What to do about posterior pelvic tilt…?

Happy Wednesday Everyone!

Wishing everyone a Happy Occupational Therapy Month this October! This week Access Community Therapists is hosting a workshop on Friday and Saturday on Wheelchair seating and positioning in the community. Pictures to come! Lindsay Alford, OT and I will be presenting this year. So excited to be a part of this workshop once again. Today, I thought I would share with you some strategies for managing a flexible posterior pelvic tilt. Over the past few months I have actually had 4 clients with similar issues. They are as follows:

  1. A flexible posterior pelvic tilt.
  2. Limited/restricted hip flexion (meaning they were not able to achieve at least 90 degrees of hip flexion before causing the pelvis to move into posterior tilt).
  3. AND a fixed or only mildly improveable thoracic kyphosis.

Although these 3 issues don’t seem overly challenging on their own, together, they make seating and positioning incredibly difficult. For example, if you just accommodate for the kyphosis and limited hip flexion by opening the seat to back angle of the seat or allowing for thoracic relief through a modifyable backrest,  the client may fall into more posterior tilt and start sliding out of their wheelchair. Oh no!

Since I’ve had so many clients with the same 3 issues, I thought I would write about a few of the strategies I’ve used so that you can try them with your clients. Keep in mind, you must do a thorough mat assessment before implementing these strategies so that you know exactly what issue you are trying to address!

1. To address posterior pelvic tilt: Use a pre-ischial shelf or IT block to stop the ITs from moving forwards on the seat:

Above are two examples of pre-ishial shelfs on cushions. the image on the left is a custom built seat made with carved foam. The second is a commercial cushion (which is more on the mild contour end-but there are more aggressively contoured cushions available). Keep in mind that the more angular and high the build up is, the more control you will have.

2.  To address the kyphosis with limited hip flexion: Open the seat to back angle or have or cut down the front of the cushion to allow for a more open hip angle. I don’t have an image for this, this is a very specific and calculated strategy. Based on the client’s hip range, you open the seat to back angle to accommodate for a comfortable/functional hip range. You must do a mat assessment and sitting assessment to find out what this angle is! If a client has less hip range on one side compared to the other, make an assymmetrical front end where you allow one leg to rest lower than the other. This is extremely effective as it prevents you from positioning the client with too much open hip angle, which could result in the loss of control for the pelvis and hence….dum dum daaaa…..sliding!! *gasp!*

3. To control the pelvis and accommodate for a kyphosis: Use a backrest to (1) block the pelvis at the back and (2) provide enough thoracic relief for the kyphosis. 

The backrest above is the comfort company Acta-Relief backrest. I just prescribed this backrest for a client who needed a lumbar-sacral push and upper thoracic relief for his kyphosis. The adjustable straps are well placed and provide a good degree of support where you need it and can be loosened off to allow for more accommodation for the kyphotic part of a client’s back. You can also get laterals for this back to provide some good midline control or guidance. Other products like the Future Mobility Prism Truefitt backrest and the Dynamic Health Care’s Armadillo backrest could also be other options for milder cases. Armadillo backrest has been reported by my colleagues to be a bit narrow, but I haven’t tried this myself. Bi-angular backrests (which have a hinge in the back) can also work here.

The photos above here are of a custom backrest fabricated by Jeff Ducklow at Ability Health Care. This is a hybrid technique using carved foam backrest and foam in place. This client had very stiff pelvic mobility. In lying, her pelvis rested in anterior tilt, but as soon as her hips were flexed, she would fall into posterior tilt. In addition to this, she also presented with a lot of extensor tone. The flexibility in her spine (anterior/posteriorly) was also at a very specific point in her back. Therefore, we built up that part of her backrest to provide a push at her upper lumbar spine to try to prevent her pelvis from falling further into posterior tilt as well as to prevent her from collapsing forwards at her trunk. Once we achieved a good position with the carved foam, we then used foam in place (poured foam) to fill in the rest of the space to ensure good accommodation of her upper back kyphosis. Neat eh?

4. To prevent the pelvis from falling into posterior tilt: Use a supportive anterior pelvic support or belt:

The above two belts are custom belts however, even a four point lap belt can work here as well (although a 4-point belt won’t really help to control for rotation of the pelvis is that is an issue FYI). The placement of the belt is so important here. In these cases, the belt should be positioned under the ASIS to hold the pelvis back and down onto the seat. If it is positioned properly it will keep the pelvis back into the system and down onto the ischial well. When a good anterior support is used with a backrest and a pre-ischial shelf, they all work to prevent the pelvis from falling into posterior pelvic tilt. Ta da!

Keep in mind that if you are dealing with all three of these seating issues in one system, you will probably need to implement most, if not all of these strategies. I hope you liked these tips! Until next time:

Seating is Super!

