DME

Blog posts of '2019' 'December'

The Pushtracker E2 - First Impressions

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Last month saw the release of a long-awaited update to the SmartDrive, the all-new Pushtracker E2!

If you’re looking at a power assist option for the first time, or you’re an experienced user of the SmartDrive with the previous Pushtracker, you might ask “why make the switch? What makes the Pushtracker E2 a must-have?” After using the previous Pushtracker for almost 3 years, I took the E2 through its paces and my usual route to university!

The first thing you notice is that the E2 is a smart watch, using the Mobvoi TicWatch E2 as the foundation. This new hardware ups the build quality and gives the user additional functionality such as apps on Google Play Store, phone and social media notifications, weather and all the rest. Like me, if this is your first smart watch you’ll appreciate getting your phone messages straight to your wrist. As a wheelchair user I keep my phone in a bag rather than my pocket – meaning that this is a game changer!

 

 

It also looks like a device that anyone would wear, which is important for many of us. I also can’t wait to change the wristband to something more stylish. The Pushtracker E2 is compatible with most standard 22mm bands. While on the topic of aesthetics, you can choose from dozens of watch faces and customise it to show both Pushtracker and SmartDrive Battery.

The instructions were simple enough – download WearOS on your phone, turn on the Pushtracker E2, and pair the two. Sign into your Google account on the E2 and go through the prompts. It takes a short while to update all the software, during which the watch may feel slow. Once set up, head into the Play Store to find your Permobil apps.

Permobil developed two apps for users to download onto the watch – Pushtracker to keep track of your wheeling activity, and SmartDrive MX2+ - your main control to activate your SmartDrive. The apps look sleek and are much more intuitive to use on the AMOLED touch screen compared with the old Pushtracker. You’ll want to Favourite the SmartDrive app so you can quickly press the menu button and launch the app before you tap.

https://www.youtube.com/watch?v=jLEK1C_6UiA

 

How does it feel initially? If you used the old Pushtracker it’s both familiar and different. In my case it was too sensitive by default, so I fiddled with the Tap Sensitivity setting until I found the sweet spot. For me that’s 70%. Be sure to go through Tap Training in the app settings menu to become familiar with the responsiveness. In any case, the first trip out with the Pushtracker E2 was like a mini retrial. I recommend everyone to carefully get the hang of it before using it in tight places. Pretty soon I was using it just as intuitively as before.

The trek to my university is almost one, giant hill, so I can't imagine tackling it without a power chair or power assist. It's a 5 minute ride from the station and just accessing the library at the top means there's a hill from every direction.

 

 

From my experience so far, I didn’t experience any disconnection with the Bluetooth while in-use, unlike the frustrating black spots I encountered with the old Pushtracker. The new hardware sports an antenna that’s 8 times stronger than before and it definitely feels like it.

The only trouble I had was in the initial tap to go during the first day or so, getting used to the new feel of the watch. The different sensitivity also meant the speed unintentionally set too early making have to stop and start again.

Finally, and crucially, is battery life. I noticed when not in-use the battery is far more capable than the old Pushtracker. How fast the E2 drains depends on how you use its smartwatch functions. Like a phone, I noticed it can get dangerously low towards the end of the day if the display is always in use. I recommend turning off the always-on display, reducing the brightness a bit and always turning off the SmartDrive app, away from its ready-to-tap screen whenever you stop using your power assist.

 

But with so many devices I now carry with me, a powerbank is an essential item in my backpack. It will also win you some friends! Charging is very fast and the E2 comes with a USB charger to plug into a computer or power adapter. If you charge with a computer, a blue USB 3.0 port will give maximum charging rate.

If I was to find a complaint, it would be that the watch is a bit large for my skinny wrist. But I can understand the designers opted for a size that can be easier used by those with limited hand function. For a touch screen, bigger is easier.

As an active user who needs to get around town every day, the E2 feels like a natural transition. Whereas before I would wear the Pushtracker only because I had to use the SmartDrive, I now wear it because it’s just useful for everything else. Have you got your hands on the Pushtracker E2 yet? Sound off on your thoughts below!

