november 2016 • vol. 15 no. 11 serving the seating and

mobilitymgmt.com

November 2016 • Vol. 15 No. 11 Serving the Seating and Wheeled Mobility Professional

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4 mobilitymgmt.comnovember 2016 | mobilitymanagement

contents

Cover Story

16 Defining DynamicComplex rehab technology’s buzzword: Seating & mobility

systems that move, change and adapt in real time.

23 Accessibility ComparoPictorial and specification comparisons of products that

make environments in the home and outside it more

accessible for wheelchair users and their families.

Mobility Management (ISSN 1558-6731) is published monthly by 1105 Media, Inc., 9201 Oakdale Avenue, Ste. 101, Chatsworth, CA 91311. Periodicals postage paid at Chatsworth, CA 91311-9998, and at additional mailing offices. Complimentary subscriptions are sent to qualifying subscribers. Annual subscription rates payable in U.S. funds for non-qualified subscribers are: U.S. $119.00, International $189.00. Subscription inquiries, back issue requests, and address changes: Mail to: Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866, email [email protected] or call (847) 763-9688. POSTMASTER: Send address changes to Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866. Canada Publications Mail Agreement No: 40612608. Return Undeliverable Canadian Addresses to Circulation Dept. or XPO Returns: P.O. Box 201, Richmond Hill, ON L4B 4R5, Canada.

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novembervolume 15 • number 11

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On the CoverThe joy and functionality of movement. Concept by Laurie Watanabe. Cover by Dudley Wakamatsu.

mobilitymgmt.com

November 2016 • Vol. 15 No. 11 Serving the Seating and Wheeled Mobility Professional

Statement of Ownership, Management and Circulation1. Publication Title: Mobility Management2. Publication Number: 1558-67313. Filing Date: September 30, 20164. Frequency of Issue: Monthly5. Number of Issues Published Annually: 126. Annual Subscription Price: US $119, International $1897. Complete Mailing Address of Known Office of Publication: 9201 Oakdale Ave., Ste. 101, Chatsworth, CA 913118. Complete Mailing Address of the Headquarters of General Business Offices of the Publisher: Same as above.9. Full Name and Complete Mailing Address of Publisher, Editor, and Managing Editor: Karen Cavallo, Group Publisher, 9201 Oakdale Ave., Ste. 101, Chatsworth, CA 91311 Laurie Watanabe, Editor, 9201 Oakdale Ave., Ste. 101, Chatsworth, CA 91311 10. Owner(s): Stevens Publishing Acquisition, Corp. (SPAC), 9201 Oakdale Ave., Ste. 101, Chatsworth, CA 91311. Listing of shareholders in SPAC.11. Known Bondholders, Mortgagees, and Other Security Holders Owning or Holding 1 Percent or more of the Total Amount of Bonds, Mortgages or Other Securities: Nautic Partners V, L.P., 50 Kennedy Plaza, 12th Flr., Providence, RI 02903 Kennedy Plaza Partners III, LLC, 50 Kennedy Plaza, 12th Flr., Providence, RI 02903 Alta Communications IX, L.P., 1000 Winter Street, South Entrance, Suite 3500, Waltham, MA 02451 Alta Communications IX, B-L.P., 1000 Winter Street, South Entrance, Suite 3500, Waltham, MA 02451 Alta Communications IX, Associates LLC, 1000 Winter Street, South Entrance, Suite 3500, Waltham, MA 0245112. The tax status has not changed during the preceding 12 months.13 Publication Title: Mobility Management14. Issue date for Circulation Data Below: September 201615. Extent & Nature of Circulation: Average No. Copies Each Month No. Copies of Single Issue During Preceding 12 Months Published Nearest to Filing Date a. Total Number of Copies (Net Press Run) 8,835 8,567 b. Legitimate Paid/and or Requested Distribution 1. Outside County Paid/Requested Mail Subscriptions Stated 5,539 6,223 on PS Form 3541 2. In-County Paid/Requested Mail Subscriptions Stated 0 0 on PS Form 3541 3. Sales Through Dealers and Carriers, Street Vendors, Counter 4 0 Sales, and Other Paid or Requested Distribution Outside USPS® 4. Requested Copies Distributed by Other Mail Classes Through 0 0 the USPS c. Total Paid and/or Requested Circulation 5,543 6,223 d. Nonrequested Distribution 1. Outside County Nonrequested Copies Stated on PS Form 3541 2,881 2,231 2. In-County Nonrequested Copies Distribution Stated on 0 0 PS Form 3541 3. Nonrequested Copies Distribution Through the USPS by Other 0 0 Classes of Mail 4. Nonrequested Copies Distributed Outside the Mail 329 43 e. Total Nonrequested Distribution 3,210 2,274 f. Total Distribution 8,753 8,497 g. Copies not Distributed 82 70 h. Total 8,835 8,567 i. Percent paid and/or Requested Circulation 63.33% 73.24%16. Electronic Copy Circulation a. Requested and Paid Electronic Copies b. Total Requested and Paid Print Copies (Line 15c) + Requested/Paid Electronic Copies c. Total Requested Copy Distribution (Line15f) + Requested/Paid Electronic Copies (Line 16a) d. Percent Paid and/or Requested Circulation (Both print & Electronic Copies) (16b divided by 16c x 100) I certify that 50% of all my distributed copies (electronic and print) are legitimate requests or paid copies.17. Publication of Statement of Ownership for a Requester Publication is required and will be printed in the November 2016 issue of this publication.18. I certify that all information furnished on this form is true and complete: Peter B. Weller, Manager, Print Production

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Editor Laurie Watanabe (949) 265-1573

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mobilitymgmt.com

Volume 15, No. 11

November 2016

REACHING THE STAFF

Staff may be reached via e-mail, telephone, fax, or mail. A list of editors and contact information is also available online at mobilitymgmt.com.

E-mail: To e-mail any member of the staff, please use the following form: [email protected]

Dallas Office (weekdays 8 a.m. - 5 p.m. CT) Telephone 972-687-6700; Fax 866-779-9095 14901 Quorum Drive, Suite 425, Dallas, TX 75254

Corporate Office (weekdays, 8:30 a.m.-5:30 p.m. PT) Telephone 818-814-5200; Fax 818-734-1522 9201 Oakdale Avenue, Suite 101, Chatsworth, CA 91311

Chief Executive Officer Rajeev Kapur

Chief Operating Officer Henry Allain

Chief Technology Officer Erik A. Lindgren

Executive Vice President Michael J. Valenti

Executive Chairman Jeffrey S. Klein

INFRASTRUCTURE SOLUTIONS GROUP

President & Group Publisher Kevin O’Grady

Group Publisher Karen Cavallo

Group Circulation Director Margaret Perry

Group Marketing Director Susan May

Group Social Media Editor Matt Holden

Food for Thought

You know what I’ve decided? Medications cost far too much to formu-late, test, fine-tune, test again, take through trials, manufacture, distribute, prescribe, regulate and deliver. Even over-the-counter meds

are too expensive.So I’ve cooked up a replacement that

costs far less. Look left: That’s a photo of my miracle cure. It provides hydration, can help clear sinuses and could help to reduce inflammation. And it’s so much cheaper than those medications that treat bacterial infections. You’re welcome.

Does that sound familiar? How about if I substitute wheelchair for medications? Now does it sound familiar?

