As my arms weakened further, OBI became a daily helper at the dining table

My initial diagnosis with MND was in 2018. Caryn & I were advised there was no treatment and we accepted that.

What we didn’t realise or couldn’t fully understand was the symptoms I might experience and how this would influence me, and us. There was plenty to think about and change was on my horizon.

For me, it was the weakness in my shoulders and arms that were the first signs.

Caryn felt that with no treatment, the next best thing to do was look for ideas and equipment to create solutions. Things that would help me with my independence, dignity and would allow me to keep doing what I’ve mostly done.

By 2019 our life had been subtly changing, things were becoming just a little harder. It was early 2019 when Caryn saw a fresh idea online; OBI – a little robot “that with the touch of a button could assist me with my meals”.

Naturally, my first instincts and first words on the subject were “I will manage without”. However not long after an OBI arrived at the house for a trial. With a chance to try OBI out – I was curious. I found it easy to use. It quite impressed me with how it allowed me to eat our normal food and recipes, without me relying on others during the meal. The only change that Caryn cuts up all my food and places it in the 4 OBI bowls. All I needed to do was touch the button and I was eating.

OBI spoons each mouthful and brings it up to your mouth. I did learn quickly not to overfill the spoon or bowls with food. Now when I “Open Wide” it’s all for me, not my shirt. Cutting up the food into manageable pieces – is the secret. And gravy or sauce is a good glue!

As my arms weakened further, OBI became a daily helper at the dining table. Caryn and I could just enjoy our meals. Because I did not need to “be fed” before or after Caryn ate hers. Nor did we need to play the other game – 1 for you – 1 for me.

Before family and even our grandchildren would sometimes help me with eating. That was a good game – but having OBI made me realise what an asset it had become in my life. A recent trip taken without OBI quickly brought that back to me.

OBI gives me a chance to eat for myself. And allows me to enjoy meals as a couple, with family and friends at home or away. I enjoy my mealtimes and the normality it gives me. OBI packs up easily for outings and holidays.

If anyone has a similar problem when it comes to mealtimes. If their arms and hand control are causing eating issues, then I would highly recommend OBI

???? ????? ???: https://mortonperry.co.nz/product/obi/

 

Preventing asymmetrical posture with a Corset

Situation:

Amanda (Quadriplegic) has spent years trialling all the standard available binders following an accident where she broke her neck. For years she was unable to find one that would last longer than 2 months, without rubbing, rolling up or cutting into her skin.
Without a suitable binder Amanda, like many wheelchair users, faced the development of an asymmetrical posture, collapsing in her spine and loss of mobility.

Task

Over time as a person adapts to many hours a day in a wheelchair their posture can deteriorate unless assisted. All binders provide some support, but we were looking for a binder that was comfortable enough that clients will continue to wear them long term and tough enough to support them effectively without damaging the skin.
We worked alongside TLM (an Italian binder manufacturer) to find a binder that would be effective in maintaining blood pressure following spinal injury and in maintaining posture long term for both paraplegic and quadriplegic clients.

Solution

We worked alongside TLM (an Italian binder manufacturer) to find a binder that would be effective in maintaining blood pressure following spinal injury and in maintaining posture long term for both paraplegic and quadriplegic clients.

The two binders we chose are the Runner+, a strong and durable everyday binder, and Five/24, a breathable lightweight binder for warmer months.
After working with Amanda to move the position of ribs and heights of the binders we settled on options which as well as maintaining posture and blood pressure for Amanda also increased her ability to reach further and push better thanks to increased core stability.
Both binders are:

  • Comfortable— The shape means it doesn’t roll up or cut into the skin
  • Long lasting—Hand sewn with high quality materials
  • Safe for people with impaired sensation—Breathable fabric helps prevent overheating
    (*particularly in the Five/24)
  • Customisable—Removable ribs and strong Velcro tabs help you get a fit that is just right
  • Adaptable—A bilateral closure option compensates for asymmetry in a user

Outcome

 

For Amanda, she is now empowered to look after her posture and well being while continuing to look and feel her best. After working with Amanda to move the position of ribs and heights of the binders we settled upon two high quality binders that not only maintained posture and blood pressure for Amanda but also increased her functionality. By giving her more stability she is now able to reach further from her chair with lower risk of injury.

