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

Posted on April 1, 2020May 2, 2023

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 the 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 the 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 a 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 roto scoliotic 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 were 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 the right, large on 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: Treatment of a category II pressure ulcer and improved asymmetric positioning through Vicair

Posted on April 1, 2020May 8, 2023

Background

Wheelchair users automatically have a high risk of developing skin breakdown. When there are additional positioning aids involved, the risk increases. This clinical case describes the treatment of an 8-month-old category II pressure ulcer and solving asymmetry for Mr. de L (Spina Bifida patient). Mr. de L is a 73-year-old male who generally uses an office chair at home. Outside he uses a manual wheelchair: an active Quicky
Argon without arm support that is fitted with a Jay Easy Visco cushion. Mr. de L mainly walks therapeutically and makes transfers, using elbow crutches.

The Problem

Mr. de L. has a sensation disturbance in the buttocks and lower extremities. At the start of the treatment in the Seating Clinic, the client suffered from a superficial pressure ulcer, category 2, with wound edge maceration. In general, the pressure ulcer does not cause pain.

The ulcer does not show signs of shear force or friction. Additionally, Mr. de L. experiences pain in the left side of his body at the height of thoracic spinal cord segments 6-8 and in the left side of his torso. Treatment with pain medication has not been sufficient. The pain in his torso occurs after sitting for half an hour: the VAS score varies strongly.

Once a week he goes to bed when the pain becomes unbearable and wants to change his position. The further assessment shows that Mr. de L’s left leg has a different bony structure and size than his right leg. He uses a corrective left shoe because of the shorter left leg. This left leg also has reduced muscle mass.

While seated and laying down the abdominal mass is positioned to the left side. He also uses a urine stoma. Once in a while, he is facing incontinence. This did not affect
the pressure ulcer.

Implementing Vicair into the seating solution

In an attempt to solve the problem at hand it was chosen to conduct pressure mapping of the current situation and of all cushions tested in the process.

All pressure maps show pressure on the ischial tuberosities (IT). When using the Jay Easy Visco cushion there is very significant pressure on the left buttock and the centre of gravity of the body
shifts to the left. It was found that when using a Vicair cushion that can be set up asymmetrically the pressure is redistributed more equally across the entire surface of the buttocks. The asymmetric setup is accomplished by relatively increasing the height of the cushion’s left side because there is less buttock/leg mass on this side.

After the pressure mapping, we chose to try out a cushion that can be adjusted to an asymmetric setup: a Vicair Positioner. By setting up this cushion asymmetrically (more volume on the left side, less volume on the right) the smaller leg/buttock mass is supported and the client experiences improved pelvic stability while seated. This cushion was tried for two weeks.

At that point, the pressure ulcer had healed, but the client showed more tendency to slide. In order to provide more stability and prevention of sliding, we decided to try out a Vicair Active for the next two weeks.

The cushion was set up in the following way in order to cater to Mr. de L. asymmetric needs: 7 SmartCells were removed from the cushion’s right rear compartment, 3 SmartCells were added to the left rear compartment and the centre compartment kept its standard filling.

A solid seat was installed on top of the wheelchair’s sling seat to prevent it from hammocking. Due to the asymmetric setup, future risk of a pressure ulcer was reduced as the pressure was more equally redistributed on the adjusted Vicair Active.

The Conclusion

Mr. de L’s pressure ulcer was healed due to the switch to the Vicair Positioner. Afterwards, his desired seating positioning and stability were achieved by using the Vicair Active with an asymmetrical setup.

He now experiences a high level of seating comfort. Mr de L. has started to stand up and sit down more often. He tries to walk two times a day in a functional manner, for instance in combination with a toilet visit or for transfers.

He is more aware of the positive effect of alternating his position. In sum, the Vicair Active was able to provide skin protection and it met Mr. de L’s positioning needs for a cushion that provides stability and can be set up asymmetrically. It was however noted that ideally, Mr. de L needed extra back support (lower lumbar and lateral support) and that it was important to improve overall lateral support.

Clinical Case: Accommodating differences in mass with a Vicair cushion Vector O2

Posted on March 31, 2020May 15, 2023

By: Carlos Kramer, Head of Education Vicair, The Netherlands

Background

In 1943 Mr. R’s parents noticed something was amiss with their young son, at barely 3 years old his right leg started bothering him and after a doctor’s visit they were told their son probably had flatfeet or suffered from short-term paralysis in his right leg.

