MARKETPLACE
PEDIATRIC & ADULT SEATING
Determining Seat-to-Floor Height
The impact on a wheelchair rider’s functional goals, activities and environments
The ‘Other’ Uses for Alternative Drive Controls
Full Effort, Full Victory
Iadmire many traits I see in seating professionals — your clinical knowledge, creative approaches to positioning and wheeled mobility interventions, work ethic and compassion.
But probably what I admire most is your ability to focus on — and cherish — the here and now, when that’s what’s needed.
In this year’s Seating & Positioning Handbook, our second feature (page 16) discusses applications for alternative drive controls — not necessarily to drive a power wheelchair, but to tilt, elevate or lower legrests, etc. Or, in one case that Gabriel Romero of Stealth Products recalled, a seating team used alternative drive controls to demonstrate that a 2-year-old with a progressive diagnosis had the ability to turn the demo chair in place so he could look at his father.
And this is what I so admire about you: Even in the face of terrible diagnoses with short life expectancies, you believe your clients’ quality of life matters. That today matters. You work incredibly hard — under incredibly tight funding limitations — to configure systems that can help them to maintain autonomy or optimize their independence and ability to move.
For those who have lost so much function, the ability to do something on their own — even just to independently tilt a few degrees — is crucial. And from a clinical perspective, of course, being able to reposition regularly can be crucial when trying to manage pressure injury risk, as an example.
As the story explains, that independence is also impactful for caregivers. A wheelchair rider worried about an overburdened spouse might hesitate to ask for yet another positioning change. But if that person can independently change position, everybody wins.
I remain haunted by a long-ago meeting at an Abilities Expo: a young mother pushing a stroller with her 3-year-old son in it. He was wearing anklefoot orthoses and very adeptly eating an ice cream cone. I smiled as I said I’d never seen such a young child eat ice cream so neatly.
His mother smiled timidly and said he was very smart. She added that due to his diagnosis, his pediatrician said prescribing a wheelchair was useless. “He’s going to die anyway,” his mother said, quoting the physician.
I recall that conversation frequently, and I’m glad that is not your response. What matters to you is that the child in your clinic, or the adult with ALS in your clinic, is in front of you now. That is enough to drive you to create, configure, and build seating and mobility solutions. And to keep trying.
I know seating and mobility systems often can’t change other realities. But as Gandhi said, full effort is full victory. Thank you. m
Laurie
Watanabe, Editor in Chief lwatanabe@wtwhmedia.com @CRTeditor
December 2024
mobilitymgmt.com
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Mobility Management (ISSN 1558-6731) is published 5 times a year, March/April, May/June, July/August, September/ October, and November/December, by WTWH Media, LLC., 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
© Copyright 2024 by WTWH Media, LLC. All rights reserved. Reproductions in whole or part prohibited except by written permission. Mail requests to “Permissions Editor,” c/o Mobility Management, 1111 Superior Avenue, 26th Floor, Cleveland, OH 44114.
The information in this magazine has not undergone any formal testing by WTWH Media, LLC, and is distributed without any warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry.
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Sunrise Medical Acquires Bath System Manufacturer Nuprodx
Sunrise Medical has acquired Nuprodx, a California-based manufacturer of bathroom mobility products, including models with positioning features and functions.
In an Oct. 7 news announcement, Sunrise said, “This acquisition strengthens Sunrise Medical’s portfolio by adding Nuprodx’s bestin-class bathroom mobility solutions to its existing broad range of assistive mobility solutions.”
David Gaskell, Nuprodx’s president/CEO, has transitioned over to Sunrise Medical and will continue to lead the Nuprodx team there. “We are incredibly excited to join the Sunrise Medical family and continue to accelerate growth,” Gaskell said in the announcement. “Joining Sunrise Medical is a tremendous opportunity to expand the reach and accelerate further development of our solutions.
“With Sunrise Medical’s global network and shared commitment to innovation and quality, I’m confident that together we will bring our life-enhancing products to a wider global audience, and help millions of people with disabilities and seniors live more independent and fulfilling lives.”
“Nuprodx’s innovative products perfectly align with our mission to improve lives of individuals with mobility challenges and well complement our current product portfolio offering,” said Thomas Babacan, Sunrise Medical’s president/CEO. “By combining Nuprodx’s proven product expertise with Sunrise’s distribution network and global infrastructure, we aim to provide even greater value to our customers worldwide, and helping more people to live more independently.”
Nuprodx was founded in 1988 by Bruce Hammer, a former professional motorcycle racer who sustained a spinal cord injury in a racing accident in 1982. As a wheelchair rider with quadriplegia, Hammer used his architecture background to design products that would help him as he traveled. Nuprodx’s patented, lightweight and portable shower-tub slider systems are designed to enhance safety in bathrooms, while also being easy to transport for travel.
Some Nuprodx models include center-of-mass tilt in space to facilitate transfers, stability and comfort. Nuprodx also offers stationary shower chairs, wheeled shower chairs, and pediatric bathroom chairs. m
2025 RehabWeek Chicago to Include RESNA Conference
During the summer, the Rehabilitation Engineering and Assistive Technology Society of North American (RESNA) announced that its 2025 conference would be part of RehabWeek Chicago in May.
In a Nov. 15 webinar, RESNA shared additional details on how the event — involving eight rehabilitation-oriented organizations — will provide CRT and assistive technology content while also giving attendees the opportunity to learn from other societies’ presentations.
Andrea Van Hook, RESNA’s executive director, began the webinar by listing the other seven RehabWeek organizations that would be participating: the American Congress of Rehabilitation Medicine; the International Consortium for Rehabilitation Robotics; the International Functional Electrical Stimulation Society; the International Society for Virtual Rehabilitation; the International Industry Society in Advanced Rehabilitation Technology; Masterclass in Neurotechnology (MiNT); and MotusAcademy.
“We’re going to bring the assistive technology to RehabWeek,” Van Hook told webinar attendees. “That’s how we fit in.”
RehabWeek takes place every two years in venues around the world. RESNA previously co-located its annual conference with RehabWeek in 2019, when the event was held in Toronto.
