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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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

Custom Seating Techniques in a Nutshell!

Hello Everyone. Sorry for the late post this week. It has been a super busy week. On November 29th and 30th, Access Community Therapists Ltd. held another “Seating and Positioning in the Community: Practical Applications” workshop at Motion Specialties. It was a great 2 days and once again, we thank our client educators for coming in to help with the course. Check out some fun photos below! Right after the course, I made a trip up North to Smithers, Kitimat and Terrace for 4 days. It was a busy trip in -20 degree weather with windchill! Luckily, I was mostly inside completing assessments and equipment specs and trials…with the exception of one outdoor power wheelchair trial BRRRRR!

After my trip, I came back to an in-house workshop for the Access team. The workshop was led by our seating gurus Jo-Anne Chisholm and Joanne Yip. At this workshop we had a chance to review seating implications for clients with Developmental Disabilities (also termed Intellectual Disabilities) and reviewed different custom seating fabrication techniques. The course was held at Ability Health Care and it was a fab day! Here is a summary and review of the different custom fabrication techniques:

FOAM IN BOX

Foam-in-Box is a custom seating fabrication technique where moulding bags are used to capture the shape of a client in the desired position. The moulding bags are filled with beads and feel a lot like a bean bag chair. The moulding bags are set up in a custom cut box, which will eventually become the frame of the seating system (i.e. seat pan, backrest board as well as the pelvic laterals and trunk laterals). Once the client is seated in the system, the moulding bags are held and manipulated into the desired position around the client. Once everything is in place, the seating technician pumps the air out of the bag to capture the shape of the client. Once a good capture has been taken and the client is transferred out of the system and the technician takes the molding bag and plasters and casts the shape of the bag. Once the cast is set and hardens, it is taken off of the bag and filled with liquid foam that also eventually hardens. This is what makes the insert for the seat. Trimming and modifying of the insert is then done to create a streamlined and functional system. Foam-in-box can be used to create cushions and backrest or entire systems. This technique allows a clinician to accommodate a client’s complex posture and can also be used to correct a client’s posture. Also, the moulding bags have wings on the sides that are used to mould custom contoured/shaped laterals. Although this technique can accommodate for very complex spinal curvatures, foam-in-place is another custom fabrication technique that can be more suitable for accommodating very pronounced spinal curvatures and body contours.

FOAM IN PLACE

Foam-in-place is a technique that involves pouring liquid foam behind a client to capture the shape of a client’s back. This is a great technique for accommodating complex curvatures of the spine. The photos below show the fabrication process with our volunteer model, Trevor! Foam-in-place inserts can be mounted onto a custom cut wood board, a custom curved/moulded plastic shell (as seen in demo), or even onto a commercial backrest shell. Spot pours can also be done to fill in contours on an existing backrest, or be done to create custom shaped laterals. Keep in mind that when fabricating this sort of system, it is important to have the other seating components in place as you will be capturing the client in the position that you hold/support them in. Also, as the foam grows, it can sometimes push a client into an undesired position such as an increased lordosis. In these cases, abdominal supports can be helpful during the pour.

CARVED FOAM

Carved foam seating is a great technique that offers a lot of angular support. Carved foam seating can incorporate custom sized ischial blocks, obliquity build-ups, leg troughing and back contouring. Carved foam systems can appear quite simple, but offer a high degree of control and correction. These systems can also be made to include pressure relieving products such as Roho insert or gel overlays (such as Action or Blake Medical gel overlays).

CUSTOM PLASTIC BACKRESTS

Ability Health Care offers 2 types of plastic backrests. They have a lightweight custom moulded backrest, which is fabricated by casting the client’s back. They also have a new backrest where they create a custom shell by designing the size and shape create a custom contour. Ability formerly used to make their lightweight version from ABS, however, they were finding that the material wasn’t as durable as they had anticipated. They have now started using an aerospace plastic that is much more durable, but is also still light weight. This is ideal for manual wheelchair users needing a higher degree of contouring and support and has been commonly made for clients with spinal cord injury. When fabricating this backrest, it is ideal that the client be seated on the cushion that they will be using with this backrest to ensure that the contours are accurate.  Ability Health Care has also developed a tilt table that allows a client to be positioned at the desired level of dump during the casting process. Pretty neat!

