Introduction

Everyone is different with their requirements for mobility equipment, and there is no such thing as a one-technology-fits-all solution. This review is our take on the ZX-1 and it is focused on the needs of those who have had strokes. My partner Rob uses a wheelchair full-time after surviving severe sepsis that caused severe strokes after surgery that went badly at the age of 47. Writing this review, with input from Rob, is Ellyn who is a bit of an equipment geek looking for anything that makes our lives easier and gives more choices for independence and mobility.

Overall, we have found that there is very little equipment on the market that specifically meets the needs of stroke survivors. This is especially true for those who are overall healthy, but need a solution that can be used with only one arm and hand, and those who want to be as active as possible yet need a power in other situations for more mobility. When we started the process the primary requirement was to have a hybrid solution of using a quality ultralight manual wheelchair that could be used actively for everyday activities in the home and a power add-on for use outdoors, indoors when he is tired and needs more mobility or when we go places for independence.

We based our decision for a hybrid approach on previous experience when Rob had a higher end power wheelchair and basic manual folding wheelchair, as this was the only choice given to him after leaving rehab. Although they sufficed for mobility, they did not fit his needs for wanting to be as active and as independent as possible, and there were many practical problems with having a large power chair that did not fit either of our needs or requirements. The result was that the power chair was hardly ever used and the basic manual wheelchair was used on an everyday basis and was uncomfortable, unsafe, and badly configured for his needs. It was clear that it was not a workable solution for the long-term, so we set out on our quest for a better solution…

Researching options

We spent a lot of time in requirements gathering and researching options. We don’t believe in trusting such important decisions that affect both of our everyday lives to only therapists or dealers who are not always up-to-date or have other motivations for the choices they make. It takes a lot of work, but we strongly believe that informed users are much better able to weigh up their needs and requirements to make good decisions, and have found this out the hard way from past experience. Our biggest resources for researching mobility equipment are SCI forums like CareCure and Apparelyzed, because sadly there are no good equipment forums for stroke survivors (see Overview of our requirements).

We looked into many types of power add-on options that might fit the requirements of a stroke survivor. Our original budget from the government was to purchase a power handbike. Although Rob had demonstrated several and he could use them, they did not fit many of our requirements. Most of them require heavy mounting systems that weigh down the manual chair when self-propelling and have quite a long footprint, making them difficult to use indoors. They are also rather difficult to use with one arm and connecting them independently would never have been possible.

For longer journeys outdoors in open spaces we have since been lucky enough to have also purchased a RioMobility Firefly. It works well but is a bit more difficult to connect and use with one arm, so it does not get as much use as the ZX-1. For those who can use a power scooter, we believe that is a viable option for many stroke survivors, and is not all relatively inexpensive (see Power Handbike Options and Other Power Handbikes).

We also considered push-rim activated power assist devices such as the Alber e-Motion drive wheels. Some of the biggest disadvantages were that they added a lot of extra weight to the wheelchair, which would not have allowed it to be propelled manually, and it is not suitable for use with one arm and hand (see Power / Manual Assist Options).

We also strongly considered the then recently released MAX Mobility SmartDrive, but after talking with many others we determined that because of upper body limitations it just would not be practical to operate with one arm and hand. We will be keeping our eye out on how the product evolves, because perhaps in future it will be a viable option for stroke survivors with additional development (see Other Power Add-ons).

Acquiring the ZX-1

We finally decided that the ZX-1 was the best solution for fitting almost all of our requirements. At the time the ZX-1 had been produced only in small amounts by the inventor Pat Tallino, who is also a wheelchair user along with being a smart guy and very helpful. He had just sold the rights for development and manufacturing to Spinergy, a well-respected wheel company.

It took us quite some time to get funding sorted out for the ZX-1 and the TiLite ZRA ultralight manual rigid wheelchair we were purchasing at the same time. Similar to most countries, our local government in the Netherlands, who provides funding through a personal budget (PGB), has a long process that must be gone through, and it was also complicated because they were not familiar with the ZX-1. At the time it was the very early days of the ZX-1 for Spinergy, and they were still going through the process for government approval also.

