Clinical Corner

Last month, Clinical Corner distinguished between outcomes and outcome measures and highlighted some of the results of a survey with therapists practicing in seating and mobility in Canada regarding the use of outcomes and outcome measures.  See Outcomes and Outcome Measures in Seating and Mobility: Current Practice to refer to that article.  This month, Clinical Corner will continue its focus on outcome measures with a look at key considerations when selecting outcome measures.

There is a subtle difference between outcomes and outcome measures in seating and mobility.  Whereas outcomes may include subjective descriptions, outcome measures can be objective, quantifiable means of validating interventions.  The results of an on-line survey suggest that many therapists involved in seating and mobility in Canada consider outcomes when working with clients.  Some outcomes, such as pressure mapping, sitting tolerance and using SMART goals, allow for some aspect of measurement to occur.  A future Clinical Corner article will provide additional details on outcome measures that help to provide objective quantification of outcomes such as those mentioned in this month’s article. 

What are the similarities and differences between assessing an individual for a power mobility device versus a manual wheelchair?  What is important to consider for a power wheelchair versus a manual wheelchair?  Does it matter if an individual cannot drive effectively the first time they use a power wheelchair?  These questions, and more, will be answered this month in Clinical Corner. 

This month, Clinical Corner has reviewed the updated terminology used for pressure injuries and the staging of pressure injuries. In addition, the position statements of the NPUAP related to pressure injuries have been reviewed. More information on Pressure Injuries can be found on the NPUAP website. 

Rigid frame wheelchairs offer some choice in the type of frame – from open frame to closed frame and from fully welded to models with fold-down back canes. Some models of rigid wheelchairs provide adjustability in the rear axle while others are fully fixed. Rigid frame wheelchairs promote efficiency of propulsion due to their light-weight design and minimization of moving parts, which allows for more efficient propulsion. A thorough assessment is required in order to match the needs of clients with the products that are available on the market for optimal fit, function and performance.

There is never going to be one model of wheelchair that is right for every client.  Manufacturers recognize this and often provide several models of wheelchairs within a category to meet the various needs and demands of clients.  This allows for optimizing both fit and function for a client through the selection of an appropriate model of wheelchair.  How we choose between models of wheelchairs goes back to the assessment and then matching the goals of seating and mobility with the choices that are available.  

Just as there are many factors that contribute to the risk for falls, there are many interventions to address the risks.  A multi-disciplinary, multi-factorial approach is important to take for older adults who are identified at high risk for falls. 

Many factors contribute to the risk of falls.  Such factors include biological, behavioural, socio-economic and environmental.  Next month, Clinical Corner will address strategies to reduce the risk of falls for older adults. 

If you have been following my blog for a while, you may recall that in October I tend to write an anniversary article to celebrate another year with Sunrise Medical Canada.  This month marks my 8^th year with Sunrise Medical!  Since October also is Occupational Therapy month across Canada, I thought I would write a little on my experiences that led me to occupational therapy.  I would also like to celebrate Occupational Therapy month by sharing a recorded webinar and by seeking input for a future webinar.  More on that later in this article!

Are we all speaking the same language in seating and mobility?  Have you heard a wheelchair cushion being called a “pillow” by someone who does not work in this field?  Do you call a “wheel lock” a “brake” on a wheelchair or an arm support an “armrest”?  Is a pelvic positioning belt the same as a pelvic belt for transportation of occupied wheelchairs?  (The answer to this last question is no!) The language of seating and mobility is evolving and, in fact, becoming standardized.  This month, Clinical Corner will address standardized terms in seating and mobility.  We will look at why standardization in terms is important and review a sampling of common terms. 

Creativity in knowledge translation helps to produce different resources that are available when and where the client needs them.  Having information shared in multiple formats helps to reinforce learning, which bridges the knowledge to action gap, which is what knowledge translation is all about!  
 

Standardized and non-standardized outcome measures in seating and mobility provide information that can be used to improve individual client results.  In addition, with informed consent, the results of standardized outcome measures can be pooled to help to provide a body of evidence that helps to inform evidence-based practice in the area of seating and mobility.  

