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On the CoverOptimal positioning can help a wheel-chair user to rise above. Cover by Dudley Wakamatsu.

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10 Stability at the Top

Why head and neck

positioning are so

important to the overall

function and success of

a seating system.

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mm beat

CRT ResearchNew Pressure Relief Studies Cited in Updated RESNA PaperWheelchair users use seat positioning functions such as tilt, but many times not in the ways that their clinicians prefer, and not in ways that are optimally beneficial.

That’s one of the take-aways of a newly updated position paper called “RESNA Position on the Application of Tilt, Recline and Elevating Legrests for Wheelchairs Literature Update."

Released in August 2015, the paper is an update of a 2009 version from the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA). This latest rendition revisits research discussed in the first paper and adds new research relevant to seat functions.

Pressure Relief UpdatesThe paper’s lead author is Brad Dicianno, M.D., University of Pittsburgh, Department of Physical Medicine & Rehabilitation. Dicianno’s fellow authors are Jenny Lieberman, MS, OTR/L, ATP, Mount Sinai Hospital, N.Y.; Mark Schmeler, Ph.D., OTR/L, ATP, University of Pittsburgh; Ana Elisa Schuler P. Souza, Ph.D., PT, Recife-PE, Brazil; Rosemarie Cooper, MPT, ATP, University of Pittsburgh; Michelle Lange, OTR, ABDA, ATP/SMS, Access to Independence, Arvada, Colo.; Hsinyi Liu, Ph.D., PT, University of Pittsburgh; and Yih-Kuen Jan, Ph.D., PT, University of Illinois Urbana-Champaign.

In an interview with Mobility Management, Dicianno noted that the team’s revision process included reviewing literature to determine which topics in the original paper had been augmented by additional research over the years.

“There were some clinical practice guidelines that have come out about different disability populations like spinal cord injury and muscular dystrophy that have talked about power seat functions being critical for daily tasks primarily related to self management,” Dicianno said. He explained the significance “that there are guidelines recog-nizing something like this as a medical intervention.”

Another study, he added, studied elevating legrests (ELRs) used in tandem with tilt.

“It was actually done on control individuals, not individuals with disabilities,” Dicianno says of the paper, “but it gave a little bit more evidence as to how elevating legrests work in combination with tilt and the impact on hemodynamics in the lower limbs. It gives some

evidence that using legrests in combination with tilt might have an effect on things like lower-limb edema.”

But the topic most impacted by new research since 2009 was pres-sure relief.

“I would say that’s where most of the updates happened,” Dicianno said. “There is a section in the new paper that basically takes the old evidence, combines it with the new evidence and provides summary recommendations about tilt and recline and how they’re used in combination, and the effects that you’ll see on pressure relief.”

Effective CombinationsThe updated paper indeed spends multiple pages on the subject of “Pressure Relief and Tissue Perfusion.” The original paper referenced the benefits of using tilt and recline together to relieve pressure; the updated version cites research that confirms those findings. In addition, the update includes more information on the range of tilt and recline needed to truly achieve skin perfusion. Degree ranges mentioned in the new paper are relatively high — for instance, at least 35° tilt combined with at least 100° of recline to gain skin perfusion over the ischial tuberosities, according to one study.

“There’s still no absolute gold standard, but this gives you some recommendations about how to use them in combination and to what extent,” Dicianno said. “Rather than black-and-white recommenda-tions, they provide general guidelines about what extents of use will result in greater amounts of pressure relief.”

Having those guidelines is important in part because not all posi-tioning systems are created equal — and not all clients follow their clinicians’ recommendations, either.

“There are some systems that actually don’t tilt back far enough to achieve the pressure relief that you want to get,” Dicianno said. “And there was also one other interesting article that demonstrated that many people are using their seat functions to reposition themselves based on discomfort in the chair, despite having been trained on the purpose for the seat functions and how they should be used.”