The core of the 2025 RESNA conference will take place May 13-15, with pre-conference workshops planned for May 12, and clinic and lab visits scheduled for May 16.
Van Hook said there will be a single exhibit hall for all the conferences, as well as joint sessions, such as keynotes and social events. But RESNA will also offer plenty of assistive technologyspecific sessions, which will qualify for IACET continuing education units — 8.5 IACET hours in total.
On May 16, attendees can visit local labs and clinics, including downtown Chicago’s Shirley Ryan AbilityLab. m
Review: Webinar Compares Brain-Computer Interface Technologies, Predicts Timelines for Success
Brain-computer interface (BCI) technology is already turning sciencefiction concepts into everyday realities. But there are many different “mind control” approaches, with different goals and applications, and differing levels of invasiveness for the components that interact with the user’s brain.
IDTechEx, an independent research firm focusing on emerging tech and related markets, took a deeper dive into BCI and its potential implications in a September webinar — “BCI: Are Consumers Ready for Mind-Reading Technology?”
Many approaches to common goals
Ultimately, BCI is technology “which can interpret our thoughts and control our electronic devices,” IDTechEx said. “These brain-computer interfaces can measure and decode neural signals and translate them into intended actions or speech.”
The webinar serves as an introduction to BCI — including a review of current models with varying degrees of invasiveness — while summarizing potential BCI applications now and in the future.
Current noninvasive technology includes electroencephalography (EEG), which uses cortical neuron activity near the scalp and requires contact with the external surface of the head or needs to be inside an ear, the webinar said. Another noninvasive form of BCI is functional near infrared spectroscopy (fNIRS), which uses near infrared light to measure changes in blood flow, and requires contact with the external surface of the head, “typically within a cap,” IDTechEx said.
One example of invasive BCI is electrocorticography (ECoG), which must be in contact with the brain, flat against its surface, and targets “local field potentials deep within the brain from large groups of neurons.”
Commercial applications include controlling wheelchairs, exoskeletons and prosthetics, in addition to controlling computers, smart phones and gaming consoles.
The webinar discussed how BCI could enhance assistive technology, making it easier to use, faster, more precise and less fatiguing to users — particularly, for example, for patients with cervical spinal cord injuries.
Predicting BCI’s future worth
Perhaps not surprisingly given the range of potential applications, there are already many companies working in the BCI space; the IDTechEx webinar listed more than two dozen. By 2024, IDTechEx’s research shows a BCI market forecast of more than $1.6 billion in 2045.
And while current statistics show the BCI market being currently dominated by noninvasive technology tied to the research and medical fields, by 2045 IDTechEx predicted that the invasive assistive technology market will be the largest BCI segment.
Bottom line: IDTechEx’s webinar was an informative introduction to the BCI market, comprising current and future uses for BCI; the different ways the technology can work; and what sorts of BCI are expected to be adopted most quickly and widely. Fascinating and highly recommended.
The free webinar is available to watch on-demand until March 25, 2025. Scan the QR code to tune in. m
Abilities Expo Announces 2025 Dates, Venues
The Abilities Expo consumer show series has released its 2025 schedule of dates and venues.
The 2025 schedule kicks off at the Los Angeles Convention Center on March 7-9. That event is followed by the New York Metro Abilities Expo, May 2-4, at the New Jersey Convention Center.
For the summer, Abilities Expo will be hosting the Chicago Expo at the Renaissance Schaumburg Convention Center, June 20-22; the Houston Expo at the NRG Center, Aug. 1-3; and the Phoenix Expo, Sept. 5-7 at WestWorld of Scottsdale.
In the fall, the Fort Lauderdale Expo is scheduled for Oct. 17-19 at the Broward County Convention Center. The final 2025 show will be held Dec. 5-7 in Dallas.
All Abilities Expos feature an exhibit hall of assistive technology, including wheelchair-accessible vehicles, plus workshops for people with disabilities, caregivers and professionals. Certificates of participation are available for professionals who attend the workshops.
All Abilities Expos are free to attend, and they feature familyfriendly activities and presentations, including adaptive sports, wheelchair dancing, and service dog demonstrations. The events are open to the public, but attendees must register for each venue.
Visit the Abilities Expo website for updated information on exhibitors, hours of operation, demonstrations and activities, and educational workshops for the specific venues. The show series was acquired by Raccoon Media Group earlier this year. m
How this seemingly basic wheelchair measurement can impact a client’s overall mobility experience
By Laurie Watanabe
Asuccessful wheeled mobility intervention is the culmination of dozens of measurements and the optimal combination of hundreds of components, all brought together in precisely the best way.
Of all the numbers to come out of a seating evaluation, seat-tofloor measurements might seem among the most basic — merely the inches or centimeters from the floor to either the front or back of the wheelchair’s seat.
But even slight differences in seat-to-floor heights can impact so much of a wheelchair rider’s day, from accessing the environment to transferring and performing activities of daily living. Plus, so many factors — such as the client’s height — are out of the seating team’s control. What seat-to-floor goals should seating teams strive for as they choose wheelchair frames, seating and other components? And what factors impact seat-to-floor heights in the first place?
Understanding seat-to-floor height
Alli Speight, OT, ATP, Motion Composites’ director of clinical education and training, pointed out that “seat-to-floor height” can refer to different sets of measurements.
“If you’re just focusing on the wheelchair and the frame itself, that’s typical seat-to-floor height,” Speight said. “When you’re talking about the whole system together — because of course, frames and seating should never be looked at separately — and you add that cushion on top of it, then you’re looking at finished seat-to-floor height. So your seating and your cushion will have an impact on seat-to-floor height as well.”
And of course, the seating team is usually working with two seatto-floor heights — front and back — for every wheelchair, because even standard chairs, such as ones in restaurants or convention center ballrooms, aren’t perfectly level.
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“Most chairs for able-bodied people have a difference of about one inch from front to back,” Speight said. While that difference is all about comfort and sitting tolerance for restaurant patrons, for wheelchair users, seat-to-floor differences front to back can be all about seated stability or optimal positioning for self propulsion.