Among my daily tasks is reading “newswire” stories, which in the Internet age includes information that arrives via e-mail and social media. And wow, am I tired of mainstream news stories and press releases that begin, “Fed up with the exorbitant prices of wheelchairs, these inventors set out to build something better.” The story then triumphantly explains that the materials to build this new wheelchair cost only a few hundred dollars, largely because they tend to include lawn chair-style seats, a skateboard and some zip ties.

I’m not talking about wheelchairs designed specifically for developing nations, or about the cool early-intervention powered ride-ons that Dr. Cole Galloway and colleagues build for infants and toddlers. Those systems are designed with purpose by people familiar with seating, mobility and the challenging environments in which they must function.

No, I’m frustrated by amateurs who seemingly glance at complex rehab technology and decide — based on price tags alone — that they can make something better. “Granny loves her new wheelchair that we built in our garage,” they say. “And we just used our kid’s old scooter and some leftovers from the tool shed.”

These stories are picked up by unwitting media and feed the under-edu-cated belief that any complex rehab technology costing more than a few hundred bucks is unreasonably priced. That includes chairs custom made to accommodate an asymmetrical or fixed posture. Or a seating system hand-built for a user with half a pelvis and precious little body surface left to bear weight. Or the head array to enable a client with a high cervical injury to independently weight shift every hour to avoid pressure injuries.

Knowledgeable innovation is great. But claiming that untested, DIY wheel-chairs are effective isn’t just annoying. It’s dangerous because all the wrong people are eager to believe it. Yeah, we’ll take the word of the guy rolling down the hill in his lawn chair with no brakes!

Hot chicken soup really can help a stuffy nose. But it doesn’t lower blood pressure, clear up psoriasis or treat depression. Do people cook a pot of chicken soup, feed it to Granny, then proclaim it a cheaper and better cure for her osteoporosis?

Then where is the respect for complex rehab technology? l

Laurie Watanabe, [email protected]

@CRTeditor

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NSM Symposium: Sharing & Celebrating ATP Excellence

NASHVILLE, Tenn. — Attending the annual National Seating & Mobility (NSM) symposium always feels like old home week in the best possible ways.

Over the years, the venues have changed — 2002’s event, the first symposium attended by a brand-new Mobility Management, was in Los Angeles. Subsequent editions of the educational and leadership meeting have taken place in Scottsdale, Ariz., and at different hotels and convention halls in Nashville, NSM’s corporate backyard.

Also over the years, the number of ATPs coming together has grown substantially, a fact that always hits home in stunning fashion upon walking into the ballroom

for breakfast on the symposium’s first day. A decade ago, most of NSM’s growth seemed organic in nature, with the company opening new branch offices. In recent years, as the complex rehab technology (CRT) industry has seen turbulent funding times, a signif-icant portion of NSM’s more recent expansion has come via acquisition of other CRT providers.

Still, the symposium dependably has an energetic, upbeat, yet relaxed vibe, and you get the feeling that the ATPs relish the chance to sit and chat over coffee with colleagues usually thou-sands of miles away. There is, after all, a lot of clinical and technological experi-ence in that room, and therefore always an opportunity to learn something new.

A New Financial PartnerThis July, NSM met at Nashville’s sprawling Gaylord Opryland Resort & Convention Center, famous for its picturesque gardens and wandering walkways (not to mention a river and riverboat tours inside the hotel). NSM effectively commandeered the resort’s Magnolia wing, which became CRT Central for ATPs, educational presenters and seating/mobility manufacturers.

Just a few weeks after the meeting, NSM made a major announcement: The company had entered into a purchase agreement with Court Square Capital Partners, thus ending its relationship with owner Wellspring Capital Management. The new agreement was expected to take

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Jay Doherty (Quantum Rehab) talked about the hierarchy of power chair driving controls.

Tom Whelan discussed Ki Mobility’s many manual wheelchair offerings, including the Rogue.

ROHO’s long-awaited AGILITY carbon fiber backrest got plenty of attention from ATPs.Lisa Rotelli presented complex case studies involving Adaptive Switch Labs’ alternative driving controls.

Thanks for letting Mobility Management share a table with you, Ralph Booker (Oakdale, Pa., office)!

In the expo hall, Judy Rowley gave a demonstration of a Motion Concepts’ head positioning system.

approximately 60 days to finalize, and that process was ongoing as this issue went to press.

Bill Mixon, CEO/president of NSM, told Mobility Management, “We feel very good about Court Square. We look forward to partnering with them. We think that they’re going to be an outstanding partner for our busi-ness, and we don’t see this as changing in any way our fundamental strategy in the marketplace. So we look forward to continuing our existing strategy.”

Mixon emphasized that he doesn’t expect NSM’s day-to-day stakeholders — clinicians and consumers — to

notice a change in how the company conducts business.“Our financial sponsor is a partner to us, but the fact

that we’ve changed our financial sponsor won’t change our operational approach to the business in any way,” Mixon said. “We think Court Square has a great reputation in the marketplace. They’re an experienced private equity team, and as a partner, they’re going to be supportive of our continued mission of taking care of clients that need sophisticated complex rehabilitation services.

“I think our team is excited about the future. We’ve had a very good relationship with Wellspring, and our team is

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NSM Symposium 2016very optimistic that we’re going to have a great relation-ship with Court Square.”

Education & ExperienceAs for NSM’s latest symposium, Mixon praised “the growth and the exciting energy that we have going on right now,” and agreed that the cumulative experience of the provider’s ATP corps is a precious thing.

“We’re very proud of it,” he said of his ATPs’ knowl-edge and their willingness to share their experiences with peers. Of the symposium, he added, “We want to

educate, we want a dialog, we want to reinforce our clinical culture. It’s very important to us. We try to do all those things at the symposium and put a lot of energy and effort into that meeting.”

And yes, NSM’s future includes plans for continued growth, via both acquisitions and new branch office creation.

“[Court Square] is going to help us continue our important clinical mission,” Mixon said. “We’re feeling good about it.” l

— Laurie Watanabe

Accessibility equipment from Bruno Independent Living Aids offer complementary solutions for wheelchair users and their families.

Gerry Dickerson, with his family, introduces his new granddaughter (and possibly a future ATP).

Dena Paxton, ATP (left), and Cyglenda Abbott, ATP (right), with Sunrise Medical’s Angie Kiger.

Amysystems’ wide range of powered positioning options and power wheelchairs drew a crowd.

All smiles in the National Seating & Mobility exhibit hall. Frank Lane, Honolulu office, test drives a Quickie QM-710.

A first look at Nessie pediatric positioning prod-ucts in the Columbia Medical booth.

Leggero showed off pediatric mobility products designed for kids with complex needs.

Yes, a river (not to mention boats) runs through the scenic Gaylord Opryland.

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mobilitymgmt.com 13mobilitymanagement | november 2016

Study: Common Disorders Frequently Misdiagnosed as Multiple SclerosisMigraine headaches and fibromyalgia are among the common disorders frequently misdiagnosed as multiple sclerosis (MS), according to a new research study.

Researchers at the University of Vermont College of Medicine, Mayo Clinic, Washington University and Oregon Health & Science University conducted the study, which also investigated why so many patients with other conditions are told they have MS.

