DME

Blog posts of '2020' 'July'

Smart Actuators – What are they and what do they do?   


Actuators are used on power wheelchairs to make the seat move – so it is an actuator that makes a seat move back into tilt, or the back support recline, or the leg supports elevate.  A smart actuator is an actuator that has a sensor attached to it, allowing it to sense its position in space.  A smart actuator is able to sense its position at any point between being fully retracted or fully extended, or for example whether the seat is in no tilt, or in 15 degrees of tilt, or 45 degrees, as opposed to being in no tilt, or full tilt.  These sensors are also linked to the specific actuator, so use of another actuator will not interfere with the information it provides, for example the use of power recline will not interfere with the tilt actuator knowing how much tilt it is in.

Why are smart actuators useful?  Smart actuators allow for very specific programming of power seat functions, taking the guess work out of using these functions and making them easier for the end user to manage.   For some users, smart actuators can be the difference between successfully managing the power functions on their chair (and hence maximising their independence) and the chair being too complex, and an alternative solution being required.

Smart actuators allow for limits to be placed on how a power seat function moves, so a tilt or recline actuator can be limited on how far it will allow the seat to move back, or the leg supports limited as to how high they can elevate.  Restricting how a power seat function moves can be helpful when a person requires a power seat function for a particular purpose, however there are risks associated with this function if they use it outside a particular range.  For example a person may require the use of power recline to assist with pressure relief, however too much recline can create issues with reflux after meals. 

The Corpus VS power articulating leg supports are another example of when restricting actuator movement is useful.  These leg supports offer 8” of vertical travel, meaning they can be programmed to lower the footplate to the floor for ease of transfers.  Without the smart actuator, a person needs to be able to judge when the footplate has reached the floor, if they don’t lower the footplate far enough, their safety may be compromised with having a small lip to manage, or if they lower the footplate too low, trying to push it through the floor, there is risk to damage to the actuator with potential risk of early failure.  The smart actuator allows the leg support actuator to be programmed to stop when the footplate reaches the floor, promoting a safe transfer and preventing damage to the actuator.

On the Permobil chairs, the smart actuators allow for programming of both memory seat functions and Independent Positioning Mode through the Intelligent Control System (ICS).  Both programming functions allow for a user to access a particular seated position through the use of one switch or button, even though the position may require use of multiple power functions to achieve.

Independent Repositioning Mode, or IRM, is use of specific power seat functions programmed to move in a sequential order, with each seat function moving to the desired angle before the next function starts to move.  IRM utilises power tilt, power elevating leg supports and power recline sequentially, with varying angles able to be programmed depending on the users needs.  This feature is typically used for those who have high pressure relief needs where it is vital that power tilt is used before power recline to maintain the persons posture in the seat.  Use of IRM means that a user does not need to remember which sequence to use the power functions in, where they are taken through the required sequence with use of a single switch or button. 

Memory seating is similar in that multiple power seat functions are involved, however slightly different in that the actuators move simultaneously, the idea being to move a person into their desired position as quickly as possible.  Memory seating has more varied uses, from setting of a ‘home’ position which can be the users preferred sitting position, to positioning for transfers and function.  For some users they have a particular position that allows them to transfer in/out of their chair independently, or a position that allows them maximum function at a work station, these are positions that can be programmed into the chair, allowing the user to move in and out of these multiple times per day with ease. 

For more information on Independent Repositioning Mode or Memory Seating, on our Permobil chairs, please contact sales.nz@permobil.com  


Rachel Maher

Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and later gained her Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.  

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service, working with children aged 0 to 16 years.   

Rachel later moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.   

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

 

 

Funding Considerations for Power Standing  


Power wheelchairs that offer the option of power standing have several physiological and functional benefits, however accessing funding for these chairs can be challenging.  Funders are keen to fund the most cost-effective option, in many instances this is provision of a separate power wheelchair and standing frame.

Having two separate solutions may work well for some, particularly for those who are unable to manage the complexities of a power stand up chair or those who have a well-established routine in place with a standing frame.  However, for others having a two separate solutions may not be ideal, in this blog I am going to focus on two common examples.

For many teenagers or young adults, regular use of a standing frame can become challenging due to a variety of reasons – it may no longer fit well into the school routine, transfers in/out of the standing frame may be challenging, or the limited mobility while in the standing frame, and often time away from their peers, creates issues with compliance.  This can result in limited opportunities for standing and weight bearing at a time when they are moving through puberty and a rapid period of growth.  