 

Sergei

 

Continuing Professional Development (CPD) requirements for Occupational Therapy registration

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New Zealand and Australia both require Occupational therapists to complete ongoing training as part of maintaining competency as a registered therapist. Both Systems require OTs to be nationally registered and to prove ongoing competence to the board on request. This competence is measured by the training and education opportunities that the therapist has undertaken throughout the year.  Both systems have an expectation that therapists will maintain standards and stay up to date with latest technology and practice by attending ongoing education. 

 

With a wide choice of ongoing education opportunities available in relation to AT, the education team at Permobil are confident that our clinical education courses meet the updated registration standard. For Australians the CPD hours have been reduced to 20 hours as of Dec 1st, 2019. It is important for therapists registered in both countries to keep up to date with the requirements their board imposes.  Audits for previous years will still require you to meet that year`s requirements.

I recently had a conversation with a senior OT / Team leader who was asking about our education opportunities for her staff. She articulated she had previously attended “CPD trainings” that did not offer her any professional development as were not pitched at a level she felt met the course description. She reported that she was happy to send her staff to workshops with our team as she felt they provided good skills and learning opportunities for her staff. She expressed her frustration at releasing staff to find that the course she sent them on did not actually benefit their roles.

An increasing number of services are working in a billable hour’s models, with national insurance schemes in place in both NZ and AU. This can put increased pressure on income generation and taking time out for education is not always seen as a priority. However, CPD needs to be given value, partly due to it being a board requirement but mostly because it helps us grow and become better therapists by setting goals and pushing ourselves to constantly grow.

How do we make CPD work for us? Set yourself clear goals and look for training opportunities that will address your goals. Read course and workshop descriptions to see if they include skills or information that will assist your practice. Talk to educators about your goals and needs if you`re not sure that it’s the right workshop for you. Talk to colleagues that have attended the training already if it`s been previously run and how they found it, time is precious, and you want to be getting the training you expect!  Just attending a workshop or webinar whilst a great way of meeting your CPD hours is not the sole intention of CPD. How will you implement what you have learned into practice? How has the training enhanced your knowledge and work role? What do you need to do next? More important than the certificate you may receive is holding onto any notes you have written at the training, better still a small reflection on what you have learned, how you will use it to improve practice and where to next.

2020 Permobil education will continue to provide educational opportunities around Australia and New Zealand. We have a range of new and existing workshops that will be run face to face around Australasia. Watch out online as we will be releasing these new additions very soon.

We will also continue to develop our webinar platform for more product specific training and of course our weekly blog! Over the next few weeks Sergei and Mal will be sharing some exciting and informative real-life experiences through our blogs and Rachel and I will return next year with the clinical blogs.

On behalf of the clinical education team and Permobil we would like to thank you for your continued support of our Blog this year and wish you and your families safe and happy holidays!

 

Rachel and Tracee-lee

To pommel or not to pommel, a look at adduction points of control

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Historically known as a Pommel or an Abductor, the new ISO terminology to describe this product parameter is a medial thigh support. This support can be independent of the seating (attached to the seat pan of the mobility base) or built into the cushion through the contours of the cushion itself.

Abduction and adduction of the hip joint are a continuum; neutral positioning is when the knee joint and hip bones are in line and symmetrical. If the knee is medial (Knees together touching) the hip joint is adducted. If the knee joint is lateral to the hip joint (Knees apart), the hip is abducted.

 

 

We frequently refer to the sitting position being as neutral as possible and we know if the wheelchair is too wide this has a negative impact on the shoulder joint for self-propulsion. So why do we use medial thigh supports in seating? When do we consider its use? What are the disadvantages of this type of support? We also know that the larger the base of support the more stability gained, abduction increases our seated base of support thus can be a preferred position. Body dimensions may also require a more abducted seated position, so why not sit everyone abducted?