Cheryl

STEPtember for The Cerebral Palsy Association of BC

Hello Everyone,

It’s September already! This post is a bit different than my other posts. You see, Access Community Therapists is participating in “STEPtember” this month, which is a fundraising campaign for The Cerebral Palsy Association of BC. My colleagues and I will be attempting to take 10,000 steps per day this month in support of this amazing cause. Today was the first day and I only managed to take 4100 steps so I am already behind. This is a cause that is so important to us at Access as we work with so many people with CP and other developmental disabilities. If you could spare a few moments and a few dollars towards this cause, I would be forever grateful. Here is the link to the Steptember website. Feel free to search my name “Cheryl Hon” and donate!

20160901_225152 (1).jpg

 

Thanks everyone for checking in. Seating is Super!

Cheryl

 

New products from Invacare, Power Wheelchair Programming Language and Nylatron Front Rigging

Happy Wednesday Everyone,

I hope you are all enjoying the beautiful weather this week. On May 6th and June 23rd, Invacare provided some super valuable inservices to the Access Team and local sales reps. Not only did we get an in depth overview of their new products, but also had a chance to learn more about programming. Power wheelchair programming jargon can be a bit confusing, to me anyways, so it was great having the opportunity to clarify what some of the language really means. A huge thank you to Jason Hrynyk for the inservice at Access and the invitation to the education day. Also, thank you to Cher Smith, OT who gave a great review of wheelchair and seating principles and programming tips at education day.

Jason brought us the Libra cushion and PSVF (posture seat visco foam) cushion for us to pressure map at the office. We used the X sensor pressure mapping system at this inservice to assess the cushions. The PSVF cushion is a really nice comfort cushion is mapped quite well as it provided good pressure redistribution as the foam allows you to submerge into it to achieve full contact with the buttocks and proximal femurs.

The Libra cushion is Invacare’s new cushion that has been designed to address skin breakdown. This is a nice stable cushion and is also quite light weight even with the gel pack at the back. From a pressure mapping perspective, when leaning side to side, peak pressures did appear, however, we do know that skin breakdown does not just occur from pressure alone. Invacare reports that this cushion has helped some clients heal their wounds. My guess is that this cushion provides a stable sitting surface and the gel at the back may be most suitable for clients who are at risk for developing wounds from either friction or shear. Just as a reminder:

Friction: Is repeating rubbing on a surface. This causes damage to the surface of the skin only

Shear: when unaligned forces push the body in one direction while another force pushes the body tissues in an opposing direction. This results in damage below the skin first.

Here is a video by KCI that describes these two concepts very well! Click here. These concepts are described in the first 2 minutes of this video.

If you get a chance to trial either of these cushions, we would love to hear your experiences!

DSC01703

Jason also brought us the e-motion wheels to trial. These are nice power assist wheels that are activated through the push rim. See this brochure for more information.

At the education day, Cher Smith and representatives from Invacare and ASL reviewed some very useful terms. Here are some programming definitions that will hopefully help when you need to adjust power wheelchair driving programming for your clients:

Joystick Programming Language:

Movement of the joystick:

  • Deadband=The space in which the joystick can move before actually moving the wheelchair. (If the deadband is large then the client will need to move the joystick further away from centre to activate the driving of the wheelchair. If the deadband is short, then less movement away fron centre is required to start moving the wheelchair)
  • Throw= How much the joystick movement is required to move the wheelchair to full speed. This can be adjusted to allow clients to reach full speed without pushing the joystick to the end of its range. Similarly, it can be adjusted so that a client needs to push the joystick to the end to reach full speed.

Force of Movement:

  • Deflection= the amount of force required to move the joystick

Power Wheelchair Programming Language:

  • Power: The amount of power a wheelchair has. This cannot be changed with programming.
  • Torque: Can be better described as “acceleration”. Torque is essentially the amount of power required to accelerate. Acceleration can be adjusted with changes to the electronics to the maximum amount of power the wheelchair has.

One last thing that was shared at this education day was the Tecla Shield . This product is so cool. It’s a device that links tablets, other touch screen devices and computers to alternate access buttons, switches, or even wheelchair driving controls. So cool! Check it out!20160623_154304.jpg

Finally, here is a new and exciting innovation created by Nathan Buskell at Motion Specialties. It’s a Nylatron foot rigging post!!!! This doesn’t look that exciting from the photo, but this post is flexible. Yes, flexible! Nathan created this product using nylon plastic material called Nylatron. He designed it for clients who often break their front rigging from heavy use. This could be from constant stomping, high tone or even from hitting the front rigging and footplates on obstacles in the environment. What an amazing innovation! And to top it off, it looks nice! Not bulky at all! I was so excited! 20160726_120320

That’s all for now folks. Thanks again for checking in. Seating is Super!

Cheryl

 

The 32nd International Seating Symposium

Happy Wednesday Everyone,

Lindsay Alford and I presented for the first time at the conference. We were definitely a bit nervous at the beginning! Hopefully we didn’t scare anyone away at the beginning! To everyone who was able to make it, thanks so much for coming. Hopefully you found our presentation on Balancing Function and Posture in Wheelchair Seating helpful in your practice. My appologies for this very late post. I’ve been meaning to share all of these new innovations from the ISS for a while now. But my oh my is working with a baby, or should I say toddler, a whole other ball game. And to think, I only have 1 so far! In any case, here are some updates from the ISS back in March.

