Nathan Maguire is a para-athlete currently competing in the games in Japan. He shares first-hand experience of how assessment, specification and set up of a manual wheelchair can impact on ergonomic function and pressure area protection, and contribute to a full and  active lifestyle.

As a full time wheelchair user for the last 16 years, I’ve had my fair share of wheelchairs; some that encouraged my independence and some that did not. Over this time, I have come to learn how important individual, bespoke chair set up is to comfort and ultimately, to quality of life.

As a para-athlete competing around the world, I come across many wheelchair users, many of whom do not have the right wheelchair for them. An immediate indicator for me of an ill-fitting wheelchair is all in the angle of the knees. When the footplate is dropped as low as it can go but the users knees still sit high, instead of straight and flat, this results in unnecessary pressure, which could result in skin breakdown. This can be easily resolved by lowering the footplate if possible or having the wheelchair correctly measured up in the first place.

Back rest height is highly individual and not one size fits all. The height of a backrest is partly dictated by the user’s disability, size and individual need. Having a backrest too low can result in instability in, for example, a high-level paraplegic/ tetraplegic, however the same backrest could suit another user with different needs, for example an amputee or low-level spinal cord injury perhaps.  In my experience a discussion with the assessor on disability, functional ability and level of activity can help with correct backrest selection.

I feel that your wheelchair should be an extension of your body and an ill-fitting wheelchair is not that. The width of a wheelchair is integral to that ideal. A seat width too wide can look akin to sitting in a shopping trolley.  The idea of growing room is not something I agree with as the wheelchair should be suited and fitted to you immediately, not a year down the line.  Similarly, a too narrow fitting chair can also have its down sides. The main issue I see is unnecessary areas of pressure, which can ultimately lead to pressure damage and consequently not being able to use the wheelchair at all until recovered.  A wheelchair too wide or too narrow in the seat also impacts stability and posture.

I know I have spoken a lot about pressure areas and skin breakdowns, but it is a constant battle for many wheelchair users and something that I also struggle with. A big part of combating this is correct cushion selection as it is in my opinion the most important part of your wheelchair. The cushion can dictate the way you’re sat, how you grow, your posture and importantly, your chances of avoiding pressure areas. There are a wide range of cushions available and it is so important to get the right one that works for your needs, whether that be through a combination of comfort, seeking specialist knowledge and even pressure mapping.  

I think, once you’ve addressed all the areas above and your wheelchair is perfectly tailored to you and your needs, there is no stopping you. You will then have the tools to live a full and independent life.

As mentioned previously I have had many wheelchairs.  As a highly independent active wheelchair user I have used my experiences to choose the chair that is right for me – the Küschall Super Light (KSL).  This wheelchair is the first wheelchair that I have been measured for in seven years and seven years is a long time in wheelchair development. So many things had changed! I was lucky enough to be measured for my new KSL by Rob at Bromalin wheelchairs, with whom I was able to discuss and pool my knowledge and experience.  As Rob is also a wheelchair user with an active lifestyle, I knew I could trust his opinion and expertise and he was able to introduce new ideas into the design and fit of my Küschall wheelchair. With all this in mind, I’m looking forward to my new KSL being the most ergonomic, trustworthy wheelchair that I have ever had and highly suited to my ever-changing athletic lifestyle. 

Nathan Maguire, para-athlete, T54 wheelchair racer.  Follow Nathan and catch up on his latest news and activities here.

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