What to do about posterior pelvic tilt…?

Happy Wednesday Everyone!

Wishing everyone a Happy Occupational Therapy Month this October! This week Access Community Therapists is hosting a workshop on Friday and Saturday on Wheelchair seating and positioning in the community. Pictures to come! Lindsay Alford, OT and I will be presenting this year. So excited to be a part of this workshop once again. Today, I thought I would share with you some strategies for managing a flexible posterior pelvic tilt. Over the past few months I have actually had 4 clients with similar issues. They are as follows:

  1. A flexible posterior pelvic tilt.
  2. Limited/restricted hip flexion (meaning they were not able to achieve at least 90 degrees of hip flexion before causing the pelvis to move into posterior tilt).
  3. AND a fixed or only mildly improveable thoracic kyphosis.

Although these 3 issues don’t seem overly challenging on their own, together, they make seating and positioning incredibly difficult. For example, if you just accommodate for the kyphosis and limited hip flexion by opening the seat to back angle of the seat or allowing for thoracic relief through a modifyable backrest,  the client may fall into more posterior tilt and start sliding out of their wheelchair. Oh no!

Since I’ve had so many clients with the same 3 issues, I thought I would write about a few of the strategies I’ve used so that you can try them with your clients. Keep in mind, you must do a thorough mat assessment before implementing these strategies so that you know exactly what issue you are trying to address!

1. To address posterior pelvic tilt: Use a pre-ischial shelf or IT block to stop the ITs from moving forwards on the seat:

Above are two examples of pre-ishial shelfs on cushions. the image on the left is a custom built seat made with carved foam. The second is a commercial cushion (which is more on the mild contour end-but there are more aggressively contoured cushions available). Keep in mind that the more angular and high the build up is, the more control you will have.

2.  To address the kyphosis with limited hip flexion: Open the seat to back angle or have or cut down the front of the cushion to allow for a more open hip angle. I don’t have an image for this, this is a very specific and calculated strategy. Based on the client’s hip range, you open the seat to back angle to accommodate for a comfortable/functional hip range. You must do a mat assessment and sitting assessment to find out what this angle is! If a client has less hip range on one side compared to the other, make an assymmetrical front end where you allow one leg to rest lower than the other. This is extremely effective as it prevents you from positioning the client with too much open hip angle, which could result in the loss of control for the pelvis and hence….dum dum daaaa…..sliding!! *gasp!*

3. To control the pelvis and accommodate for a kyphosis: Use a backrest to (1) block the pelvis at the back and (2) provide enough thoracic relief for the kyphosis. 

The backrest above is the comfort company Acta-Relief backrest. I just prescribed this backrest for a client who needed a lumbar-sacral push and upper thoracic relief for his kyphosis. The adjustable straps are well placed and provide a good degree of support where you need it and can be loosened off to allow for more accommodation for the kyphotic part of a client’s back. You can also get laterals for this back to provide some good midline control or guidance. Other products like the Future Mobility Prism Truefitt backrest and the Dynamic Health Care’s Armadillo backrest could also be other options for milder cases. Armadillo backrest has been reported by my colleagues to be a bit narrow, but I haven’t tried this myself. Bi-angular backrests (which have a hinge in the back) can also work here.

The photos above here are of a custom backrest fabricated by Jeff Ducklow at Ability Health Care. This is a hybrid technique using carved foam backrest and foam in place. This client had very stiff pelvic mobility. In lying, her pelvis rested in anterior tilt, but as soon as her hips were flexed, she would fall into posterior tilt. In addition to this, she also presented with a lot of extensor tone. The flexibility in her spine (anterior/posteriorly) was also at a very specific point in her back. Therefore, we built up that part of her backrest to provide a push at her upper lumbar spine to try to prevent her pelvis from falling further into posterior tilt as well as to prevent her from collapsing forwards at her trunk. Once we achieved a good position with the carved foam, we then used foam in place (poured foam) to fill in the rest of the space to ensure good accommodation of her upper back kyphosis. Neat eh?