In a University of Vermont announcement, lead author Andrew Solomon, M.D., assistant professor of neurolog-ical sciences, said, “Although many rare disorders are known to mimic MS, it appears that presently, a number of common disorders are frequently mistaken for MS.”

The conditions most commonly misdiagnosed as MS, the study said, were migraines, fibromyalgia, psycholog-ical conditions, neuromyelitis optica spectrum disorder, and abnormal MRIs with unexplained symptoms.

The 24 MS specialists in the study discovered 110 patients who’d been misdiagnosed, and 72 percent of them had taken medications for MS, in some cases

for years. Several wrongly diagnosed patients had also taken part in MS clinical trials.

Solomon, division chief of MS at the University of Vermont College of Medicine, pointed out misdiagnosed patients who underwent MS treatments were unneces-sarily exposed to significant side effects. They also missed out on treatments for the conditions they actually had.

The news announcement pointed out that diag-nosing MS can be difficult because “there is no specific biomarker or blood test for the disease, which likely stems from a variety of combinations of genes and environ-mental triggers. In addition, the related nerve damage can cause a wide range of symptoms, many of which are often also associated with different ailments.”

The MS specialists discovered that clinicians working with misdiagnosed patients might have misinterpreted diagnostic criteria. “MS can be challenging to diagnose correctly,” Solomon said. “Our study suggests that the misinterpretation and misapplication of MS diagnostic criteria are important contributors to misdiagnosis.” l

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University of California Health System Voices Concern Over Competitive BiddingThe executive VP of the University of California Health system (UC Health) wrote an Aug. 22 letter to the Centers for Medicare & Medicaid Services (CMS) to express deep concern over the agency’s competitive bidding program for Medicare durable medical equipment (DME).

In September, the American Association for Homecare (AAHomecare) shared the letter by John D. Stobo, M.D., executive VP of UC Health, to Andy Slavitt, acting admin-istrator for CMS.

The UC Health system comprises 12 hospitals and 18 health professional schools on seven University of California campuses: Berkeley, Davis, Irvine, Los Angeles, Riverside, San Diego and San Francisco. Stobo referred to it as “America’s largest academic health system.”

In the letter, Stobo pointed out that the competitive

bidding program “has led to a number of unintended consequences that, with proper oversight and program changes, can be avoided.”

Stobo said after competitive bidding was imple-mented, personnel in the UC Health system began having problems getting the DME they needed.

“Hospitals throughout California began to report difficulty obtaining medically necessary equipment on a timely basis,” Stobo said in his letter. “In some cases, they reported that designated suppliers had dropped out of the program, thus limiting DME availability in the region. In others, suppliers implemented reduced or inflexible delivery schedules or required that a family member pick up the item at a storefront location.”

Stobo added that patients weren’t able to be promptly

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mobilitymgmt.com 15mobilitymanagement | november 2016

discharged from hospitals, hospitals had to loan DME to patients who were going home, or patients had to purchase the DME out of pocket “even when the items should have been provided and paid for by Medicare.”

While the competitive bidding program has been highly controversial, CMS has steadfastly maintained that it has received few complaints from beneficiaries. Stobo’s letter challenges those assertions and also ques-tions the efficiency and usability of the quality-control measures CMS currently has in place.

“Unfortunately, hospitals do not report any interven-tion by [CMS customer service representatives] beyond providing a list of DME providers from the Web site,” Stobo wrote. “UC Health believes Medicare should capture situations in which a hospital case manager has called every listed DME provider and none are able to meet the expectations for timely delivery to the hospital or benefi-ciary home to ensure a safe discharge.”

Stobo added, “Case managers report lengthy wait times in accessing CSRs during business hours.”

And Stobo said competitive bidding lowered the importance of high-quality customer service.

“Hospital personnel note that prior to [competi-tive bidding’s] implementation, case managers and

discharge planners were able to select DME suppliers based on their level of customer service, including their demonstrated dependability and consistency in deliv-ering required items within the necessary time frames,” Stobo said. “They express frustration that they are no longer able to select DME suppliers based on what is in the patient’s best interest, but must use suppliers that, in their view, provide substandard customer service.”

He urged CMS to work with DME suppliers to create a streamlined system so DME can be efficiently delivered to hospitals and post-acute care providers.

“We believe that one conduit for the issue’s identifica-tion and resolution, with appropriate steps for escalation, is the only way CMS will truly be able to capture real-time information that can be evaluated and acted upon,” Stobo said in his letter. He also suggested that CMS launch pilot programs in California “to test the scalability of an approach that could be refined as needed.”

He acknowledged that any new system would be expected to encounter initial difficulties, but noted that the competitive bidding process is no longer new.

“We are concerned,” Stobo wrote, “that many [prob-lems] have yet to be fully resolved despite several years of implementation.” l

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I

ATP Series

It’s ironic that an industry called seating and wheeled mobility has at times been static when designing systems for clients with complex needs. In the past, the strategy was often to position them in their wheelchairs and then make sure they stayed in exactly the same place all the time.

That scenario required wheelchair users to do something able-bodied people were not expected to do: Stay still. Yes, there were weight shifts — intermittent tilting and reclining, or push-ups to relieve pressure. But in between, wheelchair users were set into prescribed, largely static positions that were expected to suffice for hours every day.

The human body and mind aren’t meant to remain placid, and complex rehab’s buzziest term right now might be dynamic, meant to describe seating or mobility that moves or changes much more frequently, quickly and functionally than in the past.

But within that single word are several different interpreta-tions, because fittingly, there is more than one way to move.

Different DynamicsCurrently, the word dynamic is applied to complex rehab in a few distinct ways:• Dynamic seating: Seating systems and components often

described as moving with the client, typically when the client experiences spasticity or high muscle tone and pushes against seating components. A client might lean or push against positioning components, such as a harness, intentionally, such as when leaning forward to reach something on a table. Can

also include seating systems that can be very easily, quickly and repeatedly adjusted to fit clients’ needs.

• Dynamic feedback: Systems designed to provide movement in response to the client’s movement, which can aid with proprioception and balance, and can help to reassure clients with sensory issues.

• Dynamic wheeled mobility: Wheelchairs that can change aspects of their configuration very quickly and repeatedly in

By Laurie Watanabe

In Complex Rehab, One Word Is Full of Possibilities

Product name: AEL’s Omnilink Swing-Away Lateral BracketWhat makes it dynamic: Includes a unique telescoping feature that allows the pad to be locked at varying depths without requiring the use of additional links. How the wheelchair client benefits: The telescoping feature provides additional lateral pad pressure prevention. A complication frequently seen with non-adjustable lateral pads is the increased pressure that develops between the user’s trunk and the lateral pad. For clients who pose a significant risk for skin breakdown, especially as a result of an aggressive seating posture (e.g., hypertonicity, repetitive or writhing motions), the telescoping function will allow slight pad adjustments to be made on a routine basis. Adjustments can be made while the client is seated in the wheelchair, bringing the pad toward the posterior aspect of the client’s trunk, repositioning in neutral and/or advancing the pad to the anterior trunk — all by adjusting the depth of the telescoping base. This adjustment allows for a shift in pressure application and the preven-tion of pressure injuries or skin breakdowns under the laterals. (866) 656-1486; aelseating.com A

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response to changes in environment or a client’s functional needs.The different interpretations have a couple of things in

common. Wheelchairs or seating systems with dynamic features must still optimally carry out their primary positioning and mobility functions; those goals can’t be sacrificed for the sake of the dynamic components. And ideally, dynamic features will work in concert with the rest of the system to provide a whole

experience greater than the sum of its components.As Steve Mitchell, OTR/L, ATP, says of the different types

of dynamic technology now available, “What they [all] have in common are improving function.”