Rather than following clinical guidelines to relieve pressure to the extent of achieving skin perfusion, many clients tilt just enough to feel more comfortable — the equivalent of an able-bodied person fidgeting and shifting in an office chair.

“There’s a discrepancy between what we teach and what clients actu-

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ally do, and so there needs to be a lot of work to re-educate clients and show them the extent to which you need to use these seat functions to get the medical benefit that you want to see with them,” Dicianno said.

Real-Life ApplicationsThe paper is divided into sections, including the clinical and func-tional benefits of tilt, recline and ELRs, overview of seat function use (i.e., how often consumers use positioning options), and how tilt, recline and ELRs impact posture realignment and function; physi-ologic and orthopaedic implications, transfers and spasticity; edema; and pain, fatigue and sitting tolerance. The different segments should make the paper easier to use in real-life scenarios, such as when a clinician or ATP wants to cite research as part of the docu-mentation process.

While it might be tempting to just include the entire paper as docu-mentation, Dicianno suggests it’s probably more effective to refer-ence the portions of research that specifically impact the client you’re working with.

For instance, the process of justifying tilt could include explaining that the client cannot independently and consistently perform pres-sure-relieving maneuvers, and that he also has a history of pressure ulcers and lower-limb edema. Using tilt in combination with ELRs

could help to manage that edema. But instead of attaching the entire RESNA paper — which the claim’s reviewer might not read — a better tactic is to state that there is a position paper on this topic, locate the relevant research within the paper, and then explain in bullet-point format that because the client’s condition matches up with conditions described in the research, he too could see medical benefits from using these technologies.

Dicianno explained that RESNA strives to update position papers every five years — a goal that means that by the time a paper has gone through the updating process and is formally released, additional rele-vant research papers have probably been published.

“We’re already aware of new ones that will probably impact the next [update],” Dicianno acknowledged.

And as for the topics in the original paper that really didn’t benefit from much subsequent research since 2009, Dicianno said there’s a silver lining there, too.

“The areas where there are gaps can be used in a positive way, because those are areas of needed research,” he noted. “So it certainly brings out areas where there’s not been a lot done and where we need good studies.”

Find the updated tilt, recline and ELRs paper, along with RESNA’s other position papers, in the Knowledge Center at resna.org. l

Go to www.mobilitymgmt.com/renew and use priority code MHR to keep Mobility Management coming to your mailbox. Because if your subscription stops, that would be a real pain.

September 2015 • Vol. 14 No. 9

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The clinical term for an ice cream headache (aka, brain freeze) is sphenopalatine ganglioneuralgia.

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Seating & Positioning HANDBOOK

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Consider the underappreciated postural support, so essential to successful wheelchair seating, but so overlooked compared to power bases or manual wheelchair frames.

And yet, closer examination of Adaptive Engineering Lab’s (AEL) AirLogic line of supports reveals attention to detail and thoughtful-ness to design that rivals that of any other portion of a wheelchair.

Impacting Users’ MicroclimateFor components that get relatively little fanfare, postural supports are expected to accomplish a lot. For wheelchair users who lack strength, balance or the ability to reposition themselves efficiently, postural supports can help to maintain functional positioning throughout the day and even through rigorous activities, such as propelling a wheelchair… or finger-painting after snack time.

The AirLogic line includes posture, chest and anterior trunk supports in a range of styles, from traditional to slimmer profiles. There’s even a “Backpack style” made up of two independently mounted straps that can individually address postural needs.

But all members of the AirLogic line have a common construc-tion designed to address — pun intended — a hot topic in seating.

Kirsten Davin, OTD, OTR/L, ATP/SMS, said in an interview with Mobility Management, “What’s great about the AirLogic line in general, and a big speaking point in a lot of arenas right now, is the concept of microclimate. Microclimate is a combination of heat and moisture and other elements that go into the process of creating skin issues. There are a multitude of anterior supports and trunk supports out there. But what sets AirLogic apart is its design. The AirLogic line utilizes a much more breathable fabric than its competitors, so it’s going to maximize the air movement, but also allow moisture and sweat to pass through. It wicks the unwanted, potentially problematic moisture away.”

