Posts Tagged ‘custom mold’

Custom Molded Seating Systems: Pros and Cons

Wednesday, October 19th, 2011

by Mike Duenas, ATP,
Active American Mobility and Medical Supply

Pressure ulcers (Decubitus) can be some of the most serious problems associated with clients using wheeled mobility for long periods of time. A seating system for many clients can be as basic as a foam back & seat. Some higher involved clients need to have a “Custom Molded” system to fit their actual body shape and size. This seating system if manufactured & produced properly can help many clients achieve the proper seating and posture they need while using their mobility equipment. This seating system will also help prevent the medical costs of hospitalization due to the possible development of a decubitus ulcer. Many clients that need this seating have no way to shift their body weight to allow pressure relief on any given area at a time. Pressure points can vary from person to person however; most areas are the in relation to the pelvis, spine, shoulders, back & head. Trying to eliminating or minimize the pressure (points) over these body surface areas is the goal. A custom molded system can provide the maximum amount of body surface support. The weight distribution helps prevents occurrences of decubiti. It will also increase comfort, and supports the client by distributing their weight over the broadest possible area.

When a Therapist and or ATP looks at providing a custom molded seating system for a client, they should be thinking of how having the clients upper body bear some of the overall body weight. Properly created and positioned trunk laterals & appropriately angled back supports will allow for a desired level of contact, support, and weight distribution. It’s really all about the best contouring & seating surface that can be made. A custom-molded seat may be produced in the same manner as the back cushion. In most cases you will create both the seat & back during the same evaluation. With today’s technology, a shape capturing system can make this process very easy and will help you create and make adjustments to the seating surface electronically at the same time, before you save the file. There are quite a few (manufactures) choices when deciding on custom molding. There are also a number of pros and cons associated with any of the molded systems that need to be considered.

“Pros” of creating and using a custom molded system are:
1. A properly molded seating system will increase comfort and postural support for your client.
2. Molded systems can help prevent decubiti “pressure wounds”.
3. Can help functional ability for the client’s body stability while reaching and or working with both upper and lower extremities.
4. Help prevent additional skeletal deformities while the client uses the system.

“Cons” of using a custom molded system are as follows:

1. Once molded, most systems, depending on the type of materials, are hard or next to impossible to make changes once they are produced.
2. Client is most likely set in a “Fixed” seat to back angle. Reclining type wheelchair frames do not work well because the molded seating & exact fit to client’s body shape.
3. If these molded seating systems are not done properly, it can actual cause more issues with pressure points against the client’s body and or other deformity issues can develop.

Manufacturers / Types
The quickest and easiest custom mold to fabricate is a “Mold-in-place” type mold. These types of systems require a seat and or back cushion that will allow you to remove and or install foam pieces into them first. The form pieces may be of several different types of density & thicknesses. Once you have created a very close fit with the form you can then insert a plastic bag that will serve as“Void” filler. You will take to chemicals that once mixed together will soon become a liquid foam that when poured into the plastic bag, it too will began to set-up and maintain its shape. You will need a very large and open area to produce this system and to help with the small amount if any, of extra product that will possibly fall to the floor. Basically once you pour the foam, you have to place the client on top of the cushion to allow the foam to set and capture their shape. Once it has set, cut any extra produce off and close the cushion cover. These systems are for both seat & back cushions however, they might only provide mild to moderate control for your clients. If your client is more heavily involved and needs more postural control, you might need the next system mentioned.

Another system uses molding bags that when a client is placed upon them and a vacuum removes all the air within, the client shape is captured. Think of two “bean bag” chairs you would sit on, both bags mold to your body form. Then while removing the air and shaping as you do, the bags become very firm. It’s basically a temporary mock-up mold of the intended seating system. Once the molding process is completed, a plaster cast (oldest method) or an electronic digitized file (newest meathod) is then sent to the manufacturing company. It in turn uses the plaster cast or digitized file to produce the finished foam seating system. This type of system allows for great freedom in design while providing good contouring. Also, the cover of this type of seating system is smooth, completely seam-free, and moisture-proof. This eliminates hot spots created by seams and other breaks in the seating system cover, and protects the integrity of the underlying foam. These same systems can also be created with air holes that allow liquids to move away from the clients skin. It also helps cooling and body temperature.

Whichever system you use, understand that you should have the proper training and certificates necessary to provide your clients with the best healthcare products and services they deserve.