For some of these young adults, there is potential to demonstrate how provision of a power stand up chair can be cost effective, often through demonstrating the potential to reduce carer support hours and with functional gains leading to increased independence.  If a young adult has, or may soon need, carer support hours to assist with transferring in/out of their standing frame, these are hours that are no longer needed with a power stand up chair.  A young adult also has the potential to increase their independence with access to power standing, particularly if they have reasonable hand function.  Provision of a power stand up chair may mean that a teenager or young adult can come home from school independently, being able to access their home and food from the pantry or fridge and have independence at home without needing their parents or a carer.  Some teenagers or young adults, particularly males, may also be able to use the toilet independently with use of power standing, further increasing their ability to be at home or school without support.  A power wheelchair with power standing often results in increased function, or reduced need for support, at school, typically in science and technology subjects.  Science and technology are subjects that are typically undertaken at raised tables or in an environment where a person is standing, making access to these subjects from a wheelchair more challenging.  Use of power standing can reduce the need for environmental modifications and a person may be able to participate in these subjects alongside their peers.

Another group of wheelchair users where access to power standing can often be easily justified are those with conditions that create increased tone in their lower limbs, limiting their ability to stand and walk.  For this group, regular standing or weight bearing often assists with managing their increased tone, prolonging their ability to stand transfer.  For many their ability to stand independently declines over time, and a standing frame may be considered, however independent transfers in/out of the standing frame may also be an issue.  For these people access to power standing can result in a reduction in the number of carer support hours required – in the short term as assistance is not required to manage a standing frame, and potentially in the medium term as independent transfers are maintained for longer.  Further cost benefits may occur if use of power standing maintains a person’s independence with activities of daily living at home and/or reduces the need for modifications to their environment. 

When completing funding requests for a power wheelchair with power standing, a person’s goals is often the best place to start – particularly those that are likely to maintain or increase their independence.  These goals can be complemented with information on their carer support package – and how this may change if the goals are achieved.  For those who were previously had some mobility on their feet, provision of power standing may allow a person to remain living at home independently or with minimal support, while for some teenagers and young adults, there can be a significant reduction in carer support hours, or reduced reliance on family, with provision of power standing due to an increase in functional abilities and the resulting independence it gives them.  This ability to maintain a current support package, or potentially reduce the number of carer support hours required, can be an objective way of demonstrating to the funders that a power wheelchair with power standing is a cost-effective option.

For more information on power standing on our Permobil chairs, please contact Sales.NZ@permobil.com

If you are wanting to know more about prescribing power standing, please join us on Thursday 23rd July at 1.30pm for our free webinar.  

To Register   


 

Rachel Maher

Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and later gained her Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.  

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service, working with children aged 0 to 16 years.   

Rachel later moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.   

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

 

ActiveReach – Increasing Vertical AND Horizontal Reach 


Last week we discussed the potential benefits of ActiveHeight, a feature that can increase functional independence for many, however for some, horizontal reach continues to be an issue.  Horizontal reach can be challenging for those with limited trunk control, it may be a person has difficulty reaching forward from their wheelchair seat, or they have limited rotation for when they need to access a surface side on.  Some of these users continue to have reasonable hand function and could increase their functional independence if they have a means of reaching forward to allow functional use of their hands – which brings us to ActiveReach.

ActiveReach incorporates the use of anterior tilt to bring a person up and forward, this can be further complemented by additional power functions to optimise positioning, depending on the amount of ActiveReach required.  ActiveReach allows a person to increase their functional reach by 3” for every 10 degrees of ActiveReach used, with a maximum of 45 degrees of ActiveReach available on the F5. 

The use of the modified Functional Reach Test can be a means of assessing whether a person may benefit from, or the functional reach gained from, using ActiveReach.  Use of the modified Functional Reach Test can complement functional goals identified by the person, for example a person may identify that they are having difficulty preparing a meal on the stove top as they have difficulty reaching forward to safely stir the food in the pot, or to use utensils to serve the food they have prepared.  The modified Functional Reach Test can be used to confirm that the person has limited functional reach, and to show that their functional reach has increased during a trial.

ActiveReach and Active Height can also be used together to allow a person to reach into overhead cupboards, with ActiveReach further increasing a person’s vertical height, as the anterior tilt component of ActiveReach will lift the rear of the seat providing additional height.  This combination of functions can be useful for those who have limited shoulder range of movement and are needing additional height to access unmodified environments, for example reaching items on a shelf at the supermarket.

ActiveReach can also be used to assist with standing transfers.  Some users have difficulty initiating a sit to stand, particularly if they are unable to move forward on their seat to allow their feet to be placed slightly behind their knees.  Use of ActiveReach can place a person in a position that allows for ease of moving from sitting to standing, potentially maintaining an independent or assisted stand transfer.  Maintaining this transfer can be important for those who are active in the community or wish to minimise their carer support requirements.

Maintaining independent transfers is further promoted by use of the powered foot support, this foot support is the same one used on the F5VS (Power standing) that allows for a change in vertical height in the footplate, potentially allowing a footplate to be lowered to the floor to allow for ease of standing transfers.