Davin pointed out that microclimate comes up frequently in conversations about heat and moisture being generated by the user sitting on a seat cushion, but she added, “Heat and moisture can also be a problem with anterior supports. AirLogic’s design combination of increased air movement and moisture removal system is creating a much better microclimate for the client, espe-cially if you have users who are inherently warmer, produce more sweat, or are self propelling and working up some heat.”

Moisture dissipation is also a useful feature when AirLogic is used by clients who have difficulty managing saliva, or by kids who are liable to spill their apple juice… or have apple juice spilled on them by classmates.

“It’s much easier to clean, and a much more durable system than some of the other options out there,” Davin said.

Addressing AsymmetriesNoting how many users of these supports have unique postural requirements, Davin singled out AirLogic’s ability to address them.

AEL’s AirLogic Line: Details, Details

“If you have someone who is really going to feed into a posi-tion — someone who is presenting with lateral scoliosis, trunk rotation, spinal rotation, shoulder retraction or protraction — the AirLogic line is ideal, as it will also allow for specific and more intri-cate adjustments,” she said.

“We use AirLogic products for clients who present with your typical asymmetries: kyphotic presentations, lordosis, scoliosis. But for those who present with greater asymmetry, or who require greater preci-sion in adjustment, or improved cosmetic appearance with a lower-profile support, we often incorporate the Backpack style.”

Imagine the look from the front when you carry a backpack by a single strap on one of your shoulders. That’s the idea behind the AirLogic Backpack style support.

“In the industry, there has historically been a fear associated with having an anterior support application, due to the risk of it becoming maladjusted or the client sliding down and having the support too close to the neck,” Davin said. “One great benefit of the Backpack style is that it fits much like a child’s backpack would, thus eliminating the risk of a choking hazard.

“Let’s say the client is completely unattended, and they pull out of whatever type of pelvic support was involved. You won’t run the risk of it becoming unsafe for the client because it is strictly a backpack presentation. This Backpack style also allows the thera-pist to easily and much more efficiently address single-shoulder positioning. If they have trunk rotation or shoulder protraction, you can really get in there with those separate Backpack style posture supports and make the necessary adjustments to each side.”

Clockwise from top left: AirLogic’s Standard Zippered Anterior Trunk Support, Slim Cut Stretch anterior trunk support, swiveling buckle, and Backpack style supports.

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Positioning from Every AngleAirLogic also offers anterior trunk supports with regular and slim-cut profiles to further customize the fit to each user’s preferences.

Davin has put the different profiles to good use, pointing out that Backpack style supports can be helpful when the seating team needs to avoid interfering with feeding tubes or colostomy bags. Recently, Davin used a slim-style anterior trunk support for a woman with cancer who’d had a double mastectomy and couldn’t tolerate a postural support pressing against that area.

“We did a slim-cut option that completely circumvented the breast tissue, and that allowed her to be able to have that torso support without encroaching near those surgical sites,” Davin said.

Alexis Kopca, AEL’s marketing manager, said AirLogic was born because the manufacturer heard that traditional Neoprene belts were too hot, “that they held in too much heat and that they were uncomfortable. So we wanted to come up with something that was breathable.” AEL’s engineers found their answer in layering air-mesh and perforated Neoprene fabrics, which provided breath-ability plus durability. Kopca refers to AirLogic panels as having “controlled” stretch capabilities, which has led to less tearing, even for users who are very active.

“Another point that we were working on in R&D was we wanted to make sure they were machine washable,” Kopca said, adding that AirLogic supports are “easy to take off and throw in the

washing machine, and they also dry very quickly because of that moisture-wicking property.”

