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!

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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.

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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.

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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.

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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

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Advanced Health Care and ROHO Inservice

Happy Monday everyone! In BC, we are just wrapping up the long weekend. It was rainy start to Victoria Day today, but I hope everyone had a lovely afternoon in the clear weather anyways. I’ve been MIA for a while because I just got back from New York City! Yes, that’s right, the BIG Apple! I was there with my husband for a conference as well as for some vacation time. I even brought back some photos and stories for you. I hope you like them! Before I get into that, I would love to share with you some new-ish products by the ROHO group. Shawn Aslani from Advanced Health Care Products and Andy Woodcock, Canadian Sales Manager from the ROHO group came to the Access office to give us a heads up on new products. So here you go! See below of a photo of a Roho Enhancer cushion. It is essentially a Roho cushion that has different cell heights integrated into the same cushion to offer some positioning/contouring properties. We also spoke saw the ROHO hybrid Elite cushion (sorry, no photo, but click here). This is a great option for clients who require a more stable front end for transfers or for those require more rigidity for positioning. I do caution you to do a thorough trial though as the Roho air cells are not as high as the high profile cushions, which can allow some clients to bottom out. Also, WATCH THOSE GREATER TROCHANTERS on this cushion. I’ve sometime cut the sides down or ordered a wider cushion to clear the GTs. If you are concerned, a safer option is the Roho Quadtro. You can lose stability from this cushion, but when inflated properly it can work very well. Check out the Roho Videos for inflation education. These are great resources for caregivers too!

Andy also brought in the new hardware they are using for their Agility backrests. This hardware is very, VERY  light in weight. It’s a nice design and really cuts down on the bulk without completely losing adjustability for positioning of the backrest. Most likely best for a client who can do without a lot of adjustment changes, but is not quite set for fixed mounted brackets. Shawn also brought in some Body Point products such as the Evoflex Pelvic Stabilizer. I’ve used this product quite a few times now and am really liking it. It’s nice for client’s who transfer on their own as the belt straps stay up and out of the way of the seat. It also offers a bit more positioning support than the standard body point belts. This belt also comes with a Sub-ASIS pad kit and a mounting kit. These are both great options to consider. See my post here to see how I’ve used it with a client of mine.

Now, for some fun facts about New York! We went to the Museum of Modern Art (aka MoMA) to take in some of the most iconic pieces by Van Gogh, Monet, Picasso and even Andy Warhol. During our exploration of the museum, we ran into this! The Accessible Icon Project! This project was focused on re-designing the International Symbol of Access into a more active image of a wheelchair user. I was so excited to see this at MoMA. New York is filled with older, narrow buildings with narrow hallways, narrow walkways, tons of stairs and minimal ramping. I have to say though, I did notice some changes at some of the newer tourist attractions. For example, at the 9/11 memorial, the corners of the memorial are undercut/slanted to allow for a wheelchair user to come up close to the fountain’s edge. Although the edges of the fountain were still quite high, it did make the fountain much easier to view.  On a side note, the 9/11 memorial was a truly moving and heartwrenching sight. I still remember where I was when I heard about the whole thing. We both definitely appreciated the opportunity to pay our respects at the site during our trip. Also,  the 9/11 museum opens tomorrow. We just missed it, but would have loved to have seen it. Not sure if I could have handled it though…..

On a happier note, I will leave you with a picture of the skyline of NYC from the Top of the Rock.

Thanks for checking in again!

Seating is Super!

Cheryl

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

The 30th International Seating Symposium

Hello Everyone! The 30th Annual International Seating Symposium started on Tuesday at the Westin Bayshore in downtown Vancouver. This conference is held every 2 years in Vancouver and is a fabulous event for anyone interested in wheelchair seating and mobility. The conference consists of a huge exhibition hall, poster presentations, pre-symposium courses, paper presentations and instructional sessions. So far it has been a great event with some truly inspirational speakers. Although it has been a long couple days, I thought I would post some of the new/newer products that I have had a chance to check out so far.

The first product I would like to present to you is the Progeo manual rigid wheelchairs. These are carbon fiber wheelchairs that are lightweight and incredibly streamlined in their appearance. Dave Elder from Advanced Mobility Products brought these wheelchairs to my attention. The Progeo wheelchairs were made in Italy and are not quite yet available in Canada. Hopefully soon though as these chairs look quite promising!

Stealth Products has developed a new “Mini Proportional Joystick” (which is a nice, easy to remember name). The shape, size and design of this product really stood out to me. The flat top with the built up sides made it easy to position and rest my index finger over top. When directing the joystick, the built up edges really helped to maintain positioning and steer with accuracy. Often times with other joysticks on the market, it can be difficult for clients to keep their fingers in place as they can often slip off the small topper. Stealth informed me that they can also rubber coat their joystick for added grip, which was definitely a nice feature. Different levels of resistance in this joystick are also available.

Stealth displayed their iDrive Diagnostic system that can be used to calibrate their joystick.  Another issue with other products on the market are that they are at times difficult to orient properly for the client. This can at times make trials quite difficult.

Comfort Company will be releasing a new backrest called the Acta-Relief Back very soon. This backrest is quite innovative, light weight and easily adjustable. The product consists of a metal frame with what they call Boa Reels that are tightened by rotating a dial called the Boa Closure System. Think of when you adjust the time on your watch; you pull out the watch crown (yes, it’s called a watch crown and yes I did happen to google this!) to release the cables/Boa Reels, then click it back in and turn until you have the desired level of support/tension. Et voila! You’ve adjusted the backrest to the back contours of your client! The cover also has a nice stretchy material integrated along the midline of the backrest. This is meant to allow for comfort and pressure relief along the spinous processes. This back was quite comfortable when I tried it out myself! I really liked how it could be adjusted to a client’s back contours. The ease of adjustability was a plus as well!

Advanced Health Care Products (AHC) had a few new items at this years symposium as well.  Body Point was showing off their new mounting extensions for the Evoflex pelvic stabilizer. I’ve used this product once before and found that it was a bit difficult to mount and position in the right position for the client without some added customization. With this new extension/mounting kit, these issues will likely be resolved. The only issue might be remembering to order this extra pieces when specifying the Evoflex. The Roho Group also displayed their Agility backrests, which integrates their famous Roho air cells into either the whole back or parts of the back. Definitely a backrest that I keep in mind to trial. The Roho Group very kindly hosted myself and the Access Community Therapists Ltd group in the evening after the symposium. It was a lovely event at the Fish House in Stanley Park. It was a pleasure meeting the Roho team! Thanks again for a great evening!

Ki Mobility will be releasing a new tilt in space manual wheelchair. This is a nice looking base with a high degree of adjustability. In Canada, it is projected to fall somewhere in the middle of the cost hierarchy (possibly somewhere falling in between the cost of an SR 45 and an Iris), however, this has yet to be confirmed. The selling points of this base is the smart tilt function, which is a smooth tilt mechanism that does not require weight in the chair and its reported durability. They pitch this base as a heavy duty, durable base that is meant to withstand a heavy user or client who presents with strong movement patterns. There are options for dynamic back canes as well as dynamic footrests. Although it is always hard to say how a new wheelchair base will compare to others, or stand up over time;  it does seem like it could be a strong competitor in the market!

Unfortunately, it is getting quite late and it will be an early start tomorrow morning at the ISS. That means that I will have to share the rest of my photos with you in my next post. I hope you found these points helpful though! Thanks again for reading and checking in!

Seating is Super!

Cheryl