Different types of seating can also impact the ultimate seat-to-floor height. Pedersen pointed out that typical seat cushion heights are 2", 3", 4", with custom-molded systems potentially being even taller.
“Consider the amount of immersion into the seat cushion, or if an offloading cushion is used, then the actual seated height on the cushion may vary,” she noted. “We need to consider how the height of the cushion affects the overall seated height of the client.”
Another truth — and challenge — about seat-to-floor height is that so many factors impact it.
Speight noted that even small components can make a difference: “A combination of caster forks and stem bolts in that caster system can have an impact on seat-to-floor height.”
Jessica Presperin Pedersen, OTD, MBA, OTR/L, ATP/SMS, North American director of clinical education for Sunrise Medical, said the wheelchair rider, the rider’s environment, and seating materials and surfaces can all affect a wheelchair’s ultimate seat-to-floor height. “The client’s height, including anatomical lower-leg measurement — popliteal to heel — account for lower-extremity (LE) positioning in regard to placement of the footplate. LE range of motion — e.g., hamstring tightness, amount of knee flexion — will affect footrest-to-seat height, which is a factor of required seat-to-floor height.”
Power wheelchairs have additional components that can add to seat-to-floor height.
“Group 24 batteries are taller than other batteries and require a higher seatto-floor height,” Pedersen said as an example. So could power seating systems. “Consider the space needs of seating actuators — i.e., power seat elevation — between the base and the seat pan.”
Why seat-to-floor height matters
An inch here, a half-inch there: Do these measurements truly make a difference in a wheelchair user’s day-to-day life?
“For a lot of people, it can impact their ability to transfer,” Speight said. “So do they need a specific seat-to-floor height for their wheelchair to do bed transfers? Or to allow them to do stand-pivot transfers independently or with minimal assistance?
“At the same time, they need to be functional within their environment. So it needs to work within their environment — with tables, chairs, other things they may be using during the day.”
Speight said the typical seat-to-floor on a standard chair of around 18" is where seating teams can begin. “Some of those
We need to consider how the height of the cushion affects the overall seated height of the client
— Jessica Presperin Pedersen
norms, although they might not be ideal for someone in a disability, set certain standards that we can start to work around,” she said. But then she immediately mentioned the very low seat-to-floor heights needed for clients who foot propel. “Wheelchairs for foot propellers with those hemi-height frames can get as low as 12" off the floor, floor to rail,” she said.
While those super-low hemi heights do position foot propellers for optimal heel strikes, they also make transfers more difficult. “It’s really hard to get up to do those transfers,” she said. “Your chairs in your kitchen or your toilet is potentially going to be higher. Toilets in some people’s homes are upwards of 21". When you’re trying to work with the environment, the standards have been set for able-bodied people. But your transfers are absolutely going to matter.”
Christie Hamstra, PT, DPT, ATP, Motion Composites’ clinical educator, pointed out that transfers are also different for every client. She referenced a client with a T10 spinal cord injury who drove a standardheight pickup truck.
“He goes right up there, opens the door, grabs a handle, and swings himself up,” she said of his efficient and apparently easy transfer routine. “So again, it has a lot to do with [seat-to-floor height], but it also has to do with what is the person’s preference? How are they going to end up interacting with their environment? It comes down to many factors.”
What is the ‘ideal’ seat-to-floor height?
Seat-to-floor height can have an enormous impact on propulsion efficiency for ultralightweight wheelchair riders. “It needs to be ideal for their positioning, because what they do with those lower extremities, with their pelvis, where it sits within the wheelchair, could impact how someone sits within their chair as well,” Speight said. “So you do have to look at how someone’s propelling, where they’re going to sit within their wheels, how they’re going to transfer, how it’s going to function in their environment — and they somehow all have to come together.”
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Hamstra added that seat-to-footplate height is yet another measurement to consider.
She told of seeing sample manufacturer wheelchairs being rolled up a ramp at an event. “The footplates were hitting the ground because these demos are set up in specific way to probably just roll straight, but not to go up an incline,” she explained. “So you have to think about how all of that geometry works as well. They kind of have to play along together.”
“You need a proper seat-to-floor height,” Speight said. “But your ground clearance is going to be dictated based on your lower leg length, or the frame, or the hangers that you have. And so because you need to be positioned properly with those plus your ground clearance, you might have to have a certain seat-to-floor height. But then it needs to work with everything else you have to do.”
Pedersen pointed out different factors for the seating team to consider, based on manual vs. power mobility.
“For active manual wheelchair configuration, the goal is for optimal propulsion, which means the client’s reach to the rear wheels should be considered when determining seat-to-floor height,” she said. “The rear seat-to-floor height and center of gravity play an important role in aligning the upper extremities. The front seat-tofloor height is determined by the amount of seat slope needed for trunk balance and how much ground clearance is needed to accommodate the client’s lower leg length — which can vary depending on the front frame angle (amount of ‘tuck’ of the lower legs).”
For power chair users, “the [seat-to-floor height] would be based on the person’s functional goals and to allow access under tables/desks and ensure vehicle clearance,” Pedersen added. Transfers are still a talking point, but power seating can ease those transitions. “Level transfers to various surfaces — bed, toilet, vehicle seat — are often a goal which can also be accommodated by power seat functions, i.e., power seat elevation.”
Pediatric seat-to-floor considerations
Erica Walling, MPT, ATP/SMS, is the clinical education manager in the U.S. Southeast for Sunrise Medical USA. “Seat-to-floor height for a child is going to be determined more by the functional goals of the child and family,” she said. “Factors to consider are transfers, environmental access and peer interaction. Consider functional goals and build the chair around them for optimal propulsion.”
Walling recalled working with a young child who had spina bifida and whose wheelchair, given the child’s age, had a low seatto-floor height. “He was an active user, a self-propeller. He was in an ultralightweight manual chair configured to be successful in all environments and for optimal propulsion. His mom was upset that he couldn’t sit at the same height as everybody else at the dinner table.” If that were the goal, the seat-to-floor height would have been raised to 18", compromising other functional activities.
