DME

Blog posts of '2020' 'June'

Where is the Drive Wheel and Why Does it Matter? 


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, we will focus on front-wheel drive.

Front-Wheel Drive

The front-wheel drive power wheelchair is typically going to be good for manoeuvrability 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 ploughing 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:

  • Hug the corner. When going through a doorway the end-user will want to “hug” the corner or keep a tight turn.
  • 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 manoeuvre 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.

Interested in learning more about drive wheel configuration? Join our Clinical Education Specialist, Rachel Maher this Thursday June 25th at 2.00pm for our free webinar.

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Rachel Fabiniak

Director of Clinical Education

 

 

Seating Assessment Form


As part of our recent seating assessment webinar series, we were excited to release our seating assessment form for prescribing therapists as both electronic fillable and print versions. This assessment form was developed in response to multiple requests from therapists and service providers.

Due to the wide variety of our end user seating needs, we have tried to make it as holistic as possible. As such, therapists working with more complex needs may need to add additional information and those working with less complex needs may opt to use only certain portions.

Likewise, if you are working with specific populations you may want to add some more specific questions into your assessment process. If you missed our seating assessment series repeats and would like to view those webinars, don’t fret! Just send us an email to express interest for a repeat of this series again at education.au@permobil.com.


Prior to a Seating Assessment

A well-structured and completed seating assessment along with a MAT evaluation can lead to better and more timely outcomes for end users. Being prepared before you book a seating assessment can assist you with the process from start to finish. What is the referral for? Does the end user meet the eligibility criteria for the local funding source? As a prescribing therapist, would this referral be within your scope of practice? Do you have the skills to take it on? If not, have you identified appropriate supervision and mentoring to support the process?

These are some of the initial questions we need to be asking when a client is referred to us. This may require further communication with the referrer or with the end user. Add as much information from the referral into the form before you go to the trial and be sure to confirm with the user if it’s correct. This will assist in you being more conscious of the clients’ needs and the types of questions you can ask to ensure you are getting the appropriate information.


Historical knowledge and the Interview

As with any assessment we need to be documenting the information we gather and remember that it contains sensitive and private data. Systematic documentation within an assessment not only assists with the clinical reasoning process but is also crucial information when it comes to writing the justification and articulating your clinical reasoning.

With the vast amount of information we use in the clinical reasoning process, an assessment form can assist in gathering the information you need when you come to identifying potential trial options and writing the funding justification. You don’t always have to ask the same questions or all of the questions. An assessment form can also cue you about additional information that could be important and relevant to the clinical reasoning process.


The Seating Assessment

Our seating assessment form uses the ICF model criteria to enable a holistic overview of the users needs. It is important to gain rapport and trust as an assessor and to work with the end user and their supports to get best outcomes. What is the user’s mobility goals? Postural Goals? Functional goals? What can they achieve with current equipment, what can they not do now that they want to be able to do in their next chair?

Documentation including measurements of current seating setup and mobility base can also assist in both the funding application and in identification of potential trial option configurations.


MAT Assessment

The Mechanical Assessment Tool is a crucial part of the seating assessment process as it identifies the capacity of positioning based on bio-mechanical and physiological principles. For more information on the MAT you can check out our previous blog on MAT assessment or contact us at Education.au@permobil.com especially if you’re interested in our ongoing MAT training opportunities.


Bringing it all together

Your seating and mobility assessment should guide you through the process and collect information that leads you to potential product parameters for your clients. Once identified, these parameters can be used to identify potential trial options. Sometimes we can rule out certain products based on the assessment and needs but the only way we can ensure a solution will meet a user’s needs is to complete a trial.

Ideally, a trial should always be completed within the environment of intended use. Make the most of the trial opportunities. If you are adding a specific feature to a chair because you think the user would benefit from it, then include the task in the trial and document how the task is now achievable.


When you attend the trial remember to review the assessment info before you go or better yet, have it with you so you can check that the configuration matches what you identified and document any crucial changes based on the trial. With these tips in mind, a seating assessment can be both thorough and practical!

Our education team is always available to discuss clinical matters and potential options to support you through the process, so don’t hesitate to reach out!


Tracee-Lee Maginnity
Clinical Education Specialist

Weight or Configuration: Which one is more important for a manual wheelchair?


When discussing manual wheelchairs, we often focus on the idea of having the lightest weight wheelchair possible. Yes, weight can be an important factor when we think about propelling a manual wheelchair all day. We also have to consider where the weight in the system is coming from. I said system here because it is not just the frame of the wheelchair that we should focus on when discussing weight. We also need to consider the weight of the components such as the wheels, backrest, cushion, etc… and the weight of the user!

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. 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. Therefore, weight is important, but what is even more important is the configuration. The configuration of the chair and how the person is configured to the wheelchair can be more impactful than just getting the lightest weight manual wheelchair.

Let’s think about those big hospital wheelchairs and how hard they are to push. This is because of the weight to an extent, but it is also because they are not properly fitted to us. They are meant to be a one-size fits all. What happens when we think about wheelchairs as one size fits all? Have you ever just sat in a wheelchair that is not fitted to you and propelled? Most of us in the industry have, but how many pushes did we complete? 10? 20? Did we propel on a smooth, flat, indoor surface? Then we maybe got up out of this poorly fitted wheelchair after 20 pushes on a flat surface and we think “well that wasn’t too hard”. Now, let’s take a step back and think about our client. Is our client only pushing 20 pushes a day? Are they always on level surfaces? Do they have fully innervated and strong shoulders like you do? How about their posture in the wheelchair and how it affects the position and movement of their shoulder? What about pain? Are they only propelling a few times a year or are they planning to propel every day for the next 20 years? It can be easy for someone to trial a poorly fitted wheelchair in a perfect environment, but we have to consider the individual, their environment, and their long-term goals. 

