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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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

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