ATP Series

Tomorrow's Wheelchairs

What today & yesterday can tell us about future technology

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Predicting the future is tough: How many people, epidemiologists aside, anticipated a pandemic when COVID-19 was discovered?

But by looking at the past plus what we see today, can we predict what tomorrow’s wheelchairs will be like?

ULTRALIGHTS: GOING BEYOND FRAME WEIGHT

For many years, manufacturers labored to shave ounces from the frames of ultralightweight wheelchairs. After all, frame weight has long been scrutinized by ultralightweight wheelchair riders.

But at this point, does losing a few more ounces really matter?

Christie Hamstra, PT, DPT, ATP, is the Clinical Education Specialist and Interim Director, Motion U, for Motion Composites, a manufacturer of ultralightweight wheelchairs.

“We can spend all this time as manufacturers making our chairs super, super lightweight — taking off one pound, two pounds,” she said. “They’re all getting within a few pounds of each other.”

So if frame weight is no longer a significantly distinguishing feature, what else can manufacturers do to stand out?

Hamstra said, “As the manufacturers, we look at what material we’re selecting. Is it really efficient? Is it going to last long, so the client doesn’t end up having a lot of repairs based on the frame?

“Material is really important, whether it’s aluminum, titanium, or carbon fiber. You want to ensure it’s durable. Manufacturers consider material and the design at the same time.”

And while there is plenty of debate about the merits of various frame materials, Hamstra said the materials are truly a means to an end. “It’s not just, ‘Hey, we make carbon fiber chairs, they’re amazing,” she pointed out. “Or ‘We make titanium chairs, they’re amazing.’ It’s how do we work with that material? Where are we sourcing it from? Is it put together in the best possible way to be the most efficient for that end user?”

DURABILITY IS A PRIORITY

Efficiency includes the ability of riders to depend on their chairs.

“They don’t want to have to worry ‘Oh, I’ve lost three bolts,’” Hamstra explained. “Three bolts have fallen out, or the frame is bent or cracked. People don’t want these types of problems.

“Having done quite a bit of reading and taking in every Webinar I possibly could over the last two years, and listening to engineers — we’ve worked with our engineering department to really understand how it is that we ensure our chairs are going to go out there and not break down. I know that best practices, all of the ISS [International Seating Symposium] Webinars, talked about repairs and how repairs leave people stranded.

“I don’t want this to come out wrong, but we have to figure out, as an industry, how to ensure that quality is the number-one priority when we’re putting wheelchairs out for our clients. Quality and not cost, because we know that a lot of it is driven by cost and price.”

Current funding policies force seating teams and riders to select chairs that aren’t necessarily the consumers’ first choice, Hamstra added. “It’s all driven by reimbursements. So I think that’s where we have to get users educated on advocacy so they’re able to have access to the better technologies.”

She cites Medicare policy that prevents beneficiaries from selecting a frame made of materials that are considered upgrades.

“Medicare used to allow [beneficiaries] to upgrade [ultralightweight wheelchair frames to other materials, such as carbon fiber or titanium],” she said. “You can’t upgrade anymore.”

Hamstra added that while a carbon fiber or a titanium option is commonly called an “upgrade,” she prefers a different term.

“I use the words ‘enhanced materials’ whenever I’m talking about titanium or carbon fiber,” she explained. “It’s not an upgrade. It is an enhanced material.

“Aluminum is basic. It meets the basic need or the minimum medical requirement. So an aluminum chair in the ultralightweight category meets the minimum basic requirements of what the funding source has to provide. When you’re reading funding guidelines, they’re going to give you the minimum criteria.”

But other materials, Hamstra said, have properties that lead to better performance and function, such as vibration damping.

“There are so many studies talking about how detrimental vibration is to people,” she noted. “There are studies looking at whole-body vibration, talking about how basic wheelchairs are not meeting the need for [preventing or limiting] it.”

Vibrations transferred to the rider with every roll over a flooring transition, crack in the sidewalk, curb or uneven surface can cause a number of unwanted reactions, such as spasticity.

“Or [riders] may have hardware in their spine; so many of them have had [spinal] fusion,” Hamstra said. “They’ve got spasticity, they’ve got hardware, they’ve got pain.

