Powered Wheelchairs- Driving Options

Although the Wheelchair has not significantly changed over the past 10 years, the technology that allows them to operate has.  There is a saying in our company, if a person has any consistent independent movement and the desire, we will get them mobile. 

Even with all the negative pressures in the Medical industry, innovation is no longer limited by the big four wheelchair producers. There are many switch and electronic companies that lead the charge in offering more creative ways to drive powered mobility.  Additionally many universities have gotten involved and have been stretching the options....from using an Ipad, eyegaze and video game controllers to EEG, and Voice Control.

Traditionally the joystick has been used to operate a powered wheelchair. When users could not control a joystick, there was switch control and sip and puff.  Later head control using proximity switches and modified head joysticks.  Modifying a joystick to be mounted on a arm or footrest was common.  In the past decade, fiber optics, magitek, light touch joystick has been used. More recently game controllers (ie PS4 and Xbox) have been converted to allow individuals to drive their powered wheelchairs with these systems. Many of the new technologies that are emerging are adapters, and supports to hold current control devies.

In the past few years, we have seen the Wii balance board used as a input device for children who when lean, can control a powered wheelchair.  Although this is not yet in the market place it certainly offers a wider range of options for those who have limitations in access or those who do not understand movement through space.   We are seeing many universities experiment with EEG as when you communicate and think, the waves are consistent and can be converted into a signal in which to drive a powered wheelchair.  Speech communication has also been used to drive a powered wheelchair.   Most recently, a university has been piercing people's tongues using it as a way to drive a powered wheelchair.

Unfortunately most of these newer technologies have not yet become commercially available or even made it through FDA consideration.  All these technologies are exciting for people who have lost the ability to move independently.  It is truly exciting to see more and more options available which will allow more access and integration.

We are really excited to see people thinking outside the traditional box, and are  looking forward to these new technologies that will enable more people to drive and be independent.

This Article was written by Carey Britton, he can be reached at cbritton@wheelchairguys.com  or at 954-946-5793.

Is it Important to be Certified?

It can be an unconscious decision to entrust someone who is an authority in the field we need assistance from. Whether it is building a house, having a major renovation, having your automobile repaired, having a medical procedure; there is value and peace of mind knowing that your choice is certified and reputable.

You may find it surprising that when it comes to Seating and Mobility equipment; many insurances including local Medicaid's do not require any certification or licensing that the person recommending, and providing the equipment has no certification.  At the time I am writing this, only Medicare and a few Private Insurance carriers require at a minimum an A.T.P. certification.  The ATP (Assistive Technology Provider) is a RESNA certification that requires an individual have some basic experience in DME (Durable Medical Equipment), and who sits for a test.  This certification was established to set a minimum standard to ensure that the person who was involved with the equipment has some experience, and who is requires continuing education. 

As you can imagine, some individuals take this test to gain the minimum standards required by Medicare and never increase their skills as it is not a requirement. Is that enough? There are several people who have been in this industry for decades that have great experience; however when you are looking for an expert, how do you separate a veteran ATP versus one who passed the test last week?

If you are needing basic Seating and Mobility equipment then maybe a newbie can help, but if you are facing challenges; wouldn't you want someone who you can trust? 

The NRRTS organization felt that the ATP was a good starting point, but felt that Seating and Mobility is a specialty and felt there needed to be a higher standard.  NRRTS established the RRTS (Registered Rehab Technology Supplier) which you become after meeting their standards and are listed on a Registry.  After two years of being registered, with no complaints against you, you become a CRTS (Certified Rehab Technology Supplier).  The CRTS has been the gold standard when it comes to finding an expert Seating and Mobility Specialist. 

In the past few years, there is a new SMS certification. This Seating and Mobility Specialist Certification is tested on experience, and was created by RESNA.  This test requires years of experience as there is no manual, or book to read to pass the exam. 

I find it puzzling how if you want compression stockings, only a certified fitter can help you; however with a custom wheelchair with many insurances anyone can fit you for this equipment.  I am happy to see that it is changing, but in my eyes not soon enough. Many lobby that the reason more insurance carriers do not mandate these certifications are that they may not be enough ATPs around.

There was a time where every community had an amazing physician, or an amazing therapist who were the expert in Seating and Mobility; and where the equipment supplier only had to know about their product(s).  Today, with budget cuts, and increased productivity demands; the Physician and Therapist do not have the time or incentive to be the expert. They have higher demands and expectations on the Equipment Supplier for measurement, assessment and recommendation of equipment.

