(Andriaasen, Asbeck, Lindeman, vand der Woude, de Groot, & Post, 2013)

Transcription

1 RESNA 2015 GINGER WALLS, PT, MS, NCS, ATP/SMS CLINICAL EDUCATION SPECIALIST, PERMOBIL RUSS ROLT VICE-PRESIDENT OF SALES AND BUSINESS DEVELOPMENT FOR ACTIVE CONTROLS, LLC 6/13/2015

2 Learning Outcomes Participants will be able to discuss 3 considerations in evaluation for power wheelchair input devices. Participants will be able to discuss 3 important considerations for the therapist, AT provider, and client to discuss when considering location of the power wheelchair input device. Participants will be able to identify 3 different alternative input device options for power wheelchairs and considerations for their use. Participants will be able to discuss 3 features of proposed new assessment and documentation tool, which can be used in assessment of alternative power wheelchair input devices.

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4 4 (Andriaasen, Asbeck, Lindeman, vand der Woude, de Groot, & Post, 2013)

5 ASSESSMENT Primary Diagnosis/Prognosis Past Medical History/Secondary Diagnoses/Co-Morbidities Past Surgical History (related to seating and mobility) Future Surgical/Medical/Therapeutic Interventions 5

6 ASSESSMENT Subjective Assessment (Client Interview) Cognition Speech and Language Cardiovascular, Respiratory, Digestive, Urinary Systems Can also be assessed objectively or referred out for further evaluation Objective Assessment (Mat Evaluation) Posture and Postural Control (sitting balance) Anatomical measurements Skin Integrity Neuromuscular System (strength, ROM, tone, coordination, sensation) Vision Current Mobility Skills: Amb, Manual w/c Propulsion, Power w/c Operation 6 (independence, safety, efficiency, etc.)

7 ASSESSMENT Issues and Limitations of Current Wheelchair Seating and Positioning Seat Functions and their uses Mobility Limitations Other Assistive Technology Used Especially in conjunction with wheelchair Augmentative and Alternative Communication Device (AAC) Computer Environmental Control Units (EADL units) 7

8 ASSESSMENT MRADLs Eating, Grooming, Dressing, Bathing, Toileting, Transferring, Communicating, Engaging in Sexual Activity IADLs Safety Procedures/Emergency Response, Telephone Use, Parenting, Directing Caregivers, Caring for Service Animals, House Cleaning, Laundry, Meal Preparation, Use of Transportation and Community Mobility for School, Work, Shopping, Banking, Socializing, Recreation NOTE: Movement pattern/technique used ensure wheelchair design/components promote maximum function and safety; document level of independence with/without power mobility 8

9 ASSESSMENT Home School Work Community Transportation Terrains Weather Conditions Support System/Caregivers Enter/Exit settings Maneuver within settings Reach/Access items Transfer to/from wheelchair Use personal or public transportation 9

10 Evaluation Factors Consumer s Goals Where and what is their control? Proper positioning to increase stability Should not have to work to access the drive control Progression of medical condition Cognitive ability Visual/perceptual abilities

11 Progressive Diseases: Plan for the need to make changes - dx specific considerations should be taken into account Ensure that the seating system can react to functional declines. Do not over work muscles or stress to fatigue! Document functional status & plan for equipment at the most fatigued level.

12 EQUIPMENT RECOMMENDATION/SELECTION Generate list of functional requirements. Translate that list into seating and mobility goals. Determine which products offer desired capabilities and features to support these goals. Arrange an equipment trial to assist in client s final product selection (using a variety of options). Use objective measures to compare products (photographs, skills performance, pressure mapping, etc.) 12

13 EQUIPMENT RECOMMENDATION/SELECTION If possible, a short term trial of equipment is beneficial. Wheelchair skills/mobility training may also be necessary to improve safety and and independent functioning. (Kirby et al, 2004, Best et al, 2005, & Kirby et al, 2006) Once a client demonstrates the potential for safe mobility using the trial device, a recommendation can be made and additional training can be scheduled to maximize abilities. 13

14 EQUIPMENT RECOMMENDATION/SELECTION Do the best you can at mocking up the system. Contact manufacturers for demo equipment Be creative with seating/positioning supports. Pool noodles, blanket/towel rolls, wedges, pillows Rely on past experience of team members. Trial equipment is rarely, if ever, perfect May need to schedule a follow up appointment when appropriate trial equipment is available. 14

15 Adult with SMA. Trialing single switch driving (Magitek izip3) mounted on ring on non-functional hand; utilizing postural support of present custom seating system in manual tilt w/c

16 LOCATION - Best location for consistent, safe, non-accidental access Consider mounting options SWITCH TYPE Consider force required, fatigue issues in that location PROGRAMMING Improve control, safe function

17 EQUIPMENT RECOMMENDATION/SELECTION What is the location of their most consistent control? What type of movement pattern is used? Visual/Perceptual abilities/limitations must be noted and addressed. Proper positioning/support is very important! Client should not have to work to activate the input device. Don t want positioning components to restrict movement too much. 17

18 Pelvis Positioning Lateral trunk supports (swing away) Consider after market backrest? Headrest lateral positioning pads Extremity support 7.PNG

19 Next Step - Access Chin Control Types Aesthetics/Size? Sensitivity? Chin boom vs. Haimes harness vs Center Mount? Aesthetics? Caregiver ease? Swing away? Removable? Power Recline?

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23 Mounting Examples Compact Joystick I I Permobil Corp.