4. To prevent the pelvis from falling into posterior tilt: Use a supportive anterior pelvic support or belt:

The above two belts are custom belts however, even a four point lap belt can work here as well (although a 4-point belt won’t really help to control for rotation of the pelvis is that is an issue FYI). The placement of the belt is so important here. In these cases, the belt should be positioned under the ASIS to hold the pelvis back and down onto the seat. If it is positioned properly it will keep the pelvis back into the system and down onto the ischial well. When a good anterior support is used with a backrest and a pre-ischial shelf, they all work to prevent the pelvis from falling into posterior pelvic tilt. Ta da!

Keep in mind that if you are dealing with all three of these seating issues in one system, you will probably need to implement most, if not all of these strategies. I hope you liked these tips! Until next time:

Seating is Super!

Cheryl

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New products from Invacare, Power Wheelchair Programming Language and Nylatron Front Rigging

Happy Wednesday Everyone,

I hope you are all enjoying the beautiful weather this week. On May 6th and June 23rd, Invacare provided some super valuable inservices to the Access Team and local sales reps. Not only did we get an in depth overview of their new products, but also had a chance to learn more about programming. Power wheelchair programming jargon can be a bit confusing, to me anyways, so it was great having the opportunity to clarify what some of the language really means. A huge thank you to Jason Hrynyk for the inservice at Access and the invitation to the education day. Also, thank you to Cher Smith, OT who gave a great review of wheelchair and seating principles and programming tips at education day.

Jason brought us the Libra cushion and PSVF (posture seat visco foam) cushion for us to pressure map at the office. We used the X sensor pressure mapping system at this inservice to assess the cushions. The PSVF cushion is a really nice comfort cushion is mapped quite well as it provided good pressure redistribution as the foam allows you to submerge into it to achieve full contact with the buttocks and proximal femurs.

The Libra cushion is Invacare’s new cushion that has been designed to address skin breakdown. This is a nice stable cushion and is also quite light weight even with the gel pack at the back. From a pressure mapping perspective, when leaning side to side, peak pressures did appear, however, we do know that skin breakdown does not just occur from pressure alone. Invacare reports that this cushion has helped some clients heal their wounds. My guess is that this cushion provides a stable sitting surface and the gel at the back may be most suitable for clients who are at risk for developing wounds from either friction or shear. Just as a reminder:

Friction: Is repeating rubbing on a surface. This causes damage to the surface of the skin only

Shear: when unaligned forces push the body in one direction while another force pushes the body tissues in an opposing direction. This results in damage below the skin first.

Here is a video by KCI that describes these two concepts very well! Click here. These concepts are described in the first 2 minutes of this video.

If you get a chance to trial either of these cushions, we would love to hear your experiences!

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Jason also brought us the e-motion wheels to trial. These are nice power assist wheels that are activated through the push rim. See this brochure for more information.

At the education day, Cher Smith and representatives from Invacare and ASL reviewed some very useful terms. Here are some programming definitions that will hopefully help when you need to adjust power wheelchair driving programming for your clients:

Joystick Programming Language:

Movement of the joystick:

  • Deadband=The space in which the joystick can move before actually moving the wheelchair. (If the deadband is large then the client will need to move the joystick further away from centre to activate the driving of the wheelchair. If the deadband is short, then less movement away fron centre is required to start moving the wheelchair)
  • Throw= How much the joystick movement is required to move the wheelchair to full speed. This can be adjusted to allow clients to reach full speed without pushing the joystick to the end of its range. Similarly, it can be adjusted so that a client needs to push the joystick to the end to reach full speed.

Force of Movement:

  • Deflection= the amount of force required to move the joystick

Power Wheelchair Programming Language:

  • Power: The amount of power a wheelchair has. This cannot be changed with programming.
  • Torque: Can be better described as “acceleration”. Torque is essentially the amount of power required to accelerate. Acceleration can be adjusted with changes to the electronics to the maximum amount of power the wheelchair has.

