The new TiLite Pilot: If Wonder Woman or Captain America had a wheelchair….
Superheroes live beyond comic books and Hollywood blockbusters. Just look at your littlest clients, who take on everything from siblings to math classes to vast playgrounds on a daily basis.
Look also to their loyal sidekicks (aka, parents), who must be ready in an instant to transport their kids to school, playdates or anywhere else a superhero might be needed.
These families want more than a pediatric wheelchair. They need a vehicle that can keep up with their exploits.
Optimized Propulsion from the Start
The TiLite Pilot by Permobil is sized from 8×9″ to 14×15″, with 2″ of seat width growth and 3″ of seat depth growth. The carbon fiber frame design keeps Pilot’s weight down, and the chair has a host of kid- and family-friendly features.
Doug Garven is the TiLite Product Design Manager and designed the pilot.
Asked his goals when creating a pediatric self-propelled chair, Garven said they’re very similar to his goals when designing an adult ultralightweight: “You’re trying to get the person seated properly so their wheel access is as good as it can be to allow for an efficient push stroke given the ability level. That’s why being able to position someone in a chair is so important: Everyone is different, their physical attributes are different, and you have to accommodate that.”
Garven did, however, acknowledge additional considerations when designing for children, especially younger ones: “You’re trying to be cognizant of their physical limitations. Maybe they need the wheels a little bit closer to them. The fit is so much more important because they don’t have the arm length or the strength to accommodate being out of position as well as an adult can.
“You’re definitely trying to get everything as close to the child as possible, especially in the smaller sizes.”
Curtis Merring, OTR, MOT, Regional Clinical Education Manager for Permobil, said learning to propel correctly from the beginning is crucial.
“We’re designing [the Pilot] and spec’ing this to ensure we have optimal center of gravity relative to the center of mass without compromising growth,” he said. “You’re giving the child optimal center of gravity from day one, meaning no matter where their arms are or how long their arms are, they’re going to be in a position where their biomechanics are optimized, and the stress on their joints is reduced.”
Growing in a Better Way
Growability is mandatory in pediatric chairs, which funding sources expect to last for years.
“You hope to get a couple of years of growth,” Garven said. “It depends; every kid has different growth spurts. [The Pilot can grow] 3″ in depth and 2″ in width. Most kids will hit the depth [limit] before they hit the width one, though you never know.”
There’s more than one way to grow a wheelchair. For instance, as the child’s legs grow longer, the ATP or clinician can move the seating backward. That means the child’s position relative to the rear wheels changes as his seating moves rearward.
“The way a chair grows typically,” Garven said, “is by moving the seat back. You only have so much length in the frame you can use. In smaller [chair] sizes, you see kids shoved so far forward in the seat that they can barely even reach the wheels, because they have such a little push stroke.”
The Pilot tackles growth differently.
“Our chair grows forward,” Garven explained. “That’s something that’s been done a lot in Europe, and it’s a smarter way to grow a chair, because it allows the kid to be in a good position from the beginning. As opposed to adjusting the backrest on the seat frame, the frame stays stationary, and the seat is growing forward.”
Optimally positioning for propulsion from the start can prevent unneeded stress to kids’ bodies, Merring said. “When it’s time to grow, the client has a seat that grows forward, with the femur, versus growing back into it and eventually getting to that [optimal] center of gravity.”
Growing the chair in the traditional backward direction “definitely sets him or her up for compounded issues in those joints for much longer than is necessary,” Merring said. “It’s not necessarily that they can’t learn a [new way of pushing] or that the biomechanics can’t be overcome. It’s more a matter of if you get [the positioning] right the first time, that amount of repetitive stress that goes onto the joints is reduced from a way earlier time.”
And more efficient propulsion is crucial, Merring added, to the developing child.
“Center of gravity relative to that center of mass is good for activities, performance and participation,” he noted. “Play is one of the most important aspects of any child’s life, and when [kids in wheelchairs] are playing with others, they need to be able to keep up. When you design a chair that’s more responsive to a child’s propulsion efforts, they’re more able to interact with their peers. They’re doing more activities, which better facilitates more normal cognitive and social development.”
In contrast, if a child reaches the optimal seating position only after growing — so the child is not optimally positioned for efficient propulsion from the start — the child’s activity level can drop. “For the first year with their new chair, while they’re not all the way back into the seat, fully accessing the wheels, that leads to compensatory strategies that make the child work more than they should and could lead to learned helplessness,” Merring said. “But if you introduce a chair that’s responsive from the time it’s delivered, they’ll integrate into play and development a lot quicker, decreasing the amount of work that is necessary for them to be functional and then decreasing the likelihood of developing a learned helplessness.”
Adjustments take less than a typical clinic visit to make, he added. “We can make this adjustment in less than one session. By creating a system that’s easy to adjust, we’re hopeful that we’ll have increased compliance with making these necessary adjustments because now it’s no longer a chore, but can be done in 15 minutes or less.”
Options for Today’s Superkids
The Pilot retains functional adjustability, Garven said: “We still have the ability to adjust the center of gravity. Rather than moving the wheel on the frame, we move our whole seat forward or back. We’re still allowing for that CG adjustment if [the child’s] skill set changes and they want a more active, tippier type of wheelchair.”
The Pilot provides optimal positioning and a new growth process to ensure your littlest superheroes propel most efficiently from the start.
The Pilot also has its own footplate design, Garven noted: “It rotates around a pivot point and has the ability to be anywhere in space, height or depth, wherever the clinician wants it to be. Our footplate needs to move relative to the seat because the seat’s growing forward. We had to have a way to keep that footrest in the same relative position for the kid as he or she grows.”
Wheel locks are in a kid-friendly position near where kids grab the handrims; as arms grow, the locks can be moved to a more traditional location. Anti-tips and push handles are available, with more options on the way.
Aesthetically, the Pilot has a super-streamlined, minimalist design. “Our dark carbon composite side frame, panels and seat tend to disappear, and you focus more on the colored sections of the chair,” Garven said.
Merring said kids can choose from 16 color options at no upcharge. Choosing the right combination can give the Pilot some serious — and very intentional — swagger.
“Maybe,” Merring said, “they feel like they have a superhero wheelchair. They’re going faster, they’re improving their ability to keep up with their friends, and it looks cool at the same time.”
Garven said a big design goal was “to make everything look clean aesthetically. When you start seeing the hardware and adjustment holes in the frame, it starts to look busy and complicated. It begins to look like a clunky medical device instead of a fun mobility device.”
Instead, the Pilot looks like something a superhero would use — while also being functionally heroic to clinicians and functionally convenient for parents (Garven said the Pilot’s light weight during transport will probably be what parents appreciate most).
“Every kid I’ve seen — they get into the Pilot and just take off,” Garven said. “They’re liberated to have the proper positioning. [It] helps them to gain independence and have fun. That’s what’s being a kid’s all about.”