Ride designs debuted their new Soft Fit cover for their custom ride cushions. As you can see in the images, the regular spacer cover is one layer of spacer fabric, whereas the Soft Fit has 3 layers of the famous material. The image of the under side of the cover shows how they cut out a diamond shape section for the well of the cushion. That’s to ensure that the consumer still gets the off loading properties of the cushion under such a thick cover. This is a really nice option for those who find the cushion a bit hard but don’t want to lose the unique off loading qualities of the Ride.

Ride Designs also had their tall Ride Java backrest as well as their new Ride Java cushion on display. As you can see there are pronounced scapular cut outs on the backrest,which is definitely a nice feature. As for the cushion, this is a nice commercial option for clients who would benefit from off loading their boney prominences but don’t quite need the full custom option. I’ve already trialed this one with a few of my clients!

Now here is a really cool product made by Joerns Healthcare. At the exhibits, they had their Dolfin Fluid Immersion Simulator mattress and cushion available to see and trial. This system is based off of a system that was used to transport military dolfins. Yes, that’s right, Military dolfins! Apparently, in order to transport dolfins, they need a system that will support their bodies so that they won’t collapse when they aren’t submerged under water. They used this technology in this mattress and cushion as it therefore helps to prevent collapse of the tissues in order to prevent and heal wounds and pressure ulcers. These products are available for rent as well so feel free to contact Joerns for more information.

Seating Dynamics had quite a few neat products this year. Here are some images of their dynamic footrest, backrest and head rest. The headrest was quite interesting as it has the option of being set up with a single-axis or multi-axis movements. The mounting hardware also seemed quite strong. Head positioning and tone are so complex when it comes to positioning. I am very interested in trying this item when the right client comes around.

Here is another innovative product at the ISS. Stealth Products had the Tarta Ergonomic backrest available to trial. Although this product is not yet available in Canada, it is an interesting design that provides the user with midline guidance and support, but is flexible. The modular design allows this backrest to flex backwards and side to side with the user. It is super comfortable and you can definitely see the utility of this product. Definitely worth a try for the right client!

Here are the B-Braver handrims. These handrims have a Polyisoprene non slip grip at the top. But what is truly unique about these handrims is the shape. They are rounded at the top and flat at the bottom. When holding on to them , they fit very nicely in your hand. These handrims were created by Marco Pilotto, a gentleman with C6 Quadriplegia. I always find products created by consumers to be so special. Marco was such a pleasure to meet as well. Passionate about his product that has worked so well for him as well as for many others. Marco, it was so lovely to have met you! Good luck with this product, it’s definitely a good one!

Invacare debuted their TDX SP 2 power base at the ISS. Unfortunately, this power base is not yet available in Canada. But some exciting features about this base include the new joystick with switch box for access to all the power seating functions, the improved power recline with shear and the streamlined power elevating legrests. The power recline with shear is super nice in that the backrest essentially stays in place when the system goes into recline. This may seem simple, but it’s definitely not common in many other power bases. The reason why this is useful is that if you have trunk laterals or a custom backrest for example, if there is not enough shear, the backrest will move up out of place when the system moves into recline. Then the client looses contact with their back contours or their laterals get pushed into the axillas or even past their axillas. The legrests are also unique as many manufacturers are moving away from swing away elevating legrests. This can be an issue for clients who need the swing away for specific purposes. I just actually had a client who used the swing away function to move their feet out of the way from the sink pipes in their bathroom but still needed the power elevating legrest function.

On another note, Invacare wanted me to announce that they are now cleared (since 2015) to sell power mobility in Canada without restrictions. YAY! Congratulations Invacare. It has been a long road, with a lot of hard work. Definitely looking forward to trialing the new TDX when it comes out here.

Invacare also had their new Libra cushion on display. This is a really nice foam cushion with fluid gel overlay in the well of the cushion. The well is contoured to offer some offloading of the coccyx and ischial tuberosities. The gel is also new and meant to be maintenance free. This is a super nice light weight cushion with some great pressure relieving properties. Definitely going to bring this one out for a trial and pressure mapping session! Stay tuned!

Power assist systems were everywhere at the ISS this year. Although these systems are not “new”, most of the manufacturers were launching new and improved versions of their products which was nice to see and demo. In the images above, I have the Twion (power assist),  E-fix (which converts a manual into a power drive wheelchair), Invacare e-motion wheels (power assist-no image) and the yamaha JWX-2, also known as the Sunrise Quickie X-tender and the yamaha wheelchair motor. Check out their websites for more information.

Freewheel also had a new product this year. They have actually created a way to mount their freewheel onto a manual folding frame! How exciting! They essentially created a removeable cross bar that can be added to most manual folding frames. A super nice addition to this line.