One last thing that was shared at this education day was the Tecla Shield . This product is so cool. It’s a device that links tablets, other touch screen devices and computers to alternate access buttons, switches, or even wheelchair driving controls. So cool! Check it out!20160623_154304.jpg

Finally, here is a new and exciting innovation created by Nathan Buskell at Motion Specialties. It’s a Nylatron foot rigging post!!!! This doesn’t look that exciting from the photo, but this post is flexible. Yes, flexible! Nathan created this product using nylon plastic material called Nylatron. He designed it for clients who often break their front rigging from heavy use. This could be from constant stomping, high tone or even from hitting the front rigging and footplates on obstacles in the environment. What an amazing innovation! And to top it off, it looks nice! Not bulky at all! I was so excited! 20160726_120320

That’s all for now folks. Thanks again for checking in. Seating is Super!

Cheryl

 

The 32nd International Seating Symposium

Happy Wednesday Everyone,

Lindsay Alford and I presented for the first time at the conference. We were definitely a bit nervous at the beginning! Hopefully we didn’t scare anyone away at the beginning! To everyone who was able to make it, thanks so much for coming. Hopefully you found our presentation on Balancing Function and Posture in Wheelchair Seating helpful in your practice. My appologies for this very late post. I’ve been meaning to share all of these new innovations from the ISS for a while now. But my oh my is working with a baby, or should I say toddler, a whole other ball game. And to think, I only have 1 so far! In any case, here are some updates from the ISS back in March.

Ride designs debuted their new Soft Fit cover for their custom ride cushions. As you can see in the images, the regular spacer cover is one layer of spacer fabric, whereas the Soft Fit has 3 layers of the famous material. The image of the under side of the cover shows how they cut out a diamond shape section for the well of the cushion. That’s to ensure that the consumer still gets the off loading properties of the cushion under such a thick cover. This is a really nice option for those who find the cushion a bit hard but don’t want to lose the unique off loading qualities of the Ride.

Ride Designs also had their tall Ride Java backrest as well as their new Ride Java cushion on display. As you can see there are pronounced scapular cut outs on the backrest,which is definitely a nice feature. As for the cushion, this is a nice commercial option for clients who would benefit from off loading their boney prominences but don’t quite need the full custom option. I’ve already trialed this one with a few of my clients!

Now here is a really cool product made by Joerns Healthcare. At the exhibits, they had their Dolfin Fluid Immersion Simulator mattress and cushion available to see and trial. This system is based off of a system that was used to transport military dolfins. Yes, that’s right, Military dolfins! Apparently, in order to transport dolfins, they need a system that will support their bodies so that they won’t collapse when they aren’t submerged under water. They used this technology in this mattress and cushion as it therefore helps to prevent collapse of the tissues in order to prevent and heal wounds and pressure ulcers. These products are available for rent as well so feel free to contact Joerns for more information.

Seating Dynamics had quite a few neat products this year. Here are some images of their dynamic footrest, backrest and head rest. The headrest was quite interesting as it has the option of being set up with a single-axis or multi-axis movements. The mounting hardware also seemed quite strong. Head positioning and tone are so complex when it comes to positioning. I am very interested in trying this item when the right client comes around.

Here is another innovative product at the ISS. Stealth Products had the Tarta Ergonomic backrest available to trial. Although this product is not yet available in Canada, it is an interesting design that provides the user with midline guidance and support, but is flexible. The modular design allows this backrest to flex backwards and side to side with the user. It is super comfortable and you can definitely see the utility of this product. Definitely worth a try for the right client!

Here are the B-Braver handrims. These handrims have a Polyisoprene non slip grip at the top. But what is truly unique about these handrims is the shape. They are rounded at the top and flat at the bottom. When holding on to them , they fit very nicely in your hand. These handrims were created by Marco Pilotto, a gentleman with C6 Quadriplegia. I always find products created by consumers to be so special. Marco was such a pleasure to meet as well. Passionate about his product that has worked so well for him as well as for many others. Marco, it was so lovely to have met you! Good luck with this product, it’s definitely a good one!

Invacare debuted their TDX SP 2 power base at the ISS. Unfortunately, this power base is not yet available in Canada. But some exciting features about this base include the new joystick with switch box for access to all the power seating functions, the improved power recline with shear and the streamlined power elevating legrests. The power recline with shear is super nice in that the backrest essentially stays in place when the system goes into recline. This may seem simple, but it’s definitely not common in many other power bases. The reason why this is useful is that if you have trunk laterals or a custom backrest for example, if there is not enough shear, the backrest will move up out of place when the system moves into recline. Then the client looses contact with their back contours or their laterals get pushed into the axillas or even past their axillas. The legrests are also unique as many manufacturers are moving away from swing away elevating legrests. This can be an issue for clients who need the swing away for specific purposes. I just actually had a client who used the swing away function to move their feet out of the way from the sink pipes in their bathroom but still needed the power elevating legrest function.

