Wheelchair Seating Modifications for Fractured Femur

Happy Friday Everyone! And happy belated Thanksgiving to my Canadian readers! This week I would like to share with you some seating modifications done by Dave Cooper at Priority Posture Systems. Dave even supplied the photos for this post as I unfortunately forgot to take some after we had finished the modifications. Thanks Dave! This client already had a custom fabricated seating system, which was fabricated by James Cooper at Priority Posture Systems. This system consisted of a foam-in-box backrest and custom seat comprised of a custom sized dual-valve Roho insert for the ischial well and a custom foam front end. It also has custom arm supports that were mounted on swing to side armrests for clearance of the trunk laterals during transfers. Here is a picture of her system below:

Our client sustained a right femur fracture during a transfer and needed to be casted, then splinted from her thigh to her ankle. It was definitely one of those urgent, “….oh dear! what do we do??”, kind of cases. This splint supported and held the clients’ knee in extension and it therefore needed to be supported in this position when she was using her wheelchair and seating system. This client also required modifications to her commode as she used this for bathing and toileting. So here is what we did:

As you can see from the pictures, a custom fabricated contoured pad was made and upholstered, then mounted onto the front rigging of the wheelchair. The contouring laterally was important to keep the limb in place. A neoprene strap with velcro was added later as well to keep the limb in place. On the commode the mount was secured onto one of the posts where the footrest would have mounted onto. This was a simple fix, but was somewhat difficult to troubleshoot through. We could only transfer the client in/out of the system once due to pain. Prior to this visit, the family practiced raising the head of the bed slightly and did regular hip passive range of motion exercises to maintain mobility at the hip for sitting. This was key to the success of trial and fabrication process. Funding was also a bit complicated as this was a temporary modification. This client will likely need to use the splint for at least 6 months. For this particular client, that amount of time would be unreasonable to remain on bedrest due to her medically fragile status. Some considerations were her skin health, respiratory health and bowel and bladder health. These were some of the issues that were relevant and helpful points for funding justification. Anyways, I hope you find this post helpful! Thanks again to Dave Cooper at Priority Posture Systems for the photos and the great work! Until next time!

Seating is Super!

Cheryl

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The REE at the ROO 2014

Happy Monday Everyone! Access was at the REE..yippee! We had a blast pressure mapping people, mingling with OTs, students, clients, vendors and manufacturers.

Thanks to everyone who stopped by. It was a pleasure meeting all of you. Now, on to the equipment stuff! Here is my summary of the highlights of this year’s Expo.

Active Controls was at the REE again this year. See my post from last year here! Luckily, we had a preview to their new equipment before the REE thanks to Bill Randall at NuVision Rehab. Active Controls was again showcasing their innovative Center Drive System, which connects to a series of different joysticks. The photos below are a few that caught my eye this year. The yellow joystick is called the MicroGuide. This joystick only requires 40 grams of force to activate the control. It was a super nice design that stays in place when in use. This is great for stability when driving. The supportive pads on the sides were also quite nice. Russ Rolt from Active Controls informed us that these were moveable and adjustable. He even told us about a case study where the pads were moved to block the joystick from driving to one side. This was used for the client with CP, who could only steer towards the right. With the pad in place, he was able to drive forwards and back by using the hand supports as a barrier. A nice application and great idea! Below I also have a photo of the Switch-it Touch Drive 2. I’ve written about this product before, but this was my first time trying it out. It was a nice product, but for the right client. It requires a bit more movement through the hand as you need to drag your finger across the screen, then hold to activate the control. Russ mentioned that it often worked best for clients used to using a touch screen for other activities.

Active Controls also allowed us to demo their new head array control with their Center Drive System mounted at the back of a wheelchair. The Center Drive System mounted at the back allowed for easy trials. It was also a very sturdy mount. Russ also showed us the Joybar mounted at the back as an attendant control. By having a receiver at the front and back, you could easily switch a joystick from client use, to attendant control.