The Equipment Supplier is now suffering from the same budget cuts, and now have a reduced menu of services which depend on the funding source. These insurance pressures are forcing providers to provide what is minimally necessary to maintain a level of profit for the company to ensure their doors can stay open. 

At the end of the day you have to decide who will help you, who will recommend equipment equipment that will affect your life.  The equipment supplier has to make a profit for survival; however your equipment supplier must have your best interests in mind.   The certification(s) are a layer of protection for the consumer, not only for the knowledge and ongoing education.

Not unlike another Medical Professional there is a board that they are accountable for and where their licenses or certifications can be taken away and where it will affect their ability to work. 

This Article was written by Carey J. Britton, ATP/SMS, CRTS with Active Mobility Center. He can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com. Find us on Facebook.

Repetative Strain Injury

This type of injury is becoming more and more prevalent in our society, from carpal tunnel syndrome to shoulder injuries suffered by a growing number of aging individuals in manual wheelchairs. It has always been the stance of medical professionals and insurance carriers to limit the ability of walking impaired to manual wheelchairs as their principle means of mobility. It makes sense that if you are walking impaired, that your calorie burn to intake ration is less, and using a manual wheelchair will help burn more calories, and help keep the user physically fit.

As these clients who were prescribed only manual wheelchairs for their mobility are aging, many are finding themselves having severe pain in the shoulders, which is being diagnosed as repetitive strain injuries. In addition to propelling their wheelchair throughout the day, within their homes, into the community and workplaces; medical professionals are realizing that the human shoulder has limited capacity for these functions.

The movements of pushing a wheelchair, compounded with independent transfers, and daily routines it generally too much for the human shoulder to handle.

It has always been my belief that there is a balance between manual and powered mobility for individuals who are confined to a wheelchair, and dependent for their mobility. From a mobility stance, having the ability to use manual mobility within the home and work place, as the chairs are smaller and more maneuverable is certainly an advantage. Manual wheelchair burn more calories, reducing the potential for excess weight gain; and increases strength allowing for independent transfers. Powered wheelchairs allow a user to travel across greater distances, which put users at risk for repetitive strain injuries.

Repetitive strain injuries can cost funding sources tens of thousands of dollars, not to mention loss of employment to the wheelchair user. This loss could be simply reduced by providing both a manual wheelchair, and powered system to long term users of mobility aids. It would make sense (and reduce costs) by providing this equipment to specific diagnosis; that generally develop these types of injuries.

A possible solution to save money and benefit the wheelchair population, would be to provide both types of equipment; and prompt an education program for potential injury groups to explain the benefits of using both types of equipment; thereby reducing medical care costs, and risk of obesity from inactivity.

This article was provided by Carey Britton, ATP/SMS, CRTS from Active Mobility Center, located in Pompano Beach, FL. He can be reached at 954-946-5793 or cbritton@wheelchairguys.com

Active Mobility Center Knows the Power of Networking

People buy from people they trust, and they need to get to know you before they trust you.  This process makes it difficult for companies who depend on traditional advertising. 

If you have tried print, video, social marketing, networking, and exhibits, I am sure you will have found that networking and exhibits where you are face to face with people increase your odds in building a relationship of trust which will likely recruit more customers.

Many people do not know they are networking every day of their life.  They tell people what they like and what they don't like.  In business, advertising is expensive, and networking can dramatically help increase the number of people that you can explain why you are valuable.

If you have a clear message, and can back up what your promise you will create an amazing word of mouth business. 

This article was written by Carey Britton with Active Mobility Center. He can be reached at 954-946-5793 or at cbritton@wheelchairguys.com

Running Out of the Gate

2014 is here, and things are not slowing down.  Active is looking at the industry as the glass is half full, and where there is great opportunity.  We are seeing many national companies buying up local companies and intimidating the local providers like Walmart.  Insurance is changing, and we are now learning the affects of Obama Care.  There is constant pressure to change, and the staff at Active are embracing this not to ensure survival but to become better.

Over the next few months, our customers and partners will see some major changes. Our office is having some renovations to increase it's display space, increase the retail and accessories available to our customers.  We are improving our inventory management system. A face lift on our website will be completed by February to offer a more friendly site to navigate and access the information.  An event calendar will be added and will show local and regional activies, and events to allow the community more involvement.  You will see a higher level of community visability and involvement. More interaction between our customers and business partners to help us become more valuable to the community and remove any inefficiences. Last but not Least, we will be adding more FUN.  We understand that the Medical Equipment business can be sterile and we want to improve the experience not only for our customers but also for our staff.