Being a mom herself, Walling has used a booster seat for her child, so she made that suggestion. “It was a lot of back-and-forth education with her about how important [the lower seat-to-floor height] was for his propulsion vs. making him sit way high on top of his chair so that he could reach the table. We talked about environmental
modifications, like putting a little block for him to roll up onto at the table. Considerations like that, I think, are important.”
For younger children, Pedersen added, “We want that ideal position for propulsion, and then I think a little more stability frontloading, because they often try to reach towards the floor. And they’ll try crawling onto the chair to get in.
“So a lot of times, we’ll balance the casters a little bit more off to the side to give that stability. And then we might have a little bit of length at the front, so that might change the seat-to-floor height a bit so they can access [the chair] that way.”
Ultimately, though, pediatric seat-to-floor height can be an outlier.
“Nobody can predict how one kid is going to grow versus another, even based on genetics, growth curves and growth expectancies,” Hamstra said. “The norms don’t really exist for pediatrics. So is this kid going to be able to get up and down [from the chair], and if so, then we need to have it a little bit lower to the floor. Are they going to be getting up and down out of the chair? Or is someone going to be lifting them up and down? Those are all things that you need to think about for the more active and independent [child]. We want them to be doing it on their own. So whether it’s the seat-to-floor height being lower to the ground, or there’s a decent position on the footplate so they can transition between the seat to the footplate to floor and then back up — I think those are things you can do as well if you have to compromise and make the seat-to-floor height a little bit higher.”
Your ideal seat-to-floor for a certain activity of daily living might be one [measurement], but you have to compromise on that seat-to-floor height for another activity
— Alli Speight
The art of the compromise
Seat-to-floor heights are determined by a range of components and measurements. But in the end, finding the optimal seat-to-floor height will typically require compromise.
“So your ideal seat-to-floor for a certain activity of daily living might be one [measurement], but you have to compromise on that seat-to-floor height for another activity,” Speight explained.
“Many manual wheelchair users request higher seat-to-floor heights to assist with transfers,” Pedersen said. “However, it is not always recommended to raise the seat-to-floor height for this purpose if it compromises propulsion and reach to the rear wheels. Instead, recommend physical therapy for transfer training with an optimally configured manual wheelchair.”
Asked for best-practice tips, she said, “Consider the goals of the client — transfers, environmental access, upper-extremity reach — while ensuring that the client’s anatomical measurements match the configuration of the mobility device without compromising function.
For manual wheelchair configuration, the primary goal should be optimal propulsion for preserving upper-extremity function, as well as balancing stability with maneuverability. Transfer techniques can be learned, and therefore optimal propulsion should be prioritized over attempting to match seat-to-floor heights to transfer surfaces if it compromises the rider’s reach to the rear wheels.”
Hamstra suggested that having some adjustability in an ultralightweight wheelchair — particularly for newly injured or diagnosed clients — can be helpful as those clients learn to navigate the world while on wheels.
“At least initially, while they’re trying to figure out where it is that they’re going to be [functionally], I think [some adjustability] is always a good thing,” she explained. As an example, she described “a young kid his first chair. Right after his injury, he wanted to be really high so that he would be closer to [the heights of] standing people. Then he figured out no, that doesn’t work.”
As with all complex seating and mobility situations, determining the best seat-to-floor height for a particular client is certainly a
mixture of science — taking accurate measurements and considering range of motion, for example — and compromise, as higher seatto-floor heights are great for certain situations, and not so great for others. Achieving the best seat-to-floor height is also a matter of noticing the details. For example, Speight pointed out that something as simple as a different pair of shoes can add an inch to a client’s height and significantly change that client’s heel strike if that client is foot propelling.
Given all the variables, Speight added, “My rule of thumb: I would try to demo [the seat-to-floor height] as close as possible. I would try to mimic how they’re going to be in it. Are they successful? Do we have the right positioning with it? We spend a lot of time talking about transfers. But for proper positioning, that difference of front to rear seat-to-floor height — and what that does to your pelvis, and how you sit, and then how that plays with the back angle for that positioning — if that’s what allows someone to be independent, to be functional, that gives them the stability to be able to go about their day, that’s top priority.” m
Measuring for seat-to-floor heights: It’s all in the numbers
Creating optimal seat-to-floor height depends on many factors, including knowing which measurements are most important.
“Popliteal to heel is a crucial anatomical measurement for determining seat-to-floor height (to ensure adequate ground clearance) while considering how much knee flexion will be incorporated while seated,” said Jessica Presperin Pedersen, OTD, MBA, OTR/L, ATP/ SMS, North American director of clinical education for Sunrise Medical. “A person’s height may require more knee flexion if trying to obtain a lower overall seat-to-floor height for rigid manual wheelchairs.
“Assess thigh-to-calf angle, as well as calf-to-foot angle, which will help determine foot placement and position on the footplate,” Pedersen added. “Some riders will choose to tuck their feet further under the frame, which will decrease the occupied frame length and may allow a lowered seat-to-floor height. If there is decreased range of motion at the thigh-to-calf angle, accommodation for foot place ment through the front angle or foot support can help to support the foot in the desired position.”
Ultralightweight factors
For self-propellers, Pedersen said, “optimal seat-to-floor height should be determined based on optimal propulsion and reach to the rear wheels, taking into consideration environmental access. Cushion height and front frame angles can be modified to ensure both goals are met.”
seat-to-floor height is too high, this function may be compromised.
“Front frame angle affects the amount of knee flexion and foot position on the foot plate. The greater the front frame angle, the more knee flexion — allowing a lower seat-to-floor height with
“A seat-to-floor height that is too high may compromise stability, as this affects the rider’s center of mass and can result in posterior tippiness in the chair,” she added. “You can often have a more aggressive center of gravity if the person’s center of mass is lower in the wheelchair. Also consider the rider’s ability to reach the floor: If the
still multiple reasons to be mindful of how tall power chairs get.