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29 Before Switching a Drive Input Device Positioning/Support Must have proximal stability to improve distal mobility Input Location Adjustability of the Mounting Hardware? Interface Programming Speeds Acceleration/Deceleration Joystick throw Tremor Dampening

30 Issue Stability & Consistency Considerations What is the most consistent control site? (Hand, chin, head, foot, etc?). Location Control Movements ROM Endurance & Fatigue Do different positions elicit more/less stability and control (midline mount, raising/lowering the joystick, etc.) With this control site, is there fine control or will gross movements suffice? How much movement is required to effectively operate the input? What about during tilt or recline? Does the driver have enough endurance for the chosen input device? Interface A custom goal post, tennis ball, etc. 30

31 EQUIPMENT RECOMMENDATION/SELECTION Proportional Controls Infinite control of speed (0-max) and 360 of direction Continuous and fluid response while moving further from neutral Non-Proportional (Switched, Digital) Controls Either ON or OFF Up to 8 discrete directions (Fwd, Rev, Left, Right, and every 45 between) Can be programmed for single or multiple speeds 31

32 less Single Switch Stability, Control, AROM, Endurance Multiple Switches Specialty Input Device (SID): Proportional Input 32 more Standard Joystick

33 less EADLs Stability, Control, AROM, Endurance SIDs (Drive Controls) Seat Function Control (Tilt/Recline/ELRs) 33 more Performance Adjustments (speeds, ACC/DEC, Joystick Throw, etc.)

34 Relationship: Ability & Technology Ability & Technology have an inverse relationship Decreasing Ability requires Increasing Technology 34

35 PROPORTIONAL JOYSTICKS AND HANDLES

36 Joystick Throw Joystick Throw: How far from center the joystick moves to access full speed. Light Joysticks: HMC Compact JS Lite: 17mm ASL MEC JS: 13 mm Standard Joysticks: 28mm Ultra-Light Joysticks: HMC Mini JS: 3mm ASL MEC Light JS: 6 mm Switch-It MicroGuide: 6 mm HMC VIC: 2 mm 15 mm Switch-It MicroPilot: 0 mm

37 Joystick Force Joystick Force: How much strength is required to move the joystick Standard JS Light JS Ultra-Light JS 0 ASL HMC Switch-It

38 Compact Joystick Lite Larger Throw Less Sensitive Used at: Chin Hand Foot Anywhere! 38

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41 PROPORTIONAL SID S Video Game Controller Switch-It Micropilot

42 Playstation Controller

43 Non-Proportional SID s Sip-n-Puff/Head Array Active Touch Head Array Microswitch Fiber Optics

44 Switch Options Fiber Optics TCHA Head Array

45 OTHER SWITCH OPTIONS

46 On/off/mode switches Switch Placement? Can re-mount for chin access Reposition for different part of face/head Switch type? Change electric switch Proximity, Touch Contact, Fiberoptics Programming? Remove Switch altogether? Timeout to menu/scan

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50 Head Array - Options! Easily adjustable Plug and play switches Not tied to the head Use anywhere Electric or Mechanical 50

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52 Initial Programming Parameters or Learner s Permit Driving Reduce overall speed (while maintaining chair responsiveness) Reduce power and torque Understand how to modify acceleration and deceleration to fit the needs of the client When would you to increase/decrease acceleration? If Switch Driving, try going and stopping Or, only provide a switch in one direction to start Usually turning Circles Consider remote stop switch

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54 Why Program? Set different parameters for different environments Optimize driving skills and control of environment Modify settings as needs change Progressive conditions Learning Compensate for range of motion, motor control deficits Identify type of specialty input device being used

55 Assessment Tool: Eval/Documentation of Power Input Device Scale: Dependent = 1 Posture/Balance: Unable to maintain balance and access control. Motor Control: Unable to access/operate control due to motor control/rom limitations. Driving Skill: Unable to operate wheelchair at all. Assist Required = 2 Posture/Balance: Loses position when attempting to drive and requires assistance of caregiver to reposition body in wheelchair. Motor Control: Requires assistance of caregiver to reposition self and/or wheelchair when attempting to drive due to motor control/rom limitations. Driving Skill: Requires physical assistance/intervention of caregiver to operate wheelchair safely when attempting to operate wheelchair in own environment of use.

56 Assessment tool (continued ) Supervision/Cues Required = 3 Posture/Balance: Requires supervision and/or cues for position of body due to loss of position when attempting to drive. Motor Control: Requires supervision and/or cues to reposition self and/or wheelchair when attempting to drive due to motor control/rom limitations. Driving Skill: Requires supervision and/or cues from caregiver to operate wheelchair safely in own environment of use. Independent = 4 Posture/Balance: Able to maintain posture/balance in seating system safely and independently when operating wheelchair. Motor Control: Able to independently and safely manage position of self and wheelchair without limitation from motor control/rom. Driving Skill: Able to independently and safely operate wheelchair and seating system in own environment of use.

57 Example Assessment Table for Performance with Input Device/Condition Variation Trial 1: Date: Trial 2: Date: Trial 3: Date: Trial 4: Date: Trial 5: Date: Trial 6: Date: Trial 7: Date: Trial 8: Date: Trial 9: Date: Arm rest mounted Standard joystick Midline Mounted Std Joystick Midline Mounted Std Joystick with Programming to decrease throw Midline Mounted Micropilot Joystick Chin Control mount of compact joystick light Haimes Harness mount of minijoystick Alternative Midline mount of minijoystick Head Array Sip and Puff Client Posture/Balance Motor Control/ROM Driving Skill Total Points: 1= Dependent 2= Assistance Required 3= Supervision/Cues 4= Independent Comments: Clinician Signature/Date:

58 EQUIPMENT RECOMMENDATION/SELECTION Therapist, Supplier, or Parent/Caregiver use the chair first 58 Demonstrate the chair functions Clarify expectations Do not direct too much Be Quiet!

59 EQUIPMENT RECOMMENDATION/SELECTION The very skills that are required to be safe develop through independent mobility. (Age) Appropriate Supervision 59

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