We realize change is occuring with or without us, and understand that we need to be ahead of the curve to ensure that we are here for our customers, partners and health care professionals.  We also know that what we do is very personal and that our customer wants a company who listens, who cares, who is local, and who will be there to support and educate them.

Thank you for your continued support. We understand that there is a choice for Medical Equipment and know we have to continue to earn your business and referrals.  Please continue to send in comments or suggestions on how we can continue to improve to be your number 1 choice.

This article was written by Carey J. Britton, ATP/SMS, CRTS from Active Mobility Center. Active Mobility Center, located in Pompano Beach, Florida provides and supports; seating, mobility and specialty rehab equipment.  Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .

New From Permobil 3 G Corpus Seating

Benay and Brad

Permobil's Brad Hannan, was in the house on 09/11/2013 to present on the new 3G Corpus Seating system. Permobil was created back in 1963 by Dr. Per Uddénin in a basement in Sweeden, After massive interest, in 1966 the Permobil company was created. Permobil was founded on their Front Wheel Drive Platform, and now offers chairs in Front, Mid and Rear Wheel Drive configurations.

Fifty (50) Percent of the chairs delivered are Front Wheel Drive with Forty (40) percent Mid Drive and Ten (10) percent being Rear Wheel Drive.

Front Wheel Drive (C300, C400, C500)
* Tighter Foot Position                                   * Maneuverable               
* Better Reach by User to Environment         * Better Climbing

Mid Wheel Drive ( M300, M400, M300 HD)
* Intuitive Design-Similar to walking
* Maneuverable
* Turns on this Axis

Rear Wheel Drive (C350, Street)
* Most Powerful                 * Rugged / Outdoor Chair
* Fastest Configuration

Permobil is known for it's Power Seating offering Power Tilt, Powered Recline, Powered Legrest, Powered Seat Elevator and Power Standing. Standing capabilities which is currently only availble on the C400 Jr. and C500 Front Drive Powered Wheelchairs. These chairs allow stand and drive function. 

Adjustable Seat Frame

The 3 G Seating is now being offered and is a huge improvement from the 2G Corpus Seating. These chairs are now offered lower (17 1/2"),

with the following improvements.

* Flat Seat Pan- no longer have to modify cushions to achieve proper fit
* Anterior Tilt Option- ability to tilt seat with forward tilt to help with  
   transfers or a more active body position.
* 175 Degrees of Recine- allow more reclined position
* 5" of Sliding Back- this reduces shear and allows for 10-20 degrees of
   recline when using molded seating.
* Legrests 170 Degrees with Articulation- which allows for more reclined
   position.
* Armrests- the new armrests are more durable and allow for more adjustability.
* 2 Piece Seating- which allows the seat to be a different width than the back allowing the arm
   position to be more anatomical.

Thanks to Brad from Permobil to help provide some education on Permobil and a thorough inservice to keep up to date to better serve our customers. This article was provided by Carey Britton, Seating Specialst for Active Mobility Center. He can be reached at 954-946-5793 or cbritton@wheelchairguys.com.

Change can be Hard, not being able to help is even harder........

I met a women the other day, where I was asked by their therapist to see if we could make some suggestions to improve the way she sits. This patient suffered from Quadriplegia and was currently in a new powered wheelchair. The therapist was concerned that the company who recently provided this new powered wheelchair did a poor job due to the appearance of her posture.

This patient was sitting slid forward in a posterior pelvic tilt, with a significant rounded back posture (khyphosis). This is a typical position for anyone post SCI who was not initially provided structured seating.   She was being held in the chair by her seat belt.  She had to hook her arms around the back canes (push handles) to stabilize her posture.

On inspection, it was concluded her ROHO cushion was over inflated, and her back support provided only support to her scapula with a huge gap between her pelvis and lower back support. Patient complains about sitting pain, and the therapist is deeply concerned that her posture will only progress and that it is destructive and will lead to significant health complications.  She also stated the company who provided the chair had to provide more foam to the back support since it was provided.

I asked the woman, who has been using a powered wheelchair for over thirty years, what her concerns were. She said discomfort, and in-stability.

When discussing the cushion, she said she had inflated the cushion as when it was delivered the cushion was too unstable and she added air to make it more stable. We discussed that the cushion for its therapeutic value needed to be less inflated she said that was not a possibility. We discussed that a different cushion may have been more appropriate, but she had always used a ROHO, and nobody asked her those questions. her insurance only covers a one cushion every five years.  When we discussed the back support, I offered that a back that was more contoured, possibly even molded would improve her stability and posture. She said that if she had a back that was more confining it would affect her ability to move and she was not willing at this time to compromise.