So last, but definitely not least, Active Controls has a new Chin Control joystick that is set up with their Center Drive System. This was a very nice product. It worked well with the mounting and was very stable. Check out their website for videos and more information on their innovative products.

Also present at the REE was Symmetric Designs, which is a local manufacturer based on Salt Spring Island, BC. They were showcasing their Free Form Back. This impressive design is available in 4 sizes and comes with a breathable spacer fabric cover. The unique design of this backrest allows for the individual brackets to be twisted and moved to accommodate a client’s contours or provide correctional forces wherever required. What’s nice about this product is that the adjustments can be made anytime. The best feature of this product is that it is so breathable. So many clients, who require a lot of contouring report being quite hot in these systems. This would be a nice option for a client like this.

At the Ability Health Care booth, they were displaying a custom power system that they created, for a client of mine! This system was designed to allow a client with Achondroplasia to transfer independently. This system will be set up with a custom backrest and cushion. Keep checking in to see the final product!

Ability Health Care was also showing off their new carbon fiber backrests. With these backrests, clients will initially be set up with a custom molded plastic back. Once the shape and design is perfected, a carbon fiber backrest can be made off of the shape of the plastic back. Carbon fiber cannot be changed once it is formed and therefore the plastic back must be a perfect fit before moving on to the carbon version. Of course, the benefit of the carbon fiber is its light weight…and aesthetic!

Another new product on the market is the Rifton HTS or Hygiene, Toileting System. I just set this product up for a client of mine with CP who needed a commode with a very low seat to floor height for transfers. It is a nice design that is super easy to adjust. The family loved it because they could adjust and remove the seating components as needed. Motion Specialties had this product at the REE this year.

Dynamic Health Care Solutions had a few new items. Vicair has come out with a new design for their air cells. YAY! The edges of the cells are now rounded and they have redesigned the cells with a different material to prevent them from deflating. They have also re-designed their backrest hardware and brackets. The design is quite nice as the mounting bracket itself is quite small with lots of adjustment. Motion Composites has also released an HD/Heavy Duty version of their Helio. The key to the design is the carbon fiber cross-brace, which makes this folding manual very light-weight and sturdy.

Priority Posture Systems Ltd was showing off their custom dynamic footrests. This was designed by Dave Cooper and is currently being used at Sunny Hill Health Centre. This product is ideal for those with Spastic CP who have difficulty with leg positioning and protection. Ideally, these are set-up with shoe holders, which allows the client to kick down, out and forwards. Other products on the market are limited to just an up and down motion, which generally is not adequate for many clients with significant tone and strong movement patterns.

Priority Posture Systems Ltd was also displaying their custom/off the shelf cushion for single foot-propelling clients and their raised toilet seat with cut out with silicone coating. These products are priced lower than a typical custom product, but were made with a universal design in mind. The cushion is a nice design with ischial block, full femur support for the client’s affected side, and slanted cutout for the foot-propelling side. Please contact James Cooper, if you would like more information on these products.

Westech Health Care Ltd is now distributing Ranger Wheelchairs. Ranger has just released the Batam rear wheel drive power base that has been made to be even more compact than their Express model. Check it out!

Sunrise Medical has made some changes to their more popular manual wheelchair models. The Quickie Iris for example now has several improvements including covered rockers to prevent debris from collecting in the spaces, new front rigging mounting, new pin style for the rockers and new matte colours!

The Quickie 2 also has the new front rigging mounting as well as a new light weight wheel rim option at no charge!

Advanced Health Care (AHC) was also showcasing some products with the Roho Group. The t-zone mattress, was being displayed. Here is a picture of it as I didn’t have one the last time I announced it.

Finally, here is the Blake Medical backrest. I announced this product last year after the REE, but I somehow missed it the last time. Here it is this year! The backrest is lined with their comfort gel, which makes for a very nice, soft AND comfortable backrest.

