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

Advertisements

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!

DSC01703

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

 

Belts, belts and more belts!

Happy Friday Everyone!

In BC we are gearing up for the International Seating Symposium that is being held at the Westin Bayshore in Vancouver. This is a super exciting week for those in the wheelchair seating and mobility world. I will be presenting this year along with Lindsay Alford (OT). We will be presenting an instructional session called “The Art of Balance: Function and Posture in Wheelchair Seating”. We will be introducing a clinical reasoning model that we developed. Hope to see some of you there! Here is the link to the brochure if you are interested!

Also, Access Community Therapists will be also be hosting the “Introduction to the Assessment and Management of Eating, Drinking and Swallowing Disorders: A Clinical Approach” workshop on April 28th and 29th. Register quickly if you are interested as spaces fill very quickly! Check out the website for more information.

I thought that I would post some of the positioning belts that I’ve done over the years. Positioning belts can be critical in a seating system from a postural perspective, but are often so complex to integrate into a system as they can often have an impact on the way a client functions. Since we are presenting on this very topic, I thought I would give all of you a sneak peek!14

Here is a custom pelvic support with with angular molded sub-asis pads. The sub-asis pads are secured with swing away harware. Between the sub-asis pads, there are flexible straps connected with a standard push button buckle. The purpose of this belt was to create a rigid system that the client could use when her tone was quite strong. Alternatively, when her tone was quite mild, she could leave the swing away hardware open and simply secure the buckle to allow her to move more freely in the system. Cool eh?

DSC01736Here is an example of how changing a buckle can make all the difference in the world! This client couldn’t use a positioning belt before as it would impede his ability to transfer quickly. By introducing an airplane style buckle, he was now able to use a positioning belt, which prevented him from sliding down in his seating. YAY!

DSC_0416

Semi-rigid belt with evoflex

Here is a semi-rigid pelvic support made with custom sub-asis pads. This system was made for a client who needed more rigid pelvic support but needed to fasten and un-fasten the belt independently. This belt was also done in combination with a dynamic backrest on a light-weight rigid wheelchair frame. This is a nice example of how it is possible to improve postural control while maintaining a client’s ability to function independently.

IMG_20140903_155418

Swing away hardware on arcufit

This one is a custom arcufit style belt with a swing away hardware again. The purpose of this hardware though, was to clear the belt out of the way so that the back canes could be folded down to transport the wheelchair in a trunk.

DSC_0153

Custom Rigid Pelvic Saddle

Here is a custom rigid pelvic saddle. This system was created to prevent a client with very limited hip flexion from sliding down in their seating system. Note how much anterior control was needed to keep the client up in the system in order to maintain her ability to drive and be independent in the community.

download_20141112_163011

Custom pelvic harness for comfy chair

Remember this one? This is a custom “posey” style belt used in an alternate positioning device. This system was made for a client with a lot of tone that wanted a more comfortable option. In his mobility system, he uses a semi-rigid system. This is a nice alternative that is also necessary to reduce his risk for skin breakdown in a very rigid system that he has in his wheelchair.

I hope you liked this collection of positioning belts.For those of you going to the ISS this year, see you next week!

Thanks for checking in! Seating is Super!

Cheryl

Stealth Products i-Drive and the REE at the ROO 2015

.: Stealth Products and Pride Mobility :.

Hello Everyone! I just wanted to say THANK YOU to all my amazing subscribers and readers. It has been a while since my last post, but thanks for always checking in. The past several months have been busy, which is great! Access Community Therapists just launched a new website – WOOHOO! – which I was lucky to be a part of. Check it out and let me know what you think!

Also, happy belated OT month to my fellow OTs! Occupational Therapy month was in October. There was so much OT spirit out there this year and it was so exciting to see so much enthusiam over social media over the past month.

