Page 28 - Mobility Management, March 2019

ATP Series
Fighting Fatigue
exhaustion, just a level of tiredness. They’re not able to do as much during the course of the day as they would like.”
Sayre, who has worked in long-term care settings, saw plenty of clients who looked properly positioned perhaps early in the day, but not later. “You’d start someone in one position, and they looked great,” she said. “Then I’d be walking down the hallway [later] and see them and think, ‘Oh my gosh, what’s going on here?’, whether it’s from medication or natural activity during the day. [Staffers] wouldn’t always get them back to their beds, so they’d be in their chairs, trying to sleep because they’re fatiguing.”
“Fatigue can impact their independence,” Wenzel noted. “That’s the biggest thing, their independence in their activities of daily
living, whether it’s their job duties or recreational activities. So it can impact them on an independence level and on a social level.”
Fatigue in Self-Propelling Wheelchair Users
Ultralightweight chair users can experience fatigue if their chairs aren’t optimally fitted and set up to support efficient propulsion.
“It all comes back to stabilizing that pelvis, because if you don’t have that pelvis stabilized, you lose everything else,” Sayre said. “A lot of recently injured [consumers] with paraplegia wear abdominal binders that strengthen their core.”
Sayre also talks to ultralight users about their backrests. “Can we build [support] into the back? We have contour supports we
Preserving Quality of Life When Fatigue Hits
If mobility-related pain for a wheelchair user is a shrieking siren, fatigue is quieter and creeps up on wheelchair users.
Time is precious during mobility assess- ments, and positioning and function get prioritized. Understandably, if a client is sliding feet-first out of her power chair seat, that needs to be addressed.
But what about the physical, mental and social toll that fatigue can take, in a more insidious way?
Having Dinner Together
Jean Sayre, MSOT, ATP, CEAC, is VP, R&D Clinical Development, for Pride Mobility Products Corp. She remembers working with a client at a Veterans Affairs facility who was 20 years post injury with a C7 spinal cord injury.
“He was in a power wheelchair on an
air cushion and they had some complaints about it,” she said of the client and his medical team. “As we were assessing, they said, ‘Is there any other cushion he could have? He needs to have an air cushion,
but he needs support because he’s falling over.’ It was a stability issue.”
But instead of just addressing that problem, Sayre dug deeper. “I always ask them to tell me about their entire day,” she said, explaining how she assesses clients.
She learned that this veteran and his wife had not been able to spend after- noons and evenings together because of his fatigue.
the last three years because he had to
go back and take a nap,” Sayre said. “He would tire from about 4 o’clock in the after- noon and would have to take a nap until 6:30 or 7 p.m. And she was on medication, so she had to eat around 5:30 p.m.”
The cushion Sayre recommended improved his stability, and had a wonderful side effect. “It also kept him from fatiguing. He was not only able to sit upright while he was maneuvering his power chair, but he was able to stay up all day till 7 or 7:30 p.m., and he would then go to bed. It bought him an extra three hours a day, just by changing the surface area to provide him more stability. He wasn’t constantly fighting to stay upright. Fighting to stay upright was just tiring his body all the way through.”
Maintaining Independent Repositioning
Even when physical function has fallen off and fatigue is severe, there are still ways to preserve some independence for a client.
Derek Wenzel, PT, MBA, Account
Manager for Sunrise Medical, has used today’s versatile power chair electronics to do so.
“I recently had a patient who had to push the mode button every single time to get into their powered seating features,” he said. “Quickie Power has an assignable button feature where we could program
a button and all they do is press and hold that button. The chair will perform the assignments we programmed — for this particular person, it was tilt. So they didn’t have to hit mode, get the joystick, toggle through, find tilt, pull back. They could press and hold the speed button down, and the chair starts to tilt.
“If [they’re] doing pressure relief throughout the day, and [getting] really fatigued by having to reach up to get that mode button and toggle through the joystick, that’s where revisiting with the therapist and the ATP is useful. There’s so much that can be done that can really help a patient with fatigue. We can oftentimes reduce the complexity and make it easier.”
Even if driving the power chair isn’t an option, Wenzel said he looks for other options. “I’ve been on trials where I’ve tried every Switch-It component I can, and I couldn’t get them to drive,” he said. “But I was still able to set that chair up
so they could independently hit a switch and reposition themselves when they wanted to during the day. That in itself was life changing for one patient I vividly remember.” m
“They’d never had dinner together for
26 MARCH 2019 | MOBILITY MANAGEMENT MobilityMgmt.com