That’s all for today folks! Thanks for checking in!

Seating is Super!

Cheryl

ACCESS at the Rehab Equipment Expo (aka The REE)

Happy Monday Everyone! Just wanted to give you a heads up that Access Community Therapists will be at the Rehab Equipment Expo this year! Come visit us at the Olympic Oval in Richmond, BC tomorrow, Tuesday, September 9th between 8:00am to 4:00pm. We will be at booth #48. I will be there all day and will be taking lots of pictures of equipment to show you! Be sure to check back later this week as I will have a full summary of all of the new equipment I can find! Also, feel free to drop by and say hi to me and my Access team! We would love to meet you and answer any questions you may have. There will also be candy (yuummmm) and a pressure map to play with! Can’t wait to see you there!

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

Balancing Function and Posture. Custom Seating and Manual Wheelchairs

Happy Friday Everyone! It’s almost the weekend! Just wanted to share with you a system I finished for a client with Spina Bifida. This client self-propels around indoors, but also needed a system that would be caregiver friendly and could fold AND could also accommodate custom seating components. We selected the Quickie 2 wheelchair base as it was lightweight, but could still fold. The Quickie 2 is a versatile wheelchair that has adjustable centre of gravity, various castor sizes and seat to floor height options, angle and depth adjustable back canes, and armrest options. Because of the range of options, this wheelchair is therefore a nice light weight choice that can accommodate various seating components, which came in handy for this client. This wheelchair was provided by Motion Specialties.

Here are a couple of images from the fabrication process:

With regards to the seating, we created a custom contoured backrest shell and did a foam-in-place insert. See here for more information on custom seating techniques. A custom shell backrest was selected because my client’s trunk was quite short due to her scoliosis and severe lordosis. With this custom shell, we were able to create a very deep contour with the laterals but were also able to flare the bottom to clear her thighs and trim the top to allow for scapular clearance and improved self-propelling. The shell backrest is also quite light weight, which is important for any self-propeller! We then did a carved foam seat with sensus foam ischial well for increased comfort and also created contouring for her thighs. This provided stability as well as comfort for the client. One issue that came up, was when we improved her posture and trunk alignment, we accidentally brought her up too high to reach her wheels. Oops! In order to fix this, we actually cut out the sides of the cushion and dropped the cushion/seat  between the seat canes to bring her back closer to her hand rims. Phew! crisis averted! Thanks to Chad at Ability Health Care for completing the seating for this system.

Well that’s all for today! Time to enjoy the weekend. Thanks for checking in today!

Seating is Super!

Cheryl

Seating Innovation! Carbon Fiber Custom Backrest and Custom Power Wheelchair Switch

Happy Thursday Everyone! Today I wanted to share some new seating products with you. Ability Health Care has begun fabrication of custom molded carbon fiber backrests. These backrests are super lightweight and have been based off of their custom plastic backrests that have worked very well for many clients. These backrests are ideal for manual wheelchair users who require a lightweight back support. The shape of the backrest is taken by plaster casting a client’s back and forming the backrest off of that cast. The only downside of this backrest is that poor Chad Kania, the seating technician at Ability Health Care has been taking the carbon fiber particles with him home. Apparently they can be quite itchy! =)

Another seating innovation I would like to share with you is a video by Wahbi Ghanbur from Advanced Mobility. He has made a flexible switch that is super sensitive to touch and can be mounted below the joystick handle on a power wheelchair…or likely anywhere else. In this video, the switch has been programmed to change the modes on the system. Check this out!

If you are interested in any of these great products please contact Ability Health Care for the backrest and Advanced Mobility for the switch directly! Thanks for checking in today!

Seating is Super!

