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Sunrise Medical SMA Comprehensive Manual

Sunrise medical power wheelchairs guide sma
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Comprehensive Guide to Powered Mobility
For Families of SMA
When selecting the first mobility device the choices can be overwhelming. This
document aims to guide you through the selection process as well as offer help to obtain
funding. Strollers, manual wheelchairs and power wheelchairs are all possible
alternatives. Efficiency, durability, comfort, ease of use, and other features will define
your selection.
There are several major areas you need to consider when selecting the appropriate
powered mobility device: bases, seat functions, seating systems, and access/control
methods. Today's technology allows you to mix and match a variety of features. This
mobility equipment will be used for many years to come so careful selection and
consideration is of utmost importance. We hope that you will find this guide helpful in
your decision making process.
Created by Julianna Arva, MS, ATP
Pediatric Product Specialist
October 2005

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  • Page 1 Comprehensive Guide to Powered Mobility For Families of SMA When selecting the first mobility device the choices can be overwhelming. This document aims to guide you through the selection process as well as offer help to obtain funding. Strollers, manual wheelchairs and power wheelchairs are all possible alternatives.
  • Page 2: Table Of Contents

    Table of Contents: Chapter I: Where do I start?...3 Chapter II: FAQ on early provision of independent mobility…………………………5 Chapter III: Power wheelchair bases……………………………………………………8 Chapter IV: Seat functions…………………………………………………………...…12 Chapter V: Seating systems……………………………………………………………..17 Chapter VI: Controls / Electronic interfaces /Access methods……………………….20 Chapter VII: Funding…………………………………………………………………...23 List of Resources………………………………………………………………………..26...
  • Page 3: Chapter I: Where Do I Start

    A wheelchair consists of many variables, which all need to be configured to a specific individual. No two wheelchairs are alike when done properly. In addition, it needs to fit like a pair of shoes, since it will not only act as a mobility device, but also the user’s seat and primary interface for many hours every day, for years to come.
  • Page 4 Technology Practitioners – certified clinicians), and ATSs (Assistive Technology Suppliers – certified dealers). Not all good practitioners are certified, and not all certified people are savvy in wheelchairs. This is a voluntary certification for people working with all assistive devices. However, if no other recommendations exist, this might be a good resource to find qualified practitioners.
  • Page 5: Chapter Ii: Faq On Early Provision Of Independent Mobility

    Always opt for a lesser alternative that provides efficiency – however, most children with SMA will not have sufficient strength to be efficient with a manual wheelchair. In addition, most pediatric manual wheelchairs are equal to or heavier in weight than the child occupying it, and due to growth concerns their access to the drive wheel is often not set up properly.
  • Page 6 What is a good age to get started with powered mobility? In short, as young as possible. Many children, particularly with SMA get started driving as early as 18 months of age, and some are starting even younger. Consider normally developing children –...
  • Page 7 instead of your child. Most of all, be patient – hard as it might be, your child will develop an understanding quickly if the right support is provided. Provide a safe environment while your child learns to drive – level surfaces, few obstacles, and possibly a harder surface (it requires more torque to move on carpet.) It is advisable to use low speed and torque settings for a beginner driver.
  • Page 8: Chapter Iii: Power Wheelchair Bases

    When selecting your first power chair, chances are that you will be overwhelmed with the selection and the features. You may feel like making a quick selection since you have so many other medical issues to worry about. The decision, however, is very important since this chair will be your child’s vehicle and mobility for many hours every day for several years.
  • Page 9 characteristics of rear wheel drives, they may be a good choice for heavy outdoors use and/or if you want high speed. On the downside, much of the user weight is placed above the drive wheels limiting curb climbing ability. Also revolving casters limit footrest placement options.
  • Page 10 Drive performance (Speed, range, incline, curb climbing) Performance variables may show a difference between ruggedness and durability of the different bases. Do not let these variables rule your decision, but it is recommended to have a look at them. • What is the maximum speed of the chair? Keep in mind that most chairs are programmable, so you can start slower than speed up as your child becomes proficient.
  • Page 11 Ability to accept seat functions With limited strength and endurance, chances are that your child would benefit from certain functions to be able to stay in the chair for longer periods of time. Tilt, recline, seat elevation, elevating legrests, etc. are all different options. Some chairs can be fitted and/or retrofitted with functions while others cannot.
  • Page 12: Chapter Iv: Seat Functions

