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Case Study: 27 year old male with spinal cord injury

Supplier: Pride Mobility Products
19 March, 2014

Client Information: 27 year old male Height/Weight: 6'5" and 140 lbs. Diagnosis: Spinal Cord Injury

Past Medical and Functional History:

  • The client, his brother, and friend are part of ATV racing circuit. They are the builders, racers, and mechanics for their own racing team. They race on weekends in a regional circuit.
  • He was injured when he got into a car accident 10 years ago.
  • He is paralysed from the waist down.
  • Non-ambulatory and dependant on power mobility for the last 9+ years.
  • Poor trunk control.
  • Spastic UEs.
  • Controlled and Voluntary movement in his head and neck.
  • Pressure sores on ischial tuberosities.
  • Requires consistent re-positioning throughout the day to maximise comfort level.
  • Has controlled movement in his upper extremities (UE) but does present with skeletal issues with his hands, wrists and forearms.
  • Unable to extend fingers or wrist. Arms positioned close to chest.

Past Equipment Information:

  • He has spent the last 9+ years in a rear-wheel drive (RWD) power chair with Tilt and Recline.

Client Input on Past Equipment:

  • The RWD chair had minimal suspension which caused the client to have fatigue and discomfort throughout the day.
  • He liked the stability of the chair but it was cumbersome in his home due to the large turning radius.
  • The Tilt and Recline functions had become temperamental.
  • He operated the chair and its seating function via a joystick.
  • The joystick mount was modified so that the controller was positioned on the inside of the armpad, close to his chest.
  • To maximise his comfort, trunk control, line of vision, and overall function. He always was in at least 20 degrees of tilt and 10 to 15 degrees of recline.

Environment/Activities:

  • The client lives in a very rural section of Northern PA.
  • He lives with his brother and friend (who is the primary caregiver).
  • Their entire environment is made up of uneven and rough terrain. Not many paved areas in that section of the state.
  • Their passion is ATV racing. The client is now the crew chief and head of maintenance for the racing team.
  • They spend a good part of the week working on the vehicles to prepare for the weekend races.
  • His caregiver is always by his side and provided a good amount of feedback regarding what the client would need in a new chair.

Physical Assessment:

  • The first thing noticed when evaluating the client was how tall he is as well as how he needs to sacral sit in his chair for comfort.
  • His UE control and ability to operate a chair with the joystick was very much intact.
  • For pressure management and positioning, he would require power positioning.
  • His cognition is fully intact and he is able to safely operate his power chair even through rough terrain at high speeds.
  • For postural and comfort reasons, the client preferred his normal position in the chair to be at about 20 degrees of tilt and 10 degrees of recline.

Client Input:

  • Due to the client’s background with mechanics, he had quite a bit of input on what he wanted from a power chair. Most of the input revolved around his daily life and the racing team.
  • His requests for a power chair were pretty simple:
    • Comfort
    • Joystick positioned near his chest
    • Suspension
    • Speed
    • In home maneuverability
    • Stability
    • The ability for the chair to maneuver through all kinds of terrain.

Clinical Input:

  • In addition to the client's requests, the clinical team needed to find a power base that would accommodate some of following features:
    • Tight turning radius
    • Ability to accept Tilt/Recline at 24" deep. This was required b/c of his height as well as how he sits.
    • Enough suspension that will keep him comfortable and stable while traveling through his environment.
    • Speed
    • Durability to hold up in a rugged, rural environment.

Clinical Trials & Simulation:

  • The client was evaluated in a mid-wheel drive (MWD) Q6000Z.
  • This power base had met all of the Clinical requirements as well as the requests from the client.
  • The only issue was that he had been in a RWD chair for the last 9+ years.

Findings:

  • The client did excellent in the Q6000Z and immediately loved it.
  • He also understood (before it was even explained to him) that there would be a learning curve moving from RWD to MWD.
  • He welcomed that challenge b/c it was the first chair that met almost all of his needs.
  • Due to the learning curve, he immediately asked for his turning speed to be set low until he get a better feel for the chair.

Power Mobility Device

The client was fitted in a:

  • Q6000Z with 8 MPH Motors
  • TRU-Balance Power Tilt & Recline System @ 24" deep
  • Q Logic hand control with modified joystick mount.
  • Power Tilt and Recline System operating through the electronics
  • Custom 4" wide pneumatic all-terrain tires

Power Base Specifications:

Q6000Z:

  • Mid Wheel 6 design platform delivering unmatched performance and tight space maneuverability while allowing for unlimited rehab capabilities.
  • 14" Drive Wheels with 6" Rear and Front Casters.
  • 25.875" Wide, 36" Long, 22.5" Turning Radius.
  • ATX Suspension with integrated rear dual-strut suspension and articulating beam.
  • Standard with 6mph 4-pole motors and can upgrade to 4-pole 8mph motors.
  • Omni Casters on front and rear casters prevent wheel hang ups.
  • Accepts all power positioning functions and alternative drive devices through Q Logic.
  • Group 24 batteries for longer range (up to 20 miles).
  • Vent Battery Kit option.
  • Portable and Compact Vent Tray options.
  • 24" W x 24" D Max Seating dimensions in many configurations.
  • Available with Occupied or Unoccupied Transit Kits.

Client Applications:

Q6000Z:

  • The biggest thing with finding the right chair for the client was trying to find the right mix for his condition as well as his environment and activities.
  • The Q6000Z worked perfect. Its speed, suspension, ability to negotiate obstacles and terrain along with the fact it would accept the client's power positioning needs at 24" deep turned out to be exactly right for him.
  • He was also able to adapt very quickly from RWD to MWD.

Power Positioning Specs:

TRU Balance Tilt:

  • 55 Degrees of Tilt
  • Maintains Center of Gravity (COG) Shift
  • Simplified width and depth adjustments
  • Ability to adjust COG to meet client needs and weight distribution.
  • Low standard Seat to Floor Heights
  • Ability to accept a large range of cushions, backs, full seating systems, and positioning components.

TRU Balance Power Recline:

  • 95 – 168 Degrees of Recline.
  • Standard with adjustable Shear Reduction.
  • 300 lb weight capacity.
  • Does not increase STF heights.
  • Standard with Attendant Control.
  • Provides width and depth adjustment

Clinical Benefits of TRU Balance Tilt for the Client:

  • Improved sitting balance and head control.
  • Decreased fatigue.
  • Assists with line of vision for client due to postural issues and/or skeletal deformities.
  • Improved pressure management and weight distribution.
  • Accommodate for kyphosis.
  • Provides quick position changes without physical assistance from a caregiver.
  • Can assist with improved respiratory functions for individuals with impaired respiratory status.
  • Improved COMFORT!!!!!

Power Recline:

  • Provides passive ROM
  • Improved trunk stability/postural readiness
  • Allowed for supine transfers when necessary
  • Improved positioning for urinary care
  • Pain Reduction
  • Assists with improved Respiratory Functions
  • Alleviates Orthostatic Hypotension
  • Accommodates Kyphosis and Poor Trunk Balance
  • Improves Line of Sight
  • Improves COMFORT!!!!

Q Logic Set-Up for client

  • Program for 3 modes (Home, Outdoors, Seating).
  • Program Drive Parameters especially turning speed.
  • Program Drive Lockout.

Follow-Up/Results:

  • The client has easily made the switch from RWD to MWD and it was very successful.
  • He loves the speed and stability of the chair. He commented that he never thought he would have a chair that was this comfortable because of the terrain he always drives in.
  • He also said his Z has been the best chair he's ever had, "I can get anywhere I need around the race track, fast, and without worrying about getting stuck. That's important to me."