Page 15 - Mobility Management, June 2019

Configurability & the K0005
Due to the complexity of the typical K0005 user, the ultralight’s ability to adapt is key.
“K0005 chairs should be considered the most configurable manual chairs available,” Roesler said. “Configuration plays a critical role because it allows us to fit the chair to the user, rather than fit the user to the chair.
“Configurability is important, and should not be confused with adjustability. A highly configurable chair may be fixed or adjustable, depending on the needs of the client. It implies that the clinician/supplier will be able to dial in the chair to meet the specific requirements of the user. You will tend to have a wider ranges of sizes, a selection of high-performance options, more adjustment (more options, and smaller increments), fewer compatibility issues with aftermarket seating, and the ability to set the rear wheel position to optimize propulsion efficiency.”
Roesler added, “Some will argue that there is little difference between K0004 and K0005, but the incremental adjustments and ability to get an exact fit can be critical to the user’s long-term function and quality of life.”
Rosen knows the difference that robust configurability can make. She referenced creating a new chair for a long-time K0005 user with a C6 spinal cord injury.
“We weren’t making a bunch of big changes,” she said. “We were giving him a rigid back, and I tweaked a couple of things with his center of gravity, just so he’d be more comfortable.”
Rosen did not expect a huge difference: “I thought he would be able to propel a little bit easier. His real goal was to have a good wheelchair with a solid back.” What both Rosen and her client considered a small change actually had a big impact: “It turns out he could push so well with the center of gravity adjusted that he could get across grass. That had never been a goal of his, but he realized he was propelling so well that he tried it.”
His new ability alarmed his neighbors. “They’d never seen him roll on grass,” Rosen said. “They were panicking and coming over to help, and he said, ‘No, I got this. I can do this now because of this new wheelchair.’ Later, he said he didn’t think of this as a goal because he could never accomplish it before. If you’ve never known what you could do, then you don’t know you’re missing.”
K0005s for Full-Time Users
For consumers with significant mobility-related disabilities, the high level of configurability in a K0005 can be the difference between being independently active and being dependent.
“K0004-classified wheelchairs today — at least those available through third-party reimbursement — offer minimal or no adjustability, or configurability,” said Rita Stanley, VP of Government Relations for Sunrise Medical. “These wheelchairs lack the ability to position the rear wheel, which is critical for full-time manual wheelchair users.”
“From an energy conservation standpoint,” Roesler said, “the evidence is very clear that the ability to optimally configure rear wheel position will maximize propulsion efficiency — decreasing energy cost of propelling the chair, and lowering the risk of repetitive strain. The definition of K0005 also dictates this, and
a K0005 chair tends to have smaller increments (sometimes infinite options) for both vertical and horizontal wheel position.” Time and time again in clinic, Rosen said she has noticed what
can happen when children are in chairs that are not optimally configured.
“I see a lot of clients for the first time who are teenagers with spina bifida,” she said. “They’re in pretty heavy chairs that are K0005s, but were not adjusted for mobility and function. They were really adjusted more for stability, and that limited the kids’ ability to do stuff. And a lot of them have come to my office significantly overweight.
“I feel like it’s because their chairs made them want to be inactive. Moving across the room was work, and going anywhere was work. So if my daily life is work, when I have free time and my choice is to sit on the couch and eat Cheetos or go chase my friends around, I’m going to pick the couch and the Cheetos because that’s easier.”
Because it’s so critical to efficient propulsion, Rosen said she is especially careful about axle position when designing ultralight- weight chairs for kids. She also recommends that axle position
is checked and adjusted when needed as kids get older, “to make sure we keep that axle in that functional position. I feel like the kids that I start in a [well-configured] wheelchair have always felt that it is not limiting. It’s freedom.”
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