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Case Study: 48 year old female with multiple sclerosis

Supplier: Pride Mobility Products
19 March, 2014

Patient Information: 48-year-old female Diagnosis: Multiple Sclerosis

Past Medical and Functional History:

  • She lives with her husband in a home that is accessible for a power wheelchair.
  • Has a care attendant that comes into her home a couple of hours a day to assist with her ADLs she is unable to perform.
  • Diagnosed 19 years ago and has had sporadic decline since that time.
  • Has quadriparesis.
  • History of a pressure ulcer on her buttocks.
  • Has pitting edema in both lower extremities.
  • Uses intermittent catheterisation.
  • She experiences fatigue throughout the day.
  • Her fatigue level is directly affected by the temperature (fatigue increases with hotter temperatures).
  • She reports that some days, "My arms don't work at all."
  • Non-ambulatory and dependant on power mobility for all MRADLs.

Past Equipment Information:

  • Has always used a proportional joystick to control her power wheelchair.
  • She utilises her right hand for control of the joystick in her power wheelchair.
  • She requires use of tilt and recline to maintain her skin integrity on her buttocks.
  • She uses tilt and recline to repositioning herself throughout the day and improve her sitting tolerance throughout the day.

Client Input on Past Equipment:

  • She prefers to control the wheelchair with a proportional type of control device.
  • She has tried other non-proportional devices and had limited success and was not happy with the results.
  • She prefers a mid-wheel drive configured power base for her mobility since it provides her with the best access throughout all of her environments.
  • She has stated that she doesn't want to be dependent on others for mobility.

Physical Assessment:

  • She has scoliosis and obliquity which are both reducible to a neutral alignment.
  • In the morning she has good trunk control but as the day goes on she fatigues and needs more assistance to remain in a functional position.
  • She has good head control throughout the day.
  • Her upper extremities weaken as the day goes on and unless she has an alternative input device she loses the ability to control the wheelchair.

Clinical Trials and Simulation:

  • She will continue to drive with her hand throughout the day until she weakens and then will move to an alternative input method.
  • She tried many different alternative drive controls including head array, chin control, and sip and puff. None of these input methods worked well for her.
  • Since her head control is the best site for alternative drive control the devices tried were limited to this location on the body.

Findings:

  • She continued to drive effectively with a hand control as long as her fatigue did not interfere.
  • The hand control was modified by a therapist with an L-shaped adaptation fabricated out of splinting material that allowed the client to reach the joystick while in full tilt or recline to return to an upright position. The client intends to continue to use this adaptation since it works very well.
  • A Magitek proportional controller was found to be most effective when mounted on a head band that she wears.
  • New firmware had to be loaded into her power base in order for the power seat functions to easily be controlled and to allow her to control tilt and recline with a right and left command of the Magitek system.
  • The team and client found that the Magitek system had to be reset in order for the client to be able to bring the power tilt or recline back to an upright position. This was not a big deal to the client since it just meant she just needed to hit the reset switch to reset neutral on the Magitek system.
  • She uses the power tilt and recline with the power articulating foot platform frequently throughout the day to maintain skin integrity, to shift her position in the wheelchair, and for improved sitting tolerance.
  • She reports that the tilt and recline functions are especially helpful on days where her fatigue sets in quicker.

Power Mobility Device:

Client was fitted in a:

  • She previously had a two year old Q600, so the team continued to use this power base.
  • Continued use of TRU-Balance Power Tilt and Recline System with an articulating foot platform.
  • Q-Logic hand control with a modified joystick handle.
  • Enhanced display needed for the Magitek system to be interfaced with the Q-Logic electronics.
  • A Magitek proportional input device.
  • Control of tilt and recline through the wheelchair electronics.
  • An attendant control for when others need to control the wheelchair due to weakness she is experiencing or to move the wheelchair out of the way once she is out of the wheelchair.

Power Base Specifications:

Q600:

  • Stable Mid-Wheel 6 design platform w/ a powerful drive train.
  • Rehab power base that accepts a wide range of seating and electronics options on a platform that provides tight space maneuverability.
  • 14" Drive Wheels w/ 6" Rear and 5" Front Casters.
  • 23" Wide, 36.5" Long, 20" Turning Radius.
  • ATX Suspension (Active Trac w/ Extra Stability) and a Rear Articulating Beam.
  • Std. w/ 5mph Glide motors and can upgrade to 4-pole 6mph motors.
  • Omni Casters on front and rear casters prevent wheel hang ups.
  • Accepts all power positioning functions and alternative drive devices through Q-Logic.
  • NF22 batteries w/easy front battery access.
  • Portable and Compact Vent Tray options.
  • 20" W x 20" D Max Seating dimensions in many configurations.

TRU-Balance Tilt:

  • Addresses poor sitting balance
  • Fatigue
  • Assists with maintaining postural alignment
  • Helps reduce skeletal deformities
  • Pressure management and weight distribution
  • Provides quick position changes w/o physical assistance from a caregiver
  • Decreases LE edema by promoting blood flow back to the heart when used with elevating front riggings (requires certain a degree of tilt)
  • COMFORT!

TRU Balance Power Articulating Foot Platform:

  • Assists with the decrease of LE edema when used with other power positioning (Tilt/Recline).
  • Provides a 90 degree leg angle at rest which decreases the overall length and turning radius of the unit.

TRU Balance Power Recline:

  • Provides an open seat to back angle required for hip flexion limitations and allows the consumer to close seat to back angle when environmental issues require it.
  • Provides a break from gravity during the day by reclining the back.
  • Can reduce transfers by allowing individual to rest in his power wheelchair.
  • Allows individual to provide passive range of motion to joints when utilised with articulating foot platform.
  • Accommodates for mild kyphosis.

Follow-Up/Results:

  • The client reports that the hand control setup continues to work very well for her throughout the day.
  • Once she is fatigued she easily switches over to the Magitek system in order to continue to control the power wheelchair. This system typically lasts her the rest of the day.
  • She does report that on occasion she gets neck stiffness on days that she has to use the Magitek system throughout the entire day. Although this does not happen that often, she still believes this is the best alternative input device for her.
  • She reports that having proportional control throughout the day is one of the biggest benefits the system provides to her. This truly allows for the best independence with power mobility.

Pride Mobility Products

Pride Mobility Products

Case Study: 48 year old female with multiple sclerosis