Tomorrow's Power Chairs

emPOWERed

Power Chair Components of Today and the Future Focus on One Thing: Making Every Day Better

• By Elisha Bury
• Aug 01, 2013

The joystick. The captain seat. These two iconic images defined the first power chair decades ago. Since then, and especially in the last 10 years, the industry has come a long way. Today’s power components for complex rehab conjure images of tilt, recline, seat elevation and standing as well as several out-of-this world proportional and switch driving controls, including the tablet and head array systems.

These high-tech improvements have made a marked difference on quality of life, accessibility and independence for many people with complex rehab needs. So what exactly are the industry’s tech gurus dreaming up next?

Power Seating & Positioning

Without question, power positioning has greatly improved the lives of people who use complex rehab equipment.

“For individuals with disabilities with complex medical needs, a lot of these power positioning devices, they’re not a luxury item,” says Jay Doherty, OTR, ATP/SMS, clinical education manager for Quantum Rehab. “They have functions that are critical to living safely and independently in the home and community.”

But the technology is more than just a medical necessity. It’s a confidence booster. It gives users more control. It helps people access their environment.

With outcomes like these, it’s no wonder consumers and clinicians are demanding more — and it’s a demand the industry welcomes.

A Culture of Demand

The laws of supply and demand sometimes lead to great improvements for products, and such is the case for power positioning.

No longer are power positioning components an afterthought, says Brad Peterson, VP of sales and education at Invacare Corp.’s Motion Concepts.

“Power chairs out there from all the manufacturers are better designed to accept power positioning systems,” he says. “Now your power chairs are being made with power positioning in mind. So it allows us to do a lot more as far as seat-to-floor heights and a more integrated, functional system.”

Because power positioning is top of mind, clients and clinicians are asking for the latest components. They’re also asking for components
that don’t yet exist, which drives the growth of the technology.

For example, Peterson notes that Motion Concepts’ latest development — a mount for communication devices such as a tablet or PC — came by way of demand. The mount enables someone to move the communication or electronic device farther away or closer, and it flips down to improve the visual field for driving. The device also swings away for caregiver access, transferring or transportation.

Motion Concepts’ new communication
device mount is the result of client feedback.

If Apple’s success is any indication, clients won’t be satisfied with the same old designs either, and manufacturers such as Motion Concepts are taking note.

“They want to be seen for who they are, not for the chair that they’re driving. So we want to make sure the chairs are aesthetically pleasing [and] that they’re highly functional,” Peterson says. “We don’t want to sacrifice function for form, but we need to make sure that we design our systems with a critical eye to how they look and how they function.”

Dan Critchfield, product manager for power, Sunrise Medical, agrees. “As we bring in more industrial design combined with more appealing aesthetics, we may see a higher level of use,” he says.

A Word About Modularity

But let’s go back to that integrated, functional system that Peterson mentions.

Cue the modular system. It’s one of those advancements that when you think about what it does — enabling clinicians and providers to add and remove components to meet a client’s changing needs — you wonder how we ever got by without it.

Permobil launched its modular system, the Corpus 3G and Corpus HD (the version with a 450-lb. weight capacity), more than a year ago. Amy Morgan, PT, ATP, Permobil’s national clinical education manager, says that what makes this system especially cutting edge is its low seat-to-floor height, which is the same with or without power functions.

Permobil’s Corpus 3G provides a unique modular
power positioning system with a low seat-to-floor height.

In the future, the industry will see much more of these systems, Peterson predicts.

“We think what we’re seeing in the future is more modular systems,” he says. “We’re seeing systems that more easily grow and adapt to the patient’s changing needs.”

Evidence of Peterson’s prediction rings true with Quantum Rehab’s release of the TRU-Balance 3 modular seating system last month. The company also plans to release a version with a 450-lb. weight capacity in September.

Quantum Rehab’s TRU-Balance 3 system was
launched last month and features a modular
power positioning system that adds or subtracts
functions as the client’s needs change.

The ability to add and remove power components is a revolutionary way of building complex rehab chairs. We already know that people with progressive conditions, such as amyotrophic lateral sclerosis (ALS), and growing children can benefit from the ability to make adjustments as conditions, sizes and shapes change. But the truth is, everybody changes.

The modular system increases clinicians’ confidence in prescribing because they know they can add a component down the road, Morgan explains.

In addition, Critchfield says integrating these power components enables the product itself to accomplish more tasks without taking up as much space.

“I do think there is more opportunity for integration as technology improves,” Critchfield says.

