May 2015 V ol. 14 No. 5 Serving the Seating & Mobility...
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May 2015 • V ol. 14 No. 5 mobilitymgmt.com Serving the Seating & Mobility Professional
Transcript of May 2015 V ol. 14 No. 5 Serving the Seating & Mobility...
May 2015 • V ol. 14 No. 5
mobilitymgmt.com
Serving the Seating & Mobility Professional
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www.OttoBockUSMobility.com
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may
Mobility Management (ISSN 1558-6731) is published monthly by 1105 Media, Inc., 9201 Oakdale Avenue, Ste. 101, Chatsworth, CA 91311. Periodicals postage paid at Chatsworth, CA 91311-9998, and at additional mailing offices. Complimentary subscriptions are sent to qualifying subscribers. Annual subscription rates payable in U.S. funds for non-qualified subscribers are: U.S. $119.00, International $189.00. Subscription inquiries, back issue requests, and address changes: Mail to: Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866, email [email protected] or call (847) 763-9688. POSTMASTER: Send address changes to Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866. Canada Publications Mail Agreement No: 40612608. Return Undeliverable Canadian Addresses to Circulation Dept. or XPO Returns: P.O. Box 201, Richmond Hill, ON L4B 4R5, Canada.
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On the CoverKids on the move need mobility systems that can keep up. Our annual pediatric wheelchair comparo highlights the options. Cover by Dudley Wakamatsu.
13 Pediatric Wheelchair Comparo Manual self-propelled, manual caregiver-propelled, and power
wheelchairs for kids come together in our 2015 comparison
featuring specifications, sizes, options and photos.
20 Seating & Mobility Considerations for Palliative Care Clients
Maximizing a wheelchair client’s independence and quality of
life is always a goal of the ATP or seating & wheeled mobility
clinician. But when a client is under palliative and/or hospice care,
other factors also need to be considered.
volume 14 • number 5
6 Editor’s Note
8 MMBeat
24 Marketplace: Standing Technology
26 Technology Showcase: Quantum Rehab’s iLevel
28 Technology Showcase: TiLite’s TX
30 Ad Index
May 2015 • Vol. 14 No. 5
mobilitymgmt.com
Serving the Seating & Mobility Professional
contents
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6 mobilitymgmt.commay 2015 | mobilitymanagement
In prepping for this issue’s feature story on palliative care, I read a story in the January 2014 issue of New Yorker. In his story “Lives Less Ordinary,” author Jeremy Groopman explored the relatively new specialty of pediatric palliative care and the difference it can make for children with extremely complex medical conditions.
Palliative care is a new topic for Mobility Management, so I was interested to read how palliative care clinicians work with specialists in other fields — including pediatrics, neurology, gastroenterology, oncology, nephrology, cardiology, ophthalmology, immunology and genetics, in the case of one of the patients in the story — but on behalf of the child and her family. The job of the palliative care team is to consider what’s best for the whole existence of the child, rather than just what is clinically recommended.
Groopman quoted an exceedingly bright 11-year-old named Gwen, who has a mito-chondrial disorder that wreaks havoc on her organs, particularly her liver and her diges-tive system. Of her palliative care team, Gwen said, “They make an effort to say, ‘Can I sit down and watch 10 minutes of this show with you? Can I talk to you?’ It’s not, ‘Let me just stand over you and prescribe you some pills.’”
As I continued reading, I kept getting feelings of déjà vu:One of Gwen’s doctors noted, “But there’s not much about Gwen that has ever been
by the books.”Another palliative care physician said, “I learned that you can’t treat a child’s pain effec-
tively without understanding her anxiety and her social situation.”Said another: “One easy change… would be to improve the kinds of questions that
pediatricians ask families upon first meeting them. … Typically, a doctor’s first questions are narrowly focused on the child’s illness; instead, [a palliative care team] recommends asking about the child as a person — how he or she contributes to the family, and how the illness has affected them — as a way of beginning to gauge and manage expectations.”
Sound familiar?Most of the time, seating & wheeled mobility professionals focus on functional solu-
tions that work for clients for the longer term. ATPs and clinicians are concerned about a system’s growability and adjustability because they’re anticipating changes in a client’s size or abilities.
Sometimes, the longer term includes disease progression to the point that a client’s needs change drastically, and he or she needs palliative and/or hospice care.
But either way, I realized that you ask palliative types of questions from the very start. Isn’t understanding the client’s goals one of the cardinal rules of successful seating prescription and mobility provision?
Don’t you ask what activities are critical to a client’s overall well-being? Don’t you try to build systems that aren’t only clinically effective, but also take into account that a dad wants to propel efficiently to keep up with his kids, or a kindergartner wants to drive her power chair on the grass at the park? Don’t you plan for a power chair to support augmentative communications devices and environmental controls because you know how spiritually important they can be? Isn’t one of your favorite benefits of seat elevation the fact that it enables your clients to look their families in the eye?
So maybe physicians of all specialties can learn something valuable from you: that patients are so much more than their medical conditions, their life expectancies and the projected paths of their illnesses. You’ve known that all along. l
Laurie Watanabe, [email protected]
Editor Laurie Watanabe (949) 265-1573
Group Publisher Karen Cavallo (760) 610-0800
Publisher’s Assistant Lynda Brown (972) 687-6710
Group Art Director Dudley Wakamatsu
Director, David Seymour Print & Online Production
Production Coordinator Charles Johnson
Director of Online Marlin Mowatt Product Development
SECURITY, SAFETY & HEALTH GROUP
President & Group Publisher Kevin O’Grady
Group Publisher Karen Cavallo
Group Circulation Director Margaret Perry
Group Marketing Director Susan May
Group Social Media Editor Ginger Hill
mobilitymgmt.com
Volume 14, No. 5
May 2015
editor’s note
Palliative Pros
REACHING THE STAFF
Staff may be reached via e-mail, telephone, fax, or mail. A list of editors and contact information is also available online at mobilitymgmt.com.
E-mail: To e-mail any member of the staff, please use the following form: [email protected]
Dallas Office (weekdays 8 a.m. - 5 p.m. CT) Telephone 972-687-6700; Fax 866-779-9095 14901 Quorum Drive, Suite 425, Dallas, TX 75254
Corporate Office (weekdays, 8:30 a.m.-5:30 p.m. PT) Telephone 818-814-5200; Fax 818-734-1522 9201 Oakdale Avenue, Suite 101, Chatsworth, CA 91311
Chief Executive Officer Rajeev Kapur
Senior Vice President & Richard Vitale Chief Financial Officer
Chief Operating Officer Henry Allain
Executive Vice President Michael J. Valenti
Vice President, Erik A. Lindgren Information Technology & Application Development
Executive Chairman Jeffrey S. Klein
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After Permobil acquired air-cell technology manufacturer ROHO Inc. in late March, the president of Permobil North America, Larry Jackson, intimated that the power wheelchair manufacturer wasn’t finished with acquisition plans.
The purchase added ROHO’s air-cell cushions, with their skin protection and positioning technology, to a complex rehab stable that already includes Group 3 and Group 4 power chairs, complex powered seating, and custom-built ultralight-weight manual chairs, thanks to the May 2014 acquisition of TiLite.
Founded in 1973 by electrical engineer Robert H. Graebe, ROHO manufactures products that are currently sold in 65 countries around the world, according to the news release.
With this latest addition, Jackson pointed out that the company can now fully compete “against all the other manufacturers in the space.”
Independent OperationsIn an interview with Mobility Management, Jackson, said ROHO management, including ROHO President and industry veteran Tom Borcherding, would remain in place.
“As far as the sales team, we plan to sell through our sales organiza-tion,” Jackson said. “There will be a change from [ROHO’s] indepen-dent reps to our sales organization, much like TiLite.”
Permobil has purchased the medical division of ROHO, which ROHO VP of marketing Susan Lynch defined as wheelchair seat cush-ions and backrests, support surfaces, and other air-cell accessories.
Jackson said the Permobil/TiLite sales force will sell ROHO cush-ions and backs, while support surfaces sales will be handled by a different sales force going forward.
ROHO’s other specialty seating lines, such as seating used in the motorcycle industry, were not part of the Permobil acquisition.
ROHO end users are unlikely to notice any changes, Jackson added.“I don’t see any changes from a consumer standpoint; I don’t see
changes in the product offering that we have. What I see is the ability for us to invest more in ROHO and bring more innovation to the market. So the user should see, hopefully, some newer products down the road that we can bring to the market. The clinicians should see that the same rep who sold Permobil can now sell ROHO. Maybe it’ll simplify that process.”
ROHO’s headquarters will remain in Belleville, Ill., much as TiLite has continued to work from its corporate offices in Washington.
“With TiLite, we’re trying to guide them and invest in the company even more,” Jackson said. “We’ve put a lot of investment in the
company which you haven’t necessarily seen yet. As far as the company itself, TiLite has run basically independently. They’re out there in Pasco, Wash., and ROHO’s will be a very similar approach as well, outside of St. Louis.”
A Logical ChoiceBuying ROHO made sense, Jackson explained, particularly after Permobil acquired TiLite.
“When we purchased TiLite, what was evident is that we needed a cushion company as well. People in manual chairs use a lot more cushions and backrests than people in [Permobil] chairs. The hope and the idea is that we can bring some innovation to ROHO through these two product lines, through TiLite and Permobil, and have
their products fit our products even better, whether it be through sizing or new, innovative features. We feel there are synergies there, for sure.”
ROHO has also collaborated with other wheelchair manufacturers, including Sunrise Medical and Ottobock, who incorporate ROHO air cells in some of their cushions. Jackson said he hadn’t had formal discussions on that topic given the early phase of the acquisition, but believes ROHO will continue those partnerships.
ROHO’s Strong ReputationROHO’s Susan Lynch said numerous other companies have sought to purchase the company in the past, but that Permobil was the best fit.
“The reason why the Graebe family entertained the opportunity with Permobil was really because of close alignment of culture and level of quality,” she said.
“Permobil is certainly a recognized leader in power wheelchairs and everything that they do, and much like TiLite, in their acquisi-tion last year, they’re really perceived as a leader in that area of seating & mobility. So because Permobil is a leader and recognized ROHO as a leading brand in wheelchair cushions and support surfaces overall, the Graebes knew that putting ROHO in Permobil’s hands is really putting the brand in very capable and caring hands.”
