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Did you know your Power Wheelchair could have Bluetooth?

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We live in a connected world. A world full of phones, tablets, and computers. Most of us use technology every single day. For many of us, it is difficult to even be without technology for a few hours. We are constantly looking at our phones whether it is to see the time, make a call/text, or use one of the thousands of apps available to us. For individuals with impaired hand/upper extremity weakness, being able to fully use a phone or computer is not always possible.
 
For many years now, most power wheelchair manufacturers have integrated Bluetooth into their chairs. What does this mean? It means that the wheelchair user can have their phone, tablet or computer connected to their wheelchair. The power wheelchair can control their phone, tablet, or computer with their driving device. Bluetooth can be utilised with any driver control: joystick, head array, chin drive, etc…

The type of connection will depend on the type of device. For iPhones this connection will be through switches where a blue box will appear on the phone allowing for selection of items. For Android and Microsoft phones and computers this connection will be through mouse emulation where a mouse pointer will appear on the screen.

The video below is an example of a Bluetooth iPhone connection with switches. A big Thank You to Todd Stabelfeldt for posting this great video.
 
 
 
The best part about Bluetooth on the wheelchair? As a therapist you can set this up on your client’s wheelchair. The set up will vary slightly based on each manufacturer and the age of the wheelchair and also the type of joystick or speciality input device is being used.
 
Included below are two quick start guides for getting started with Bluetooth on both iDevices and Android/computers on Permobil power wheelchairs with the Permobil Joystick Module.
 
 
 
 
 

Independent Repositioning Mode:  Getting the Most Out of Your Power Seat Functions

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We have been discussing the importance of power seat functions for the past couple blogs and what those power seat functions can do for the user. Often because of the limited mobility of the individual utilising the power wheelchair, power seat functions are used for pressure management. Pressure management or shifting weight off the user’s bottom is crucial to help to decrease the risk of skin breakdown. There are numerous research studies that discuss which combination of power seat functions are best for pressure management. The research shows that superior pressure relief may be achieved by utilising both posterior tilt and recline. Based on research by David Kreutz in 1997, the individual is recommended to initially move to a fully tilted position to stabilise the pelvis, and then follow with activation of the recline system so as to minimise loss of postural stability. Then reverse this order for coming back up to a driving or functional position: Recline and then tilt. This order is important because if the user starts for example with power recline they may lose their stable seated position or increase shearing to their sacrum. Commonly, users will have access to power posterior tilt, power recline, and power elevating legrests. In this case, the user should complete the following sequence for pressure management: posterior tilt, elevating legrests, recline. Then, reversing this order for coming back out to an upright driving position. When the user is fully tilted and reclined, this position is also helpful to reposition the user. Many users may be able to unweight their pelvis and shift their own hips in this unweighted position.

So, what is the challenge with utilising the sequence of posterior tilt, elevating legrests, and recline to maintain postural stability during pressure management? This sequence can be difficult for the user to remember, or maybe the user does not know the difference between recline and posterior tilt if they were not educated by their therapist or other seating specialist. This can create a fear for therapists and many will prescribe just posterior tilt in order to prevent the potentially negative effects of the 3 power seat functions when not used in the right sequence. Or, maybe the user is given all 3 power seat functions, but instructed to only use tilt for their pressure management. This is where it is important for manufacturers to see this limitation and develop a solution.

This solution for Permobil is called Independent Repositioning Mode or IRM. IRM comes standard on every F series, M3 and M5 power wheelchair.  This mode can be turned on to where the user can press a button on the controller, hit a switch, or use the actual joystick to enter the independent repositioning mode. Because the chair has smart actuators, when the switch for example is hit, the chair will take the client into a pre-set or therapist set amount of tilt, legrest elevation, and recline in the proper sequence one after the other. The user only has to know in this case to hit one button.  Users no longer have to worry about going all the way into posterior tilt before elevating their legs and then reclining. This feature is designed to take the stress and difficulty away from the user, but also empower the user to be able to be independent with their own pressure management.  Independent repositioning mode can also help with exactly what it says – repositioning. For some users, they are able to hit a button and go into this position so that they can independently repositioning their seated posture.  While the user can be set up for the standard IRM position, the therapist can also choose the final position of IRM so that this feature can be utilised for every users’ needs.

Click here for more information on power chairs.

Rachel 

 

References:

Kreutz, D. 1997. Power tilt, recline or both. Team Rehab Report, March: 29–32.

 

Power Seat Functions  |  Elevation

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Today we will look at the power seat function for elevation.  When we talk about elevation, we are referring to the raising up of the seat pan. You may also hear elevation referred to as seat elevate, or lift. Elevation can be beneficial to the user for functional, psycho-social, and physical benefits.