The issue of restraints versus function versus postural supports is a large one!  This month, Clinical Corner began to address the issue of restraints versus postural supports and personal assistance services devices.  Future Clinical Corner articles will address issues such as how to minimize the use of devices that could be considered restraints on wheelchairs and when do we consider the effect of the device on an individual. 

Clinical Corner first addressed electric mobility scooters in Scooters: The Essentials of What You Need to Know.  With spring emerging in many parts of Canada after a long winter, and with summer just around the corner, it is a good time to revisit electric scooters as the promise of good weather often leads us to think about outdoor mobility. 
 

Last month’s Clinical Corner article addressed adjustable, modular wheelchair seating with a focus on cushions.  The article reviewed the spectrum of seating, from off-the-shelf to custom seating and described modular seating as the bridge between standard seating and custom seating.  If you missed that article, see Adjustable Modular Wheelchair Seating: Cushions.  This month, Clinical Corner will continue to address adjustable, modular wheelchair seating, with the focus on back supports. 

Wheelchair seating is fundamental in seating and mobility prescriptions.  Combined with the correct wheelchair base for an individual, seating can promote posture and positioning, provide stability, facilitate function, address pressure management and enhance comfort and sitting tolerance.
 

This month, Clinical Corner has a guest blogger!  Robert Norton, a Sunrise Medical colleague, provides his insights on selecting the ideal mini proportional joystick. 
 
For a refresher on specialty controls, please refer to the 2013 Clinical Corner article, Specialty Controls for Power Wheelchairs. 

Last month’s Clinical Corner article focused on Selecting a Cushion Based on Seating Goals.  The article highlighted the importance of conducting a thorough assessment and establishing goals for seating and mobility.  Common goals of seating and mobility were outlined.  These include: pressure management, positioning, function/stability, heat and moisture dissipation, impact and vibration dampening, comfort, or a combination of the goals.  As I mentioned last month, both the cushion and the back support work together to achieve desired results.  This month, let’s continue the discussion and focus on generic product parameters in back supports to help achieve client seating goals. 
 

The assessment is the foundation for all that follows in seating and mobility.  Conducting a thorough assessment that includes an interview and hands-on component, in addition to understanding the client’s desired outcomes and expectations, is the first step in determining goals for seating and mobility.  Once the goals for seating have been established, generic product parameters can be selected to match the goals for seating and mobility.  This month’s Clinical Corner article will review the common goals of seating and mobility and offer considerations to facilitate achieving those goals through seating.  Although both the cushion and back support work together to achieve desired results, the focus of this month’s article will be on cushion selection.  Back support selection based on seating goals will be the topic of a future Clinical Corner article. 

Last month’s Clinical Corner article addressed parasport and focused in particular on Wheelchair Basketball.  See Wheelchair Basketball for the full article.  This month, let’s continue our look at adaptive sports for individuals who use wheelchairs.  

If it’s October, it’s time for a Clinical Corner article that celebrates another anniversary with Sunrise Medical Canada.  This month marks 7 years that I have been with Sunrise Medical. Time flies!! Allow me to share some reflections of the past year with you. 

In 2015, I wrote a 3-part Clinical Corner series on seating and mobility considerations for individuals who are bariatric. Here are links to the articles:
 

• Seating and Mobility Considerations for Individuals who are Bariatric - Part 1: Body Shape
• Seating and Mobility Considerations for Individuals who are Bariatric - Part 2: Assessment and Seating
• Seating and Mobility Considerations for Individuals who are Bariatric - Part 3: Mobility Base

Getting the right fit is important in seating and mobility.  The fit of the seating system can affect comfort, function, posture, and skin integrity.  This month, Clinical Corner will focus on how to understand seating sizing for cushions, back supports and head supports.  A few “tricks of the trade” will be shared so that clinicians can better understand how to request the correct size of seating for an individual. 

Last summer, Clinical Corner looked at two different sports for individuals who are wheelchair users – handcycling and wheelchair tennis. See Wheelchair Tennis and Handcycling for the full articles. This month, let’s continue our look at parasport with a focus on wheelchair basketball.

