turning radius," says Mark Greig, senior product manager, power wheelchairs, at Sunrise Medical in Longmont, Colo. "That's not going to be your longest point. Usually it is out to the footrest."

Bariatric chairs do, however, need strong motors and low gears to manage such tight spins, manufacturers say.

Obstacle Clearance WHEN IT COMES to moving over obstacles, "You can stop a wheelchair with small front wheels with a broomstick," says Tom Finch, president of Teftec Mobility & Seating in Spring Branch, Texas. "If you look at obstacle clearance on most rear-wheel-drive chairs, it's not very much. We realized what we had to do was to make a front-wheel-drive chair so that both the wheels were larger, number one. And two, they had a rotating force that aided the larger wheels to get over the obstacle."

Jacono agrees. "Front-wheel- drive chairs, out of all of them, are going to be the best- designed to handle obstacles because the largest wheel is your leading wheel."

Larger wheels, however, can have a downside. "You might also lose some functionality in the design of the chair because once the wheels get a certain size, they have to be placed outboard of the seating system," says Dick Fuller, manager of technical services at Everest & Jennings in St. Louis. "They get in the way of getting the seat down as low as you would like."

Terrain Handling HOW WELL A chair performs on soft or uneven terrain involves not only tires but also the overall design of a chair, manufacturers say. Wider tires and gripping tread are best for outdoors, but they can limit access through narrow spaces at home and cause other problems.

"Greater rubber tread like on mountain bikes grips better outdoors, but it is going to bring garbage into a person's home," says Dave Maxwell, product manager for motorized wheelchairs at Everest & Jennings.

And tire width is not everything. "Although having a little wider tire might help you a bit, the main thing with traction is how much weight you have over the drive wheels," notes Greig.

That's an element of design many manufacturers consider. "We have almost 84 percent of the rider's weight over the drive wheel. That's where you get your power to handle outdoor terrain; it creates the traction," says Pride's Meuser.

Still, wider wheels and softer terrain cut into battery life. "If a person takes a chair out in a sandy area and they are expecting 20 miles per charge," notes Winston Anderson, president of Merits Health Care Products in Cape Coral, Fla., "that can be reduced to 10 miles per charge because you have more resistance."

Stability WHILE ALL CHAIRS are required to be stable, some configurations are better than others, manufacturers say. Drive- wheel location and suspension play a major role. "A midwheel has an inherent instability, where there's a feeling of rocking or teeter-tottering," says Jacono. She notes that such shaking may be intolerable for some patients, especially those on respirators who can't be startled.

"When you are driving a midwheel and have the wheels off the ground, it's unstable," agrees Bob Smith, sales manager of Old Forge, Pa.-based Golden Technologies. "Until," he adds, "you really learn how to use the controller to drive a midwheel and maneuver it without fishtailing around. The rear-wheel- drive unit gives you a much stronger comfort level."

While front-wheel may be good at obstacles, it can challenge a stable ride. "The downside of putting caster wheels in the back, which is what you have to do with front-wheel-drive chairs, is that it becomes directionally unstable," says Finch. "If you have ever backed your car up at high speed, you'll know how badly it wants to turn."

Speed AFTER-MARKET COMPANIES can boost top speeds to more than 10 mph, but "fast" production wheelchairs are typically in the 6-8 mph range, manufacturers say. Such speed is achieved by incorporating more powerful motors, different gearing and larger wheels. Drive- wheel placement and weight balance are also important, say manufacturers.

"You are going to be able to get chairs that go the fastest and are controlled the easiest with rear-wheel drive," claims Jacono.

Still, other features may have trade-offs.

"If a client wanted the ultimate in maneuverability, we wouldn't give him a high-speed motor," says Meuser. "We would keep the center of balance and optimize the rider's weight over the drive wheels. But if you have a newly injured kid, and speed is what he is looking for, and he has the dexterity to maneuver around his house, we can deliver that."

"The way to look at it is a balance of speed, power and maneuverability," adds Scott Higley, national sales manager for Pride Rehab. "If you want a fast car, you don't run out and buy a dragster because you couldn't pull a dragster into a parking lot very well. It doesn't take turns very well. What matters is how fast can you really go around an office, or how fast can you go around a pool. Just doing speed for speed's sake doesn't make sense. There is the stability issue and the safety issue, of course."

Style IT ISN'T JUST the practical aspects of power wheelchairs that users consider, manufacturers point out. "You would be surprised how many times that somebody's top priorities never make it to the product because they get so focused on the styling," notes Diego Picchetti, vice president of marketing at Everest & Jennings. "They are willing to give up, say, medical upward trunk support because they love the style of the chair."

Meuser has seen that, as well. "We learned in scooters that people care as much about tending to their physical needs as they care about satisfying their mental needs, their peace of mind," he says. "When they feel as if they are on a nonmedicinal-looking device, they just feel healthier."

That appeal makes a difference in the HME showroom. "If you sit one product alongside another product," says Smith, "when people come in to look at it, the paint that really shines draws attention."

Style doesn't necessarily sacrifice performance, manufacturers note. "There are a lot of different ways that you can get an aesthetically pleasing-looking chair without sacrificing features and functions," says Greig. "We have a lot of different ways you can customize the look of a chair so that it reflects your own personal image of yourself. We have done it with plastic shrouds so you get more of a uniform body look, captain seats, but also with aluminum tubing."

Color plays a key role, according to manufacturers. "You can get whatever color you want. You can get red. You can get blue. You can get white. You can even custom design the body to match your car," notes Anderson. "So if you have a red car, you can get a red powerbase."