If seat-to-floor height is too high, a power chair rider “may have reduced head clearance for vehicle access, and they may not be able to access tables/desks,” Pedersen said. “Seat-to-floor height can affect a rider’s visual field when driving from a power wheelchair — we need to be aware of floor-to-eye height.” m
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Preserving Autonomy
Alternate drive controls can do so much more than make a power chair roll
By Laurie Watanabe
Alternative drive controls give some wheelchair clients the opportunity to drive their power wheelchairs even if they’re unable to use a traditional joystick.
But alternative drive controls — sip and puff, head arrays and other switch systems, and lately, eye-gaze systems — can also enable wheelchair riders to control power seating, even if they are only able to drive their chairs for short distances … or not at all.
Clients voice their priorities
Tracy Beavers is the CEO of Tolt Technologies, manufacturer of an eye-gaze system called Ability Drive.
Asked why it’s so important that alternative drive controls also be considered for their seating and positioning functionality, Beavers said, “It’s important mostly because our clients tell us it is really, really important. When we first put out Ability Drive, we didn’t think of that. We didn’t actually have the ability to access seating in there. Our clients came back and said that between driving and seating [functionalities], they would choose seating.”
As an example, Beavers described a client who had a version of amyotrophic lateral sclerosis (ALS) that caused such constant discomfort that he needed to change positions every few minutes (see sidebar).
“By time he communicated what he needed with his speech device to his wife, and she made the adjustments, she felt like she couldn’t do anything,” Beavers said. “And then they got Ability Drive, and he was able to make those adjustments by himself. She called us in tears and said, ‘I can take a shower now.’ Just the little things make a huge difference. He was more comfortable; she could take a shower. It was really, really important for that couple.”
Beavers also acknowledged the social and emotional importance of a client being able to reposition independently. “We have folks who sleep in their chairs. Just imagine if you couldn’t move all night while sleeping — those little things add up. Now we have a couple of clients who drive their chairs in next to their spouses [who are in bed] and actually sleep in their chairs. It’s that connection, right? You want to sleep with your spouse. So it’s also about maintaining those relationships.”
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‘he wanted the independence’: a caregiver’s story
How can power seating and alternative drive controls preserve function and improve quality of life for a client with amyotrophic lateral sclerosis (ALS) — even if those drive controls aren’t often used to actually drive the power wheelchair?
Kara Hayden, MS, a speech language pathologist based in Portland, Oregon, asked that question of Jan Steinbock, who was married to Donnie Graham, a client of Hayden’s living with ALS.
In their conversation, Hayden asks about eye-gaze technology for power wheelchair and power seating controls, and how this assistive technology enriched the lives of both Graham and Steinbock.
Scan the QR code to read this bonus story on Mobility Management’s website. m
your wheelchair? Whether that’s just seating controls or even driving it?’ They very easily latch onto the idea of controlling their seating, just being able to adjust their footrest a couple inches. It was, ‘Yeah, I want to be able to do that.’”
Donnie Graham
Caring for the caregivers
Hayden suggested that to clients who have lost so much function, preserving as much autonomy as possible is crucial.
“If for any reason, their communication software is not working, at least their Ability Drive software is,” she said, using Tolt Technologies’ alternate driving system as an example. “If they’re thinking, ‘I want [to move] a little bit more this way or a little bit less that way,’ they don’t have to talk to anyone about it.”
That ability to move themselves into optimal positions for various activities is also more efficient than relying on others to do so. “With their communication device, sometimes they have to be a little to the right to get to it, depending on the skill of their caregiver,” Hayden said. “So [with the ability to control positioning themselves] they only have to do that with one piece of technology. Then from there, they’re good to go. And they have full autonomy over everything else. It eliminates so much for them, but also for caregivers. The burden on the caregivers — I can’t emphasize that piece enough.
“The burden on caregivers is so high these days, and they’re not paid enough. Oftentimes, family members might not be paid at all, and it’s just a lot of work. You’re trying to live your life and their lives for them too, and get it all done. It’s just a lot of work.”
A hierarchy of preferences
Kara Hayden, MS, is a speech language pathologist who has worked with clients who have ALS.
“Part of my communication evaluation is especially for ALS,” Hayden said. “I always say, ‘Imagine you could do all these things. I’m going to ask you, zero to 10: How important is it to be able to maintain or regain access to this skill or continue to have access to it?”
The choices include accessing email, text messaging, operating music playlists. and controlling the TV. “Even if they’re not in a power wheelchair yet, I say, ‘Imagine you had a power wheelchair. Would you want to be able to drive this chair outside, or operate the seating controls?” Hayden said. “And typically, if I just offered [power wheelchair] driving, they weren’t so interested.”
But if the clients were told they’d be able to reposition themselves via power seating, they were typically more enthusiastic about being able to control their power chairs on their own.
“So for their mobility, I’d say, ‘You’re walking right now, but within the next five years — because we only can fund one of these every five years — would you be interested in being able to operate
Beavers personally knows how difficult caregiving can be. “I’ve been a caregiver for one of my kids,” she said. “And you end up with 20,000 things that you need to do, and some of them are really high priority and some of them are not. And so, you always kind of run into things that don’t get done as well.
“So we have heard that it reduces the caregiver burden so that the caregiver doesn’t burn out as quickly. And then we have other folks who wouldn’t ask to be [repositioned], even though they were uncomfortable, because they had already asked for so much, and they didn’t want to burden their caregiver any more.”
Combining alternative drive controls with power seating can offer much-needed solutions.
“It allows for the clients to be in control and give them a chance to take responsibility for an aspect of their treatment plan that they can handle,” Beavers said. m
Typically, if I just offered [power wheelchair] driving, they weren’t so interested
Kara Hayden
DONNIE GRAHAM PHOTO COURTESY JAN STEINBOCK
Adaptive Switch Laboratories designs products that specifically meet the needs of our clients. We are excited to introduce the new ASL 125 Orbit Joystick for extremity control. The 125 Orbit Joystick will surpass expectations with its responsive new polymer spring which provides the Orbit Joystick with an utra smooth driving experience allowing it to seamlessly move through a full range of motion. The Orbit Joystick requires just 50 grams of force to reach maximum speed and full throw is reached with only 4 mm of movement. For detailed information about the 125 Orbit Joystick and our other groundbreaking new products, please visit our website.
