EQUIPMENT

.:  JAECO  :.

I would like to share with you a product called the JAECO. This product is really cool and was shown to me by James Cooper from Priority Posture Systems Ltd. James has the only demo model of this product in Western Canada and I was super excited to see it in action! The JAECO is essentially a dynamic orthosis or exoskeleton that can enhance a client’s upper limb function by assisting them against gravity. The system can be mounted on a wheelchair or even a table top and is secured to the client’s arm with strapping. The JAECO can be adjusted to meet the client’s needs through the number of blue elastic bands added onto each part of the system. Check out the photos below!

James has informed me that he has set up this product for clients with various conditions including Muscular Dystrophy and Spinal Cord Injury (Quadriplegia). It has helped clients with a variety of functional activities including eating and drinking independently and even with work based activities such as computer work or other table top tasks. As you can imagine, a product like this could greatly improve a client’s independence and function. Definitely an interesting product worth a trial for the right client!

.:REAR WHEEL DRIVE POWER WHEELCHAIRS:.

Access was fortunate to have the opportunity to have an inservice with KCI at Motion Specialties. They brought in their new mattress technology called the AtmosAir. This mattress consists of SAT (or “Self-Adjusting Technology”)cells that essentially self-adjust to the weight and level of load from the client. Click here to see more about this product. This is a product that is marketed as a “no maintenance mattress”. Definitely a neat product worth a trial and a pressure mapping session at some point to see how it measures up to others.

Motion Specialties also provided us with an inservice on Rear Wheel Drive Power Mobility. This was a great inservice with lots of valuable information.  Many of our clients who live in rural areas across the Province rely heavily on rear-wheel-drive bases as they are better able to manage the terrain and weather. Here is a synopsis of our session:

1) Invacare Storm Series: Torque SP, Arrow and Ranger X:

  • Torque: plastic polymer suspension (yellow plastic at rear castors)
  • Ranger X and Arrow have spring shock suspension (yellow coil at reach castors)
  • Ranger X: Bariatric (400lb weight capacity)
  • Frame: frame width is 26.5″, with two lengths: short: 28.5 and long: 31.5
  • Speed: Torque and Arrow: 6.5mph, Ranger X: 5mph
  • Lowest STF height (no tilt): 17.75″
  • Pricing starts at: $8909
  • Personal impression from trial: Generally speaking, I find Invacare wheelchairs to have a very smooth, intuitive drive. This could be great for a client who may need an easier to drive and learn to drive wheelchair. It is also a fairly quiet power wheelchair. For clients who prefer a lot of power and torque, this may not be the first choice, however, overall a nice ride.

2) Quantum Rival:

  • Points of interest: the base is quite long compared to others. Replaced the R4000
  • Frame: width is 25.25″, length is 36″ (which is 5″ longer than the Torque)
  • Suspension: Active Track ATX with rear spring suspension
  • Speed: 6 mph, with high speed available (up to 7.5 mph)
  • Lowest STF height (no tilt):16.5″ (lower than Torque)
  • Pricing: starts at $8406
  • Unfortunately, we didn’t get to trial this one as there weren’t any at Motion at the time. This chair is however, marketed as a “rugged” power base. Feel free to let me know if you have any impressions of your own!

3) Sunrise Xplore:

  • Points of interest: This base has a lowest STF height. Also, rear wheel is forward biaised for it has 6 wheels on the ground for stability
  • Frame: width is 25.5″ and the length is 36″
  • Suspension: Very soft suspension (same as the Experience), meant to absorb vibrations.
  • Speed: 6.5 mph
  • Lowest STF height: 15.25″ without tilt and 17″ with tilt
  • Pricing: starts at $9650 (NOTE: This base is on the higher end. Also, repairs to the Experience and Xplore can cost more than an Invacare base due to the cost of parts. This is important to note for Ministry funded clients who may want to upgrade with personal funds. If the repairs cost more than the funded wheelchair, the client could be responsible for the difference in cost for the repairs)
  • Personal Impressions from Trial: This power base was quite smooth but peppy! It was also quite intuitive, but the drive can be quite a shock if you aren’t used to a quick start. Would be good for clients who prefer this kind of drive.