In the news announcement, Tom Borcherding referred to Permobil as “a world-class company” and added that the power chair manufac-turer “has successfully driven innovation in the market for advanced rehabilitation technology. We look forward to continue developing our products and technology as part of the Permobil team.”
“As far as what we call healthcare transformation, ROHO is out in front of that,” Jackson said. “They’re doing outcomes-based research. I think there are some opportunities for us as a sales organization to get out there and prove these outcomes that they’re starting to get.
Permobil’s Larry Jackson: “We’re Not Done” After Buying ROHO
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“The other thing that excites us about ROHO is they have a truly global reach. They sell in Russia, they sell in Chile, they sell in China. Anywhere you go in the complex rehab market, you see ROHO. So that gives us an opportunity, a foothold.”
An example, Jackson noted: “We’re going to build an office in Sao Paulo, Brazil, and ROHO has been selling cushions there for 10 years.”
Jackson added that ROHO and Permobil share the same vision.“These were the three companies that formed Users First,” he
pointed out, referring also to TiLite. “And there was a reason for that: We had the same philosophy and the same culture already. That’s a good thing. It makes a much easier transition for us because we all believe in the same thing: taking care of the users. That’s what our mission is, to take care of the users.
“I think the most important thing to me is we’re going to try to increase the spending in R&D and bring some more innova-
tion. ROHO has a lot of really good innovation that just needs to be brought out, and I think with the sales force that we have, we can fulfill those needs.”
Permobil was purchased by Investor AB in the spring of 2013. A a year later, Permobil purchased TiLite, then followed up in 2015 by adding ROHO.
Jackson said Investor AB is “very excited with the complex rehab space, and we’ve gone out and tried to get the best companies to add to power chairs. We’ve been in power chairs for 47 years; they believe in our company, and they believe in our management team. We went out and got TiLite, and ROHO we’ve been working on for a long time. Everybody that I know of has tried to buy ROHO over the years. It’s a great product and great company.”
Regarding future moves, Jackson gave a tantalizing response: “We’re not done.” l
Permobil Acquires ROHO
New Study Says CMS Could Save by Postponing Collection of Appealed O&P Claims
A new analysis commissioned by the American Orthotic & Prosthetic Association (AOPA) suggests that postponing paybacks of claims until after the appeals process is finished could be a win-win for both orthotic and prosthetic (O&P) providers and the Centers for Medicare & Medicaid Services (CMS).
In a March 19 news conference, several O&P experts said the huge number of Medicare-denied O&P claims currently awaiting a deci-sion at the appellate level were forcing O&P businesses to lay off employees or close their doors, thus hurting beneficiary access to crit-ical healthcare services.
A study conducted by Dobson DaVanzo & Associates focused on CMS’s Recovery Audit Contractors (RAC) level 3 audits, “the only type of appeal for which CMS currently pays interest,” the report said. So many RAC-denied claims have been appealed to the Administrative Law Judge (ALJ) level that the system is seriously backlogged, and decisions that are supposed to be rendered within 90 days are currently delayed for three years or longer.
About 51.9 percent of those denials are overturned at the ALJ level, thus requiring CMS to pay interest to those affected providers.
Under a new proposal, CMS “would no longer be responsible for paying interest for each favorable or partially favorable RAC disposi-tion,” the report says. Currently, a provider must repay CMS when a RAC audit results in a claim denial, even if the provider appeals the decision. The proposal instead suggests that CMS not collect repay-ment from a provider who appeals until and unless the provider loses a level 3 ALJ decision, “thus eliminating CMS’s need to reimburse providers with interest.”
The report points out that because CMS ends up losing half of the appealed cases — and because a backlog of appeals means claims can wait years for a final decision — the agency has to pay large amounts of interest. Changing the policy, the study says, could save CMS $12 million over 10 years.
A policy change could also save O&P businesses that have to re-pay Medicare for denied claims, then wait years for appeals decisions they often win. But the burden of having to repay CMS, then wait years for eventual payment, has caused providers to cut staff or shutter their businesses, which ultimately hurts consumers who use orthotics or prosthetics.
Charles Dankmeyer, president of AOPA, told Mobility Management, “When a practice can no longer sustain itself, it needs to lay off employees. As that practice gets smaller, those patients who have a long-term relationship with that provider may lose that relationship because that person’s no longer available. And that’s really very tragic. If you’re familiar with those folks that wear prostheses and orthoses, they develop life-long relationships with their practitioners, and it’s very upsetting to lose your clinician.”
Mary Palmer, business manager of Nelson Prosthetic & Orthotic Laboratory in Buffalo, N.Y., says her company has had to lay off employees for the first time in its history. “It’s affected patient care greatly, not only because we have less employees to provide the services, but because patients are waiting a lot longer for service. And it’s taking us longer to provide that service, and the uncertainty of when we’re going to get paid is also bearing on our services for that patient.” l
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One More Time: Medicare Separate Benefit Bill Reintroduced in U.S. HouseA bill that would establish a separate Medicare benefit category for complex rehab technology (CRT) has been reintroduced in the U.S. House of Representatives.
H.R. 1516 was reintroduced on March 19 by Rep. Joe Crowley (D-N.Y.) and Rep. Jim Sensenbrenner (R-Wisc.), the members of Congress who introduced a CRT separate benefit bill to the previous session of Congress. That bill expired when the Congressional term ended.
In a March 20 statement to members and other stakeholders, NCART Executive Director Don Clayback said the new bill’s language is the same as the former’s, “with one important addition. H.R. 1516 includes a new provision that will allow all CRT codes to be billable as a ‘purchase’ rather than subject to ‘capped rental’ treat-ment. This recognizes the individualized nature of CRT items and that they are supplied to meet permanent, not short-term, needs.”
The Problem with Capped-Rental Policies for Complex Rehab TechnologyIn an interview with Mobility Management, Clayback explained why classifying CRT as rental items is a lose-lose-lose situation for Medicare beneficiaries, CRT providers and even the Medicare program itself.
“As you know, CMS changed their policy to where they reclassified certain items to capped rental,” Clayback said. “The theory for capped rental is based on a person having a short-term need for equipment that they use on a temporary basis. CRT items are individualized to the person; it presents problems from the provider perspective, trying to individualize a piece of equipment or technology to a person which really is based on a long-term need. And you’re now going to be paid for that based on a monthly payment.
“It compromises the type of equipment and the quality of equip-ment that the person gets, and as importantly, if this person needs this equipment more than 12 months, which I would say is the case for 99 percent of CRT equipment, Medicare actually pays more over the rental period than if they just purchased it outright. With things being classified as rental, it makes it more difficult for the provider to really individualize a piece of equipment for that person’s specific needs.
“For the Medicare beneficiary, it compromises their access to the right type of equipment, and from a financial perspective, it actually costs the Medicare program and the beneficiary more money if that item is rented over a 13-month period when it could be purchased outright.”
More Support from Consumer OrganizationsIt’s a message that’s also resonating with the consumers who use CRT. Clayback said the Muscular Dystrophy Association will officially support the new bill.
“They will be mobilizing their membership to reach out to Congress to push for passage,” the NCART announcement said. “MDA joins the list of over 50 national consumer and medical profes-sional organizations supporting the CRT bills.”
During the last session of Congress, 168 members of the House supported the CRT separate benefit category bill. The Senate companion bill had 22 co-signers.
Clayback indicated in his interview that he expected a new Senate companion bill to be re-introduced soon by Sen. Thad Cochran (R-Miss.) and Sen. Chuck Schumer (D-N.Y.), who introduced the bill into the previous session of Congress. The Senate bill had not dropped at press time.
For more information on H.R. 1516 and to stay up to date on the bill’s progress, visit ncart.us or nrrts.org. l
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Citing “unprecedented corporate growth during 2014,” National Seating & Mobility (NSM) has hired Darrell Chiasson to be its director of service delivery, and Chris Paz to be its director of supply chain management.
In a news announcement, NSM said Chiasson has 20 years of clinical engineering leadership and 35 years of overall experience in health care. The announcement said Chiasson “will focus on building a best-in-class service organization that will improve client service experience while minimizing downtime and repairs.”
Chiasson said integrated customer service was crucial due to NSM’s large number of new branches nation-wide. “We intend to set the industry standard for service delivery,” he noted.
Sandi Neiman, COO of NSM, said of Chiasson’s
appointment, “We are focused on a proactive service delivery model where patients are delighted, not frus-trated. Darrell’s seasoned service delivery leadership will help NSM differentiate itself in speed, accuracy and responsiveness.”
NSM also announced Chris Paz has become its director of supply chain management. The company said Paz would be working with NSM’s vendors “to help ATPs get the most appropriate products and service to meet client need.” Paz’s career experience includes more than a decade in purchasing and managerial experience in the medical rehab and automotive industries.
Paz said of his new position, “I am happy to contribute to such a great company. I look forward to building strong relationships with NSM’s complex rehab technology users and clients.” l
NSM Announces New Service Delivery & Supply Chain Directors
Darrell Chiasson
Chris Paz
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Pediatric Comparo 2014
Manufacturers were invited to submit information on their pediatric wheelchairs in three categories: Manual, caregiver-propelled (including “stroller-style" wheelchairs); Manual, self-propelled; and power. To qualify for this comparo, the wheelchair had to be available in a seat width of 14" or smaller. If information is unavailable or not applicable to a particular wheelchair, “N/A" is noted.
Wheelchairs are listed in alphabetical order by manufacturer name, then model name. The information provided here is self reported by the manufacturers and is listed as space permits. Text may have been edited for space; additional accessories or components may be available.
This comparo is designed to be a starting point for clinicians and ATPs considering mobility choices for infants, children and teens. Please consult manufacturers for additional information and models by using the Resources listed at the end of the comparo. This comparo is also available as a downloadable pdf at MobilityMgmt.com.
Manual, caregiver-propelledWheelchair widths and lengths, seat widths and depths, and pushbar heights are listed in inches. Wheelchair weight and weight capacity are listed in lbs. Amounts of tilt and recline are listed in degrees. Positioning components are listed as space permits; check with manufacturer for possible additional components. Wheelchair disassembly refers to how the wheelchair folds and/or how the seating system is removable for easier transportability. Crash testing refers to whether the chair has been tested to the WC19 standard to be used as seating within a motor vehicle.