Many of the early Clinical Corner articles were written about seating and positioning. Some of the articles included:

• Skin Protection and Cushion Materials
• Skin Protection and Cushion Design
• Skin Protection and Cushion Covers
• Seating Considerations - The Back Rest

The Clinical Corner article, Manual Mobility: The Basics, describes the different categories of manual wheelchairs, known generically as transport, standard, custom folding, custom rigid and tilt-in-space. It was noted that the more rigid the wheelchair, the easier it is to propel the chair as rigidity decreases flex in the frame of the chair. The ideal is that all of the energy of propulsion is translated into movement as any frame flex is lost movement. The more rigid the wheelchair, the more efficient the propulsion can be. This is one of the reasons that custom rigid wheelchairs are selected for individuals. Sometimes, however, an individual requires a custom folding wheelchair to suit their needs. In this case, it is important to understand how rigidity can be enhanced in a folding frame wheelchair in order to optimize efficient propulsion. (Recall that rolling resistance also effects efficiency of propulsion. See the Clinical Corner article, Rolling Resistance in Manual Wheelchairs, for more on rolling resistance.) This month’s Clinical Corner article will look at some of the ways in which rigidity can be enhanced in a custom folding wheelchair.

In September of 2015, I wrote an article for Clinical Corner, entitled “Best Practices in Seating and Mobility Assessments”.  As outlined in that article, the following concepts were found to be necessary for best practices in seating and mobility assessments: experience; hands-on techniques; skills; technology; resources; self-directed learning; follow-up; and consumer relationships.¹  The article expanded on each of the concepts.  Click here for a link to the article.   This month, let’s take a second look at some of the best practices in seating and mobility assessments, specifically technology and resources.  Let’s also consider why we should take a second look at products and technology.
 

Last month’s Clinical Corner article addressed The Evidence on Tilt, Recline and Elevating Leg Supports. The article reviewed the clinical benefits of tilt, recline and elevating leg supports and summarized the research findings with respect to angles required for redistributing and relieving pressure through tilt and/or recline. This month, let’s look at the practical application of power positioning. For what reasons do individuals use their power positioning features? How often are individuals completing pressure relieving movements through power positioning? How can technology assist individuals with pressure management?

Past Clinical Corner articles have addressed Dynamic Tilt and Pressure Distribution and Weight Shifting and Pressure Management. The article,Dynamic Tilt and Pressure Redistribution from October 2012, addressed clinical indications for tilt-in-space wheelchairs and the research related to dynamic tilt and pressure redistribution. The article,Weight Shifting and Pressure Management 2.0 from February 2016, addressed recommendations on duration and frequency of repositioning for pressure ulcer prevention based on clinical practice guidelines.

Have you ever driven your vehicle and felt like you had to correct the steering to continue to go in the direction you intended? Most likely, the answer is yes. This may have occurred if you drove over a bumpy dirt road or other rough terrain. It may have occurred if two wheels were on one surface, such as a road, and the other two wheels were on another surface, such as a soft shoulder, or when there was a transition between two surfaces. Drivers of power wheelchairs also may experience circumstances when correction of the steering is required. This month, Clinical Corner will focus on technical solutions to address steer correction in power mobility.

Seat elevation in a power wheelchair is a lift of the seat pan on the vertical plane, as the picture below illustrates.  Seat elevation raises and lowers the height of the seating system, without changing seat to back or seat to floor angles.  While seat elevation can be prescribed with other power positioning features, such as power tilt, recline and elevating leg rests, the focus of this month’s Clinical Corner article will be solely on power seat elevation. 

Why the title “Six in The Six”?  Well, October marks my six year anniversary with Sunrise Medical.  For the past two Octobers, I have celebrated each anniversary with a look back and I thought I would do the same this year.  Although Sunrise Medical Canada’s head office is just north of “The Six” (or Toronto as it is more commonly known), I cannot resist an alliteration for the title of this anniversary article of Clinical Corner. 

Past Clinical Corner articles have looked at Power Assist Wheelchairs and Power Wheelchairs.  Let’s continue our look at powered mobility by focusing on scooters this month.  We will look at clinical considerations in determining if a scooter is an appropriate mobility device for an individual and look at the essential components of a scooter to better understand this mobility device. 

The summer is a great time to think about sports.  Last month’s Clinical Corner article focused on wheelchair tennis.  If you missed that article, click here: Wheelchair Tennis.  This month, let’s look at handcycling. 