ASL 125 Orbit Joystick shown with Single and Dual Dot Switch Mounting Systems
positioning & independence: the power of a good turn
In his lengthy tenure in the seating industry, Gabriel Romero, VP of sales & marketing for Stealth Products, has helped plenty of power wheelchair clients learn how to use alternative driving controls to get around their homes, schools, workplaces and neighborhoods.
But in the process, Romero has also seen driving controls do much more than drive.
A child proves his capabilities Romero recalled an assessment for a 2-year-old with a terminal diagnosis.
The seating team focused on interventions. “What are we going to try first?” Romero recalled the “great” clinician asking. “She was saying he had potentially good movement, but cognitively, we don’t know if he can pick it up. He’s 2. He’s not going to be driving down the hallway first thing, but can we get [his parents] to see that he can turn in place? That he can go and stop?”
The team set up a head array. “He’s tiny,” Romero said. “And I noticed he’s just gazing at his dad. Mom’s the one engaged and talking [with the seating team]. But Dad’s the one entertaining him. Dad pulls out a little toy, a sound toy.”
After turning down the power chair’s speed, the team demonstrated the head array to the child and his parents. “He’s clicking on a couple of things, but not doing anything else. I said, ‘Hey, Dad? Do you mind coming over here, out of his vision a little bit, and can you play with that toy?’
“Magic happens. Without us telling [the child] anything, he goes right to his dad and comes off of [the switch], clean. Everybody laughs. Is it a fluke? So I tell the dad, ‘Can you get behind him?’”
Dad did. His son once again turned completely around in place to face his father, then stopped.
Developmentally, Romero pointed out, “He’s in the exploration stage. He’s hearing sounds behind him that he can never see. From a learning perspec tive, imagine hearing something behind you that you can never see and never know what it is. You hear somebody’s voice, but they never come around to introduce themselves.”
Once the child proved he could, at the very least, turn in place to see his father, the family “didn’t look eight years into the future,” Romero said. “They looked at the potential of what could be done now with him. Just in that moment, he could ‘chase’ his dad.”
Power tilt provides greater autonomy
Romero also worked with a firefighter who’d fallen from a highway overpass during a rescue and sustained a severe brain injury.
Romero smiled as he remembered. “There were serious neurological injuries, but I was thinking, ‘Can he understand how to use a power seating function?’ We could give him switch activation to control his own tilt function.”
The team added power tilt and a switch to control it. Some time later, Romero made a house call to check on the head positioning and asked how the power tilt was working out.
“She said, ‘It’s fantastic!’ She would ask him to tilt back, and he did. He started tilting for different things, for breathing, bowel movements, for relaxing. He was able to control it himself.”
During meals, the woman asked her husband to tilt back slightly. She told Romero that even though the tilt was not pre-set, she believed her husband was tilting back to the same position for every meal. Romero measured the degrees during a test tilt, and “Without even knowing the degrees, he was tilting back to where he knew he was supposed to be. He was consistent.
“We saw a functional use [for power tilt] for somebody who would never be able to drive a power chair due to his injury and limitations. But could he be in a power chair and still benefit? Absolutely. She said, ‘The doctors told me he had no [cognitive ability], but I knew there was something there.’ I said, ‘If anybody’s going to know him, it’s going to be you, because you’re the one who’s with him.’”
What one good turn deserves
The ability to turn a power chair, even just in place, provides such autonomy, Romero added. Imagine facing one way while listening to a conversation in the kitchen, then turning in place for a different conversation in the living room.
Or imagine using power chair controls to turn away from a conversation.
Romero was called in to set up a Stealth Products i2i head positioning system on the firefighter’s manual tilt-in-space chair. But during the assessment, Romero said to the man’s wife, “I see that he recognizes you.”
The woman agreed: “He definitely does recognize my voice and can follow my voice, too.”
Romero chuckled. “I have a teenager now. I would tell parents, ‘You know what my goal is? I want every parent to experience a teenager turning their back to them. Even teenagers with disabilities.’”
Parents, Romero said, always laugh. “But they understand this is critical for development. It’s not only about turning to hear sounds. It’s also about connection. At school, it’s about turning to be included in conversations.”
He thought again about that firefighter in a manual tilt chair — unable to drive, but still able to make connections with his wife.
“She was able to start seeing that, which really helped her emotionally,” Romero said. “It was like, ‘Hey, he’s there when I’m talking to him. [Doctors] told me he’s really not understanding my voice, but I know he squeezes a little bit on my hand. When he hears me, I can see his excitement.’”
When the woman was manipulating a strap on her husband’s footrest, “he could see she was struggling, so he tilted back. She said to him, ‘You just did that so I didn’t have to be on my knees. You moved your legs up so I could adjust your footrest!’ I get a little emotional when I’m thinking about that.” m
seating & positioning marketplace
Power seat elevation has been available on Alltrack chairs since 2008. With 11" of vertical elevation, this extremely solid, stable and durable design has been helping people reach new heights for 15 years. Available in both standard and heavy-duty configurations, Alta 11" power seat elevation can support user weights up to 400 lbs. and allows users to drive safely at up to 25% of the maximum programmed forward speed. All this function is delivered with no additional mechanical lockouts or modifications to the standard suspension, ensuring each user can safely enjoy the full capabilities of their Alltrack base.
Amylior Inc. (888) 453-0311
www.amylior.com
The UNO Single Switch Scanner with Bluetooth enables a person with one consistent switch site to control multiple functions. This includes power chair movement, seat functions, phones, tablets and communication devices. A standard attendant control allows the attendant to assist as the client needs without totally taking over or changing to another drive setting. While in Bluetooth or auxiliary mode, the patient can use a phone or communication device, and the attendant can control the movement of the chair. The UNO is designed for multiple sclerosis, ALS, spinal muscular atrophy, locked-in syndrome, high-level spinal cord injuries, or any client who has only a single constant switch site.
