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

Clinical Case: Enhancing positioning and maintaining skin integrity, by using Vicair cushions

By: Erin Davis, Occupational Therapist, Southern Rehab

Background

In this study we will be describing a case of a 31 year old female, Miss Y. Miss Y was diagnosed with an anoxic brain injury post anaesthetic which resulted in spastic quadriplegia and severe cognitive impairment. Additionally there is bilateral acetabular dysplagia with complete dislocation. The anoxic brain injury followed from a cardiorespiratory arrest during an eye surgery that Miss Y underwent at an age of
18 months old. Presently she has a high level of tetraplegia and is non-communitive. She requires a wheelchair (tilt-in-space) for mobility and is dependent on full assistance for mobilising, transfers (predominantly made by ceiling track hoist) and all self-care and daily activities.

Miss Y lives in her own home, just next door to her parents and has two main caretakers who support her in her daily activities. She enjoys getting out in the community in her wheelchair or by driving along in one of the vans of her carers. She enjoys shopping, meeting her mother at work and many other community activities. She loves the spa in her home, enjoys sitting outdoors in the delightful garden and loves being involved in tasks around the home. She enjoys watching television and listening to the recordings of her favourite music and television series.

The Problem

The problem she faced was that Miss Y’s seating no longer met her postural needs and did not support her pelvis, trunk or legs. She was mobilised in planar seating (with no contouring) and the attached flat lateral trunk supports were too small and not positioned correctly. In detail this meant that a number of things needed to be taken into account when addressing her positioning, when lying down the following was noted:

  • Her pelvis has an anterior tilt, obliquity (left 1½” lower) and rotation (right forward). With a T-roll institu the tilt moves to posterior and her obliquity reduces by ¼”
  • Her trunk shows significant scoliosis (convex to the left) which has its apex at the lumbar/thoracic junction. There’s a rotation through the thoracic spine (left forward) and lumbar lordosis.
  • Her left hip is internally rotated and adducted over the midline and her right hip is in external rotation.
  • Her left knee has a flexion contracture of approximately 30 degrees.
  • There is minimal movement through the joints that enables corrections.

When sitting in a supported seating on a plinth miss Y had the same postural anomalies as when lying down, though her obliquity was increased to 2½” discrepancy.
An x-ray revealed further details about Miss Y’s situation and it was noted that her thoracic alignment is normal apart from mild rotational deformity in the lower thoracic. Her lumbar spine has marked rotoscoliotic deformity, convex left with a Cobb angle of approximately 46 degrees. Her pelvis is distorted with mild subluxation pubic symphysis and bilateral acetabular dysplasia. It also showed that there is complete bilateral dislocation of both hips, with superior displacement of the proximal femora. Furthermore her right leg is internally rotated.

Actions taken before using Vicair

Modifications to Miss Y’s existing seating was considered but deemed not an option because more contouring was required than the seating could sustain. After several trials her wheelchair was set up with the following things to attempt to address the problem at hand:

  • A multi-layer contoured foam cushion with additional custom contouring was placed at the pelvis and medial thigh area to support her pelvic obliquity, dislocated hips and her thigh position.
  • A dual foam back support with a contouring cube system on a solid shell was used. The system was custom contoured in the lumbar and thoracic spine area to support her lumbar lordosis and trunk rotation.
  • D-shaped, curved lateral trunk supports (medium on right, large of left) offset were used to support her scoliosis.
  • A contoured headrest.
  • A centre point anterior support harness and a 2 point hip support belt were used.

This seating system needed to be reviewed and adjusted every 6 to 12 months and prior to starting the clinical trial it was found that it wasn’t supporting her accurately. Limited further contouring was achieved but she was starting to get reddening of her skin over her left ischial tuberosity. In exploring more options Miss Y attended the local spasticity clinic and had reviews with Orthopaedic Consultants to determine what medical input could assist the management of her dislocated hips and left knee contracture. Surgery, however, is not an option as the family declined any further general anesthetic due to this being the initial cause of her diagnosis. It was determined that she could perhaps benefit from botox in her left hamstring and alternative seating.

Implementing Vicair into the seating solution

It was determined that Miss Y required a system that she could immerse into to accommodate and support her rather than the system being moulded to her. Vicair cushions have immersive qualities and it was therefore decided to trial a Vicair Vector of 6cm high with an increased amount of Smartcells in the medial thigh support and right rear greater trochanter areas.
It was found that further depth was required, therefore the Vicair Vector of 10cm high was introduced. It was found to be successful at capturing Miss Y’s pelvis and maintaining her skin integrity. Shortly after, the Vicair Vector O2 became available on the market and it was agreed to trial the 10cm high Vicair O2 version as well to see the difference between this and the standard Vicair Vector cushion.
The Vicair Multifunctional back support cushion was also trialled, replacing the foam contouring on the existing back shell. It was set up with an increase in cells in the lower three compartments. It was found that Miss Y now had contact with her entire trunk and therefore gained the support in the lumbar region that she required.