Manual, self-propelledFrame type refers to wheelchair’s rigid or folding frame design. Wheelchair seat widths and depths, front and rear seat-to-floor heights, and backrest heights are listed in inches. Product weights and weight capacities are listed in lbs. Camber angles are listed in degrees. Center-of-gravity information indicates range of adjustability in inches or that center of gravity is adjustable. Front and rear wheel choices are listed as space permits; check with manufacturer regarding other possible options.
PowerWeight capacities are listed in lbs. Seat widths and depths, power base widths and depths, and seat-to-floor heights are listed in inches. Top speeds are listed in miles per hour. Transit options refer to whether the wheelchair has been tested to WC19 or ISO standards and/or has securement points built in. Tilt is listed in degrees. Positioning options are listed as space permits; check with manufacturer regarding other possible components.
Man
ual, C
areg
iver
-Pro
pelle
dW
idth
/Len
gth
Seat
Wid
th/
Dept
hW
eigh
t/W
eigh
t Ca
pacit
yTi
lt Re
cline
Posit
ioni
ng
Adju
stab
ility
Disa
ssem
bly
Seat
ing
Posit
ion
Whe
els
Cras
h Te
sted
?Pu
shba
r Hei
ght
Cano
py/S
tora
ge
Columbia Medical
Inno
va C
G-T
ilt
23.5"
/35.5
"13
-18"/1
2-23
(1"
increm
ents)
51.5
lbs. w
/wh
eels/
165 l
bs.
-5° t
o 50°
ad
justab
le
85° t
o 105
° ba
ck an
gle
adjus
tmen
t
Later
al th
orac
ic, la
teral
hip/th
igh, h
eadr
est
supp
orts;
abdu
ctor
Seat
dept
h, arm
rest
heigh
t/ang
le, fo
otres
t he
ight, f
ootp
late a
ngle
Fram
e deta
ches
from
fol
dable
base
; arm
rests/
back
cane
s fold
down
N/A
6x1"
fron
t, 12x
1.5" r
ear
Yes
N/A
N/A
Convaid
Crui
ser
22-2
8.5"/
44-5
5"10
-18"/6
-21"
27-3
0 lbs
. w/
whee
ls/75
-250
lbs
.30
° fixe
dN/
ABa
ck ad
justab
le ten
sionin
g stra
ps
Seat
dept
h, foo
tplat
e he
ight, p
ush h
andle
he
ight, h
eadr
est h
eight
Folds
com
pactl
y side
to
side
Forw
ard fa
cing
7.5x2
" fro
nt;
11.5x
2.5" r
ear;
8" fr
ont/1
1" re
ar on
lar
gest
size
Yes
28-4
8"Re
gular
or de
luxe
cano
py op
tions
How to Read
This Pediatric Wheelchair Comparo
Pediatric Wheelchair Comparo 2015
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Pediatric Wheelchair Comparo 2015M
anua
l, Car
egiv
er-P
rope
lled
Wid
th/L
engt
hSe
at W
idth
/De
pth
Wei
ght/
Wei
ght
Capa
city
Tilt
Recli
nePo
sitio
ning
Ad
just
abili
tyDi
sass
embl
ySe
atin
g Po
sitio
nW
heel
s Cr
ash
Test
ed?
Push
bar H
eigh
tCa
nopy
/Sto
rage
Convaid
Trek
ker
24.3-
26.3"
/ 42
.5"11
.75-13
.75"/
6-16
"
30-3
1 lbs
. w/
whee
ls/75
-110
lbs.
-5 to
45°
fixed
or
adjus
table
80-17
0°
Acce
pts a
fterm
arket
seati
ng; p
elvic
belts
, lum
bar s
uppo
rt,
butte
rfly o
r H ha
rnes
s, lat
eral s
uppo
rts, fo
ot po
sition
ers, u
pper-
extre
mity
supp
ort t
ray
Dept
h-ad
justab
le se
at pa
n, he
ight-a
djusta
ble
solid
back
syste
m,
heigh
t-adju
stable
he
adres
t
Folds
com
pactl
y flat
Forw
ard or
rear
facing
7.5x2
" fro
nt, 1
1.5x2
.5"
rear
Yes
28-4
3"
Regu
lar or
de
luxe c
anop
y; ac
com
mod
ates v
ent/
sucti
on m
achin
e tray
, O2
tank
holde
r, IV
pole
Convaid
Rod
eo
21-2
7"/3
0.5-
36"
10-1
6"/7
-18"
29-3
9 lbs
./75-
170 l
bs.
5° to
45°
adjus
table
90-11
0°
Cush
ion op
tions
, later
al tru
nk su
ppor
ts, to
rso
supp
ort v
est, b
utter
fly
or H
harn
ess,
thigh
su
ppor
ts,
foot p
ositio
ners
Seat
dept
h, ba
ck,
footp
late h
eight
, he
adres
t heig
ht, a
ngle
adjus
table
ELR
Folds
com
pactl
y flat
Forw
ard fa
cing
7.5x2
" fro
nt; 1
1.5x2
.5"
rear
Yes
28-4
8" ad
justab
le de
pend
ing on
size
Regu
lar or
delux
e ca
nopy
; O2 t
ank b
ag
avail
able
Drive Medical
Kan
ga T
S
18", 2
0",
22"/3
7"10
", 12"
, 14
"/11.5
-13.5"
47 lb
s. w/
whee
ls/20
0 lbs
.45
° ad
justab
leN/
A
Adjus
table
head
rest,
latera
ls, ab
ducto
r, hip
addu
ctors,
5-po
int
harn
ess,
angle
-ad
justab
le foo
trest,
tray
Widt
h-ad
justab
le fra
me,
seat
dept
h, se
at-to
-bac
k an
gle, h
eight
/ang
le-ad
justab
le tra
y
Rem
ove s
eat a
nd ba
ck
cush
ions,
fold-
down
ba
ck ca
nes,
folds
side
to
side
Forw
ard fa
cing
8" fr
ont, 2
0" re
arYe
s38
.75-4
3.5"
Heigh
t-adju
stable
ca
nopy
Drive Medical
Wal
laby
20", 2
2"/3
7"12
", 14"
/12"
37 lb
s. w/
whee
ls/15
0 lbs
.N/
AN/
AHe
adres
t, 5-p
oint
harn
ess,
ELRs
Widt
h/he
ight-
adjus
table
head
rest,
flip-b
ack p
adde
d des
k arm
rests
Folds
side
to si
deFo
rward
facin
g6"
fron
t, 22"
rear
Yes
33-3
9"N/
A
Freedom Designs
NX
T M
ini
17"/2
1"10
", 11",
12
"/8-14
"
15 lb
s. wi
thou
t rea
r whe
els/7
5 lbs
.
0° to
45°
adjus
table;
am
ount
of
tilt ca
n be
selec
ted &
fix
ed
90°, 1
00°,
110°
, 115
°
Freed
om D
esign
s cu
stom
ized/
spec
ialize
d reh
ab se
ating
Seat
widt
h adju
sts
from
10" t
o 12"
; dep
th
from
8" to
14" p
lus 2"
m
ore w
ith se
at fra
me
exten
sion
Fram
e fold
s side
to
side;
back
post
folds
for
ward
; pus
h han
dles
fold i
n; rem
ovab
le se
ating
Forw
ard fa
cing
3”, 4”
, 5”, 6
” fro
nt
plasti
c or a
luminu
m m
ag; 1
2” m
ag or
16
”/18”
spok
e; alu
minu
m or
plasti
c-co
ated h
andr
ims
avail
able
Yes
18-2
4" an
d 20-
26"
Rem
ovab
le he
ight-/
weigh
t-adju
stable
ca
nopy
with
top
wind
ow &
rear
pr
ivacy
pane
l with
zip
per p
ocke
t
Leggero
DY
NO
26.5"
/34.5
"7-1
4"/
8.5-13
.5"26
.5 lbs
./80 l
bs.
20° fi
xed
30°
Dyna
mic
seati
ng,
thor
acic
supp
orts,
he
ad su
ppor
ts, hi
p gu
ides,
med
ial kn
ee
block
, tray
All c
ompo
nent
sFo
lds fla
t in 1
piece
Forw
ard fa
cing
10" f
ront
, 16"
rear
Yes
30-4
3"De
luxe c
anop
y
0515mm_PedWCComparo1319.indd 14 4/9/15 11:32 AM
mobilitymgmt.com 15 mobilitymanagement | may 2015
Man
ual, C
areg
iver
-Pro
pelle
dPediatric Wheelchair Comparo 2015
Wid
th/L
engt
hSe
at W
idth
/De
pth
Wei
ght/
Wei
ght
Capa
city
Tilt
Recli
nePo
sitio
ning
Ad
just
abili
tyDi
sass
embl
ySe
atin
g Po
sitio
nW
heel
s Cr
ash
Test
ed?
Push
bar H
eigh
tCa
nopy
/Sto
rage
Leggero
TRA
K
24.5"
/32"
8-15
"/9-15
"29
lbs./
80 lb
s.45
° ad
justab
le30
°Th
orac
ic su
ppor
ts, he
ad
supp
orts,
hip g
uides
, m
edial
knee
bloc
k, tra
yAl
l com
pone
nts
Folds
flat in
1 pie
ceFo
rward
facin
g7"
fron
t, 16"
rear
Yes
34-4
3"N/
A
Ottobock
Kim
ba N
eo
23.75
-27
.5"/3
5.6-
45.3"
Multip
le/Mu
ltiple
23-2
5 w/
whee
ls/12
1 lbs
.-1
0° to
35°
adjus
table
N/A
Varie
s by s
eatin
g sys
temSe
at de
pth
Folds
flat
Forw
ard an
d rea
r fac
ing6.7
5" fr
ont, 1
1" re
arYe
s28
-45.7
5"
Cano
py va
ries b
y se
ating
syste
m;
storag
e ben
eath
se
ating
syste
m
Ottobock
Kim
ba K
ruze
20.9-
25.6"
/35.6
-45
.3"
11.8-
16.5"
/11-
19"
25.4-
32 lb
s. w/
whee
ls/99
.2-16
5.3 lb
s.N/
AN/
A
Harn
esse
s, an
kle
hugg
ers, p
elvis/
trunk
po
sition
ing, a
bduc
tion
block
, hea
d pos
itionin
g
Seat
dept
hFo
lds fla
tFo
rward
facin
gFo
urYe
s39
.8-47
.7"Su
n-sh
ade c
anop
y or
rain c
over
Stealth Products
Ligh
tnin
g
14"/3
5"14
"/12-
14"
27 lb
s./10
0 lbs
.30
° fixe
dN/
A
Head
rest, l
ateral
th
orac
ic su
ppor
t, H
harn
ess,
heel
loops
, co
ntou
red cu
shion
Seat-
to-b
ack a
ngle
(85-
95°),
seat
dept
h ex
tensio
n kit,
push
ha
ndle
Folds
flat w
/lock
able
carry
strap
Forw
ard fa
cing
6" fr
ont, 1
0" re
arYe
s36
"Ca
nopy
w/h
eadr
est
exten
sion
Stealth Products
Spri
te
24"/3
5"14
"/Spe
cify
dept
h nee
ded
27 lb
s. wi
th
whee
ls/10
0 lbs
.30
° fixe
dN/
A
Head
rest; l
ateral
th
orac
ic, an
terior
th
orac
ic &
latera
l pe
lvic s
uppo
rts; fo
ot po
sition
ers, e
tc.