Below are some pictures of the custom contoured backrest. This backrest is made by a CNC machine that cuts out a custom designed shape that is drawn by the technician. Once the shape of the shell is cut out, the backrest is curved to the appropriate level of contour needed for the client and foam is glued onto the shell. Foam-in-place can also be used to create the insert if more custom contouring is needed. This backrest is not light, but is quite durable and would be ideal for a client who is quite hard on their equipment.

MORE CUSTOM ITEMS

In addition to the custom seating techniques, Ability Health Care can also fabricate custom commodes, custom toilet seats, alternate positioning devices and custom power wheelchair drive controls. In the photo below, Jeff Ducklow fabricated a custom “wafer board”, which was a drive control that was discontinued, but still needed by a client. Jeff was able to fabricate a system using an ABS plate with buddy buttons. A really nice looking drive control that will definitely work well for his client. Also, Ability informed us that Helio is now making depth adjustable backcanes, which is a great feature for clients needing custom seating components.

A special thanks to Russ, Chad, Jeff, Trevor and Mariska  at Ability Health Care for hosting the Access team!

Thanks for checking in today and for reading is rather long post!

Seating is Super!

Cheryl

Workshops, Whitehorse and Wheeling

Hello Everyone! Happy Monday! Last week was a busy week for Access Community Therapists Ltd. We held the “Seating and Positioning in the Community: Practical Applications” workshop at Motion Specialties in Burnaby on September 27th and 28th. Despite the torrential rains on Friday and Saturday, it was a great turn out and we had a lot of fun practicing landmarking, mat and sitting assessments and even got to work with some volunteer clients.  Here are some photos from the day. FYI, we are hosting the course again on November 29th and 30th. If you would like to register for the course, check out the Access website.

After the workshop, Jo-Anne Chisholm and I left for Whitehorse, YT. Yes, that’s right! Whitehorse in the Yukon Territories! Access Community Therapists does a seating clinic up there every 2-3 years. It’s an exciting and busy week. It feels almost like a seating marathon of sorts! On this trip, the technicians from Priority Posture Systems Ltd came with us to fabricate the seating systems and to complete various seating modifications for clients with quite complex needs. Unfortunately, I didn’t have a chance to take many photos on this trip, but here is one system that we did. It’s a planar foam “I” shaped backrest  with asymmetrical swing away trunk laterals and carved cushion with ischial block and built in pommel. This system also has an arcufit-style positioning belt and i2i headrest. What was quite interesting about this case, was that we originally spec’d a foam in place backrest. Unfortunately, when trying to fabricate the system, the foam in place could not hold the clients’ posture. We instead needed to proceed with a planar foam back, which provided much more support and control.

I’ve been meaning to post this up for a while now. Sorry for the delay! 2 weeks ago, we received a short presentation By Krista Best and Kate Keetch (Associates of Bill Miller from UBC) on wheelchair skills and the importance of teaching our clients how to improve their wheeling skills. Although most of the clients we see are long time wheelchair users, I definitely saw the benefit in wheelchair skills training. The benefits to our clients included things like, improved community access, shoulder preservation and improved posture and positioning when wheeling. During the presentation, we were offered a chance to try doing a wheelie. To keep us, or I should probably say “me” safe, 2 bricks were used to prevent the wheelchair from moving or rolling away, and an orange safety strap was secured to the crossbar for added security. This is what it looked like!

For more information on wheelchair skills, visit www.wheelchairskillsprogram.ca. This is a great website with assessment/training forms and research on wheelchair skills.

Thanks for reading! Seating is super!

Cheryl

EVENTS & COURSES

 .:  MOTION SPECIALTIES GRAND OPENING  :.