Check out these “dynamic dynamos,” complex rehab compo-nents and systems that feature different dynamic functions, all in the name of better accommodating clients with complex needs. l

Product name: Matrix Seating USA’s Easy FitWhat makes it dynamic: Adjustable micro-modular custom-molded wheelchair seating is infinitely adjustable and flexes to accommodate the client while maintaining the client’s position. Matrix Seating also flexes with the wheelchair movement resulting in shock absorption and reducing sheer and pressure.How the wheelchair client benefits: The adjustable micro-modular custom mold can be added to or reduced, as the user’s size requires. For example, Matrix Seating can be easily grown to accommodate weight gain and body shape changes. Matrix Seating adjustability can enable incremental changes to posi-tioning in order to provide orthotic spinal correction. (800) 986-9319; matrixseatingusa.com

Product name: Symmetric Designs’ Axion Rotary InterfaceWhat makes it dynamic: Enables headrest pads and head positioning devices to rotate with the user’s head, transforming headrests into dynamic posi-tioning devices.How the wheelchair client benefits: When the Axion is implemented with the user’s head support, it allows the head support device to rotate, resulting in reduced shear forces, increased peripheral vision and users can now have their head supported while still having freedom to move their head horizontally. (800) 537-1724; symmetric-designs.com



Defining Dynamic Wheeled Mobility

quickly and routinely change their seated config-urations. “I’m using the term on the fly — indepen-dent adjustment for my chair and my seating,” Borisoff says. “The motivation behind it is function — things you can’t do or have difficulty doing. An additional benefit is also probably better health outcomes.”

Mitchell calls this concept dynamic wheeled mobility, and says it “represents an entirely different way of thinking about what the ultra-light’s configuration should do for its user. It combines the concept of dynamic reconfigura-tion with the use of recently introduced add-on components to give users the ability to quickly

change the base configuration of their chair for better usability in multiple environments and activities.”

The difference between dynamic wheeled mobility and dynamic seating, Mitchell adds, is “While both address problems caused by a static configuration, the similarities end there. Dynamic seating involves using designs and components which manage forces between the user and the seating system. It is a way to mitigate the effects of increased tone and excessive movement. Jaimie and I had independently come to the realization that the ability to

ATP Series

Defining DynamicProduct name: EasyStand’s GliderWhat makes it dynamic: Features Active Standing Technology that enables a user or caregiver to facilitate motion with the arms that is reciprocated in the legs. How the wheelchair client benefits: Simulates the motion of cross-country skiing, which provides increased range of motion at the ankles and hips while also weight bearing. Adjustable resistance cylin-ders can also be engaged to provide additional possibilities for cardiovas-cular conditioning. Users complete a self or assisted transfer in a seated position and use the hydraulic or optional electric lift to stand. Sit-to-stand provides a gradual transition to standing and allows those with tightness the ability to progress toward full extension. (800) 342-8968; easystand.com

Product name: Bodypoint’s PivotFit Shoulder HarnessWhat makes it dynamic: Bodypoint dynamic posture supports include propri-etary materials to control the amount of stretch and provide comfortable movement. The manufacturer tests to ANSI/RESNA WC-3: S3 2013 Standard for Postural Support Devices to ensure product safety and performance. The dynamic PivotFit provides a body-contouring shape with curve-hugging Laminar Pads. This support is used for shoulder retraction and/or trunk rotation. The carefully engineered swivel buckle equalizes tension to allow for precise pad placement for an individualized fit. How the wheelchair client benefits: Jordan (pictured) gained stability and head control using the dynamic PivotFit. Now he operates a head array mouse system for computer use in school and for fun. (800) 547-5716; bodypoint.com

SSteve Mitchell is a clinician at the Cleveland VA Medical Center. Among his focuses are veterans with spinal cord injuries, and Mitchell himself is an ultralightweight wheelchair user.

Jaimie Borisoff, Ph.D., product manager of high-performance wheelchairs at PDG Mobility, also uses an ultralight wheelchair. In addition to designing for PDG, Borisoff is the Canada Research Chair in Rehabilitation Engineering Design at the British Columbia Institute of Technology.

Borisoff designed, and Mitchell has used, the new PDG Elevation, an ultralightweight manual wheelchair capable of changing configurations as its user’s environment or tasks demand.

Borisoff notes the different forms of dynamic seating systems, from “when you basically have a backrest or a footrest with a spring on it, and it’s for clients with tone and spasticity as a means of absorbing energy and/or increasing range of motion,” to manual wheelchair seating with tilt and recline: “And in most cases, it’s for the less-independent client. Often, they’re not independent drivers and, for example, have significant pressure management goals. In manual, it’s been primarily more about health and medical goals.”

And then there is the PDG Elevation, which empowers clients to

PDG Mobility’s Elevation wheelchair

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dynamically reconfigure key aspects of an ultralight’s seating had a huge effect on the overall usability of the ultralight for the full-time active user. This is distinctly different from what I understand about dynamic seating.”

On-the-Fly Adjustments: Born of NecessityThe impetus for Elevation, Borisoff says, was a combination of factors: “A long-term buildup of things I was having difficulty doing, plus realization of a couple of things.”

Those revelations came from Borisoff’s observations about the many ways he’d used his wheelchairs in the past and in different environments, from the basketball court to the laboratory.

“I have very poor trunk control as a T3 para,” he says. “So how did I play basketball? I played in massive squeeze positions, 6" to 8". Your center of gravity is lower; you’re much more maneuverable. But you’re not going to see that in a day chair very often.

“I had a standing wheelchair that I used when I worked in research, basically to work at countertops, to be able to reach coun-tertops, which is a more functional position in labs. But I found that I wasn’t standing in it at all. I was in a semi-standing position, but I was very stable and comfortable, I could still grab my wheels. I was in a functional position for working at a countertop.”

Mitchell, in contrast, remained capable of functional ambulation after his injury, but — as a clinician in a wheelchair seating clinic — he also had access to ultralight chairs. At his supervisor’s invitation, Mitchell began using them more frequently as time went on. “I began noticing as I was getting older that it was getting more and more difficult to stand for prolonged periods of time and cover distances, just the wear and tear that my body had taken,” he says. As he personally dialed in a borrowed wheelchair to be efficient around the hospital, Mitchell says he became fascinated by “the effect configuration had on efficiency.”

Unable to take the VA hospital’s wheelchair off the grounds, Mitchell eventually obtained his own wheelchair, “which has a very short wheelbase. It’s dialed in for very efficient propulsion on level surfaces, but I hit one of the expansion strips in the garage [at work], and I didn’t realize that these little casters that make it so easy to go on level surfaces are quite a liability when you’re outside.”

The result: “I did an endo my first time taking my chair to work, so I began realizing that even though I thought I knew how to configure a chair for work experience, when I began using it in the real world, that was a totally different animal altogether.”