History was made at Wimbledon this year with the addition of wheelchair singles events.  Previously, wheelchair tennis was played only in doubles at Wimbledon.  For Clinical Corner this month, let’s take a closer look at the sport of wheelchair tennis, from both competitive and recreational levels. 

Last month’s Clinical Corner article was about the role of the therapist assistant in wheelchair provision.  Many occupational therapists and physiotherapists from across Canada contacted me via email to provide feedback on their use of therapist assistants in seating and mobility, in response to my request for information.  Drawing from the information provided, the article focused on the various tasks that are assigned to rehabilitation assistants throughout the steps of wheelchair provision, from referral to discharge.

Recently, a therapist provided a suggestion to me to write a Clinical Corner article on the role of the therapist assistant in wheelchair provision, from referral to discharge.  What a great topic!  Having worked in a number of different clinical settings prior to joining Sunrise Medical, my personal experience has been that the role of the therapist assistant with respect to wheelchair provision varies depending upon the practice setting and the size of the institution or agency in which one works.

Clinical Corner is 5 years old!  As I mentioned in Happy Anniversary..., I began writing articles related to the clinical aspects of seating and mobility for our monthly Sunrise Medical Newsletter, SUNMED News, in January 2011.  In March 2011, a blog was started as a way to archive the Clinical Corner newsletter articles and to have them accessible to those who do not receive our newsletter. 

The safety of individuals who must remain seated in their wheelchairs during transit remains an important consideration for therapists prescribing wheelchairs. I have previously written articles on RESNA standards, including WC19 Wheelchairs Used as Seats in Motor Vehicles; WC18 Wheelchair Tiedown and Occupant Restraint Systems (WTORS) for Use in Motor Vehicles; and WC20 Wheelchair Seating Systems for Use in Motor Vehicles. These articles provide information that is helpful in understanding these related standards.

I first wrote about Weight Shifting and Pressure Management in November 2013. Weight shifting and repositioning are important parts of pressure management to prevent pressure ulcer formation for individuals who use wheelchairs. Click here for the November 2013 Clinical Corner article, which contains information on what occurs internally to the tissue surrounding the pelvis during sitting.

Hello all! When I lead in-person education sessions on wheelchair cushions, one of the questions that I am frequently asked is, “How do you get staff to put the cushions on the correct way?” When the cushion is removed from the wheelchair to clean the cover and/or the cushion base, mistakes some...

Let’s finish the trilogy on assessments by looking at the overall process of wheelchair provision, of which assessment is only one step, by taking a broader look at all the steps that go into providing an appropriate wheelchair for an individual

In September, I wrote about Best Practices in Seating and Mobility Assessments. If you missed that article, click here.

This month, we will take a more detailed look at the information that should be gathered during the seating and mobility assessment. It must be remembered that the assessment is just one step in the overall process of wheelchair provision.1 A future article of Clinical Corner will address the additional steps identified in the Rehabilitation Engineering & Assistive Techology Society of North America (RESNA) Wheelchair Services Provision Guide.

Has it really been a year since I wrote the article, Happy Anniversary …, in which I marked my 4 year anniversary with Sunrise Medical? This month I celebrate my 5 year anniversary with Sunrise Medical. Where does the time go?

Like I did in last year's anniversary post, I thought I would reflect upon the past year and share some thoughts - both professional and personal - with you.

Conducting a thorough assessment is vital to ensuring an optimal seating and mobility prescription for a client, but what are the best practices in seating and mobility evaluations? A study conducted by Mary Isaacson, EdD, OTR/L, ATP, published in Assistive Technology, sought to answer that question.¹

Have you ever sat in a chair and tried balancing yourself by tilting backwards onto the back two legs of the chair? Perhaps you held onto the table in front of you and used your arms to push yourself backwards to find the balance point? You may remember doing this when you were a child in either grade school or high school. Some o fyou may have experienced going past the tipping point and having the chair fall behind you, or if you were lucky enough, you quickly recovered bu moving your weight forward to prevent falling backwards. (I am not recommending anyone try this while sitting in a chair - it can be dangerous and you can fall backwards and get hurt! I just realize that it is something I have done in my youth and I have seen my own children do it too – and, of course, I cautioned them against it.)

