WHEELCHAIR SEATING CASE STUDY
COMFORT COMPANY VECTOR (VICAIR TECHNOLOGY)
CROWN THERAPUETICS ROHO CONTOUR SELECT
Client Name: John Doe Patient
Current Wheelchair: New Quickie Q7 Ultra Lightweight (2 Months Post Delivery)
Current Seating on New W/C: Adjustable Tension Back Upholstery with Roho Contour Select Cushion
Clinical Facility: Hill Country Regional Hospital-Inpatient Rehab/Wound Care Clinic
Pressure Mapping System: Vista Medical FSA UT1010-7306
Client is a mid-thirties male who presents with Lower Extremity Paralysis (Paraplegia) due to previous brain stem cerebral vascular accident post approximately 6 years. Slight scoliotic curve at lower/mid thoracic region. Active spasticity in bilateral lower extremities. Very good upper torso balance and very good upper extremity strength most in part from self-propelling previous wheelchair for all activities of daily living. Client lives independently in accessible modular home with son within mostly accessible subdivision and exterior environment. Client maintains full time employment at regional hospital facility and is very active within the community. Previous wheelchair used was TiLite Titanium Rigid Frame Ultra Lightweight wheelchair with Sling seat and adjustable tension upholstery. Wheelchair cushion utilized was Jay Seating Jay 2 Standard Profile Cushion.
Previous wheelchair was in need of refurbishing as well as seating was no longer supportive in lower lumbar region, cushion was deteriorated and client was experiencing pain, discomfort and redness in right gluteal/ischial tuberosity. Client also complained of early fatigue during the course of the day.
New W/C Application
New Quickie Q7 Ultra Lightweight Wheelchair was specified and measured for proper fit. Standard equipment included: Tubular armrests, anti-tippers, clothing guard/panels and integral push handles. Optional equipment included: Flip up footboard for ease of transfers and positioning lower extremities, adjustable angle-flip down back for ease of transporting. Non-flared front end due to physical stature of client and risk of impact to frame. Flat free inserts were also supplied due to history of flats on previous w/c wheels. Cushion utilized with delivery of new W/C was Crown Therapeutics ROHO Contour Select Adjustable 4 Compartment Cushion for maximum pressure relief as well as lower extremity positioning. Client requested adjustable tension back upholstery for adjustability and support even though a modular low profile back was discussed and recommended. New W/C was delivered in January 2012.
Post Delivery Concerns
After 2 months of daily use client made contact to discuss possible concerns of new chair and seating. Client continued to complain of pain, discomfort in right side lower torso although not as severe as previously stated. Continued fatigue late in day accompanied by lower back pain/discomfort. Upon visual inspection of seating posture, client was found to be “sacral sitting” with posterior pelvic tilt as well as slight, right lower extremity adduction. Client was positioned too far to back of chair. Observations made included inappropriate posterior thoracic support at lumbar and lower thoracic spine from adjustable tension back upholstery. ROHO Contour Select cushion, even though correctly inflated and adjusted for proper positioning of lower extremities was still not completely eliminating discomfort in right IT even with regular pressure relieving by client. Client was in wheelchair for approximately 8-12 hours a day and continued to be fatigued by end of work day. Client rated new wheelchair and seating at a 6-7 on a scale of 1-10 compared to previous wheelchair and seating which was ranked at 2 before new application.
After observations and discussions it was decided to replace the adjustable tension sling back with a modular back for rigidity and extra support of lower thoracic/lumbar area thereby reducing strain and fatigue from sitting and self-propelling throughout the day. It was also decided to try a different pressure reducing/positioning cushion with the same seating medium used with the Roho Contour Select which was air. Products chosen were: Comfort Company 12” Tall Actaback with Adjustable Stays for increased lumbar support and Comfort Company Vector Cushion with Vicair technology. Modular back was installed and positioned for client comfort as well as maximum lower thoracic/lumbar support while sitting and propelling. Vector cushion was adjusted for lower extremity support as well as maximum pressure relief in sacral/IT areas, paying particular attention to right side compartments of cushion. A pressure mapping session was determined to be crucial in determining if there was any “loading” of client’s right side while in seated position. Client was advised to use new components while mapping system was secured for further assessment.
Client used new seating components for 2 weeks while mapping system was acquired and session was scheduled. Upon re-evaluation of client at 2 week mark there was marked improvement in pain and discomfort in right side of seating area as well as reduced fatigue and more stamina throughout day. Upon visual inspection of client while seated and propelling, posture and pelvic positioning had improved tremendously and client was seated in slightly forward of midline position which he stated he was able to maintain throughout the day due to back support. This posture allowed client to exert maximum thrust on wheels with his upper extremities instead of relying on upper torso leverage thereby reducing fatigue and increasing stamina throughout day.
Pressure Mapping of Cushions
It was decided to proceed with the pressure mapping session to solidify the presence of increased pressure in clients right IT area while using both cushions during the mapping session to attain the best results and utilize the cushion with the most support as both were adequate for positioning of the lower extremities but the Comfort Company Vector seemed to alleviate 80-90% of pressure related pain and discomfort.
A Vista Medical FSA UT1010-7306 Pressure Mapping Interface System with FSA Flexible Pressure Wheelchair Mat was utilized for mapping sequence conducted at Hill Country Regional Hospital in the Inpatient Rehab/Wound Care Clinic with clinical staff present. Client switched to Roho Contour Select Cushion which was reassessed and inflated to proper pressures for maximum support and positioning and “pressure map” was captured. Client then switched to Comfort Company Vector Cushion which was used with previous adjustments and currently utilized by client for daily use. The Comfort Company Vector Cushion was then “captured” by mapping sequence.
After mapping had been completed and compared it was noted that client had a moderate/severe pressure or “loading” area while seated in Roho Contour Select Cushion which was unable to be improved even with multiple adjustments to pressure within the select compartments of the cushion. On the other hand, while seated in the Comfort Company Vector Cushion, the “load” area was noted but to a much lesser extent with even distribution of pressure gradients throughout the area in question. Both cushions were “mapped” on new Quickie Q7 with Comfort Company Actaback installed and adjusted.
The right combination of seating components were successfully integrated with new wheelchair frame to offer client comfort, support and correct posture while he is seated for extended hours every day. It was discovered on further assessment that client also had a slight right side scoliosis at the mid-thoracic area which was associated with the “loading” or increased pressure on the right IT/gluteal area. Once this condition was addressed and properly supported with modular back and lumbar support was increased to compensate for the posterior pelvic tilt, the loading area was decreased but not to the point that it was properly supported with the Roho Contour Select Cushion. The Comfort Company Vector with Vicair Technology proved to be the better choice for client to evenly distribute surface pressure across the entire cushion area while maintaining lower extremity positioning to prevent adduction. Client reported less pain and discomfort and more stamina with less fatigue at end of day with the combination of Comfort Company Actaback and Comfort Company Vector Cushion. Pressure mapping of both cushions clearly illustrate the right side “loading” area on the Roho Cushion versus the Comfort Vector Cushion as well as the lower overall average “pressure” gradient across the entire sitting area on the Vector compared to the Contour Select.