Michael s. Duenas / ATP
Active American Mobility
13003 Murphy Rd, G1
Stafford, Texas 77477

TIRR Hospital Houston Offer Many Treatment Modalities

Wednesday, October 19th, 2011

Specialized Treatment Modalities

TIRR Memorial Hermann has numerous specialized treatment modalities. These specialized programs are offered for both inpatients and outpatients. Links to more information are also provided.

•Wheelchair Seating and Mobility Program
•Enhanced Therapies
•Spasticity Management


1. GAITRite: Changes in a person’s gait pattern can lead to an increased risk for accidental falls and fall-related injuries. A normal gait pattern helps to prevent injury and maintain independence. The GAITRite system records timing and distance parameters on a portable electronic walkway connected to a computer.

As a patient walks across the walkway, the system inputs data into the computer to document walking patterns, including both step time and step length. This captures abnormal walking patterns persons have adopted to compensate for muscle weakness, pain or limb shortening.

Patients using assistive devices and ambulatory aides such as crutches, walkers or canes, use these during their gait analysis. Therapists can use this data to assist with interventions and treatment designed to improve balance and gait. The data also helps to show progress.

2. Locomotion Training: Locomotion therapy supported by an automated gait orthosis on a robotic treadmill has established itself as an effective intervention for improving over-ground walking function impaired by neurological diseases and injuries.

Patients with neurological movement disorders are benefiting from intensive robotic rehabilitation therapy delivered at TIRR Outpatient Services Center at Kirby Glen, using the Lokomat®, the world’s first driven gait orthosis. The Lokomat assists walking movements of gait-impaired patients and is used to improve mobility in individuals following stroke, spinal cord injury, traumatic brain injury, multiple sclerosis or other neurological diseases and injuries.

The Lokomat is the first in Houston, the second in Texas, one of 30 in the United States and one of 100 in the entire world. It was provided for use at TIRR by a grant from the Medallion Foundation.

3. NeuroRecovery Network: TIRR is one of seven specialized member centers of the Christopher and Dana Reeve Foundation (CDRF) NeuroRecovery Network. The CDRF has launched the NeuroRecovery Network grant program to provide support for the translation of basic science and applied research into intensive, activity-based rehabilitation treatments.

It will also support the establishment of specialized centers to provide standardized care based on current scientific and clinical evidence. The program is funded by a joint agreement between the CDRF and the Centers for Disease Control and Prevention.

The therapy regimen includes highly specialized treatment strategies while using a body weight support system to optimize sensory cues to facilitate recovery of the nervous system. This treatment is provided daily during two-hour sessions and includes an hour of treatment on a treadmill followed by overground treatment time to increase carryover of the therapy session. Learn more about the NeuroRecovery Network.

Specialized Treatment Modalities

Wheelchair Seating and Mobility Program
The Wheelchair Seating and Mobility Program at TIRR provides assessments for inpatients and outpatients requiring the use of wheeled mobility in their home, work and community environments. The program enables the patient to try a wide variety of manual and power wheelchairs, seating and positioning accessories and environmental challenges. This allows the patient to trial the device and make accurate and informed decisions based on its performance.

The Seating and Mobility Program is designed to:

•Maximize independence and safety in the home and community
•Improve posture and function in the wheelchair
•Prevent secondary medical, orthopedic and skin problems caused by improper seating
•Provide demonstration equipment, simulation of the seating system and diagnostic tools, such as pressure mapping, to optimize comfort and function
With so many products in the market to choose from, information on the latest technology can be overwhelming.

TIRR keeps abreast of new and innovative technologies and monitors federal guidelines in the area of seating and mobility. We also work closely with local, certified and credentialed durable medical equipment providers and manufacturer representatives to provide comprehensive, patient-focused options.

For more information or to schedule an assessment, call 713-797-7386.

Specialized seating and mobility assessments include the projects below.

SMARTWheel® assessment – The SmartWheel is a clinical tool that assists clinicians with:

•Wheelchair Selection and Set-Up: The SmartWheel quantifies patient ease or difficulty in propelling different chairs or chair set-ups.
•Propulsion (momentum/propel) Training: Real-time visual feedback assists wheelchair users to reduce force and repetitive stress on their arms by using longer, less frequent strokes.
How a person propels a wheelchair is analyzed by a TIRR therapist specially qualified to perform the assessment by measuring every push on the hand rim. The SmartWheel then puts the data into easy-to-use automated summary reports to give clinicians better data to help manual wheelchair users improve quality of life.

