The TEAMS behind your Medical Equipment

Any time you want something done right, you need a team behind you.  Whether it is a medical procedure, a legal matter, or acquiring new equipment- you need a team to ensure that the job is done right.

Seating and Mobility Equipment can be intimidating, and the process painful and confusing.  A team with the knowledge and experience in this area is essential.  There are two teams, the one that helps you select and provide you with your equipment and the one that keeps it working for the equipment's useful life.

The initial team would consist of  you, your physician, a physical, occupational and possibly a speech therapist, your family, caregivers and the equipment supplier. Each of these individuals are crucial in providing information to ensure that the equipment fulfils your needs, and your goals.  You are responsible for helping the team what your goals/desires are for your future, what you need your equipment to do to keep up with your life demands.  Your physician will need to provide a history, and any goals/concerns that they have. The Physical and Occupational Therapist(s) bring information on body posture, functional capability, and expected prognosis.  These clinicians perform a functional assessment and are very involved with the equipment prescription. Your family and caregivers need to voice their concerns about function, equipment and accessibility issues. The supplier brings equipment knowledge and works directly with all involved to help recommend the most appropriate equipment based on all the information that is gathered.

This team works really hard to trial and document the equipment, which is sent to the insurance for consideration.  This team works with the insurance provider to provide any additional documentation that is needed to receive an approval. On delivery, the Equipment supplier works with the user, the clinicians, and the caregivers to adjust and optimally fit the equipment.

Once the equipment is used on a daily basis, the technical service department because the support team to help maintain, adjust and repair the equipment; until such time the equipment is worn out and needs to be replaced. 

In the event that the equipment no longer fits, or there is a change of condition, the user is referred back to the physician and clinical team to review the equipment and make any recommendations on changes needed.

This article was written by Carey J. Britton, ATP/SMS, CRTS at Active Mobility Center. Active Mobility Center is a Seating and Mobility Specialty company located in Pompano Beach, Florida. Carey can be reached at (954) 946-5793 or at cbritton@wheelchairguys.com .

What's More Important Wheelchair Brand or Wheelchair Configuration?

The Wheelchair Frame or the Wheelchair Configuration?

It is important to understand that when you are using a wheelchair, scooter or powered wheelchair; the seating and frame configuration is more critical than the brand of chair that you own/buy.  As an expert in the industry, I find most consumers coming to me with questions on which brand; Quickie, Invacare, Colours, Permobil or Tilite wheelchairs and which is the best.  If you had asked me a few years ago, I may have had a preference, however today through innovative new technology there are only subtle differences.

The wheelchair frame is important, however the configuration of the frame and the seating is much more critical to the function and well being of the user.  As I am sure you will agree, many wheelchair users posture is less than perfect in their wheelchair; even if the chair brand is a good one.  You can have the best of equipment but if it isn't configured properly it is only contributing to the problems you are facing.

How Can I Improve My Posture & Function? 

/As a professional, when I am asked this question, I suggest they see their physician or their physical/occupational therapist.
Their medical professionals may have insight on why they sit the way that they do. It is good practice for any wheelchair user to use a team of people to help solve these issues. 

Assuming their physician clears the user with no physical limitations, we can work to improve posture and positioning.  This may require only an adjustment; or it could require new seating and positioning equipment or an entirely new device.

The goal is aways to start at the pelvis. The human pelvis is where everything is attached, and requires the greatest attention in sitting. The goal is to place the pelvis in as close to neutral position as possible. Of course for some individuals having the pelvis anteriorally tilted or posteriorally tilted will be necessary. A stable pelvis is the route of function, which equates to mobility and quality of life. The seating supports are also very critical in the positioning and stabilization of the pelvis.

The position of the lower extremities (legs/feet) are important to consider, as they are tied to the pelvis and require support and positioning.  The angles at the feet/ankles,  the angles at the knee and the angle of the hips are very important for positioning as well as for function and mobility.

What DO I  Need to Know ?

If you are are a wheelchair user, you need to understand that how you are positioned in your wheelchair frame, the orientation, and the seating supports will improve your posture, improve your stability, improve your function and improve your health.  Failure to consider this early, when he body is flexible can result in contracture and deformity that can increase life complications. 

Who Can Help Me?

There is a seating and mobility specialist in nearly every community. This may be a physician, therapist or RESNA or NRRTS. These organizations maintain a list of practicing experts who can assist you with all your equipment needs. You should find and align yourself with a team who can monitor and make recommendations as your body changes or when you are confronted with an obstacle.

