DME

Blog

What is Dry Floatation?

______

 

Last week, we heard from Mal on the impact that Mr. Graebe and ROHO had on his life and he used the words “DRY FLOATATION™ Technology”. This week we are going to dive a little deeper into the design of a ROHO cushion and explain what Dry Floatation is. In designing the ROHO cushions, Mr. Graebe realised the best way to protect the skin would be if the client could be placed in water because of the benefits of floating. He knew that it would be impractical to achieve true floatation in a cushion, so Mr. Graebe concentrated on achieving the same type of floatation but used air instead of water. This idea developed into what is known as DRY FLOATATION™ Technology, and it’s a ROHO exclusive. Mr. Graebe spent many years in his garage working on his idea of Dry Floatation and in 1971 he released the first ever ROHO cushion – a high profile ROHO cushion.

 

  

The adjustable air-filled cushions and mattresses mimic the pressure relieving properties of water, removing friction and delivering stability and comfort no matter where you go or what you do. DRY FLOATATION™ Technology is based on 4 principles characteristics of water that causes floatation.

Here are the 4 principles:

1.          Low Surface Tension – Fluids have very low surface tensions, which allow an object to penetrate its surface with little force. The ROHO design of many small interconnected air cells made of a soft, pliable neoprene rubber results in a very low surface tension. This limits the amount of skin deformation.

2.           Constant Restoring Forces – both air and water have very small molecular forces of attraction that can be displaced. This displacement provides hydrostatic forces, or floatation, that are nearly constant no matter how deeply immersed the object is. What this means is that the ROHO cushion allows a person to sit immersed in the cushion for long periods without an increase in pressure over time.

3.           Six Degrees of Freedom – Each cell within a ROHO cushion can move in any direction, allowing the cushion to move with the body, in the same way water moves. The result is that instead of the skin and underlying tissue deforming, the cushion itself deforms. This minimises both friction and shear forces.

4.          Low Friction and Shear – Friction occurs when two surfaces rub together. The courser the surface, the more friction exists, increasing the likelihood of tissue breakdown. ROHO cushions and mattresses are made of a neoprene rubber that has been treated to reduce friction to minimal levels. Shear is a lateral force that occurs at a deep tissue level. This is the result of friction holding the skin in one place while gravity pulls the skeleton and attached tissues down. Shear can be a major issue when someone is lying in bed with the bed head elevated, or for someone seated with kyphosis and a posterior tilt of the pelvis. By minimising friction with the coating of the neoprene, as well as the size Degrees of Freedom, DRY FLOATATION™ Technology reduces shear forces.

Whether you are sitting on a ROHO cushion, you have a friend or family member that uses a ROHO, or maybe you have gotten a ROHO cushion for your client, hopefully you see just how much thought went into the design behind ROHO. We want to thank Mr. Graebe again for his contribution and positive impact on the lives of so many.

For more information on pressure injuries check out the Pan Pacific Prevention and Treatment of Pressure Ulcers: Quick Reference guide.   http://www.woundsaustralia.com.au/ptpu/index.php

 

Rachel and Mal

 

The man behind ROHO DRY FLOATATION™ Technology

______

 

In 1978 a young electrical engineer, Robert H. Graebe, was introduced to a patient with a pressure injury. He witnessed a doctor excise tissue from the site. The doctor’s comment “we do not know how to prevent these sores” left such an impression on Mr Graebe that it inspired him to find a way to prevent pressure injuries. As a result, he invented a new technology, DRY FLOATATION™ Technology, and a range of products named ROHO. Since then ROHO products have changed the lives of millions of people in 65 nations, enabling them to pursue productive, independent lifestyles.

On Saturday 15th September the Starkloff Disability Institute in St Louis honoured Mr Graebe with a Lifetime Achievement Award.  The Starkloff Disability Institute is a non-profit organization dedicated to helping people with disabilities participate fully and equally in all aspects of society.

The award caused me to reflect on the impact Mr Graebe has had on my life. In 1980, at the age of 19, I was a passenger in a motor vehicle accident which resulted in a spinal cord injury at T5, complete. In 1982 I started to develop skin problems due to pressure, and in my research found the ROHO cushion. Ever since my first single valve cushion in 1982 I have been sitting on ROHO cushions. I have been using a ROHO Quadtro Select Mid Profile for several years now.

 

 

Thanks to Mr Graebe I have remained free of sitting acquired pressure injuries for 38 years! Mr Graebe’s invention has had a profound and life changing impact on me. It has allowed me to remain active, to successfully run a business, to play wheelchair basketball both here in Australia and internationally, to travel extensively, to meet fantastic people from all walks of life, to be a productive member of society, to be financially independent and so much more.

