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

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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