Seat
widt
h/de
pth,
back
an
gle, fo
otpla
tesRe
mov
able
seati
ng;
fram
e fold
s flat
Forw
ard fa
cing
6" fr
ont, 1
0" re
arNo
36"
N/A
Thomashilfen
EASy
S
23.62
5-28
.75"/2
9.5-
31.87
5"
7.5-
14.25
"/6.25
-13
.75"
35-4
1 lbs
. w/
whee
ls/77
-88
lbs.
-10°
to 35
° ad
justab
le90
-180°
Abdu
ction
bloc
k, he
ad
pillow
Seat
widt
h, de
pth;
back
he
ight
Rem
ovab
le se
at; fo
lds
flat
Forw
ard or
rear
facing
; hig
h-low
base
avail
able
7.5" f
ront
, 10"
rear
Yes
36.25
-47.2
5"
Sun/
rain c
anop
y; ac
com
mod
ates v
ent
tray,
O2, fe
eding
eq
uipm
ent
0515mm_PedWCComparo1319.indd 15 4/9/15 11:32 AM
16 mobilitymgmt.commay 2015 | mobilitymanagement
Man
ual, C
areg
iver
-Pro
pelle
d
Man
ual, S
elf-P
rope
lled
Wid
th/L
engt
hSe
at W
idth
/De
pth
Wei
ght/
Wei
ght
Capa
city
Tilt
Recli
nePo
sitio
ning
Ad
just
abili
tyDi
sass
embl
ySe
atin
g Po
sitio
nW
heel
s Cr
ash
Test
ed?
Push
bar H
eigh
tCa
nopy
/Sto
rage
Thomashilfent-
Rid
e
23.62
5",
28.75
"/29.5
", 31
.875"
7.125
-13
.75"/6
.75-
13.75
"
35-4
3.5 lb
s. w/
whee
ls/77
-88
lbs.
-10°
to 35
° ad
justab
le90
-140°
Abdu
ction
bloc
k, he
adres
t, rigi
d or
flexib
le lat
erals,
ches
t ha
rnes
ses,
hip be
lts
Seat
widt
h, de
pth,
back
he
ight, h
eadr
est
Rem
ovab
le se
at;
folds
flat
Forw
ard fa
cing;
high-
low ba
se av
ailab
le7.5
" fro
nt, 1
0" re
arYe
s29
.875-
47.25
"
Sun/
rain c
anop
y; ac
com
mod
ates v
ent
tray,
O2, fe
eding
eq
uipm
ent
Fram
e Typ
eFr
ame T
ubin
gW
eigh
t Cap
acity
/Ch
air W
eigh
tSe
at W
idth
/Dep
th
Fron
t/Re
ar
Seat
-to-F
loor
Back
rest
Hei
ght
Cam
ber A
ngle
Cent
er o
f Gra
vity
Seat
Bac
k Ang
les
Fron
t Whe
els
Rear
Whe
els
Ki Mobility
Clik
Rigid
1.125
" 700
0 seri
es
alum
inum
165 l
bs./1
2.5 w
/o
rear w
heels
8-16
"/8-1
6"11
.5-20
"/11.5
-20.5
"9-
18"
0-8°
Adjus
table
1.5" t
o 4.25
"80
-100
° in
2° in
crem
ents
.75" R
ollerb
lade/
light
ed Ro
llerb
lade,
1" po
ly, 1"
poly
alum
inum,
1"
pneu
mati
c, 1.5
" poly
, 1.5
" sof
t roll
alum
inum
Spok
e (18
-24"
), m
ag (2
0", 2
2", 2
4"),
Spine
rgy S
pox (
22",
24"),
Spine
rgy L
X (22
", 24
"), co
lored
mag
s
Ki Mobility
Spar
k
Foldi
ng1"
7000
serie
s alu
minu
m
168 l
bs./1
9 lbs
. w/
spok
e rea
r wh
eels
10-1
6"/1
2-18
"13
-21"/
11-18
.5"13
-24"
0°, 2
°, 4°
Adjus
table
N/A
.75" R
ollerb
lade/
light
ed
Rolle
rblad
e, 1"
poly,
1"
poly
alum
inum,
1"
pneu
mati
c, 1.5
" poly
, 1.5
" sof
t roll
alum
inum,
2"
poly,
2" pn
eum
atic
Spok
e (18
-24"
), m
ag (2
0", 2
2", 2
4"),
Spine
rgy S
pox (
22",
24"),
Spine
rgy L
X (22
", 24
"), co
lored
mag
s
TiLite
Aer
o T/
TRA
/TR
Rigid
1" al
uminu
m or
titan
ium
265 l
bs./1
2 lbs
. (A
ero T)
, 11.1
lbs
. (TR
A), 9
.3 lbs
. (TR
)
12-2
0"/1
2-20
"15
-21"/
13-2
1"8.5
-21"
(fold
ing,
adjus
table)
; 5-2
0"
(fixe
d, TR
)0°
, 2°, 4
°, 6°, 8
°, 12°
5"80
-101
°
23 op
tions
from
3"
to 6"
, inclu
ding
micr
o cas
ters,
light
-up m
icro c
aster
s, Lit
eSpe
ed bi
llet
alum
inum
w/so
ft ro
ll/po
ly tir
e
67 op
tions
from
20
" to 2
6", in
cludin
g Sh
adow
, Golz
Tw
in-Sta
r Exc
hang
e, Sp
inerg
y SPO
X or
LX an
d Top
olino
Ca
rbon
Core
mag
TiLite
Aer
o X
Ser
ies
2
Foldi
ng1"
alum
inum;
tit
anium
upgr
ade
optio
nal
265 l
bs./1
5.6
lbs. (fi
xed f
ront
); 18
lbs.
(swing
aw
ay)
12-2
2"/1
2-20
" (d
epth
adjus
table
back
/fram
e op
tiona
l)
13.5-
21.5"
/13-
20"
11-2
0.5" (
foldin
g bac
k, ad
justab
le); 1
1-20
" (fi
xed b
ack,
adjus
table)
0°, 2
°, 4°, 6
°, 8°
6"80
-101
°
23 op
tions
from
3"
to 8"
, inclu
ding m
icro
caste
rs, lig
ht-u
p micr
o ca
sters,
LiteS
peed
bille
t alu
minu
m w/
soft
roll/
poly
tire
67 op
tions
from
22" t
o 26
", inc
luding
Shad
ow,
Golz
Twin-
Star
Exch
ange
, Spin
ergy
SPOX
or LX
and
Topo
lino C
arbon
Core
mag
Sunrise Medical
Zipp
ie X
’CA
PE
Foldi
ng1"
roun
d alum
inum
165 l
bs./1
9 lbs
.8-
16" (
grow
s to
18")/
8-18
" (gr
ows
to 20
")13
-18.5"
/11-
18"
9-24
"0°
or 3°
-0.5"
to 2.
5"-8
° for
e to 2
4° af
t
11 op
tions
from
3"
to 6"
, inclu
ding
micr
o-lig
hted
, low-
profi
le, al
uminu
m so
ft ro
ll and
polyu
retha
ne
14 op
tions
from
12"
to 24
", inc
luding
mag
, m
ag 5
spok
e, LIT
E sp
oke a
nd Sp
inerg
y ch
oices
Pediatric Wheelchair Comparo 2015
0515mm_PedWCComparo1319.indd 16 4/9/15 11:32 AM
mobilitymgmt.com 17 mobilitymanagement | may 2015
TiLite
Twis
t
Rigid
1" al
uminu
m16
5 lbs
./12 l
bs.
(12x1
2")
8-15
" (2"
built-
in gr
owth
)/8-1
6" (3
" bu
ilt-in
grow
th)
13-2
1.5" (
up to
2.2
5" bu
ilt-in
adjus
tmen
t)/12
-19.5"
(u
p to 3
.5" bu
ilt-in
adjus
tmen
t)
8.5-2
1" ad
justab
le0°
, 2°, 4
°, 6°, 8
°, 12°
6"80
-101
°
12 op
tions
from
3" to
5"
, inclu
ding m
icro
caste
rs, lig
ht-u
p micr
o ca
sters,
LiteS
peed
bille
t alu
minu
m w/
soft
roll/
poly
tire
12 op
tions
from
18"
to 24
", inc
luding
Sh
adow
, Golz
Tw
in-Sta
r Exc
hang
e, Sp
inerg
y SPO
X or
LX an
d Top
olino
Ca
rbon
Core
mag
Driv
e Con
figur
atio
nW
eigh
t Cap
acity
Seat
Wid
th/D
epth
Base
Wid
th/L
engt
hSe
at-to
-Flo
or
Top
Spee
dEl
ectr
onics
Tran
sit O
ptio
ns?
Tilt
Posit
ioni
ng
Amysystems
Allt
rack
P
Mid-
or re
ar-wh
eel d
rive
300 l
bs.