AEL had a cool new trunk lateral hardware called the Omnilink  and it had loads of adjustability! Quite easy to actually adjust the components as well, which is so important when trying to get it into the “just right” position.

NXT and Vicair had some cool new hardware innovations. Check out that headrest mount that can be easily positioned out of the way. Also, check out the backrest quick release bar and the trunk lateral depth adjustment piece. Quite a nice feature if you ask me. Also, Vicair has made some improvements with their covers to make them more breatheable.

DSC01808

I’ve featured the symmetric designs backrest before on the blog. But here is is again. Such a unique product. They have also made some improvements to make this system more durable and easy to adjust. They also have a new website, which is absolutely beautiful. Definitely a cool product that I would love to trial with the right client.

DSC01789

Ki mobility had a power tilt system on display at the ISS. This system can be added onto their tilt in space wheelchair to make it easy for a client to access their own tilt. It was a really nice system and was super smooth.

Ottobock had two really cool products this year at the ISS. They had their new adjustable carbon fiber wheelchair called the Voyager Evolution wheelchair. They also had their Terra Flair cushion, which integrates Roho air cells at the back of a foam cushion. This was a very comfortable cushion. Definitely going to keep this one in mind for a trial!

 

20160303_125459

So that’s all for my ISS summary. I hope you found some products here that may help one of your clients in the future. I leave you with this picture of me and Lindsay right before we presented. We don’t look that nervous do we? Perhaps we hide it well! 😉

Thanks again for checking in! And remember, Seating is Super!

Cheryl

Belts, belts and more belts!

Happy Friday Everyone!

In BC we are gearing up for the International Seating Symposium that is being held at the Westin Bayshore in Vancouver. This is a super exciting week for those in the wheelchair seating and mobility world. I will be presenting this year along with Lindsay Alford (OT). We will be presenting an instructional session called “The Art of Balance: Function and Posture in Wheelchair Seating”. We will be introducing a clinical reasoning model that we developed. Hope to see some of you there! Here is the link to the brochure if you are interested!

Also, Access Community Therapists will be also be hosting the “Introduction to the Assessment and Management of Eating, Drinking and Swallowing Disorders: A Clinical Approach” workshop on April 28th and 29th. Register quickly if you are interested as spaces fill very quickly! Check out the website for more information.

I thought that I would post some of the positioning belts that I’ve done over the years. Positioning belts can be critical in a seating system from a postural perspective, but are often so complex to integrate into a system as they can often have an impact on the way a client functions. Since we are presenting on this very topic, I thought I would give all of you a sneak peek!14

Here is a custom pelvic support with with angular molded sub-asis pads. The sub-asis pads are secured with swing away harware. Between the sub-asis pads, there are flexible straps connected with a standard push button buckle. The purpose of this belt was to create a rigid system that the client could use when her tone was quite strong. Alternatively, when her tone was quite mild, she could leave the swing away hardware open and simply secure the buckle to allow her to move more freely in the system. Cool eh?

DSC01736Here is an example of how changing a buckle can make all the difference in the world! This client couldn’t use a positioning belt before as it would impede his ability to transfer quickly. By introducing an airplane style buckle, he was now able to use a positioning belt, which prevented him from sliding down in his seating. YAY!

DSC_0416

Semi-rigid belt with evoflex

Here is a semi-rigid pelvic support made with custom sub-asis pads. This system was made for a client who needed more rigid pelvic support but needed to fasten and un-fasten the belt independently. This belt was also done in combination with a dynamic backrest on a light-weight rigid wheelchair frame. This is a nice example of how it is possible to improve postural control while maintaining a client’s ability to function independently.

IMG_20140903_155418

Swing away hardware on arcufit

This one is a custom arcufit style belt with a swing away hardware again. The purpose of this hardware though, was to clear the belt out of the way so that the back canes could be folded down to transport the wheelchair in a trunk.

DSC_0153

Custom Rigid Pelvic Saddle

Here is a custom rigid pelvic saddle. This system was created to prevent a client with very limited hip flexion from sliding down in their seating system. Note how much anterior control was needed to keep the client up in the system in order to maintain her ability to drive and be independent in the community.

download_20141112_163011

Custom pelvic harness for comfy chair

Remember this one? This is a custom “posey” style belt used in an alternate positioning device. This system was made for a client with a lot of tone that wanted a more comfortable option. In his mobility system, he uses a semi-rigid system. This is a nice alternative that is also necessary to reduce his risk for skin breakdown in a very rigid system that he has in his wheelchair.

I hope you liked this collection of positioning belts.For those of you going to the ISS this year, see you next week!

Thanks for checking in! Seating is Super!

