Case Studies: Finding the Right Fit

When Tilt Facilitates MRADLs

Client: Jerry Peppel
Primary diagnosis: Corticobasal Degeneration
Secondary condition: Pressure injury
Equipment: Raz-AT with calf panel

Florida native Jerry Peppel served in the United States Army in the midst of the Cold War. Stationed in Germany after graduating from Officer Candidate School, Peppel oversaw training and field employment for more than 500 officers and enlisted soldiers. After returning to the U.S. in 1969, he continued to serve in the Army Reserve until 1973, then embarked on a 40-year career in the automotive industry.

tilt case study


This photo shows the Raz-AT Rehab Shower Commode configuration used by Jerry Peppel; the Raz Design team also added a Bodypoint Aeromesh calf strap.

In 2012, Jerry was diagnosed with Corticobasal Degeneration (CBD), described by the National Institutes of Health as a progressive neurological disorder resulting in the loss of nerve cells and atrophy of multiple areas of the brain, including the cerebral cortex and basal ganglia. Symptoms typically begin presenting at around the age of 60 and may at first present unilaterally, though both sides of the body will eventually be affected. Symptoms are similar to those seen in Parkinson’s disease clients: poor coordination and balance, lack of movement, rigidity, limb dystonia, difficulty swallowing and visual-spatial impairments. Patients with CBD may also develop difficulty speaking and may experience cognitive involvement. Eventually, they lose the ability to walk.

Keeping the Caregiving at Home

Jerry’s wife, Joyce, wanted to care for her husband at home, but needed support to do so. One of the devices that made a crucial difference was the Raz-AT Rehab Shower Commode by Raz Design. The Raz-AT replaced a bath bench that Jerry had been using, according to Raz Design President Nelson Pang. Asked why the Raz-AT was selected, Pang said, “The tilt function — 40° — was a major reason. The softness and comfort of the seat was another factor, especially important given his pressure injury history.”

That history factored into the Raz-AT’s configuration. “Raz does custom work based on the needs of each individual client,” Pang said. “In Mr. Peppel’s case, no specific custom work was done. However, several accessories were added onto his chair to aid in redistributing pressure as well as increase comfort. Mr. Peppel’s chair was fitted with molded flat arm-pads and a calf panel.” (The Raz-AT pictured includes a Bodypoint Aeromesh calf strap, which wasn’t available when Jerry’s chair was ordered. Most Raz-ATs, however, are specified with some type of calf support to prevent the client’s feet from slipping off the foot supports.)

How Tilt Can Help

In a Raz Design blog post, Joyce Peppel described how the tilt function supported her caregiving efforts: “The tilt allows me to clean him properly, since I cannot stand on my head to clean him. I also tilt him back to make it easier to slide him back.” In addition to be able to more easily and efficiently perform hygiene tasks thanks to the tilt function, Joyce said the Raz-AT’s anterior tilt function — up to 15° — facilitated standing transfers.

“The forward tilt helps get his feet to the floor to stand him upright,” she said. “Jerry is only 5' 6", and with the chair adjusted as low as it will go, his feet do not reach the floor. But if the chair is tilted forward, he can help me stand him up because his feet reach the floor.”

In fact, Joyce said Jerry liked the Raz-AT so much, even with his pressure injury history, that he stayed in the chair even after hygiene tasks were finished. “Since the Visco foam seat is so comfortable,” she said, “we even use it as a wheelchair around the house.”

Jerry Peppel passed away in 2016, but his family agreed to share his story to help other families in similar situations. Asked how the Raz-AT improved Jerry’s lifestyle, Pang said, “I believe Jerry’s condition was quite advanced by the time he received his Raz chair. Activities such as school or work were not really an option. The goal was to make life easier for him and his family. The Raz chair simplified things for his wife, who oversaw his hygiene routine.”

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

In Support of Upper-Extremity Positioning