Page 9 - Mobility Management, May/June 2022

the right combination of switches.”
And regarding mini joysticks: “I have had a few people with ALS
[for whom] I’ve used mini joysticks, but I think those tend to be the most beneficial for people who have muscular dystrophy and other conditions that affect distal movement. If the muscles can’t overcome the weight of the arm against gravity, taking a couple of ounces off the amount of effort required to move the joystick isn’t going to make a world of difference. So we normally prescribe a compact joystick with the same effort that the [standard] joystick has. It generally works pretty well.”
What Ice Cubes Can Accomplish
There are big upsides to building adaptable wheelchairs.
“One of the benefits is it’s making an ice cube instead of a snow-
flake, so you can adapt it as the illness progresses,” Mitchell said. “It’s one of the things that’s been really helpful and allows us to serve the needs of veterans better.
“Anytime we provide equipment to a veteran, it’s theirs to keep. But if it’s in good condition and we do get it back, those options that made it easier to configure for their needs also make it easier to reconfigure for another veteran. So we tell our veterans that
up front, and if we do get a chair back that’s in good condition, sometimes we can quickly reconfigure and reissue it, and save the person the time that’s usually required to order something new.”
Keeping It Simple
Mitchell acknowledged that the 80/20 approach doesn’t fit every ALS client. “They’re not all the Cleveland VA custom configuration, these ice cubes that I do,” he said. “We do get people that are going to be exceptions. And then we might go more along the traditional Complex Rehab route, where it’s more like a spinal cord [injury] chair, especially if we know that their condition’s progressing pretty slowly and they’re younger.
“Others who unfortunately progress more rapidly are more urgent as far as giving them something. That’s where reconfigured chairs are helpful. Odds are [ALS is] probably not going to all of a sudden plateau to where their condition’s not going to change.”
While Mitchell’s approach is different from what you might expect for ALS clients, he said his approach is actually simple.
“Even for the 20-percent chairs: Those are going to take a little bit more work, but even then, I’m using mechanical switches,” he said. “I’m not using sensors. I haven’t done a head array in prob- ably 10 years, and I’m getting good outcomes.
“These are really easy solutions. It’s custom, but not that compli- cated. It’s simple. It’s been so rewarding.” m
Editor’s note: Steve Mitchell’s opinions do not constitute an endorsement of any specific product, nor do they represent the official policy or positions of the Department of Veterans Affairs.
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