9/6/2017. Cushion and Back Comparison: What s New? Disclaimers. Objectives

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1 Cushion and Back Comparison: What s New? Presented by: Erin Michael, PT, DPT, ATP/SMS Manager, Patient Advocacy and Special Programs International Center for Spinal Cord Injury Kennedy Krieger Institute Disclaimers No conflicts of interest and no financial interest in the products mentioned. The products listed are based on response from local equipment representatives. Working primarily in spinal cord injury for the past 9 years. Do not have personal experience with every product mentioned Objectives The participant will be able to identify two new backrest technologies and the one advantage that each provides over previously available equipment. The participant will be able to identify three new cushion designs and one advantage that each provides for positioning or pressure management over previously available equipment. The participant will be able to list three clinical methods to determine the best cushion and/or backrest for your client. 1

2 WHAT S NEW IN BACKRESTS?! ROHO Agility Carbon Backrest Lighter weight (starting at 1.75 lbs with hardware) Flat-weave, 12K carbon fiber composition Mounting hardware, is closer to the backrest canes for streamlined appearance and performance 15 degrees of forward and rearward angle adjustment in 5 degree increments Invacare Matrx MX2 Backrest Lighter weight (1.5 lbs and up) Cutouts for breathability Slotted for easy height adjustment Fixed mount or quick release hardware 30 degrees of angle adjustment 2

3 Jay J3 Back with HV Technology Jay J3 back with heating/ventilation (HV) technology Patented internal thermal technology Evaporative cooling Rechargeable battery, up to eight hours of continued use from a full charge Specialized cover Ottobock Ortho-Shape Backrest Custom molded Contouring/molding actually occurs through the shell itself versus the foam Lighter weight and much lower profile than standard molds Can be modified at delivery or down the road to a certain degree with heat gun Comfort Company Acta Relief Backrest Boa reel and cable system Open back frame design Can accommodate many postural abnormalities May relieve pressure on lateral pads or eliminate need for laterals 3

4 Quantum ADI Q-Backrest After market back Can mount directly to TRU-Balance 3 seating without an interface Available in 3 contours WHAT S NEW IN CUSHIONS?! Smart Check by ROHO Exclusively for ROHO Sensor Ready cushions Meant to take the guess work out of proper inflation level & improve user s confidence Individualized for each user and can be reset, as necessary 4

5 ROHO Hybrid Elite Cushion Redesigned As name indicates, hybrid cushion Benefits of both air and foam, where they are needed Comfort Company Inception Simulation Kit A tool that can be used to design a custom seat cushion Options are limitless & cushions can be as contoured or supportive as you design them The cushions are grow-able and adjustable, if necessary Training with the kit is available by webinar or live Comfort Company Inception Simulation Kit 5

6 Ottobock Terra Flair Cushion Hybrid cushion; air and foam Specialized ROHO cells, Foam profile designed to reduce transition area between air & foam Rest Suspension Foam, tested to 5 years and still resilient Tested well over rough terrain for shock absorption, vibration dampening DETERMINING THE BEST SEATING SYSTEM FOR YOUR CLIENT Subjective Report Document positive/likes and negative/dislikes about current seating Current pressure concerns or history of skin breakdown Location Stage(s) Pain/discomfort Ask for details Relate pain to activities, postures or equipment 6

7 Subjective Report Are there activities they feel that they cannot do secondary to current equipment or positioning? Ask them to recall cushions and/or backrests they ve previously utilized Social factors to consider Observation Observe posture in current equipment Front, side and back Photograph, as necessary Observe overall fit of current equipment Note products used Pay particular attention to equipment set-up Mat Assessment - Supine PICTURE! Picture: unitedspinal.org 7

8 Mat Assessment - Supine Note how the body responds to the transition from sitting to supine Note the position of the spine and pelvis Observe position of head and shoulders Mat Assessment - Supine Assess knee to hip relationship Hamstring length Knee flexion and extension ROM Assess the hip to pelvis relationship Hip flexion, ad-/abduction, rotation ROM What motion occurs in the hip joint vs. low back? Inspect skin Mat Assessment - Sitting Picture: unitedspinal.org 8

