PURPOSE OF A COMFORT WHEELCHAIR

PURPOSE OF A COMFORT WHEELCHAIR

PURPOSE OF A COMFORT WHEELCHAIR FEEDBACK AND ANSWERS FROM DISCUSSIONS WITH HEALTH PERSONNEL Get up from bed and be more healthy Long term passive seating is dangerous. A comfort wheelchair is a good solution in many cases. The wheelchair user must have variation and the user should avoid pain like bedsore and decubitus which is very painful. The treatment is also very expensive Get stability for the body and variation in the seating position. Avoid additional consequential damages like posture damage and deformities in the back, legs, head position and so on Relief of the user and relief of the nursing staff s workload, like less repositioning after sliding, easy transfer situations and so on Improve vital body functions like breathing, blood circulation, heart and digestion Increase mobility for the user Increase quality of life and more social participation Be able to participate in social life: See something, communicate with others, perform activities in the daily life like eating, shopping and move around USUAL CHALLENGES OF LONG TERM SEATING WHEELCHAIR USERS: Skin integrity issues Decreased functionality and participation Inability to change posture Deformities Discomfort and pain Difficulties regarding digestion and other Vital body funtions

Kjetil Gausel is CEO of Netti by Alu Rehab, a comfort wheelchair manufacturer and comfort wheelchair specialist. Mr. Gausel started his job career in Netti 25 years ago. The company was established in 1989, and the head quarter is located in Norway with divisions in Denmark and China, including sales in more than 30 countries. All companies within Netti by Alu Rehab Group is certified according to European medical standards: ISO-9001 and ISO-13485 Medical devices. CEO KJETIL GAUSEL EXPLAINS FOLLOWING GOOD REASONS TO CHOOSE A NETTI COMFORT WHEELCHAIR: Netti wheelchair products are Norwegian design, and the Netti quality concept is reflecting the Scandinavian concept of wellbeing and dignity for all people European and Asian clinical findings show significant improvements in health conditions and activity daily life for long term seating wheelchair users, when using Netti comfort wheelchairs. This is our motivation for being a comfort wheelchair specialist, and we know we enable joy of life for many people. Netti by Alu Rehab has worldwide experience in seating comfort, and we were one of the inventors of comfort wheelchairs in the 1990 s The Clinical Test Protocol and 5 seating steps we are committed to, is designed according to best practice guidelines and current, updated research findings about long term seating. These concepts are developed by Bart Van der Heyden. He is a physio therapist and an independent, inter national seating expert in Europe and USA. We are happy to support with sponsoring contributions of clinical test programs, education and training which is conducted by Mr. Bart Van der Heyden and other seating experts and health institutions in Europe and Asia. We are updated with current knowledge about good seating solutions and we are eager to develop more solutions for the future. On the next pages you can read more about the clinical test approach, the 5 Seating Steps and also find some examples of research and findings about clinical eviden ces and international agreed best practice guidelines. My-Netti.com 3

CLINICAL TEST PROTOCOL FOR COMFORT WHEELCHAIRS Hans Sagen is director of sales and business development in Netti by Alu Rehab. He explains more about the clinical test protocol: BACKGROUND AND PURPOSE OF A CLINICAL TEST PROTOCOL Netti by Alu Rehab has committed to the clinical testing for its products and has conducted clinical studies together with users and clinicians on a wide range of our products: Netti Dynamic System, Netti III, Netti 4U wheelchairs, Netti Vision and Netti Mini. So far, these clinical tests have been conducted in Norway, Denmark, Germany, France, China, the Republic of Korea and Japan. The clinical test protocol is developed to measure outcomes when using different types of seating interventions or specific seating strategies for specific users or user groups. Measuring outcomes helps to determine which Netti models, accessories and adjustments can benefit the wheelchair user most. ABOUT THE CLINICAL TEST PROTOCOL The specific clinical test protocol and the assessment form has been developed by Bart Van der Heyden, physio therapist and an independent wound care, seating and mobility specia list. More info: www.super-seating.com. The clinical test protocol can be used to collect data and measure outcomes when using seating and positioning sy stems and helps documenting seating interventions. The form will ask questions to get a better understanding of the client s situation, clinical challenges and goals and will try to document seating and/or clinical interventions and record their impact of the client's seating situation and comfort. ABOUT THE CLINICAL TEST PROTOCOL: The specific clinical test proto col and the assessment form has been developed by Bart Van der Heyden, physio therapist and an independent wound care, seating and mobility specia list. More info: www.super-seating.com. The clinical test protocol template consists of 10 pages and is easy to use for care givers. Please, contact us or check www.my-netti.com if you want to learn more about the sequences of the clinical test.