After being on the waiting list for a ZX-1 for quite a while and finally having all government approvals, we purchased a ZX-1 in the US and had it shipped to Europe in June of 2013 – it was the first ZX-1 in Europe. It took some time before Rob could really use it, because when we received it he had a broken leg and was in a full length plaster leg cast. It also took some time to get everything adjusted properly on the ZX-1, but most of this we think was because we had one of the earliest produced, and needing it to be rushed in order to receive our government funding in time. In other words, we were on the bleeding edge, but we were thrilled to receive it (see ZX-1 Photo’s and Video’s).

User profile for a ZX-1

There are many different types of users that the ZX-1 is a good fit for. Generally, they are those that have upper body limitations, those who do not want a large heavy power chair, and those who do not need all of the features of a full blown power chair. Some examples are users who have inadequate upper body, arm and hand control due to paralysis, hemiplegia/hemiparesis, cerebral palsy, multiple sclerosis, joint disorders, muscular disorders, injuries and amputations (see ZX-1 User Profile).

Some of the stroke deficits that Rob has are hemiparesis, neglect, and hemianopsia, along with post-stroke seizures and general fatigue. Most mobility equipment does not address the needs of these conditions, which are very common after severe strokes. The general thinking by many physical and occupational therapists is that non-ambulant stroke survivors can only use a power chair, and many are not aware of the ZX-1, or the many practical problems encountered at home and in the community when using a power chair.

Hemiparesis, also known as hemiplegia, is weakness or paralysis of the entire side of the body. When using a manual wheelchair it means that he needs to propel with only one arm and one leg (toddling). Propelling a wheelchair with only one side keeps him fit and active and is good for his rehab in trying to use his stroke affected side, but it is very difficult and tiring for long distances. Equipment that can be used when needed that does not limit his capabilities and future potential is paramount.

Neglect is a lack of attention and awareness and the ability to respond to objects located on the stroke-impaired side. It makes it hard to be aware of and get around obstacles. Having equipment with a small footprint makes it much easier and saves him a lot of energy in not having to make many attempts to get around obstacles. It also saves a lot of damage to our house in hitting furniture, door frames, etc., not to mention our pets if they don’t see him coming to get out of the way (see ZX-1 Dimensions).

Hemianopsia is the loss of visual field to both eyes, which makes it difficult to see obstacles and is also very tiring. Equipment with simple joystick-driven controls that can be used with one hand makes it easier to operate and manoeuvre inside the house and also when we go places and there are many people around that he does not see. It also helps me in not having to clear a path in front of him for people who do not give much space for a wheelchair rider, which is very common where we live. The ZX-1 has saved a lot of people from being whacked in the legs from a big heavy power chair.

Practical implications of a ZX-1

We live in a 350 year old house that we converted many small steps to ramps and widened doorways as much as possible. Because it is an old house, there are many structural changes that we cannot make without compromising the integrity of the house. Some of the ramps are quite high and do not have an adequate slope and are impossible to use when only using one arm and leg for propulsion. When Rob had only a power chair he was not able to negotiate our doorways and ramps without getting stuck, and if he did get stuck, it was hard to get him out. The ZX-1 has enough power to go up the ramps and because of its small footprint, it is easier to negotiate the doorways. Should het get stuck, we are able to disconnect the ZX-1 to get him through.

Although it does not have as much power or range as many high-end power chairs, they are adequate for our needs. The highest default speed is at about a slow jogging pace which is fast enough when accompanied by someone else, which he usually is. Because of upper body and visual limitations he does not yet want to travel at high speed. Possibly the need for speed will change over time, which will be possible by increasing the default settings with a programmer (see ZX-1 Joystick Programming).

Of course, it would always be great to have more range, but we find the range acceptable for what we use it for now, but we are hoping to upgrade to lithium batteries to give it a longer range. Be aware that the heavier the user and wheelchair are, including accessories and whatever else may be being carried, the slower the speed will be, and it will also affect it’s handling of ramps and inclines and it’s range.

Adjusting a ZX-1

There are requirements for the wheelchair that are necessary in order to use a ZX-1, the most important of which are a rigid frame with a horizontal round camber tube — no folding chairs. We bought the ZX-1 at the same time as a TiLite ZRA ultralight manual rigid wheelchair, but it can also be added later. If you have a very narrow chair with a lot of accessories on the camber tube, it’s easier to have it in mind when you configure a manual wheelchair, rather than wait and find out that there are conflicts (see ZX-1 Chair Requirements).