Changing the Configuration to Fit the TaskBorisoff noticed that he rarely used his standing wheelchair to stand all the way up. “What if you could dial [a standing chair’s position] back to a semi-standing position?” he says. “You could use it all the time because it is lighter, less bulky and less heavy. A standing chair has too much structure for optimal wheeling. But could we keep the chair in the footprint of an ultralight?”

Mitchell noted that he sometimes felt uncomfortable on minivan

wheelchair ramps “and I wondered why that was. Some of them are about 10°, and I just felt my chair was too tippy and I was having to lean forward too much.”

They had both identified multiple situations in which a static ultralight chair configuration was less than optimally efficient.

“Jaimie and I live on opposite sides of the continent and didn’t actually meet until we presented [a seminar at a conference] for the first time,” Mitchell says. “What we have in common is that we are both ultralight users with spinal cord injuries working in fields related to rehabilitation technology. We’ve learned through our own experience that one static configuration will never be optimal for every context in which we need to use our chairs. Unlike most end users, we have hands-on experience with ultralights that provide dynamic reconfiguration. Most of Jaimie’s experience is with the Elevation. Most of mine came as a result of using a sliding seat on a modified early-production Icon A1.”

As Mitchell refined his understanding of dynamic wheeled mobility, he streamlined his thinking into two “rules.”

“One is the law of mutually exclusive configurations,” he says. “There is an inverse relationship between the optimal configuration for level propulsion and the optimal configuration to do just about everything else. In an ultralight configured according to the wheel-chair clinical practice guidelines, the user will tend to sit lower and further back in the chair relative to the wheels. The problem is that the user’s function tends to be best when they are situated higher and toward the front of the chair.

“I call the second rule the conservation of contextual angles. It holds that changing key angles of the ultralight, its user or the environ-ment will require changes to angles elsewhere to offset that change. It sounds complicated, but it’s really about equilibrium. Someone sitting in a chair with a low rear seat height for efficient propulsion will probably be lower than a person who is sitting in an average dining room chair. Their hands will probably be near shoulder level whenever they wash dishes or cook at the stove. If they have to lean forward, additional shoulder flexion will be needed just to keep the hands at the same level. Keeping the hand below the shoulder is almost impossible. The ability to increase the rear seat height and adjust the back angle forward can make a significant difference.”

The conservation of contextual angles rule, Mitchell says, “explained for me why I was uncomfortable going up some ramps

There is an inverse relationship between the optimal configuration for level propulsion and the optimal configuration to do just about everything else

— Steve Mitchell

Defining Dynamic Wheeled Mobilitycontinued




in my clients’ minivans. I have a seat angle of 14°, a back angle of 95°, and very little of my weight over the front casters. One day it dawned on me that if I am on a 10° ramp, my effective seat angle becomes 24°. My back angle is now 105° and provides no support. My chair also becomes much tippier. Because I have a static configu-ration, I am unable to restore my seat and back angles or change my position relative to the pushrims. My only option is to lean forward as much as I can to keep from flipping back as I push. Leaning forward results in very extreme wrist, elbow and shoulder angles.” Changing Configurations in the Real WorldBoth Mitchell and Borisoff had come to the same conclusion: At different points in a user’s day, different seating and wheelchair configurations become ideal. Therefore, no single wheelchair config-uration can always be optimal, assuming an active user engaging in many tasks each day in different locations.

“I live in Vancouver where it rains a lot, and it’s hilly,” Borisoff says as an example. “I’m wheeling when it’s wet, and when you’re going down a slope, you slide and grip, slide and grip because it’s slippery, and I’m hoping I don’t lose my grip and pitch into traffic.

“I thought, Hang on: Bring it down into maximum dump, open up the backrest, and you’re super stable. Now I’m very tippy on level ground so I need to be aware, but it’s great for going down slopes. Going uphill, it’s the opposite: Crank it way forward, and you’re super uncomfort-able on level ground, but you’re going uphill. So it’s comfortable for that, you are less tippy, and you have a backrest to push against.”

One of the Elevation wheelchair’s most critical functions, Borisoff says, gets less attention “but is actually used more, and that’s de-el-evation: getting into a more aggressive dump or squeeze.” Being able to adjust rear seat-to-floor angles relative to front seat-to-floor measurements can help with seated stability in many situations, including navigating slopes. “You throw it into fairly serious recline with maximum squeeze,” he says, “and you can go down slopes without having to be in a wheelie.”

A second major Elevation function is, as its name suggests, the ability to elevate the wheelchair’s seat. The result, though, is unlike what you’re used to seeing in power chairs, in which the seat rises along with the footplate, thus preserving the angle of the user’s legs. Nor is it the entirely upright, perpendicular positioning you typically

see in a standing wheelchair or standing frame.Instead, the Elevation’s seat elevation function is between the

two, an intermediate position reminiscent of what you see in ante-rior tilt. Borisoff says the chair offers about 10" of seat elevation while retaining seated stability for its user, who sits in a sort of designed “pocket” while elevated.

“You can reach a shelf in your kitchen, a higher shelf at the grocery store, you can wheel up to a bar,” he says, adding that while elevated, the user can still reach the wheels to maneuver and propel.

Elevation also offers an adjustable backrest: Open up the angle to adjust weight distribution and dial in the “tippiness” that’s great for going down hills. Close up the angle to get more backrest support while wheeling up-slope. In between, users can adjust back angle for comfort or to tackle a task at hand.

“It was easy to add in backrest adjustability,” Borisoff says. “What’s interesting about the backrest is the functional possibilities were not as obvious to me. It’s by far the most underutilized and underappre-ciated function.”

Borisoff further talks about seating situations other than wheeling. “Remember, we only spend about 10 percent of our time in a wheelchair actually wheeling — hat tip to [Stephen] Sprigle and [Sharon] Sonenblum. The rest of the time, we are simply sitting at a desk, doing the dishes, or any other daily activity. So adjustable posi-tioning for different tasks can have a major impact on wheelchair seating, not only in propulsion. And just the ability to fidget or make small seating changes can improve comfort throughout the entire day, and probably pain and fatigue.”

Usable Dynamic ConfigurabilitySeat elevation, an adjustable backrest and on-the-fly configurability weren’t the only features on Borisoff’s list of goals. He also had to incorporate all that added functionality without sacrificing the signature features of ultralight chairs: low overall chair weight and easy portability.

“That’s the secret sauce in this: I’m surprised I don’t get noticed more often,” he says, referring to the Elevation’s extra functional features. “That’s a design goal, too: [Elevation] is not any bigger; it doesn’t look any different unless you look underneath it. It has the same width and height of an ultralight chair.”

That’s especially critical to the ultralight user demographic. As an engineer, Borisoff is designing for an aesthetically savvy audience attuned to consumer trends. Their expectations for their personal wheelchairs is usually very different than the expectations of staffers buying manual tilt-in-space chairs to be used by their patients in long-term care and similar institutions.

“I refer to it as the ultralight form factor,” Borisoff says. “The [ultra-light] user is more sophisticated, I think.”

The usability of a dynamic wheeled mobility system also comes down to time and convenience.

