This Is How We Roll: Pediatric Case Studies

A Sports Fan Hits the Courts

Meet the Client

Client:
Adam, 11

Diagnosis:
Spastic cerebral palsy

Major Goals:
Be optimally mobile at school and at home; facilitate participation in school, sports and community activities.

Good intentions don’t necessarily count for much in the world of complex rehab seating & wheeled mobility. It’s not enough for the rehab team to want a client to be active and mobile. If a wheelchair falls short in other ways, its user will see right through it. Perhaps that’s especially the case with children, who — unencumbered by concerns over “long-term clinical outcomes” and other grown-up issues — may simply refuse to use a chair they don’t like.

Wheels Outdoors, But Crawling at Home

Such was the case with Adam, 11, who has spastic cerebral palsy as well as very clear expectations for his seating & mobility equipment.

Todd Dewey, an ATP at Numotion’s Charlotte, N.C., office, and Michael Duda, ATP with the Permobil Group, worked on a new solution for Adam and his family. Adam’s previous wheelchair, the ATPs reported, was “too wide, difficult to propel, and unable to access key areas in [Adam’s] environment.”

Wheelchair Sports Participation

Adam likes his new, easier-to-propel chair so much that he wants to use it at home, too.

As a result, Adam preferred to crawl rather than use the chair when at home. Adam, his ATPs said, is “able to walk short distances with crutches and AFOs, but with high reliance on upper extremities and limited by fatigue.”

The entire seating & mobility team was therefore motivated to make Adam’s next chair a big step up from his current equipment situation. The ATPs wanted to configure the wheelchair frame to allow Adam maximal participation and access. They wanted to optimize pushrim biomechanics and to keep the chair lightweight, as recommended by evidence-based practice guidelines. And the chair had to be growable to keep pace with a kid eager to play wheelchair sports.

A Chair Built Just for Him

Dewey and Duda chose a TiLite Aero Z wheelchair with a 10" seat width and 12" seat depth. The Aero Z has a 17" front seat-to-floor height and a 15" rear seat-to-floor, with a depth-adjustable back/frame. Other specifications: 2" foot platform risers, no taper of the front end, 9" back height, 1.75" center of gravity, .75" rear wheel spacing, 6° of camber, 4" casters and 22" rear wheels.

The ATPs explained that the Aero Z has “2" of growth in seat/frame depth and lower-leg length when needed via 2" foot platform risers and a depth-adjustable back. Any changes in width can be accommodated by spacing of side guards and rear wheels.” The chair has a 2" TiLite foam cushion and TiLite adjustable-tension back and seat upholstery.

Wheelchair Sports Participation

Adam’s newly expanded accessibility extends to the basketball courts, where he plays for the Charlotte Rollin’ Hornets.

Dewey said of building the chair, “Adam measured 9.5" at his hips with jeans and wears AFOs and sneakers, so I was a bit worried that the width of his shoes wouldn’t fit into the small inside space of a 10"-wide frame (7.5"). I measured his shoes three times and finally decided to go for it. The outcome was perfect.”

Given Adam’s young age, his rehab team also wanted to make sure they were putting him in a good position to propel himself for years to come.

“Adam’s wheelchair is ideally configured for him with optimal biomechanical alignment and pushrim access,” his ATPs said. “His fingertips are able to touch the rear axle of the wheelchair with his arms hanging straight down. This is important to allow for optimal propulsion, activity and access, while preventing injury and pain. This is a great example of evidence-based practice in action: How an ultralightweight manual wheelchair can be configured to allow a child to grow and participate optimally in his environments at home, school, sports and the community.”

Come on In!

The most important testimonial, of course, comes from Adam himself and how he views his new chair.

“He loves his chair,” Adam’s mother reported. “It has changed his life, and I am not kidding.”

Adam now uses his Aero Z to play for the Charlotte Rollin’ Hornets basketball team, but perhaps the ultimate compliment is that his Aero Z is regularly invited into the house.

“Before the new chair, he never asked to have his old chair in the house,” his mother said. “He preferred to crawl. Now he loves his chair so much he asks us to bring it in all the time. He is more upright now moving around the house. Now we just need a ramp, and he can come and go as he pleases.”

This article originally appeared in the August 2015 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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