“Other than my wheelchair my binder is my next most important piece of kit… Not only is the binder about aesthetics, it increases my stability and proprioception (with it on I know where I am in space). It is great for my blood pressure, my posture and push. Wouldn’t be without it! ”
Amanda

If you want to find out more contact us today on 0800 238 523

Topro Taurus – Helps journalist Melanie Reid get her life back both mentally and physically

After purchasing the Topro Taurus at a Naidex exhibition, Melanie Reid, who left the hospital with an incomplete C6/7 spinal injury, has said that the walker has transformed her life.

Her husband bought her the Taurus after seeing her rehabilitation and mobilisation efforts decline after losing her intensive in-patients NHS physiotherapy.

Melanie explained: “Only the very wealthy could replace that with private physio – and we weren’t.

“The Taurus has been, without exaggeration, a game-changer and a psychological life-saver. It’s the single best bit of kit we’ve bought since my accident – an unpaid, ever-ready physio assistant. Without it, I would spend morning to night in a wheelchair.

“I use it every single day and would be utterly lost without it. It allows me to stand, pressure-relieve and exercise — both on my own, or with carers and family.

“Every morning, with my husband guiding the machine in front and my carer following with the wheelchair, to catch me if my knees buckle, I stagger up and down our living room as many times as I can for 20 minutes.

“It’s non-functional walking, in that I daren’t do it alone, and I can’t use my arms to do anything else while I’m standing, but the benefits are incalculable. It allows my organs to fall into their proper place; gets my cardiovascular system going – I puff and my heart races; stretches leg tendons and muscles; straightens my back; encourages bone density; and helps my paralysed bowels and bladder function better. There is no doubt it eases pain and stiffness in my legs and torso, and reduces the ache from pressure on my buttocks.”

As well as physical improvements, the journalist has said that it has benefitted mentally and emotionally too.

“Mentally, it lifts my spirits enormously, lets me see the world the way I used to and staves off depression,” added Melanie.

“I also use the device during the day — by myself, which means so much to me. I park my chair in front of it, brace my knees against the battery, and it raises me to a standing position where, alone, I’m quite safe. If I collapse, I can only fall back into the chair. Here I can stand, weight-bearing, using my elbows only as support, for up to five minutes.

“At night, I use it to get into bed. I stand next to my bed and my husband then removes my chair and pivots the frame around me, so that I turn and sit down on the bed. This avoids using a transfer board. I also use it whenever I have to change wheelchairs, avoiding transfers.

“The Taurus has been significant in reducing my use of painkillers, antispasmodics and antidepressants. It has helped to reduce my bladder infections and constipation.”

Melanie stressed that the walking aid might not work for everyone, as every disability and spinal injury is different.

She continued: “But if the Topro Taurus works for you, it’s priceless. And it’s dependable. After seven years of daily use, mine has only needed a new rocker switch and a battery. My husband and I fondly call it The Norwegian. We even took it to France on holiday in my mobility van.”

Paul Briggs, Managing Director of Topro, commented: “I am delighted to hear how much of a difference the Taurus has made to Melanie’s life in terms of her daily activity and on-going physiotherapy and rehabilitation.

“Anyone that reads Melanie’s column in The Times Magazine every Saturday can not help but be inspired by her and I would urge anyone who has not read it to take a look regardless of whether they are living with a spinal injury or not.”

Melanie Reid writes Spinal Column in The Times magazine every Saturday. She has received no payment or benefits in kind for writing this.

The Vela Tango chair makes daily life easier for Claus with cerebral palsy

Claus uses the Vela Tango chair for support with his activities in the kitchen so that he can manage them independently.

Claus has lived with cerebral palsy all his life. The paralysis is mainly evident on the left side of his body. A few years ago, Claus suffered a fracture in the lumbar area when he had a fall. This meant that Claus required a new adjusted kitchen and supportive aids to allow him to manage his kitchen activities independently. There is space for his legs under the cooker that can be adjusted in height for a seated person.

Claus has problems with his balance and finds it difficult to stand up. In addition, he has problems with his knees and with walking. On occasion he has to use his walking frame or electric wheelchair. He has some personal assistance, but in general, he manages daily life himself, both in the kitchen, at mealtimes, and doing daily chores at home.

Making daily life easier

To keep active after his fall, Claus has been given a VELA Tango Electric (El) Sit-stand Chair with a shallow seat and electric adjustment of the sitting height. The electric adjustment of the sitting height is essential for Claus, e.g. when he has to stand, since he has stiff hips.