Motion Specialties had their grand opening at their new location on North Fraser Way in Burnaby. It was a fun event with equipment demo sales, a power wheelchair obstacle course, contests and prizes and some great manufacturer exhibit booths. FYI, they will be honoring their special demo prices for the next couple weeks. So, if you have a client with limited funding, contact Motion ASAP to see if they have anything available that might work for a client of yours! I love looking at demo equipment as I often have clients who need equipment that may not be eligible for funding. At a discounted rate, however, some funders may be willing to provide funds if the needs are there. On another note, here are a few seating related highlights from the event!

NXT (pronounced “Next”) by Dynamic Health Care Solutions displayed their new lateral supports. Its a swing away style lateral support that has an additional anterior pad. This is a neat design and the hardware is quite adjustable in length. Because of the rigidity of the anterior support, it might be an option for a client who requires more support than chest strap can provide. In the second picture, note that there is a blue lever that releases the swing away mechanism. This was a really innovative mechanism that could be easier for some clients to release themselves. This would need to be trialed to determine suitability of course, but still a really neat idea!

NXT also debuted 3 new foam cushions: the Bio Fit, the Nu Fit and the Kul Fit. These are mild contoured foam cushions. All of the cushions are made with foam with antibacterial properties. The Bio Fit has a layer of Blue Visco Gel foam that helps to reduce heat build up and also has perforations for increased comfort and softness at the seat area. The Nu Fit cushion is similar in feel to the Bio Fit, but only has a soft foam overlay rather than the gel infused foam overlay. The last cushion was the Kul Fit cushion. This was a very interesting cushion as it was made out of breathable reticulated foam. This foam is quite spongy in feel and allows liquids to pass right though it. This would be great for a client with incontinence issues and needs to wash their cushion frequently. It was quite comfortable to sit on and was a firmer cushion relative to the others. I would be interested in pressure mapping this one for sure.

Motion Composites has a new carbon fiber manual wheelchair called the Veloce. This is a very light (8 kg or 18 lbs) folding frame wheelchair with a sporty, streamlined design. It is a chair that is designed to fall between the manual folding frames and a rigid manual. This wheelchair was easy to maneuver and self-propel.  I definitely have clients that manually self-propel, but still need a mobility device that can be folded for transport so, this might be a great option for them! I also really liked the flip up style footplate. This design is not available on most rigid frame wheelchairs, which can be an issue for some clients who need to stand to transfer. Although this isn’t a rigid wheelchair, the weight and design of the wheelchair might make this wheelchair somewhat comparable. I’m looking forward to trialing this one soon to see how it really performs.

Invacare brought 3 cushions to demo at the grand opening. The first was the Matrx PSVF cushion or “Posture Seat Visco Foam” cushion. This is a super soft foam cushion with some mild contouring. This cushion was designed specifically for optimal comfort. They also had the new Stabilite cushion, which had a “Thinair” bladder for added pressure relief. This cushion also had rigidizers on the sides that help to prevent the cushion from slinging on an upholstered seat. This was a firm, but comfortable cushion that had a mild to moderate contour. The last cushion was the Matrx Flovair, which had the “Thinair” bladder as well as a fluid gel overlay. The fluid gel is meant to reduce shear, while the “Thinair” bladder is meant to reduce peak pressures. The Flovair and Stabilite cushions were reported to pressure map better than the Matrx Vi line. I have yet to pressure map these myself, but I could see these cushions working well for a client requiring a firm supportive surface for sitting, some contouring, but also would benefit from added pressure relief.

Invacare also had their powered Aquatec Ocean E-VIP commode on display. This is an ideal commode for caregivers as the seat elevates making it much easier for peri care. They also debuted their “Special Soft Seat“. This is a new product, not to be confused with their “soft seat”. This product would be ideal for clients who require extra pressure relief due to either high risk for skin breakdown or long bowel routines.

.:   SEATING AND POSITIONING WORKSHOP  :.

Access Community Therapists held the “Seating and Positioning in the Community: Practical Applications” workshop at Motion Specialties in Burnaby on September 27th and 28th. Despite the torrential rains on Friday and Saturday, it was a great turn out and we had a lot of fun practicing landmarking, mat and sitting assessments and even got to work with some volunteer clients.  Here are some photos from the day. FYI, we are hosting the course again on November 29th and 30th. If you would like to register for the course, check out the Access website.

