Page 16 - Mobility Management, October 2018

ATP Series
Setting Up for Success
clients] are going to need to be in more of a crunch position, more of a seat angle so you can maintain trunk balance. I use 3.5" of difference between front and rear seat-to-floor height. My back angle is just slightly open; it’s probably at about 93°, so it’s pretty straight. I try to lock my pelvis out so it gives me that trunk control.”
Seating: Balance & Control
Ramage’s comments touched on an important factor in deter- mining the success of manual mobility for this client population:
seated balance and control.
“I think as I’ve aged, my posture has changed,” he said, “and I
need to adjust slightly. For instance, I use a solid backrest; I use
a JAY J3 low thoracic back with a 9.5" height. The shell is 9" tall, but it’s set off of the seat rail so from the top of the backrest down to the seat, the measurement is about 13". It’s about 4" from the seat rail to the bottom of the shell.
“I’ve used different types of foam supports inside my back as my posture’s changed, just to accommodate the changes. You’ve got to watch your skin on the back and keep it protected. I’ve
C5-C8 Quadriplegia: Should Manual Mobility Be an Option?
Lower-level cervical spinal cord injuries result in significant functional limitations, though actual function varies from client to client. Still, when shoulder, arm and hand function are impacted — as well as weakness that can make trunk
control and balance an additional challenge —
should power mobility be the first option
considered? Or should the client and the
seating and mobility team consider self-
propelled manual mobility?
A Loaded Question?
Jim Black, Director of Product Management & Marketing for Invacare Corp., indicated that seating and mobility specialists can be split in their opinions.
“I said it was a loaded question,” he
explained, “because some clinicians feel you
can be damaging the body [by using a manual chair]. And we have to look at that.”
So what are the advantages to using a self-propelled chair for a client with C5-C8 quadriplegia?
Brad Ramage, account manager for Sunrise Medical, has used both power and manual mobility since sustaining a C7-8 incom- plete spinal cord injury.
“I used a power chair and a manual chair for a lot of years,” Ramage said. “But the only time I used the power chair was when I was at home. We had a small horse farm, four acres. So I had a power chair set up for outdoors. My son was really big into sports as well, so I was able to use the power chair at home, in the yard, to get a lot of things outdoors done quicker.”
Josh Anderson, VP of Permobil, has successfully used an ultra- lightweight manual chair for decades, even with a higher-level (C5-6 incomplete) injury.
“Being in a manual chair, there’s the perception that you’re less disabled,” he said. “I do think that there’s compromise. I can’t push through a field of grass because I’ll just expend all of my energy, unlike a para[plegic]. I do feel like there’s a lot of benefits, too. Like the ability to drive a car. I may not be able to go up the steepest hill on my own or down the steepest hill on my own. If
I had a power chair, I could manage all of that. I may not be able to reach everything, because I don’t have a seat elevator. But with my manual chair, I can load it in and out of a car, and that’s
in large part due to the fact that it’s super lightweight, and it fits me to a T, so there’s no extra material I’m having to negotiate when loading it in and out of the vehicle. Yet, I’m not compromising my seated position, either.”
The Best of Both Worlds
Black suggests the best answer to the ques- tion of power vs. manual might be yes.
“I think our industry should allow some- body of that disability level to have both,” he said. “I know that’s controversial, but I really believe that with a SmartDrive or e-motion [power-assist system] — if I have a perfectly
set-up product and I put those devices on there — I’m going to be even more efficient. For longer distances, we all need those, para or quad[riplegics]. But for quads, to go to their kids’ soccer games, they need power to go through five soccer fields to watch their kids play. I think you should have both, but that doesn’t take away from the [importance] of proper fit and the proper setup [for the ultralightweight chair].
“If I put somebody in an e-motion wheel and I maximize where that wheel is, and then I extend the front end so the casters don’t dig in — I would give them the opportunity, absolutely.”
Accessibility and perception might be among the primary reasons to consider self-propulsion. Anderson pointed out that with his optimally fitted ultralight chair, he’s often capable of boarding planes without using an aisle chair, if his seat is near the entrance. And Black pointed out the advantage of a wheelchair that doesn’t need to be transported in an accessible vehicle, using a teenager as an example.
“If you can take the chair apart and put it into the car, this kid can live a normal life, instead of always having to be dropped off by his parents in their van. It creates a lot more accessibility in the world. I just know that being included in everything is very important for anybody with a disability.” m
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