Claus and his therapist discussed usability issues carefully for the design of his new kitchen. The oven has a side opening and the dishwasher is placed at a height so he can operate both easily while using his chair. When he uses the chair in the kitchen, it is easy for him to adjust the chair height. The chair’s shallow seat is also ideal: Claus will not pinch the backs of his thighs when using it for supported standing, and the seat ensures an active sitting position at the same time.

Claus on the VELA Tango El sit-stand chair

  • I use the chair for kitchen work, food preparation and eating. In the kitchen, I set the seat high so I can stand at the kitchen table and work and use the oven easily.
  • I always put the brake on! I’ve fallen off a chair because I forgot to put the brake on, so now I’ve learned my lesson.
  • The seat is really good, especially when I stand up. The shallow seat also means that I don’t pinch the backs of my thighs, and it provides good support when I stand. The seat is also good for sitting on when I use the chair at the dining table.
  • It is easy to adjust the seat height electrically, and when I set the chair high, I almost stand up. This is essential for me because I can’t bend my hips much.
  • It’s easy to move around the kitchen in the chair because of the large wheels, which roll smoothly across the floor.

Lilly regained her independence with VELA Tango Activity Chair

Lilly has arthritis with a significant disability in the back, shoulders, hips and knees. Lilly is also a short woman (142 cm in height), which makes it difficult for her to achieve a good sitting position at the same time as having a safe work posture.

Her arthritis means that she finds it difficult to manage daily tasks independently. She spends a lot of time in the kitchen, where she also has her dining table. To get around the house, Lilly uses a walking frame for support.

Lilly cannot operate an ordinary chair with gas because of her arthritis. Therefore, she has been given a chair that can be height-adjusted using electric controls, the Vela Tango Electric (El).

Despite the fact that daily life is extremely difficult for Lilly, she had not imagined it possible to find a chair that would relieve her difficulties and make her more self-reliant again. Like many others, she was loath to ask for help or be a nuisance. It was her children who took the initiative and pushed for it, which she is very glad about. Lilly therefore wants to encourage others in similar situations to ask for help.

”It means a lot to me to be able to carry out the daily tasks that I’ve always done my whole life. Now I can happily prepare food for several days and it makes a world of difference that I can peel the potatoes myself. Good food means a lot for living well with arthritis – and it boosts my desire to do other things.”

Lilly has become much more mobile thanks to VELA Tango El, and she has regained her independence. It is important to Lilly not to be dependent on help from others.

  • The chair is always in the kitchen where I use it for kitchen work and as a dining chair, and when sitting at the dining table to do something with my hands, e.g. crocheting.
  • I find the chair really useful, especially in the kitchen, although there isn’t much space.
  • Now it’s possible to set the chair at a height where I can make food, wash up and put things in the cupboards. It’s now even nicer to be able to do things myself, and the chair relieves a lot of pressure, so I don’t get as tired as before.
  • The chair is easy to adjust in height, so I don’t have to bend down to the base units either.
  • The armrests are nice to rest your arms on, and I also use them for support when I get up and sit down in the chair.

Measuring Pressure interface and shear on cushions fitted correctly versus upside down

Background

At a recent seating seminar therapists were asked if they had experienced a client sitting on their wheelchair cushion placed upside down? The answer was “Yes” 80% had experienced this more than once. Asked if, in their opinion, would this place their client at further risk the majority answered “Yes”!

The Problem

If the cushion is placed incorrectly in chair, how can we minimise risk for pressure & shear?
The following 3 cushion types had their data measured:

1. Vicair Aircell cushions
2. Flotation cushion
3. Gel cushion

The tools used were a pressure-map and an iShear. iShear is the world’s first tool to measure total shear force in the seat of a wheelchair. It is placed under the cushion and communicates the results to an app through a bluetooth connection.
The total shear force (TSF) in the seat plane measured by the iShear is the anterior-posterior force parallel to the seat plane. It’s measured between the cushion and the seat base interface.

Conclusion

The Vicair Aircell technology cushions performed significantly better than flotation and gel cushions for pressure and shear when used upside down. Further evaluation and clinical research is suggested.

The Research

We rely on the following statistics presented on the right of the pressure mapping image and interpreted in combination to help objectively contrast pressure care products and personal positioning. Comfort, fit, temperature, moisture, set up and posture are also important considerations.