On another note, Invacare wanted me to announce that they are now cleared (since 2015) to sell power mobility in Canada without restrictions. YAY! Congratulations Invacare. It has been a long road, with a lot of hard work. Definitely looking forward to trialing the new TDX when it comes out here.

Invacare also had their new Libra cushion on display. This is a really nice foam cushion with fluid gel overlay in the well of the cushion. The well is contoured to offer some offloading of the coccyx and ischial tuberosities. The gel is also new and meant to be maintenance free. This is a super nice light weight cushion with some great pressure relieving properties. Definitely going to bring this one out for a trial and pressure mapping session! Stay tuned!

Power assist systems were everywhere at the ISS this year. Although these systems are not “new”, most of the manufacturers were launching new and improved versions of their products which was nice to see and demo. In the images above, I have the Twion (power assist),  E-fix (which converts a manual into a power drive wheelchair), Invacare e-motion wheels (power assist-no image) and the yamaha JWX-2, also known as the Sunrise Quickie X-tender and the yamaha wheelchair motor. Check out their websites for more information.

Freewheel also had a new product this year. They have actually created a way to mount their freewheel onto a manual folding frame! How exciting! They essentially created a removeable cross bar that can be added to most manual folding frames. A super nice addition to this line.

AEL had a cool new trunk lateral hardware called the Omnilink  and it had loads of adjustability! Quite easy to actually adjust the components as well, which is so important when trying to get it into the “just right” position.

NXT and Vicair had some cool new hardware innovations. Check out that headrest mount that can be easily positioned out of the way. Also, check out the backrest quick release bar and the trunk lateral depth adjustment piece. Quite a nice feature if you ask me. Also, Vicair has made some improvements with their covers to make them more breatheable.

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I’ve featured the symmetric designs backrest before on the blog. But here is is again. Such a unique product. They have also made some improvements to make this system more durable and easy to adjust. They also have a new website, which is absolutely beautiful. Definitely a cool product that I would love to trial with the right client.

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Ki mobility had a power tilt system on display at the ISS. This system can be added onto their tilt in space wheelchair to make it easy for a client to access their own tilt. It was a really nice system and was super smooth.

Ottobock had two really cool products this year at the ISS. They had their new adjustable carbon fiber wheelchair called the Voyager Evolution wheelchair. They also had their Terra Flair cushion, which integrates Roho air cells at the back of a foam cushion. This was a very comfortable cushion. Definitely going to keep this one in mind for a trial!

 

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So that’s all for my ISS summary. I hope you found some products here that may help one of your clients in the future. I leave you with this picture of me and Lindsay right before we presented. We don’t look that nervous do we? Perhaps we hide it well! 😉

Thanks again for checking in! And remember, Seating is Super!

Cheryl

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

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

Thoraco Lumbar Sacral Orthosis (TLSO) as a Seating Modality

Happy Wednesday Everyone! I wanted to share with you a custom fabricated Thoraco Lumbar Sacral Orthosis (TLSO) that was fabricated by Alan Keith Valley Orthocare in Surrey, BC. This back brace was made for a client with C5 complete spinal cord injury. This client had  very limited trunk control and had been using a custom fabricated ABS backrest for a while with a chest strap, however, due to the flexibility of her spine, these components still did not provide adequate control and support. This made it difficult for the client to establish appropriate sitting balance for functional activities, it made it difficult to manually self propel in a manual wheelchair and also resulted in constant and severe nerve pain.

This TLSO was fabricated by casting the client’s trunk in the desired position. Alan Keith, Orthotist, then fabricated the brace from the contours taken from the cast. Several follow-up appointments were made to adjust and tweek the brace. For example, the bottom of the TLSO was trimmed back to allow the client to lean forwards for transfers and for off loading for pressure relief. The top of the brace was flared for added comfort. Sheepskin pads was added as the client was developing redness at the back of the pelvis over her PSIS. In addition, foam pads were added to allow for additional clearance of the spinous processes, which were also prone to pressure if the brace moved slightly out of place.  See the photos below.