The combination of power seat functions used in ActiveReach is complex, however use of ActiveReach can be made easy for the end user by using smart actuators.  The smart actuators on the Permobil chairs allows for the desired ActiveReach position to be programmed into the chair, allowing a person to move to this position by use of a button or switch.  This means that the user does not need to remember what sequence to use the power functions in, or where each function needs to be positioned to, for successful use of ActiveReach.

For more information on ActiveReach on our Permobil chairs, please contact sales.nz@permobil.com  Our Customer Service team will direct your enquiry to the relevant Territory Sales Manager for your region.

If you are wanting to know more about prescribing ActiveReach, please join us on Thursday 23rd July at 1.30pm for our free webinar.  

To Register 


 

 

Rachel Maher
Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and later gained her Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.   

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service, working with children aged 0 to 16 years.  

Rachel later moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.  

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

 

 

 

 

Power Seat Elevation - Desirable or Essential?


This week the spotlight is on power seat elevation, also known as power elevating seat or hi-low.  Power seat elevation is a powered seat function that raises and lowers the seat, to provide a varying amount of vertical seat to floor height. It does not change the seated angles of the seat relative to the ground.

 

Power seat elevate is a power wheelchair seat function that can increase the quality of life for an end user, however it is often a seating function that funders consider ‘desirable’ as opposed to ‘essential’.

For many of our users, we can justify to the funder how power seat elevation is essential to maximise an end user’s independence, often to facilitate independent transfers or increase a person’s vertical reach.  Power seat elevation allows the user to adjust the height of their seat to optimise transfers, either by raising the seat to floor height to allow for ease of standing transfer, or to allow the seat to floor height of the power wheelchair to be set just higher than the surface they are transferring to, for ease of use of a transfer board.

Power seat elevation also allows a person to increase their seat to floor height to increase their vertical reach, allowing them to reach items such as a light switch or items in a cupboard that may otherwise be beyond their reach.

RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) have recently updated their Position Paper on the Application of Seat Elevation Devices for Wheelchair Users.  For those new to the RESNA Position Papers, these papers summarise current research and best practice trends for a variety of topics.  The 2019 update on the use of power seat elevate provides additional insight on where power seat elevate may be beneficial, or perhaps even essential, for end users.

A person is typically prescribed a power wheelchair as they do not have sufficient upper limb function or endurance to achieve all day independent mobility in a manual wheelchair, hence are more likely to have issues with upper limb function and/or fatigue. 

A person seated in a power wheelchair is typically positioned at a lower level than their standing peers, which forces a wheelchair user to maintain an upward gaze to achieve eye contact.  This can result in a person sitting in increased cervical extension for prolonged periods of time, this posture can be uncomfortable for any person, and can ultimately lead to pain.  For those who have an increased thoracic kyphosis, their posture may result in them sitting in a degree of cervical extensional already, hence they may not have sufficient range of movement to allow them to make eye contact with a person in standing.

Use of power tilt can assist with improving eye contact for some users, however this may not be ideal for others who have good upper limb function and need to be positioned upright to maximise their independence.

Many wheelchair users are also living and working in environments that are designed for a person who is standing and walking, for example kitchen bench and cupboard heights are typically set for a person in standing, as are light switches and elevator buttons.

A wheelchair user may have sufficient range of movement to access these environments, however this often results in them reaching above their head, hence using their shoulders towards their end range of movement frequently throughout a day, which can also result in pain and fatigue.

When considering whether to request power seat elevation on a chair, we perhaps need to consider the frequency and duration that a person needs to undertake overhead activities and the potential impact of this over a length of time.  It may be that transitioning a person to power mobility may resolve any shoulder pain that was caused by self-propelling, however a person may still experience pain if they are needing to reach overhead a number of times each day as part of maintaining their independence at home or work.

So how much seat elevation can we get on a chair?  The amount of seat elevation available varies between 8 and 14 inches, and how this is achieved varies from chair to chair.  Power seat elevation on the Permobil chairs is referred to as ActiveHeight, this allows 12” of seat elevate on the Permobil F3 and M3 and 14” on the F5 and M5.

In addition to elevate, the seat also moves back over the base by 3.5” to allow maximum stability while driving the chair in an elevated position. This stability is important for users who may be using ActiveHeight outdoors or for extended periods during the day.

For more information on ActiveHeight on our Permobil chairs, please contact us at sales.nz@permobil.com or call 0800 115 222.

If you are new to prescribing power seat functions or want to know more, please join us on our webinar this Thursday 9th July at 1.30pm.

For further information on the RESNA position papers, follow the link here 


  

 

Rachel Maher
Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and later gained her Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.  

Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service, working with children aged 0 to 16 years. 

Rachel later moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes. 

Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.