.:  REE AT THE ROO :.

Hello Everyone! Welcome to my very first post! The Rehab Equipment Expo at the Richmond Olympic Oval (REE at the ROO) was held on Monday, September 9th, 2013.  The entrance fee was only $2, which was waved if you arrived by transit, shuttle, biked or carpooled, so, definitely worth a visit!  The venue was great and the exhibit booths were informative with lots of equipment to see and demo.  I always enjoy browsing the equipment and trying things out.

Advanced Mobility was debuting their JACO by Kinova, a joystick controlled robotic arm. Kinova was founded in 2006 and is a Canadian based company. This robotic arm consists of six axes of movement and even has a 3-fingered hand. The product was inspired by the creator’s family members who had Muscular Dystrophy. This isn’t by any means a cheap product, but the functional benefits for a client would be unparalleled. With the right funding, this product would make a huge difference in someone’s life. I will definitely be keeping this one in mind!

Active Controls Rehab Solutions had an exhibit booth and were showing off their new Center Drive System. This product definitely caught my eye at the Expo this year. This product can work with most power wheelchair bases (except for Invacare bases) and is essentially a joystick that can be removed and plugged back into place quickly and easily. The mount for the Center Drive System can be set up in various positions however, at the expo, the system was set up at the center of the seat and behind the backrest as an attendant control. The tiller style joystick (or “JoyBar”) was a creative design that would definitely be appealing to clients who like the scooter style drive, but require more supportive seating from a power wheelchair base. The Center Drive System can be even be paired with a variety of different joystick options including the Switch-It drive controls, which have a variety of great products including the Touch Drive 2, the Micropilot miniature joystick and integrated tray and switch drive controls. The pads/hand supports on both sides of the joystick are quite nice as well. Very soft and comfortable. I am definitely looking forward to trying these products out with a client!

Body Point also had a few new items. On their chest harness they have designed a clip at the front of the chest harness that can swivel while its secured. This is a nice design as it will help to keep the harness in place over the chest and shoulders. At their booth, they were also showing off their new commode/shower chest straps. The material of these chest straps were antimicrobial and were also perforated for quick drying. The material was soft to touch. I will definitely be trying these out soon.

The ROHO group has a new backrest called the Agility back system. This is a nice design with Roho air cells down the center of the back and along the laterals. Great for pressure relief along the spinous processes and along the ribs on the laterals.  The backrest has some mild midline guidance and would likely benefit a client needing lower lateral contact. There is also a milder contoured backrest with air cells only along the back. Although this back is quite simple, extra foam can likely be added for better contouring, support and control. The back of the backrest can also be customized with colour panels, which is a nice option for the user.

Vicair has also come out with a backrest. The NXT VC backrest is a moderately contoured backrest with Vicair air cells that can be moved around to different sections in the backrest (similar to their cushions).  Moving the air cells around will allow for accommodation as well as increased contact and support at different parts of the trunk/spine while still providing pressure relief. Definitely a different and interesting concept for a backrest that could definitely work with some clients. Like the cushions, for clients who have sensation, this product will likely work best if they prefer the feel of the Vicair cells. I’ve been finding that some clients love the feel of the air pockets while others don’t prefer them.

Ride Designs has created new mounting hardware for their backrest. This is a nice design that allows for more flexibility with regards to positioning. What’s particularly unique about this hardware is that it allows the backrest to be mounted forward from the canes. Standard mounting hardware does not usually allow for this. Overall, this hardware is streamlined and has a nice clean aesthetic.

Ability Health Care has been making custom fabricated ABS backrests. These backrest have worked well for many clients with severe spinal curvatures that are difficult to control and support with a commercial backrest. These backrest are light weight and ideal for manual wheelchair users who don’t want to add a lot of weight to their system but require the support and control to function and manually self-propel. These backrests are made by taking a cast of the client’s back. Once the cast is set, the ABS is heated and molded to the cast shape. What makes these backrest special are that they can be mounted at any height, position or orientation. If funds are available, these backrests are a great option.