I have also been fortunate to work with the ROHO product line for 20 odd years. In that time, I have seen countless lives of end users, their families, and their therapists, improved by ROHO products.

One of the highlights of my career was the opportunity to meet and dine with Mr Graebe. I often share that on that occasion I got to thank him personally for saving my arse for all these years. I am so delighted that Mr Graebe has been honoured for his incredible work. What an amazing thing that he was moved to invent a product that would, and does, help prevent pressure injuries. He has truly changed the world of millions of people for the better. What an amazing legacy!

Mal

We would love to hear your stories on how Mr Graebe’s invention has had a positive impact on your life!

 

 

Making it for Madi

 _____

Madison de Rozario in her custom TiLite ZR

In the past two blogs have been discussing TiFit and the importance of a chair made to fit the individual. Today, we will be looking specifically at how we worked with Madison De Rozario to design a TiLite ZR made for her and her lifestyle.

To start the process, we met with Madi to find out what her life looks like: what does she love to do, what does she like about her existing chair, and what would she change if she could? Some of the key things about Madi mentioned included: her love for her dog (Sebastian), that she travels a lot, that she wants her chair to stay looking good despite her hectic lifestyle, to be “minimalistic”, and to be ultra-light, but very strong.

Despite Madi having an extremely strong upper body, her pelvis requires only a 285mm (11”) rear seat width. She really wants the front of the seat to be narrower, which follows the contour of her body.

So, we specified the chair to have a 37mm (1.5”) taper from midway down the seat to the front of the seat.

We worked out that, based on her arm length, 480mm (19”) is the best rear seat height for Madi, and that a front seat height of 508mm (20”) gave her adequate stability while allowing her to get under tables and desks. The seat upholstery to footplate height of 300mm (12”) is quite short in relation to her floor to seat height, and Madi wanted this to look as clean as possible, so Madi chose an open loop titanium footplate which needed to be custom made for her chair. We used the same rear wheel axle position as her existing chair and measured the overall length of her existing chair as this worked perfectly for her. Based on her frame length, overall length, and wheel base length the required front angle was worked out, using Computer Aided Design Technology, to be 83.5 degrees.

 

 

Madi also wanted her feet to sit nice and snug in her footplates, so measuring the width of her favourite shoes we specified a footrest width of 178mm (7”). Finally, Madi wanted her chair to be narrow at the front castors, so she can get into tight corners and use a “3 wheel” technique for going down the aisle of aeroplanes (with someone supporting the weight of the chair by holding the rigidiser bar at the back of the chair, one of the rear wheels is removed. This makes the chair narrower and able to be rolled down the aeroplane aisle, negating the need for an aisle chair. Because Madi’s chair is small, it also fits on the overhead locker of most planes). To achieve this, we specified a front castor width of 362mm (12.5”).

TiLite’s commitment to truly custom building the Z and T series chairs from the ground up allows for chairs like Madi’s to be made to fit her body and lifestyle perfectly.

Check out the video to see how the chair turned out.

Mal

 

 

 

TiLite Tifit  - How a TiLite rigid manual wheelchair is made

_____

 

We have been discussing the importance of configuration and how we want the wheelchair to fit like a prosthetic. To get this perfect fit, it is crucial that each chair is custom made to each client. We call this custom fit TiFit. Tifit includes all T-series and Z-series rigid manual wheelchairs. For TiLite, that means that when you order a TiFit wheelchair your wheelchair starts as a long metal tube. The photo  is an actual photo from inside of the TiLite manufacturing plant.

Once your script is sent to TiLite the building begins. TiLite has the help of engineers and computer aided drawings to ensure that each chair is built to your exact specifications. You can even request a copy of your computer aided drawing, CAD, from TiLite that will show the exact measurements of your wheelchair. The photo below is an example of a CAD drawing from TiLite. Once the chair has been ordered and gone through the TiLite configurator, your wheelchair is then cut, bent, and welded into its final product.


The idea is that no two people are exactly the same, so why should your wheelchair be! The wheelchair should be made to fit like a prosthetic not pulled out of a box off the shelf. In doing this, we are ensuring the proper alignment of the shoulders to minimise the risk of shoulder pain and dysfunction. We are also ensuring that the wheelchair is comfortable, more efficient, and gives the ultimate performance. Next week we have the privilege to hear from Madison de Rozario and the importance of customisation of her wheelchair.

