Client Information: 69-year-old male Diagnosis: T4 complete spinal cord injury 40 years ago
Past Medical and Functional History:
- Has been independent for years, but now has a care provider come to his house for assistance in the morning and evenings to assist with care that causes him pain and fatigue.
- Has use of both upper extremities, but with significant pain due to overuse of left arm and a rotator cuff tear in his right shoulder.
- Has no sensation from the chest down.
- Not pursuing surgical repair for rotator cuff tear at this time.
- Now requires assistance with transfers and some ADLs.
- Has propelled a manual wheelchair for 40 years, but now having difficulty secondary to pain in both upper extremities.
- Has a significant left pelvic obliquity.
- History of pressure ulcers.
- Has significant scoliosis with "S" curves. Leans to the right significantly.
- Has pain when propelling a manual wheelchair.
- Rigid frame manual wheelchair.
- Solid back rest with lateral trunk supports and a hip guide to provide support and improve alignment of trunk.
- Skin protection seat cushion to address skin integrity issues.
- Also is using a manual mechanical lift for transfers when help is available.
- Lives in an accessible home with a very open concept that he and his wife built.
- The surrounding environment is paved and he has access to his entire yard through the back entrance to the house.
- He works as a teacher and the work environment is entirely accessible as well.
- Manual mobility has become more difficult as his pain increases with manual wheelchair propulsion.
- Even though he has postural support in the manual wheelchair, when he propels he leans significantly to his right in order to push the wheelchair with less pain. This significantly affects his posture.
- His shoulder injury has also impacted his ability to reach over his head for activities.
- His transfers are now performed with a mechanical lift whenever possible.
- When a mechanical lift is not available, his transfers need to be performed on a level surface since going up an incline adds to the pain and is not an easy transfer to perform any longer.
- He was finding his independence level dropping on days where his pain was at its worst.
Clinical and Functional Mobility Evaluation
- His postural and spinal deformities have progressed significantly over the years.
- His right rotator cuff tear has really impacted his ability to participate in activities throughout the day.
- Since the changes to his seating system in his manual wheelchair did not make enough of a difference in his posture and function level, he decided to pursue a power wheelchair and power seating to address his issues.
- His goal is to regain as high a level of independence as possible.
- The team found that they could stabilise his position in the seating system when he is not propelling a manual wheelchair. The team recommended power mobility.
Clinical Trials and Simulations:
- A power base was tried within his home and he was able to maneuver in and out of all of the rooms in his home.
- When he drove the power wheelchair, he was able to maintain optimal alignment of his trunk. This was one of the main objectives for moving forward with power mobility.
- His transfers were performed with less effort with the power seat elevation function of the wheelchair. This allowed him to transfer across a level surface or in a downward direction.
New Power Mobility Device:
Client was fitted in a:
- Q6 Edge
- TRU-Balance Power Lift and Tilt with a power recline system
- TRU-Comfort Back and a gel seat cushion
- Power Articulating Foot Platform
- Q-Logic hand control with EX controller
- Stealth distal lateral thigh supports with bayonet (quick-release) hardware.
- A pair of stealth lateral trunk support pads with swing-away hardware.
- An adjustable skin protection seat cushion.
Power Base Specifications:
- Stable Mid-Wheel 6 Drive Design and ATX Suspension
- Rehab power base that accepts a wide range of seating and electronics options on a platform that provides tight space maneuverability
- 14" drive wheels with 6" front casters and 6" rear casters
- 24" wide, 35.5" long, 20" turning radius
- Split rear articulating beam
- Standard with 5mph 4-pole motors and can upgrade to 6mph motors.
- Accepts all power positioning functions and alternative drive devices through Q-Logic
- NF22 batteries with easy front battery access
- Portable and compact vent tray options
- 22" W x 22" D maximum seating dimensions in many configurations
- The Q6 Edge was the perfect choice for this individual's needs.
- The Q6 Edge provides the client with a stable 6-wheel power base platform that has plenty of maneuverability for his everyday indoor use.
- The Q6 Edge provides suspension to handle the different outdoor terrain the individual may need to access.
- It provides the power positioning components the consumer needs for independent function.
- Addresses poor sitting balance
- Reduces fatigue
- Assists with maintaining postural alignment
- Helps reduce skeletal deformities
- Pressure management and weight distribution
- Provides quick position changes without physical assistance from a caregiver
- Decreases LE edema by promoting blood flow back to the heart when used with elevating front riggings (requires certain degree of tilt).
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.
TRU-Balance Power Seat Elevation:
- Allows the consumer to be at eye level when speaking to peers and others.
- Allows transfers to happen across level surfaces or downhill, having less impact on his shoulders.
- Allows ADLs to occur with arms in a lower position and not always reaching over his head. This can reduce shoulder pain during these activities.
Q-Logic Enhanced Display:
- Full color graphical display used with specialty drive controls and displays system data.
- 2 built-in 1/8" switch jacks for mode and on/off
- Bluetooth mouse emulator
- Built-in infrared control
- 9-pin input to accommodate most industry proportional and non-proportional controls
- Integrated single switch scanner
Follow Up Results:
- His posture while seated in the wheelchair has significantly improved. His posture is no longer affected by wheelchair propulsion.
- When he has to perform an independent transfer, it is safer and with less pain.
- Pressure reliefs are performed with the power tilt and recline which allows for improved skin integrity and less impact on his shoulders.
- The power wheelchair has let him continue to put off his shoulder surgery and still allows him to live as independent as possible with less shoulder pain.