Overall, the client using the brace has reported improvements with regards to nerve pain, sitting balance, ability to self-propel and function. It is important to note that if a TLSO is suitable for a client, the wheelchair seating must be adjusted to accommodate the brace. Also, it is important to note that a TLSO only really provides support and control for the trunk. What I found was that although the TLSO worked beautifully for this client, we ended up lacking support and control at the pelvis, which was resulting in the client falling into posterior pelvic tilt and falling into obliquity (right side higher). I will now be exploring custom cushion options with this client and will likely be trialing a Ride Custom cushion as this will likely be the best way to maintain her pelvic positioning while also preventing the risk for skin breakdown.

Thanks for checking in today!

Seating is Super!

Cheryl

Common Postures in Seating

Hello Everyone! Here is a video on common postural terms used in wheelchair seating assessment. Although some of you may use variations of these terms, hopefully this video still helps as a quick reference! Please feel free to send me any feedback on these videos or even requests for other video topics. I would be happy to try put something together if it can be helpful to anyone out there. Thanks again to my talented friends, Desy Cheng, Kyle Hay and Jeremy Jude Lee at Vanmedia.

Thanks for checking in today! Seating is Super!

Cheryl

Motion Specialties Grand Opening

Hello Everyone! Happy Wednesday! Yesterday Motion Specialties had their grand opening at their new location on North Fraser Way in Burnaby. It was a fun event with equipment demo sales, a power wheelchair obstacle course, contests and prizes and some great manufacturer exhibit booths. FYI, they will be honoring their special demo prices for the next couple weeks. So, if you have a client with limited funding, contact Motion ASAP to see if they have anything available that might work for a client of yours! I love looking at demo equipment as I often have clients who need equipment that may not be eligible for funding. At a discounted rate, however, some funders may be willing to provide funds if the needs are there. On another note, here are a few seating related highlights from the event!

NXT (pronounced “Next”) by Dynamic Health Care Solutions displayed their new lateral supports. Its a swing away style lateral support that has an additional anterior pad. This is a neat design and the hardware is quite adjustable in length. Because of the rigidity of the anterior support, it might be an option for a client who requires more support than chest strap can provide. In the second picture, note that there is a blue lever that releases the swing away mechanism. This was a really innovative mechanism that could be easier for some clients to release themselves. This would need to be trialed to determine suitability of course, but still a really neat idea!

NXT also debuted 3 new foam cushions: the Bio Fit, the Nu Fit and the Kul Fit. These are mild contoured foam cushions. All of the cushions are made with foam with antibacterial properties. The Bio Fit has a layer of Blue Visco Gel foam that helps to reduce heat build up and also has perforations for increased comfort and softness at the seat area. The Nu Fit cushion is similar in feel to the Bio Fit, but only has a soft foam overlay rather than the gel infused foam overlay. The last cushion was the Kul Fit cushion. This was a very interesting cushion as it was made out of breathable reticulated foam. This foam is quite spongy in feel and allows liquids to pass right though it. This would be great for a client with incontinence issues and needs to wash their cushion frequently. It was quite comfortable to sit on and was a firmer cushion relative to the others. I would be interested in pressure mapping this one for sure.

Motion Composites has a new carbon fiber manual wheelchair called the Veloce. This is a very light (8 kg or 18 lbs) folding frame wheelchair with a sporty, streamlined design. It is a chair that is designed to fall between the manual folding frames and a rigid manual. This wheelchair was easy to maneuver and self-propel.  I definitely have clients that manually self-propel, but still need a mobility device that can be folded for transport so, this might be a great option for them! I also really liked the flip up style footplate. This design is not available on most rigid frame wheelchairs, which can be an issue for some clients who need to stand to transfer. Although this isn’t a rigid wheelchair, the weight and design of the wheelchair might make this wheelchair somewhat comparable. I’m looking forward to trialing this one soon to see how it really performs.

