DME

Blog posts of '2019' 'September'

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.    

 

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. 

 

Rachel