“A lot of times, they have a higher pain threshold [vs. ablebodied people]. Their bodies may not interpret pain the same way that someone who doesn’t have a neurological or some other sort of impairment does, but it’s affecting them in other ways. Maybe they have an intense amount of fatigue, because of all of that vibration that is going up into their body.”

THE FUTURE FOR ULTRALIGHTS

Asked what she’d like the future of ultralight chairs to be like, Hamstra mentioned the freedom of riders to have more choices.

“Consumers and users are much more savvy than they were even five years ago,” she noted. “They talk to other users. There are chat groups, Facebook groups, TikTok groups, and users know what they want. They’re not going to be very satisfied hearing, ‘This is all your insurance is going to cover.’ Working with Unite for CRT and doing the [Washington, D.C.] fly-in and those types of things are going to help make the technology more available to the consumer, without them having to pay $5,000 up front if they want a titanium or a carbon fiber frame.”

She would also like riders to be able to match their chair to different activities. “I believe everyone should have at least two chairs,” she said. “Having to have one chair to fit every activity 24/7 for five-plus years is absolutely ludicrous. It doesn’t work. It’s one of the reasons that people’s shoulders are wearing out and maybe they have to go into a power chair.”

Hamstra recalled meeting a young woman at an Abilities Expo last year: “She was in a chair that was probably 2" to 3" inches too wide. It was a rigid chair, and it hadn’t been fit by an ATP. She had Ehlers-Danos syndrome.

“Ian Denison [a physiotherapist and researcher at the University of British Columbia] says that for every inch [of seat width] that you have beyond what you need, you can decrease propulsion efficiency by up to 10 percent. So she was decreasing her propulsion efficiency by 20 to 30 percent. We got her into this smaller chair, and it was so much better.”

The young woman’s original chair featured 3" light-up casters, even though Hamstra learned the woman didn’t pop wheelies or need casters that size. But when Hamstra started configuring the chair, the woman asked for those light-up wheels.

Hamstra countered: “‘But you just told me that it was better with these 5" wheels.’ She said, ‘Christie, if I don’t have those light-up wheels, people don’t notice me, and people don’t talk to me.’ I was so humbled by that.”

That conversation changed how Hamstra interacts with clients. “Every time I teach clinicians, I say, ‘You have all the book knowledge, you have all the technical knowledge of an ATP, but none of us have that experience of being in the chair. So if we do not listen to what they want and why, we might just be writing them off. Like, ‘That’s dumb, you don’t need that, it’s not going to work for you.’ But that girl said, ‘Christie, if I don’t have those, people don’t talk to me. They don’t see me.’

“So I found aftermarket 5" light-up casters. It really does have to be hugely client centered in every bit of it.”

POWER CHAIRS: SIZE DOES MATTER

While chair size is a common topic in the ultralight space, it’s also a trending topic for power wheelchairs.

Brad Peterson, VP of Sales/U.S. for Amylior, said power chair size is very much on the minds of manufacturers.

“I was recently in Tennessee visiting providers and therapists,” Peterson said. “Many of them were happy to see a new narrow power base option. They see the benefit in having a narrower base, and they liked having something else to choose from.”

In addition to improved maneuverability from a more compact base, Peterson said appearance is also affected by chair size.

“I like the narrowness of it, I like the compactness,” he said of bases with smaller widths. “I like that we can fit a chair more to the person. Beyond fitting the power positioning system or the seating, we can also get them a smaller base, which I think helps with the overall aesthetic, can help with balance and feel, and can help a person’s overall sense of how they look in the chair.”

As an example of narrower options, Peterson said Amylior has two narrow Alltrack-based chairs: “We have a 21"-wide and a 24"-wide base. Both can achieve these widths with full-size 14" drive wheels and the same motors and suspension you will find in our standard M3.

“What I like about our 24" base is you get that 24" width, but with Group 24 batteries. That means someone whose seat width is 18" or narrower will have a chair where the widest part is the base and not the seat — 1.375" doesn’t sound like much of a difference, but it sure can be.

“Some of today’s chairs, including our 21"-wide, are so narrow that if [the seating is] over 15" or 16" wide, the widest point of the system is still going to be your arms or your joystick mount. So having options is great, even if it’s for getting on a ramp or a lift for a van. Having choices is good, because everyone is different. I think smaller is better, as long as we don’t sacrifice overall function or performance.”