Shear force

This indicates the total shear force in the seated plane. It is accepted that high shear force overtime is associated with deep tissue injury and tissue torsion. A reduction in this force reduces risk. Shear force or sliding force is often inversely proportional to peak pressure. It tends to increase with time and, when it is high, it can be considered there is some sliding on the seated surface. The rotational component of the Shear mapper can quantify some postural instability by measuring pelvic rotation.

Dispersion index (Regional distribution)

Under 50% is linked in literature to lower risk of pressure injury development. This is a measure of tissue load specifically over the vulnerable IT area.

Coefficient of variance or CoV

The measure of rate of change in a tissue’s weight bearing. If this is over 50% there is some risk for a tissue torsion/stress/strain/shear injury. COV can be misleadingly high if weight bearing is not immersive.

Peak pressure Index

Indicates the area of highest point pressures.

Sensing area

This is the size of the weight bearing area. The larger the area the better for pressure distribution.
Pressure mat is orientated with the front right of the cushion at the bottom right of the screen. Shear map is oriented as the icon indicates. Rotation depicted by arrow and figures indicate magnitude.

Reducing pressure ulcer incidents and saving money in staff maintenance time, by using Vicair cushions

By: Darrin Brooks, MS, PTA Director of Rehabilitation Solaris Senior Living, Naples, Florida

The Issue – Pressure Ulcers due to inappropriate seating

In a rehabilitative environment, improper sitting is the source of a slew of issues that lead to a bad quality of life, as well as medical complications and miseries for the client. Pressure injuries were reported at 9% of the residents at our institution. Furthermore, employees spend time everyday maintaining and monitoring equipment, resulting in a considerable amount of time spent on maintenance on a weekly basis, taking time away from patient care.

The Solution – Introducing Vicair Products

We presented Vicair products to multiple residents as the standard offering in an effort to save money on staff maintenance time, minimise the occurrence of pressure ulcers, and ultimately strengthen our institution’s reputation as a quality patient care institution. This appeared to be a dicey gamble at first, as I was investing about $300 per client, for a total annual commitment of $30,000. I was certain that the experiment would be successful based on my past experience with Vicair, but I couldn’t be certain until the data came in.

The Result – Quick Recover, prevention & time saving

Vicair wheelchair cushions seem to last a lot longer, which saves me time and money.

“After switching to a Vicair, residents who had developed a pressure spot on their regular cushion quickly healed.”

When I first showed the Vicair cushions to the nursing staff, they were immediately impressed by its comfort, pressure-relieving abilities, and adjustability. Residents who had acquired a pressure injury on their usual cushion swiftly recovered once they were moved to a Vicair, according to the nurse unit manager.

“It was clear right away that the Vicair cushions significantly sped up the healing process.”

We began an informal observational study of pressure sores with and without a Vicair cushion. The Vicair cushions rapidly became noticeable as having a significant impact on healing. We put all patients with pressure areas on a Vicair wheelchair cushion at that point, and we didn’t have to look any further to observe how much more successful the cushions are in the healing process. The number of residents suffering from pressure injuries has dropped from 9 percent to 1 percent. In every case, the patient appreciated the cushion’s comfort, and the therapist appreciated the option to adapt the cushions to the patient’s preferences.

Our financial situation improved once we switched to Vicair cushions. Despite the initial outlay, the nurse hourly rate, prescription costs, and treatment supply costs were decreased as a result of fewer pressure injuries. Now there are fewer injuries to attend to the nursing team can also spend more time on patient resident care.

Every administrator understands how much time, effort, and money a single acquired pressure injury contributes to a patient’s treatment. Not to mention the time and effort it takes to report an acquired pressure injury.

The Conclusion on Vicair wheelchair cushions

I’ve never seen how much difference one type of cushion can make on so many facets of patient and staff wellbeing in my 30+ years of expertise. I can’t say enough good things about Vicair cushions and all of their other items. They are a brand that I am pleased to have as a resource for my patients’ requirements. Beyond merely making a sale, I’ve personally witnessed their dedication to the patient’s well-being. They make my patients happy, and everyone is pleased when the patient is pleased.

“I cannot speak highly enough of Vicair cushions and all of their products.”

