Posts Tagged ‘pressure mapping’

Case Study: Comfort Company Vicair Cushion

Wednesday, May 2nd, 2012

WHEELCHAIR SEATING CASE STUDY

COMFORT COMPANY VECTOR (VICAIR TECHNOLOGY)

VS.

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

History

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.

Recommendations/Reevaluation

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.

Summary/Conclusion

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.

Results from ROHOResults from Vicair

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.

http://www.invacare.com/cgi-bin/imhqprd/inv_catalog/prod_cat.jsp?s=0&catOID=-536885209

http://www.ottobock.com/cps/rde/xchg/ob_us_en/hs.xsl/18039.html?id=18121

Michael s. Duenas / ATP
Active American Mobility
13003 Murphy Rd, G1
Stafford, Texas 77477
281-495-4400
mduenas@aamobility.com

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