Cheryl

Happy Wednesday Everyone,

I am officially back from maternity leave and have missed all of you! To make up for my absence, I have some exciting information and new equipment to share with you. Back in November we had our seating meeting. We were fortunate enough to have a Ride inservice hosted by Ed Bell from Advanced Mobility along with a Skype session with Joe Bieganek from Ride Designs in Colorodo. Here are some tips that we learned from our session:

RIDE CAPTURE TIPS

  • Best to do the capture in the client’s wheelchair
  • Slings can be used to lower a client onto a simulator. Make sure positioning in the sling is good so that client can be positioned appropriately over the simulator.
  • May have to take off clothing guards or space out wheels to fit the simulator
  • The integrity of the back of the capture on the simulator must be intact so the capture can be taken forward from the backrest if the simulator cannot be set up far enough back. Towels/a pillow or foam can be placed in front of the backrest to support the client as long as the optimal position of the pelvis is maintained during the capture.
  • Send photos of the client on the simulator with the capture for extra context.
  • 3/4″ under the ITs are required at a minimum.
  • If the client has a pelvic rotation and you would like to maintain this in the capture, scoring the front and back of the GTs on both side of the cushion can be helpful.
  • If the client presents with a severe pelvic obliquity and you are unable to get a deep enough impression of the IT, you can wedge up on the higher side to get the impression.
  • There is a soft fit option for clients who cannot manage with the firmness of the material. The new soft fit cover can have 3 layers of spacer mesh. If the client is getting redness on the femurs, then a layer of spacer mesh can be added under femurs.
  • Figuring out length: When the client is in the simulator, measure from the back of the sim pan to where you want the cushion to end on the client. If the client has been moved forwards for the capture, indicate this and document how many inches the client has been moved forwards (i.e. by 1″ or 2″). A picture with a measuring tape is helpful here. Ideally, a capture will have 1/2″ of foam intact at the back of the sim pan.
  • Best to send cushions back if they are intact (not modified) and still under warranty.
  • You can carve through the cushion and add to the bottom to clear ITs. You can also add to the bottom if more height is required.
  • When taking impressions of the thigh, push on the proximal and distal aspect of the femur rather than the mid-thigh to get a more accurate impression
  • INTERESTING OPTION: You can ask ride to make a cushion exactly the same as the impression capture. Just write”respect the shape as captured-full contact”. Then once the cushion arrives, the GTs, ITs and coccyx can be carved out.
  • FYI, the carving coating does not matter, though the painting at the front helps to reinforce the edge. On the order form, a request can be made to reinforce the front for transfers if this is foreseen as an issue.
  • Also, any custom modifications made on the request form can increase the overall price of the cushion.

Ki (pronounced “kee”) Mobility Inservice: Bill Randall from NuVision Rehab also came to the meeting to show us the Ki Mobility line of manual wheelchairs. I’ve seen these wheelchairs several times at the ISS and have been wondering when they would be available for demos. Thanks to NuVision Rehab, we now have access to these! Yay! Here are some of the new wheelchairs he brought in to show us.

Folding chairs: All of the Ki Mobility folders have dual interlocking cross braces which allows increased rigidity and more responsive energy efficient chair. The power x hinge gives a solid lock and rigidity and also allows the chair to fold without the back canes flaring. All folders have a 250 lb weight capacity.  There is also a heavy duty  option with a weight capacity of 350 lb.  The largest size is 22 wide x 20 deep, which weighs 26 pounds.  The heavy duty package is $500 upcharge but this can vary. There are also 10 standard colours.

Catalyst 4:  

  • X4 mag is standard wheel which is more rigid and durable wheel
  • Weighs 24 pounds.
  • Pricing is at lowest end. (Compares to Breezy 600 or Myon. $1395 at base price).
  • No tie downs, BUT the chair will allow dealer to retrofit tiedowns on all of their models except for the Catalyst 4C.
  • Can get to 14.5″ seat to floor height and can also accommodate a drop base.

Catalyst 5VX: 

  • Entry level to adjustable chair (Comparable to the Quickie 2 lite)
  •  2.5” centre of gravity adjustment
  • Can adjust camber.  Can invert axle plate.
  • Armrests are a dual taper design for a more rigid feel but is still removable.
  • Single post are through bolted not clamped. Therefore arms won’t splay with heavy use.
  • Folds very narrow.
  • Has angle and depth adjustability

Catalyst 5

  • Comparable to Quickie 2.
  • 3.5” centre of gravity adjustment.
  • Rounded and rectangular side frames.
  • weighs 23 lbs
  • Increased rigidity. Depth and angle adjustable back.  Performance caster journal allows more seat dump.  Can get 4” total dump.

Rigid chairs:

Tsunami: Economically priced wheelchair and is eligible for Ministry funding.

  • 11.4 pounds.
  • Larger diameter tubes, which are more rigid.
  • Higher energy efficiency over titanium which has more flex.
  • Can get growable frames on the XP option, which cuts frame and puts coupler in between.  This adds ounces of weight.
  • Casters are bolted on Sunami
  • Center of gravity is bolted on frame.  4.5” Centre of gravity adjustment.
  • Option of 2” seat depth growth.
  • There are many options for front rigging angles.
  • ¼” increments for rear seat to floor height adjustment.
  • Sunami has fold down non-locking back.