EXAMPLE USING THE CLINICAL TEST PROTOCOL: Analyzing the impact of Dynamic Seating Components on the wheelchair user s seating position: MAIN DIAGNOSIS - CEREBRAL PALSY BACKGROUND AND PURPOSE Dynamic seating systems or dynamic components enable distal movement, creating an open kinetic chain (1), which may help to stabilize proximal segments and increase core seating stability and postural alignment. The purpose of this clinical evaluation was to analyze the outcomes of using dynamic seating components with users with cerebral palsy. S pecific M easurable A chievable R elevant T ime related METHODOLOGY 4 Netti Dynamic System cases have been reviewed over a 3 to 6 months period. A seating assessment was performed with each wheelchair user prior to using a dynamic seating intervention. Tone, range of motion, posture, skin integrity and ADL status were assessed and S.M.A.R.T (Specific, Measurable, Achievable, Relevant and Time related) goals for the dynamic seating intervention were set. Posture, tone, range of motion and ADL status were checked immediately after the dynamic seating intervention and each month following the dynamic seating intervention. The seating outcomes were measured by evaluating the initial S.M.A.R.T goals for a period up to 6 months post dynamic seating intervention. One of the four case reports about dynamic seating is shown on the next page. (1) Reference / Source: Ellenbecker, T.S., and Davies, G.J. (2001). Closed Kinetic Chain Exercise: A Comprehensive Guide to Multiple Joint Exercises, (1st ed.). Champaign, Ill.: Human Kinetics. ERGONOMICAL FRAME CONSTRUCTION SEATING CUSHIONS ACCESSORIES My-Netti.com 5

RESULTS CLINICAL TEST STUDY We are committed to using and collecting the data from the clinical evaluations in an ethical way. Mr. M.O. is one of the wheelchair users that was a part of the clinical studies regarding Netti Dynamic System. Please note that photos of M.O. and personal data are described in details as a part of the clinical test. However, we don't use these photos and personal data of the user in marketing publications, according to our ethical guidelines. We only use these data and photos at seminars with professional attendants. FINDINGS SEATING EVALUATION CLIENT: M.O. FEB. 2014: 18 years 75 kg / male Assistive independent living center resident CP / Spastic Diplegia Very strong tone Cognitive impairments Extension tendency right lower extremity C- Scoliosis convex right Symmetric tonic neck reflexes, Athetosis Functional upper extremities Hip flexion limitation 90 degrees left and right Tight hamstrings Windswept hips to L POSTURAL GOALS Controlling movements & spasticity frequency Decrease repositioning after sliding: now every 10 min Decrease sliding: now every 10 min when seated Address wear and tear of the wheelchair and accessories Improve symmetry to increase manual wheelchair propulsion ability

Read more about Netti Dynamic System and the comprehensive range of Netti comfort wheelchair solutions: www.my-netti.com SEATING INTERVENTION: Netti Dynamic CED SEATING OUTCOMES JULY 14TH, 2014: Controlled movements & spasticity frequency: Client has less tone and sits more aligned and stable even after spastic episodes. Address wear and tear on the equipment: No visible signs of wear and tear after 5 months of use User sits in the chair from: 8-11 am 12-13 pm 15-18 pm repositioning is need 5 to 10 times a day before the seating intervension, it was up to every 10 min when seated. NETTI DYNAMIC SYSTEM INTERVENTIONS WHICH ENABLE DISTAL MOVEMENTS BY CREATING AN OPEN KINETIC CHAIN, IMPACTED: The stability of proximal segments Seating time Sliding Repositioning frequency Tone Pain Equipment wear and tear On the wheelchair users with Cerebral Palsy My-Netti.com 7

