Mobility Beyond the Wheelchair
CASE HISTORY: Barry is a 33-year-old man, rendered a C5-6 quadriplegic in 1987. Barry lives in a wheelchair accessible townhome, and leads an active lifestyle. He requires attendant care assistance in the morning and evening. Barry is a lawyer and partner in his own firm. He drives a van, and functions well beyond his physical potential. CLINICAL CONSIDERATIONS: Barry used a power wheelchair until 1991, when he began driving. He then switched to a manual wheelchair for his primary mobility. Barry’s choice of manual wheelchair was the Chair You Wear custom, rigid frame manual wheelchair. He uses a Low Profile Roho cushion, and regular back upholstery. Barry drives a Ford Econoline full size van that was modified to suit his specific needs by Ricon Canada. His van and manual wheelchair were both outfitted with an E-Z Lock automatic tie down system, allowing Barry to secure himself and drive safely from his manual wheelchair. Modifications include a remote control entry system with Ricon power door openers and an S-Series automatic lift. Barry’s van was also outfitted with reduced effort steering, emergency power back-up and a 13.5” diameter steering wheel. He accesses the gas and brake with MPDD 3700 manual hand controls. The center quad-console provides other primary functions such as starting, gear shifters and emergency brake operation. Barry initiated occupational therapy and vendor involvement in the spring of 1997. The problem identified at the time was that of deteriorating posture. Barry’s pelvis was posteriorly tilted, resulting in a flexed trunk position and beginning of kyphosis. His pelvis is level laterally although his shoulders are slightly asymmetrical. Barry’s poor posture was effecting his function and causing upper body pain. Barry’s wheelchair was also assessed, requiring a major tune up, clean up and a variety of repairs. The goals identified were to improve Barry’s posture, reduce the risk of deformity and skin breakdown, enhance his function, maintain safe van driving ability and active lifestyle, and to assist Barry in projecting a professional image. Ideally, a new wheelchair, compatible with all seating equipment would be of most benefit to Barry. If the wheelchair and seating were changed, however, a new assembly on the wheelchair would be required to allow for the automatic tie down system. Barry has no outside funding to assist with equipment and van replacement. Barry made a decision to have an “overhaul” done to his wheelchair to clean it up and maintain its working order, and to change his seating within the current wheelchair.
TREATMENT/APPROACH: A compromise between the clinical seating goals and the client’s mobility beyond his wheelchair was necessary. A thorough assessment was completed and a review of available equipment completed. Barry agreed on the need for back support, however, wanted the support to be minimal and comfortable so as not to interfere with his function. The choice of cushion would not change, as Barry is used to the Low Profile Roho, and has not experienced any skin problems. Because Barry is in a custom manual wheelchair that is no longer on the market, many of the newer backrests are not compatible with the backcanes or design of the wheelchair. The J2 Back, Jay X-Treme Back and Pax Back were tried unsuccessfully. OUTCOME: Barry’s wheelchair was cleaned up, and maintenance completed with new parts to ensure safe and efficient mobility. A new cushion with extra cover was in place. Quickie Adjustable tension upholstery was installed and adjusted with a custom Sunmate foam lumbar support placed within the straps of the back upholstery. The cover over the back of the upholstery ensures that the seating appears clean and minimal. With these changes,
Barry’s posture has been improved. He does ideally require more back support than he currently has, but this can be adjusted somewhat through the back upholstery. His function and level of independence has been maintained, and the risk of deformity and skin breakdown has been decreased. He has continued use of both his wheelchair and van until he is financially able to replace both at the same time. The ultimate goal of maintaining Barry’s lifestyle while considering his mobility beyond the wheelchair was achieved. EQUIPMENT: Ford Econoline Full Size E-150 van with: Ricon S-Series lift, power door opener, E-Z lock automatic tie down system, MPD 3700 hand controls, 13.5" reduced diameter wheel, reduced effort steering; Ricon quad command console; Chair You Wear custom, rigid manual wheelchair; Quickie Adjustable Tension back upholstery; Low Profile Roho cushion; Custom Sunmate lumbar insert.