Rogue: More expensive and ideal for a client with third party funding.

  • 10.6 lbs
  • fold down locking back frame
  • Rogue can have 3 or 9 degrees of recline.
  • Tiedowns can be specified.
  • Flip back footplate available
  • Castors are welded rather than bolted
  • Rogue caster can be adjusted with person in chair.
  • Single or double caster forks.  (Ideally, better to go with double castor forks if it is for a heavy user or the user requires power assist/power wheels.

Tilting chair

Focus CR: Tilt wheelchair with a 5 year warranty on the tilt system and frame.

 

 

  • Hand activated tilt that has only one cable.  The foot tilt has no cables.
  • No plastic bushings and has stronger pins.
  • Rockers are cast aluminum and act more like a gear. There are sealed bearings and the rockers are inset from the side of frame so that it does not collect dirt/food.
  • Width adjustable
  • Standard tilt range -5-50.
  • Can do dynamic back or heavy duty up to 400 pounds.
  • Can be aggressive for centre of gravity for self-propelling (but there may be still issues with the client being able to reach the brake independently without a long extension)
  • Smart tilt allows centre of gravity to be easy to set up.
  • Numbers to indicate tilt angle are not easily visible, but a silver sharpie can be used
  • When changing centre of gravity, the client can stay in the chair during the adjustment! Wow!
  • Foot rest receiver and caster housing are in line.  Can adjust with plate on frame.
  • Has spring loaded flip up antitippers.

Just wanted to say thanks again to Ed Bell, Joe Bieganek and Bill Randall for the great inservice day!

Thanks for checking in! Until next time! Seating is Super!

Cheryl

Stealth Products i-Drive and the REE at the ROO 2015

.: Stealth Products and Pride Mobility :.

Hello Everyone! I just wanted to say THANK YOU to all my amazing subscribers and readers. It has been a while since my last post, but thanks for always checking in. The past several months have been busy, which is great! Access Community Therapists just launched a new website – WOOHOO! – which I was lucky to be a part of. Check it out and let me know what you think!

Also, happy belated OT month to my fellow OTs! Occupational Therapy month was in October. There was so much OT spirit out there this year and it was so exciting to see so much enthusiam over social media over the past month.

Back in September we had the REE at the ROO and Access was lucky enough to get a private inservice by Mark Scott from Stealth Products. Since I am still technically on maternity leave I was able to bring my son, ‘T’ to the REE and the inservice by Stealth. Mark was even kind enough to entertain ‘T’ with his fabulous cartoon character impressions! Thanks Mark! Anyways, back to wheelchair business!…..

It was great learning about the new i-Drive system and seeing how to use it with their head array drive control and fiber optic switch. Stealth has designed their head array with proximity sensors, which allows the system to be activated once the user is close enough to the pad without needing to physically contact it. The distance required to activate the head array is programmed with the i-Drive system. Although proximity switches are not new in this industry, this head array is particularly smooth and allows the user to have optimal control based on their individual abilities/movements.

The i-Drive system also makes it possible to program and adjust their drive controls through a smart phone or tablet rather than a specialized remote. In addition to sensitivity settings, the head array set-up with the i-Drive is particularly exciting as it can also customize channel assignments and also has “double tap assignment” and “double tap timing adjustment”. This means that any pad or switch can be programmed to control a power chair to move in any direction. Also, by holding 2 switches at the same time, can allow the user to switch directions or switch modes on their wheelchair. This is super exciting as the user only requires 2 reliable directional movements in order to control a power wheelchair to move in 4 different directions and control the modes on their chair. For example, if a client can only reliably hit the back occipital pad and the left temporal pad, by hitting them at the same time can allow the user to move in another direction such as to the right. Then, hitting it again can allow the chair to move in other direction such as backwards. Double tapping either the back or left pad can then be programmed to access the modes of the chair.This was super cool!

In addition to showing us the i-Drive, Margaret and Sydney from Pride Mobility also brought in their new Q6 Edge 2 power wheelchair, which is a midwheel drive power base. This version has notable changes to the aethetic design of the base. They’ve also created a very sturdy base with a strong footplate as you can see from Mark standing on it. In addition, Sydney informed me that Pride has improved the sensitivity of the drive. This hopefully addresses the feedback they were getting from the previous version of the Q6 Edge. Definitely worth a trial with all of these improvements!

.: REE at the ROO :.

The REE at the ROO was once again a great exhibition. It was great seeing so many familiar faces at the event and there were many new products to see. Upon walking in, I ran into Dean Robertson, who has just started a company called Access Driver Rehab Specialists. He was showcasing new hand controls from the UK that he has been working with. These are not only aesthetically pleasing, but also very functional. The hardware is quite minimal and there is also voice activated controls.

Permobil debuted their new F3 and F5 power bases. Both bases have a new distinct design and aesthetic that is different than the former Permobil lines. The F3 and F5 are front wheel drive power bases that offer a variety of power functions including anterior and posterior tilt, seat elevation and on the F5, power standing. Check out their website for more information! These chairs are definitely really cool!