– Darrin Brooks, MS, Director of Rehabilitation

VIEW OUR SELECTION OF VICAIR WHEELCHAIR CUSHIONS

Clinical Case: Preventing sliding and creating stability with a Vicair Adjuster O2

By: Carlos Kramer, Head of Education Vicair

Background

Diagnosed with congenital spinal muscular atrophy at only 11 months old, Mrs. C – now 60 years old -has lived with this challenging disability for quite some time now. Throughout all her life her dependability on others has been what bothers her the most. As a teenager she couldn’t just go out for a night with friends, she was depending on her parents for all her movements. Other than that she however never got any ‘special’ treatment growing up, she went to a normal school and participated to the best of her abilities.
Mrs C. was able to walk until she was about 30 years old, after which she started using a manual wheelchair. After five years she switched to a power wheelchair, overtime transfers became more difficult as her limb and trunk muscles started to fail. She is now dependant on lifts for all her transfers. The arrival of an adjustable power wheelchair, an ETAC Balder in combination with Focal arm supports changed a lot as she regained her freedom to do things more independently.
In her initial set-up Mrs. C developed a category II pressure sore in the area of her IT’s. This was eventually remedied when she received a ROHO contour select cushion.

The problem

Despite having contributed a great deal to the healing of the pressure sore, Mrs C. is not happy with her ROHO cushion. Her biggest objection is that she feels like she is constantly sliding out of her chair. Her partner and caregiver confirms this as he indicates that he needs to reposition her frequently on a daily basis. Apart from the sliding, she also indicates that on her current cushion she doesn’t feel comfortable going outside independently. Every ledge she has to go up or down she feels her position shift, unable to reposition herself this creates uncertainty and fear. During the positioning Mrs C’s hip limitation also needs to be taken into account, her wheelchair back and seat are positioned in a larger angle than 90 degrees in order to facilitate this.


In order to assess her situation two measurements were conducted: an iShear measurement and a pressure mapping. The pressure map shows the ideal pressure redistribution qualities of the Roho cushion. Through the iShear measurement we can see that Total Shear Forces play a role and that the shear force is almost equally distributed.

Actions taken before Vicair

To prevent the sliding from happening, Mrs C. tried using a positioning belt. To her disappointment this did not help, the sensation of sliding and the actual sliding was not prevented. Besides this the belt needed to be positioned extremely tight also causing discomfort. Before starting the trial with Vicair, Mrs C. had one last meeting with a Roho consultant to optimize her positioning. This expert optimized her position at the event mrs C. attended by making some adjustments, it turned out however that on a daily basis this optimal position could not be maintained. Partially because neither her caregiver nor home care knew how to maintain the set up on a daily basis.

Implementing Vicair into the seating system

When Mrs C. first came into contact with Vicair at the Supportbeurs 2018 (rehabilitation exhibition) in Utrecht two cushions were suggested as possible solution: the Vector O2 and Adjuster O2. The Adjuster O2 turned out to be the most optimal solution, this due to its superior immersion and pressure redistribution qualities. Additionally the Adjuster O2 is extremely good in situations where the lines of the body need to be followed and the pre-ischial bar would minimize any sliding. Hence the clinical trial was started with the Vicair Adjuster O2, 10cm high. The initial set up of the cushion was not ideal so during the trial the cushion was adjusted into the optimal position. The figure below shows the adjustments that were made to the filling grade of the Adjuster so that Mrs C. was deemed to be positioned correctly.

Again a pressure mapping measurement was conducted and an iShear measurement. When we compare the pressure map to the earlier situation, we can see that the pressure redistribution qualities of both cushions can be considered equally good. It’s noteworthy however that we almost see no trace of the legs on the pressure mapping of the Roho cushion. The Vicair Adjuster O2 pressure map shows in light grey a contour of the legs, indicating more support of the legs. The iShear measurement also favours the Vicair Adjuster O2 as it reduces total shear by 20%.

Conclusion

After a trial of several weeks, the results are very positive: Mrs C. is delighted with her Adjuster O2. She no longer experiences the sensation of sliding forward and indicates a great amount of stability. The first is confirmed by her partner as he no longer needs to reposition her, the correct position she’s being put into in the morning lasts all day. Mrs. C shows us that the gained stability on her new cushion allows her to have more function in her upper body: she demonstrates a movement of leaning forward that she was beforehand unable to do independently. There has been no record of pressure sores, demonstrating the AD qualities of the cushion. She also shows us that she has now changed the positioning of her feet, old pictures show her feet completely on the edge or half outside of her feet support. She shares that she took this position to sort of brace herself, trying to work against the sliding. Now her feet are normally positioned on the support. Summing up her story she tells us that she has regained her confidence to move around outside. The increased stability has returned her self-confidence to move onto, off and over ledges without ever fearing the consequences.

