Wheelchairs have been crucial throughout history for helping people get around, but it wasn’t until the 20th century’s world wars that technological advances—driven by demand from wounded soldiers—pushed mass production of wheelchairs into high gear.

The most prominent wheelchair designer was probably U.S. President Franklin D. Roosevelt, who wanted to improve upon bulky 1920s wheelchairs after he got polio as an adult.

Here’s a look at the evolution of wheelchairs:

The first known representation of a wheelchair is a Chinese stone carving from about A.D. 525 showing a man sitting cross-legged in a chair with three wheels.

Crusaders in the 12th century brought wheeled carts similar to wheelbarrows used for moving people or cargo from the Holy Land to Europe that required at least one person to push them.

After arthritis and gout left Spain’s King Philip unable to walk, a servant in 1595 created a chair mounted on four small wheels with leg rests and an adjustable back so Philip could get around, presumably pushed by others.

A German paraplegic watchmaker named Stephan Farfler, in 1655, invented a self-propelled cart, also called a mechanical tricycle, with a hand crank to power the device’s front wheel and a steering wheel to direct it. Farfler created what may have been the first self-propelled wheelchair when he was 23 because he wanted to move independently after losing the use of his legs and lower body as a child.

Around the same time, Sir Thomas Fairfax, the retired commander-in-chief of Parliament's Armies during the English Civil War, used a chair with wheels and hand-operated levers to move and steer it. Repeatedly injured in battle, he could only walk short distances.

Eighteenth-century visitors to Bath, the fashionable English spa, often needed to be shuttled around. “Bath chairs” that were upholstered or made of wicker were invented, with one wheel in the front and two in the back. The occupants steered and attendants pushed from behind.

Gout, which causes severe foot pain, was a health problem for many people at the time and led to the manufacture of wing-arm “gouty chairs,” which had handles on the arms similar to clock-winding mechanisms. They were connected by rods to wheels so people could turn handles to propel the chairs. 

By the 1800s, most wheelchairs models looked like furniture, with wooden spoked wheels similar to those on wagons for migrants heading west, according to Alan Hawk, historical collections manager at the National Museum of Health and Medicine.

The Shakers, a utopian religious community, wanted to ensure members could participate in everyday activities regardless of age or disability. They were known for their craftsmanship and simplicity in fine furniture making and, around 1830, created a modified rocking chair with wheels. 

Other chair designs emerged from trade shows from the 1830s and 1840s and at the Great Exhibition of 1851 in London, where Ward's improved recumbent chair—which looked like an armchair on wheels—made its debut. 

Photographs from the Civil War from 1864 and 1865 show wounded soldiers who had limbs amputated sitting in wooden wheelchairs with caned seats and backs. 

Improvements in technology, coupled with higher demand for wheelchairs after the Civil War, resulted in an increase in manufacturers. By the 1870s, there were advertisements for "invalid chairs" in popular magazines. In 1900, Sears, Roebuck & Co. offered a separate catalog of relatively affordable wheelchairs, which boasted 100 different models by 1909.

Commercially produced wheelchairs from the late 19th and early 20th centuries typically had high backs, wide seats, armrests, adjustable footrests and large wheelbases. The 20th century also saw the use of wire-spoke wheels replacing wooden wheels, Hawk says.

People who couldn’t afford manufactured wheelchairs in the 19th and early 20th centuries made their own. In her widely read 1846 housekeeping manual, domestic scientist Catharine Beecher suggests taking wheels off children's wagons or bicycles and attaching them to rocking chairs.

FDR—who contracted polio at age 39 and was paralyzed from the waist down—had the financial wherewithal to buy the best wheelchairs but found it difficult to move around in the bulky, one-size-fits all models of the era. 

Undeterred, Roosevelt created one that was compact and discreet and allowed him to maneuver narrow hallways and tight corners, according to the Franklin D. Roosevelt Presidential Library and Museum. 

“He converted several kitchen chairs into wheelchairs,” his wife Eleanor Roosevelt wrote in an article in the February 1963 issue of McCall’s. “Being armless and light of weight, they were extremely easy for my husband to manipulate.”

Amputations for soldiers who served in the Civil War, World War I and World War II increased demand for wheelchairs and, as time went on, medical advances meant higher survival rates for the amputees.

“War disables many people, and this created more wheelchair users during this time,” says Evan T. Baughman, a doctoral candidate at the University of California, Davis with expertise in the sociology of disability. 

Medical care advances also meant that people with disabilities lived longer, Baughman explains.

In the 1930s, Everest and Jenning (E&J) became the first company to mass produce wheelchairs. Their highly influential model was made from lightweight metal tubing, had a foldable frame and was self-propelled. This style is still seen in medical facilities today. 

Wheelchairs changed even more after World War II, Baughman says, with more standardized designs that weighed less and were more portable. The advances, combined with an influx of younger and athletic wheelchair users, led to wheelchair sports, Hawk says. The National Wheelchair Basketball Association was created by World War II veterans in 1946. 

Many athletes found the E&J wheelchair unsuitable for basketball and racing, so they modified them for more stability and maneuverability, Baughman says. The best now incorporate titanium, carbon fiber and aluminum—making them extremely light and strong.