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”. Let’s think about this idea – Fitting the wheelchair like a prosthetic. What do I mean? We can think about the individuals with amputations that have a prosthetic and how important that perfect fit is. The fit of that prosthetic is crucial in the success of the individual’s mobility. 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. They may be forced to be in bed or sit in that recliner in the corner because of these challenges with a poorly fitted prosthetic. The same holds true for a manual wheelchair user. 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 help to limit the risk of shoulder injury – the wheelchair should be fully customised to the individual. It should be fitted just in the same way that a prosthetic is fitted to an individual. This means that we can’t always just have a wheelchair that is out of a box and then custom configured to add the components that we need, but instead the wheelchair should be custom built to the individual.

If you're interested in hearing more about achieving this custom fit join our LIVE webinar on June 11th at 2.00pm  on TiFit: How to achieve a tailored fit for every individual to learn more.  

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Common Concerns About Early Power Mobility Devices

Part 12 - The last part in our series about developmental milestones in early childhood focusing on mobility.  


Perhaps one of the mostly widely known authors on this topic are Wiart and Darrah from an article published in 2002 entitled “Changing philosophical perspectives on the management of children with physical disabilities: Their effect on the use of powered mobility.” The authors highlight the paradigm shift that occurred around that time frame and that several factors contributed to the new philosophy.

Two very important political changes occurred

1. Change the language

In 2001 the World Health Organization (WHO) changed the language associated with people with illnesses or conditions. Before this, terms such as handicapped, disabled, or abnormal were used to describe people. This language attributed the physical condition as something “wrong with the person”. Additionally, passing of the Americans with Disabilities Act (ADA) in 1990 contributed to the conversation of how to characterize disabilities. The ADA admitted that the concern was with the environment. If ramps were used instead of stairs the person using a wheelchair could “participate” in activities of their choice.

2. Providing access 

In conjunction, the new WHO model; the International Classification of Functioning, Disability and Health (ICF) describes functioning using two components

  1. Body structure and function, and
  2. Activities and participation

Taken together they ascribe that a person may have a disability but it is the lack of access (stairs in this example) that “handicap” the person. Therefore, changing the environment allows access to the environment. 

So, what does this have to do with wheelchairs? According to the ICF a wheelchair is part of the environment. The reason infants and young children have difficulty with environmental exploration is because there has not been a suitable wheeled mobility device for many young children with disabilities until the Explorer Mini by Permobil was developed.  


The Importance of Perception 

Caregivers, and clinicians have been reluctant to recommend or accept a wheelchair as it may be seen as a “last resort”, a failure, a sign of a disability (2). In fact, the disability is not having access to one’s environment! This is particularly troubling for infants who need environmental exploration to learn, play, socialize and find who they are in their world. Not having access to a properly fitted mobility device is the handicap. 

Six mothers participated in an in-depth interview regarding the use of power mobility (2). In this study, all mothers stated that their child demonstrated increased independence and personal control. Further stating that the increase in independence enabled their children to engage in meaningful life experiences (2). Finally, the mothers in this study also noted that peers and strangers reacted positively to the child, seeing the child rather than a device and realizing that the child was more capable than what the person expected. The child’s ability to engage with other children allowed the child to develop friendships and be involved in activities at their age level. 


Where we are today with early mobility devices 

Nearly 2 decades have passed since this new paradigm shift has occurred so why have we not adequately addressed the needs of infants and young children. Why might we still be resistant to accepting a new mobility device for infants and young children. I would ask you to consider this: the evidence clearly demonstrates that the ability to access one’s environment allows one to participate in life events. For infants, it contributes to learning and growing. Perhaps in the next few years we will have your stories of how mobility changed your child and your family. 


1.Wiart, L. & Darrah, J. (2002) Changing philosophical perspectives on the management of children with physical disabilities: Their effect on the use of powered mobility.  Disability and Rehabilitation, Vol 24. No.9, 492-498.

2.Wiart, L., Darrah, J., Hollis, V., Cook, A., & May, L. (2004). Mothers’ perceptions of their children’s use of powered mobility. Physical and Occupational Therapy in Pediatrics, Vol 24 (4). Doi:10.1300/J006v24n04_02

3.World Health Organization ICF. International Classification of Functioning, Disability and Health. Geneva: World Health Organization, 2001


 

1.Wiart, L. & Darrah, J. (2002) Changing philosophical perspectives on the management of children with physical disabilities: Their effect on the use of powered mobility.  Disability and Rehabilitation, Vol 24. No.9, 492-498.

2.Wiart, L., Darrah, J., Hollis, V., Cook, A., & May, L. (2004). Mothers’ perceptions of their children’s use of powered mobility. Physical and Occupational Therapy in Pediatrics, Vol 24 (4). Doi:10.1300/J006v24n04_02

3.World Health Organization ICF. International Classification of Functioning, Disability and Health. Geneva: World Health Organization, 2001