After several minutes of listening and learning what her needs were, and more importantly what she was unwilling to compromise over; it was obvious that there was little we could do to improve the situation.  She is an adult and can make her own informed decisions. At this time her function outweighs any physical complications that will result in the future from sitting in a destructive manor.

I offered her some information, and suggested she watch her postural progression and remember that there are other options if and when she is open to trying them. As a Seating and Mobility Specialist, I was disappointed that I could not help; however understand that I am not in her body, and understand that it is ultimately her decision.

Carey Britton, is the seating and mobility specialist forActive Mobility Center. He can be reached at 954-946-5793 or at cbritton@wheelchairguys.com .  

Don't Eat the Marshmallow...Yet!

 I was fortunate to be invited to the Big Breakfast in Ft. Lauderdale this week to see and hear Dr. Joachim de Possada who is  speaker and author.  His famous book "Don't Eat the Marshmallow" has sold millions of copies world wide. What sounds like a funny title has deep meaning and consequences.

Back in the 50's, a study was conducted with children where they were sat a in a room, given a marshmallow and told if they waited until the reviewer came back they got two marshmallows.  The outcome of this study was that only 1 out of 3 didn't eat the marshmallow.  Later it was investigated that these same 1 out of 3 were more successful, they had better pay, better grades and an overall better life. 

Dr. Possada

There is a payoff in learning self discipline, patience; and to delay self gratification. Joachim had further studied this in other counties, and found that free/open societies had the same results where as with communist or severely under developed counties were 1 out of 10 who didn't eat the marshmallow. 

Dr. Possada went on to say that you can go through the pain of discipline now, or suffer through life with the pain of regret. He explained that when talking with people towards their life's end, that 1 out of 3 people were content and happy with the life they led. 2 out of 3 felt regret that they didn't do something. The same 2 out of 3 had less family and friends come and visit them.

My take away with this was that we all need to be patient, work on our self disciplines, and be grateful. Although there is lots of knowledge in the world, the one that applies the knowledge is more successful. We need to be memorable and spend time with those we love; after the money and fame is over we are left with friends and family.

Thank you to Chris Roehm, who organizes the Big Breakfast and provides great speakers to improve our business community.  Carey Britton, seating and mobility specialist,  writes for Active Mobility Center. He can be reached a 954-946-5793 or cbritton@wheelchairguys.com

Staff Presentation: Enrico Cartei on Ramps

Not All Ramps are Created Equally !

Enrico presented on Ramps on 07/24/2013 to help educate our staff.  His presentation showed that ramps are not only important for the safety of the patient, but also will preserve the integrity of the equipment being used.

ADA (The Americans with Disabilities Act)

Twenty-three years ago this week our nation established a comprehensive mandate to eliminate discrimination against people with disabilities by enacting the Americans with Disabilities Act (ADA). The Department of Justice is proud to play a critical role in enforcing the ADA and opening up the gateways to full participation and opportunity for people with disabilities. Today, the Department of Justice is working towards a future in which all the doors are open to equality of opportunity, full participation, independent living, integration and economic self-sufficiency for all for persons with disabilities.

General Rule

For Businesses and other Public areas, for every 1" of rise (height), the ramp has to be 12" in length. In a home setting it can be 12" length for every 2" in rise. It should be noted that although in residential setting the ramp can be steeper, if the equipment user is using a manual wheelchair, having the ADA standard for public areas will be much safer and easier.

Types of Ramps

Fixed Ramps, which include concrete and wood style ramps.  Wood fabricated ramps can be inexpensive if you have a handy person who is good with carpentry. Wood although inexpensive, needs to be treated, and inspected regularly due to wear and exposure to the elements. Concrete ramps are very durable, need little maintenance; however can be expensive, and may not be desirable for re-selling a home. 

Modular Ramps, are a good option when the rise is high, or when there are obstacles in the way. These ramps are typically made from Aluminum. Typically constructed with a platform off the door, and can be configured as needed to allow safe egress to/from the location. Many times when the equipment user is in a rental home, this type of system is required as it can be dismantled and taken with them. These ramps can get costly but in many cases are less than concrete or wood.

Portable Ramps- the most common ramps, these can be used for thresholds, for steps or for entry into vehicles.
These ramps are offered with and without rails, with and without side rails and folding and non-folding.  Threshold ramps are offered in Rubber, Aluminum and Fiberglass. They can be configured for a small step or over sliding glass door tracks. The 2-5 foot ramps are offered in a single folding style. When getting over 5 foot, the ramps typically fold twice allowing the ramp to be transported in a vehicle.