 

Rachel

 

 

Why the Fit Matters – An End-User`s Perspective

_____

 

This week we are going to hear from Malcolm about his experience with his TiLite wheelchair and how important the fit is to him. For TiLite, the T-Series and Z-Series wheelchairs are a made to measure frame or as we call it TiFit. The TiFit chair is designed specifically to each person. We will learn in a couple weeks about the exact process that TiLite goes through for each T-Series or Z-Series wheelchair that is ordered, but first let’s understand from an end-user perspective why this matters.


Malcolm Turnbull
As someone who is totally dependent on my wheelchair for mobility and sits in the wheelchair for an average of 12 to 16 hours a day, the fit of my wheelchair is critical for comfort, performance and aesthetics. There is good literature on the importance of custom built wheelchairs, for example: The PVA “Preservation of Upper Limb Function Following Spinal Injury” includes the recommendation “Provide manual wheelchair users with SCI a high-strength, fully customizable manual wheelchair made of the lightest possible material.” Today, I want to give an end user perspective on why this is important.

There is no perfect analogy for this, but I will start with one anyway. For the first 25 odd years of my life as a wheelchair user, I just wore off-the-shelf clothing: jeans, pants, jackets, shoes, etc… Then, I had the opportunity to go to the RehaCare Expo in Germany and came across clothes made specifically for wheelchair users! The pants have no seams at the back, no pockets at the back, and are higher at the back to compensate for the seated position. The shirts are shorter at the front than normal shirts, but the back remains the same, which means they sit better in the seated position. The jackets are also shorter at the front and the sides, meaning they not only sit better, but they are not overflowing onto the wheels. I even found leather shoes with zips on both sides which makes them easier to put on and take off. Now, I love wearing clothes designed this way. The clothes feel better, I feel more comfortable, they are safer in terms of pressure care, they are more convenient, and I think they look better too. Can I get by with off-the-shelf clothes? Yes, but they are nowhere near as good.

Madison de Rozario in her custom TiLite ZR

For me it is the same with TiFit. Of course, the prevention of upper limb injury is important. But the way my chair fits me perfectly feels better, more comfortable. It looks better, like I am sitting in it rather than on it. It is safer, knowing I can specify where my front castors are in relation to my overall length means it is less likely to tip over forwards. Being able to specify the width of the front castors means that I can get into the tight corners of my house, and bathrooms when I am travelling. It also means I don’t scratch my car as much when I am transferring in and out of my chair. Knowing that my front leg angle can be exactly what it needs to be to fit all my other dimensions means my legs sit better and do not slide off my footplates when I am pushing around. Add to this the fact that it rolls better, and you can see why TiFit is important to me

 

1. Link to “Preservation of Upper Limb Function Following Spinal Cord Injury” 

 

 

Weight or Configuration:

Which one is more important for a manual wheelchair?

_____

 

We just finished last week’s blog talking about the differences between titanium and aluminium, one of those differences was the weight of each metal. Weight can be an important factor when we think about propelling a manual wheelchair all day. Studies show that the average full time manual wheelchair user completes 2,000 to 3,000 pushes every day! This is an enormous amount of work that we are asking the shoulders to complete. Therefore, weight is important. However, weight does not just come from the frame.


We can have the lightest frame wheelchair, but if we load it down with armrests, heavy cushions and backrests, solid tyres, etc… we just cancelled the weight we saved in choosing a lighter weight frame. It is important we think about the components that we are putting on the wheelchair. With each component that we add onto the chair, we should ask ourselves, “What is the purpose/goal of this component?”. Perhaps not every added component is necessary or perhaps we can make sure we are getting the lightest weight components that meet our goals and needs. The less weight on the chair, the less demand we place on the shoulders, right? This is true, but if we don’t have the proper configuration, then even the lightest weight wheelchair will be difficult to push.
 
Configuration, how the chair is made to fit you or your client, can be considered more important than weight. When we think about those big hospital wheelchairs we think about how hard they are to push. This is because they are not properly fitted to us. They are meant to be a
one-size fits all. For an individual’s wheelchair it is important that we throw out the idea of one-size fits most and we instead think of the phrase: “fit the wheelchair like a prosthetic”. We can think about the individuals with amputations that have a prosthetic and how important that perfect fit is. If the fit is not correct, they often will have pain, skin issues, and eventually may not be able to use the prosthetic for mobility. The same holds true for a manual wheelchair. The manual wheelchair should be an extension of the individual using it and if we truly want the individual to have the easiest time propelling and limit the risk of shoulder injury – the wheelchair should be fully customized to the individual. This means that we can’t just have a wheelchair that is out of a box and then custom configured to add the components that we need, but instead the chair should be custom made to every individual.
 
