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Almost everyone who uses a hospital wheelchair as their primary form of mobility is hugely dissatisfied with its performance. They would like it to be more functional in terms of maneuverability, comfort, and portability.
It is likely that your hospital wheelchair has one, more, or all of the following problems.
It is too heavy.
It is too wide.
Your feet stick out too far in front.
Your rear wheels are set too far back.
Your rear wheels have no tread.
Your rear wheels cannot be removed.
Your backrest is too high.
Your front casters are too large and flutter.
It is difficult to self-propel unless on a flat, hard, and smooth surface.
It is difficult to turn/spin and requires a lot of space to maneuver.
It is difficult or impossible to wheelie.
It skids going down steep slopes.
The high mount wheel-locks interfere with your push stroke.
The push handles interfere with your arm movement for self-propulsion
The high/padded armrests interfere your arm movement for self-propulsion.
It is very difficult or impossible to self-propel in rough terrain or up steep inclines or to jump up and down curbs.
In order to make the necessary modifications, it helps to understand why and how the hospital wheelchair became what it is.
The modern hospital wheelchair is the result of marketplace competition to mass produce the lowest priced wheelchair that can be sold worldwide. It is intentionally designed to be made as cheap as possible, yet still masquerade as an acceptable wheelchair.
Evolution has come in the form of cost reductions at the expense of functionality. The design of hospital wheelchairs has evolved to such a level that I don’t think it’s possible to make them any cheaper. Therefore, making modifications will require spending some money on replacing certain components and changing the design to be more functional.
I am calling my modified wheelchair "Frankie".
Using the bestselling Drive Silver Sport I ($116) as the example (the prices I use are my rough estimates based on wholesale costs:
A. The Rear Wheels
The DSSI uses a rear wheel that is secured to the wheelchair’s frame by a bolt. The wheels cannot be easily removed. Therefore, the wheelchair is very heavy and awkward to pick up. By replacing the $1 bolt with a $3 quick release axle and $2 axle receiver, the wheel can be removed for easier transport. Said differently, the reason for using the bolt is to save 2x$4=$8 when producing the wheelchair.
The DSSI uses a plastic mag wheel with a solid rubber tire with no tread. This tire is only suitable indoors. It is the modern version of a wooden wagon wheel. This wheel cost about $5. A more functional and comfortable rear wheel has a pneumatic tire with tread. Such a wheel costs $15.
The rear wheel axle is placed in a reinforced hole the back support strut. This position makes it very difficult to self-propel the wheelchair. Moving the axle forward involves adding a bracket that would cost, maybe $5 dollars more. Thus, the current axle positioning creates a savings of $5 dollars when producing the wheelchair.
Therefore, to greatly improve the function and portability of a hospital wheelchair, a new bracket needs to be created and installed to house a quick release axle and pneumatic wheel. Since manufacturers purposely do not do this to save money, you will have to make DIY brackets (from 1" plywood and punched 1" Zinc square tubing) as I have done.
B. Front Casters
The DSSI uses an 8”x1” plastic front caster wheel. The reason for this large caster is to make it easier for an attendant to push the wheelchair over cracks and bumps. These obstacles are likely to be obscured by the wheelchair user. A large caster wheel is more likely to roll over these obstructions. It is also highly likely to flutter back and forth unless going very slowly.
A more functional front caster is 5”x1.5”. This size caster works well both inside and outside. It is less likely to flutter, but it is more expensive by $10 or so. Hence the use of the 8”x1” plastic caster by the manufacturer.
If you replace your rear wheels and move them forward, you will also need to reduce the diameter size of your front casters to provide room for the rear wheels.
Option 1: The cheapest and easiest solution is to purchase 6”x1” caster wheels ($14) and replace the 8”x1”. In this case, you will provide an additional 1” of room for the rear wheel. The problem is that a 6” caster is still likely to flutter, and it is mounted to the original cheap steel caster fork that doesn’t spin well. You have also limited your ability to move your rear wheels forward. But 6" is better performing than 8" (except for rolling over large obstructions).
Option 2: Replace the entire original fork with a new active aluminum wheelchair fork with a 4”x1.5” or 5”x1.5” caster wheel. This switch will provide the greatest performance but will cost a little bit more. You will have sufficient room to move your rear wheel 4" forward. This caster fork cost me about $30 (per fork) to acquire.
C. Footrests
The DSSII uses swing away footrests that are angled forward which causes the wheelchair user’s feet to stick out in front of them. This position is awkward and reduces the maneuverability of the wheelchair. It makes it difficult to open doors and turn in tight spaces. In addition, the user’s legs are separated. The folding plastic footrests tend to bend and cause the user’s legs to rotate inward creating an ungainly and uncomfortable seating position.
The user’s feet are placed in this position in order to provide clearance for the large 8” front casters. Use of smaller more suitable (more expensive) casters would reduce the need for the excessive foot forward position. Use of a (more expensive) central folding foot platform would provide a foot position that is more stable, comfortable and visually pleasing.
I created a Footrest Swing which allows my legs to bend at a natural 90 degree angle. My feet rest together on a solid wood platform which is secured by nylon webbing. The Footrest Swing doesn’t interfere with the folding function of the wheelchair. In order for the Footrest Swing to not interfere with front caster rotation, the 8” wheels must be reduced to 6” or less (unless you have short legs and you feet are raised above the caster).
D. Backrest
The DSSII has a very high backrest with permanent push handles. The top of the backrest folds down for reducing its profile for storage/transportation. The top of the backrest and push handles interfere with proper self-propulsion. There is no option to adjust the backrest height or remove the push handles since these options would cost an additional $5 or $10 to offer.
When I removed the top of the backrest and push handles, the backrest was too low to be supportive (for me). Therefore, I made a solid panel from a scrap 1/4" PVC board with an old camping pad to provide proper support. This panel can be removed when folding the wheelchair.
E. Rear Tubing
The bottom frame chassis has a piece of metal tubing that extends backward. The back section of the tubing will need to be cut off in order to provide ground clearance when in a wheelie since the frame of the wheelchair has been lowered. Put the plastic cap back on. The purpose of the tubing is to serve as a mount for an anti-tipping device.
F. Armrests
The padded armrests that are mounted on top of the upper armrest bar cause you to flair your elbows outward to avoid them. As a result, you are likely to engage in poor pushing technique creating excessive Internal Rotation of the shoulders which can lead to Shoulder Impingement Syndrome and chronic shoulder pain.
Since they are permanently fixed (to save manufacturing costs) rather than adjustable or removable, I took (broke) them off with a hammer.
Once you realize that the design of a hospital wheelchair is based on the desire to manufacture it as cheaply as possible and NOT to meet the mobility and comfort needs of the wheelchair user, you can see that making modifications will not result in a loss of functionality. They will result in improved functionality. The modifications are essentially undoing the evolution of “cheapness” that has resulted in its current design.
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