Concerns When Choosing a Ramp

Care is needed when dealing with an outward swinging door.   Most ramps have edges for safety, and typically front doors open outward. Many times the ramp edges interfere with opening and closing a door. There are ways to overcome this and a mobility consultant should be contacted to help these issues.

Securing a ramp is important for safety. If a ramp is used intermittently, securing may not be as
important. If a ramp is left at a step, it should be secured with proper hardware or pins to ensure it does not move or create an unsafe condition.

Ramps have different coatings for traction. Some have grooves within the material and others use gritty adhesive paper which offers traction.

Popular Manufacturer's of Ramps

There are many ramp manufacturers today. The most common is EZ Access, Guldmann, PVI, and Pride.  There are others, and a consultation can guide you on which may be right for your application.

Conclusion

If you are uncertain on what type of ramp is for you, it is important to have a trained professional consult you over the phone or visit your location; measure and make recommendations on what equipment is right for your and your needs.

Great Job Enrico ! your information not only helped our staff, but also will help our customers. Active Mobility Center offers a wide range of assistive and rehab technology equipment. Their staff is expert in listening and matching equipment to your specific needs.  If you or someone you know needs advice or equipment, we can be reached at (954) 946-5793 or sales@wheelchairguys.com

Assessible Travel Part 2 : Cruising

Crusing the World

Crusing has become a very popular way to travel the world; and the vacation of choice for people with mobility challenges.  Where else can you book a vacation, and do not need for a vehicle, access to enterainment, meals, and more....

Cruise ships docking at U.S. ports are required to have accessible facilities for disabled travelers, under the Americans with Disabilities Act (ADA)._¹ This includes on board services suitable for special needs travelers who must use motorized wheelchairs and/or mobility scooters in order to get around while vacationing.

 Accommodations for travelers with special needs will vary by cruise line and among individual ships. You should discuss these itesm when booking your cruise.

• Assistance from airport to pier; during embarkation & debarkation
• ADA-compliant cabins, doorways, corridors and ramps
• Grab bars, raised toilets, wheelchair-friendly bathrooms
• Areas to charge power wheelchair batteries and store mobility equipment

 Air Travel to your Destintation

It may be necessary to travel by air to the location of the cruiseline.  This can be stressful and confusing, Active Mobility Center has provided you with information in a previous article that can help.

Accessible Vacation Information

Cruise ship passengers who need to use a wheelchair, power chair, or power scooter should research accessible vacation options before setting sail. Here are a couple of places to start.

1. Cruise Line Websites Information on cruises with accessible itineraries and other disability travel services is easily found online. Begin by searching for 'disability cruises' or 'cruising with a wheelchair,' and go from there.

2. Accessible Travel Agents This type of agent specializes in disabled travel booking.

As demand grows for wheelchair accessible vacation packages, more cruise lines are expected to provide a wider range of travel services specially designed for the disabled traveler.
When you need personal mobility assistance, look to Active Mobility Center first for the highest quality in wheelchairs, scooters and power wheelchairs, compact scooters and wheelchair accessories. Simply contact us at 1-800-326-4463 to learn more.

Happy 4th ! from Active Mobility Center

Every year at this time, I reflect on how Active Mobility Center and our Country's Independence Day have much in common.  For many people with walking impairments, it is a time to celebrate; as not to long in our history, people with mobility impairments were left inside their homes and were not felt as EQUAL.  Their impairment left them "Disabled" or "Invalids" and were looked down upon. 

With the passing of the ADA, Americans with Disabilities Act,  in 1990;  the world has literally opened up doors, improved access, and increased independence for all. 

Active Mobility Center, in 1992, opened its doors to ALL people with Mobility Impairments, with the goal to maximize their abilities, and to Make Every Day Independence Day ! It may sound like a corny expression, but each and every day, our experienced staff listen to our customers, gain knowledge and understanding of what their obstacles are and offer solutions with equipment, or with recommendations to other professionals within our community. 

Through Equipment; wheelchairs, scooters, powered wheelchairs, gait trainers, walkers, bicycles, and handcycles; we are allowing people to stand and be equal.  We believe it is our duty, to ensure that all have access to mobility allowing everyone to be MOBILE, INDEPENDENT and FREE.


From all of us at Active Mobility Center, Happy 4th, !
Carey

Carey Britton is the resident Seating and Mobility Specialist wth Active Mobility Center, he can be reached at cbritton@wheelchairguys.com, or at (800) 326-4463.