Quantum Rehab has launched a new Tru Balance 3 Rehab seat. This seat is priced on the higher end but offers power tilt, recline, seat elevation, and articulating footrests. The sides of the seat and armrests are designed to allow various mounting options for seating components and assistive technology.

The FreeWheel is a removeable wheel that can be secured to a manual wheelchair with a rigid footrest. It is designed to manage rough or uneven terrain. Clients that have this product often take this when traveling as it enables them to  manage terrain like cobblestone sidewalks or even sand (apparently)! It is quick to put on and take off, which makes this product incredibly versatile.

The Smart Drive is a product by Max Mobility. It’s a new power assist device that mounts to the back of a manual wheelchair and can be removed when it isn’t needed. Other power assist systems are set-up through the wheels. If a client wanted to remove these, they would need to bring another set of standard wheels with them, which isn’t practical. Clients with products like the Magic Wheels (power assist wheels) will often leave them on at all times. What’s nice about the Smart Drive, is the ability for the client to set-up and remove the system as needed.

The TiLite AERO T is a light weight aluminum rigid frame manual wheelchair. The dual tube style has been used here to achieve a lighter weight without sacrificing strength and durability. I was asked to feel the weight of 3 different sized tubes and it was clear that the narrowest tube was far lighter than the other wider tubes. The total weight of this base is 12 lbs.

This new wheelchair is called “Elevation” and has been designed by Instinct Mobility. PDG is now distributing this product, which is quite exciting. This is an incredibly unique manual wheelchair that has 10 inches of dynamic seat dump and elevation and 30 degrees adjustment to the back angle. Essentially, this wheelchair allows a client to move from sitting to standing by simply engaging a lever located on the seat rails of the chair. (Note: There is a video of this on the Instinct Mobility website). This wheelchair has been designed primarily for clients with paraplegia but modifications can be made to the placement of the levers to make it possible for clients with other functional abilities to use it.  Although this manual rigid wheelchair is heavier than others on the market, the functional and medical benefits of this system are significant. Definitely worth a trial with the right client.

Priority Posture Systems Ltd. are now fabricating alternate positioning devices or “comfy chairs”. The foam in these comfy chairs are custom carved to meet a client’s unique or complex postural needs. These systems can also include a dynamic tilt option and elevating legrests that are operated by hand levers (similar to manual wheelchair tilt systems). These systems are quite aesthetically pleasing and are upholstered in the fabric of the client’s choosing.

The i2i is a Stealth Products head and neck positioning system. I have used this product a couple of times and it has worked very well for clients with head and neck flexion, extension, side flexion or rotation deformities. This product is great but must be trialed to determine whether a client can tolerate such rigid control.

There were so many great new products at the REE this year. One product that I missed, but heard about afterwards was the Blake Medical Geo-Matrix Silverback Backrest. This backrest apparently integrates the blake gel for added pressure relief and comfort. Definitely a product I wish I didn’t miss. I will have to get a picture of this one soon to show all of you!

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

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

Attendant Power Assist! The Viamobile

Hello Everyone! Happy Wednesday! Can you believe August is coming to an end? My, my this summer has gone by quickly! I have a few exciting announcements to make. Access Community Therapists Ltd has two upcoming courses: The Pressure is On: An Interdisciplinary Approach to Pressure Management in the Community on November 7th and 8th and Wheelchair Seating & Positioning: Practical Applications on November 28th and 29th. To register, please visit the Access website and fill out the registration form. Both courses are highly interactive and offer hands on experience with clients. Check out some photos of the seating course here! Hope to see you there!

Now, onto some new rehab stuff! I just set-up an attendant power assist on a manual tilt-in-space wheelchair called the VIAMOBILE (by invacare). There actually isn’t much information online about this product, which was surprising to me. The system is comprised of a remote handle that turns the system on and off and powers the motor to either roll forwards or backwards. When the system is turned on, the centre wheel drops onto the ground. This offloads the rear wheels, which can tilt the system a bit forwards. Luckily we were working with a tilt-in-space wheelchair. That way, the client can be tilted slightly when the system is on.  Here are some photos of the system:

Invacare has just revised this product and it is now super easy to remove and set-up. I love that it can be so easily removed. My client who needed it, manually-self propels indoors, but lives in a very hilly neighborhood and his caregivers were having a lot of trouble getting him around the community. Because he manually self-propels, we needed to keep the wheelchair light. By removing the motor of the viamobile when indoors allowed us to do that. The viamobile was set up on a Quickie Iris manual tilt wheelchair. See some images below.