In addition to forcing self-propulsion from a vulnerable position (in shoulder abduction), the increase in the width of the seating may also decrease accessibility in some environments. The clinical reasoning process needs to consider the hip ranges of motion established in a MAT assessment, tone patterns, proximal stability of the pelvis, and users’ functional goals to determine the seating parameters. What kind of supports are required based on the capacity of someone to gain functional support and stability?

 

                                  Abduction                                                             Adduction

                                                                                     

  

 

 

 

 

 

 

 

 

 

 

 

 

If a femur is positioned in more abduction than there is passive range, the impact on the pelvis will be seen with the pelvis rotating in the same direction to enable the femoral position.  This is commonly seen when a non-reducible wind sweeping position is not accommodated. Wind sweeping is the tendency for both limbs to sweep to one side – one hip will be abducted and the other adducted.

Longitudinal hip surveillance studies have provided us invaluable information on hip migration, causations, high risk group identification and resulted in guidelines such as https://www.ausacpdm.org.au/wp-content/uploads/2017/05/2014-Aus-Hip-Surv-Guidelines_booklet_WEB.pdf - which is an excellent resource.

 

 

 

The resource explains “Progressive displacement can result in asymmetric pressure that may deform the femoral head and or acetabulum (also termed acetabular dysplasia). Hip dysplasia may lead to degeneration of articular cartilage and pain25. Problems with limited range of movement and pain can interfere with function, ability to be positioned, hygiene and personal care. In a large subset of children the progressive displacement can develop into dislocation of one or both hips (Cooke et al, 1989).”

For anyone working or caring for young children with Cerebral Palsy and mobility impairment, potential risk groups have been identified and are encouraged to be referred to a hip surveillance program. Seating positioning recommendations for these children is likely to include some abduction for either chair or bed positioning.

One thing a pommel is not is a load bearing surface or a safety stop! When someone does not have the hip flexion ranges to sit with the hips bent at 90 degrees they are likely to “slide” out of the seating as they try to open their hip angle to meet the seat-to-back angle of the seating. I have been involved in cases like this where the support people then ask us to make the seat more ramped – based on the anti-thrust seat concept they may have had as a child or seen others utilising. If they do not have the range to sit in a 90 degree seat-to-back angle, raising the front of the cushion will only make it more difficult to maintain a flexed hip. They will continue to attempt to open this angle by sliding into posterior pelvic tilt (PPT) – see my previous blog for more on that.

If there is a pommel fitted this is often all that is holding the individual in the seating if they don’t have the capacity to bend their hips enough. When doing custom seating I would often have support workers or carers asking for this pommel to be larger as it stopped the user from sliding out. If we are prescribing AT, It is part of our job as a therapist to be able to articulate and educate what the points of control are and how they can benefit someone’s positioning and ultimately their function.

 

             A Dreamline Swing-Down Abductor Pommel

So, what is a pommel? What point of control is it addressing? The purpose of a pommel or leg troughs in a cushion are solely intended to reduce the level of adduction. The ongoing implication for adduction includes instability, increased difficulties with personal care and hygiene tasks, increased pressure risk at the knees and of significant concern, increased risk of posterior hip dislocation especially for those individuals who have never had opportunity of the hip fossa fully developing through walking and weight bearing.

When considering a pommel or a support to decrease adduction, there are several factors to consider. Should it be integrated into the cushion? This is likely to be determined by factors such as transfer style. Should it be removable? What environments is the user in requiring support? Can the support workers easily fit and remove it as required? How high is it? Generally, it does not need to protrude above the user’s thighs. What angulation can be achieved? Can it be adjusted for ongoing needs?

Do you want to know more about product parameters, MAT or functional seated positioning? Permobil offer a range of workshops including practical hands-on learning opportunities, blogs, workshops and webinars. Don’t hesitate to reach out to us for further information! Follow our blog to be the first to find out more details on our 2020 training opportunities which will be released very shortly!

 

Tracee-lee Maginnity