I was recently talking mobility technology with Rafael Iberra, legendary world-class wheelchair racer, who’s now a manager for one of the country’s more esteemed providers. There we sat in his Atlanta office – Rafy, a big, buffed guy with paraplegia, and me, a slender, spastic guy with cerebral palsy. We are two individuals whom, within the medical model, one might place at opposite ends of the disability and mobility spectrum. Yet, in reality, as Rafy and I discussed – both sitting in high-end titanium manual wheelchairs – stereotyped prescriptions of mobility technology based on classifications of disability don’t apply in the real world, as each user’s abilities, needs, and lifestyle are the real gauge by which mobility technology should be selected.
Up until as recently as a decade ago, it was commonplace for rehabilitation facilities to follow blanketing rules for prescribing mobility technology – that is, quadriplegics were prescribed powerchairs, and paraplegics were prescribed manual wheelchairs, period. It didn’t matter that maybe, as a quad, you had good use of your upper arms, and that you would be more comfortable with self-propulsion, better fitting a manual wheelchair than a powerchair. Nor did it matter that if you were a para, with shoulder problems, and lived in a very physically demanding environment like San Francisco, requiring long commutes via public transportation and sidewalk travel, you’d be better suited with a powerchair than a manual wheelchair. Clients were often merely handed mobility technology based on medically-defined classifications rather than an understanding of individual needs.
This ideology extended itself into therapy centers where, as a child, I saw myself and my friends with extremity-affecting disabilities directed toward mobility technology based almost entirely on upper-lower-extremity medical classifications – the children with spinal bifida received manual wheelchairs and the children with muscular dystrophy received powerchairs. In fact, till this day, the prescriptive rules for insurer funding of mobility technology is still rooted within the model of prescribing mobility technology based more on medically-defined classification, and less on individual needs. And it’s within the ignoring of individual needs where the fallacy of defining mobility technology for specific disability occurs — the prescription of mobility technology isn’t a fixed equation, it’s a variable application.
Even more interesting to me beyond such an antiquated medical model, is the psychology, stigmas, and stereotypes that it has spawned, aspects that profoundly influenced my own self image. As a very young child, I was fortunate to receive a powerchair. Initially, a powerchair provided me with great liberation, permitting mobility within the world at large, and fostered overall personal growth that I couldn’t physically achieve in a manual wheelchair. However, as I reached adolescence, I sought greater independence, desiring to define my boundaries as most children my age. Growing up with a disability made mobility – specifically, wheelchair technology – part of who I was, and in that way, compelled me to push my limits in that arena just as other kids may pursue sports or peer groups or fashion trends – again, testing boundaries toward self-exploration and definition. And, so for me, I chose to explore my abilities to not only use powerchairs, but also manual wheelchairs – that is, seemingly crossing over the boundaries of the era’s mobility protocol.
What surprised me most through my process of mobility exploration wasn’t the physical difficulties of learning to use a manual chair, but the stereotyped reactions I received from professionals and laymen alike toward my wishing to use a manual wheelchair. People were genuinely baffled by someone of my disability level sitting in a ultralightweight manual wheelchair – after all, why would a teenager with sever cerebral palsy want to exhaust himself using a Quickie when he had an E&J Power Premier charged up and ready to roll? The fact was, I used and loved my powerchair, but it didn’t give me the daily exercise I needed to further my physical abilities, it didn’t fit in my friends’ cars, and it wasn’t nearly as fun to tinker with as my high-performance manual wheelchair – divided mobility, powered and manual, allowed me to live a far richer life than being pigeon-holed into only one form of mobility. Nevertheless, despite the justifications I felt obliged to give toward my use of cross-over mobility, many people purely seemed aghast at my using a manual wheelchair, just as they were by a parapelegic using a powerchair.
Today, 21-years after I decided to accept both powered and manual mobility in my life, I am convinced it was among the most meaningful decisions that I ever made – cross-over mobility technology allows me to live the most active, healthy, convient life. Nevertheless, every once in a while, I still encounter stigmas and stereotyping toward those with more profound disabilities using manual wheelchairs, and those with less-involved disabilities using powerchairs. As an example, this notion recently came up while I discussed high-performance manual wheelchair design for those with quadriplegia and other four-extremity disabilities, and a gentleman commented that “any quadriplegic whom uses a manual wheelchair isn’t really a quad” – a comment as entirely absurd and stereotyped as I’ve ever heard. While the comment certainly wasn’t based in reality – there’re many quadriplegics whom use manual wheelchairs – it was based in an outdated, ignorant mode of mobility prescription based on medical definition, not individual ability and wishes. Fortunately, such views are less frequent as the age of disability awareness continues unfolding in our lifetime, but unfortunately, such stereotyping and stigmas still exist.
Despite the lingering old ideology toward prescribing mobility technology, I am inspired that, in many ways, the medical model has changed for the better, looking at mobility technology more on an individual basis than as blanket prescription. These changes are most seen through technology offerings like quad quick-release axles and projection pushrims on the sportiest ultralight manual wheelchairs, as well as light-rehab powerchairs featuring captain’s seats and one-piece footplates for users with less-involved disabilities. Indeed, the age of cross-over mobility technology is here.
Of course, it’s ultimately up to each of us on an individual basis to determine which forms of mobility technology are most fitting for our needs and lifestyles. For some, the most meaningful mobility might be manual wheelchairs; for others, the most meaningful mobility might be powerchairs; and, for still others, the right mobility might be a combination of manual wheelchairs and powerchairs – defined by lifestyle, not merely disability. To twist a cliché, cross-over mobility technology isn’t about what you have; rather, cross-over mobility technology is about who you are.