Adaptive Switch Laboratories Inc. (800) 626-8698 www.asl-inc.com
Thanks to cutting-edge materials and manufacturing, CG Air isn’t just a cushion; it’s a revolution. Crafted from nonpermeable, medical-grade PVC with patented highfrequency welds and injection molding, the one-piece CG Air is a pinnacle of cleanliness and durability. Easily meeting infection control and sterilization protocols, it’s a breeze to clean: Toss it into the washing machine or autoclave. CG Air’s cell shape provides stability without compromising pressure reduction or comfort. Innovative air channels facilitate a controlled flow beneath the user. Choose 2", 3" or 4” cell heights; single- or dual valve; sizes ranging from 14x14" up to 30x 24"; and three cover options.
Amylior Inc. (888) 453-0311 www.amylior.com
The clinically developed Dynamic Arm Support is patented and adjustable, providing an option for intervention and prevention for the upper extremity following injury or neurological events. It provides three points of support at the elbow, forearm and hand with a focus on preventing contractures, shoulder pain and shoulder subluxation. Uniquely shaped pads facilitate a functional, neutral position of the forearm and hand. Clinical presentations that could justify the Dynamic Arm Support include hemiparetic shoulder; documentation of decreased upper-extremity range of motion; shoulder pain in the resting seated position; and risk for subluxation of the shoulder.
Bodypoint (800) 547-5716
www.bodypoint.com
The ASL 110 FUSION Proportional and Digital Head Array, a multi-use drive control, has functionality built in through programming for a range of diagnoses. The FUSION will allow a person to control speed and direction fully proportionally. Adjustability options fit customizable needs and disability progressions. The ASL 165 FUSION Display, Programmer and Attendant Control can personalize the FUSION to a specific client’s needs and can be used as a display and attendant control that works with or takes over the FUSION drive control. The ASL 110 is designed for clients with multiple sclerosis, ALS, cerebral palsy, arthrogryposis or high-level spinal cord injuries.
Adaptive Switch Laboratories Inc. (800) 626-8698
www.asl-inc.com
The rear-wheel-drive AVIVA Storm RX is for users who travel outdoors, but also need maneuverability indoors. It is intuitive to drive and is an easy transition for people changing from a manual wheelchair to a power chair. The compact base offers better maneuverability in tighter spaces, while SureGrip suspension increases traction when going over obstacles. Front caster bushings decrease vibrations to reduce rider fatigue. Front casters are moved outboard to allow a center-mount front rigging. The center mount front rigging can tuck under up to 7˚. Comes with the Motion Concepts Ultra Low Maxx seating system and LiNX electronic controls.
Invacare Corp./Motion Concepts (888) 433-6818
www.motionconcepts.com
Alta Power Seat Elevation
CG Air Therapeutic Cushion
ASL 110 FUSION
ASL 102 UNO Single Switch Scanner
Dynamic Arm Support
AVIVA Storm RX
SUPRACOR
• PROVIDES TOTAL PRESSURE MANAGEMENT
• COMPLETELY VENTILATED
• ABILITY TO ADJUST IMMERSION
• ANTI-MICROBIAL & ODOR RESISTANT
• INSERTS INCLUDED
• REIMBURSABLE UNDER HCPCS E2624
San Jose, CA Supracor is please d to introduce our Elite Series of Adjustable Cushions featuring Stimulite ® honeycomb. The Elite cushions are based on the Stimulite ® Classic, Contoured and Slimline cushions. The new Elite version of these cushions utilizes the same construction as the original cushions but adds an inside pocket which enables them to be adjustable using the provided inserts. These inserts will vary in stiffness and can be placed in the pocket to alter the overall firmness. Removing the inserts all together allows more immersion into the cushion, especially helpful for users with bony protuberances. The inserts provide many options for therapist or end users to work with and will help them fine tune the cushion for maximum comfort and performance.
For more information, please contact us at 800-787-7226 or visit our website www.supracor.com
Classic Elite
Slimline Elite
seating & positioning marketplace
The PRO ELR (pictured) features a 2" pivot point adjustment, plus calf pad and leg-length adjustments to provide a personalized fit for each wheelchair rider. The system is available with optional knee pad/adductors to enhance comfort and protect the knee area. The PRO ELR system is available on the Catalyst 4 and Catalyst 5 families of Ki Mobility manual wheelchairs. Also available: the standard ELR, a value option designed with a low-profile aesthetic and calf pad and length adjustments to ensure a comfortable fit.
Ki Mobility (800) 981-1540 kimobility.com
The ACTA-Relief back support features the revolutionary, award-winning BOA Fit System consisting of three integral parts: a microadjustable dial, super-strong lightweight laces, and low-friction lace guides. BOA is a dial-based performance fit system designed to effortlessly adjust, bringing comfort and support to the lower and upper thoracic regions. The ACTARelief can assist in accommodating postural deformities and allows for immersion through the shell, creating pressure redistribution of the user and can be adjusted and readjusted as needs may change over time. Available in sizes 14-20" wide and 10-22" long, offering a Solution for Every Body.
Permobil (800) 736-0925
www.permobil.com
The NXT seating lineup includes back supports tailored for support and comfort: Choose from pelvic or thoracic shapes with posterior, posterior lateral, or deep lateral support options. The scapula cut-out shape encourages a natural range of motion and improves shoulder freedom, while QuickFit hardware offers full adjustability; lateral contours can be bent in or out for personalized postural control. The NXT Cushion multi-layer design and smartGEL Infused Visco Technology offer deep immersion, even pressure distribution, and reduced heat buildup to minimize the risk of skin breakdown. A smartx3D antimicrobial four-way stretch cover ensures breathability and comfort.
