Page 21 - Mobility Management, August 2017

as carbon fiber provides a positive strength-to-weight ratio. New designs providing a higher degree of breathability to dissipate heat and moisture away from the client are being utilized. Incorporating modularity, or the ability to quickly configure and modify components, expands our capability to manage change in condition over the course of the product use.
Jeff Rogers: When we launched this product [Sunrise’s new JAY J3 HV back with adjustable microclimate], we didn’t want to sacrifice adjustability, how the back functions, how it worked and how it interacts with the customer. Weight was definitely a big consideration. As you look at the more high-end types of wheel- chairs in the market today, that’s the buzzword with every one of them: How much does it weigh, what’s its transport weight?
For this system, we saw an advantage for people with certain diagnoses who may have a tendency to present a certain way. Someone with multiple sclerosis has a tendency to have a hard time controlling their core body temperature. Same thing with a spinal cord injury. And we saw that need. That’s where we went with this. We truly saw a need out there, and if some [consumers] are able to pay for this, then great — let’s provide it and see how it goes, see how it evolves. If we can help this get rolling and our competitors start doing the same, I think it’s great. I think it’s providing a solution to a problem for our customers.
Q: What Should the Assessment Accomplish?
MM: When a seating team is trying to determine the ideal backrest for a wheelchair user, what factors should they consider? What questions should they ask of the wheelchair consumer?
Suzanne Eason: The client and their family are the first and most important consideration. Next is how much control the client has posturally. How much support they need and if their trunk can be aligned well or if they cannot be aligned well, what and how do they need to be accommodated specifically to see, breathe and interact with their environment.
Cindi Petito: The first factor a seating team should assess is does the client have any spinal or postural deformities? How much, if any, correction do you want to accomplish with the back, or do you want to accommodate?
I also assess pelvic positioning — do you need support through the back to support the PSIS to bring the pelvis position into neutral? Do you need to provide any pelvic positioning through the backrest?
Considering heat and skin integrity and any bony spinal prom- inences is very important. Do you want scapular support, or does the client need their scapulas free for upper-body function, such as propelling a wheelchair? Do they need lateral trunk support?
These are all important questions for the postural seating team to consider and ultimately determine the choice of backrest between aftermarket, aftermarket that can be customized, or a custom modular back that can be modified to meet the indi- vidual complex needs of the client.
Scott Brown: When determining the proper back support for your client, there are numerous considerations, which may
include but are not limited to:
— What did they like/dislike about their previous back support? — What level of positioning support is needed (e.g., back
height, depth of contour, etc.)?
— Are we trying to correct a postural asymmetry or accommo-
date for a fixed deformity? This may determine whether a custom back is required or whether a pre-fabricated option is appropriate. — Are lateral thoracic supports integrated into the design, or
can they be added?
— Daily activities: What does their normal day look like?
This can allow us to match the proper back design to maximize functional ability.
— What type of mobility device do they use, how adjustable is the seat depth, back angle, etc.? This may steer us toward different hardware attachment styles and variations.
— How important is the weight of the back support? If the client is in an ultralight wheelchair, we may want to consider carbon fiber as a material option to minimize added weight to the chair.
— How is the individual transported? Do they require a trans- port-certified back support?
— Do they fold their chair, and if so, do they need a removable back so they can fold the frame?
— How does the individual transfer in and out of their mobility device? This will be impacted by the type of lateral support introduced (e.g., integrated laterals may require a different type of transfer method than swing-away laterals).
— Do they have issues with heat buildup? Do we need to maximize breathability?
— Is a caregiver involved, and what is their level of involve- ment? This can often be a determining factor in the type of hardware selected for that individual.
— How much change in condition is anticipated? This may speak to the adaptability required in a back support.
Jeff Rogers: Is there one single question you can ask? No, I think [the assessment] just gets a little easier and comes with time.
But you can try to understand more about their environment and understand what they do. If you have someone that’s trans- ferring on a daily basis and it’s problematic when something is confining them, you’re probably not going to want to do a deep backrest that really wraps around the body. You probably want to do swingaway laterals.
You’re going to try to understand what their day-to-day life looks like to help understand what back would suit them the best. And having that adjustability already in the back is going to help a lot so regardless of how close you get it, you know you can tweak it in the field. m
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