Clinical Case: Pressure redistribution and stability through immersion on an Adjuster 12

By: Fiona Smith, Occupational therapist HBDHB & Megan Ransley, Sales Area Manager, Physiotherapist Morton & Perry

Background

This case describes the situation of a 46-year old male: Mr. S. Mr. S suffers from end-stage kidney disease (not palliative) and is on hemodialysis three times a week. He underwent a right below-knee and left below-knee amputation in subsequent years. Furthermore he is diagnosed with peripheral neuropathy, hypertension, type two diabetes that is poorly controlled and diabetic retinopathy. Mr. S. lives alone in his own home. Despite being unable to work, he was mobile, independent and active. His first amputation concerned his right toe as a consequence of gangrene. His right lower leg was later amputated due to an infection and non-healing of the toe wound.
In the subsequent year his left leg was amputated below the knee due to a non-healing and necrotic left heel ulcer. Mr. S. was in considerable pain due to the ulcer. Due to significant small vessel foot disease and no revascularization options he chose to have the second amputation. Mr. S. was fitted with a basic self-propelling manual wheelchair with a basic flat foam cushion following his first amputation. It was hoped that Mr. S. would be fitted with a prosthesis after healing of the stump and that he would return to independent mobility. This goal was however not achieved due to the very slow healing of the wound.

The Problem

Mr. S.’s problem situation consists of a threefold of things:

  • The manual wheelchair he was issued did not meet his physical and functional needs. He was unable to self-propel effectively due to poor configuration of the wheelchair.
  • He demonstrated a poor sitting posture in the wheelchair. He was positioned in a posterior pelvic tilt causing him to slide forward. In further assessment it was established that his posture was fully flexible and that the canvas back support and seat had become slung and were making his posture even worse.
  • The wheelchair cushion did not afford Mr. S. sufficient pressure redistribution as he indicated a sitting tolerance of approximately an hour. After which he would experience pain under both ischial tuberosities (Its) and in his sacral region. Despite being able to weight shift independently he could not sit in his wheelchair comfortably all day and needed to switch to different surfaces to reduce discomfort.

Actions taken before using Vicair

In an attempt to improve his positioning and try to meet his needs, the wheelchair was reconfigured. The rear wheels were brought forward, to improve access to the push rims. The front-and-rear-seat-to-floor-height was adjusted to enable safe transfers. The changes however turned out to be insufficient to assist Mr. S. in his daily functioning and position him comfortably.

Implementing Vicair into the seating solution

A trial was started with the Vicair Active (9cm) and a Vicair Adjuster 12, of which we will discuss the details shortly, however, two other adjustments were made to the seating system that are relevant to the situational assessment:

  • S. was issued a TA-iQ front-wheel drive power wheelchair with tilt and HiLow. This enabled him to access his him and the community independently without experiencing the fatigue that was caused by self-propelling. This new wheelchair configuration would also allow for future-proofing of foot placement prosthetics.
  • A firm contoured back support was fitted to his wheelchair: nxt Active Contour height-adjustable backrest. This back system assisted in facilitating an upright position and prevent slumping.

Pressure mapping comparisons

Pressure mapping was undertaken on all three cushions: a foam cushion, the Vicair Active (9cm) and the Vicair Adjuster 12. Single peak pressures seen over the ITs sitting on the foam
cushion were eliminated as the legs could be used as weight-bearing surfaces.

Foam cushion

Pressure mapping of the foam cushion demonstrated that Mr. S. was weight-bearing significantly through both ITs, but in particular the right with a peak of pressure seen there. It also demonstrated that Mr. S.’s weight was unevenly distributed with almost no weight being taken through the thighs. The picture showed a small surface area of weight-bearing. This cushion allowed only one hour of sitting before pain was experienced in the ITs. It is likely that over time the foam was compressing and the cushion’s pressure redistribution properties were diminishing.

Vicair Active (9cm)

It was thought that the firm front of the Vicair Active 9 would enable safer and easier transfers while affording the pressure redistribution Mr. S. required. As can be seen from the pressure mapping images, significant improvement was made in relation to the pressure redistribution with a much larger surface area taking weight. This cushion was adjusted by removing 5 cells from both the left and right compartment to allow immersion. Mr. S. commented that the cushion felt comfortable and supportive. He sat well with an improved upright posture. He managed to transfer with ease.