AEL hired a fashion designer with high-performance sports gear experience to develop such concepts as an anterior trunk support zipper that is “invisible,” its teeth turned inward toward the user rather than facing front, and silver threading for curb appeal — critical, Kopca said, because AEL is working on solidifying its reach to adults after being long known for its pediatric solutions.

So far, AirLogic’s overall strategy and features are working, with seating professionals especially loving the line’s breathability and durability. AEL Sales Manager Lindsay Koerner noted, “ATPs have said those two features have saved them time and money typically spent on replacement harnesses and service calls. [The supports] hold up much better over time, don’t tear, and they’re great for those more active users, those patients with high tone and spas-ticity that would typically tear a harness.”

Kopca declined to elaborate too much on future plans for an AirLogic line that clearly focuses on all the details, including buckles that can swivel for a more precise fit, and top and bottom buckles that are different, so the supports can’t be accidentally fastened upside-down by caregivers. But she promises there’ll be more. “We are definitely looking at expanding the line and the technology as far as we can,” she said. “It’s very popular, and the feedback has been very positive. It’s very exciting for us.” l

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Seating & Positioning HANDBOOK

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Everyone who’s ever played a game of Jenga can attest that it’s not the blocks at the top that cause the giant crash. Rather, it’s the instability of the base.

That logic also applies to head and neck positioning.“Creating a stable pelvis and spine is really about building a stable tower to

create an upright head,” explains Pete Cionitti, director of product manage-ment, Therafin Corp.

When the tower starts to sway before crashing, the blocks at the top often end up misaligned. If you think of the head and neck the same way, it’s easy

to see how every decision about positioning affects the way the client ulti-mately sees and interacts with the world.

So once a clinician has the building blocks of the foundation in place, what can be done to ensure the top has the necessary stability for life-long benefits?

The Importance of Getting It Right Figuring out the geometry of head and neck positioning is

paramount, as proper head and neck positioning has many benefits for clients. In fact, missing the mark on this important positioning component sends shockwaves though the client’s physical, social and clinical states of being.

Consider the function of the head and neck. “Most of our basic, everyday functions occur with the head. Vision, hearing, breathing, communication

and eating all involve the head and neck,” says Gabriel Romero, VP of sales and marketing, Stealth Products.

Proper head and neck positioning greatly improves vision and with it mobility, says Amy

Morgan, national clinical education manager at Permobil. “The head must be stable for the eyes to work effectively. Vision is directly related to

mobility, and having a stable support for the eyes to work off of makes this much more effective.”

For example, correcting head and neck positioning helps clients use environmental

By Elisha Bury

The Importance of Fine-Tuning Head and Neck Positioning

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controls, such as switches and head arrays, more effectively, says Sam Hannah, ATP, Symmetric Designs.

“When the head is aligned and supported, movement from this posi-tion is less strainful and will result in more ability to engage and then return to a neutral position,” he says.

In addition, Morgan says that proper positioning improves client operation of head controls.

“Proper support and positioning of the head supports/switches is crit-ical for safe and effective operation of a driver control that is operated with the head. Just like the eyes need a stable base for controlled scan-ning, vision, etc., proper head/neck supports allow the user to access the driver control/switches in a more controlled manner,” she says.

In addition to navigating the environment safely, vision is imperative for communication, social interaction and learning, says Hannah.

“The eyes serve as a very important way in which we communicate,” Romero says. “A gesture — respect, interest, appreciation and under-standing — is often a gateway to learning. Eyes are capable of expressing emotions as well.”

Not to mention, interacting with the world is challenging when the chin is dropped and the eyes are looking downward, Cionitti says.

“Eye contact is needed to truly connect with individuals or when speaking with groups,” says Steffen Tiskus, training and development coordinator, power positioning, Motion Concepts.

Tiskus also warns that improper head and neck positioning compro-mises nonverbal communication along with verbal communication. He explains that nonverbal communication is often overlooked but has great importance in overall communication.