This article was written by Carey J. Britton, ATP/SMS, CRTS to offer general but important information on wheelchair configuration and seating.  Carey is the resident Seating and Mobility Specialist for Active Mobility Center. He can be reached at cbritton@wheelchairguys.com or (800) 326-4463.

Wheelchair Clinic at Broward Center for Independent Living

This past Friday, November 1st, we held our 2nd Wheelchair and Seating Clinic hosted by Broward Center for Independent Living, Nova University and Active Mobility Center.  The clinic is held the first Friday of each Month; offering education, adjustments and recommendations on adatpive and rehab equipment used by people with Mobility Impairments within our community.

This clinic was started with the concern that many people do not know much about their equipment or the importance of seating and positioning. Through the development of a progam with Adrienne Lauer, OT and professor at Nova University and Carey Britton, Seating/Mobility Specialist at Active Mobility Center, we have started something special.

This month, we met with 11 individuals to help maintain and improve their seating and mobility.  We expect to expand these services and are constantly listening to attendee's on how we can improve our program.

For more information or to schedule an appointment, please contact Brian at BCIL  954-722-6400.

This article was provided by Active Mobility Center which is located in Pompano Beach Florida, and questions or comments can be directed to (954) 946-5793 or cbritton@wheelchairguys.com .

Nova South Eastern University OTs come to Active Mobility Center

On Monday, we welcomed nearly 40 second year Occupational Therapy Students for a morning Seating and Mobility training.  Each year, we host this training to provide a glimpse into the world of complex rehab and assistive technology equipment.  We divided the group in to four groups and created stations including; Insurance Coverage and the process of getting equipment, manual wheelchairs and scooters, seating and positioning, and powered wheelchairs.

With smaller groups, the OTs were able to ask questions and interact with each presentation. At the Insurance coverage session, the groups heard how complicated the process is. There are many changes in health care that make the intake, insurance verification and needed documentation a specialized process. The groups were disappointed in learning that the complex rehab process can take 2-4 months for patients to receive their permanent equipment.

At the manual wheelchair and scooter group, they learned about standard through ultra light wheelchairs, about tilt in space and recliners, and the differences in scooters. The groups were fascinated on how the process to determine the equipment was more involved that thought. They had not learned about competitive bidding and how it is negatively affecting individuals needing this type of equipment.

The groups learned about how many different types of foam cushions, contoured cushions, and molded seating types there were. Some were overwhelmed not sure how they could ever grasp how much information, and options were available.

In the powered wheelchair group, the students were shown the different types of powered wheelchairs, different ways to control them, powered seating systems and were able to trial driving these chairs; including a stand and drive permobil. 

Concluding the program we discussed how important the team (physician, therapy staff, equipment provider, individual and caregivers) is in equipment provision.  We discussed how the physician initiates and drives the process; however the PT and OT are just as important, and in some cases more important.  We discussed the importance of a good dialogue on the history of the patient, their past equipment experience, patient environment, patient dimensions, patient goals, and caregiver needs.  It is critically important to gather this information, and openly discuss the options to ensure that the patient is satisfied and that their life is improved. What is selected and provided affects that patient for a minimum of five years. 

It was impressed on these students, that if they find themselves helping someone with complex rehab, that they seek assistance if they are unsure of what best resolves the needs.  We explained that ego's should be checked at the door as the process is not for us, but the individual needing this equipment.  We suggested that once they find a position that they find a peer mentor to help them. Additionally they should find a RESNA and/or NRRTS registered provider to be part of their seating and mobility team/program.

Although many of these OTs may never be involved with Complex Rehab Equipment, they now have some basic knowledge, were give some valuable tools and have  a better respect for Complex Rehab Equipment.

This article was provided by Carey Britton, Seating and Mobility Specialist for Active Mobility Center located in Pompano Beach, Florida. Carey can be reached at 954-946-5793 or at cbritton@wheelchairguys.com .

Quickie QM710 Power Wheelchair- Product Review

Scott Sweeney, representative from Sunrise Medical was in the office to provide an update on the Quickie QM710, Mid Drive Powered Wheelchair.  The QM710 has been marketed with Spider Track technology, where the chair has an aggressive suspension allowing it to traverse rougher terrain; including 4" curbs. Additionally the suspension dampens the ride reducing the seating displacement of the rider.  In the past year, we have seen several satisfied wheelchair users who have decided on this product to meet their needs.

New Improvements:
* New Lower Seat to Floor Height Available (16 1/2")
* Power Legrest Extension to allow standing on the footrest for transfers
* Black Wheel Option
* 12" Seat Elevator, scissor mount, and can drive at reduced speed when elevated

The QM710 is a good option for patients to consider when choosing a mid wheel drive system. 