Modularity can even come to the rescue with funding. For example, think about that power seat elevator, which is hard to get funded.

“I’ve had this situation happen, where the consumer decides that the seat elevator was denied so they’re going to go with a tilt and recline system,” Doherty explains. “But then they find out a few months down the road that they have other funding for it, but they weren’t aware of it at the time. Now they can get their seat elevator funded. … To retrofit it would be difficult.”

That is, it would’ve been difficult before the modular systems.

Adjusting the World

Sure, the new modular systems can adjust to changing needs for power positioning, but the adjustability of the system covers much more than that.

For example, the articulating foot platform on the TRU-Balance 3 can be dialed into an individual’s needs to properly support the legs and feet through all arcs of motion, and the seat size can be adjusted independent of the back size, Doherty says. In fact, fine adjustments can be made while the client is in the chair, saving time for everyone involved.

Adjustability is especially important for the provider, Doherty explains. He remembers when he worked as a clinician and provider. Oft en he would take a client’s measurements in the rehab center, and by the time the chair came in, the client had already gone home and gained weight from lack of activity. The chair no longer fit. With this new system, however, adjustments can be made without purchasing a new chair. All this is to say that Doherty predicts adjustability will continue to be the wave of the future.

“The adjustability and the ability to give the consumer the ability to independently change their position will continue to be present, but the way the end user can change positions will continue to be explored,” he says.

Morgan agrees. She says tomorrow’s power positioning systems must have adjustability plus memory. Morgan describes this function as taking “the guessing game out of it for the client.”

Already Permobil’s Independent Repositioning Mode enables the rehab team to set an ideal position for the client’s pressure relief or other clinical goal. The chair automatically moves into the correct position.

This function is especially important when using tilt and recline, Morgan explains, as there’s a specific sequence — tilt and then recline — to prevent shearing and other negative outcomes.

“Sometimes it’s hard for even the clinician to remember that sequence, much less the user themselves,” Morgan says.

In addition, recent studies have shown that people aren’t tilting as far as needed for proper pressure relief, according to Morgan.

Clients “think that by tilting just a little bit that they’re getting good pressure relief when they’re really not,” she says. “Sometimes tilting
20° or 30° feels like a lot, but really pressure relief comes more at 45 or
more degrees of tilt.”

By setting the tilt to move into position automatically, clinicians can be sure the client is getting the proper pressure relief.

Also when clinicians can set the system to remember angles, it allows them to prescribe technologies to clients that might not otherwise get them. For example, Morgan says sometimes positioning components move out of place during recline, but with Permobil’s Intelligent Control System, the clinician can simply limit the angles of certain functions to prevent the client from reclining past a certain point.

“I have the ability to stop that where it is and also reevaluate it, change it and improve it, give them more in the future if that’s indicated,” Morgan says. “So you have a lot of programmability options within the seating systems themselves to make them work for people.”

Improving Access

What’s more, tomorrow’s power positioning systems will likely be available to more people and help them do more in their environments.

Already the addition of a 450-lb. weight capacity to power positioning systems is bringing power positioning to a whole new set of clients.

“Previously, power seat functions have been significantly limited for those larger individuals just because of the stress they put on the power,” Morgan says. “The Corpus HD has given people that are larger the ability to have full range of tilt, recline, leg elevation and even seat elevation. That’s pretty impressive to be able to have a durable system that can withstand that type of force, but also give those people opportunity to, for example, get their feet above their heart.”

The Corpus 3G also has a function in which the footplates lower to the floor completely, and then the seat elevator raises the seat so that “someone can independently do a sit-to-stand transfer out of the chair, kind of like a lift chair might do,” Morgan says.

In fact, access to the environment is the next big thing for power positioning.

“I believe that, for the most part, manufacturers have addressed mobility and positioning. Now we need to focus on increased accessibility and independence to improve the whole life experience,” Critchfield says.

He says the industry is moving in that direction.

“For example, the ability to reach high cabinets with a 12" seat elevator while maintaining a seat height of 16" makes an incredible impact on an individual’s independence without the need for home modifications,” Critchfield says.

Morgan sees people having more access to independent living through improvements in components such as seat-to-floor height and transferring.

“In the past we’ve thought of power seat functions primarily for pressure relief,” Morgan says. “But now I think we’re opening our eyes more to how power positioning can really improve someone’s function and their activities and their participation in different things.”

In the end, manufacturers might not have the most power over what changes will come.