As time passed, the problems however only got worse to the point of being unable to walk. His parents pressed for a second opinion from the Sint Maartenskliniek in Nijmegen, the Netherlands, and quickly a relatively rare diagnosis was established: polio.

His right leg had been affected and as a consequence had lagged in growth and muscle strength.
Now aged 78, Mr R has a rich medical history with a number of key points that played a primary part in the condition of his health and mobility.

Throughout most of his life, he made due with orthopedic shoes to assist him in walking. In ’99 he broke his right hip after stepping off a ledge, losing his balance and as a consequence falling. It’s very likely that the imbalance and fall were caused by the limitation in his right leg. The head of his hip was broken and via surgery reattached with a metal pin.

After a lengthy rehabilitation process at several institutions, Mr R. ended up seeing one of the country’s experts in post-polio at the Amsterdam Medical Centre (AMC) and was assigned an AFO (Ankle Foot Orthesis).

After several measurements and tryouts, he became more mobile again. At the request of the AMC, he participated in a study researching the effects of an AFO for post-polio patients.

In Mr R’s individual case, a significant increase in the development of muscles was observed. For the study, he went through a general health check which he passed with flying colours apart from a minor deviation in his bladder which could be fixed.

As doctors examined further, they found something else and in 2011 Mr. R. was diagnosed with prostate cancer. Signalling the beginning of a further deterioration of his health and quality of life. Even though Mr R has now officially been declared cured of cancer, it greatly affected his physical well-being.

Radiotherapy affected his intestines and as a result, he is now dependent on catheterisation and flushing his intestines. Due to the illness, he also lost a significant amount of muscle strength and is now for two years dependent on his wheelchair for most of his daily activities.

The problem

This case focuses on the importance of proper positioning and creating stability when there needs to be dealt with a difference in body mass in the seating surface, even pressure distribution is also important to safeguard skin integrity in an asymmetric position. Polio affected Mr. R’s right leg which can both be observed in the difference in length and muscle mass. There’s a 4cm difference in circumference between the right and the left leg just above the knee.

Due to this difference in muscle mass, Mr R is always positioned slightly crooked. In his current set up he also feels that he slides forward in his chair, indicating unstable positioning.

In addition, he indicates being uncomfortable and not being able to sit in his chair all day and feeling fatigued. The crooked position is confirmed when we conduct a pressure mapping measurement. As can be seen in figure 4 there’s a clear difference in pressure between the two sides. More pressure on his left leg could possibly also be the cause of the discomfort that he describes.

Existing set-up before Vicair seating system.

Mr R. showed us two cushions, one that was a standard cushion delivered with the wheelchair that has never really been used. This to the fact that this was never prescribed as a flat cushion could never support the asymmetry in his body. In response to this demand, Mr R received a Jay Easy Visco to better fit his needs for a contoured cushion.

The pressure map displayed in Figure 1 shows the situation when Mr R was seated on the Jay Easy Visco, hence his problem was not solved with this contoured cushion.

Implementing the Vicair seating system

The difference in mass along his right leg creates an asymmetry in his seating position. In a case with asymmetry, you could normally expect to make use of the Vicair Adjuster O2.

However, in this case, the choice fell upon the Vicair Vector O2 for precision positioning and accommodating the difference in mass along the entire leg rather than just supporting the asymmetry it causes in the hip area.

The extra compartments in the Vector O2 allow for precision positioning along the entire leg. The front compartments in the Vector O2 would also support his legs, improving leg alignment and stability of his legs whilst seated. First Mr. R’s position was assessed in an unadjusted Vicair Vector O2.

This is in order to make a proper judgement of where adjustments needed to be made. The assessment showed that, as expected, some adjustments needed to be made. The images show the differences in pressure between the Vicair Vector O2 in its standard configuration and the adjusted version.

The pressure maps show that the pressure has been significantly decreased.

The unadjusted Vector O2 was already an improvement in comparison to the Jay Easy Visco. The adjusted VectorO2, however, shows even more pressure improvement and we can now also see the leg support the cushion provides represented on the pressure map.

