Protect Your Shoulders With The Power Pack

If you have been using a manual wheelchair for any significant length of time you will already have some sense of what it costs your shoulders. The repetitive push stroke, done hundreds of times a day, places a cumulative load on the rotator cuff, the shoulder joint and the tendons of the upper arm in a way the body was never designed to sustain indefinitely. Up to 80 percent of long term manual wheelchair users develop shoulder pain at some point, and a good number develop more serious problems including rotator cuff tears that are difficult to treat.

A wheelchair power pack is one of the most practical and underused solutions to this problem and this guide explains what it is, how it works and who it is most likely to suit.

The main types of power assist device

Power assist rear wheels

The most common type of power assist is a set of motorised rear wheels that replace the standard rear wheels on the users existing chair. Motors are integrated in to the wheel hub and sensors in the hand rim or wheel detect each push and provide a corresponding boost. The Alber e-motion is the best known example of this type and has a strong clinical reputation for reducing shoulder load during propulsion. The Alber Twion includes regenerative braking, which recharges the battery when the user brakes, extending the range between charges.

Power assist wheels suit self propelled users who want to maintain active propulsion and independence while reducing the cumulative load on their shoulders. They are compatible with a range of manual wheelchair frames and the wheels can be removed and the chair used manually at any time.

Rear push assist for attendant propelled chairs

For transit or attendant propelled chairs there are rear-mounted push assist units that attach to the back of the wheelchair frame and provide motorised assistance to the person pushing. These are controlled either by the attendant through the push handles or via a simple hand control, and they are particularly useful on slopes, inclines and longer distance outings where pushing fatigue becomes a significant issue for carers. The Decon E-Drive is one of the more established options in this category and allows the attendant to switch between assisted and manual pushing as needed.

This type of device addresses a problem that often goes undiscussed: the physical toll on carers. Pushing a manual wheelchair for any significant distance, particularly up inclines or over uneven ground, places considerable strain on the carers back, shoulders and wrists. A push assist device on an attendant chair protects the carer as much as it does the user.

Front-mounted power units

Front-mounted power attachments fix to the front of the wheelchair frame and provide drive through a single central wheel. These can be useful for outdoor use over uneven terrain and some models handle grass, gravel and rougher ground more confidently then rear wheel systems. They tend to be bulkier then hub-integrated options but offer good range and suit a wider range of manual wheelchair frames.

Why shoulder protection matters clinically

The shoulder problems associated with long term manual wheelchair use develop gradually rather then with a sudden injury. The push stroke places repeated impingement pressure on the tendons of the rotator cuff, particularly during the initial phase where the arm reaches forward. Over months and years this leads to inflammation, thickening and eventually tearing of tendon tissue that is difficult to reverse.

What clinical evidence consistently shows is that reducing the load per stroke is the more effective approach to shoulder preservation then simply resting. A power assist device achieves this because it amplifies each push rather then replacing it. The user continues to push with the same frequency but each stroke requires significantly less force.

In our experience people who make the change to power assist wheels often say the difference is most noticeable at the end of the day. The familiar shoulder ache that has become a background feature of life simply reduces, sometimes considerably.

Who benefits most from a power pack

Power assist devices make the most meaningful difference for users who cover significant daily distances, who live or work in areas with slopes, who are beginning to notice shoulder fatigue that was not present earlier in their wheelchair use, or who have a condition progressively affecting upper body strength.

They are also worth considering for users who are not yet experiencing problems but who are young enough that the cumulative impact of decades of manual propulsion is a serious long term consideration. Prevention is considerably more straightforward then treatment when it comes to shoulder injuries.

Practical considerations

Weight and portability

Power assist wheels add weight to the chair and this is worth factoring in to the decision. The Alber e-motion wheels weigh around 3 kg each, adding approximately 6 kg to the chair overall. For users who travel frequently and need to lift the chair regularly, the added weight is a consideration. Most power assist wheels can be quickly removed from the axle, returning the chair to its standard manual configuration for transport and storage, which manages this issue to a significant extent.

Battery and range

Most power assist wheels provide a range of around 15 to 20 km on a full charge under normal conditions. Real world range depends on the users weight, terrain and the proportion of the day the assist is used. Charging time is typically two to four hours and most batteries are removable for convenient charging without moving the whole chair. Its worth checking whether the battery for any model you are considering meets airline regulations if air travel is part of your routine, as lithium batteries are subject to specific requirements.

Please bear in mind that power assist devices may be available through the NHS wheelchair service or through Continuing Healthcare funding in some circumstances. Its worth raising the question at your next review if shoulder health is a concern.

To see our range of wheelchair power assist products please click here, or please feel free to call us and we will be happy to help.

Frequently asked questions

Will a power assist device work with my existing wheelchair? 

Most power assist rear wheels are compatible with standard axle fittings and fit a wide range of manual wheelchair frames. Compatibility depends on the axle size, camber tube diameter and rear wheel specification of your chair. Its worth contacting the supplier with your chair make and model before purchasing to confirm compatibility, as not all frames suit all devices.

Does using a power pack mean I lose independence? 

Not at all. Power assist devices are designed to support propulsion rather then replace it. You continue to steer and control the chair exactly as before. The motor simply reduces the effort each push requires. The independence associated with self propulsion is fully retained.

How much does a wheelchair power assist device cost? 

Entry level rear push assist units for attendant chairs start at around £500 to £800. Power assist wheel systems for self propelled users such as the Alber e-motion are a more significant investment, typically in the range of £3,000 to £5,000. This places them out of reach for many private buyers without funding support, which is why exploring NHS and Continuing Healthcare routes is well worth doing before purchasing privately.

Can I take power assist wheels on a plane? 

This depends on the specific battery used. Most power assist systems use lithium batteries which are subject to airline regulations on watt-hour capacity. Many models are designed with airline-approved batteries and this is clearly stated in the product specification. Its essential to check before travelling and to notify the airline in advance as you would with any powered mobility equipment.

Do power assist wheels require a lot of maintenance? 

They require more attention then standard manual wheels but the maintenance involved is not onerous. The wheels and motor housing should be kept clean and dry. Batteries should be charged according to the manufacturers guidance and not left fully discharged for extended periods. Most suppliers recommend an annual service check. Beyond this the day to day maintenance is minimal.