While there are inexpensive chairs with style, design generally has a price. But manufacturers say they do seek ways to limit costs. "We try to keep things simple because of the cost involved," says Picchetti. "We spent a lot of time with industrial designers looking at the plastic cowling to give it a look that people are receptive to, and a choice of colors that they can pick from without changing the cost of the product."

Seating Flexibility/Powerbases MANY MANUFACTURERS TODAY make available flexible seating systems that can be used in various rehab applications and with various types of disabilities. "It starts out in traditional basic wheelchairs with the hammock seats that you would see on manual wheelchairs. They will upgrade those with solid seats, and they will put something like Jay seating systems in place," explains Smith.

This flexibility is a major factor behind the huge popularity of powerbases. Power seating can be added to powerbases as individuals need it, says Jacono. "That is the difference between a traditional cross-brace frame that can fold and a separate seat and base that can become a powerbase," she says.

There's strong market demand for such chairs. "One of the trends that has come out in the last 12 to 18 months," Jacono says, "is [that] the requirement for power seating has crept down more into what before we would have considered a midrange product that did not have these rehab options available to it. Now that's an expectation."

Still, she says, aesthetics are not the primary driver of sales. "The primary distinction between going from a cross-brace to arigid frame is the ability to easily change seating," Jacono says. This way, manufacturers say, users can change seat-back height add power seat lift, recline or weight shifting to the chair-and that's important to the user.

"If you have a customer that may have [multiple sclerosis] and has to go to a power chair because they are no longer able to operate a scooter, they are used to all of this style and used to the seat," says Higley. "It's not good if you say they have to go into this really medical-looking product."

Portability ANOTHER SELLING POINT can be the power wheelchair's transportability, manufacturers say. Transportable wheelchairs work well, says Greig, for those who want to use them for occasional outings and then store them.

Such a chair's practicality, however, depends on the frequency of use and who is using it. "To pick the seat up that weighs 40-60 pounds, to pull the shroud off and to take out each battery that weighs 25-30 pounds, and to pick up the base that weighs 80-100 pounds-how many old people can do that and put it back together?" asks Anderson.

Some options are lost with portable chairs. "By going to a frame that can fold," notes Jacono, "you give up features such as independent wheel suspension. You give up the chair being modular and being able to change seating down the road."

Durability is also compromised. "The more plastic you put on the chair, the lighter you can get it," says Greig. "But at the same time, the less durable it is going to be."

For high-end chairs, weight control is hardly a consideration. "Our chair is not light because we built it to be the only chair somebody would ever buy," says Finch. "The axle shafts are bigger than my Cadillac axle shafts, the gears are bigger than my Cadillac transmission gears, and so forth."

Portable chairs can't rival that durability, but giving up on portability can be a tough compromise for some riders.

"I think it is a very important psychological factor; it is not a frequently utilized factor," says Jacono. "I think people are afraid not to get it just in the off-chance there is some day when they might need to use it."

Programmability distinguishes controllers, but all power wheelchairs and powerbases falling under the K11 Medicare reimbursement code by definition include programmable controllers. With programmability, such parameters as acceleration, deceleration, turning, braking and tremor dampening can be set by manufacturers and fine-tuned by providers according to their assessment of patient needs and preferences.

"What we mean by that is that you can take a programming device, and you can dial in or dial out sensitivity, maneuverability and speed," explains Bob Smith, sales manager of Old Forge, Pa.-based Golden Technologies.

The range of options in controllers is not huge. "There are two major OEM companies," explains Smith. "There's Penny & Giles and Dynamic Controls. You have to figure probably 90 percent of the market are using those two solid-state controls."

However, this hasn't stopped innovation. "We have gone one step beyond to have electronic accessory devices for the chair that auto-detect when plugged into the wheelchair," says Dave Maxwell, product manager for motorized wheelchairs at Everest & Jennings. Just like plug-and-play components for computers, the devices allow providers to add features easily. "For example, a power seating system might have an extra box called a seat module, which controls the motors that make the seat tilt, recline, go up and down, and it will detect that when you plug it in," he says.

Elyria, Ohio-based Invacare Corp., which manufactures its own controller, is using infrared technology to make the joystick a simple universal interface to external devices. "You can take someone with a very unique set of abilities and rehab needs," says Julie Jacono, senior product manager, power wheelchairs, "and not only get them to drive successfully, but also interface with computers, communication devices, other things in their homes like environmental controls,power seating-and all through one switch if that person could only access one switch." -D.C.

Group 22 and U-1 batteries run most powerchairs on the market. According to powerchair manufacturers, the former holds a longer charge and provides a range about 1 1/2 times larger than the latter, but some question the value of its weight.

"It is a good selling point that a chair will go 30 miles on a single charge," says Winston Anderson, president of Merits Health Care Products in Cape Coral, Fla., "but show me a person out there who will drive their powerchair 30 miles before a recharge. Most people will use a chair an average of four to five miles a day. Is a big battery really that important?"

Another distinction in power systems is whether the charger is on board. Smaller size and convenience have made on-board chargers more popular on newer units than they have been on traditional power wheelchairs, manufacturers say. "The difference is, with on-board chargers, the charger is always an integral part of the powerbase, inconspicuously hidden within the unit," says Bob Smith, sales manager of Old Forge, Pa.-based Golden Technologies. It's there when it's needed. "All the client ever has to do if they are low is plug into a 110 outlet to recharge the batteries."

Better chargers connect to 220-volt systems as well, manufacturers say. -D.C.