Cells were added on the right side of the cushion to accommodate for the missing mass and a number of cells were taken out on the left where the normal leg is positioned. Figure 7 shows the adjust filling grade of Mr R’s Vector O2.

Conclusion

Immediately after the adjustment, we can observe an improvement in Mr R’s position. It was easily spotted by the line of his shoulders that is now positioned straight.

He also immediately indicates that he feels more supported. A longer testing period should point out of the cushion also delivers the desired results for the long term. After about a month of testing, Mr R is still positioned nicely straight in his wheelchair on the adjusted cushion. He, however, indicates that he has a new fitting shoe for his AFO and received new leg support for his wheelchair.

His seating set-up has therefore changed a bit but he has easily adjusted the cushion by adding and removing a number of single cells in compartments. This does, however, indicate that a different AFO has an influence on his positioning and therefore new shoes in the future might further affect his position in the wheelchair.

The combination of his new shoes and feet supports created a higher positioning of the thighs and it was therefore decided to create a foam wedge under the front of the cushion to make up for the distance that has been created and re-establish the support on the legs fully. This would be a temporary solution as the arrival of his new AFO might change the situation again.

In addition, Mr. R tells us that he no longer experiences the sensation of sliding forward. A very positive change is that he now also prefers to stay in his wheelchair for daily activities. In restaurants, for example, he used to transfer to another chair but now prefers to stay in his wheelchair. It shows a high level of comfort that he now can remain in his chair all day. Last he indicates using his new Vector O2 on holiday this summer during hot weather and confirms that the cushion’s breathability really supported temperature control – his old cushion was a lot warmer.

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

Posted on March 31, 2020May 15, 2023

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’

“To me, the Vicair Vector meant no more pain!”

Posted on February 25, 2020October 30, 2023

“It’s at the end of the summer of 2006 and I am at the middle of a beach, when I suddenly come to a standstill.”

A very strange experience, because I simply can’t walk anymore. At least, not without pain. As the weather was great, I decided to sit down and wait until I felt better. Maybe I had just strained a muscle? I never started to feel better though. Which meant I found myself stumbling of the beach to get to my apartment. Maybe a hot bath would help, I thought, but it did not bring any relief. Unfortunately I had to spend the rest of my vacation in pain…

Back home the pain did not go away and walking got more and more difficult. Until one morning I woke up and found that both my legs were still sleeping and would not wake up with me (and to this day they are still asleep). I compare it to the strange feeling you get in your legs when you’ve been sitting in a wrong position for too long. Wondering what might be the cause I did start to fear that it would probably be something worse than a strained muscle. Reluctantly I made a doctor’s appointment.

“I was finally tested for and diagnosed with MS (Multiple Sclerosis)”

It was after the holidays, early 2007 when I had my first appointment with a neurologist. It was a relief to find that he took my complaints seriously right away. First he did some tests to rule out other possible causes for my complaints, before I was finally tested for (by use of MRI, Spinal puncture etc.) and diagnosed with MS (Multiple Sclerosis).
During the first year good and bad days fluctuated a lot, but I still could “walk”. Until the day came that I had to face the fact that, when I really wanted to go out and do something, I would need a wheelchair (at first now and then…). I went for my first wheelchair in 2008.

“To me, the Vicair Vector 10 meant no more pain”

By now I was using my wheelchair on a daily basis (both in- and outdoors) and sitting in it started to hurt more and more. To solve this I had been sitting on a Jay Basic cushion, but my technical advisor introduced me to the Vicair Vector 10 cushion. It was love at first sit! No more pain when sitting, the pain in my tailbone disappeared and the cushion offered me so much more stability! Super! Besides that I really love the fact that the Vector is really lightweight.

“A few months ago I met the Vicair team at the MS-day of the Dutch National MS Foundation.”

We agreed to replace the blue SmartCells in my cushions for the new silver-grey versions, in exchange for the right to use the price-winning picture that I had made and that showed my Vector cushion (annual photo contest “I can live with MS”- red.) .The new cells are really great! They are even softer to sit on and very comfortable.

Not only the Vicair cushions are great, Vicair’s customer service is super! This service enhances the quality of the product and results in a positive user-experience. Keep up the good work!”

My wheelchair is not a limitation, it enriches my life!