11-1
6" an
d 15-
20"/u
p to
16" a
nd up
to 19
"23
.5"/3
5"As
low
as 15
.25"
8.5 m
ph (R
WD)
, 6.5
mph
(MW
D)PG
Drive
s R-n
etTie
down
s com
patib
le wi
th EZ
-Loc
k and
Q’
Strain
t
50°
Seat
eleva
tion f
or all
se
ats; re
cline
, pow
er EL
Rs av
ailab
le w/
large
r sea
t size
s; cu
stom
optio
ns in
clude
lat
eral ti
lt, lat
itude
tilt,
eleva
ting s
tretch
ers
Pow
er
Pediatric Wheelchair Comparo 2015
800.333.4000 www.SunriseMedical.com
From early interventionto independent mobility,
Zippie wheelchairs give children the confidenceto learn, grow, make new friends and
bravely explore their world!
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Zippie_Lily_MobilityMng_May2015_Layout 1 4/8/15 1:35 PM Page 1
0515mm_PedWCComparo1319.indd 17 4/9/15 11:32 AM
18 mobilitymgmt.commay 2015 | mobilitymanagement
Pediatric Wheelchair Comparo 2015
Ottobock
Skip
pi/S
kipp
i+
Rear
110 l
bs.
10-15
"/11.8
-14.6"
22.4"
/27.6
"18
" 5 m
phN/
AInt
egrat
ed tie
-dow
n an
chor
point
s25
° pow
er, 30
° man
ual
Re
cline
, swi
ng-a
way
footre
sts, h
eight
-ad
justab
le arm
rests,
ad
justab
le ba
ck he
ight
Permobil
K30
0/M
300
PS J
r.
Front
(K30
0), m
id (M
300)
165 l
bs.
11-1
6" in
1" in
crem
ents/
6-
18" i
nfinit
e ad
justab
ility
24"/4
0" (K
300),
36.5"
(M
300)
16.5"
5 o
r 6.5
mph
(K30
0), 6
mph
(M30
0)R-
net
ISO71
76-19
; stan
dard
cra
sh-te
sted 4
-poin
t tie
-dow
n brac
kets
45°
Man
ual re
cline
, m
anua
l ELR
s, 8"
po
wer s
eat e
levati
on
Permobil
K45
0 M
X
Rear
125 l
bs.
10-1
6"/1
0-18
" (M
X);
6-18
" (tu
bular
back
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0515mm_PedWCComparo1319.indd 18 4/9/15 11:32 AM
mobilitymgmt.com 19 mobilitymanagement | may 2015
Pediatric Wheelchair Comparo 2015
ThevoSleepingStar
ThevoTwist
RECARO Monza Nova Reha
EASySEASyS Modular Swifty
RECARO Performance Sport
tRide tRide+ High/Low base
EASyS+ High/Low base
Visit www.thomashilfen.us
· 309 South Cloverdale Street · Unit B 12 · Seattle WA 98108 · E-Mail: [email protected] · Phone: 866 870 2122 (toll free) · Fax: 866 870 0801 (toll free)
Amysystems1650 ChicoineVaudreuil-Dorion, QC, Canada J7V 8P2(888) 453-0311amysystems.comAlltrack P series
Columbia Medical11724 Willake St.Santa Fe Springs, CA 90670(800) 454-6612columbiamedical.comInnova CG-Tilt
Convaid2830 California St.Torrance, CA 90503(888) CONVAIDconvaid.comCruiser, Rodeo, Trekker
Drive Medical99 Seaview Blvd.Port Washington, NY 11050(877) 224-0946drivemedical.comKanga, Wallaby
Freedom Designs2241 N. Madera Road Simi Valley, CA 93065(800) 331-8551freedomdesigns.comGeneration Next NXT MINI
Ki Mobility4848 Industrial Park RoadStevens Point, WI 54481(715) 254-0991kimobility.comLittle Wave Clik, Spark
Leggero LLC20900 Frontage Road, #G3Belgrade, MT 59714(800) 965-9229leggero.usDYNO, Trak
Ottobock HealthCareP.O. Box 203910Austin, TX 78720(800) 328-4058ottobockusmobility.comKimba Kruze, Neo; Skippi/Skippi+
Permobil300 Duke DriveLebanon, TN 37090(800) 736-0925permobil.comK300/M300 PS Junior, K450 MX, Koala
Quantum Rehab182 Susquehanna Ave.Exeter, PA 18643(866) 800-2002quantumrehab.comQ6 Edge with TRU-Balance 3
Stealth Products104 John Kelly DriveBurnet, TX 78611(800) 965-9229stealthproducts.comLightning, Sprite
Sunrise Medical2842 Business Park Ave.Fresno, CA 93727(800) 333-4000sunrisemedical.comZippie X’CAPE, Zippie ZM-310
Thomashilfen North America309 S. Cloverdale St., B12Seattle, WA 98108(866) 870-2122thomashilfen.usEASyS, tRide
TiLiteP.O. Box 3970Pasco, WA 99302(800) 545-2266tilite.comAero T/TRA/TR, Aero X Series 2, TWIST
Resources
0515mm_PedWCComparo1319.indd 19 4/9/15 11:32 AM
20 mobilitymgmt.commay 2015 | mobilitymanagement
“Your seating considerations completely change.” That’s what Joe McKnight, ATP/SMS, RRTS, VP of clinical development for Access Medical in Carlsbad, Calif., said when asked how the assessment and equipment provision process is different for clients in palliative or hospice care.
McKnight speaks from experience. Access Medical works closely with the University of California, Irvine, Medical Center, whose ALS clinic typically comprises 160 to 180 patients in various stages of the disease. “I see one or two new ALS clients a month,” McKnight says, adding that he recently built a power chair with switch access for a 10-year-old with ALS.
“We can’t do anything more than palliative care at this point.” That’s what Alisa Brownlee, ATP, manager of assistive technology services for the ALS Association’s national office and greater Philadelphia chapter said when asked the same question. “We don’t call it palliative care, but that’s our model.”
While some similarities persist between building a seating & mobility system for, say, a client with spinal cord injury and a client with ALS, many other rehab team goals do change or are influenced by relent-lessly progressive diseases such as ALS. In a palliative care situation, the emphasis is on improving quality of life and relieving discomfort, rather than aggressively seeking improvements in condition or function.
In these cases, decisions need to be made about complex tech-nology in the midst of complex clinical conditions — all while keeping
the humanity of the client front and center.
Challenge #1: Client Goals ChangeWhen working with ALS clients, McKnight says, “Your seating considerations completely change.” Speaking of ALS clients, he notes, “You know that they’re going to sacral sit. You know that you’re seating them for a whole different consideration. They may not be driving more than 10 or 15 feet between the living room and bedroom, or the living room and bathroom. All you want to do is make sure that they can constantly tilt and change position and that they use those power seating functions for comfort throughout the day, because they’re in that chair for extended periods of time, and they need to be constantly moving. They don’t have muscle control in order to move their bodies, so we’re using those power seating func-tions in order to achieve some comfort for them.”
While a power chair is typically built to provide mobility, many ALS clients rely on their chairs for much more, Brownlee says: “Some people with ALS end up living out of the chair, meaning they can’t be transferred into a bed, and use the chair for sleeping. This is why most wheelchair evaluators try to get the recline feature covered under insurance. Wheelchairs for people with ALS are not often used for transportation — versus the majority of the disabled population — and are used for weight shifting and comfort as opposed to going out to the community.”
How Do Seating & Mobility Priorities Change for
These Clients?
ATP Series
By Laurie Watanabe
20 mobilitymgmt.commay 2015 | mobilitymanagement
In these cases, decisions need to be made about complex tech-nology in the midst of complex clinical conditions — all while keeping
and are used for weight shifting and comfort as opposed to going out to the community.”
0515mm_Palliative2023.indd 20 4/9/15 12:25 PM
mobilitymgmt.com 21 mobilitymanagement | may 2015
Challenge #2: Balancing Many Goals at OnceA major challenge of working with a client in palliative care is meeting multiple needs with one seating & mobility system.
With ALS patients, McKnight says, “They may be seriously respi-ratorily compromised. When I was talking to some of the folks at the International Seating Symposium, I was asking, ‘Are you having any luck with bi-angular back systems so I can open up the intercos-tals, drop the diaphragm, roll those shoulders back, get some air into them?’ Adding even just a little low-flow O2 to some of these patients really makes a difference in their overall cognitive response.”
Brownlee concurs that ALS requires the seating & mobility team to be continuously and quickly responsive: “Because of the progres-sion of the disease, the wheelchair needs to accommodate a changing body: weight loss, BIPAP or vent, and different driving mechanisms. These changes are often rapid and require constant monitoring.”
Challenge #3: Speed MattersWith ALS, but also with some other quickly progressive diseases such as cancer, being able to make complex decisions and follow through efficiently is imperative.
Recalling a recent new ALS patient, McKnight says, “When we took Steven on, he’d had 12 members of his family die from ALS. I took him on in June; he died in October or early November — that rapid. Getting his chair underneath him, getting everything done, getting the insurance considerations: How do you get a chair under an ALS patient that rapidly?
“When you’re dealing with patients that are in hospice or patients that are dealing with end-of-life issues, your payor source suddenly becomes vitally important. You don’t have your traditional 90 to 120 days to mess around with getting paperwork back from the doctor and getting everything done to get a chair underneath your patient. You don’t have that window. It’s got to happen yesterday.”
Challenge #4: Complex Technology Comes at a Trying TimeWhile racing against a progressive disease can be difficult for the ATP, OT or PT trying to secure the right equipment for a client, Brownlee says psychosocial issues can be just as challenging.
“All these devices are new, overwhelming and represent a visual/physical manifestation of the disease,” she points out. “This differs from those born with a disability that approach assistive technology as an extension of themselves. It’s important to understand this distinction. People with ALS often put off, until the very last moment, obtaining a wheelchair.”
The strain extends to caregivers, as well. “Once they’re on hospice and they’re coming to end of life, the costs and the financial burdens are horrendous,” McKnight says. “They’re often not living in a big, beautiful mansion with lots of space. They’ve got a hospital bed, a ventilator, an IV pump and all this other stuff in the room. And I come in with a chair that’s 26.5" wide and 35.5" long and I want to put a ventilator on the end and all the bells, whistles and wires. And we’ve
got to put a Hoyer lift in there. It’s a lot of stuff in the barn.“We’ve collapsed a lot of tolerances, and emotionally and spiri-
tually, [caregivers] are often very, very challenged. It’s important to remember that you’re dealing with a population that is sometimes at their breaking point emotionally and spiritually. Sometimes even intellectually, you’re trying to impose technologies on them that are a little bit beyond where they are.”