Proper positioning also improves basic bodily functions, including inhalation, exhalation and swallowing, which in turn “leads to improvements in nutritional status (and) reduction in choking risks,” says Tiskus.

Clinically speaking, proper head and neck positioning is essential to preventing deformities such as scoliosis, kyphosis, and cervical and pelvic obliquities, according to Romero.

Morgan explains that better alignment can reduce muscle tightness and pain — pain that might include everything from headaches to disc herniations.

“Abnormal posture can impact the nerves and spinal cord in a nega-tive way, causing upper-extremity weakness, paresthesias (and more),” Morgan says. In addition, contractures of the head and neck can develop, and resulting asymmetries can negatively impact the vision system.

Getting this aspect of seating right is so essential that it is often considered to be the most challenging aspect for seating professionals, Tiskus says.

The Clinical Cues for PositioningWondering whether a client is at risk for poor head and neck posi-tioning? Two screening criteria can alert clinicians that head and neck positioning might be an issue.

The first is the client’s diagnosis. Some diagnoses intrinsically lead to poor head and neck positioning:

• Cerebral palsy

• Amyotrophic lateral sclerosis (ALS)• Multiple sclerosis• Arthritis• Traumatic brain injury• Muscular atrophy• StrokeSpinal and pelvic deformities also require head and neck support.“A kyphosis or scoliosis can result from many different disabilities

and lead to improper alignment of the head and neck,” says Hannah.Other deformities can include forward head posture, cervical

lordosis, hyperkyphosis, lateral flexion contractures, abnormal cervical rotation and torticollis, according to Morgan.

“Improper support can also contribute to upper back, scapular and

If you ask Pete Cionitti, director of product management at Therafin Corp., what the rehab world needs now is a new HCPCS code for head positioning technology.

The reason is that improving head positioning technology centers on three objectives: “lighter-weight materials, more intimacy of fit and custom tailoring without burdensome setup,” he says.

However, accomplishing these goals is challenging with today’s allowables.

“Technology advances require investment in research and development, and those investments need to be realized through economically sustainable product sales,” Cionitti says. “The state of the industry is trending toward ‘design to a code.’ This often results in a cheaper product versus an improved solution. Very few new tech-nologies exist for this reason.”

A unique HCPCS code would improve funding and advance

today’s head and neck positioning products. l

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Head and neck positioning needs to be considered as part of the entire seating system to be effective

— Sam Hannah, ATP

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Stability at the Topshoulder issues as the body tries to find stability elsewhere,” she says.

Tiskus points out that severe extensor tone can present some chal-lenges with head and neck positioning as well.

In addition, look for dysphasia and respiration as head and neck positioning can help solve these problems.

Clinicians need to pay attention to swallowing and oral secre-tions, says Stephanie Tanguay, a clinical education specialist at Motion Concepts. “Some consumers will be at risk for aspiration, and specific head positioning may be a critical aspect of preventing this.”

“Aspiration as the result of dysphagia can lead to serious pneumo-nias that can be life threatening,” adds Cionitti. Good head positioning along with care in feeding can greatly reduce aspiration.

“A decrease in respiration can have both immediate and long-term effects. Over the long term, there can be serious pulmonary hyperten-sion and edemas which can even lead to heart failure. A well-positioned head can help keep the airway open and improve respiration,” he says.

The second red flag for poor head and neck positioning is client symptoms.

“Difficulty swallowing, breathing, headaches and pain, low blood pressure, and eye gaze position are all some of the warning signs that

the head/neck are not positioned properly,” Hannah says.Other “warning signs include excessive flexion/extension in the

cervical spine, inability to hold the head against gravity, difficulty in swallowing/breathing (and) pain in the cervical spine,” says Tiskus.

Romero says that fatigue, excessive drooling and coughing can be signs that the head is not in the correct position. He says it’s important to position the head so that clients don’t use up all of their energy to hold the head upright.