Let’s start with the functional benefits. The first benefit is the improvement of or independence with transfers.  Many people need to complete lateral transfers, where they slide across from their wheelchair to another surface such as the bed, toilet, or car. The difficulty with lateral transfers occurs when the user has to go from a lower surface to a higher surface. With seat elevate, most transfers out of the wheelchair can now be level or with a slight decline. The seat elevate can also be helpful with sit to stand transfers.

Another great function benefit of elevation is the improvement of the user’s vertical reach.  Often with sitting in a wheelchair, activities or tasks will become overhead.  This means that the user has to be able to reach overhead to complete this task or activity. Seat elevation may allow the user to increase their independence by completing overhead activities, and this can also lead to additional physical benefits. Overhead reaching could increase the user’s risk of shoulder impingement or perhaps the user does not have the strength in their arms or trunk to complete this task or activity, and with seat elevate this will no longer be a problem.  It’s not just about the shoulder.  There is also a large impact on the neck, or cervical spine, with constantly performing overhead activities or looking up throughout the users’ day. Seat elevation can reduce the potential problems of overhead reaching.

 

Finally, let’s touch on the psycho-social benefits. In a previous blog, I discussed this topic of being able to come to eye level with your peers. This seat elevation allows the user to come to eye level with their peers, promoting the user to be part of the conversation. Seat elevation gives the user the power to choose at what height they want to be.

There are of course are a few limitations even when the user is able to elevate.  Many times, I hear people talk about how with seat elevate they will be able to reach into all of the cabinets in their kitchen.  Now, this could be true, but for many users they can now get up to open the cabinet, and reach the first few items, but they will have difficulty reach all the way into the cabinet.  This is because the user is typically seated back and would have to lean forward in order to reach further into the cabinet. This is one example, but we can see that seat elevate while very beneficial for independence with some functional activities may not provide the solution for all tasks or activities. Last week we briefly discussed ActiveReach™ and its benefits with vertical reach. For those clients that are looking to get that further reach, have better access to their sink and kitchen, and to even further enhance their participation through active posture, ActiveReach™ that includes both elevation and anterior tilt might be the right choice.

Remember, not everyone will need seat elevate, but it is important to assess each individual and determine if the function is appropriate. 

 

 

Power Seat Functions: We want to hear from you!

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Often when we think about power wheelchairs and their power seat functions, we think of tilt first. Tilt is a great power seat function, but depending on the power wheelchair and the manufacturer, power wheelchairs can have other power seat functions. These power seat functions may include: elevating leg rest, recline, standing, or the Permobil ActiveReachTM.  When we think about power seat functions and their use we might think about how these power seat functions allow the end user to be independent with their pressure management. We might think of power seat functions for health benefits like to assist with decreasing lower extremity swelling, but what about for functional independence and psychosocial benefits? While it is very important to remember that these power seat functions can help assist with pressure management and other health benefits, for the next couple weeks I want to focus on all of the power seat functions and how these functions help benefit end-users in their everyday life.
 
If you or anyone you know is using a Permobil power wheelchair and uses their power seat functions to increase their independence, get more involved in the community, return to work/school, or maybe just for fun we want to hear from you! Please email Rachel.Fabiniak@permobil.com with your story and photo, so that we can include you in our next blog!
 
As a therapist it can be difficult to determine which power seat functions would be reasonable and necessary for my client to have on their power wheelchair.  It is important for us to consider the goals of the client and to determine if a power seat function could help to achieve this goal.  A great example of this is with ActiveReachTM.  Perhaps a client would like to increase their independence in their morning ADLs, activities of daily living.  Many times they might not be able to fully access their sink because the sink is too high.  Or maybe they can use elevate on their wheelchair to raise up closer to the sink, but they are sitting too far back in their chair to fully use the sink.  With ActiveReachTM, they are able to not only elevate, but to tilt forward to allow for full access of their sink.  Clients who couldn’t reach to brush their teeth in the sink before might be able to complete this activity independently because of this power seat function. This is just one example of how a power seat function can assist with independence.
 
Over the next couple weeks, I look forward to discussing how our users utilise their power seat functions.
 
Rachel
 

Power Wheelchair Suspension: What you need to know and look for

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Over the past 3 weeks we have talked about drive wheel configuration and some tips on how to decide which option is right for you. This week we are going to discuss power wheelchair suspension. The suspension can vary from chair to chair even within each manufacturer, but there are some key points that we should discuss.


Most power wheelchairs on the market are going to use compression springs for their suspension. There are two types of compression spring that are typically used: Linear and Non-linear.


Non-linear springs as seen in the photo below allow for changes in compressive load at different points of the range. What this means is that you can have the looser spring coils at the beginning phase to help with climbing over obstacles. The trade-off will be that you will lose some of the overall stability of the chair when not climbing. Many manufacturers will use one non-linear spring as their suspension.