Suggestion #1: Prepare for & Expect ChangeWith progressive diseases such as ALS, clients’ conditions will change. The best a seating & mobility team can do is to prepare for it — and that starts with education.
“Prior to any consideration of ordering a wheelchair for a person with ALS, the therapist must know the Forced Vital Capacity (FVC) of the [client],” Brownlee says. “FVC is a breathing test to help determine the strength of the breathing muscles. A person with ALS and their medical team make medical decisions based on that number. The current criteria for a person with ALS to enter hospice is 40 percent or lower VC. If a therapist is recommending a wheelchair and the person with ALS has a VC of 20 percent, is the physician going to recommend hospice? If so and the patient signs on, they are not eligible for a wheelchair from insurance.
“Or say for example a doctor sees a patient with a VC of 30 percent and does not order hospice, but in the next few months before the wheelchair is delivered, the patient’s respiratory functions decline to the point where they need hospice ASAP. If they sign on, there will be no wheelchair delivery, and in the worst-case scenario, the wheelchair vendor is financially responsible for the chair.”
Another ALS example involves increasing loss of function that requires a change to alternate driving controls — which aren’t funded by insurance once a patient agrees to hospice. “When they’re at 30 to 40 percent [FVC], they’re losing hand function and can’t operate the tilt-in-space function anymore, and they want to,” Brownlee says. “But we’re stuck.”
Communication from the beginning is vital.“The average VC of 40 percent or lower enables a person with ALS
to sign onto hospice,” Brownlee says. “Some well-meaning primary care physicians will sign them on before that percent, thinking they would get more support services, which is often not true. That means [patients] are not eligible for wheelchairs or communications devices. It is our hope that people with ALS, caregivers and therapists that work with them communicate with the medical team before any discussion of hospice takes place. People with ALS and their families don’t under-stand the impact of this discussion regarding DME coverage.”
Along those lines, Brownlee recommends informing patients that Medicare “only covers one wheelchair every five years. It’s important to educate families: If they use that allotment for a manual wheelchair or scooter, they will not get a power wheelchair from insurance.” It’s a critical point, Brownlee adds, because many patients and families gravitate toward equipment that looks less clinical.
“The most important person who has to understand all this is the consumer,” Brownlee says. “And in my experience, the most prom-
0515mm_Palliative2023.indd 21 4/9/15 12:25 PM
22 mobilitymgmt.commay 2015 | mobilitymanagement
Positioning & Palliative Careinent person who doesn’t understand this is the consumer. It’s too overwhelming.”
As for avoiding a scenario in which a wheelchair becomes useless as the patient progresses, Brownlee says, “The therapists that we use and the seating specialists will work really closely with [the wheelchair provider] to get the chair that someone needs from the beginning, that can transition with the disease.”
Suggestion #2: Identify What’s Most ImportantAccessing their communities and workplaces, or even some parts of their homes, may no longer be possible for patients in later stages of their diseases. But even as their world gets smaller, McKnight says it’s important to find out what the patient’s priorities are.
“We’re using the assistive technology functions in terms of Bluetooth and infrared,” he notes, “to appreciate the things that they need to do around their home, like maybe turn on and off lights or change the TV channels so that they’re not constantly burdening their caregiver to say, ‘Now I want to watch Fox News,’ and ‘Now I want to watch the sports channel.’
“Much of our concepts surrounding the client’s need for functional driving or propulsion are often secondary. I may very well be building them a big lounge chair that supports their daily needs and makes them functional and comfortable. Keeping them in good spinal align-
ment is secondary or at least lower on the list of priorities unless it compromises respiratory function, bowel/bladder function, etc.”
As Brownlee mentioned, a power chair may be where an ALS client spends the most time. “The majority of our folks end up living out of that wheelchair,” she says. “I can’t tell you another disease where that might happen. People don’t have a Hoyer lift, or they refuse them — they don’t like that feeling of being in space. The house won’t accom-modate a Hoyer lift. They can’t move a bedroom to the first floor. So they end up living out of their wheelchair and using a commode because they can’t get upstairs.
“As the disease progresses, you need a two- to three-person transfer, and we don’t have a healthcare system that pays for home-health aides to do that. So they can’t transfer anymore. And their choices would be: Do I want to stay in my hospital bed, or do I want to stay in my wheel-chair? The bottom line is if you stay in the wheelchair, at least we can weight-shift you.”
Suggestion #3: Look for Ways to Save TimeEfficiency is key for working with palliative care and hospice patients, and finding manufacturers who can expedite their services can help ATPs to shave precious time from the delivery model.
“Permobil and Quantum Rehab in particular are amazing at being able to say, ‘It’s an ALS patient, it goes right to the front of the
ATP Series
0515mm_Palliative2023.indd 22 4/9/15 12:25 PM
mobilitymgmt.com 23 mobilitymanagement | may 2015
line,’” McKnight says. “‘This chair will be built today and it will ship tomorrow and you will have it.’ Or the reps will just say, ‘I’ve got a brand-new demo that just arrived yesterday morning. Let’s put this chair together.’ We turn around and we build the chair right there.”
Suggestion #4: Keep the Client in the CenterAn ALS diagnosis is doubly difficult, because of the prognosis and the potentially rapid progression that doesn’t give patients and families much time to come to terms with it.
Brownlee notes that when losing mobility and when losing the ability to communicate, “You have to go through the loss cycle. It’s like the grief cycle. But we tell our client, ‘I’m sorry, we don’t have time for that. We don’t have time for you to cope.’ We had somebody in clinic last week who said, ‘I’ve fallen 12 times.’ We said, ‘We think you really need a wheelchair,’ and he said, ‘No, that won’t work in my lifestyle.’”
A suddenly acquired, swiftly progressive disease leaves little time for the patient to absorb his/her new situation — so McKnight mentally prepares to explain, for instance, how to use a seating func-tion multiple times before a client or caregiver will learn it.
“We have to be very patient and understand that we’re going to be going out [to patients’ homes] again and again,” he says. If a family member or hired caregiver speaks a primary language other than
your own, finding a translator early in the process can help to reduce learning curves and frustration levels across the board.
Beyond that, McKnight says that regardless of what clients are experiencing within the healthcare system, he works hard to continu-ally regard them first as people rather than first as patients.
“Remember that you’re dealing with a human being, and all control has been removed from them,” he says. “This is a person who has been autonomous their entire life, and particularly in my patient popu-lace, ALS seems to affect the best, the brightest, the most generous, the most caring. They’re now a patient population that is being addressed in the third person, and they’re being addressed as a disease. And we need to remember to address them as John or Sue, and look them in the eye, and ask them what’s important to them.”
McKnight says working with ALS clients “is a big privilege,” despite the many challenges they face. He feels the same way about patients in palliative care in general.
“I’m going to see a kid this afternoon who’s a cancer patient,” McKnight says. “He’s 22 years old and a full hemi-pelvectomy. He’s got his right iliac crest and that’s it; the sacrum’s gone, the entire left ilium, the entire left leg, the ischials are gone. And he’s on everything from methadone to marijuana to try to treat his pain levels. That becomes a very interesting seating situation, to try to manage all of that.” l
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0515mm_Palliative2023.indd 23 4/9/15 12:25 PM
24 mobilitymgmt.commay 2015 | mobilitymanagement
Step-UpThe Dolomite Step-Up is a platform support with an H-style frame to freely roll under chairs or wheelchairs for best transfer posi-tioning. The hydraulic model can assist client to a standing position. Soft arm pads provide pressure relief and can be adjusted for best positioning; they can also be fitted with brakes, grips or elbow stops.
Clarke Health Care Products(888) 347-4537clarkehealthcare.com
RoWalker400Designed to support early mo-bilization, particularly for cardio-thoracic and abdominal surgery patients, the RoWalker400 offers safe and secure support during walking and standing training. The RoWalker400 also accom-modates oxygen, drain bags and IV poles, and has a user weight capacity of 400 lbs.
Handicare(866) 276-5438handicare.com
Hero 3This semi-electric, aluminum-framed standing chair features flip-back armrests and a detach-able, swing-away footrest. Featur-ing an anterior/posterior stability mechanism and an electric stand-ing mechanism, the chair can be built to suit the individual needs of the user.
Dalton Medical Corp.(800) 347-6182, ext. 7101daltonmedical.com
Omni 2 Mobil For pediatric clients up to 80 lbs., this stander can be used either prone or supine, with all body supports adjustable in multiple ways to achieve an optimal fit. Shoe supports adjust for plantar flexion, dorsiflexion, inversion, eversion and rotation. Options include neckrests, shoulder pads and trays.
Mulholland Positioning(800) 543-4769mulhollandinc.com
standing marketplace
0515mm_StandMarket2425.indd 24 4/9/15 12:46 PM
mobilitymgmt.com 25 mobilitymanagement | may 2015
RocketAvailable in two sizes — 50-lb. or 75-lb. capacities — the Rocket specializes in multiple positions. It can be used prone, supine, vertical, and for postural drainage. Rocket folds for easy transport, and a trigger tilt system provides angle adjustability through 110°. Shoe supports adjust for plantar flexion, dorsiflexion, inversion, eversion and rotation.
Mulholland Positioning(800) 543-4769mulhollandinc.com
F5 CorpusPermobil’s standing chair has a new front-wheel-drive base and boasts the latest Corpus seating system. That means even more versatility, including a full range of posterior tilt; the option of ante-rior tilt; a low 17.5" seat-to-floor height; and a 300-lb. weight ca-pacity. The F5 power base focuses on ride comfort to optimize a user’s time in the chair.
Permobil(800) 736-0925permobil.com
Buddy RoamerThis hands-free, rear-suspension, dynamic weight-relieving walker encourages the interactive move-ments required in a typical gait pattern. The graded suspension system allows for increased/decreased lift by easy adjustment. Available in three sizes, from 12" to 35" inseams, and with optional forearm and shoulder supports and an abduction pommel.
Pacific Rehab(888) 222-9040pacificrehabinc.com
Superstand HLTThe newest generation of Super-stand maintains the line’s superior positioning capabilities, and now boasts a horizontal, high-loading transfer surface to facilitate convenient, safe transfers into the system. The 30" loading height eliminates awkward bending to make positioning the user much easier. Can be configured prone, supine, upright or multi-position.