“In the first prototype [of the adjustable back control], it wasn’t a lever, it was a twist knob,” Borisoff recalls. “Have you ever adjusted the seat in an old Volkswagen? It’s the same thing, a twist knob, and it was a pain to adjust. You can imagine I never used it. It would take 15 seconds instead of one or two seconds with a [current Elevation]

There’s no point in making an ultralight wheelchair with on-the-fly adjustments that isn’t quick and easy to use. It’s just going to be abandoned

— Jaimie Borisoff

ATP Series

Defining Dynamic



lever. It sounds ridiculous that the [time difference] would stop someone from using it, but it would. An adjustment that takes a long time to do is more akin to a better ATP nuts-and-bolts setup adjust-ment than to an on-the-fly adjustment that would be used instantly anytime during the day.

“That really speaks to the usability. There’s no point in making an ultralight wheelchair with on-the-fly adjustments that isn’t quick and easy to use. It’s just going to be abandoned.”

Mitchell includes add-on components in his interpretation of dynamic wheeled mobility, defining those components as “something that can be added to an optimally configured chair. The casters are usually the limiting factor in being able to use the chair outdoors, so the Free Wheel [wheelchair attachment] came out. You only use it when you need it, and when you take it off, your chair is no different than before you installed it.”

Other add-ons, by that definition, would include certain power-assist systems, such as Max Mobility’s SmartDrive, which Mitchell notes can be easily added to an ultralight chair and acti-vated, but does not require a chair configuration change to use.

As for the future viability and need for dynamic wheeled mobility,

Mitchell points out, “Legs and walking is a way to get your brain and your hands someplace to do something functional. Most functional activities are hard to do at a seated level, especially if you’re in a dialed-in chair where your rear seat-to-floor height is in the 16" to 17" range. Shoulders do wear out over time, and there’s ways that the wheelchair can be serving a different role, but we have to be able to have these adjustable angles to do that.”

“I envision my giving a talk at RESNA or ISS [International Seating Symposium] in the near future titled something like On-the-Fly Dynamic Seating for Ages 2 to 102,” Borisoff says. “There should be on-the-fly seating adjustability for almost all wheelchair users. That doesn’t always mean the adjustments are going to be made inde-pendently [by the user]. Say a parent has a 2-year-old and elevates him to the dinner table or to join in a family conversation. Imagine what that means for the quality of life for the parent and the kid both.”

“Unless one uses a chair that provides dynamic reconfiguration, they are unlikely to know what it can do,” Mitchell says. “It is my hope that clinicians and researchers come to a realization that relatively small dynamic adjustments can help preserve upper-limb function with only a negligible effect on weight. Until there is sufficient demand, we will find that the ultralight will continue to fall short in our ability to mean-ingfully implement the clinical practice guidelines in the very activities where they need to be implemented the most.” l



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Movement on a Micro ScaleDynamic movement doesn’t need to be extreme to be significant to wheelchair users. Case in point: the Micro-Stimulation (MiS) technology offered by Thomashilfen.

“Micro-Stimulation is a gentle feedback or response generated by the individual’s movement,” says Darlene Hawthorne, president of Thomashilfen North America, who notes that even subtle movements, such as those caused when taking a deep breath, can start a beneficial, dynamic cycle of movement. “Originally, MiS was placed in beds to allow freedom of movement for those who lack mobility and needed stimulation to prevent pressure wounds. Through years of technology and science, MiS technology has evolved to [include] tiny spring wings in the backs of mobility chairs and surfaces that benefit many other conditions, such as autism, Down syndrome, hypertonic and hypotonic children, as well as adults with Parkinson’s and dementia.”

Feeling small, physical movements in response to their own movements can be reassuring and reaffirming to users with sensory difficulties.

“With the gentle feedback from the MiS or spring wings, each individual receives a small response to their movements, recon-necting the neurological and physiological connection, allowing the individual to relax and improve body perception,” Hawthorne says.

“The stimulation also promotes blood flow and supports the freedom of movement for a more restorative sleep.”

As with the rest of the dynamic seating and mobility movement, Hawthorne expects micro stimulation technology to continue to expand. “We have seen some incredible, positive response with our MiS technology in our ThevoTwist pediatric wheelchairs from kids with various conditions,” Hawthorne notes. “The chal-lenge is to provide stabilized seating with the freedom of movement to encourage independent activities such as reaching and stretching to further enhance the development of fine motor skills. We contin-uously see improvements with micro stimulation, and it is a new concept in how we traditionally think about seating and stabilizing all in one. Fortunately, ATPs and therapists are seeing the positive results of the freedom of movement and are trying to develop other ways to achieve both stabilization and movement.” l

Thomashilfen NA showed off its support surface Micro-Stimulation technology at June’s Cure SMA confer-ence in Anaheim, Calif.

ATP Series

Defining Dynamic


http://www.alumiramp.com

http://matrixseatingusa.com


F

Technology Series

For our first-ever Accessibility Comparo, aimed at technology that facilitates participation and inclusion in different environments and activities, we invited manufacturers of wheelchair-accessible vehicles, bath systems, lifts and ramps to self-report specifications and sizing for their products.

Measurements are reported in inches and/or feet, as appropriate. Weights are listed in pounds (lbs.). In many cases, products have ranges of measure-ments, such as weight capacities. Options may be included in standard pricing or available as up-charges. Data was edited for space, and additional options, accessories, sizes, etc., are available. Custom sizes for some products may also be available on request. “ADA” is an abbreviation for requirements and standards associated with the Americans with Disabilities Act. “N/A” is listed if a category doesn’t apply or if no information was submitted. “WC in driver’s seat” refers to whether the user can drive the vehicle from his/her wheelchair.

These comparos are intended to be introductory resources for mobility and accessibility professionals seeking to compare products within a certain cate-gory. For more information, please contact the manufacturers as listed in the Sources list at the end of this story. l

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tion

Leng

ths

Wid

ths

Port

able

?Su

rfac

eHa

ndra

ils?

Wei

ght

capa

city

Optio

nsRi

se

heig

htAccess4U Access4U Access4U AlumiRamp AlumiRamp Prairie View

IndustriesM

odul

ar

Port

able

Fol

ding

Thre

shol

d

Alu

mili

te L

ands

cape

Arm

ada

Mul

tifo

ld

Mod

ular

Port

able

fo

ldin

g

Thre

shol

d

Port

able

Mod

ular

Port

able

Alu

min

um

Alu

min

um;

fold

s in

hal

f for

ca

rryi

ng; t

op

lip g

rabs

ont

o de

ck w

hile

lo

wer

lip

flexe

s to

terr

ain

Alu

min

um; 3

ty

pes:

sel

f-su

p-

port

ing

mod

el

rest

s ag

ains

t do

orw

ay; a

d-ju

stab

le m

odel

ha

s sc

rew

feet

Pow

der-

coat

ed

alum

inum

Ano

dize

d al

umin

um

Alu

min

um

2', 3

', 4', 5

', 6', 7

', 8'

. Pla

tfor

ms

= 4x

4', 4

x8', 5

x4',

5x5'

, 5x6

', 5x8

', pl

us c

usto

m

size

s

2', 3

' 4', 5

', 6'

1-3"

rise

(sup

-po

rted

ram

ps);

1-6'

leng

ths

(sta

ndar

d ra

mps

); 2.