4) Sunrise Quickie 646:

  • Points of interest: This is an aggressive power base. Rear wheels are forward biaised so that the rear anti-tippers contact the ground.
  • Frame: width is 25.75″ and length is 33.5″
  • Suspension: Rockshox suspension that can be adjusted based on client weight and ride preference
  • Speed: 8.5 mph
  • Lowest STF height: 18″ without tilt
  • Pricing: $11,275 (this is the most expensive of the bunch)
  • Personal Impression from Trial: This was another very peppy power base. I found this base to be quite “jerky”, but still intuitive enough to drive. Definitely a base for a client needing a more aggressive base. This base also has a very high speed compared to the others. Considering the price, this base would be ideal for a client really needing the extra power and speed, who can tolerate or prefers a more aggressive drive.

5) Permobil C350:

  • Points of interest: This chair has one of the better suspensions and is a quiet base. The style of the base is also more subdued in design.
  • Frame: 24.5″ wide, 36″ long
  • Suspension: Shock Absorbing Suspension System with coil shocks on from swing arms and rear anti-tippers
  • Speed: 5mph, this is a slower base compared to the rest, but Permobil will be making the high speed option of 6.5mph a standard feature in the future…
  • Lowest STF height: 18″ without tilt
  • Pricing:$7675, this is the cheapest power base of the bunch!
  • Personal Impression from Trial: This is a very quiet and smooth ride. Probably the smoothest and quietest base of the group. Clients who like a quiet, smooth and intuitive ride with a modern looking base will definitely prefer this base. Unfortunately, many rear wheel drive power wheelchair users generally prefer a more powerful, “torquey” drive. This is probably not the base to choose for a client needing to manage rough terrain.

6) Sunrise P222SE:

  • Points of interest: This is a tippy power base, but is also quite fast. It’s an older model base, but clients who still have them, really love them.
  • Frame: 24.5″ or 25.5″ wide, 31.5″ long
  • Suspension: Fiberglass leaf spring positioned length wise under the seat frame
  • Speed: 8.5 mph
  • Lowest STF height: 18″ without tilt
  • Pricing: $8295, not an expensive base (a bit more expensive than the permobil without tilt. This base is much more expensive if tilt is needed as it jumps up to $14,120 with tilt)
  • Personal Impression from Trial: This base was very very peppy. It’s a small looking base that packs quite a bit of punch! Not the best suspension of the bunch, but with the top speed hitting 8.5 mph, I can see why some clients are sticking with this base. Considering it is a bit tippy, I would definitely be selective with who I would trial this base with.

7) Ranger Express and 904S:

  • Points of interest: The Express comes in a compact base option, however, this compact base also has a lower weight capacity. The 904S is a customizable base that is often used by power soccer players.
  • Frame: Express: 25.5″ wide x 32″ long, Compact version is 23.5″ wide x 31″ long,  904S: 24.5″ wide x 32″ long
  • Suspension: Express: Rigid front frame and low torsion rear suspension   904S: Front Articulating Beam and no rear suspension
  • Speed: Express: 6.5 mph, Compact: 7 mph, 904S: up to 9 mph
  • Lowest STF height: 17″ without tilt
  • Pricing: Express $8798, 904S $9898
  • Personal Impression from Trial: I find that Ranger bases have a very distinct and memorable drive. These are very zippy bases that also pack a lot of punch. They are also relatively smooth and intuitive drives as well. Ranger is a local business that will often make custom modifications and additions based on the needs and wants of the clients using these bases. This makes them a great option for clients using their chairs for a variety of functions including sports like power soccer.

.: QUICKIE IRIS vs. QUICKIE SR45:.

The SR 45 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.

.:DRIVE STATION:.