Any comments can be directed to: Carey Britton, Seating and Mobility Specialist for Active Mobility Center. He can be reached at 954-946-5793 or cbritton@wheelchairguys.com.

Adaptive Car Seats

This week, we were fortunate to have Debra Britton provide a presentation on Car Seat Positioning Equipment. This is a regular training program at Active Mobility Center to promote and educate products to the staff, customers and professionals. If you have an interest in any specific products or services, let our office know so you can receive an invite to the programs.

Car seats are essential and mandatory for small children in motor vehicles. As children grow, or have seating and positioning needs greater than a off the shelf carseat, an Adaptive Car Seat may be necessary.  Off the shelf car seats have been crash tested as they sit so it is not recommended to add any foam/changes to these systems. Although this may work well, it changes the product and places any legal responsibility on this person in the event an accident arises.

Car Seats can be a challenge for parents with special needs, as they are not covered by Medicare, Medicaid and most insurance carriers. Medicare (Sadmerc) determined coding, and Car Seats as a transportation device and used outside the home are not covered items.  It is important to note that there are alternative funding sources that may be able to help.

Car Seats are more safe than transporting children in their primary mobility systems (ie. wheelchairs) even if transport brackets are added. Transport Brackets, also not funded through most insurance, although allow a place to strap a wheelchair into a bus or van, are not intended, as stated in their owner's manuals, with the use to be seated in the chair while it is strapped down.  Tie downs are a topic for another presentation. 

There are several products available for this purpose including products from; Columbia Medical, Convaid, SnugSeat, and Thomashilfin.  These products should not be looked at as a one product fits all, and each have certain benefits which can help a particular child.

Car Seats

The Traveller Plus EL, Carrie, Hippo, and IPS are all adaptive Car Seats. These system are similar to off the shelf systems, but are larger, and offer more padding and support to provide support and stability for a special needs child/adult.  These systems allow for a 30 pound to over 100 pound person to use them with the abililty to adjust many of them in seat depth. Some of these offer foot supports and some allow the feet to hang.

Booster Car Seats

This category comprised of the Recaro, and Pilot offer another option for support and adjustability. These systems look more like the off the self booster / car seat systems. They work really well, but have limitations in width adjustment.

More Supportive Car Seats

Recently the Carrot and Spirit systems have entered the market, offering supports similar to what you would see in a wheelchair in a car seat. For larger and involved clients needing extensive support; these systems may be the answer.

Common Questions

How do I know what product to Pick?
These products range from $500 to several thousand depending on the options and needs. Choosing a product should include the assistance of a Physiatrist, Physical or Occupational Therapist and a Seating Specialist. Since this equipment is expensive, you do not want to waste valuable resources on the wrong product.

Where do I get these products?
Most Seating and Mobility companies stock Demo's of these products and can assist you in trialing them for fit, and helping make recommendations after discussing the vehicle and assessing the patient with a therapist or physician.

Who Installs these products in my vehicle?
This is getting more difficult due to our litigious society.  There are certified people in the community who install car seats and should be consulted if after reading the directions you have any concerns or questions.

We want to Thank Debra for providing an outstanding training program and look forward to her next topic.  This article was re-written by Carey Britton, Seating Specialist for Active Mobility Center. Carey can be reach at (954) 946-5793 or at cbritton@wheelchairguys.com .

 

Molded Seating at Active Mobility

Each week at Active Mobility Center, the staff presents on products and services to ensure staff properly educated. This week Robert Bowman and Carey Britton provided a joint presentation on Molded Seating Systems.

Molded Seating Systems are very specialized seating where an impression is taken of the patient, and where a seat and back is created that matches this shape. Molded Seating is expensive, custom, and is not for everyone.

We consider Molded Seating when a patient has asymmetrical postures that cannot be supported by off the shelf, planar seating or modular seating.  These patients are seen by a physician and ruled out for a TLSO (body brace) and where less supportive seating will not support and protect the patients posture from further decline/deformity.

There are many factors to consider when deciding on molded seating. After determining that other seating will not accommodate the patients posture; we need to determine the environment the equipment will be used, who the caregivers are, and if there will be any foreseen changes in condition.  For children and individuals who change weight/size, there is concern for molded seating to be outgrown. Additionally if there are multiple caregivers, there is concern that the patient will placed in the seating the same way each time; failure to sit in contours properly can increase pressure, or cause postural issues.

There are several types and brands of molded seating.  The most common is Silhouette, Pindot, OBSS, and Ride Designs. Each has its benefits, and after a thorough evaluation, each can be considered to best meet the goals and needs of the patient.