OUR GOAL TO CREATE A GOOD SEATING INTERVENTION BY USING BEST PRACTICE EXPERIENCE AND CURRENT RESEARCH ABOUT SEATING INDEPENDENT RESEARCH RECORDED IMPACT ON THE FOLLOWING SEATING RELATED ISSUES BY USING TILT, RECLINE AND ELEVATING LEG SUPPORTS: POSTURAL REALIGNMENT AND FUNCTION (Lange, 2000b; Sommerfreund & Masse, 1995). PHYSIOLOGICAL IMPLICATIONS (Lacoste, Weiss-Lambrou, Allard, & Dansereau, 2003; Nwaobi, 1987) Netti can support partners with user assessments, or seminars on seating assessments techniques and the use of: Clinical test protocol Seating interventions on specific clinical cases Seating interventions on specific clinical diagnosis Postural and mobility management of different diagnosis with specific seating challenges ORTHOSTATIC HYPOTENSION (Bradley & Davis, 2003) VISUAL ORIENTATION, SPEECH, ALERTNESS, AROUSAL, RESPIRATION, AND EATING (Kreutz, 1997; Lange, 2000a) BOWEL AND BLADDER MANAGEMENT (Wyndaele, 2002) TRANSFERS AND BIOMECHANICAL ISSUES (Bayley, Cochran, & Sledge, 1987) SPASTICITY (Kreutz, 1997) CONTRACTURES AND ORTHOPEDIC DEFORMITIES (Lange, 2006) EDEMA (Kinzer & Convertino, 1989) PRESSURE RELIEF (Aissaoui, Kauffmann, Dansereau, & de Guise, 2001; Hobson, 1992; Vaisbuch, Meyer, & Weiss, 2000) 5 Outcomes & new possibilities 4 Create the seating solution 1 Understand the postural influence 2 The user s possibilities 3 Seating goals & strategies WHEELCHAIR PUSH-UPS FORWARD AND SIDE LEANING (Coggrave & Rose, 2003; Henderson et al., 1994; Hobson, 1992; Vaisbuch et al., 2000) PAIN, FATIGUE, AND SITTING TOLERANCE (Kolich, 2003) DYNAMIC MOVEMENT (Reinecke, Bevins, Weisman, Krag, & Pope, 1985) SOURCE: RESNA - Rehabilitation Engineering & Assistive Technology Society of North America, April 2008. www.resna.org ALL PEOPLE ARE UNIQUE, AND HOW CAN WE USE GUIDELINES TO ACHIEVE GOOD SEATING SOLUTION TOGETHER WITH EACH USER?