I would introduce a very cool product on the market. It’s called the “Drive Station” power wheelchair control that is essentially made from a video game controller. This product is made by Switch-It Inc and has two mini proportional joysticks as well as “action and direction pad buttons”. The client can use the proportional joysticks or the buttons to drive a power wheelchair. This is a very cool product that was originally designed for war veterans with Acquired Brain Injuries. Apparently, they found that some of these injured war veterans had more success learning to use the Drive Station control in comparison to a standard joystick. Perhaps because the system was quite intuitive and familiar…

I have not trialed this product with any war veterans, however, I have recently trialed this product with a client with Muscular Dystrophy with Motion Specialties. What’s quite nice about this drive system is that it can be placed at midline and the client can use either their left or right hand to drive. This is a great option for clients who may fatigue quickly with one hand as they can easily switch to their other hand if needed. Also, if using the proportional joysticks becomes too difficult, the buttons on the Drive Station also can be used to drive the wheelchair. Some things to consider with this product, however, are that the proportional joysticks do have a bit more resistance than the go-to HMC Mini Joy. In addition, if the Drive Station is not mounted on a fixed mount, it could slide out of reach for some clients or be set-up in the wrong position for optimal access. I am currently still working on a custom seating system with Ability Health Care for this client. Once seating system and the custom mounting of this control is completed, I will definitely share the pictures with you so stay tuned!

.: TLSO :.

I wanted to share with you a custom fabricated Thoraco Lumbar Sacral Orthosis (TLSO) that was fabricated by Alan Keith Valley Orthocare in Surrey, BC. This back brace was made for a client with C5 complete spinal cord injury. This client had  very limited trunk control and had been using a custom fabricated ABS backrest for a while with a chest strap, however, due to the flexibility of her spine, these components still did not provide adequate control and support. This made it difficult for the client to establish appropriate sitting balance for functional activities, it made it difficult to manually self propel in a manual wheelchair and also resulted in constant and severe nerve pain.

This TLSO was fabricated by casting the client’s trunk in the desired position. Alan Keith, Orthotist, then fabricated the brace from the contours taken from the cast. Several follow-up appointments were made to adjust and tweek the brace. For example, the bottom of the TLSO was trimmed back to allow the client to lean forwards for transfers and for off loading for pressure relief. The top of the brace was flared for added comfort. Sheepskin pads was added as the client was developing redness at the back of the pelvis over her PSIS. In addition, foam pads were added to allow for additional clearance of the spinous processes, which were also prone to pressure if the brace moved slightly out of place.  See the photos below.

Overall, the client using the brace has reported improvements with regards to nerve pain, sitting balance, ability to self-propel and function. It is important to note that if a TLSO is suitable for a client, the wheelchair seating must be adjusted to accommodate the brace. Also, it is important to note that a TLSO only really provides support and control for the trunk. What I found was that although the TLSO worked beautifully for this client, we ended up lacking support and control at the pelvis, which was resulting in the client falling into posterior pelvic tilt and falling into obliquity (right side higher). I will now be exploring custom cushion options with this client and will likely be trialing a Ride Custom cushion as this will likely be the best way to maintain her pelvic positioning while also preventing the risk for skin breakdown.

.:   CUSTOM REACHER   :.

I would like to share with you a very special tool that was fabricated by Chad Kania at Ability Health Care. It’s a custom reacher!! I realize that this isn’t exactly a seating modality, but it’s such a neat device that I really needed to share it with you! This device was fabricated from scratch! It is a super light weight aluminum reacher that was made for a power wheelchair user who needed a device that could be used to pick things up from the floor and be used as a device to open heavy drawers and access items in drawers that were out of reach. Here is an image of the reacher.

The total length of the reacher was 36 inches long, which was specific to the client’s needs.

The reacher could be pulled apart and folded in half at the middle. This made it easier for the client to bring it with them in the community.

The handles and latch were also custom fabricated. The latch allowed the client to pick up an item on the floor and keep the item secured to the reacher while the client pulled the item up within reach. The plastic used to fabricate the reacher was light weight, but also sturdy and durable.

Here is a photo of the end of the reacher. The black part of the reacher is actually rubber coated for better grip. Also, note the hook on the end. This hook was used to open drawers by hooking onto the handles while the client used their power wheelchair to pull the drawers open. There is also a magnet at the end of the reacher.

.:   CUSTOM CARVED FOAM SEATING SYSTEM   :.

This is a carved foam seating system that was fabricated in Whitehorse, YT by James Cooper from Priority Posture Systems. 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.

.:   REVIEW OF 5 MID-WHEEL DRIVE POWER WHEELCHAIRS   :.

Access Community Therapists Ltd received an equipment inservice by Motion Specialties (Centric Health). We compared 5 mid-wheel drive power wheelchairs, received a ton of amazing information on each chair, and were actually able to trial each of the bases ourselves. Here is a brief summary and comparison based on this review as well as for some of our own overall impressions from the trial.