Prime Engineering(800) 827-8263primeengineering.com
standing marketplace
Mobility & Seating ProductsFOR CHILDREN, TEENS & ADULTS WITH SPECIAL NEEDS
For more product information visit www.drivemedical.com and to order call toll-free at 800.371.2266 or 516.566.2019
Seeing is believing! To request an appointment with our local rep, contact us at [email protected] or at 516.566.2019
Mobility_Management_4/15.indd 1 3/30/15 9:05 AM
0515mm_StandMarket2425.indd 25 4/9/15 12:46 PM
26 mobilitymgmt.commay 2015 | mobilitymanagement
If life is made up of little moments and details, perhaps the same can be said of truly functional seating & wheeled mobility.
There are, for instance, many clinical benefits to wheelchair seat elevation, including facilitating of transfers and reduc-tion of risk for the neck pain and injuries that can be caused by constantly having to look up at the world from a standard wheel-chair height.
These benefits are significant. But ask a power chair user what he or she values most about seat elevation, and you’ll probably get a different, more personal story.
Elevation Without True Functionality The seat elevation option is not new, says Jean Sayre, MSOT, COTA/L, ATP, CEAC, senior director of R&D clinical development for Quantum Rehab.
“Seat elevation has been around for decades, but has been primarily used in static or very slow non-functional positions,” she notes.
That left wheelchair users in a quandary: Elevation offered many advantages, but practi-cally speaking, consumers were immobile when at those greater heights. For instance, elevating at the supermarket could enable consumers to reach items on higher shelves. But since consumers couldn’t drive at a functional speed while elevated, they’d either take a very long time to traverse a supermarket aisle, or they’d have to repeat-edly elevate, then return to a lower position so they could drive down aisles more quickly.
“What we heard from clients,” Sayre explains, “was that if a power chair could safely drive at a functional speed while elevated, it would improve so many activities, from grocery shopping in real time to socializing with peers. We have been informed that clients just want to be able to accomplish their daily activities in a timely manner. The clients voiced that this is one of the injustices they face on a daily basis: If they are fortu-nate to have seat elevation, why does it have to be so slow?”
The traditional problem: “As power seating elevates, the center of gravity rises, and in some conditions, stability decreases,” Sayre says. “This is why power elevating seats typically have full drive lockout or severe speed inhibits, dramatically limiting driving.”
A Real-Time Solution Quantum Rehab’s answer is the new iLevel system, used in conjunction with the manufacturer’s new Q6 Edge 2.0 power base. With a single-stage drivetrain and caster arms redesigned for enhanced performance, the Edge 2.0 can be ordered with
iLevel: Raising Clients to Greater HeightsiLevel, or the system can be retrofitted later on.
“With our mid-wheel-drive, 6-wheel power base, we knew that if we could further stabilize the power base while the seat was elevated, we could create a safer, faster, ‘walking’ speed mode at
10" of lift,” Sayre says. “One can also elevate and/or lower while the mobility base is moving.”
Sayre explains that as the seat elevates, iLevel uses advanced electronics to increase the stability
of the suspension. In keeping with iLev-el’s “real-time” operation, the seat raises or lowers in just 24 seconds, so consumers don’t have to endure interminable lag
times whenever they want to change positions. The result is that iLevel “allows
faster ‘walking’ speed stability up to 3 mph,” Sayre says — thus enabling power
chair users to keep up with companions while also maintaining eye contact during
conversations.“The ADL benefits of iLevel are countless and
fairly obvious,” Sayre says. “Again, being able to grocery shop while elevated at walking speed, for example, dramatically increases
functional independence. “However, iLevel users most
commonly have noted how unexpect-edly impacted they’ve been by the
social and emotional benefits. One of our managers is a power chair user of 39
years, and discusses how different the world can be when elevated. At social mixers, he’s at
conversational standing height with others. He can stroll the mall with his fiancée, arm in arm. He can enjoy meals at high-top tables with friends. And, he can move through crowds where he’s seen, where people look him in the eye. Just think of a college student moving through a campus hall in a power chair, where instead of being low in the crowd, he or she travels shoulder-to-shoulder with peers, conversing at walking speed. The mom/dad that is preparing a meal for their family accom-plishing the task in less time. The person that is wanting the benefit of standing and desiring to be at eye level, but is discour-aged when he/she receives the news that their bone density will not support that desire. iLevel can be the alternative for that person. These are such real, life-changing examples of how elevated motion can truly touch a client’s spirit while increasing access and functionality.”
Tackling the Funding DilemmaSeat elevation has long been a contentious point between
0515mm_TechShowQuantum2627.indd 26 4/9/15 11:36 AM
mobilitymgmt.com 27 mobilitymanagement | may 2015
healthcare professionals who praise its bene-fits, and funding sources who question its medical necessity.
While wholly aware of the debate, Quantum Rehab introduced iLevel at February’s International Seating Symposium (ISS) in Nashville, as if to openly challenge reluctant payors by showing off the systems’ function-ality. ISS attendees were invited to elevate, then drive through a zig-zagging course and down a ramp while in raised position.
Asked why the manufacturer would invest so much in a positioning option that many funding sources balk at providing, Sayre says, “We see seat elevation as both a medical and quality-of-life issue. It is not a luxury item; it is a necessary tool for the client to achieve their daily activities, whether it includes transfers, reaching, protecting their joint integrity, providing relief to their musculature, enhancing their ability to hear, sensory awareness, socialization, and simply empowering the person. There are so many physical, physiological, social and psychoso-cial benefits from elevation as a true tool toward the client’s well-being that it should be available to everyone in need.”
One of the iLevel’s premiere fans is Kiel Eigen (pictured), a
22-year-old who sustained a C5 spinal cord injury in a football accident in his early teens. “In my previous chairs, I rarely used the seat lift because I really couldn’t move anywhere,” he says. “With iLevel, I have full mobility at standing height…I have independence and stature that I haven’t known since my accident.”
Eigen adds that the system has “doubled my functionality over a normal power chair.”
That fact seems to motivate Quantum Rehab representatives, who speak in terms of human rights when it comes to the new iLevel.
“It is such an injustice for a person not to have seat elevation,” Sayre says. “The world isn’t all at sitting height, and in seeing how much more access to functional inde-pendence and socialization that elevated mobility provides, it’s impossible not to recognize the life-changing role it plays in clients’ lives. We believe that from funding sources to manufac-turers, everyone must recognize the entirety of the client expe-rience — and iLevel is one way we’re striving to best serve the entirety of those with complex rehab needs.” l
— Laurie Watanabe
In the summer of 2014, Mobility Management ran a three-part series on the pressure ulcer and deep tissue injury research of Amit Gefen, Ph.D., Tel Aviv University.
This article series is now available as a FREE pdf. Just go to mobilitymgmt.com/14pu to download your copy.
Then stay tuned as Mobility Management begins a NEW series this summer, based once again on the research of Dr. Gefen.
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mobilitymgmt.com
new discoveries series | mobilitymanagement
For instance, Gefen says, “You can simulate cases of a patient with a scar that’s what we call an hourglass scar — it goes all the way through [the multiple types of tissues], and it has a bottleneck so it’s like two craters. You can see how they concentrate the loads around it. That’s opposed to a patient without a scar.”Gefen used a medical-grade stain-less steel model of a boney prominence to simulate an ischial tuberosity pressing against lab-grown tissues.
“It’s pressing this tissue-engineered muscle, and then you can look at the depth of individual cells in the construct in response to the level of deformation,” Gefen says. “You can see the damage.“So here you have the injury threshold at the cell level. You can plug that back in to the diagrams of deformations, and you can say at a certain spot, I’m expecting damage to happen within 60 minutes, two hours, whatever. Of course, that’s also a function of the posture of the anatomy, but also of the cushion.”The technology is evolving, even if it hasn’t yet caught up to all the possible presentations you see in clients taking part in your daily seating evaluations. And even if current technology can’t yet duplicate every condition you’ll encounter in seating clinics, it’s still a leap ahead of what the industry has had in the past. Gefen points out that up to now, wheelchair seat cushions have largely been developed using able-bodied people as the models because that’s what has been available.In contrast, Gefen points out that this research shows how loads impact and potentially damage tissues, and how that damage can change a wheel-chair user’s body.
“At least [the research] can give you some rough estimates and scientific debate on why [one] cushion is performing better than the others. And basically you can do it with any cushion, it’s all generic technology. I’m even thinking at some point in the future, you can basically design new cushions with these tools.” l
The following articles were originally published in Mobility Management June, August and September 2014 issues.© 2014 Mobility Management
In the summer of 2014, Mobility Management published a three-part series highlighting the pressure ulcer research of Amit Gefen, Ph.D., professor of biomedical engineering at Tel Aviv University.Concern about pressure ulcers, particularly in clients with disabilities such as paralysis or loss of sensation, is hardly new. But what made this research so intriguing is the angle Gefen took. With degrees in mechanical and biomed-ical engineering, he approached the problem of pressure the way an engineer would. He wanted to know how tissues in the human body — skin, muscles, fat — respond to loads. But not just on the surface of the skin, which is the focal point of a lot of seating discussions. Gefen wanted to know how tissues respond internally, where damage is harder to observe and detect. So he created human tissues in labo-ratory settings, then used computers to extrap-olate results that would otherwise be impossible to attain.
“I’ve been in this field as an independent researcher for 15 years now,” Gefen told Mobility Management in 2014. “During that time, I tried to integrate expertise and different fields of knowl-edge to increase the influx of research in this field. Mechanical engineers develop tools to simulate how these structures behave, and I’m not the only one who’s doing it, but I basically adopted these computer simulations from mechanical engineering. It’s much more difficult to look inside the body.”Growing human tissue in a lab as a substitute for animal tissue is still a new capability, but one that holds tremendous opportunities for research.One potential benefit: Studies can proceed without needing to first find large numbers of human partici-pants who all have pressure sores at the same stage. The relatively small number of clients in the seating & wheeled mobility industry — particularly those with a specific stage of pressure sore or complications such as specific types and locations of scarring — has challenged researchers in the past.“There are still a lot of limitations,” Gefen says. “[Lab-created tissues are] not representing morbidities and co-morbidities that one can have in a real-world scenario. And we are going there, but it takes time.”
Pressure Ulcer Research: A New Frontier By Laurie Watanabe, Editor
mobilitymanagement Research BonusThe New Frontier in Pressure Ulcer Research
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If you know TiLite’s TR, a rigid-framed ultralightweight manual chair, the manufacturer’s new TX will seem strikingly familiar.
