My husband used a head controller. I had the wheelchair rep put the joystick in the back for me. He reversed the controls (so me pushing fwd on the stick would propel the chair fwd, unlike when DH pulled on it to go fwd, if that makes sense.) I do know it was harder for him to have fine control over the chair using the head controller. For the most part, he was fine, but there were situations where it was easier for me to move him. I ended taking over maneuvering into and out of the van after a several frustrating attempts by him. I would back him up the ramp, then be able to position him up front, as he usually preferred. I'd then back him up, turn and exit the van with him facing forward. He did like the autonomy of being able to control the chair by himself, though. Anything to give him some control.