5-6'

le

ngth

s (a

djus

t-ab

le ra

mps

)

3', 4

', 5', p

lus

cust

om le

ngth

s

4', 5

', 6', 8

', plu

s cu

stom

leng

ths

5', 6

', 7', 8

', 10'

, 12

'

36",

42",

48",

plus

cus

tom

w

idth

s

29" v

an ra

mp;

30

" sta

ndar

d

30" &

36"

st

anda

rd;

cust

om w

idth

s av

aila

ble

29" &

36"

st

anda

rd;

cust

om w

idth

s av

aila

ble

36" s

tand

ard;

cu

stom

wid

ths

avai

labl

e

30"

No

Yes

Yes;

easi

ly

inst

alle

d

Yes

No

Yes

Gro

oved

, sl

ip-r

esis

tant

su

rfac

e in

depe

nden

tly

test

ed to

mee

t A

DA

gui

de-

lines

Gro

oved

, sl

ip-r

esis

-ta

nt s

urfa

ce

inde

pend

ently

te

sted

to m

eet

AD

A g

uide

-lin

es

Gro

oved

, sl

ip-r

esis

tant

su

rfac

e in

depe

nden

tly

test

ed to

mee

t A

DA

gui

de-

lines

Knur

led,

sl

ip-r

esis

tant

su

rfac

e

Knur

led,

sl

ip-r

esis

tant

su

rfac

e

Slip

-res

ista

nt

trac

tion

tape

Yes

No

No

No

Yes

No

750

lbs.

750

lbs.

750

lbs.

600

lbs.

750

lbs.

800

lbs.

(5

-8');

600

lb

s. (1

0',

12')

(tw

o ax

les)

Typi

cal

slop

e of

1"

per f

oot;

can

be

inst

alle

d to

fit

terr

ain

Typi

cal

slop

e of

1"

per f

oot;

can

be in

-st

alle

d to

fit

terr

ain

Typi

cal

slop

e of

1"

per f

oot;

can

be

inst

alle

d to

fit

terr

ain

Any

rise

Any

rise

Varie

s by

ram

p le

ngth

: 5'

= 5-

10";

6'=

6-12

"; 7'

= 7-

14",

etc.

Safe

ty g

ates

, sta

irs, p

icke

t-ty

pe ra

iling

s,

com

mer

cial

(IBC

) ram

ps, c

usto

m d

esig

ns

for u

nusu

al lo

catio

ns

Can

be in

stal

led

to fi

t var

ious

con

ditio

ns

and

envi

ronm

ents

; man

ufac

ture

r doe

s no

t rec

omm

end

inst

alla

tion

stee

per t

han

1:6

incl

ine

Cust

om s

izes

to m

eet d

iffer

ent c

ondi

tions

an

d en

viro

nmen

ts; m

anuf

actu

rer d

oes

not r

ecom

men

d in

stal

latio

n st

eepe

r tha

n 1:

6 in

clin

e

Alu

min

um o

r fou

r col

ors

of p

owde

r co

atin

g (te

rra

cott

a, s

late

, sag

e or

san

d)

Cust

om s

izes

are

ava

ilabl

e up

on re

ques

t

N/A

Ram

ps




Type

Cons

truc

tion

Leng

ths

Wid

ths

Port

able

?Su

rfac

eHa

ndra

ils?

Wei

ght

capa

city

Optio

nsRi

se

heig

ht

Prairie View Industries

Prairie View Industries

Mul

tifo

ld R

each

Sing

lefo

ld

Port

able

Port

able

Alu

min

um

Alu

min

um

6', 7

', 8', 1

0'

2', 3

', 4', 5

', 6',

7', 8

'

30"

30"

Yes

Yes

Slip

-res

ista

nt

trac

tion

tape

Slip

-res

ista

nt

trac

tion

tape

No

No

800

lbs.

(6

-8'),

70

0 lb

s.

(10'

) (tw

o ax

les)

800

lbs.

(2

axl

es)

Varie

s by

ram

p le

ngth

: 6'

= 6-

12";

7'=

7-14

"; 8'

= 8"

; et

c.

Varie

s by

ram

p le

ngth

: 2'

= 2-

4";

3'=

3-6"

; 4'

= 4-

8";

etc.

N/A

N/A

Ram

ps

Vehi

cles

Entr

y# o

f Pas

seng

ers

Ram

p lo

catio

nRa

mp

type

Entr

y hei

ght/

w

idth

Head

room

Seat

ing

WC i

n dr

iver

’s se

at

Optio

ns

Mobility Ventures

MV-

1 D

X SU

VSi

de o

f veh

icle

6 w

ith o

ptio

nal

jum

p se

atIn

-floo

rD

ual-l

engt

h po

wer

ed56

" hig

h, 3

6"

wid

e59

.5"

No,

but

bes

t st

orag

e in

cla

ssN

oSt

anda

rd s

elf-

leve

ling

susp

ensi

on;

rear

-fac

ing,

fold

ing

jum

p se

at; m

e-di

um w

indo

w ti

nt, e

nhan

ced

radi

o,

enha

nced

radi

o w

ith n

avig

atio

n, 1

7"

alum

inum

whe

els

Mobility Ventures

MV-

1 LX

SU

VSi

de o

f veh

icle

6 w

ith o

ptio

nal

jum

p se

atIn

-floo

rD

ual-l

engt

h po

wer

ed56

" hig

h, 3

6"

wid

e59

.5"

No,

but

bes

t st

orag

e in

cla

ssN

oSt

anda

rd se

lf-le

velin

g su

spen

sion

; int

eri-

or tr

im p

acka

ge (r

osew

ood

acce

nts,

eb-

ony

leat

her u

phol

ster

y, le

athe

r-w

rapp

ed

stee

ring

whe

el, e

tc.);

ext

erio

r trim

pa

ckag

e (c

hrom

e fa

scia

, tur

n si

gnal

in-

dica

tors

in si

de m

irror

s, et

c.);

enha

nced

ra

dio;

fold

ing

jum

p se

at, e

tc.

Mobility Ventures

MV-

1 SE

SU

VSi

de o

f veh

icle

6 w

ith o

ptio

nal

jum

p se

atIn

-floo

rM

anua

l56

" hig

h, 3

6"

wid

e59

.5"

No,

but

bes

t st

orag

e in

cla

ssN

oSt

anda

rd s

elf-

leve

ling

susp

ensi

on;

whe

elch

air r

estr

aint

kit;

rear

-fac

ing,

fo

ldin

g ju

mp

seat

; driv

er’s

conv

enie

nce

pack

age;

AM

/FM

radi

o w

ith C

D/M

P3,

auxi

liary

inpu

t; m

ediu

m w

indo

w ti

nt;

full

whe

el c

over

Pool

Type

Pow

ered

by

Lift

capa

city

Seat

trav

elRo

tatio

nSe

atin

gAD

A co

mpl

iant

?Op

tions

Aqua Creek Products

Scou

t 2 L

ift

In-g

roun

d &

ab

ove

grou

nd;

with

pul

l-out

le

gres

t & a

djus

t-ab

le s

eat p

ole,

ca

n cl

ear u

p to

26

" wal

l

24v

batt

ery

with

ch

arge

r; so

lar

char

ger o

ptio

n av

aila

ble

375

lbs.