“We take a lot of feedback from the physicians, clinicians, rehab technology providers and the end users,” Doherty explains. “We take that feedback and are constantly looking at, what we can we do better based on the feedback they give us? Is there something they are asking for that we can meet a need? I don’t necessarily know where it’s going, but it’s always changing based on the feedback.”

Electronics

At a recent industry/consumer show, a Permobil display showed off a museum of electronic drive controls. Among the technologies on display were head arrays, a cup navigator, touch switches and a mini joystick with a finger cup control that require less throw and pressure. When you see all of these technologies laid out before you, it really shows how hard the industry is working to improve driveability for today’s power consumers.

Permobil’s Amy Morgan, PT, ATP, national clinical education manager, agrees that we’ve come a long way in only a short time.

“The past three to four years is when everybody upped their game in the electronics field, and everyone updated their electronics even further,” she says.

Today’s Exciting Electronics

One thing the electronics industry understands is that there is always room for improvement. So when Mobility Management questioned electronics experts Lisa Rotelli, director of Adaptive Switch Laboratories, and Chris Ligi, director of global sales at Switch-It, the word that kept popping up was fine-tuning.

Rotelli, for example, says electronics have helped clinicians finetune a chair to meet a client’s needs. In fact, today’s electronics can even make a switch feel more like a proportional drive control using sensors and lightning switches with fiber optics. Some of these switches do not require pressure and can be initiated simply by covering the switch, Rotelli says.

“You can now, with today’s electronics, program that so much better that it feels like a proportional joystick, which gives people more control of their environment,” Rotelli says.

Specialized programming can adjust acceleration, top speed and response when moving to a different switch — all individualized to the user.

And that old joystick has given way to many other options.

Ligi describes Switch-It’s version of the mini joystick, which requires little pressure and flexion for activation and reduces throw.

“It takes even less movement — or really no movement — and you can adjust how much pressure or force you need in order to operate,” Ligi says. “So you have clients that have limited range of motion or no range of motion and are just extremely weak; they could not operate any kind of control before. And that’s opened up the doors to let them use that to start driving chairs again.”

When clinicians have more options, clients have more say in what types of devices they want and ultimately more control of the chair.

Rotelli says today’s electronics are more adjustable and changeable than ever before, which is especially important for clients with progressive diseases, such as amyotrophic lateral sclerosis.

For example, Rotelli says a system might have three switches in a head array: backpad, right and left . When the client becomes weaker and loses rotation on the backpad, she’ll take the sensor out and plug it in somewhere where the person might still have functional movement, such as near the finger or the thigh. Then she’ll add a switch there.

“So we can really with the technology match their ability for a very long period of time,” Rotelli says.

For Morgan, the excitement of today’s technology really comes down to one thing: integration. She says today’s chairs no longer have separate, external controls for everything from communication devices to PCUs.

“Environment controls, turning on the TV, changing channels, talking on the communication device — all of this can be done inherently through the chairs now instead of needing to plan a whole separate switch and system for the operation of those devices,” she says.

Permobil’s 2013 Power Trip display features an array
of electronic drive controls, including a mini joystick,
head array and finger cup control joystick.

A Step in the Right Direction

Ligi says advancements in electronics are really made in one of two ways: baby steps or giant leaps. He describes the process of fine-tuning the programming as baby steps.

“It’s always been good, and it’s definitely a step in the right direction. But it’s expected; it’s a natural evolvement,” he says.

The giant leaps, on the other hand, don’t happen oft en, Ligi says, but when they do, “it’s like, ‘Oh wow, this is not just one more programming parameter; this is a whole new way of driving.’”

A lot of times Ligi says those steps are made by integrating something familiar from another industry into the mobility system, such as a PlayStation control that someone already knows how to use, or Switch-It’s new capacitive touchscreen that mimics the way people use a cell phone or iPad.

Ligi says he knows he’s onto something good when he see a lightbulb go on for a clinician, as it did for a provider whose client had an old RIM control joystick on the headrest that was breaking down.

“He’s sitting there thinking should he repair that or should he get a new one or should he get something else, (and) the client was just going to town on their iPad, just surfing the Internet with their knuckle. And it really didn’t exist, a tablet-type control,” Ligi says. “When he saw our Touch Drive, he thought, ‘Oh wow. That’s perfect. That’s how they can drive a chair.’ So it’s kind of those aha moments that you realize you’re really onto something, that you can really help a lot of people drive that couldn’t before.”

The Future Is Wireless

Smart homes are complex rehab’s fl ying car. We’ve been talking about them for years, but just how close are they to reality?