Molded Seating traditionally was covered in vinyl, however over the years several options and foam densities are now available. Gel, Air and Visco Foam Inserts and overlays can be used to help with pressure, posture and positioning.

Prior to molding a patient, a clinician should be involved to determine the limitations and range in anatomy to determine the best position for the patient for siting, posture, stability and function. 

Please contact Carey J. Britton, seating specialist for Active Mobility Center for any questions or information on Molded Seating or seating/positioning needs. He can be reached at (954) 946-5793 or cbritton@wheelchairguys.com  .

Walker & Wheelchair Combo

For years we have consulted customers for four wheeled walkers and companion wheelchairs. For individuals who limited ambulation and nee the support from a walker and fatigues needing a seat, the four wheeled walker has been a great solution. For long distances, these walker users, have sat on the seat and had a caregiver push them which is not safe; but for many transporting a walker and wheelchair is not practical.

Now mobility challenged individuals have another choice, a 4 wheeled walker, with seat that converts to a companion wheelchairs.

 

 

 

This article was provided by Carey J. Britton, Seating and Mobility Specialist for Active Mobility Center and can be contacted at (954) 946-5793 or cbritton@wheelchairguys.com . 



Wii Wheelchair Gives Mobility to Disabled Infants

• Cerebral Palsy
• Multiple Sclerosis
• Muscular Dystrophy
• Paralysis Cures
• Spinal Cord Injury
• Traumatic Brain Injury

Technology is amazing; this has been used in NY as a creative game that teaches mobility challenged children how to safely drive a powered motorized device (PMD). This information was shared to me from a local therapist in South Florida as we were talking about emerging technology for children and adults with mobility challenges.

 

A team of researchers, in 2009 developed the prototype of a motorized wheelchair in order to provide “safe powered mobility to infants with physical disabilities who are less than two years of age.” IC Tots on Bots is a collaborative research project among the departments of Computer Science, Occupational Therapy and Physical Therapy at Ithaca College in New York.

The balance board has responsive pressure sensors in each of its four corners and built in Bluetooth capabilities. They are using a commercial Bluetooth adapter and WiiYourself! C++ library to access balance board data within our robotics software. Their software compares the values of the four pressure sensors to determine which, if any, direction the infant is leaning. When a sustained lean is detected, the robot begins to move in that direction. When the child reaches out for an item, he or she leans in the direction of the item and moves towards it. We believe this will be the most intuitive method for a young child to learn to use.

Because each child moves differently from any other, the researchers are working on creating parameter files that are tailored to the individual. In addition, the Pioneer 3 robotic platform uses sonar to keep from bumping into objects, which helps keep babies safe from collisions. For ultimate peace of mind, there is also a remote-control joystick that provides wireless parental override.

                                 

 

It is great when people think outside the box and apply different technologies to create new solutions that may improve people's lives.  This should be a great tool in schoos and therapy centers to help children to move through space, increase development and improve independence.

 

This device was not found currently available in a recent search.

 

Carey Britton, Seating and Mobility Specialist for Active Mobility Center can be reached at (954) 946-5793 or cbritton@wheelchairguys.com

 

What is a Seating and Mobility Specialist?

Most people are unaware of how important seating is, especially when you are confined to a mobility device.  For years companies outside the medical equipment industry have been studying chairs, and standing. In the business world, there are studies that show loss of productivity, as well as work related injuries from sitting too long, or in chairs that are not ergonomically correct.   If so many studies have been documented on ambulatory individuals; wouldn't it be true that wheelchair users are much higher risk?

Traditionally the Seating Specialist was a physiatrist, physical or occupational therapist; however with changes in funding, reductions in reimbursements and the changing equipment/technology, this role is being done by the equipment supplier.

Now called a Seating and Mobility Specialist, this position is  a very important one. They sit at the same table as the physician and clinical therapists when discussing and offering suggestions on seating and mobility equipment based on the patients physical and environmental needs.  They know how insurance and funding work, and can help you navigate through this process. They are a resource, helping make recommendations to other medical equipment services.

The Seating and Mobility Specialist (SMS), is a certification that requires continuing education to maintain the credentials. This ensure that have the skills and most current trends and knowledge. 

For anyone who needs seating and mobility equipment, it is important to discuss your needs, goals and expectations with one of these professionals to ensure your satisfaction and ensure life quality.

This article was written by Carey J. Britton, seating and mobility specialist for Active Mobility Center. He can be reached at (954) 946-5793 or cbritton@wheelchairguys.com