PERMOBIL M300

The Permobil M300 is a very nice looking power wheelchair base. The design is streamlined and great for clients looking for a clean, simple yet modern looking base. Clinically, I have been finding that many younger clients have been drawn to this base because of the aesthetics and other features. This base comes with a 3 year warranty on motors and the gear boxes. It has one of the lowest seat to floor heights with power tilt function (17 1/2 inches). It is however, a more expensive power wheelchair if any upgrades are added. That being said, the Permobile actually comes out to be the cheapest base without power tilt access through the joystick as this requires upgraded electronics. During the driving trial, this wheelchair was very smooth. It had a much softer ride than some of the others and also had a very quiet motor. I had one client trial this power base and he reported that he loved driving this base into class as the sound of the motor didn’t seem to disturb others or draw attention to himself.

QUANTUM Q6 EDGE

Quantum Rehab has just reduced their prices on the Q6 Edge and is now cheaper than their Q6000Z model.  While most other power wheelchairs require an electronics upgrade to get tilt through the joystick, this feature comes without a price upgrade. This base is likely best suited for an “urban wheelchair user” or clients who use their wheelchairs mostly at home. The reason for this is that the top speed is only 5 mph in comparison to 6 mph, which is offered by all of the other bases. This power wheelchair also comes with smaller batteries and is not an aggressive wheelchair. Some clients have reported some difficulty driving this power base because the programming and drive of the base is not as intuitive as some of the others. Based on the drive trial we did, this base was not as responsive as the others.  It is definitely a base that requires a thorough trial before prescription.

INVACARE TDX SP

The Invacare TDX SP was reported by Motion Specialties to be “the bench-mark wheelchair for setting up the standard for mid-wheel drive power wheelchairs”. Over the past 6 years, this product has done very well in the market. This power base has a narrow total external width of 24″ with intuitive drive controls. During the trial, this base was responsive and had a nice smooth drive.  Clinically, I have found that many clients prefer the drive style of this base when compared to some others. Some clients have reported to me that they are able to maneuver this power base well in their homes and are also able to manage terrain in the community. At present, Invacare is undergoing a review with the U.S Food and Drug Administration (FDA) and have temporarily stopped the manufacturing process of their power bases. This means, that at present, the supply of power bases is limited to what has already been produced. Ordering of specific options, features and colours is limited at this time, but they report that they should be up and running in the spring of 2013, however, there are no guarantees.

SUNRISE QUICKIE QM 710

The Sunrise Quickie QM 710 is a new power wheelchair that features a “Spider Track Suspension”. According to Motion Specialties, this suspension allows the base to “articulate well up ramps and thresholds”. During the driving trial, this base was quite powerful. It had an intuitive drive and quick acceleration speed. My colleagues and I, quite enjoyed this power base as it was a very smooth drive. For funding purposes, this power base requires solid justification due to it’s higher price point. The cost to repair this base is also higher compared to others in the market. This is something to keep in mind if, for example, a cheaper base is funded by an agency like the Ministry of Social Development and Social Innovation (MSD), but the client decides to pay for the upgrade to this base, that agency, like MSD may not pay for the cost difference required for the repairs.

SUNRISE QUICKIE XPERIENCE

The Quickie Xperience is a rugged and powerful wheelchair base. It has a G3 coil spring suspension, which has been “reported to be one of the best in the market”, as indicated by Motion Specialties. This power base is perceived to be most expensive option however, when it is specified with upgraded electronics and a power tilt system, the price comes out to be somewhere in the middle compared to its competitors. This base comes with the lowest seat to floor height 16″ of the group. Because of this, for certain funding agencies, this base can only be justified based on the required low seat to floor height. During the drive trial, this power base was quite smooth and fast. It had a quick acceleration and was quite intuitive to drive. The repairs on this base, like the QM 710, are more expensive relative to others on the market.

I hope this review was helpful to you. If you required more detailed specifications on these power wheelchairs or other power wheelchair bases, Motion Specialties has great “Therapist Resources” page that can be accessed by simply creating an account with them. Check out their website at http://www.motionbc.com.

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