The mantra for complex rehab technology (CRT) could be “There are no absolutes.” In this industry, no two clients are alike…not to mention that they change as they age or as medical conditions progress.
So, very little in the CRT world is black and white, always or never, on or off. Except, of course, when it comes to alternative driving controls for power wheelchairs — in particular, the ones using switch systems, which by definition are either on or off, going or stopped.
Exploring New Boundaries for Head Arrays
Switch-It’s new Dual Pro proportional head array seeks to get ATPs and seating & mobility clinicians to rethink what they expect from head arrays.
The Dual Pro will get immediate buzz for its two sensors: one for Proximity (Crawl) and the other for Force (Force). Used in combination, Switch-It says the sensors can replicate the type of proportional driving delivered by joystick systems.
But Robert Norton, Switch-It’s VP of sales, added that the Dual Pro’s parameters can be directly dialed into the chair without requiring extra equipment — a potential time-saver for the seating & mobility team.
“You have full control, on-board programming,” he noted. “There’s no dongle, no computer, no software to download. It’s all right there on the back pad: Adjust how much speed the user uses while they are in the Proximity range, and then how much force is required to achieve 100-percent speed by using the Force sensors. That is fully adjustable from all three pads individually. So because there is no proportionality — there is no gradient to proximity switches, obviously, they’re just on or off — what you’re actually adjusting is the percentage of speed of the chair.”
As an example, Norton said, “If the chair is set up at 100 percent, and you have two of the five lights chosen for Proximity, then they’re going to go at 40-percent speed. Each of the lights in that scenario would represent 20-percent speed. So when [the client is] in the Proximity range, they would go at 40-percent speed. And then with the Force, there are up to five lights as well. The more lights [that the programmer chooses to use], the more force is required to activate.”
More Precision for Clients
ATPs and clinicians who dial in head arrays for clients often need to fine-tune per each client’s needs. The Dual Pro’s system can offer more precision to accommodate a range of abilities.
Norton said, “If I have somebody that just constantly wants to push on the back pad — or someone who has a hard time coming off of the back pad and was never a candidate for a head array, because any time they would touch the back pad, they would start driving — with this product I can actually turn off the Proximity, and they have to press pretty deeply into the back pad to be able to drive. So they can rest their head on the back pad and deliberately press back further to activate it.”
For Angie Kiger, M.Ed, CTRS, ATP/SMS, marketing channel & education manager at Sunrise Medical (which acquired Switch-It in spring of last year), the Dual Pro’s ability to evolve with the client could be helpful during training. The new head array can, at any time, operate as a traditional switch system.
“When I first start teaching someone who is very young,” she said, “It’s on and off, stop and go. So by leaving [the Dual Pro] as a full-on switch option without adding any force or any sort of proportionality to it, I can really work on that stop/go, stop/go. And as the client becomes much more confident in their skills, I can get them to understand that I can give them proportional control of this chair. So I think it helps with the learning curve for some of these clients.”
The Dual Pro’s adjustability could also be a boon for adults experiencing changes.
“Two of the scenarios that have come up in some of the in-services and in speaking with clinicians,” Norton noted, “are number one, ALS — so they could very well drive with the proportionality at the beginning of using the head array, and as they progress and lose muscle strength and ability, you can move them over to just a straight proximity head array. You can progress with them. And then second, going in the other direction — a new spinal cord injury [client] may have a [cervical] collar on and very limited movement; they could drive as proximity. All of a sudden that C-collar comes off, and they’ve got range and they gain more strength in their neck. Now you can start to give them more proportionality as they strengthen. You can adapt either way.”
Seeking the Best of Best of Both Worlds
Andrew Parker, Switch-It’s product and engineering manager, said the Dual Pro concept began as a pair of head arrays shown off to REHACARE attendees.
“We did a pressure-based head control and we did an adjustable proximity-based head control,” Parker said. “We got a bunch of feedback from the field, and their electronics are very similar; they complement each other. So we decided to put them together. We ended up putting proximity sensors inside the pressure head control, so when your head gets within the proximity sensor, it calibrates the pressure sensor. It’s a redundancy and safety [feature]. Then we decided to make the proximity adjustable and the pressure sensor adjustable, and put them in the same head array.”
That, according to Parker, was not the biggest design difficulty. The real challenge was “making it easy to program, not needing a computer or a smartphone or anything.”
As far as the type of client who could benefit from the Dual Pro, Parker said, “All the existing head control/head array users out there that have good head control and really want more adjustability and the ability to control their wheelchair in a more fine-tuned manner.”
Kiger added, “If they’ve got someone who complains about their current head array, they would be at the top of my priority list to give [Dual Pro] a whirl. The other one would be if someone’s got really good head control, but they fail at other things. That would be the client I would look at.”
Norton said providers should find Dual Pro equally attractive from a funding perspective: “For a dealer, it is coded as a proportional head control as opposed to a proximity one, so the reimbursement on it is about $1200 higher than that of a standard head array. Even if you use it as a fully switched system, turn off the force on all three pads and just use it as a standard proximity head array, it is still programmed as a proportional system and therefore is coded as a proportional head control.”
The Dual Pro is currently available in two sizes, adult and pediatric, with Parker adding that more options and accessories are in the queue for 2016. But the Dual Pro is already robustly functional: It can be configured so its user can completely turn the power chair off and on again without assistance.
“You can set it to be a switched head control like we’re used to so it would fit the current people using them,” Parker said. “You can add in proportionality as they become proficient or as they want it in the field. So it fits existing populations of people, and then gives them some options.”
And the Dual Pro gives options to the seating & mobility professionals working with those populations. As Norton said, “Every user changes at some point, right?”