Last month, we began our look at head supports and focused on assessment and generic choices available in mounting hardware. Click here if you missed Wheelchair Head Supports – Part 1.  This month, let’s continue our look at head supports and consider the choices available in pads and possible customizations.

This month, let's think about head supports for individuals who use wheelchairs. Essentially, there are 3 circumstances under which we may be considering head supports for individuals - for people who do not have good head control and require head support when seated upright; for people who have good head control when seated upright, but require support of the head when using a tilt or recline feature in seating; and for people who remain seated in a wheelchair in transit and who are required by the transportation provider to have a head support affixed to the wheelchair while the individual is in transit.

Let’s continue our discussion on seating and mobility considerations for individuals who are bariatric. (If you missed the first two articles in this mini-series, you can click here for Part 1 on Body Shape and click here for Part 2 on Assessment and Seating.) This month, we will look at the mobility base...

Last month, we started a discussion on seating and mobility considerations for individuals who are bariatric.  I wrote about body shape and that it is a person’s unique shape and weight distribution that must be evaluated when assessing for seating and mobility.  (If you missed last month’s article, click here for Part 1.)   Let’s continue the discussion.

This month, let's start a discussion on seating and mobility considerations for individuals who are bariatric. According to Mosby's Medical Dictionary, bariatrics is "the field of medicine that focuses on the treatment and control of ovesity and diseases associated with obesity"1. The first thing to remember when working with individuals who are bariatric is that there is no "one size fits all". This month's article will focus on body shape. People come in different shapes and sizes and it is a person's unique shape and weight distribution that must be evaluated when assessing for seating and mobility.

In May 2012, I wrote an article for my Clinical Corner blog, titled “Wear in Wheelchair Cushions”. If you missed that post, you may click on the following link to read the article. I continue to receive questions on how to determine when a wheelchair cushion requires replacement so I thought it would be a good idea to revisit this topic. This month, I will update the discussion on wear in wheelchair cushions by reviewing research that has been published since my blog article was posted.

Last month, we looked at Wheelchair Tie downs and Occupant Restraint Systems (WTORS) and the previous month, we looked at WC19 - the voluntary standard for wheelchairs used as seats in motor vehicles. Let's continue our look at the factors that enhance safety for individuals who remain seated in their wheelchairs while travelling in motor vehicles. Specifically, we will look at WC20, which is the voluntary standard related to seating devices for use in motor vehicles, and we will look at some of the recommendations from the Guidelines for Use of Secondary Postural Support Devices by Wheelchair Users During Travel in Motor Vehicles.

Last month, we looked at WC19 - the voluntary standard for wheelchairs used as seats in motor vehicles. This month, let's look at Wheelchair Tiedowns and Occupant Restraint Systems (WTORS) and how these work in conjunction with WC19 compliant wheelchairs.(If you missed last month’s article, please see click here.)

This month, let’s think about safety, wheelchairs, and transit.  Individuals who remain seated in wheelchairs while travelling in vehicles are “45 times more likely to be injured in a crash than the typical passenger”1 (p. 2).  The “typical” passenger in a vehicle transfers into the vehicle manufacturer’s seat, which is secured to the vehicle, and uses the occupant restraint system; that is, the seat belt system that also is secured to the vehicle.  Individuals who must remain seated in wheelchairs while travelling in vehicles also are at risk of injury in “non-collision events”, such as sudden braking or sharp turning, resulting in the wheelchair tipping, securement failure, or the occupant falling out of the wheelchair1 (p. 4).  Many individuals who must remain seated in the wheelchair during transit do not have postural control or the ability to stabilize themselves or their wheelchairs during these non-collision events, which can result in serious injuries.

… to me!  This month marks my 4 year anniversary with Sunrise Medical.  I cannot believe how the time has flown by.  I thought that for this month’s Clinical Corner article I would write something very different and share some of my memorable experiences with Sunrise with all of you.