This system is by no means cheap. Many funding agencies such as Ministry will not fund this system. You may have to look for private funds for a system like this, which is definitely a downside. On a brighter note, an attendant power assist can be extremely useful to prevent caregiver injuries as well as to enable your clients to get out more often in the community. Definitely worth while, if you can find funding. This system was set-up by Jody Mair and Nathan Buskell at Motion Specialties. Thanks to you both for setting this up! Until next time!

Seating is Super!

Cheryl

Sunrise Medical Quickie Tilt in Space Wheelchairs

Happy Friday Everyone! It’s snowing here in Vancouver and it’s the weekend before Christmas! Although it makes commuting a bit of a challenge in this city, I’m kind of hoping some of it will stick around over the holiday. Today, I thought I would post on the new Quickie tilt-in-space manual wheelchair, the SR 45. This wheelchair has been out for about a year or so and has been marketed as a lower end version of the Quickie Iris, which is one of the best tilt-in-space manual wheelchairs available on the market. The Quickie Iris is a great base to work with as there is so much adjustability, flexibility and real estate on the frame, which makes it easier to mount  seating components and is also great for setting up full custom fabricated seating systems.

As for the the SR45, this wheelchair replaced the Tilt FX , which had a similar rotation in space mechanism  as the Iris but was not the same quality as their “Intelligent Rotation in Space Technology”. This technology has now been added to the SR 45 as well as many more features that are similar to the Iris. Despite the marked improvements made on the SR 45 model and the added “Intelligent Rotation in Space Technology” on this model, Sunrise has also decided to  price this model in close range to the PDG Fuze T5o, the Orion II or even the Invacare Concept 45. So now the question is, what’s the difference between these two wheelchairs? Since the SR45 is so much cheaper than the Iris, but has the same tilt technology and very similar features, funders may lean towards a more economical model. In any case, here is a quick break down of the differences:

QUICKIE SR 45:

–  0-45 degrees of tilt (no other ranges available and cannot add anterior tilt for transfers or eating/swallowing positioning)

Weight capacity is 265 lbs, with no heavy duty option, max width is also 20 inches.

75 degree front rigging, no available contracture hangers (might be an issue for clients with very tight hamstrings)

Lowest seat-to-floor height is 14 inches (keep in mind for clients who need a specific seat-to-floor height for standing transfers or access issues)

-Limited colour selection

-Base is made in Mexico and is made of  steel (Although the weight differences are minimal, this model is likely a slight be heavier)

-Base price is $2795.00

QUICKIE Iris:

Free growth kit (for width growth) within the first 5 years

Dynamic back option available on this model only

Variety of tilt ranges, with the standard range being 0-55 degrees.

Weight capacity is 250 lbs, also has a heavy duty option with a weight capacity of 350 lbs 

Various front rigging options

Lowest seat to floor height is 12.5 inches

-Larger colour selection

-Base is made in California and is aluminum

-Base price is $4075.00

Overall, the improvements made on the SR45 are great. Although it may make justifying an Iris a bit more difficult, it is a great economical option in comparison to other available models on the market.  I hope this breakdown is helpful for all of you. I would like to thank Carla Carrico from Motion Specialties, Jeff Ducklow from Ability Health Care and Tara from Sunrise Medical for helping me break down the differences between these two wheelchairs.

Also, FYI, Access is hosting an Introduction to Assessment and Management of Eating, Drinking and Swallowing Disorders: A Clinical Approach workshop on February 28th and March 1st. Check out the Access website for more information if you are interested!

If you are off next week, I hope you have a wonderful holiday! Thanks for checking in.

Seating is Super!

Cheryl