9 Mat Assessment - Sitting Firm surface, feet supported (as able) Assess balance: Independent/ Hands free Hands dependent Dependent Assess posture without support Mat Assessment - Sitting Align pelvis as optimally as possible, assess effect on trunk posture Align pelvis and trunk as optimally as possible, assess ability to raise hands Align pelvis and trunk as optimally as possible, assess head position and control Take anatomical measurements Anatomical Measurements 9

10 Equipment Trials When feasible, obtain the products and observe the client seated on them. If highly customized products are needed or the specific products are not readily available, create a simulation Schedule follow-up visits to allow time to obtain equipment through the local rep or the vendor Pressure Mapping PICTURE Picture: comfortcompany.com Pressure Mapping Allows the clinician to visualize pressure distribution over the seating surface Generally, performed during static sitting Cannot evaluate internal stress & strain May assist with ranking cushion effectiveness Research is variable on efficacy of pressure mapping and our own clinic experiences have shown this 10

11 Outcome Measures Tool for Assessing Wheelchair Discomfort (TAWC) General survey focused on activities performed throughout the day Three parts Asks broad questions Only asks about comfort & discomfort Functional Mobility Assessment (FMA) Self-report outcome tool 10 questions; participant answers from completely agree to completely disagree or does not apply. Designed to measure the perceived effectiveness of their current mobility device CHOSING THE EQUIPMENT Factors to Consider Stress Perpendicular ( Pressure) Parallel ( Sheer ) Muscle and fat are more susceptible to pressure than bone Moisture accumulation increases risk to tissues 11

12 Choosing a Back Rest Manual vs. power mobility Height Overall weight Postural deformity present? Correct Accommodate Sitting balance History of skin breakdown over the spine Choosing a Cushion History of skin breakdown Body composition Pelvic position Correct Accommodate Sitting balance Choosing a Cushion Results of pressure mapping, if applicable Ability to perform an effective pressure relief Potential for moisture Sweating Incontinence Social factors 12

13 Choosing a Cushion Pain Overall weight, in manual wheelchair users Cushion materials Essential Clinical Questions Will the client be able to sit consistently where I think they should? What changes are predicted to occur to this client over time? How capable and consistent will caregiver and client be at maintenance? What are the lifestyle considerations? Transfers, transport, etc. Is the client comfortable? What Does the Research Say? Tissue deformation is the most likely culprit behind pressure injuries. Deformation can occlude the blood vessels, leading to ischemia; however, it damages the cell s cytoskeleton and/or alters membrane perfusion properties. Damage from deformation occurs faster than damage from ischemia! 13

14 What Does the Research Say? Our basic knowledge of how the wheelchair user s body and the cushion interact is limited. Pressure mapping can quantify some of the external forces, but it has limited, if any, ability to quantify the internal tissue responses. Clinical observation skills and experience of the prescriber are important. In Conclusion We live in an era of innovation; new products are coming on the scene regularly Form relationships with your local equipment reps to keep up to date on the latest products Use your skills as a clinician and/or ATP and look at the big client picture to guide your product choices. There is NO one-size-fits-all solution Treat each client as the unique individual that they are Perform equipment trials or simulations to the best of your ability to assist in the decision making Questions?? 14

15 References Brienza D, et al., An MRI investigation of the effects of user anatomy and wheelchair cushion type on tissue deformation. Journal of Tissue Viability. 2017; Crane B, Wininger M, Call E. Orthotic-style off-loading wheelchair seat cushion reduces interface pressure under ischial tuberosities and sacrococcygealregions. Arch Phys Med Rehabil. 2016; 97(11): Hollington J, Hillman SJ. Can static pressure mapping be used to rank pressure-redistributing cushions for active wheelchair users? J Rehabil Res Dev. 2013; 50(1): Hong EK, Dicianno BE, Pearlman J, Cooper R, Cooper RA. Comfort and stability of wheelchair backrests according to the TAWC (tool for assessing wheelchair discomfort). Disabil Rehabil Assist Technol. 2016; 11(3): Medola FO, Elui VM, Santana Cda S, Fortulan CA. Aspects of manual wheelchair configuration affecting mobility: a review. J Phys Ther Sci. 2014; 26(2): Contact Me For more information, please do not hesitate to contact me: Erin Michael, PT, DPT, ATP/SMS Michaele@kennedykrieger.org Phone: (443)