According to Morgan, if improper head/neck positioning is not addressed, it can worsen over time, leading to progressing deformities.

“Gravity has an effect on everything, so when we are working with clients who have limited movement, the head becomes the pendulum of the body. Where the head is placed usually dictates where the body will end up,” explains Romero. “Creating sound positioning options allows for the client to control the stability needed in the cervical region. It becomes harder and harder to position a client who has been sitting one way their whole life. If we can position the client the right way early on, it gives them a greater chance of having a comfortable and correct seating position that will help prevent the bones and muscles from growing incorrectly.”

Correcting Improper PositioningProper head and neck positioning is a long-term process, the key to which is setting goals and figuring out how to meet those goals, says Chris Reidmiller, national sales manager, Therafin Corp.

For example, some goals could be “improving comfort, oral motor function, heightened awareness, airway passage, preventing postural deformity and providing stability for function,” says Reidmiller.

At the same time, goals need to be realistic, says Tiskus, because there are “trade-offs between more aggressive positioning options versus the inevitable reduction in movement that these type of supports provide the individual.”

To set goals, clinicians must gather as much information as they can from clients. Asking some key questions can lead clinicians in the right direction.

“What is the therapist working with? Is the client faced with a progressive or regressive disease? Could a headrest possibly work as a therapy tool?” Romero says. “Each question and answer should care-fully be evaluated in order to give the client the necessary positioning.”

Romero suggests that clinicians use journaling to record as much information as possible during the seating evaluation.

“By writing as much information down as possible during an evalua-tion, this allows the therapist/clinician to look back at the end of the day and reevaluate if any changes would positively affect the client’s ability to be more mobile,” he says. “This could also help in future evaluations (and) tracking progress of a client.”

During a seating evaluation, clinicians should consider the client’s current position, what the most functional seated position would be, range of motion, the extent of deformities, and how seating surfaces and other positioning components will affect head and neck position, says Hannah.

“Almost every major part of the body (pelvis, torso, arms and legs)

Seating & Positioning HANDBOOK

As one might expect, proper head and neck posi-tioning for pediatric clients is especially important to assist them with growth and learning.

“Proper head and neck positioning in pediatrics will reduce the chance of children growing into a posture that could require diffi-cult correction or surgery during later years,” says Sam Hannah, ATP, Symmetric Designs.

In addition, improper head and neck positioning can impact learning, especially language learning, says Pete Cionitti, director of product management at Therafin Corp.

“A dropped head and lowered gaze will impact observation for both the learner and the teacher, and development can be delayed,” he says.

However, head and neck positioning is not necessarily more important for children.

“I think it is equally important for children and adults alike,” says Permobil’s National Clinical Education Manager Amy Morgan. “With kids — just like with adults with new injuries — we are trying to prevent poor posture from developing.”

The difference with pediatrics, however, is oversupporting the head and neck.

“The catch is — if we provide too much support all the time — they might rely solely on the supports provided and not develop the motor control to manage their posture on their own,” Morgan says. “It

is a delicate balance.” l

Head & Neck Positioning Considerations

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coincides with each other when positioning the body. Move one part and it will move the other,” says Reidmiller.

“The client’s lower body and trunk should be well supported to ensure the head and neck can be positioned with minimal support,” says Hannah. “Stabilizing the client’s trunk will put less strain on the head and neck. Head and neck positioning needs to be considered as part of the entire seating system to be effective. Once the trunk is well positioned and supported, the head and neck can then be positioned so that (it) makes, breathing, swallowing and vision less effortful.”

Tanguay adds that “head positioning away from midline may be a compensation result of deficits of specific quadrants of the consumers’ visual field. It is important to determine if the head position is a purposeful attempt to see from an intact aspect of the optic field.”

Morgan warns that supporting the head is a delicate balance because the clinician doesn’t want the client to rely too much on the provided supports.

