In today's manual wheelchair world, creating a product that stands apart from all the others is one of the main challenges. "It's hard to differentiate yourself in the manual wheelchair market right now," says James Papac, general manager of Tyrone, Ga.-based Levo USA, noting that many new models mirror one another in weight and features.

Some manufacturers, however, are answering the users' call for increased flexibility.

Levo, for example, offers a standing wheelchair designed to eliminate health problems associated with an inability to stand. "Our standing wheelchairs are expensive and difficult to get funded," Papac acknowledges. "But one decubitus ulcer surgery can cost $60,000-a much bigger price to pay."

The customers' need for increased flexibility also motivated Elyria, Ohio-based Invacare Corp. to design a folding wheelchair. The Spyder features an adjustable seat angle and fold-down back to provide more flexibility in positioning. The new model especially suits newly injured patients who "don't always know right away how they want to sit," says Mark Sullivan, director of product management.

Flexibility aside, users want comfortable, lightweight wheelchairs, says Jack Bowser, president of the durable equipment division at Mundelein, Ill.-based Medline Industries. That means K001 and K002 models are low in demand. Instead, "dealers can sell a K004 chair to a K003 patient, down-code to K003 and still make money on the product," Bowser explains. He adds that carrying just one chair also makes for less inventory.

Manufacturers also are grappling with a changing marketplace. The number of manual wheelchair manufacturers is decreasing, they say, even as the market is increasing, thanks in part to the aging of baby boomers.

However, Derek Holloway, sales and marketing manager of Winco, Ocala, Fla., cautions that profits, reimbursements and demand will slow. He advises providers not to put all their proverbial eggs in the manual wheelchair basket but instead to carry a variety of products. "Keep a reality check and learn from the past," Holloway says. "Nothing stays the same in this ever-changing medical marketplace."