The SmartWheel is for people with good hand function and has the following benefits:

•Eliminates pushing on the tire
•Gives a better grip for better performance with every push
•Eases pain in hands and wrists
•Provides greater control when braking
•Retrofits to your existing wheels
TIRR is one of 60 sites in the United States and the only site in Texas to have the SmartWheel clinical tool. It is offered on an inpatient and outpatient basis.

Enhanced Therapies

Animal-Assisted Therapy
TIRR utilizes Caring Critters, a nonprofit, all-volunteer, Houston-area organization. Caring Critters enhances the lives of TIRR patients by providing them opportunities for interaction with animals in a positive, nurturing environment.

Music Therapy
A music therapist’s role is to address the cognitive, speech/language, physical, and psychosocial needs of a patient, using Neurologic Music Therapy techniques. Music therapy is often requested to co-treat with other therapies, such as physical or speech therapy, and to facilitate functional movements and/or cognitive and speech behaviors.

•When co-treating with a physical therapist, music therapy may provide rhythmic stimulation to normalize a patient’s gait cadence, velocity and stride length.
•Music therapists address verbal expression in co-treating with speech therapists.
Music therapists also use song writing and lyric analysis activities to help address coping and adjusting issues. In addition, music is extremely helpful as a mnemonic cue in orientation and learning strategies for memory deficits.

Music Therapy is neurologically based and backed by more than 10 years of research at TIRR. Music therapists at TIRR:

•Hold a bachelor’s degree in music therapy
•Have passed the National Board Certification Exam for Music Therapists
•Are trained and certified in Neurologic Music Therapy (NMT)
Therapeutic Pool
The inpatient therapy pool offers aquatic therapy for patients with orthopedic and neurological disorders who experience symptoms such as pain, weakness, weight bearing restrictions after surgery, swelling, and/or changes in muscle tone. This therapy combines traditional exercise with the water’s buoyancy to enhance and accelerate the rehabilitation process. The pool is kept at a therapeutic 92 degrees and is accessible by stairs or chair lift.

Therapeutic Recreation
Therapeutic recreation specialists use recreational modalities and experiences to:

•Improve functional abilities in therapy
•Provide education and training in recreational skills and attitudes for healthy recreation participation
•Promote social interaction and healthy living through group and community recreational and leisure experiences
Therapeutic recreation therapists at TIRR have the training and unique ability to combine a group of people with a wide range of disabilities and functional levels who share a common interest or focus. Therapeutic recreation:

•Promotes social interaction and appropriate recreational participation
•Encourages creativity
•Helps with coping and adjustment while the patient works on enhancing functional abilities
TIRR therapeutic recreational therapists have four-year degrees and national certification training.

Spasticity Management

Spasticity is a form of muscle overactivity which can result in contractures, abnormal postures, and pain and stiffness in the muscles of the body due to damage to the central nervous system. Spasticity can result from traumatic brain injury, stroke, cerebral palsy, multiple sclerosis, spinal cord injury and other diseases associated with the brain.

Spasticity frequently impairs one’s mobility, positioning, comfort, care and ability to perform activities of daily living. Commonly used management strategies for spasticity include oral medications, intrathecal baclofen, orthopedic procedures, bracing and splinting, and medications which are injected directly into the muscle. Successful management of spasticity in patients with central nervous system disorders requires the expertise of a well-integrated team of clinicians.

Traditional therapeutic approaches, such as muscle stretching, positioning and movement exercises, are basic components of a management program.

Research has proven the value of new treatment options in maximizing the benefits of therapy. These options include:

•Medications that are injected directly into the spastic muscle, such as phenol and botulinum toxin (Botox®), are used in conjunction with casting, splinting and orthotic management.
•The intrathecal baclofen pump, a mechanical device, is surgically implanted and delivers medication directly into the brain and spinal cord. This treatment targets the lower limbs and can affect the upper limbs as well. The pump is the first new treatment for spasticity of cerebral origin approved by the FDA since 1981. Patients who could potentially benefit from the pump undergo a trial to assess their response to the therapy. If there is a favorable response during the trial, patients are admitted for surgical implantation of the pump.
Oral medications may be beneficial for some patients, particularly those individuals with spinal cord injury.

Some patients may be candidates for orthopedic surgeries to correct deformities resulting from spasticity or to augment the effects of other anti-spasticity treatments.

Patients or families interested in spasticity management for inpatients and outpatients may call 713.797.5942 or toll-free 1.800.44.REHAB (73422).