Vicair Adjuster 12

Trial of the Vicair Adjuster 12 cushion was carried out as a comparison. Mr. S. immediately commented that this cushion felt even more comfortable. This is likely because of the depth of
the cushion. Mr. S. is a heavy man and could immerse deeply into the Adjuster 12 cushion without the need for cells to be removed. This deep immersion afforded a greater surface area over which his weight was distributed, giving even pressure redistribution and the feeling of greater comfort. The greater immersion available from the Vicair Adjuster 12 cushion also enabled Mr. S. to feel more stable within his wheelchair. The pre-ischial bar provided a barrier to the pelvis sliding forward.

Shear forces

As Mr. S. indicated the sensation of sliding forward in his initial seating system a shear force assessment was made by using iShear. This demonstrated that Mr. S. was experiencing not only downward pressure but also dangerous forward shearing forces (sliding force). Shear forces were reduced from 125.5N on the foam cushion, to 83.2N on the Active 9 cushion, then to 62.2N on the Adjuster 12 cushion. This demonstrates that Mr. S. was able to sit more upright, with less sliding forward. The reduction in shear force is likely contributing to the preference towards the Adjuster 12 cushion the increased comfort and to improved sitting tolerance.

The Conclusion

Mr. S. is now comfortably using his new powered wheelchair with the Vicair Adjuster 12 and nxt backrest. He is able to remain in his wheelchair comfortably for the duration of the day. He can now use his wheelchair without the risk of pressure and shear related injuries. The new configuration allows him to safely and independently access his home and community.
The Adjuster 12 provides Mr. S. with high-pressure distribution properties that are needed to enable him to sit safely and comfortably all day. The pre-ischial bar prevents him from sliding forward, whilst deep immersion provides stability. Furthermore the cushion is low maintenance and easy to understand. The Vicair Adjuster 12 turned out to be the ideal product choice and solution for Mr. S.

Clinical Case: Pain relief through pressure redistribution on a Vicair Adjuster O2

By: Carlos Kramer, Head of Education Vicair

Background

In this case we will discuss the situation of a 53-year old male: Mr. R. He was diagnosed with small fibre neuropathy in 2014 which displays itself in nerve pain from the fingertips to the toes. It also affects the autonomic nervous system, which causes gut, bladder, stomach problems and reduces muscle tone. Mr. R. suffers from chronic pain and fatigue in addition to spasms that show in his fingers and legs, especially when he’s sitting on a couch or laying in bed (resting position). He also catheterizes, but is still able to urinate normally.
A medication cocktail is used to help ease Mr. R’s situation, it consists of anti-depressants, anti-epileptica that need to assist in falling asleep in addition to pain killers. Mr. R. makes use of a manual wheelchair and tries to walk as much as possible. He has no history of skin breakdown. Lastly, Mr. R. has an ankle flexion limitation.

The Problem

In his current seating solution Mr. R. suffers from pain in his buttocks, due to atrophy. He experiences the pain mostly under his sitting bones (IT’s). He experiences neuropathy pain when areas are pressured. A very basic example of this is when drying his legs with a towel after a shower, 30 minutes after the activity he still suffers from pain.

The situation before Vicair

Mr. R. makes use of a Quickie Helium wheelchair that was fitted with a Jay basic cushion. His back is a tension adjustable system. He experienced pain from the seat cushion and felt like a lot of pressure was being caused by the cushion. In order to assess the current situation a pressure measurement was done via pressure mapping (figure 1). The pressure map confirmed the sensation described by Mr. R. as a lot of pressure is shown in the IT area.

Implementing Vicair into the seating solution

In order to redistribute pressure the Vicair Adjuster O2 (6cm) was introduced. This model’s known quality for equal pressure distribution was thought to solve the pressure spikes shown in
the pressure map. Another pressure measurement was conducted when the wheelchair cushion was implemented into the seating system. The measurement (figure 2) shows a significant decrease in spiked pressure points and an overall redistribution of pressure, which would hopefully in time result in less pain.

The Conclusion

After three weeks of testing his new Vicair Adjuster O2 (6cm) cushion in his manual wheelchair, Mr. R. experienced a significant improvement. He no longer had the sensation of sensitively painful sitting bones. Overall the pain that he experiences has been reduced, hence the Adjuster O2 was a welcome change.

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