Case Studies: Finding the Right Fit

Making the Case for a Folding Frame

Client: Mark Holbert
Primary diagnosis: Double lowerextremity amputation
Equipment: Xenon2 FF (Fixed Front) folding ultralightweight wheelchair; fixed front with 80° bend; 2" center-ofgravity preset; 0° camber. Seating: 15.7" seat width/19.7" seat depth; fold-down, angle-adjustable back with 1" dump; JAY J3 back, 16" wide and 15" high with foam and shell. Components: Natural-Fit ergonomic handrim; 24" wheels with 5x1.5" aluminum soft roll casters; aluminum anti-tippers.

folding frame case study

XENON2 IMAGES COURTESY SUNRISE MEDICAL.

When working with a client who has lost both lower extremities — one at the knee, the other one entirely gone — your first thought might involve how to seat him so he’s stable.

That was certainly one consideration for the Sunrise Medical team working with Mark Holbert, a member of the United States Army Special Forces who lost both legs after stepping on an IED in 2010 while in Afghanistan.

But it wasn’t the biggest task the seating and mobility team faced. Instead, said Jesus Ibarra, Associate Product Manager, “The challenge was that sometimes he’s going to be in the chair using his prosthetics, and other times he would not be. So we had to find a balancing act between those two positions and distributions of weight and load.”

With & Without Prosthetics

folding frame case study

XENON2 IMAGES COURTESY SUNRISE MEDICAL.

Angie Kiger, M.Ed., CTRS, ATP/SMS, Clinical Strategy & Education Manager, provided additional details, including that the IED that injured Holbert resulted in a very high-level amputation. “It’s a difficult prosthetic for him to wear and stand on [on the left side],” she said. “The other amputation is right at the knee. So Mark primarily wears his prosthetics at work and when he rides his motor tricycle. Every time I saw him at his house, because I was part of the photo shoot team, he was out of his prosthetics.

“I asked Mark, and he said, ‘When I’m at home, I rarely wear them.’ He’s not been able to find ones that fit well.”

Kiger and Clinical Rehab Manager Robert Agostino interviewed Holbert for more details, such as how often he wears his prosthetics, where he usually wears them and how much they weigh. Holbert’s chair would need to fit and work efficiently, regardless of whether or not prosthetics were present.

The seating and mobility team chose Sunrise’s new Xenon2 folding ultralightweight wheelchair with a fixed front. “What I found refreshing about this chair is it gives us the ability to play with the back angle, which isn’t a very common feature on a folding frame chair,” Agostino said. “Typically, folding-frame chairs have a fixed back angle, and there’s little you can do with it. But with the adjustments on the Xenon2, you do have the ability to play with your back angle.”

Building in 1" of dump helps to keep Holbert stable in his seat, regardless of whether or not he’s using his prosthetics — he weighs 180 lbs. without his prosthetics and 200 lbs. with them.

U.S. Army Strong

Holbert, a government contractor, is a frequent flyer. He’s also a trike rider and a triathlete. And he still prefers a folding frame.

folding frame case study

XENON2 IMAGES COURTESY SUNRISE MEDICAL.

Kiger reported that Holbert explained, “Folding for me is easier for transport, especially when I am traveling by myself. And my motorcycle is set up for a folding chair.”

“When he drives, he wears his prosthetics most of the time,” Kiger added. “He drives an adapted van, but he stands up to put the chair in his vehicle. [The chair] has got to be lightweight; he’s kind of off balance when he’s in his prosthetics. He’s not overly stable on them; he doesn’t take a whole lot of steps on them. He wants to be able to grab the chair and throw it into his van very easily. He’s said, ‘It’s more of a pain for me to take off the wheels and play Tetris putting the chair in the trunk or back seat.’”

Have folding frame designs shaved enough weight to make them competitive with rigid frames when it comes to transport? Kiger believes the industry “is getting there. We’ve been telling people for years that they’ve got to have a rigid. But the reality is some folks prefer folding — whether it’s because of the swing-away mechanism for the legrests, or they’ve just always been in a folding, or they want it for the convenience of a smaller vehicle. Now with an option like the Xenon2, we don’t have to say, ‘We’ve got to put you in a rigid.’”

For the record, the footrest on Holbert’s chair locks into place and pops out when it’s time to fold the chair. Also for the record, Holbert has had a rigid frame before, and he’s had a folding frame before the Xenon2. In the end, the combination of folding-frame convenience in a lighter-weight design that includes a fold-down back won Holbert over.

“He said he likes it for travel,” Kiger said. “He scoots forward in his chair — he likes to be able to change position a little, depending on whether he has his prosthetics on or doesn’t. It was a personal preference for him.”

This article originally appeared in the August 2018 issue of Mobility Management.

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