Power chair lengths are also getting shorter. “With the new [narrower] chair, we are getting calls for shorter lengths, especially for pediatrics,” Peterson acknowledged. “We want to make it narrower and shorter, so the overall wheelbase is smaller with smaller casters, smaller drive wheels, and smaller components. So, once again, it’s an aesthetics thing. It’s an image thing.

“Looking at how you make the chair so the seating is integral is important, because we talk about turning radius and length, but turning radius and length are most often dictated by other factors, such as the size of someone’s feet, their seat depth, or whether they have a vent/O2, backpack, etc.”

Peterson refers to those measurements as “a functional turning radius or length. So by designing a chair around a person, you can shorten the footprint of the chair and still have it be functional without giving up anything.”

And he remains mindful of appearance, as well. “If we get too narrow with the base, so your arms are hanging out beyond the base, or the joystick mount is hanging out there, then you haven’t solved anything. Yes, the base is narrower, but as far as getting through into spaces, you might still be stymied.

“Plus, if you’ve got an 18"-wide chair, normally that seat’s going to be 22" or 23" wide at its widest point on top of a 21"-wide base. Think about a 27"-wide top on a 21"-wide base. That would look strange, but it may be functional for that particular individual. I’m sure there’s a reason someone may need a narrower base, independent of the size of the seat. We like to give them options and alternatives to choose from.”

THE IMPORTANCE OF SUSPENSION

Peterson also believes the perspective on suspension is evolving. “When I was in Tennessee, and I had a bunch of therapists who were new to mobility, I said, ‘Suspension’s a big deal.’ I think we’re finally looking at it more as ‘What does it mean to comfort and the overall stability of the user, in addition to performance?’ — rather than the marketing of ‘What does it mean I can climb?’”

Peterson explained how suspension impacts the activities of Benjamin Leclair, a professional wakeboarder who joined Amylior’s marketing team after sustaining a spinal cord injury.

“He’s the first to tell you he likes his suspension because it helps dissipate shock and vibration, so his tone doesn’t kick in as much or as frequently,” Peterson said. “It helps him with trunk control and fatigue. So even if you’re going over cobblestones, uneven terrain, truncated domes, or sidewalks of an urban environment, the suspension’s a big deal. If it allows you to climb and go crazy places, great, all the better. But for function, comfort, reducing tone, and things like that, clinically, it’s a huge need. It always will be.”

A robust suspension helps Leclair to drive with a standard joystick despite the varied terrains he navigates. “He’s a quadriplegic and he uses the joystick,” Peterson said. “If you look at the videos we have of him online, he’s outdoors. He’s in mud. He’s on uneven terrain. He’s on trails, so a jostle can also mean the loss of his control, too.

“I think the only modification he has is a U-shaped goal post [as the joystick handle]. That’s the only thing he has to help him keep his hand or his gloved hand on that joystick. Other than that, it’s pretty standard stuff.”

The suspension on Leclair’s chair, in addition to handling rugged terrain, also keeps him optimally positioned, Peterson added. “Our ATPs and clinicians go to great lengths to get someone positioned correctly, where they’re going to be the most functional. They’re going to be the safest in terms of skin integrity. They’re going to be best served by remaining in that position, but that doesn’t mean they should have to only drive over level floors. They should be able to go where they’ve got to go or do what they’ve got to do. And suspension can be a huge part of maintaining that position we work so hard to achieve.”

When asked what factors are most important to power chair riders, Peterson said, “I think if you were to talk to 10 consumers, you might get eight different answers. Just like we all have different tastes and needs in our consumer products, a lot of chairs develop brand loyalty because they work, because they’re reliable, because someone is used to the chair. They have a great outcome, so they want to go back to that chair.

“For a lot of people who are going into their first chair, it’s curb appeal, pure aesthetics. Sometimes they have to like the way it looks for them to get into it and understand or appreciate what it can do for them functionally. But I think in this day and age, what I hear is comfort and absolutely, durability. I think especially with the pandemic and how it changed people’s ability to get repairs done as quickly as they used to, someone wants a system that’s going to work. They don’t want to be bed or chair confined. So durability and reliability are a huge deal.”

ENVISIONING TOMORROW’S TECHNOLOGY

Brothers Barry and Jered Dean are co-founders of LUCI, manufacturer of smart technology, including sensor systems, for power wheelchairs and seating.