This is why every TiLite rigid manual wheelchair is made custom for
each individual, because while the weight is still important, the configuration is key to success.
 
Rachel
 
 

 

 

 

Mono Tube Frame versus Dual Tube Frame

________

      

 

Rigid Frame Chairs Versus Folding Frame Chairs

_____
 
There was a time, back in the 1970s and early 80s, that the vast majority of wheelchairs were folding frame. That has changed dramatically over the years. At some point in the mid -1980s, I went from my folding chair to a rigid frame chair and have stuck with rigid frame ever since. So, what is the advantages and disadvantages of rigid and folding frame wheelchairs?
Let’s start with a general statement: Well designed and fitted rigid frame wheelchairs perform better than well designed and fitted folding wheelchairs! Rigid frame chairs are more rigid, have less flex in the frame and are easier to push. A quick look at wheelchair sports wheelchairs shows that, for sports that require speed and agility, no one plays in a folding frame wheelchair.
 
Rigid frame chairs are also generally significantly lighter as there are
less parts and hardware (eg. Crossbars, fold up footplates, removable legrests). This is important for people who lift their own wheelchair in
and out of the car, and is also one of the reasons they are easier to
push.  Rigid frame wheelchairs have less moving parts (eg. folding
cross bars, removable side guards, flip up footrests) which results in
less maintenance and breakages. Because they are welded into a rigid frame they are stronger and hold up to the rigors of travel, knocks, and bumps much better.

In addition, rigid frame chairs are generally able to be built with a lot more customisation. It is important to understand the difference
between custom made and custom configurable. A truly custom-made
wheelchair will be built around the person and not have limited options on measurement like front leg hanger angles, seat length, seat width, backrest height and angle, position of front castors etc. A good indication of whether something is custom made is to ask if the manufacturer can provide a CAD drawing of the wheelchair.
 
Given all the advantages of rigid frame chairs, why would someone use a folding frame chair? If someone has been using a folding frame wheelchair for a while and has developed their technique for transportation and are happy with the performance, then they will likely stay with what they are familiar with and is working for them.

A good number of people use roof mounted hoists on their vehicles that work best with folding wheelchairs. This in itself is reason enough to stick with a folding chair.  Another strong reason people will use a folding chair is for transfers, especially standing transfers. With lift up footrests and swing away legrests, folding frame wheelchairs work much better for standing transfers.
 
Some people find folding frame wheelchairs easier to store and lift into vehicles. While the advancements in rigid frame chairs have made them smaller and very convenient to store in vehicles, and are lighter to lift, some people find folding frames work better for them.

Finally, folding frame wheelchairs work better for people who foot propel their wheelchairs. The option for “hemi” height with swing away legrests makes foot propelling possible.

Overall there are significant advantages to rigid frame chairs over folding frame chairs, but in the end it boils down to what the user prefers!
 
 
 

Functional Mobility versus Exercise: Should Propelling a Manual Wheelchair be Exercise?

_____
 
To answer this question let’s start by defining what functional mobility is. Functional mobility is the ability for someone to move around in their environment. We all have to move around in our environments, whether it is our home or community, to be able to complete all of our daily activities. For an individual with a mobility impairment, this might mean that you need a walker, orthotics, or for this discussion, a wheelchair to move around in your environment. Using myself as an example - in order for me to complete my daily activities I will move around by walking. This is not exercise for me. I need to be able to move around all day. Now imagine if I had to skip or run every time I moved. This would be not only exhausting, but also a lot of work for my body. I would likely not be able to complete all the tasks or participate in all the activities that I wanted to each day if I had to skip or run everywhere. Therefore, my options would be to either rely on someone else to help or I would simply not be able to participate.


Keeping this theory in mind, then the same thought process should hold true for a person who uses a wheelchair as their means of mobility. If it is exercise to propel the chair, then you can become exhausted before the day even begins. You might not be able to participate in certain activities or engage in your community if you are exhausted because you are constantly “exercising”.

Functional Mobility should not be exercise! Functional mobility is a right for all of us, no matter what form of mobility we use.

Pushing a wheelchair can be exercise, like a brisk walk or jogging. But remember, not all able-bodied people choose this as their exercise. Also, the upper limbs are more vulnerable to injury than lower limbs so “pushing for exercise” needs to be done in a way that does not present a danger of upper limb injury. We will explore this more in later blogs specifically about shoulder injury prevention.

Per Udden, the founder of Permobil, said it best:

“Every person has the right to have his or her disability compensated as far as possible by aids with the same technical standard as those we all use in our everyday lives.”

 

Subscribe to our blog