    Seat functions may seem intimidating or an “overkill” sometimes. They do, however, serve many functions in the areas of prevention, enhanced function and comfort. Try to simulate some of those functions so you can experience for yourself what they mean – imagine a Lazy boy’s recline or elevating leg feature, or how you change positions in your car seat.
  • Page 13 • Compensate for limited trunk stability – even a slight tilt may utilize gravity to help extend the trunk and maintain a more extended position • Reduce shear as much as possible, as compared to recline • Maintain proper position related to AAC (Alternative and Augmentative Communication) devices, computer, even when tilted •...
  • Page 14 • Increases respiratory capacity • Allows change of hip position for pain relief • May allow reduction of attendant/caregiver hours Elevating legrests Elevating legrests change the angle of the legrest relative to the seat. It may be available with articulation, which means that the footplates move down on the legrests while elevating.
  • Page 15 • May reduce repetitive injury of the neck, by allowing eye to eye conversations • Allows access to ADLs (Activities of Daily Living) – cooking, microwave, sinks, water faucet, etc. Seat to floor function The seat lifts off from the base and moves forward than lowers the occupant to the floor.
  • Page 16 • Less gastro-intestinal complications, because there is less pressure on the internal GI organs • May allow use of a public urinal for male users • Increases self confidence by allowing to assume an “equal”, standing position and eye to eye conversations...
  • Page 17: Chapter V: Seating Systems

    While comfort in a wheelchair is often quite neglected, it is very important especially with SMA. When seating children in wheelchairs we have a tendency to focus on prevention rather than comfort, though both are of equal importance. Comfort translates into decreased pain and improved sitting tolerance, and better function.
  • Page 18 Children with SMA also tend to prefer softer materials on both the seat and the back - to get a “hugging feeling” – which makes for a more pleasant sensory experience.
  • Page 19 Armrests and laptrays: Armrests should be as close to the body as possible to provide support, and preferably built with a softer material. The more weight bearing assumed through the arms, the less pressure on the buttocks. Laptrays are often used to provide a surface for activities, if the child has difficulties pulling up to a table, or to provide more upper extremity support.
  • Page 20: Chapter Vi: Controls / Electronic Interfaces /Access Methods

    Access methods are usually categorized by “proportional” or “digital” controls. Many users with SMA will be candidates for proportional controls, whether a standard joystick unit or an adapted version.
  • Page 21 However, the user needs to be able to move in all 4 quadrants. This joystick minimizes fatigue and enables many users with SMA to drive throughout the day. It is, however, quite fragile, so special care needs to be taken when transferring in and out of the chair, etc.
  • Page 22 Specifically for SMA, children have a tendency to get tired before the day is over, so an attendant control would allow the caregivers to drive the chair when fatigue occurs.
  • Page 23: Chapter Vii: Funding

    The key to obtaining funding is good documentation. You should work with professionals who have expertise and credibility to supply such documentation. It is always recommended to have a physical or occupational therapist involved with the process in addition to the physician and the supplier. In general, the physician signs off on the prescription, but they usually refer the details to other professionals.
  • Page 24 Description of the need and requirements should always precede description of the final product. • Assessment methods and clinical trials. The reviewer needs to be able to follow your team’s thought process. How did they come to the conclusion that this is the appropriate device? A brief description of the assessment methods will help them understand the proposed equipment: client interview, mat assessment, driver training, pressure mapping, trial in the home, trial in family vehicle, etc.
  • Page 25 Do appeal. A large percent of equipment gets denied, and a large percent of those appealed get approved. Also keep in mind that every time you do not appeal, you damage your chances of getting equipment approved in the future, as well as that of others. Every single equipment which was fought for until it is approved, helps improve the system and the future of technology availability for people with disabilities.
  • Page 26: List Of Resources

    These links are provided for convenience only. FSMA possesses no control over such links, and makes no express or implied warranties, representations or endorsements of any kind regarding any linked site, and assumes no liability of any kind for any information contained in any linked site. Conferences/Trade shows: •...
  • Page 27 • Invacare www.invacare.com Manufacturer of power and manual mobility, hospital beds, accessories, etc. • Sunrise Medical www.sunrisemedical.com Manufacturer of power and manual mobility, hospital beds, accessories, etc. • www.asl-inc.com Manufacturer of switched solutions/adaptive controls for individuals requiring more comprehensive access than a joystick.