5 SEATING STEPS The 5 seating steps is an approach developed by seating expert Bart Van der Heyden according to his best on-field practice and his consideration of current research and findings. We consider 5 seating steps to be a good way to consider and create good Netti sea ting solutions. Step 1: Understand the postural influence Step 2: Assess and observe to understand the wheelchair user s possibilities Step 3: Set seating goals and determine strategies Step 4: Create a seating solution to fit around the wheelchair user Step 5: Measure outcomes: Measure if seating goals and seating strategies of step 3 are met A MIND MAP of keywords we can discuss with you when we have a dialogue about a seating solution or a seminar, using the 5 seating steps approach: Gravitiy Fatigue Postural Tendencies Wheelchair Interaction? COMFORT Compensations Assymmetries Wheelchair Interaction? STABILITY STEP 1: Understand Postural Influences Head Position Back support Adjustment FUNCTION TIME Tone Open vs. closed kinetic chains What do I see? When do I see it? Why do I see it? OBSERVE STEP 2: Assess Specific Measurable Achievable Relevant Time specific SMART GOALS What EQUIPMENT would meet goals? STEP 3: Set seating goals STEP 4: Create a seating solution 5 SEATING STEPS MINDMAP COMPLEX SEATING MANAGEMENT BART VAN DER HEYDEN, PT MORE INFO Netti By Alurehab My-Netti.com Did I MEET MY GOALS? STEP 5: Measure outcomes Bart Van der Heyden, PT = SuperSeating www.super-seating.com We consider the best way to use and utilize the 5 seating steps is a dialogue between you, our local dealer and possibly with support from Netti by Alu Rehab training staff or a seating expert. We can discuss challenges and a good strategy to find a seating solution and reach your goals. On the next pages we describe a few examples of independent research about clinical benefits on some of the comfort wheelchair features, and information about how to learn more about these topics. ASK OUR STAFF To give you information about training and seminars, and possibly a demonstration of the Netti comfort wheelchairs and features. Or you can visit our website: www.my-netti.com My-Netti.com 9

CLINICAL EVIDENCES ON COMBINING TILT WITH RECLINE To use a separate tilt and recline function is well documented regarding to decrease the risk of «shear» and «sliding forward». START USING TILT BEFORE USING RECLINE TO REDUCE SLIDING For many persons with neuromuscular diseases it is necessary several times during the day to reduce the negative influence of the gravity forces on the spine by resting backwards in the wheel chair. To reduce the risk of sliding of the body when getting into resting position, always start using tilt in space and then use recline. And when returning to upright sitting position always start with recline and then tilt in space. Source: Best Practice Guidelines (BPG13) Tilt, Recline and Elevating Leg rest for Wheelchairs prior to workshop at the 4th International Interdisciplinary Conference on Posture and Wheeled Mobility; SECC, Glasgow, 7 9 June 2010 WHEN RECLINING, FIRST TILT THEN RECLINE TO REDUCE SHEAR FROM SLIDING FORWARD Note on Shear: Shear/friction are necessary to keep the person from sliding out of the chair the key is to avoid having that shear/friction where normal forces are highest (i.e., not on the bony prominences). The solution is to make the coefficient lowest where the pressures are highest, and highest where the pressures are lowest. Taylor found that when you control shear, you can significantly reduce pressure at a decubitus ulcer by a factor of six. Source: Taylor V. Pressure Mapping Clinical Protocol. 1999 ISS Handbook.

Learn more about prevention and treatment of pressure ulcers and international agreed Best Practice The Quick Reference Guide by EPUAP/NPUAP and other organizations listed below presents a summary of the recommendations and excerpts of the supporting evidence for pressure ulcer prevention and treatment. The goal of this international collaboration was to develop evidence-based recommendations for the prevention and treatment of pressure ulcers that could be used by health professionals throughout the world. An explicit scientific methodology was used to identify and critically appraise all available research. In the absence of definitive evidence, an expert opinion (often supported by indirect evidence and other guidelines) was used to make recommendations. THE QUICK REFERENCE GUIDE is intended for busy health professionals who require a quick reference in caring for individuals in the clinical setting. PRINTED COPIES OF THE ENGLISH VERSION OF THE QUICK REF- ERENCE GUIDE can be ordered, and PDFs downloaded, from the following websites: NPUAP npuap.org EPUAP epuap.org Australian Wound Management Association (AWMA) awma.com.au Hong Kong Enterostomal Therapists Association Society www.etnurse.com.hk New Zealand Wound Care Society (NZWCS) nzwcs.org.nz Wound Healing Society Singapore woundhealingsociety.org.sg International Pressure Ulcer Guideline internationalguideline.com Source: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014. THE USE OF NPUAP/EPUAP/PPPIA material does not imply endorsement of products or programs associated with the use of the material. My-Netti.com 11

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