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

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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