Linear springs on the other hand allow for consistent stability throughout the compression range. For Permobil, these springs are also adjustable. The factory will set the suspension spring resistance based on the weight of the user and then the supplier or manufacturer representative will have the ability to further adjust depending on the needs of the user. With the Permobil M and F series, the suspension will be composed of multiple linear springs to achieve optimal traction and suspension.


 

Why does this matter? The shape and the coil distance have an impact on how a spring works and effects the user. The better the suspension, the greater the decreased forces on the end-user. This could lead to increased seating tolerance, pain management, spasticity management, and decreases the risk for loss of balance or position in the wheelchair. One of the biggest points that I think about is driving over any uneven terrain whether it is just a sidewalk or grass at a park. It is important that as the chair goes over each bump that this bump is not felt by the user or limited as much as possible. If each bump is transmitted up to the user, then the user will likely not maintain their seated position. They will also feel all this vibration. According to one study by Wolf and colleagues in 2007, this vibration can lead to many impairments including fatigue and pain.

 

 

 

The final thought that I believe is one of the most crucial points to make is that the suspension on the wheelchair should always be there for you or your client. We know how important suspension is and the negative impact that not having this suspension could be to our clients. Therefore, we need to make sure that the wheelchair will maintain its suspension in any position and over all surfaces. No matter what position the user takes the Permobil power wheelchair to, such as elevate, posterior tilt, active reach, or standing, the suspension remains the same. If you want to drive your wheelchair in elevate, active reach, standing, or other positions, you want to be sure that your suspension will continue to support you in those positions and not lock out.


It is important to know that each manufacturer will have different suspension set up on their chairs. As a client, therapist, or carer make sure you ask about the suspension to determine which option is best for you.

Rachel

 

 

Part 2 Power Wheelchairs: 

Where is my Drive Wheel and Why Does it Matter?

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The drive wheel on a power wheelchair is the larger wheel if you are looking at your wheelchair or client’s wheelchair.  The location of this drive wheel can have a large impact on how the power wheelchair drives and manoeuvres in different environments.

There are three main types of drive wheel configurations on power wheelchairs: front-wheel drive, mid-wheel drive, and rear-wheel drive. In this blog today, we will focus on mid-wheel drive.

MID-WHEEL DRIVE

The mid-wheel drive power wheelchair is the most recent technology developed for power wheelchair bases. It attempts to combine the positive aspects of front-wheel and rear-wheel drive into a hybrid product. Mid-wheel drive has many benefits.  The most well-known benefits being the small turning radius and intuitive driving.  The mid-wheel drive power wheelchair has the smallest 360  ̊ turning radius which can improve manoeuvrability for many individuals in their home or smaller spaces.  The intuitive driving benefit is due to the placement of the drive wheel. Typically, in the mid-wheel drive, the client will be sitting directly over the drive wheel, which is where the chair will turn/rotate from.  This axis of rotation being directly under the individual is what makes the driving intuitive or often people will say “easier to learn”.  It is important to remember that in some cases the mid-wheel drive may not line up directly below the client and therefore may lose some of that intuitive driving.  The final benefit to discuss for mid-wheel drive is the stability.  Because a mid-wheel drive wheelchair has 6 wheels on the ground, this chair will offer superior stability. This can be the case whether ascending, going up, or descending, going down, ramps or inclines.

While there are many benefits for mid-wheel drive power wheelchairs, there are a couple considerations when deciding if mid-wheel drive is right for you or your client.  In being a superior option for stability, the 6 wheels on the ground also means that more energy from the ground is transferred to the client. Imagine going over a bump, because there are 6 wheels you could feel that bump 3 times versus the 2 of the front-wheel drive.  This could potentially limit the ride comfort for the individual in the chair.  Luckily, depending on each manufacturer, we have suspension to help decrease the impact of having 6 wheels on the ground.  I LOVE talking about suspension and we will have a blog post coming soon to talk all about suspension in power wheelchairs and the importance of the suspension.  The other comment I hear about mid-wheel drive power wheelchairs is the potential for “high centring”.  This term is used to describe when the centre drive wheels lose traction and may not be able to move in certain situations. This is particularly a risk with uneven terrain and was previously the biggest disadvantage of the mid-wheel drive power wheelchair. However, depending on your manufacturer, newer technologies and suspension can compensate and have greatly decreased the risk of this occurring.

The mid-wheel drive power wheelchair is the most popular drive wheel configuration and for good reason.  As technology continues to progress, the mid-wheel drive continues to have greater benefits with less limitations.

Keep in mind that not everyone will benefit from the same drive wheel configuration and it is important to ask questions and complete an evaluation to determine which drive wheel would be best for you or your client.