Posted on February 25, 2020October 30, 2023

Even when I was little, I’ve always been pretty active. I’ve had several interests from an early age, including playing the saxophone, riding horses, and dancing. After I studied animal care, I decided to study on and become a veterinarian for animals with disabilities. As such, it requires physical exertion. As a young dancer, I was incredibly flexible, and it was great for ballet. When I was 22, though, my body could no longer sustain it. I had ‘Patella luxations’ a fancy medical term describing displaced kneecaps. I was afraid of a reoccurrence of the luxation, so in 2014 I had surgery. I was nearly back to normal after nearly 1.5 years of recovery.

“But within a month, my life was flipped upside down after I had finally finished rehabilitating.”

After rounding up my rehabilitation, I had erased all the phone numbers for the hospital and physical therapists from my phone. It felt so good! Until a car disregarded me and my bike five weeks later. When I was struck, my life was completely turned upside down. My whole tibial plateau was fractured because of the event. Instead of getting started with my career-oriented goal in England, I had to reside in a hospital for a month and return to my mother’s home because I required a lot of help and assistance to get better.

“I noticed a friend on Facebook who fractured their ankle and was training for a marathon in a wheelchair.”

I was taken to that idea and bought a wheelchair online. Over the course of the next three months we were training together and in the end, did the marathon and crossed the finish line with smiles on our faces. Soon after I got assigned a wheelchair tailored to my needs. However, after a day of sitting in it, my behind was pretty uncomfortable.

“I got in contact with Vicair at a mobility exhibition.”

At the event, I got to trial several Vicair wheelchair cushions, and the Vicair staff were very helpful. I decided on a Vicair Adjuster O2 and it has made a big difference. Now when I use my wheelchair to workout, I can use all my energy to improve my lap times. It certainly makes a difference having a cushion that shapes your body. My bum is no longer numb, and the tingling sensation is gone, and so is the pain.

“My friends were envious of me because they wanted to rest on my cushion as well.”

I also attended music festivals in my wheelchair. My friends were envious of me because they wanted to rest on my cushion as well. On my previous cushion, I wanted to get out of my wheelchair as soon as possible. I no longer have that desire. I can do anything in my chair, including going out for drinks and snacks and exercising – all while sitting in my own wheelchair with a Vicair cushion. It certainly enhances my life, and I intend to achieve much more in the future.

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A Paralympic Champion and a Vicair wheelchair cushion… the winning combination

Posted on February 25, 2020October 30, 2023

Mirjam de Koning is a former Dutch professional swimmer with a form of paraplegia. She participated in 2 Paralympic Games and 2 World Championships. Where she won a combined 3 Gold Medals, 4 Silver Medals and 3 Bronze Medals. Mirjam held 4 World Records.

Mirjam was born with damaged connective tissue. Over the years her condition deteriorated and Mirjam had to spend most of her days in bed. For this reason she had experimental surgery done in 2000, during which unfortunately a nerve was damaged. This left her with a form of paraplegia and she had to start using a wheelchair. After the surgery, Mirjam decided to play basketball.
However after 4 years, she had to stop as she had too many basketball-related injuries. In 2004 she switched to swimming. What a success story this decision soon became!

A few months before the London Paralympics Mirjam came to Vicair (headoffice in The Netherlands) asking if we could help her during her preparation.

At that time she was suffering from pressure injuries and they were affecting her Paralympic training schedule. Of course we immediately agreed to help and the same day she was using the Vicair Vector cushion. The pressure injuries healed, Mirjam could train more and… she won a Bronze medal on her last Paralympic race ever.
After the London Paralympics Mirjam became a member of the Vicair product development team the same team that developed her Vicair Active wheelchair cushion.

Paralympic Games
Gold medal – first place 2008 Beijing 100m backstroke S6
Gold medal – first place 2008 Beijing 50m freestyle S6
Silver medal – second place 2008 Beijing 100m freestyle S6
Silver medal – second place 2008 Beijing 400m freestyle S6
Bronze medal – third place 2012 London 100m backstroke S6

World Championships
Gold medal – first place 2006 Durban 50m freestyle S6
Silver medal – second place 2010 Eindhoven 50m freestyle S6
Silver medal – second place 2010 Eindhoven 100m freestyle S6
Bronze medal – third place 2006 Durban 100m freestyle S6
Bronze medal – third place 2006 Durban 100m backstroke S6