According to Rotelli, some of the electronic capabilities to access the home environment are currently being used, and there’s no denying this is the wave of the future.

Computers are helping people activate lights and heating/air remotely as well as open doors. Tomorrow’s power chair might just be the next control center.

In fact, some of this is already being done on a small scale.

“Our problem was getting access to the device, and that’s become a lot better,” Rotelli says.

The driver for this type of technology is the increased use of computers, which is another area Rotelli sees improvements coming for power chair users.

“What I see happening now are more and more clients wanting — and should be having — access to their computers, access to their iPads and their tablets. That technology is here today, but I see that evolving completely,” Rotelli explains.

One of the biggest benefits for wireless technology is the transfer of information, Rotelli says, including the remote monitoring of problems with the chair and components, such as batteries.

Technicians will be able to tell what is happening to the chair before they go to the client’s home to repair it. In addition, some repairs, such as soft ware and firmware upgrades, can be done remotely.

“That’s something that’s really big and it has only been in the last few years that companies are able to instead of buying a new controller for their wheelchair, actually just update your firmware,” Rotelli says. “And that’s huge, and that’s really beneficial for the client.”

She says both of these improvements will cut down on the time that clients are without their power chairs and save providers time.

But before the industry can embrace this change, there are a few bugs to work out.

“Once I unplug something from my general system, it means I’m going to have to have battery power to make it work,” Rotelli says. “So that’s something else I need to charge, something else I need to think about.”

Ligi also says there are issues with seamless integration and who — either manufacturers or third-party electronics companies — will provide the wireless technology.

“I think it could be double work. For example, if we do Bluetooth and they do Bluetooth, is that going to be a redundancy? Or is one going to be better than the other?” Ligi questions. “There’s a lot of things that we’re going to have to figure out how they’re going to play out and what’s going to be the most seamless.”

Morgan also says that even though clients ask for the ability to use their phones and computers through their chairs all the time, the quickly advancing technology has inhibited the integration into the chair.

“The problem is phone technology is changing so rapidly. As soon as you get it set for one type of system, it’s going to be obsolete for the next system,” she says.

The Future Is Not Black and White

Ligi predicts that the future will soon bring drive controls that are not all proportional and not all switch.

“One of the other things we’re trying to do is, even though our name is Switch-It, we’re really trying to move more toward proportional devices,” he says. “In the past, it’s been kind of like, okay, you can drive with a joystick — kind of a staple around here — but you can drive proportional with a joystick, or you can drive switch through a head array. And we feel like it’s not just a black-and-white type of world.”

Ligi says Switch-It is looking at more hybrid devices that combine the best of both worlds and can adjust with the client’s needs.

“In some cases, a kid, for example, they may just go into extension the first time they drive because they’re so excited, and they may not be able to move their arm forward or backward. They can only move it laterally,” Ligi says. “So you may just start with switches on a tray, and let them go left and right for all their directions.”

But once the client settles into a daily routine, as long as he or she has the capability to move the hand or arm forward and backward, Ligi says the clinician can convert the switch to a proportional control.

By reprogramming the same device or enabling a provider to hit a provider-accessible panel, the device could become proportional without needing a new device — or more importantly, new funding — Ligi explains.

Obstacles Ahead

With all of these advances on the horizon, you’d think our power pros would have their creativity tapped.

Unfortunately, funding is making our industry think outside more than just one box, and their creativity is making these advances possible for all clients, not just the ones capable of paying out of pocket.

Rotelli cites access to iPhone and Android technologies as one example.

“A lot of times people say, ‘Well, this becomes a huge funding nightmare.’ Well, it does and it doesn’t because funding is there for people to have telephone access. And if I can access my iPhone or my Android phone, then that is an avenue that I can get funding for somebody because it is a safety issue.

Once I have access to that, then my whole world opens up so I can get back into life,” she says.

Rotelli says the key to getting people access is that the industry must explore other avenues such as this one.

“We have to make sure that we take a look at the whole funding realm,” she says. “Vocational rehab pays a lot for computer access because that’s a vocational opportunity for somebody. So we’re going to have to get more creative as time goes on.”

The bottom line is technology will have to keep up with today’s changing client.

“Our age groups are a lot more computer savvy and … that’s really going to change how we not only view people with wheelchairs, but work with clients with wheelchairs because we can all have the same access,” Rotelli says. “And that’s what the goal is.”

This article originally appeared in the August 2013 issue of Mobility Management.