With having a rather narrow wheelchair that has a lot of needed accessories, it was a tight fit with getting everything configured to work with the ZX-1. Some of the initial adjustments that caused some conflict were the backrest rigidizer bar, the armrest brackets, the backrest release bar, user friendly anti-tips, and D’s hub Locks. With some initial trial-and-error and tweaking we were able to get them all working together and none of the accessories needed to be removed. We had excellent support by Spinergy while we were making the adjustments, and now that there is a dealer in the Netherlands we also receive good local support (see ZX-1 Anti-Tilt Mechanism Adjustments).

Just as a note, because the manual chair is usually used for foot propulsion manually, it requires the front seat height on the wheelchair to be lower when one footrest plate is raised and the other is lowered. When using the ZX-1 with both footplates lowered, we find that the front seat height is a little too low, and it causes Rob to sit at an angle which is not comfortable for long periods. Although this is not specific to the ZX-1, because it also happens if I am pushing his chair, we have found that having an adjustable height air cushion helps. We have a Varilite Evolution PSV seat cushion that we add more air to raise the height of the seat cushion when being used with the footplates with the ZX-1 and it also helps make it a smoother ride.

Connecting the ZX-1

It’s easy to connect and disconnect the ZX-1 with minimal assistance and with no use of tools or heavy parts to move. This was very important for us because Rob only has one hand and arm to use while connecting and disconnecting. He has not yet been able to connect it by himself, but we are hoping that with the aid of a mirror to the side to see what is happening under the chair, that he will be able to do it in the future. Disconnecting is very easy and requires no assistance.

There are no heavy adapters or mounting systems, so the manual chair is not weighted down when self-propelling. This was extremely important to us because even a small amount of extra weight affects Rob’s ability to propel with one arm and foot when he is not using the ZX-1. Unlike many other power add-ons, there were no modifications needed to the manual chair that compromise its use when being used manually – it was the only similar type of power add-on that we found that did not compromise the chair.

Safety mechanisms

The ZX-1 has safety mechanisms for brakes, an anti-tilting mechanism and a free-wheel mode. It has two brake systems: The first is electromagnetic so that when the joystick returns to the center position, the ZX-1 slows down. The second is when the ZX-1 comes to a stop, a disc park brake is automatically activated. This makes it very easy to operate without having to engage brakes by the user.

The anti-tilting mechanism is used when traveling down an incline to stop the armrests from dipping down due to the ZX1 rotating forward around the camber tube because of the momentum caused by stopping abruptly. It is able to handle most ramps and small curbs, similar to a power chair, and we have not had problems with the ramps that we have encountered so far.

Because we have not had a problem with ramps, we are questioning the need for the anti-tilting mechanism, because it sometimes restricts the height the front wheels can be raised to get over obstacles and steep inclines. I have been told by others that if we don’t want to use the anti-tilts we can minimize this affect by keeping the rear wheels of the wheelchair as low as possible at all times, even slightly scrubbing the ground, so they act as a sort of training wheel or outrigger. Another option is to narrow the gap between the backrest posts and the ZX-1’s armrests, which will in itself act as an anti-tilt.

There is also a free-wheel mode, which is intended to permit it to be moved if needed without power, but is not meant for use while sitting in the chair to be propelled manually. I consider this a safety mechanism after once having to push a scooter uphill for many kilometres in blazing heat after the battery died.

Environmental factors

The ZX-1 has large wide drive wheels, built in suspension (shocks), wide soft-roll casters and a shock absorbing polymer (dampner) on the front fork. These help minimise bumps that can cause Rob seizures, especially on the brick roads that are typical where we live. Many people use a FreeWheel with the ZX-1 to give it more all-terrain capabilities. Unfortunately a FreeWheel cannot be attached to Rob’s wheelchair because he uses flip-up footrests, and we also think he might struggle coordinating both a FreeWheel and the ZX-1 due to his stroke deficits. We are working on a solution by making our own all-terrain third wheel, but it has taken some time.