“For example, the rehab team may attempt to use a lateral swing-away head positioning pad to keep the client from rotating or later-ally tilting to that side; however, the client senses the support pad, and it actually encourages them to push into the pad instead,” she says. “This can be problematic from a hardware perspective (having to with-stand that extra force) and is also contrary to the intention of the pad itself. Another option might be to try to control the head with an occip-ital pad so that sensory feedback is not provided in the direction of the movement we are trying to control.”

One way to address this issue, Morgan says, is to avoid prescribing too many supports. She recommends using swing-away technology or equipment with parts that can be removed for part of the day.

Still, Morgan says that getting positioning right will require trial and error.

Step Up Your Positioning GameFortunately, choosing systems that provide good head and neck support is easier today than it used to be.

Several manufacturers make head positioning devices, and the choices have expanded, Hannah says.

Many of today’s systems have sought-after features such as custom-ization, dynamic components, fine-tuning adjustability, and head rota-tion support.

However, clinicians need to err toward simplicity as they solve client positioning problems.

“Keeping the systems as simple but effective as possible can help us make sure we are not just successful in a clinical environment only,” says Romero. “We have to remember that families take these products home with them. If they cannot replicate proper positioning of a head positioning system by themselves or get frustrated with how it func-tions, we do not gain ground on creating a functional system.”

Morgan agrees. She believes the key is easily adjustable, durable hardware. Morgan explains that the hardware needs to hold up against high amounts of forces, such as from individuals with a lot of tone. She acknowledges that this combination is not always easy to come by.

In addition, Morgan says the positioning hardware needs to blend in well so that people see the client and not the chair.

In fact, seeing the client is really the key to the whole head and neck positioning game. When the client is properly positioned, everything falls into place physically, socially and clinically instead of crashing down. l

• Symmetric Designs’ Savant Headrest with Twin Mounting Hardware and Axion Rotary Interface — According to Sam Hannah, ATP, Symmetric Designs, the customizable device “enables the fitter to shape the support to the exact needs of the client.” In addition, the tele-scoping component of the hardware allows the clinician to make fine adjustments. Add the Axion Rotary Interface to give the client lateral rotation capabilities while still being supported. • Whitmyer Headband Support and Stealth Products’ i2i — Steffen Tiskus, training and development coordinator, power positioning, at Motion Concepts, says Whitmyer’s headband support, which is mounted to a pulley system, offers “anterior support for those individ-uals who cannot hold their head against gravity.” It also allows dynamic control that is mostly rotational. The i2i “provides good neutral align-

ment of the head/cervical spine, however, limits any type of cervical movement,” he says. What’s on Tiskus’ wish list? An aggressive head and neck support system that enables range of motion in the cervical spine.• Whitmyer Heads Up — “The Heads Up is a newer product which can provide some support of upright head orientation while allowing some right/left rotation,” says Stephanie Tanguay, a clinical education specialist at Motion Concepts. “It appears to have some applications for assisted muscle function to support the head and encourage control and strengthening of the neck musculature.” Tanguay cautions clinicians about using dynamic headrest mounts to accommodate extreme exertion of extensor forces. “Appropriateness of these inter-ventions is determined on a case-by-case basis, as injuries could

occur,” she says. l

Industry Experts Share Current Technology Picks

Keeping the systems as simple but effective as possible can help us make sure we are not just successful in a clinical environment only. We have to remember that families take these products home with them

— Gabriel Romero

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Stimulite Slimline XS CushionWith a mild contour and profile, Supracor’s Stimulite Slimline cushion is designed for active wheelchair users. Thanks to its two-layer honeycomb construction, the cushion is machine washable and lightweight. Honey-comb cells flex with movement to reduce shear forces, and the intercon-nected, open-cell design distributes weight evenly while allowing air movement to promote moisture evaporation.