The “X” in the TX name, of course, refers to the chair’s cross-brace. This is a folding chair, and in design parlance, that means more parts than in a rigid chair. Historically, that’s been a tough truth to hide: Those additional parts result in a design that’s clunkier than the sleek, minimalist lines of today’s rigid ultralights.
But after your first glance at the TX, you’ll wonder: Is that a folding chair?
Translating a Simple Idea Doug Garven, TiLite product devel-opment manager, is the industrial designer who created the TR Series 2.
“I was looking at our TR and wanting to figure out a way to make a TR that could fold,” Garven told Mobility Management.
That sounds easy enough to do with TiLite’s signature chair, whose sweeping lines convey rolling elegance. But the premise was the only easy part of this project.
“When you see the TX, it seems like such a simple idea and execution,” Garven admits. “Just put a crossbrace on there, and it folds! But it’s actually a very complicated design in that it’s a TiFit chair — it’s custom made to the user’s individual specifications. That’s where the devil in the details comes in.”
TiFit is the manufacturer’s name for the process of building a one-of-a-kind chair for each user. In essence, Garven had to create a design that could accommodate consumers within a wide range of sizes. The new TX offers seat widths from 12" to 20", seat depths of 14" to 20", and accommodates users up to 265 lbs.
For each consumer ordering a TX, Garven says, “Every cross tube length is different. The links that hold the cross tubes to the side frames are different and unique to each chair. Every tube on there is custom.”
And that’s not all. Mimicking the TR’s graceful design required minimizing the appearance of those parts that enabled the TX to fold.
“A folding mechanism adds parts and pieces to a chair,” Garven
Raising the Bar for Folding Ultralights
says. “Trying to hide them, trying to tuck everything up as close as possible underneath the seat was the aim to emulate the lines of the TR. To do the one, it forced the other.”
The result is astonishing. Once you add a seat cushion to the TX, it’s tough to see the crossbrace unless you’re looking for it. The frame’s remarkable simplicity doesn’t divulge that this chair is a folder.
“Unless you’re looking underneath the chair,” Garven says, “you really don’t see it.”
Raising Expectations for Folding ChairsWhy all the effort to hide the crossbrace and folding mechanism in the first place?
“Just to change the dynamic and perception of a folding chair,” Garven says. “Aesthetically, the cross bracing and folding mecha-nism add what I like to call design clutter. It takes away from the overall clean lines and aesthetics of the chair, which you typically have with a rigid. For some people, the look of a folding chair was maybe a deterrent. Maybe we’ve now taken that deterrent away.”
Compared to rigid counterparts, folding chairs are expected to look more boxy, to perform less spectacularly because more moving parts equal less rigidity, and to weigh more.
While Garven acknowledges that ride quality in a folding chair cannot attain that of a rigid, he clearly set out to reduce compro-mise wherever possible — starting with a custom fit.
“The frame is totally built around the individual, whatever dimensions they supply,” he says. “That’s part of our prosthetic-like fit that we pride ourselves on.”
The flip side of that equation, he notes, didn’t make him any friends in the fabrication department.
“Being able to do all the customization that we offer in our TiFit chairs really makes it a challenge on the manufacturing side because every tube on it is unique,” Garven says. “Even the cross tubes, left and right, are not the same length.
“Most manufacturers like to have parts that are alike, tubes that are always the same, cross tubes that are always the same. That way they can stock an inventory of that part, and when the size comes up, they can pull it off the shelf. That’s something that
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can’t be done with the TX because each part isn’t made until we get an order. Then we plug the numbers into our model, and it generates the tube dimensions. Until then, don’t know what those dimensions are going to be.”
Optimizing Consumer ChoiceThe TX definitely does not compromise in the clinician/ATP/consumer choice department. You can have a front seat height from 15" to 21", and a rear seat height of 13.5" to 19". Choose 0°, 2° or 4° of camber, a front frame angle of 70°, 80° or 85°, and a center-of-gravity adjustment of 3.75" or fixed.
Still think that folding chairs have little curb appeal? The TX offers 23 front-wheel options, 67 rear-wheel options, 15 options for handrims and aesthetic choices that include six titanium frame finishes, 16 frame colors, six color anodize packages and seven Ultrasuede colors.
“Choice matters,” Garven says. “We like our customer, the user, to be able to choose whatever make or model they prefer and give them options to personalize the chair and make it perfectly fitted for their needs.”
One of the major reasons that some consumers prefer folding designs over rigid ones is transportability. “There are people who have learned to get in and out of a car with a folder,” Garven says. “They drive a truck or something with access behind their seat. So
they fold the chair and just pull it in behind them. It’s easier than breaking it down and taking the wheels off and pulling it across them to put it in the car.”
The TX’s many details include a spring-loaded footrest that flat-tens to normal position when being used, then rises in the center when no weight is on it. Once the TX’s owner transfers out of the chair, the footrest “unlocks.” No more reaching down to manually unlock the footrest before folding.
“It’s something that helps make the user’s day easier,” Garven says.
The TX abounds with such details — such as the ability, thanks to the compact, “tucked-under” crossbrace, to pull the rear wheels off for transport, just as you’d do with a rigid chair. Do that, and the transport weight of a 16x16" TX is about 11 lbs.
Consumers are unlikely to immediately notice all this sweating of the engineering and design details — but Garven is fine with some intrigue remaining behind the scenes.
“That’s part of the coolness of what we do,” he says. “It isn’t something that necessarily jumps right off the chair. It might take days or weeks for someone to recognize a design feature or detail, or they may never notice it. What they will notice is how precisely fitted their TiLite is to them, how much this improves their mobility and allows them to focus on their daily lives.” l
— Laurie Watanabe
Savaria Corp. reached new finan-cial heights in the fourth quarter of 2014, the company announced in a news bulletin. The Canadian manufacturer of elevators, stairlifts and vertical platform lifts reported revenue upwards of $80 million for the first time, with an EBITDA of 13.5 percent. President/CEO Marcel Bourassa said of the record-setting quarter, “Our increased efforts to develop new products have been successful,” and he singled out the Stairfriend, a lift for curved stairs, as one of Savaria’s recent highlights. Savaria is headquartered in Ontario, Canada… The European Parkinson’s Disease Association has launched Parkinson’s Life, a “Webzine” for the international Parkinson’s community. “It will contact everyone touched by the disease, wherever they are in the world, from people with Parkinson’s and their families to healthcare professionals, carers and decision makers,” a news announcement said. The official launch of parkinsonslife.eu was
briefly…an international editionApril 11, also known as World Parkinson’s Disease Day… The ALS Association has welcomed ALS of Nevada, the organiza-tion’s newest chapter and 39th affiliate nationwide. Visit online at ALSANV.org; the chapter is based in Las Vegas… German and Japanese researchers reported mobility improvement in patients who used a Cyberdyne exoskeleton for physical therapy sessions over three months. The March issue of Kawasaki SkyFront i-newsletter said all eight study partici-pants had sustained spinal cord injuries and “had all reached a chronic state in their condition so that further improve-ment was unlikely.” The participants did physical therapy using the exoskeleton for 90-minute sessions five times a week for 90 days. “Electrodes placed on the muscles monitor potential differences, allowing [the exoskeleton] to read these muscle signals and respond with support from the motorized exoskeleton,” the newsletter said. Researchers then compared participants’ abilities to stand up from a seated position, walk 3 meters, turn around and walk back, while noting the time and assistance needed to complete the task. Participants improved their speed, the distance they could cover, and lengths of their stride after completing the exoskeleton PT. Researchers were from BG University Hospital Bergmannsheil in Germany and the University of Tsukaba in Japan. l
Savaria’s SL-1000 stairlift. Courtesy Savaria Corp.
European Parkinson’s Disease Association, a “Webzine” for the
international Parkinson’s community. “It will contact everyone touched by the disease, wherever they are in the world, from people with Parkinson’s and
and decision makers,” a news announcement said.
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Group Publisher Karen Cavallo(760) 610-0800
Publisher’s Assistant Lynda Brown(972) 687-6710
Advertising Fax (866) 779-9095
ad index
Altimate Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Amysystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Broda Seating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Convaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Drive Medical/Wenzelite Re/hab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Ki Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Numotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Ottobock HealthCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Permobil/TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Pride Mobility Products/Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Prime Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Stealth Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Sunrise Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Symmetric Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Thomashilfen North America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
advertisers’ indexCompany Name Page #
pediatric wheelchair comparo
standing marketplace
Amysystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Columbia Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Convaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13, 14
Drive Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Freedom Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ki Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Leggero LLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14, 15
Ottobock HealthCare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15, 18
Permobil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Stealth Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Sunrise Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 18
Thomashilfen North America . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15, 16
TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16, 17
Clarke Health Care Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Dalton Medical Corp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Handicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Mulholland Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
Pacific Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Permobil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Prime Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Company Name Page #
Company Name Page #
MM EditorialAdvisory Board
Josh Anderson TiLite
Mike Babinec Invacare Corp .
Pat Boardman Astrum Healthcare
Lois Brown Consultant
Beth Cox The VGM Group
Susan Cwiertnia VARILITE
Jay Doherty Quantum Rehab
Amit Gefen Tel Aviv University
Rick Graver Medtech Services
Ryan Hagy Numotion
Julie Jackson Invacare Corp .
Angie Kiger Sunrise Medical
Kara Kopplin ROHO Inc .
Karen Lundquist Ottobock
Joe McKnight Access Medical
Amy Morgan Permobil
Julie Piriano Pride Mobility Products/ Quantum Rehab
Lauren Rosen St . Joseph’s Children Hospital of Tampa
Mark Smith Wheelchairjunkie . com
Rita Stanley Sunrise Medical
Barry Steelman Permobil
Stephanie Tanguay Motion Concepts
Cody Verrett ROVI
0515mm_AdIndex30.indd 30 4/9/15 12:51 PM
The Aero X Series 2 brings great value through stellar quality, reliability, and innovation:• Superior rolling dynamics provide rigid-like performance• Modularity for convenient configurability in the field• Redesigned cross-brace geometry for easy, narrow folding• Patented Speedloader front caster housing and two caster position options
The Aero X Series 2 reminds us all that value can be achieved without compromise.
BEATING THE COMPETITION FROM THE GROUND UP.
SERIES 2