There are many factors that influence the maneuverability of manual wheelchairs and I previously have written articles on many of these factors.  Past articles have been written about rolling resistance, overall weight, centre of gravity and weight distribution between the front casters and rear wheels, caster housing position, rear wheel camber, and rear wheel position in standard wheelchairs.  All of these articles are available on Clinical Corner and can be found by using the Search feature in the upper right corner or looking through the tag cloud in the lower right. This month, I would like to focus on one simple choice that affects turning efficiency and performance and that is the choice of the fork in a custom, adjustable folding wheelchair.

In previous Clinical Corner articles, I have written about generic off-the-shelf wheelchair cushion design and materials, cushion covers, and wear in wheelchair cushions.  I have also written about customizing off-the-shelf seating to address skin protection, positioning needs or personal choice.  All of these articles can be accessed by either using the search toolbar in the upper right corner or by clicking on the appropriate tag in the lower right corner of the blog.  This month, let’s continue to look at seating with a focus on custom seating.

In our focus on manual wheelchairs, we have looked at the effects of horizontal and vertical rear wheel position in manual wheelchairs.  This month, let’s look at lateral position and camber in the rear wheels of custom folding and rigid frame wheelchairs.

In a previous article, I wrote about the position of the rear wheels of a manual wheelchair and its effects on centre of gravity and weight distribution between the front casters and rear wheels.  This month, let’s focus on how the position of the front casters effects the load distribution between the rear wheels and front casters.

In a previous article, I spoke about rolling resistance in manual wheelchairs.  Let’s take a step back and look more closely at what is meant by the term “rolling resistance” and what factors contribute to the rolling resistance in a manual wheelchair.  Before we look at rolling resistance, let’s have a quick physics lesson

​This month, let’s continue our focus on manual wheelchairs by looking at the effects of the vertical rear wheel position in manual wheelchairs.  Both standard and custom folding wheelchairs allow for vertical positioning of the rear wheels.  Positioning the rear wheel up or down the frame of a manual wheelchair will have effects on seat-to-floor height, orientation in space, and rear wheel access.

​Last month, I wrote about centre of gravity and its application to different types of manual wheelchairs. This month, I would like to address an important consideration related to centre of gravity when prescribing standard wheelchairs.

​Last month, I wrote an introductory article on the different types, or categories, of manual wheelchairs available.  This month, let’s focus on centre of gravity and its application to manual wheelchairs.

The position of the rear wheel on a manual wheelchair relative to the frame effects the position of the centre of gravity and will impact the performance of the wheelchair.  The graphics below illustrate the position of the rear wheel along the horizontal plane, which changes the weight distribution between the rear wheel and the front casters.

​This month, let’s go back to the basics and look at the different types of manual wheelchairs available.  As I have written in a previous Clinical Corner article, funding agencies for mobility devices vary province by province in Canada and each agency has different criteria on who is eligible to receive a manual wheelchair and which type or category of manual wheelchair can be considered for a qualified individual.  Each province also has its own classification terms.  For example, a particular model of a manual wheelchair may be in a certain category in one province and a different category in another province.  This month’s article will look at generic classification of manual wheelchairs at an introductory level.  The categories of manual wheelchairs include transport, standard, custom folding, custom rigid, and dynamic tilt.  Let’s take a look at each one.

In the past, I have written about wheelchair cushions and how materials and product design affect skin protection.  This month, I would like to focus on weight shifting and its role in skin protection.

​Before we address the impact of weight shifting on pressure management, let’s have a brief review of what happens to our bodies when we sit, assuming we are sitting with a neutral pelvis; that is, that the pelvis is not tilted anteriorly or posteriorly.  When we sit with a neutral pelvis, the ischial tuberosities are the lowest point on the pelvis.

In Canada, funding agencies for mobility devices vary province by province and each agency has different criteria by which a person may be eligible to receive a manual wheelchair and which type or category of manual wheelchair can be considered for a qualified individual. Therefore, it is difficult to make generalizations about funding programs, but, typically, funding sources consider funding the provision of a manual mobility device if a person is expected to require the device on a long-term basis (e.g., at least six months).  Please note that this is different from a temporary or short-term need, which is often accommodated through rental, which may be covered through a person’s extended health care benefits.  Thus, when looking at prescribing a mobility device for an individual for a long-term basis, therapists need to look at the future needs of the person.  Since funding cycles typically are a minimum of five years, therapists need to look ahead to anticipate a person’s future needs, in addition to immediate needs, to prescribe a mobility device that will work for an individual not only now, but also in the future.