The Conclusion

Instead of sitting on top of her seating and being pushed forward, Miss Y is immersed into it, therefore cradling her dislocated hips and filling all the gaps at her spine to give improved support. There’s no longer a case of reddened areas as aggressively as before on her left ischial tuberosity and when it occurs it is resolved after an evening in bed. With her new seating solution she is also able to mobilise longer in her wheelchair without the same degree of concern for her skin integrity. The Vicair Vector O2 has also been a welcome change for the standard 10 cm high cushion as it offers the ability to be washed off by machine washing. After food or drink was spilled the Vicair Vector O2 cleaned off easier. Additionally the Vector O2 was easier and faster to dry out if they happened to be out in wet weather. There was one concern raised regarding where the liquid would go if spilled on the cushion, but this was rectified by the use of a Kylie pad tucked in the cover under the cushion. Due to the success of the Vicair Vector O2 and Multifunctional back in her wheelchair, Miss Y’s car seat was stripped back and set up with the same products to give the same support when she is using this chair.

Clinical Case: Actively assisting in healing a pressure injury with the Vicair Active O2

By: Megan Ransley

Background

Mr. R has been in a wheelchair for many years, due to an accident that caused a spinal injury. At 26 years old he became quadriplegic at C6 level. He is a very capable manual wheelchair user and is fully independent in his life. He even runs his own business with great success. He has always used a gel-based cushion in his wheelchair. It was given to him by the spinal unit, where fear of pressure injuries
was clearly expressed. Whilst Mr R admits it has been annoying to massage the gel forward every day and the fact that the cushion is relatively heavy, he always considered himself to be ‘a Jay man’.
Like many of his friends that are in a similar position, he could not imagine moving from his cushion, he trusted it and it has done the job for many years. His biggest fear was that a pressure injury might appear if he switched cushions.

The problem

Mr. R has recently developed a red area on his bottom that is not going away. He is getting older and his shoulders are less able to push. Older age also brought along other health issues regarding his kidney function and bowel program. He had spent some time in hospitals and the red area most likely arose from those inpatient stays and a greater amount of passive sitting during that time (whereas he usually moves about a lot in his chair). His occupational therapist wanted to investigate cushions which could provide robust postural support but would be lightweight, easier to maintain and provide the best pressure care.

Implementing Vicair into the seating system

His OT proposed the Vicair Active O2 ( 9cm high) and Mr R was reluctant, but since it was only getting worse he agreed to give it a try. The idea was that the Active O2 would assist in healing his wound and if wanted he could always return to his Jay cushion once the wound was healed. Due to the open weave of the Active O2, it was expected that it would provide a lower temperature to help manage the microclimate of his wound that in turn could speed up the healing. An added bonus was the lightweight nature of the cushion of which his shoulders would benefit.
His first impression of the cushion was very positive, he felt great stability and that he was positioned more upright than on his Jay. He instantly experienced that he was in a better position to push and that it was also easier to do so. His posture is not yet ‘ideal’ but to Mr R it’s the function and the protection that really matters.

Conclusion

A week into the trial Mr R provided us with the following summary:
“The Vicair seating trial has gone extremely well showing a marked improvement over my current Jay Active. Of particular note is a fading of the dark patch and general skin colour improvement over a relatively short period of around 10 days Prior to this the dark patch has remained largely static in size and colour for some months sitting on the Jay Active. The only seating change has been the Vicair I would, therefore, assume its responsibility for the improvement.”

Following this, Mr R went into surgery for a Gall Bladder removal after which he once again gave us his comments, it had now been two months since he swapped to the Vicair cushion:
“Vicair cushion continues to impress, being a little more immobile (pressure relief wise) this last week has seen my butt stay at worst status quo but actually we think continuing to improve.
Given I was up and about the day after surgery I was feeling a bit fragile and unable to perform normal pressure relief regime. The Vicair appears to have given the needed protection even though my movements been greatly reduced…I’m extremely happy as you can imagine, attached pics show botty day before surgery and last night!”

The wound continues to improve, Mr R is delighted with the Active O2 (9 cm) and he now very much considers himself ‘a Vicair man’

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