I had the pleasure of meeting Russ Rolt from Active Controls again at the REE. He was showcasing the new proportional chin control joystick and new mounting hardware for the Center Drive System. Based on feedback, Active controls has made the Center Mount Drive System adjustable so that it can be brought closer to the client. The system now has a ball joint, which allows for much improved positioning capabilities. YAY! I also want to thank Bill Randall from NuVision Rehab and Russ Rolt for the sample Power Buddy. This is a power port that you can plug into your power wheelchair to charge your electronic devices like your phone or GPS. Check this product out here!

Nathan Buskell at Motion Specialties had their custom lateral tilt mechanism on display at the REE. This was a nice, smooth lateral tilt that didn’t require much force to activate. The only con, would be the placement of the handle/wheel needed to engage the lateral tilt as it is low on the wheelchair, although this is often an issue with many of the custom lateral tilts out there. A nice design overall though!

Sunrise Medical was debuting their new Quickie Xperience 2. This midwheel drive power base now has an external power seat function box that can be mounted in front of the joystick. Definitely a nice option!

The Roho Group was showcasing their Smart Check device that allows users to check the inflation of their cushion once it has been properly set. This is a fabulous device however, there has been some feedback that it can be a bit tricky to use. It is also quite expensive. If, however, it can be set-up properly, it is an invaluable tool to have with a Roho cushion.

And last, but certainly not least, Advanced Mobility had the Firefly power assist to demo at the REE. This was indeed a fun product. Easy to drive and incredibly fast, smooth and peppy! This product is being exclusively distributed by Advanced Mobility in the lower mainland. Contact them to try one out.

That’s all for today! Thanks for checking in. As always,

Seating is Super!

Cheryl

Super Innovations at Advanced Mobility

Happy Thursday Everyone! I am finally back in OT action,…well kind of. We had our little boy in January and since then I have been a bit busy!

I’ve been meaning to tell you about these amazing innovations at Advanced Mobility. Thank you Wahbi Ghanbur for sharing this with me. Advanced Mobility has recently purchased a 3D printer and have been making custom joystick toppers. Since this is a new project, Advanced Mobility has offered to make these custom joystick toppers by donation! Isn’t that exciting? Wahbi has told me that he has already made skulls, pokemon and star wars characters, just to name a few!. Here are a few images of the 3D printer and a few of the toppers he had at the shop!

Wahbi Ghanbur at Advanced Mobility also shared this fabulous video with me recently. Wahbi actually created a way for his client to control his remote control car through his ASL head array. Check it out here!

If you are interested in any of these great innovations, feel free to contact Advanced Mobility. Thanks again Wahbi for sharing these with me! AND a special THANKS to all my followers!

and Don’t forget! Seating is Super!

Cheryl

Custom Power Wheelchair Transfer System

Happy New Year Everyone! Welcome to the first post of the year 2015! As some of you may know, we are expecting our first little one in January 2015! My husband and I just moved and life has been busy in December….hence my MIA status. I still have lots to share with you over the next year but the posts may be a bit less frequent…but hang in there! Seating will continue to be super!

As a welcome back, I thought I would share some photos from Access Community Therapists’ Wheelchair Seating & Positioning Workshop that took place on November 27th and 28th at Motion Specialties. It was another great turnout and we just wanted to say THANK YOU to our client educators for helping us out again.

So, here is a system that was finished right before Christmas last year (2014). It was a custom transfer system that was fabricated on a Permobil M300 base. This base was provided by Fran Wilson, Sales Representative from Self Care Home Health Products. Chad Kania, Seating Technician, from Ability Health Care created the transfer system and built the custom seating system. This system was made for a client with Achondroplasia (Dwarfism). The goals of the system were to:

1) To improve her comfort and positioning
2) To improve her ability to transfer independently
3) To improve her ability to function independently in and around her home

Prior to this, this client had an 18″ wide x 18″ deep, standard power wheelchair with basic seating. She required the use of a step stool to get into it and sat in the system with her legs completely extended and made no contact with the backrest. This was causing her back pain as she essentially sat completely unsupported. Also, in order to get into the system itself, she needed someone to help her get the step stool every time she needed to transfer.

The biggest obstacle was of course….FUNDING! With some good old fashioned OT letter writing, this system was eventually cost shared by the Ministry of Social Development and Social Innovation and Community Living BC. MSDSI funded the wheelchair base and seating (The Permobil M300 with tilt and the seating system), while CLBC funded the power transfer system. YAY!

The seating system consisted of a foam-in-place backrest with fixed, flat, trunk laterals. The seat was made from carved foam. It was made with a custom drop at the front to allow for a bend at the clients’ knees. Pelvic laterals were also used to guide the clients’ pelvis into the system when she transferred.

Once the foam-in-place backrest and seat were fabricated, trialed, trimmed down and upholstered, here is what it looked like:

Once the seating was completed, custom armrests were made. The standard armrests were used as transfer aids. Custom mounting of the joystick was also needed to get it into a optimal position for driving. In addition, the foot platform was created with a roller blade wheel was installed at the bottom to prevent the system from scratching the wood floors in the home.