Back in September we had the REE at the ROO and Access was lucky enough to get a private inservice by Mark Scott from Stealth Products. Since I am still technically on maternity leave I was able to bring my son, ‘T’ to the REE and the inservice by Stealth. Mark was even kind enough to entertain ‘T’ with his fabulous cartoon character impressions! Thanks Mark! Anyways, back to wheelchair business!…..

It was great learning about the new i-Drive system and seeing how to use it with their head array drive control and fiber optic switch. Stealth has designed their head array with proximity sensors, which allows the system to be activated once the user is close enough to the pad without needing to physically contact it. The distance required to activate the head array is programmed with the i-Drive system. Although proximity switches are not new in this industry, this head array is particularly smooth and allows the user to have optimal control based on their individual abilities/movements.

The i-Drive system also makes it possible to program and adjust their drive controls through a smart phone or tablet rather than a specialized remote. In addition to sensitivity settings, the head array set-up with the i-Drive is particularly exciting as it can also customize channel assignments and also has “double tap assignment” and “double tap timing adjustment”. This means that any pad or switch can be programmed to control a power chair to move in any direction. Also, by holding 2 switches at the same time, can allow the user to switch directions or switch modes on their wheelchair. This is super exciting as the user only requires 2 reliable directional movements in order to control a power wheelchair to move in 4 different directions and control the modes on their chair. For example, if a client can only reliably hit the back occipital pad and the left temporal pad, by hitting them at the same time can allow the user to move in another direction such as to the right. Then, hitting it again can allow the chair to move in other direction such as backwards. Double tapping either the back or left pad can then be programmed to access the modes of the chair.This was super cool!

In addition to showing us the i-Drive, Margaret and Sydney from Pride Mobility also brought in their new Q6 Edge 2 power wheelchair, which is a midwheel drive power base. This version has notable changes to the aethetic design of the base. They’ve also created a very sturdy base with a strong footplate as you can see from Mark standing on it. In addition, Sydney informed me that Pride has improved the sensitivity of the drive. This hopefully addresses the feedback they were getting from the previous version of the Q6 Edge. Definitely worth a trial with all of these improvements!

.: REE at the ROO :.

The REE at the ROO was once again a great exhibition. It was great seeing so many familiar faces at the event and there were many new products to see. Upon walking in, I ran into Dean Robertson, who has just started a company called Access Driver Rehab Specialists. He was showcasing new hand controls from the UK that he has been working with. These are not only aesthetically pleasing, but also very functional. The hardware is quite minimal and there is also voice activated controls.

Permobil debuted their new F3 and F5 power bases. Both bases have a new distinct design and aesthetic that is different than the former Permobil lines. The F3 and F5 are front wheel drive power bases that offer a variety of power functions including anterior and posterior tilt, seat elevation and on the F5, power standing. Check out their website for more information! These chairs are definitely really cool!

I had the pleasure of meeting Russ Rolt from Active Controls again at the REE. He was showcasing the new proportional chin control joystick and new mounting hardware for the Center Drive System. Based on feedback, Active controls has made the Center Mount Drive System adjustable so that it can be brought closer to the client. The system now has a ball joint, which allows for much improved positioning capabilities. YAY! I also want to thank Bill Randall from NuVision Rehab and Russ Rolt for the sample Power Buddy. This is a power port that you can plug into your power wheelchair to charge your electronic devices like your phone or GPS. Check this product out here!

Nathan Buskell at Motion Specialties had their custom lateral tilt mechanism on display at the REE. This was a nice, smooth lateral tilt that didn’t require much force to activate. The only con, would be the placement of the handle/wheel needed to engage the lateral tilt as it is low on the wheelchair, although this is often an issue with many of the custom lateral tilts out there. A nice design overall though!

Sunrise Medical was debuting their new Quickie Xperience 2. This midwheel drive power base now has an external power seat function box that can be mounted in front of the joystick. Definitely a nice option!

The Roho Group was showcasing their Smart Check device that allows users to check the inflation of their cushion once it has been properly set. This is a fabulous device however, there has been some feedback that it can be a bit tricky to use. It is also quite expensive. If, however, it can be set-up properly, it is an invaluable tool to have with a Roho cushion.