They also carry the perspective of caregivers. LUCI was inspired by Barry’s daughter, Katherine, a lifelong power chair rider. Katherine’s parents wanted her to move through the world more safely in her power chair, and they asked Jered, an engineer, to create technology that would help.

New to the Complex Rehab Technology (CRT) space, the Deans are personally invested in what tomorrow’s technology will be able to do.

“But tomorrow is up for grabs,” said Barry, LUCI’s CEO. “We can do an article every year on what tomorrow looks like and let it be the same, like we have been. And we’ll always say, ‘Well, this is out there, someday. That is out there, but not for us.’

“We have a phrase inside our company, which is that we try to move at the speed of the need, and the need is great. And for kids who are like my daughter was — who are young, maybe they’re 1 year old — they are going to need some sort of intervention, which can change their entire future. How long do we let certain gatekeepers limit the innovation for intervention?”

While he believes “clinicians and a vast majority of salespeople” joined the industry to help people, he added, “The system as it is right now isn’t succeeding. You’ve got [right-to-repair] laws being kicked around in Colorado and Massachusetts that are saying it’s not working. Regardless of whether that’s the solution, our industry is making national media for service issues and delinquencies.

“It’s time to say, okay, who are we going to be? And that shouldn’t just be answered by the private equity firm that owns one company. That should be answered by these people whose heart is in it. The clinicians, and some of the salespeople, and most of all the users and their caregivers — that’s a voice that’s not always at the table.”

A HESITATION TO COLLABORATE?

Jered Dean, LUCI’s CTO, has worked in the aerospace, medical dialysis, and automotive industries, among others.

“Before LUCI started, I got the opportunity to work in a lot of industries as a consultant to help bring people innovation,” he said. “As you come into this industry, it’s an interesting one in that there’s sort of a default to no — which I’ve seen a little in other industries, but it’s strong here. There’s a fear-based default to no that most of the companies here have.”

Jered also referenced “these mythical stories where usually the bad guy is either funding or some sort of regulation. Before I worked in this industry, those regulatory bodies were actually seen as partners. And I still see them that way. It’s interesting that the industry doesn’t.”

Jered said LUCI’s team is actively collaborating on initiatives to advance technology: “We’re working on some things to get open APIs [Application Programming Interfaces] out there to use for research. We just helped submit and start a new committee on the standards board at RESNA to look at driver assistance systems and to start developing standards in cooperation with other companies.”

Jered added that he’s fielded questions on why LUCI is working on projects that aren’t mandatory. “Well, because that’s how you develop technology in a mature industry,” he noted. “We’re doing what we can to push, but I do think those are toxic behaviors that are built into the functioning of this industry that need to change.”

PART OF THE SOLUTION

Barry said part of LUCI’s drive comes from wanting to make the most of the support the new company has received. “We’ve found a lot of like-minded individuals,” he said. “We’ve met a lot of people who I think understood the heart of our team, and then joined us and taught us. Those kinds of people willing to walk alongside us and teach us and let us be new to this industry, but not kick us out. That’s a really big deal. And we feel that and honestly, we’re trying to honor it. There are certainly lots of parts of the journey.”

“We feel that as pressure to continue to push,” Jered agreed. “That’s [behind] many of the updates we’re working on — our direct responses to the amazing people that we get to work with that provide feedback, that have been encouraging and [supportive] along the way.”

As far as consumers’ and caregivers’ roles in helping to create tomorrow’s technology — Barry noted that while of course, they should be at the heart of innovation, the industry’s current environment doesn’t always support that kind of brainstorming.

“I went through a certain kind of education,” he said, explaining that initially, his strategy was “Just talk to the user. The user will tell you what they need. And there’s nothing wrong with that thought.

“But the fact is sometimes we, as an industry, are so far behind, it’s a cop out to put it all on the user. Sometimes the ecosystem is dysfunctional in some way that is keeping innovation out, and it’s not fair to ask the user to do the lifting of helping to visualize the future. Not when it’s ‘Can you get me my wheelchair in six months?’ ‘No, I cannot.’ So it’s hard to sit down with that group of people and say, ‘Dream with me,’ because they’re going to say, ‘I’m dreaming of not being trapped in my bed while I wait for some sort of [repair] cycle to occur.’”

This article originally appeared in the May/Jun 2022 issue of Mobility Management.

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