Motion Composites (519) 942-8441 www.dynamichcs.com/nxt-back-supports/
The ROHO QUADTRO SELECT cushion series offers unmatched stability and positioning for wheelchair users through its innovative ISOFLO Memory Control valve. This unique feature allows you to easily adjust the air in four separate compartments of the cushion, ensuring customized support for individual needs. With the ability to isolate air flow, the ISOFLO valve provides greater stability while maintaining the pressure relief benefits of ROHO’s renowned air cell technology. With QUADTRO SELECT, users experience the perfect balance among skin protection, stability and comfort, making it an ideal choice for prolonged sitting and enhanced wheelchair positioning.
Permobil (800) 736-0925 www.permobil.com
Introducing a whole new approach to bespoke back support: the Matrx MAC Multi-adjustable Contour Back Series. Completely configurable for the widest range of body shapes, conditions and adjustable for changes, the Matrx MAC is a new way to provide custom fit, positioning and comfort. The Matrx MAC is a modular solution, complementary for manual or power tilt and recline applications. Dual-layered density foam provides balanced comfort and support, or a HUG Stamina Fibre option for enhanced immersion and envelopment. Customizable trunk support featuring three contour depths with asymmetrical contours available addresses specific postural needs.
Motion Concepts LP (888) 433-6818
www.motionconcepts.com
TRU Balance 4 power positioning is now available with more power seat configurations and provides 10°, 20° or 30° of power anterior tilt. Other features include up to eight customizable memory seating positions and an articulating foot platform that lowers to assist with transfers. TRU Balance 4 requires iLevel power adjustable seat height, power anterior and posterior tilt, power recline, and a power articulating foot platform. It is available on the Edge 3 Stretto, Edge 3, and 4Front 2 power chairs. Seating sizes range from 16" wide x 14" deep to 22" wide x 22" deep. With eight customizable memory positions, users have the ability to recall the saved positions.
Quantum Rehab (800) 800-8586 quantumrehab.com
PRO ELR
NXT Seating and Positioning
Matrx MAC Back
ACTA-Relief
ROHO QUADTRO SELECT TRU Balance 4 Power Positioning
TWO DRIVING MODES
IT’S
YOUR CHOICE
Unveil new realms of freedom with the E-Motion® DuoDrive™, fusing revolutionary power assist with your manual wheelchair. Its lightweight, dual-mode design seamlessly transforms mobility, empowering you to navigate effortlessly, conquer inclines, and extend your adventures.
Two Driving Modes: Easily switch between manual and Cruise Mode for a customized travel experience.
Extended Battery Life: A single charge delivers up to 12 hours of uninterrupted movement.
Advanced Slope Capability: Master inclines with the DuoDrive's robust electric motors.
seating & positioning marketplace
The Trakz-AT (Attendant Tilt) is a tub slider with dual-arc, rotational tilt geometry. The system offers 35° of tilt, enough to allow the client’s feet to clear the tub wall, which reduces the effort for the caregiver. The Trakz-AT also features Rotational Tilt Geometry, which allows the chair to be located closer to the rear wall, leaving more room for the client’s feet and legs. This also allows the Trakz to fit in smaller bathrooms and reduces the effort required to tilt the chair, allowing for single-handed activation. The Trakz-AP (Attendant Propel) model is non-tilting and requires the client’s legs to be lifted over the tub wall. Both Trakz models feature the patented Zbrilok safety latch system.
Raz Design (877) 720-5678 razdesigninc.com
The L.U.B.S. (Lateral Upper Body Supports) system is an innovative new approach to lateral support that can be mounted on any wheelchair backrest or to the wheelchair canes. Engineered from stainless steel and aluminum alloys, L.U.B.S. provides strong and secure, 360° degrees of pad positioning and contouring to ensure support is exactly where it needs to be. Free Form or solid pads are available in a variety of shapes and sizes to meet the needs of a wide range of wheelchair riders.
Symmetric Designs
(800) 537-1724
www.symmetric-designs.com
EPiC (Effortless Postural Control) Seating is a postural management system that allows the introduction of movement into a wheelchair seating environment. The system provides the ability to change positions for function while maintaining control of the pelvis, thus mitigating the opportunity to introduce shear. The segmented back support system provides stationary pelvic support and a moving thoracic segment. The system also incorporates an anatomical pivot point, contributing to improved stability. All secondary positioning supports attached to the thoracic segment move in unison with the body, reducing the frequency of repositioning events.
Stealth Products (800) 965-9229
https://epic-seating.stealthproducts.com
Respira Back Supports are designed to be the lightest and coolest alloy backs on the market. Featuring both passive and active ventilation, Respira Back Supports provide a healthy microclimate for the wheelchair user. The Sport Trim model features Stimulite padding and silver thread air mesh for odor control. The Comfort Trim model features perforated, cooling gel-infused memory foam to dissipate heat and moisture right through the shell. Respira Back Supports are designed to breathe, and are engineered to perform.
Symmetric Designs (800) 537-1724
www.symmetric-designs.com
Stimulite Elite Series
Supracor’s new Elite series of adjustable cushions, featuring Stimulite honeycomb, is based on the Stimulite Classic cushion, Contoured cushion and Slimline cushion. The Elite versions use the same construction as the original cushions, but add an inside pocket that enable them to be adjustable. Removing the inserts allows more immersion into the cushion; the pocket can also address pelvic obliquities. The Elite series — which provides uniform pressure relief, reduced shearing, and ventilation — is recommended for wheelchair users at risk for pressure injuries and can prevent skin maceration by allowing air to circulate and moisture to evaporate.
Supracor (800) 787-7226
supracor.com/collections/medical
Ability Drive is an alternative control interface that enables clients to control a power chair with their eyes. Using virtual buttons and eye-gaze technology, people unable to use a joystick can regain movement and seat positioning independence. Ability Drive is a combination of hardware and an app that runs on an approved eye-gaze device. The app senses the client’s gaze on virtual buttons that send directional movement commands to the Ability Drive hardware interface. These buttons overlay the forward camera view. Clients can stop the wheelchair’s movement by looking at the stop button, looking away from the computer, or closing their eyes.
Tolt Technologies (425) 242-3902
https://tolttechnologies.com
Trakz-AT
EPiC Seating
Lateral Upper Body Supports
Respira Back Supports Ability Drive