Trav

el v

arie

s as

se

at p

ole

is

adju

stab

le;

mee

ts A

DA

re

quire

men

ts

360°

rota

tion

Incl

udes

adj

ust-

able

foot

rest

, fli

p-u

p ar

mre

sts,

ad

just

able

lap

belt

Yes

Ada

ptab

le to

mos

t exi

stin

g 6"

dee

p an

chor

s. A

cces

sorie

s in

clud

e ch

est

stra

p, h

eadr

est,

lock

able

cov

er, p

ull-o

ut

legr

est,

slin

g se

at, s

olar

cha

rger

, tra

ns-

port

car

t, up

grad

e pa

ckag

e (a

dditi

onal

ba

tter

y, h

eadr

est,

ches

t str

ap a

nd

cove

r)

Pool

Lift




Modular RampsPortable Folding RampsThreshold Ramps

Helping People LIVE at HOME

Access4U was established to provide people affordable access so they can live at home and enjoy life to the fullest. Aluminum modular ramps can be customized to each home with standard modules. Access4U also offers customization accesso-ries such as angled platform, gates, landing pads, and stairs to fit special require-ments. The product line is completed with threshold ramps, solid or MINI ramps and portable folding ramps. Designs have been reviewed to insure ADA compliance, easy installation and durability.Call: 800-355-7025 www.access4uinc.com

C

M

Y

CM

MY

CY

CMY

K

See us at Medtrade 2016 Booth #937

SourcesAccess4UModular, threshold & portable folding ramps(800) 355-7025access4uinc.com

AlumiRampAlumilite Landscape & Armada system ramps(800) 800-3864alumiramp.com

Aqua Creek ProductsScout 2 Pool Lift(888) 687-3552

aquacreekproducts.com

Clarke Health Care ProductsOceanVIP & WheelAble(888) 347-4537clarkehealthcare.com

Columbia MedicalOmni Rolling Chairs & Optima TSS(800) 454-6612columbiamedical.com

Mobility VenturesMV-1 DX, LX, SE(877) 681-3678mv-1.us

NuprodxmultiCHAIR mc6000Tilt(707) 934-8266nuprodx.com

Prairie View Industries (PVI)Multifold, Multifold Reach & Singlefold ramps(800) 554-7267pviramps.com

RiftonHTS (Hygiene & Toileting System)(800) 571-8198rifton.com


Accessibility, Compared & Contrasted


http://www.access4uinc.com

Right now someone is using something like this to stop their vehicle.

Only QAP works to stop dangerous modifications and keep your clients safe on the road.

Unregulated vehicle modifications done by those without the proper training can put the lives of your clients or patients with disabilities, and their families, at risk. Only Quality Assurance ProgramTM dealers are accredited to sell, install and service mobility equipment that puts their safety first. Ensure your clients’ adaptive vehicles are tailored to fit their every need—say no more to dangerous modifications and know more about safe driving options.

What you don’t know can hurt you.

Find a QAP dealer near you at NMEDA.com/Mobilityor call 844-232-1736

16_NMEDA_0124_QAP_MobilityManagementFullPgAd_R1V1.indd 1 9/23/16 11:45 AM

http://nmeda.com/mobility


seat cushion marketplace

SoftechA fully automatic, self-contained alternating cushion system, the Softech operates very much the way an alternating support surface does. All system components are integrated into the cushion, so there is no separate control box. All areas of the client’s posterior receive pressure redistribution as many as 60 times an hour, to provide pres-sure relief similar to doing a pressure lift. The battery-operated system runs for more than 40 hours per charge and is custom-built to each client based on locations of current pressure injuries and unique client needs. Since the systems are hand-built, Aquila can provide a cushion of any size.

Aquila Corp.(866) 782-9658aquilacorp.com

Matrx Flovair ContourThe Invacare Matrx Flovair Contour cushion is designed to provide pelvic stability, pres-sure management, leg positioning and pres-sure relief to wheelchair clients living with skin-integrity issues. The moisture-resistant, zippered inner cushion cover easily wipes clean for quick and convenient maintenance for consumer or caregivers. The zippered inner cover design also helps ATPs and clini-cians who need to access the Matrx Flovair Contour to make seating modifications in clinical or provider settings.

Invacare Corp.(800) 333-6900invacare.com

LaminarThe Laminar is made of viscoelastic polyurethane gel foam (Pudgee) on top of open-cell viscoelastic polyurethane foam (Sunmate), with a removable, washable stretch-fabric; waterproof Dartex; or Stretch-4 cover. Available in 16", 18" and 20" widths and 16", 18" and 20" depths, the Laminar has an unlimited weight capacity. An optional non-halogenated fire retardant can be added to the SunMate layer for extra protection. Other options include generic contouring and a Dureflex waterproof film. The Laminar was designed for wheelchair users at high risk of pressure injuries or skin breakdown.

Dynamic Systems Inc.(855) SUNMATEsunmatecushions.com

Synergy Spectrum FoamThis HCPCS-coded E2607/E2608 cushion is constructed of viscoelastic foam with a four-way-stretch standard cushion cover. Available in widths from 10" to 32" and depths from 10" to 28", the Synergy Spectrum Foam is sized to fit a large range of your wheelchair users, from pediatric to adult and bariatric (thanks to the cushion’s 650-lb. weight capacity). The Synergy Spectrum Foam is 3" high and designed to provide positioning support and skin protec-tion. Available options include an inconti-nence cover and a solid seat insert.

Quantum Rehab(866) 800-2002QuantumRehab.com

Hybrid Elite SRThe Hybrid Elite Single Compartment cushion is now Sensor Ready and compat-ible with ROHO’s Smart Check feedback system. The Hybrid Elite SR is an adjustable, air-filled wheelchair support system that combines the ROHO Dry Floatation cellular design with a contoured foam base. It’s built to conform to a client’s seated shape in the pelvic loading area to provide skin/soft tissue protection, positioning and an environment to facilitate wound healing. Smart Check can assist its user by saving an inflation range during cushion setup, then checking the cushion to make sure inflation remains within the saved range.

ROHO Inc. (800) 851-3449roho.com

MeridianThe Meridian, with its E2624/E2625 coding, is designed for clients at a high risk of skin breakdown who also require symmetrical positioning support, including prevention of posterior pelvic tilt. The Meridian is an adjustable, self-inflating, dual-chambered multi-stiffness foam and air cushion with dual valves. Wave contoured, closed-cell bases are available for added postural positioning; a closed-cell Wedge is also an option. The Meridian is available in widths from 12" to 24" and depths from 14" to 20" and has a weight capacity of 750 lbs. Choose from a tailored mesh or inconti-nence cushion cover.

VARILITE(800) 827-4548varilite.com

1116mm_SeatCushionMktpl30.indd 30 10/5/16 2:55 PM

www.mv-1.us (877) 681-3678© Mobility Ventures LLC

Revolutionizing Accessible Transportation.

Built from the ground up and not a conversion, MV-1 is designed to withstand

the demands of round-the-clock operations. MV-1 is ADA compliant, FMVSS

certified with no exceptions or exemptions and the only purpose-built mobility

vehicle that meets the “Buy America” act. Contact Mobility Ventures to learn

why more transit authorities are switching to MV-1.

CNG is a factory-installed option.

MV1 Mobility Mgmt.indd 1 1/27/15 2:48 PM

http://www.mv-1.us

S E R I E S 2

http://tilite.com

november 2016 • vol. 15 no. 11 serving the seating and

Documents