Invacare brought 3 cushions to demo at the grand opening. The first was the Matrx PSVF cushion or “Posture Seat Visco Foam” cushion. This is a super soft foam cushion with some mild contouring. This cushion was designed specifically for optimal comfort. They also had the new Stabilite cushion, which had a “Thinair” bladder for added pressure relief. This cushion also had rigidizers on the sides that help to prevent the cushion from slinging on an upholstered seat. This was a firm, but comfortable cushion that had a mild to moderate contour. The last cushion was the Matrx Flovair, which had the “Thinair” bladder as well as a fluid gel overlay. The fluid gel is meant to reduce shear, while the “Thinair” bladder is meant to reduce peak pressures. The Flovair and Stabilite cushions were reported to pressure map better than the Matrx Vi line. I have yet to pressure map these myself, but I could see these cushions working well for a client requiring a firm supportive surface for sitting, some contouring, but also would benefit from added pressure relief.

Invacare also had their powered Aquatec Ocean E-VIP commode on display. This is an ideal commode for caregivers as the seat elevates making it much easier for peri care. They also debuted their “Special Soft Seat“. This is a new product, not to be confused with their “soft seat”. This product would be ideal for clients who require extra pressure relief due to either high risk for skin breakdown or long bowel routines.

I hope this post was helpful for anyone who wasn’t able to make it. Thanks again for checking in!

Seating is Super!

Cheryl

Workshops, Whitehorse and Wheeling

Hello Everyone! Happy Monday! Last week was a busy week for Access Community Therapists Ltd. We held the “Seating and Positioning in the Community: Practical Applications” workshop at Motion Specialties in Burnaby on September 27th and 28th. Despite the torrential rains on Friday and Saturday, it was a great turn out and we had a lot of fun practicing landmarking, mat and sitting assessments and even got to work with some volunteer clients.  Here are some photos from the day. FYI, we are hosting the course again on November 29th and 30th. If you would like to register for the course, check out the Access website.

After the workshop, Jo-Anne Chisholm and I left for Whitehorse, YT. Yes, that’s right! Whitehorse in the Yukon Territories! Access Community Therapists does a seating clinic up there every 2-3 years. It’s an exciting and busy week. It feels almost like a seating marathon of sorts! On this trip, the technicians from Priority Posture Systems Ltd came with us to fabricate the seating systems and to complete various seating modifications for clients with quite complex needs. Unfortunately, I didn’t have a chance to take many photos on this trip, but here is one system that we did. It’s a planar foam “I” shaped backrest  with asymmetrical swing away trunk laterals and carved cushion with ischial block and built in pommel. This system also has an arcufit-style positioning belt and i2i headrest. What was quite interesting about this case, was that we originally spec’d a foam in place backrest. Unfortunately, when trying to fabricate the system, the foam in place could not hold the clients’ posture. We instead needed to proceed with a planar foam back, which provided much more support and control.

I’ve been meaning to post this up for a while now. Sorry for the delay! 2 weeks ago, we received a short presentation By Krista Best and Kate Keetch (Associates of Bill Miller from UBC) on wheelchair skills and the importance of teaching our clients how to improve their wheeling skills. Although most of the clients we see are long time wheelchair users, I definitely saw the benefit in wheelchair skills training. The benefits to our clients included things like, improved community access, shoulder preservation and improved posture and positioning when wheeling. During the presentation, we were offered a chance to try doing a wheelie. To keep us, or I should probably say “me” safe, 2 bricks were used to prevent the wheelchair from moving or rolling away, and an orange safety strap was secured to the crossbar for added security. This is what it looked like!

For more information on wheelchair skills, visit www.wheelchairskillsprogram.ca. This is a great website with assessment/training forms and research on wheelchair skills.

Thanks for reading! Seating is super!

Cheryl

Wheelchair Seating Anatomy 101

Hello Everyone! Here is a short video on wheelchair seating surface anatomy. This video provides an overview of relevant anatomical landmarks required for seating assessment. Although there are several other landmarks that are relevant during your assessment, this is a quick cheat sheet for your reference! Enjoy!

Thanks for watching! Seating is Super!

Cheryl

Video by Vanmedia