History Meets Health

According to data from the Federal Statistical Office of Germany, about 1.4 million Germans rely on a wheelchair for mobility.

But not all wheelchairs are created equal. High-performance models from BMW, such as those used at the Paralympic Games, are custom-made and can cost €30,000 or more. Typical, foldable rental wheelchairs in hospitals, by contrast, cost roughly €200 and are not suitable for permanent use.

How did the different types of wheelchairs come about? Who was the first to conceive of supporting people with disabilities in this way? This article tells a brief history of the wheelchair.

Ancient Mobility Milestones

As early as 300 BC, the Chinese transported people and goods on wheeled carts. The first wheelchairs designed exclusively for people appear in Chinese paintings dated to 525 AD.

In the West, a comparable vehicle did not appear until 1655. A paraplegic clockmaker from Nuremberg named Stephan Farffler (1633-1689) constructed a kind of handbike from cranks and gears.

Also out of personal necessity, English Parliamentarian commander Sir Thomas Fairfax (1612-1671) late in life devised a self-propelled chair to compensate for one of the many disabilities he carried from the English Civil War.

In Atlantic City, New Jersey, wheelchairs were first rented in 1887 to allow people with disabilities to travel on the sidewalks. The comfortable mode of transport soon drew interest from able-bodied people as well. Wealthy tourists would even have servants wheel them through the streets and, apparently, through the snow.

Invented From Necessity

Like many of its predecessors, the modern steel wheelchair was invented out of self-interest. Mechanical engineers Harry C. Jennings Sr and Herbert Everest developed the first lightweight, steel, foldable portable wheelchair in 1933 after Everest broke his back in a mining accident. Inspired by folding camping chairs, Jennings designed the X‑brace frame, a concept that — apart from newer materials and technical improvements — remains in use today.

In 1952, Canadian engineer George Klein noticed in conversations with veterans that many were tetraplegic. Their hands could no longer be used to propel a chair. Klein promptly developed an electrically powered wheelchair controlled by a joystick.

Frames and Function

Thanks to advances in technology and inclusion, today’s wheelchairs are more powerful, lighter and more versatile than ever. During the Paralympics, people with disabilities regularly deliver top athletic performances.

Modern manual wheelchairs for daily use generally fall into one of two categories: foldable (collapsible frame) or nonfoldable (rigid frame).

Foldable wheelchairs are typically less expensive and are especially suitable for people who need to store the chair frequently or load it into vehicles.

Rigid-frame wheelchairs, by contrast, have fewer moving parts because of welded joints. That reduces overall weight and the energy required to push them. Rather than absorbing kinetic energy through flex, rigid frames transmit it.

Rigid chairs also usually have quick-release rear wheels and backs that fold flat, so they can be disassembled quickly and stowed in a car. Many rigid models are made of aluminum or titanium and are therefore very light. Shock absorbers in the wheels also provide a more comfortable ride.

There are now attempts to combine the advantages of both types. In these models, the chair joints can typically be mechanically locked during travel. After the trip, the joints can be unlocked and the chair folded.

High-end wheelchairs — often made from ultralight materials, with multiple seating options and terrain-specific settings — can now cost as much as a small car.

Conclusion

Perhaps no other aid symbolizes disability and participation as clearly as the wheelchair. It is notable that the first functional wheelchairs were designed and built by people with mobility impairments and that they continued to be developed by people with mobility impairments.

It is also telling that able-bodied people initially envied wheelchair users for being pushed, immediately stripping that mode of its exclusivity, and that today wheelchair users move independently — under their own power or at least under their own control — instead of waiting for helpers.

Seeing Beyond Wheels

Perhaps the history of the wheelchair teaches us instead that participation is truly desired and successful only when it no longer matters who is in front of or in the wheelchair because people see one another instead of seeing the wheelchair, this symbol of desired and successful participation.

This story has been translated from Univadis Germany, part of the Medscape Professional Network.