​This month, I would like to focus on early intervention devices – also known as adaptive strollers.  We will look at what makes adaptive strollers different from mainstream, commercial strollers and why early intervention devices may be prescribed.

​If you have been following my blog, you will know that I previously have written a series of articles on de-mystifying power wheelchairs.  I wrote about batteries and motors, the controller, and selecting electronics.  These articles are available on my blog and can be found by using the Search feature in the upper right corner, or by looking through the “tags” section in the lower right corner of the blog if you would like to read more on these topics.  This month, I would like to continue to focus on power mobility, by comparing mid-wheel, rear-wheel and front-wheel drive power wheelchairs, as it is important to understand how drive base affects the performance of a power chair.

​Off-the-shelf seating works well for the majority of people who use wheelchairs; however, there are some people who require either customization of off-the-shelf seating or, for those who have more complex needs, custom seating systems.  This month, I will discuss some of the modifications that are available in off-the-shelf seating that address skin protection, positioning needs, or personal choice.  Some modifications can be done by a therapist in the field.  For example, closed cell foam can be carved using an electric carving knife.  If done at the factory, many of the customizations involve no additional charge, but to be sure, check the order form.  If the customization is not listed on the order form, it does not necessarily mean it is not possible – it may simply mean it is not a frequently requested modification.  Checking with the customization department of the manufacturer will give you all the information you need about possibilities and prices.

​Recently, my colleague, Ron Claughton, Account Manager with Sunrise Medical, and I presented on specialty controls at the Canadian Seating and Mobility Conference (CSMC) in Toronto. Not only did we discuss various specialty control options, but we also demonstrated the use of specialty controls both live and through videos. Therapists and vendors were given the opportunity to drive power wheelchairs using alternate input devices. Hands on is a great way to learn, but of course, not everyone is able to attend CSMC, so I thought I would share some information on specialty controls in this month’s blog article.

​This month, let’s talk about Pushrim Activated Power Assist Wheelchairs (PAPAWs). Let’s focus on the clinical benefits and considerations associated with their use.

In my last article, I wrote about some of the common equipment and musculo-skeletal factors that influence the potential for sliding while seated in a wheelchair.  This month, I will discuss how features of generic seating and wheelchair configuration may assist in preventing sliding, depending upon the person’s clinical presentation.  Considerations for seating contour, correct angles, and gravity and how they may assist in preventing sliding will be discussed.

​Last month, I wrote about the effects of sliding and the common “quick fixes” and why they tend to not work effectively.  This month, I would like to review some of the common equipment and musculo-skeletal factors that influence the potential for sliding as it is only by understanding the causes of sliding that we can find the true solutions.  Next month, I will discuss features of generic seating and wheelchair configuration that may assist in preventing sliding

​This month, I would like to focus on the prevention of sliding from a wheelchair.  I will talk about the effects of sliding and the common “quick fixes” and why they do not work.  Next month, I will review how understanding the cause of sliding helps to find the true solution.  I will discuss features of generic seating and wheelchair configuration that may assist in preventing sliding

​This month, let’s focus on dynamic tilt, or tilt-in-space, wheelchairs.  We will look at the clinical indicators for their use as well as what the research has found regarding dynamic tilt and pressure redistribution.

​In continuing our series on de-mystifying power wheelchairs, this month let’s look more closely at electronics.  Electronics for power wheelchairs can be categorized into expandable and non-expandable options.  What this refers to is the degree to which the electronics allow different input devices, power options, drive profiles and functionality with assistive technology.

As I stated in last month’s article, in continuing to “de-mystify” power wheelchairs, we will look at how the controller, or control module, works to provide instructions to the motors to move the power wheelchair in the desired manner

​In last month’s article, I wrote about Power Programming Basics and the common adjustments that can be made to the programming of a power wheelchair to affect the drive-ability of such a chair for a particular user.  Over the next few months, I would like to focus on the “gross anatomy” of a power wheelchair base to help in de-mystifying power wheelchairs for those who may not feel comfortable working with power wheelchairs.  A power base includes the following: wheels, casters, motors, batteries, and the controller.

