How We Roll: Ultralight Case Study
Getting the Right Fit
How critical is fit for a consumer using an ultralightweight manual chair? Clinicians will talk about the importance of being able to efficiently propel for a lifetime, particularly if a new ultralight user is young. ATPs will talk about how a chair’s light weight or transportability will benefit a consumer’s lifestyle.
But maybe the biggest indication of the importance of a great fit comes from consumers themselves and how far they’re willing to go to find the right answer.
A Fit Not Quite Right
That was the case with Alexandria Allen, now 22, diagnosed with T12-L4 paraplegia following a car accident at age 17.
CAD drawing of Alexandria Allen’s chair.
Listening to Alex tell her story in her own words (see sidebar) reveals an irrepressible spirit combined with enormous determination. Calling herself “a quick learner,” Alex adapted well to living with her disability. What she couldn’t adjust to, however, was the difficulty in getting a wheelchair that fit her properly.
And Alex’s difficulty was not limited to a single incident. Brandon Edmondson, OT/ATP/CRTS, director of clinical sales & outcomes for Permobil, said of Alex’s history, “She has had three chairs, not counting a temporary rental, in only four short years since her injury.” Alex described her previous chairs as “extremely too large and heavy,” and was feeling increasingly desperate to find a better solution.
She was so determined to find a chair that fit that she purchased one out of pocket — to no avail. Still relatively new to the world of seating & wheeled mobility, Alex went looking for a solution at an Abilities Expo event for consumers.
Alexandria’s Challenges & Goals
At the Abilities Expo, Alex met Ginger Walls, PT, MS, NCS, ATP/SMS, clinical education specialist at Permobil, and Terry Mulkey, TiLite VP of sales for the eastern region.
They noted, Edmondson reported, that Alex “needed some assistance with stability, as she has a rod placement (rods T8-S1) and found herself sliding out of chairs in the past. She was also experiencing some moderate shoulder pain due to an inefficient propulsion set-up. Shoulders were abducted too far secondary to chair width.”
Alex and her new team were seeking a chair “as light as possible for loading and self-propulsion.” Plus, Edmondson said, “We just wanted to make sure we got her chair right after all her struggles and personal investment into getting a chair that was fit for her.”
The team decided on a TiLite TR (titanium rigid chair) with an Ergo seat, a tapered frame with a tapered ROHO cushion, and Spinergy LX wheels. Modifications included 2° of camber and minimal wheel spacing.
Photos courtesy TiLite & Alexandria Allen
Alex’s old chair: “You can see that she’s not centered, and it has a lot of space combined with a very wide front end,” Brandon Edmondson said.
A Fit for Alexandria’s Life
“Alex’s case is unfortunately an example of what happens all too often to young and capable clients,” Edmondson said. “She was provided with several chairs that were just not fit to her and were too big for her. She chose some options that were only needed rarely that increased the weight of her chair, and some others for style without regard for weight and function.”
That made everyday life in those chairs much more difficult than it had to be. “It is possible to address both,” Edmondson said of those factors, “and paying attention to both made this chair a huge success for her in the real world. The extra space in her old chair affected her posture, her push efficiency, and most importantly her function. She stated, ‘I just never felt like I was sitting straight.’ The wider seat and frame put her too far away from her activities of daily living tasks. Reaching items on countertops and making transfers were all a larger challenge than they needed to be.”
From a propulsion perspective, Edmondson added, “She also didn’t have great wheel access. The chair had a higher-than-necessary center of gravity, which in turn limited her wheel center of gravity adjustment. Lowering her center of gravity overall allowed her wheels to be placed at an optimal position — 4.0" — which sounds aggressive, but in reality is very achievable if the chair isn’t built too high.”
On the postural side, “The new chair had an Ergo seat, which she trialed at Abilities Expo, and it was chosen for stability and the improvements it made in her posture,” Edmondson said. “It also helped to accommodate her range-of-motion limitations in her spine. Special attention was also paid to the seat taper and footrest spacing so she wouldn’t have to be constantly managing her lower extremities. Her legs and feet stay in place now much better, and the narrower front end lets her get closer to everything she’s trying to pull up close to and fits in tighter spaces with ease.”
As for seating, “She has a tapered ROHO cushion that was achieved by simply deleting a couple of cells on the outer edges. This provided a lightweight solution while maximizing her skin protection.”
Photos courtesy TiLite & Alexandria Allen
Alex’s new chair is a rigid titanium TiLite TR with an ergonomic seat and a tapered ROHO cushion.
Timely Solutions
The overall result has been an ultralightweight chair that’s a better fit — clinically as well as for Alex’s lifestyle — than previous chairs.
“We should all continue to be mindful that function and ability for clients like Alex lie in our hands,” Edmondson said. “Wouldn’t it be nice if, as a rehab community, we could get her as functional as possible sooner? It shouldn’t have taken Alex four years and paying out of pocket for one along the way that still wasn’t right to finally receive a chair that allowed her to be truly independent and functional. We’ve got to continue to learn that these chairs are really lessons in physics, and when you pay attention to the physics of the specs you’re choosing, you’ll create a better outcome for your clients.
“She’s a great example of why we need to all continue to improve our skills and pay attention to the details!”
Introducing Alexandria
Hello everyone! My name is Alexandria Allen. When I was 17 years old, I was involved in a serious motor vehicle accident, leaving me paralyzed from the waist down. Growing up with a disabled grandfather through my teen years, the drastic change wasn’t hard to accept. I am a quick learner, and with much perseverance I found ways to adapt and overcome my disability.
To my dismay, I would find out what is extremely hard to stomach about a disability is the difficulty in getting a wheelchair that is properly fitted. Every chair I have ever received was incorrect. I was so desperate, I finally decided to buy a chair on my own and pay out of pocket.
I was hoping to finally get something more suitable, which ended up being sized extremely too large and heavy. Nothing is more depressing when you can’t get a wheelchair that feels like it’s equipped to fit your needs and lifestyle. It’s not like a pair of shoes you can just go back to the store to return.
Since I have only lived with my disability for four years, I never knew what was wrong with my chairs. I just knew I never felt right in them. Disappointed with my outcomes and being relatively new to my injury, I decided to go to the Abilities Expo to see what all the hype was about.
That is when I met the guys from Permobil and TiLite and was immediately drawn to the company. I was extremely enthused to meet people that were so determined to help not only me, but anyone that had questions. They weren’t only interested in answering questions, either. They were set on making sure I was set up with the perfect chair for once in my life.
I was set up with Terry Mulkey and Ginger Walls, who spent an extensive amount of time double-checking measurements and discussing every part of the chair with me. I never met anyone more knowledgeable!
This article originally appeared in the January 2016 issue of Mobility Management.