Since this system was delivered to the client, she has been using it for a variety of activities around her home such as:

i) Getting her coat out of the closet independently
ii) transferring in and out of bed independently
iii) using the sink in the bathroom
iv) getting to the table for meals and snacks independently
v) opening and closing doors independently

Hearing about all of these functional activities was like an OT dream! Here is a video of the system. This should help with visualizing how this system actually works!

Hope you enjoyed this post and thanks for checking in!

Seating is Super!

Cheryl

Access Pressure Workshop and Seating Tips and Tricks!

Happy Friday Everyone! Last week Access Community Therapists and Advanced Mobility Products hosted a workshop called “The Pressure is On: A Model of Practice for Occupational Therapists”. This was a 2-day intensive and interactive workshop on wound prevention, assessment, management and treatment. The workshop instructors included Jo-Anne Chisholm (OT), Joanne Yip (OT), Heather McMurtry (RN, WOCN), Lindsay Alford (OT) and Cheryl Hon (Me!!..I’m an OT). It was a great workshop with a great turn out!

On the first day, we focused on an interdisciplinary model of practice for wound care and treatment. The images below capture some of the days events. Wound prevention equipment, cushions, mattresses and wound dressings galore! We also focused on preventing under and over prescription of medical equipment for wounds. This is such a big issue when it comes to wound care and prevention. The second day was all about Pressure Mapping. We even had help from some client educators who helped us practice pressure mapping skills and interpretation. Thanks again to everyone who was able to make it!

Now, onto some fun seating tips and tricks! I thought that I would share some of my recent seating mods, accessories and ideas. Perhaps these might work for some of your clients! Here we go!

Below is a wheelchair and seating system that was set-up by Jody Mair from Motion Specialties. This client had CP and required an arcufit belt for pelvic stability. Pelvic laterals were not an option for her because of the way she transferred and moved in her wheelchair. A swing away mount was used on her pelvic belt as her family needed to fold the back canes down in order to fit it into their vehicle. Without this mount, the back canes would not fold down far enough. Although swing away brackets were not as strong as solid brackets, for this client it was sufficient.

Next! A custom pelvic harness for an alternate positioning device/comfy chair. This comfy chair was custom fabricated by Russ Bain at Ability Health Care and the harness was made by Chad Kania. This comfy chair had power tilt and was made with custom carved foam cushions. The client that used this system had extremely limited hip flexion, significant postural deformities and was prone to skin breakdown due to constantly moist and fragile skin. Due to limited hip flexion, keeping this client in an upright position was extremely difficult. On his manual wheelchair, he had a foam-in-box seating system with a custom molded pelvic bar. We didn’t want to do the same in his comfy chair as this was meant for him to be positioned upright, but in a more relaxed position. So, this is what we did! A mesh fabric, posey-style pelvic harness that was secured with 2 clips on the sides. The mesh fabric was breathable to prevent moisture build up. The harness itself helped to prevent sliding down in the system, but was soft to prevent pressure and to enhance comfort.

Here is a custom mounted cup holder and stylus holder that was fabricated by Wahbi Ghanbur at Advanced Mobility Products. This system was made for a client with Quadriplegia. This client uses a stylus in the community to reach and access buttons (such as elevator buttons) and pin pads in the community. If you haven’t noticed, most pin pads at store check-outs have a “security cover” over the buttons. For someone with Quadriplegia (or anyone who has difficulty isolating finger movements), these are next to impossible to access. The stylus is an effective tool here, IF it can be easily accessed by the person of course! So here was my solution to the problem: a custom mounted holder for the stylus! The cover at the top is actually made of soft rubber to prevent the stylus from falling out.

Here is a rather simple solution for feet on wheelchairs. GRIP TAPE! YAY for grip tape! I use grip tape quite often on footplates as it often helps to prevent feet from sliding off or out of position. This was a rather nice application of grip tape on a manual rigid wheelchair. As you can see, there is no actual plate, but wrapping the grip tape around the tubes was a nice way to keep the tape in place. This was also done by Wahbi at Advanced Mobility Products.

And last but definitely not least, here are some custom modifications that were designed and fabricated by Ed Bell at Advanced Mobility Products for a home weight machine. This system was made for a client with paraplegia who used a manual rigid frame wheelchair for mobility. The custom adaptations involved a custom thigh bar that was similar to those flip down bars on a chair lift at the ski hills or the flip down bars on an amusement park ride like the Coaster at the PNE. This helped to keep the client and wheelchair on the ground when using the weights and pulleys. In addition to this, the system also had custom clamps that secured to the front rigging of the wheelchair. This was needed to keep the front end of the wheelchair down and in place to prevent the client from flipping backwards when using the weights.

I hope you enjoyed some of my tips and tricks! Have a great weekend everyone!

Seating is Super!

Cheryl