Page 14 - Mobility Management, April/May 2020

ATP Series
Prosthetics & Mobility
Limb loss means less ability to manage body temperature via sweating, as clients have a smaller overall skin surface area. Sunrise Medical recently began offering the JAY Fluid cushion with Cryo Technology, which aims to prevent pressure injuries and cool the patient’s skin for up to eight hours.
Overheating is a constant issue for a Sunrise Medical client named Gabe, born without upper or lower extremities.
“He gets so hot so quickly, so he needs to make sure whatever his seating is made out of is breathable, because his temperature instability is crazy,” Kiger said. “It’s not just what’s in the material as far as what’s inside the seating support, but it’s also: Is there a way to cool the person?”
Customizing Power Systems for Protheses
Holbert, a proponent of ultralightweight manual chairs that allow him to travel and more efficiently get in and out of a vehicle, has the upper-body strength to propel himself forward, and prefers it that way. While power chairs may also be the choice for limb loss clients, Kiger said the focus is on the functional abilities of the client and their priorities.
“I had one young man that I met that said his therapist had tried for years to push him toward a power chair and he said: ‘I don’t want it. I want to be able to go into the city streets and hang out with my buddies. If I get a power chair, I’m actually slower,’” she said. “With kiddos, they just want to get out and play and interact as fast as possible.”
But most limb loss clients do require a power chair system, whether it’s due to age, strength levels or their ability to use their extremities, said Tiskus of Motion Concepts. CRT companies already offer devices and customizations that can increase independence for clients while using the chair and when transferring in and out of it.
“The reality is, depending on the age of the patient, our bodies were never meant to do that type of repetitive motion, coupled with the patient’s body weight, coupled with the weight of a manual chair, even the lightweight wheelchairs,” Tiskus said. “We tend to gravitate more towards power chairs to save their shoulder joints so they still have the ability to do activities of daily living with their upper extremities, and reduce the amount of fatigue that they experience.”
The power chair systems they use are dependent on what type of prostheses they use, and how much dexterity they have with the prosthetic limbs, he said.
“If they have limited dexterity, there’s different types of switches, different types of specialty input devices like head arrays or chin booms,” Tiskus said. “We have a power chin boom, a separate switch wherever it makes sense to mount it, that allows them to independently adjust height and swing the device out of the way when they need it to for transfers or to have a conversation without the joystick in front of them.”
Independent transfers can also be difficult without the help of a customized power system, according to Tiskus. His company offers a power-down transfer arm for lateral transfers, as it can be hard for someone with non-functional extremities to scoot off a
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slide board to transfer out of their chair.
“It’s very difficult for somebody with no use of their upper
extremities to position a slide board and make sure it’s in an appro- priate position for their specific needs,” Tiskus said. “The system is mounted directly on a dual-post armrest, they hit a switch, and this will actually power down and convert them to a transfer support system, such as a modified slide board that can be padded, solid, gels.”
One product that Tiskus has seen consistently help limb loss clients is the vertical platform lift, an elevator in the front part of the seating system that can allow somebody to shift body weight as they come forward out of the chair.
“From there, they have the ability to hit whatever switch makes sense for them that they can access that will lower them to the ground and then they can scoot forward,” Tiskus said. “It allows for safe transfers from the floor to the seat and back and vice versa.”
Evaluating What CRT Can Offer
There is no lack of solutions for people with limb loss. But ampu- tees and clients with congenital limb loss can certainly benefit from ATPs and other CRT professionals evaluating how they can better cater to this patient population.
Kiger said the CRT team should remember small aspects of a mobility system that can make clients’ lives more comfortable, such as putting in a piece on chairs for residual limbs.
“If they don’t have their prosthetic on or do not have a prosthetic, it’s uncomfortable from a pressure standpoint, depending on where the limb was amputated, for it to be hanging there,” Kiger said. “Sometimes people don’t think to add that extra component to support it. If you’ve got your prosthetics on, in theory, they would be able to use the footplate. But if you don’t have it on at that point, it could be uncomfortable.”
Other solutions can be considered for pressure management as well. Beyond traditional tilt and recline systems and lateral tilt systems for clients who cannot tolerate a full range of redistribu- tion, Tiskus has seen anterior (forward) tilt work well for clients with lower-extremity amputations.
“We worked with several patients who have lower-extremity limb loss, and they have the ability to independently put on and take off those prosthetic limbs,” Tiskus said. “They just need to be in a position more anterior to allow them to access the prosthetic limb and be able to take it on and off and then help transition from that seated to a standing position.”
Motion Concepts’ UpFront system allows for up to 45° of anterior tilt, reflecting a growing trend among manufacturers that are increasingly offering forward tilt. Tiskus noted that anterior tilt appears under-utilized, and clients could immediately benefit from its broad adoption.
“I’d love to see people taking a closer look at this because those systems can really make a difference to give a greater level of independence to somebody, especially for sit-to-stand transfers,” Tiskus said. “Hopefully with more exposure, with more manu- facturers making products like this, it will open a door and give greater levels of independence for these individuals.” m
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