So far the ZX-1 has handled well on grass, gravel, tight packed sand and leaves, but we have not yet tried it in the ice and snow. You can also get off-road knobby tires for it, which we hope to do sometime soon. Armrest extensions are also an option, which we would recommend if you are tall like Rob is, but they can also be retrofitted later if you are not sure if you need them.

Accessibility and travel

The ZX-1 can be separated from the chair for going to places that are not fully accessible, which unfortunately is quite common in Europe. We often encounter high curb cuts and a few steps at almost all restaurants and shops, along with all of our friend’s houses. We can usually manage it by disconnecting the ZX-1 and manually lifting the chair to get past the barrier, and then reconnecting the ZX-1. We can also leave the ZX-1 unattended and locked so it does not get ripped-off if we leave it outside (we will use a bike lock). All of these situations were impossible with a power chair, and there were times that we had to turn around and go home because of lack of access.

It’s fairly easy to transport the ZX-1 in the trunk of the auto. Sometimes I lift it but it is still quite heavy and requires some back work. We also have telescoping ramps that we can use and are also considering a small portable lift. Removing the batteries drops the weight so it can be lifted into the trunk easier, but we have not yet tried it. We think the lithium batteries and removing the anti-tilt mechanism might make it easier for transport without needing ramps, a lift or a strong back. Transportation was a big problem for us with a standard power chair, because most require full-size vans and lifts in order to transport them. Especially in Europe, a van is not a viable option for most places that we go because of narrow roads, lack of parking and the high costs of operation.

The ZX-1 can also be easily stowed on airplanes, with charging possible in other countries. Be aware that the voltage switch on the charger needs to be manually switched between 110v and 230v — we made the mistake of thinking it was automatic and fried the charger.

Quality and maintenance

The ZX-1 was purpose built for adding power to a wheelchair, using already proven wheelchair and scooter components. All of the components used on the ZX-1 are components that we have chosen for other equipment or would have chosen if needed, from quality manufacturers (see ZX-1 Specifications).

I do all of the maintenance on Rob’s mobility equipment and it’s important to have equipment that I am able to fix easily and cheaply. Most of the components can be replaced by ordering online without needing to order through expensive dealers or wait for repair people. This was especially important to us, because we have often waited months for repairs that we could have done more quickly, cheaply, and most of all, with much less hassle, if we did them ourselves. By having the power components separate from the wheelchair it also means that if there is a problem he is still mobile with his manual wheelchair.

We both have a dislike for equipment that is not designed well for ease of use, maintenance or with aesthetics in mind. Although appearance may not be a primary reason for choosing a mobility device, it certainly helps. Rob has a real aversion to any equipment that appears too handicapped, especially a big power chair. The ZX-1 tucks in nicely under his wheelchair and is not really noticeable. It is also really quite and overall very unobtrusive when being operated. The core is a stainless steel base and other than one cable running to the joystick, there are no cables or wires that can get caught on things. The carbon cover is especially nice looking and really protects the components well. Most people who see it comment on how cool it is, and unlike some equipment that we have had, they also seem to treat it better than net well designed equipment. Overall, it’s a really nice looking piece of kit!

Our take on the ZX-1

Although the ZX-1 is quite expensive, for much less than the cost of a power chair we were able to buy a ZX-1 power add-on and a TiLite ZRA wheelchair. Also the overall cost of ownership is much less than a power chair. If you are contemplating getting a ZX-1, and it fits your specific needs and requirements, the benefits by far outweigh the cost.

Rob says that it takes some time to get used to it and adjust it to your personal needs and capabilities, but it is a good investment. He said it really helped to start slow and enlarge his actual radius step-by-step and to set goals and increase them. He likes that he is not too confined in a power chair and can be active. When asked about how he felt about his manoeuvrability, he said “Like a dancer I make pirouettes”.

In a nutshell, the ZX-1 has been a big win with us, and we are both very happy to have it. We have absolutely no regrets in the choice we made. We give it an unequivocal two thumbs up!

More information?

We’ve made a short impromptu video of some of the major topics of this review that you can find at: https://www.youtube.com/watch?v=lBQZ_j5UFkU

If anyone has any questions, you are welcome to contact us at: questziontime@gmail.com.