Supracor(800) 787-7226supracor.com

WC19-Tested Power SeatingQuantum Rehab’s new iLevel and TRU-Balance 3 power

seating systems are WC19 crash-test compliant to be used as seating in automotive vehicles. That means seating teams can offer

Quantum Rehab’s power tilt and recline, articulating foot platform and seat elevation in a crash-tested package on

the Q6 Edge, configured individu-ally or together, with up to a 300-lb.

weight capacity.

Quantum Rehab(866) 800-2002

quantumrehab.com

Custom CushionCapable of being built to almost any size, Ride’s Custom cushion is made of a Brock composite material that enables air to circulate to keep skin dri-er. The cushion offloads at-risk bony prominences and redistributes sitting forces to areas that can tolerate more weight. The result is a higher level of postural control, plus superior skin protection. The E2609 cushion weighs about 3 lbs.

Ride Designs(866) 781-1633ridedesigns.com

Poziform Positioning Poziform postural supports include pelvic positioning belts, chest harnesses and lower-extremity supports for pediatric and adult clients. The wide range of styles, sizes and materials makes it easy for seating teams to find the combinations that fit their clients best. Belts and harnesses come with all needed attachment hardware.

Drive Medical(877) 224-0946drivemedical.com

Icon Back SystemFor more versatility and comfort than sling upholstery can provide, the Icon Back System combines quick installation with a wide range of adjustability. New VariLock hardware offers simple operation and an integrated permanent mount system. Icon backs are available in four styles (low, mid, tall and deep) and can fit wheel-chairs 12" to 24" wide.

VARILITE(800) 827-4548varilite.com

APK2Think of an alternating mat-tress, and you get the idea behind the APK2 cushion, a fully automatic alternating system. All areas of the posterior experience redistribution of pressure as often as 60 times per hour to lower the risk of pressure-related skin breakdown. The battery-operated cushion runs for more than 40 hours on a single charge, and every unit is hand-made to the client’s personalized needs — including the loca-tions of current pressure ulcers.

Aquila Corp.(866) 782-9658aquilacorp.com

product revue

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Liquid SunMate FIPSFoam-In-Place-Seating (FIPS) is a custom-contouring seating system designed to help correct or slow progressive deformities. The finished open-cell viscoelastic foam system distributes body weight evenly and can be easily modified to accept belts and harnesses, gel or air inserts, or adjustable supports. A custom seat, back or a total wheelchair system can be molded in minutes.

Dynamic Systems(855) 786-6283sunmatecushions.com

Matrx Libra CushionMade with high-resilience foam, the Matrx Libra is designed for cli-ents who need the highest levels of skin protection, positioning and adjustability from their seat cush-ions. The Matrx Libra incorporates Ultra-Fresh anti-microbial and odor protection and has a highly flexible Platilon inner layer for extra pro-tection from moisture.

Invacare Corp.(800) 333-6900invacare.com

Quickie Centermount LegrestThis new power centermount legrest provides an increased range of articulation — now up to 7.5" — to maintain comfortable leg positioning during elevation and to prevent knees from bending during elevation. A span of 3" to 19" offers an optimal fit for clients with various lower-leg lengths, and left and right sides can be adjusted independently if needed. The Centermount also extends the footplate to the ground to assist with transfers. It’s compatible with the Quickie QM-7 and Pulse series of power chairs.

Sunrise Medical(800) 333-4000sunrisemedical.com

Seating & Positioning HANDBOOK

AmyseatAmysystems is an aftermarket power seating veteran, having provided seating solutions for highly involved wheelchair users for nearly 20 years. Power modules are designed and built to ensure they can adapt to the most complex positioning requirements, including the possibility of customization to meet the individual needs of every client.

Amysystems(888) 453-0311amysystems.com

Dynamic Systems Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Freedom Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Permobil/TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Pride Mobility Products/Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Symmetric Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

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THE F5 CORPUS®

FEATURING A/P TILTJen Goodwin

Permobil user since 2013Anterior tilt must be clinically recommended by a licensed professional. Additional support features such as knee blocks and chest straps may need to be prescribed. See More