And last, but certainly not least, Advanced Mobility had the Firefly power assist to demo at the REE. This was indeed a fun product. Easy to drive and incredibly fast, smooth and peppy! This product is being exclusively distributed by Advanced Mobility in the lower mainland. Contact them to try one out.

That’s all for today! Thanks for checking in. As always,

Seating is Super!

Cheryl

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

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

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

Standing Power Wheelchair with Added Seating Modifications

Happy Easter Everyone! I hope you were able to enjoy the long weekend. This weekend I was able to catch up on some much needed rest and errands. For once, I actually feel ready for the week to begin. So, to give you a start to the week, check out this power wheelchair I set up with the help of Motion Specialties! It’s a Ranger Express (rear wheel drive) power wheelchair with standing function. There are a few other manufacturers that offer the standing function, such as Permobil and Levo. The Ranger Express was chosen for this client because it was a rear wheel drive power base, the clients’ driving preference (most are usually front wheel drive) and because of the style and positioning of the knee blocks (which best suited this client during the trials). The stander function on power bases is a great addition, but involves a few considerations. Some of these considerations include access to funding (these things are expensive!), the ability of the client to move into a standing position from sitting (not as straight forward as it may seem….lots of positioning considerations here!) and safety (bone density issues, cognition and safety awareness). In addition, with regards to the base itself, many of them have a lower max speed and are set up with a front wheel drive, which some clients may not be used to.

In order to make this base work for my client, several modifications were required. This client had a backrest that she used in her power wheelchair and in her manual wheelchair. This meant that the backrest needed to be removeable from the new power base. Her backrest was made using a foam-in-place insert to accommodate her back contours. This insert was set up in a Jay 2 backrest shell. Typically, backrests are mounted and bolted on to the back plate of the Ranger wheelchair, preventing it from being removed.  Nathan, the technician from Motion Specialties, therefore designed a track-like system that allowed the backrest to be removed by sliding the back onto the plate instead. In addition, to maintain the appropriate amount of seat depth, Nathan essentially needed to move the whole back plate further back on the base…not a quick job by any means! You can see this below where Nathan is wearing green and Bill Randall, sales representative is wearing purple. I promised to post a flattering picture so hope you both are happy with this one! =)

Further customization was needed to increase the “shearing” of the backrest when the wheelchair went into standing. When we trialed the initial set-up with the client, the backrest moved up too high causing the laterals to move up too far up and into the client’s axillas. Nathan then made a custom bracket that allowed the backrest to move downwards more when using the standing function. See below:

The last few customizations included grip tape for the footplate and ankle huggers to prevent the client’s feet from losing positioning and moving into standing, a custom Body Point chest strap with custom auto style buckle sewn in by Nathan, and added velcro under the armrests to secure the chest strap when not in use. This was necessary to ensure the client’s ability to use the stander independently.

The modifications that were made by Nathan and Bill really made this system work for my client. Thanks so much for all your hard work! It really did make a difference for this client! The standing function itself was selected for the health benefits as well as to improve my clients’ independence and level of function. Here is a link to a resource by RESNA outlining some of the benefits of wheelchair standing devices. Hopefully this will help with your justification letters! Also, an exciting announcement! Access Community Therapists Ltd, is offering a wound/pressure management course called “The Pressure is On ” in June. It’s a two day practical course on wound assessment, pressure mapping and intervention. We will be hosting it on June 6th and 7th at Advanced Mobility Products in Burnaby, BC. Click on the link or visit the Access website to register. Jo-Anne Chisholm, OT, Joanne Yip, OT and Heather McMurtry, RN, WOCN will be the main instructors and I will also be there assisting with the break out sessions. Register soon as space does fill up quickly!

Thanks for checking in today! I hope you enjoyed the case and hope to see you at the pressure course!

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