Standing Power Wheelchair with Added Seating Modifications

Happy Easter Everyone! I hope you were able to enjoy the long weekend. This weekend I was able to catch up on some much needed rest and errands. For once, I actually feel ready for the week to begin. So, to give you a start to the week, check out this power wheelchair I set up with the help of Motion Specialties! It’s a Ranger Express (rear wheel drive) power wheelchair with standing function. There are a few other manufacturers that offer the standing function, such as Permobil and Levo. The Ranger Express was chosen for this client because it was a rear wheel drive power base, the clients’ driving preference (most are usually front wheel drive) and because of the style and positioning of the knee blocks (which best suited this client during the trials). The stander function on power bases is a great addition, but involves a few considerations. Some of these considerations include access to funding (these things are expensive!), the ability of the client to move into a standing position from sitting (not as straight forward as it may seem….lots of positioning considerations here!) and safety (bone density issues, cognition and safety awareness). In addition, with regards to the base itself, many of them have a lower max speed and are set up with a front wheel drive, which some clients may not be used to.

In order to make this base work for my client, several modifications were required. This client had a backrest that she used in her power wheelchair and in her manual wheelchair. This meant that the backrest needed to be removeable from the new power base. Her backrest was made using a foam-in-place insert to accommodate her back contours. This insert was set up in a Jay 2 backrest shell. Typically, backrests are mounted and bolted on to the back plate of the Ranger wheelchair, preventing it from being removed.  Nathan, the technician from Motion Specialties, therefore designed a track-like system that allowed the backrest to be removed by sliding the back onto the plate instead. In addition, to maintain the appropriate amount of seat depth, Nathan essentially needed to move the whole back plate further back on the base…not a quick job by any means! You can see this below where Nathan is wearing green and Bill Randall, sales representative is wearing purple. I promised to post a flattering picture so hope you both are happy with this one! =)

Further customization was needed to increase the “shearing” of the backrest when the wheelchair went into standing. When we trialed the initial set-up with the client, the backrest moved up too high causing the laterals to move up too far up and into the client’s axillas. Nathan then made a custom bracket that allowed the backrest to move downwards more when using the standing function. See below:

The last few customizations included grip tape for the footplate and ankle huggers to prevent the client’s feet from losing positioning and moving into standing, a custom Body Point chest strap with custom auto style buckle sewn in by Nathan, and added velcro under the armrests to secure the chest strap when not in use. This was necessary to ensure the client’s ability to use the stander independently.

The modifications that were made by Nathan and Bill really made this system work for my client. Thanks so much for all your hard work! It really did make a difference for this client! The standing function itself was selected for the health benefits as well as to improve my clients’ independence and level of function. Here is a link to a resource by RESNA outlining some of the benefits of wheelchair standing devices. Hopefully this will help with your justification letters! Also, an exciting announcement! Access Community Therapists Ltd, is offering a wound/pressure management course called “The Pressure is On ” in June. It’s a two day practical course on wound assessment, pressure mapping and intervention. We will be hosting it on June 6th and 7th at Advanced Mobility Products in Burnaby, BC. Click on the link or visit the Access website to register. Jo-Anne Chisholm, OT, Joanne Yip, OT and Heather McMurtry, RN, WOCN will be the main instructors and I will also be there assisting with the break out sessions. Register soon as space does fill up quickly!

Thanks for checking in today! I hope you enjoyed the case and hope to see you at the pressure course!

Seating is Super!

Cheryl

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Semi-Rigid Pelvic Belt and Dynamic Backrest on Manual Rigid Wheelchair

Hello Everyone!  Happy Thursday! I wanted to share with you a system I did back in the winter for a client of mine with Cerebral Palsy. She was a client that needed a sturdy, lightweight wheelchair that she could self-propel indoors. Although her family pushed her wheelchair in the community, it was still very much a priority for her to be independent at home. She formerly had a manual folding frame wheelchair that was very difficult for her to push. This was due to the weight of the chair itself as well as her spastic movements. She was also very hard on her last wheelchair as she transfers with A LOT of momentum. Due to her high extensor tone she had literally bent the back canes open several times and had loosened off and eventually stripped almost every screw on the entire wheelchair. (oy…..)

Initially, I began with trials of folding frame manual systems with power assist type products. This was pretty much a “fail” as the power assist wheels were too quick and difficult for her to manage. The system we ended up choosing included a rigid frame manual wheelchair called the Quickie Q7 by Sunrise Medical with a Prism Truefitt backrest by Future Mobility and Jay 3 Air cushion (Note: be careful with the Jay 3 cushion well size, it can bit a bit small for many clients and can load the GTs. It worked well for this client though! I also personally prefer the air version over the fluid version as the gel has a tendency to move out the back of the cushion and client often “bottoms out”). This system was provided by Brandon Misky from Motion Specialties. I ended up going with a rigid system because it was lightweight and durable. In order to help with her manual propelling, we ended up going with Natural Fit Handrims. These worked beautifully for her! This client had difficulty letting go of the standard handrims and would often get her fingers caught or let go of  the rims at different times, causing her to veer to the right or left depending on which hand was left caught up. The Natural Fit Handrims by Quickie totally eliminated this problem. Yay!

 

I must admit, it was a bit complicated during the delivery and set-up of this system as she needed a semi-rigid pelvic support and dynamic backrest and I had never done this on a rigid frame before. Needless to say, there were a few “hiccups” along the way….

The dynamic backrest and semi-rigid pelvic bar were fabricated by James Cooper from Priority Posture Systems Ltd. Here are a few “obstacles” we ran into during the set-up/fabrication process: First, the frame on the new Q7 is oval not round. This made mounting of the dynamic backrest a bit of a challenge as most of the parts James had were meant to fit round tubes. The weight of the dynamic backrest was also a bit of an issue as it made the wheelchair more tippy. The wheels were therefore moved back to make the system more stable. That was necessary for safety when she transferred.

Second, the semi-rigid pelvic positioning system needed to be something that could be done up by the client independently. This was a significant challenge due to her tone and difficulty with positioning independently in general. We originally decided to go with a 4-point lap belt. This unfortunately didn’t work as the flex in the belt caused it to flip over. The client also had trouble managing the belt during transfers as she would often land on it and wouldn’t be able to get to it once she was in her system. We decided to switch out the 4-point belt and used the Body Point Evoflex system instead. This worked amazingly well! When the client unfastened the belt, it would actually maintain its position on the side (check out the Body Point Website for an image of this!). The custom fabricated ASIS pads were mounted to the Evoflex. This was necessary to further rigidize the system to prevent rotating of the pelvis.

The last issue that came up was the mounting of the armrests. Because of the positioning of the dynamic backrest, T-post style armrests were needed rather than the cantilever style that were originally requested. Due to the limited amount of real-estate on these rigid wheelchairs, mounting of all of these seating components was a bit of a challenge. A special thanks to Brandon and James who were able to troubleshoot with me to make this system work for the client. The hard work paid off and the client and family have been very happy with the system.

Thanks so much for checking in today! I hope some of these points come in handy if you ever set-up a system like this one. Feel free to send me your stories or feedback! Your comments are always welcome!

Seating is Super!

Cheryl