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

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Semi-Rigid Pelvic Belt and Dynamic Backrest on Manual Rigid Wheelchair

Hello Everyone!  Happy Thursday! I wanted to share with you a system I did back in the winter for a client of mine with Cerebral Palsy. She was a client that needed a sturdy, lightweight wheelchair that she could self-propel indoors. Although her family pushed her wheelchair in the community, it was still very much a priority for her to be independent at home. She formerly had a manual folding frame wheelchair that was very difficult for her to push. This was due to the weight of the chair itself as well as her spastic movements. She was also very hard on her last wheelchair as she transfers with A LOT of momentum. Due to her high extensor tone she had literally bent the back canes open several times and had loosened off and eventually stripped almost every screw on the entire wheelchair. (oy…..)

Initially, I began with trials of folding frame manual systems with power assist type products. This was pretty much a “fail” as the power assist wheels were too quick and difficult for her to manage. The system we ended up choosing included a rigid frame manual wheelchair called the Quickie Q7 by Sunrise Medical with a Prism Truefitt backrest by Future Mobility and Jay 3 Air cushion (Note: be careful with the Jay 3 cushion well size, it can bit a bit small for many clients and can load the GTs. It worked well for this client though! I also personally prefer the air version over the fluid version as the gel has a tendency to move out the back of the cushion and client often “bottoms out”). This system was provided by Brandon Misky from Motion Specialties. I ended up going with a rigid system because it was lightweight and durable. In order to help with her manual propelling, we ended up going with Natural Fit Handrims. These worked beautifully for her! This client had difficulty letting go of the standard handrims and would often get her fingers caught or let go of  the rims at different times, causing her to veer to the right or left depending on which hand was left caught up. The Natural Fit Handrims by Quickie totally eliminated this problem. Yay!

 

I must admit, it was a bit complicated during the delivery and set-up of this system as she needed a semi-rigid pelvic support and dynamic backrest and I had never done this on a rigid frame before. Needless to say, there were a few “hiccups” along the way….

The dynamic backrest and semi-rigid pelvic bar were fabricated by James Cooper from Priority Posture Systems Ltd. Here are a few “obstacles” we ran into during the set-up/fabrication process: First, the frame on the new Q7 is oval not round. This made mounting of the dynamic backrest a bit of a challenge as most of the parts James had were meant to fit round tubes. The weight of the dynamic backrest was also a bit of an issue as it made the wheelchair more tippy. The wheels were therefore moved back to make the system more stable. That was necessary for safety when she transferred.

Second, the semi-rigid pelvic positioning system needed to be something that could be done up by the client independently. This was a significant challenge due to her tone and difficulty with positioning independently in general. We originally decided to go with a 4-point lap belt. This unfortunately didn’t work as the flex in the belt caused it to flip over. The client also had trouble managing the belt during transfers as she would often land on it and wouldn’t be able to get to it once she was in her system. We decided to switch out the 4-point belt and used the Body Point Evoflex system instead. This worked amazingly well! When the client unfastened the belt, it would actually maintain its position on the side (check out the Body Point Website for an image of this!). The custom fabricated ASIS pads were mounted to the Evoflex. This was necessary to further rigidize the system to prevent rotating of the pelvis.

The last issue that came up was the mounting of the armrests. Because of the positioning of the dynamic backrest, T-post style armrests were needed rather than the cantilever style that were originally requested. Due to the limited amount of real-estate on these rigid wheelchairs, mounting of all of these seating components was a bit of a challenge. A special thanks to Brandon and James who were able to troubleshoot with me to make this system work for the client. The hard work paid off and the client and family have been very happy with the system.

Thanks so much for checking in today! I hope some of these points come in handy if you ever set-up a system like this one. Feel free to send me your stories or feedback! Your comments are always welcome!

Seating is Super!

Cheryl