​Recently, my colleague, Ken Kalinowski, and I presented a workshop on the Power of Programming at the Canadian Seating and Mobility Conference (CSMC) in Toronto.  (Ken is the Senior Service Technician and Technical Trainer with Sunrise Medical.  He teaches Power Technical Training Programs in Canada and the United States.)  I think it is fabulous to have the opportunity to learn hands-on, but for those of you who did not have the opportunity to attend CSMC and who are not very familiar with programming for power wheelchairs, this month’s article will help to increase your comfort level with the very basics of programming for power chairs.

​Often when I go into hospitals and other facilities – places that have equipment pools for seating and mobility, but limited budgets for replacement items – I am asked “How can you tell if a cushion is worn out?”  Because of the frequency of that question, I thought it would make a great topic for Clinical Corner.  It is also a topic that is applicable for evaluating an individual wheelchair user’s cushion to determine when a replacement cushion may be needed if there are no provincial funding guidelines.

Recently, I received an email question through my blog from an occupational therapist and her question struck me as a really interesting example of how product design can influence skin protection in a particular clinical scenario.  With the therapist’s consent, I will share a synopsis of her question to me and my response. (Please note that some of the details regarding the client have been altered to ensure client privacy.)

​Well, if you have been following this series, you will know that I have written about different aspects of wheelchair cushions, such as the material, design, and cushion cover, and how these may affect skin protection for a person using the cushion. You will also know that I have said that no one cushion will work best for all people. This month, I would like to write a reminder for everyone to consider wheelchair configuration and how this may influence the effectiveness of the cushion in providing skin protection.

​Past articles have looked at various materials commonly used in wheelchair cushions and different types of cushion covers and their relative ability to effect skin protection.  This month, let’s think about how some materials may be formed into a cushion and how the shape and design of a cushion can effect skin protection

​Last month, we focused on materials commonly used in wheelchair cushions.  This month, let’s look at the different types of cushion covers and how the type of cushion cover used may effect skin protection.  Cushion covers?!  Are they really that important?  Well, in a word – yes!

​This month, let’s focus on materials commonly used in wheelchair cushions and how choice of material can affect skin protection.

Last month’s article gave us an overview of pressure sores, staging of pressure sores, factors associated with pressure sores and some prevention strategies.  This month, I would like to look at how seating can assist in the prevention of skin breakdown and pressure ulcers.

In one of my previous articles, I wrote about the many possible goals of seating.  This month, I would like to take a closer look at one goal in particular – skin protection.

​In one of my previous articles, “More on Practical Seating Considerations – Posterior Pelvic Tilt”, I wrote about the importance of the back rest when seating a client who presents with a posterior pelvic tilt. This month, I would like to talk about back rest selection in general.

​So far with respect to practical seating considerations, I have written about pelvic obliquity, posterior pelvic tilt and anterior pelvic tilt.  This month, I would like to focus on practical seating considerations for a client who presents with a pelvic rotation.

In last month's article, I wrote more on the practical seating considerations for posterior pelvic tilt. This month, I would like to focus on practical seating considerations for a client who presents with an anterior pelvic tilt.

One of the first steps in the prescription of a wheelchair for a client, after the interview and information gathering, is the hands on assessment.  The hands on assessment is crucial as it provides key information necessary for matching client needs with product parameters.

In last month's article, I wrote about cushion considerations for seating a client with a posterior pelvic tilt. This month, I would like to discuss the importance of the back rest when seating a client with posterior pelvic tilt. In addition, I would like to talk about the role of gravity in assisting with positioning for a client who presents with a posterior pelvic tilt.

In last month's article, I wrote about cushion considerations for seating a client with a pelvic obliquity. This month, I would like to continue with this practical approach to look at cushion considerations when seating a client with a posterior pelvic tilt.

Last month, I talked about the importance of the hands on assessment as a mat assessment provides so much information regarding a client's seating needs. It is a step in the assessment process that cannot be missed.

In last month's article, I talked about the goals of seating and considerations for generic seating product parameters to achieve seating goals for your client. 

This month, I would like to take a practical approvach so that you can see how choice of a cushion can help to achieve seating goals. Let's take the example of a client iwth a pelvic obliquity.