Sunrise Medical SMA manual

1 Comprehensive Guide to Powered Mobility For Families of SMA When selecting the first mobility device the choices can be overwhelm ing. This document aims to guide you through the selection process as well as offer help to obtain funding. Strollers, manual wheelchairs a nd power wheelchairs are all possible alternatives. Efficiency, durability, co[...]

2 Table of Contents: Chapter I: Where do I start?.............................................................................................3 Chapter II: FAQ on early provision of independent mobility…………………………5 Chapter III: Power w heelchair bases……………………………………………………8 Chapter IV: Seat f[...]

3 Chapter I: Where do I start? A wheelchair consists of many variables, whic h all need to be configured to a specific individual. No two wheelchairs are alike when done properly. In addition, it needs to fit like a pair of shoes, since it will not only act as a mobility device, but also the user’s se at and primary interface for many hours every[...]

4 Technology Practitioners – certified c linicians), and ATSs (Assistive Technology Suppliers – certified deal ers). Not all good practitioners are certified, and not all certified people are savvy in wheelchairs. This is a voluntary certification for people working with all assistive devices. However, if no other recommendations exist, this mi[...]

5 Chapter II: FAQ on early provision of independent mobility Why is efficient mobility a prior ity? Children learn through exploring their envir onments. Without efficient and independent mobility, you child is more likely to deve lop dependency on others. Think about how a child learns: approaching objects that tweak their curiosity, touchi ng the[...]

6 Some people opt for a hybrid solution, a power assisted device. This is essentially a manual wheelchair equipped with motors in the wheel hubs. When the user pushes the handrim, it activates the motors whic h help th e chair to roll faster and longer. These devices are easier to push than manual wheel chairs, and eas ier to transport than power w[...]

7 instead of your child. Most of all, be patient – hard as it might be, your child will develop an understanding quickly if th e right support is provided. Provide a safe environment while your chil d learns to drive – level surfaces, few obstacles, and possibly a harder surface (it requir es more torque to move on carpet.) It is advisable to u[...]

8 Chapter III: Power wheelchair bas es When selecting your first power chair, chance s are that you will b e overwhelmed with the selection and the features. Y ou may feel like making a quick selection since you have so many other medical issues to worry about. Th e decision, however, is very important since this chair will be your child’s v ehic[...]

9 characteristics of rear wheel drives, they m ay be a good choice for heavy outdoors use and/or if you want high speed. On the downside, much of the user wei ght is placed above the drive wheels limiting curb climbing ability. Also revol ving casters lim it footrest placement options. Ability to accept a ventilator If you child is likely to need a[...]

10 Drive performance (Speed, range, incline, curb climbing) Performance variables may show a differen ce between ruggedness and durability of the different bases. Do not let these variables rule your decision, but it is recommended to have a look at them. • What is the maxim um speed of the chair? Keep in mind that most chairs are programmable, s[...]

11 Ability to accept seat functions With limited strength and endurance, chances are that your child would benefit from certain functions to be able to stay in the chair for longer periods of tim e. Tilt, recline, seat elevation, elevating legrests, etc. are all different options. Some chairs can be fitted and/or retrofitted with functions while ot[...]

12 Chapter IV: Seat functions Seat functions may seem intimidating or an “overkill” som etimes. They do, however, serve many functions in the areas of preven tion, enhanced function and comfort. Try to simulate some of those functions so you can experience for yourself what they mean – imagine a Lazy boy’s recline or elevating le g feature,[...]

13 • Compensate for limited trunk stability – even a slight tilt m ay utilize gravity to help extend the trunk and maintain a more extended po sition • Reduce shear as much as possibl e, as compared to recline • Maintain proper position related to AAC (Alternative and Augmentative Communication) devices, computer, even when tilted • Safer[...]

14 • Increases respiratory capacit y • Allows change of hip position for pain relief • May allow reduction of a ttendant/caregiver hours Elevating legrests Elevating legrests change the angl e of the legrest relative to the seat. It may be available with articulation, which means that the footplates move down on the legrests while elevating. [...]

15 • May reduce repetitive injury of the neck, by allowing eye to eye conversations • Allows access to ADLs (Activities of Daily Living) – cooking , microwave, sinks, water faucet, etc. Seat to floor function The seat lifts off from the base and moves forward than lowers the occupant to the floor. Benefits: • Peer interaction for child ren [...]

16 • Less gastro-intestinal complications, because there is less pressure on the internal GI organs • May allow use of a public urinal for male users • Increases self confidence by allowing to assume an “equal”, standing position and eye to eye conversations[...]

17 Chapter V: Seating systems Proper selection and professional guidance in the seating system is of utmost importance, since it is the ultimate interface between the us er and the wheelchair. This is the seating system surrounding the client all day, and can make all the dif ference in comfort, sitting tolerance, and prevention of secondary compli[...]

18 maybe years. A contoured back, on the ot her hand, provides more contact surface therefore more comf ort. In general, the more contour, the less freedom of movement – which m ay make contoured backs somewhat more appropriate fo r children with low trunk control, as they provide more support. Children with SMA also tend to prefer softer materia[...]

19 Armrests and laptrays: Armrests should be as close to the body as possible to provide support, and preferably built with a softer material. The more weight bearing assum ed through the arms, the les s pressure on the buttocks. Laptrays are often us ed to provide a surface for activities, if the child has difficulties pulling up to a table, or to[...]

20 Chapter VI: Controls / Electronic int erfaces / Access methods The advancement of power wheelchair electronic s in the past couple of decades has been quite amazing. There is a variety of access met hods available to control the m ovement of a power wheelchair as well as the seat functi ons. In fact, even if only one part of your body can move w[...]

21 • Mini joystick This is pretty widely used among wheelchair users with SMA. If there is not enough strength or range present to use a standard joystick, the Mini m ay be a very appropriate alternative. It p rovides full proportional control (which is typically better, a more natural way to drive) , and also allows access to all seat functions.[...]

22 hand, elbows, feet, or just about anyw here where consistent movement is detected. Many users with SMA may opt for fiber optic switches, which can detect very slight motion in any dire ction and can be placed anywhere aro und the body. • Single switch scanning If all else fails but the user has consis tent reliable moveme nt in one direction a[...]

23 Chapter VII: Funding The key to obtaining funding is good documentation. You should work with professionals who have expertise and cr edibility to supply such documentation. It is always recommended to have a physical or occupational therapist involved with the process in addition to the phys ician and the supplier. In ge neral, the physician si[...]

24 Description of the need and requireme nts should always precede description of the final product. • Assessment methods and clinical trials. The reviewer needs to be able to foll ow your team’s thought process. How did they come to the conclusion tha t this is the appropriate device? A brief description of the assessment m ethods will help th[...]

25 Do appeal. A large percent of equipment ge ts denied, and a large percent of those appealed get approved. Also keep in mind th at every time you do not appeal, you dam age your chances of getting equipment approved in th e future, as well as that of others. Every single equipment which was fought for until it is approved, helps improve the syste[...]

26 List of Resources: These links are provided for c onvenience only. FSMA possesses no control over such links, and makes no express or imp lied warrant ies, representati ons or endor sements of any kind re garding a ny linked site, and assumes no liability of an y kind for any information contained in any lin ked site. Conferences/Trade shows: ?[...]

27 Manufacturers: There are innumerable products available related to wheelchairs. Hu ndreds of cushions , seating accessories, switches, etc. This list is not intended to be compre hensive, rat her provide refe rences for som e of the largest and most wid ely used manufactur ers with products related to powered mobility: • Permobil www.permobil.[...]