Cheryl

Tilite TR Series 3 Manual Rigid Wheelchair

Hello Everyone! TGIF! Today, I would like to share with you the Tilite TR Series 3 manual rigid wheelchair. This is a popular model by Tilite and it’s also a custom ordered frame! By custom, I mean that this wheelchair has a specified fixed dump. Having a fixed dump helps to reduce the weight of the base significantly and is highly recommended for client’s who are absolutely sure of how much seat dump works for them functionally. Reducing the weight and amount of “play” in the base is also important for maintaining shoulder health as well as for efficiency when self-propelling. The one in my pictures is a carbon fiber base, which makes this base even lighter! It is by no means a cheap base, but a great choice if funds are available. On this base we set up an ADI carbon fiber backrest and a Ride Designs custom cushion. The 3rd image is the Ride capture. We also set up Frog Legs suspension forks, which can really help to absorb shock from the terrain. This can really benefit a client who experiences a lot of tone.

The ADI backrest is a nice option as it is super lightweight and has a nice contour. It’s such a shame to spec a really nice lightweight wheelchair frame, then stick a heavy backrest on it with heavy mounting hardware. I try to remember to consider some of these lightweight options when ordering a wheelchair base like this one. The Ride cushion is also a super lightweight cushion that offloads the client’s boney prominences. This is a great cushion for client’s at high risk for skin breakdown due to impaired sensation. Again, this is another expensive product but necessary for many to maintain skin integrity. In addition to this benefit, this cushion also supports the pelvis very well. Many of my clients have said that this cushion has helped to improve their postural alignment and has reduced nerve pain and discomfort. Many also report improved proximal stability and functional performance such as ability to transfer. Keep in mind that this a custom cushion that needs to be done by a “Ride Certified” technician and/or therapist. Also, keep in mind that this cushion can be highly customized. For example, for clients who need to manually transfer, the front end can be specified to be lower/flatter so that the well is not as deep. This makes moving forwards on the seat easier. Keep in mind that you might also lose a bit of well depth that way, so it is important to do these specifications with an experienced vendor. Ed Bell, from Advanced Mobility helped me with this system. Also, I wanted to share with you a custom sip and puff system that was built by Wahbi Ghanbur at Advanced Mobility. This sip and puff control has been modified to allow for control of 4 additional devices including the power base. This system will work with RNET electronics. Advanced Mobility only has a few of these available as they were custom built as a sort of in house project. They are looking for a good home. Please contact a sales representative at Advanced Mobility if you are interested in this system.

Thanks for checking in today! I will leave you with a photo…mind you, a bit of a blurry photo of me with Tom Hetzel and Joe Bieganek from Ride Designs. This photo was taken at the ISS this year. A fun pairwith a great product! Hope you don’t mind me sharing this! Until next time!

Seating is Super!

Cheryl

Wheelchair Accessible Vanity for Spinal Cord Injury Client

Happy Thursday Everyone! I just got back from Terrace, BC last week and have been looking forward to sharing something very special with you! A custom wheelchair accessible vanity and adapted make-up set-up. This system was made for a client with quadriplegia and was created from scratch by Chad Kania at Ability Health Care. Actually, Chad used to build custom furniture before he entered the seating technician profession. Knowing this,  I knew he would do an amazing job at building a set-up like this one. This vanity was partially funded  by the BC Rehab Foundation through GF Strong. Thank you to them for approving such a project.

This vanity had so many neat components to it. Such as a powered, height adjustable function, a cut out at the front to allow for better access, a custom elbow support for stability during make-up application, a custom mascara holder/applicator, a moveable mirror for close up make up application, and a hair dryer mount on a gooseneck post. The hair dryer will be plugged into the wall with an x10 module that will be accessed through a separate switch. As you can see from the pictures, all of the make up brushes, and hair brushes have been modified with universal cuffs and the containers have been mounted onto a wooden board with velcro for easy access.

This project was such a fun one. It was so exciting to help my client gain independence with this part of her life.

I will now leave you with a photo of my flight leaving Terrace. It was another great trip. Until next time!

Seating is Super!

Cheryl

 

 

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

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