Rachel

 

 

Mecenzi’s story of herself and her new F5 VS

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“I go places and people look down at me, I would rather look them in the face.” – Mecenzi

If we have the ability to fully access and participate in our environment, we may forget that this human right is not possible for everyone. Think about your daily life. Can you reach the counter in your kitchen to make a sandwich, or reach inside the refrigerator to grab a drink? What about reaching up in your closet to get your clothes? That is just in your home. Now think about experiences in your community. Can you look face to face with your friends and family? Can you give your loved ones a hug without an awkward bend over shoulder in your face outcome? How about accessing counters at a restaurant to pay your bill? For many individuals with a mobility impairment their environmental access is greatly limited. It’s not just environmental access though. How would you feel if you had to sit down in a chair at a party while everyone around you was standing and talking? For some individuals with a mobility impairment, they find it difficult to fully interact with their peers when they are unable to look them in the face. For individuals with mobility impairments it might not just be accessibility and peer interaction but returning to or choosing a career path that typically requires standing throughout the day. While accommodations can typically be made, what if instead of adapting the environment we adapted the individual’s mobility device?


Today I want to share with you Mecenzi’s story of herself and her new F5 corpus VS.
Mecenzi’s story, as you will see in the video below, illustrates how with the assistance of the F5 Corpus VS, Mecenzi has greatly improved not only her independence, but how being able to stand up makes her feel.

 

 

 

Part 1 Power Wheelchairs:

Where is my Drive Wheel and Why Does it Matter?

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The drive wheel on a power wheelchair is the larger wheel if you are looking at your wheelchair or client’s wheelchair. The location of this drive wheel can have a large impact on how the power wheelchair drives and maneuvers in different environments.

There are three main types of drive wheel configurations on power wheelchairs: front-wheel drive, mid-wheel drive, and rear-wheel drive. In this blog today, we will focus on front-wheel drive.
 
Front-Wheel Drive
The front-wheel drive power wheelchair is typically going to be good for maneuverability indoors and optimal for outdoor use. This is because of the larger drive wheel being the first wheel to overcome the uneven terrain versus the smaller casters. Because the front wheels are connected to the drive motors, these pull the casters over obstacles and through various terrains versus if the casters were the front wheel. In the case of the casters being in front, the casters are being pushed, the force generated is forward and downward. This would be similar to a plowing effect and can increase the likelihood of becoming stuck in certain situations. For individuals looking to go over all terrains, the front-wheel drive wheelchair may offer the best solution.

Another benefit of front-wheel drive is the smoothness of the ride. Look at how many wheels are on the ground. In the case of front-wheel drive there are four wheels versus the six wheels with a mid-wheel drive chair. This means that as the end-user goes over a bump in a front-wheel drive chair, they would feel the force of that bump two times versus three in a mid-wheel drive. This can also be important for individuals that may easily lose their positioning when going over any uneven terrain.
We could talk about front-wheel for hours, but the final benefit to mention is the front-wheel drive chair’s smallest front turning aspect. In all the configuration options, the chair will turn on its drive wheel.
 
The photo below shows an example of a bathroom. In this bathroom the sink is positioned against the wall. Because the wheelchair turns on its drive wheel and the end-user can only pull themselves so close to the wall before turning, we can see the only chair to gain full access to the sink is the front-wheel drive. Does this mean that everyone should have a front-wheel drive wheelchair? No, but it does mean that it is important for clinicians, suppliers, and clients (end-users) to consider the environment that the client lives in.
 
 
Often, I hear that people stay clear of front-wheel drive because it doesn’t have as small of a turning radius as mid-wheel drive and it is harder to learn to drive. Both of those statements are true. The front-wheel drive will have a slightly larger 360 degree turning radius, but as you saw above it has the smaller front turning aspect which may be utilised more than someone turning in a full circle. Front-wheel drive may be less intuitive to learn how to drive versus mid-wheel drive, but with a little practice and a few key tips, many users find front-wheel drive to be just as easy to learn as mid-wheel. The two key points I like to teach someone when learning to drive a front-wheel drive wheelchair is:

1. Hug the corner. When going through a doorway the end-user will want to “hug” the corner or keep a tight turn.
2. Turn towards the problem. For example, when positioned adjacent to a wall/barrier, turn toward the wall/barrier, then slightly reverse to allow the rear casters clearance for turning in the desired direction. This might sound complicated, but if you remember to turn into the problem you will easily maneuver away from the problem.

Keep in mind that not everyone will benefit from the same drive wheel configuration and it is important to ask the questions and complete an evaluation to determine which drive wheel would be best for you or your client.
 
 

What is Dry Floatation?

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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

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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!