COTFCS14
1
7/23/2019 COTFCS14 http://slidepdf.com/reader/full/cotfcs14 1/1 COTF CASE STUDY REVIEW A S S IS TIV E TEC H N O LO G Y /S EA TIN G E q u i p m e n t A Wider Range of Activities Ani ta Zafr ani , OT CASE HISTORY: It was a cool fall day in November, 1967 when 18-year-old L.B. slipped on a pile of leaves during a neighbour- hood pick-up game of touch football. From that moment when he sustained a spinal cord injury, L.B.’s life changed dramatically. Thirty years later L.B. presents as a remarkably productive, self-directed man. He is employed as a computer programmer and enjoys a number of serious hobbies (gardening, cooking, and committee work to name a few). His residence is the Rehabilitation Institute of Toronto. Without a doubt L.B.’s remarkable quality of life is attributable to his outstanding personal qualities combined with the availability of state-of-the-art power mobility, seating, and environmental control units. In 1994 after using certain equip- ment for many years, L.B. decided that his needs were not being fully met and the long process was begun of assessing and pre- scribing technology that would help him achieve his goal of access to a wider range of activities. CLINICALCONSIDERATIONS:Since L.B.’s physical capabilities have been unchanged for decades and are well-known to ther- apists at the Rehabilitation Institute of Toronto, the focus was not on the usual obligatory careful motor assessment. The cervical cord was injured at the level of 4 and 5 and there is no active movement or sensation below the level of injury. Spasticity is pre- sent in lower extremities and edema is observed in both feet and hands. He has had episodes of respiratory distress due to weak- ened chest muscles. Due to weakness of trunk muscles he wears a custom firm corset to maintain upright body posture. Skin breakdown over his left ischial tuberosity has been a recurring problem over the years. TREATMENT/APPROACH:The Queen Elizabeth Hospital Seating Clinic was consulted in April, 1994. The team carried out a series of trials and tests throughout 1994 and 1995 and the data was collected and organized in tables. In order to objectively prove the significant pressure relieving power of combining the recline and tilt on L.B., computerized pressure mapping tech- niques were employed. Results of these tests indicated clearly that only by combining the power recline, power tilt, and power ele- vating legrest mechanisms could the risk of skin breakdown in longer sitting hours be removed. OUTCOME:The client has more control when stopping quickly; the out-of-range system is safer (e.g. the wheelchair automati- cally stops if the driver has a spasm that sends him out of the range of control), and its proportional drive system means that the driver can accelerate slowly rather that starting at his regular speed. Through the Peachtree head control L.B. operates drive, tilt, recline, powerlegs, shear reduction(VSR) and a cellular telephone. When in his room, the head control becomes an environ- mental control unit that controls his lights, radio, tape recorder, telephone, and call bell. In L.B.’s own words: “I have a wider range of activities as a result of using the Peachtree and the Action Storm wheelchair.” EQUIPMENT: The Invacare Action Storm power chair had strong torque for getting over bumps, and is lower and narrower, allowing L.B. to get on trains and under tables that were previously inaccessible to him. Furthermore, the desired head control (Peachtree) was optimized for this chair and smooth and consistent driving characteristics could only be guaranteed if the Peachtree was interfaced onto the Storm. The Peachtree head control was selected because it requires little effort to drive and is easier on the neck than other head controls. It is very versatile and can interface with all controls from the one area that L.B. can move, which is his head. A S S IS TIV E TEC H N O LO G Y /S EA TIN G E q u i p m e n t CLIENT: 48-year-old M ale CONDITION: Spinal Cord Injury resulting in Quadriplegia (1967) ACKNOWLEDGE Stephen Tse, occupational therapist who worked extensi on this case Lewis Boles Motion Special ABOUTTHEAUT Anita Zafrani, O occupational th at the Rehabilit Institute of Toro Publication supported by a grant from M otion Specialties Inc.
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Transcript of COTFCS14
7/23/2019 COTFCS14
http://slidepdf.com/reader/full/cotfcs14 1/1C O T F CA S E ST U D Y R E V I E W
A S S I S T I V E T E C H N O LO G Y /S EA T I N G
E q u i p m e n t
A Wider Range of ActivitiesAni ta Zafrani, OT
CASE HISTORY:It was a cool fall day in November, 1967 when 18-year-old L.B. slipped on a pile of leaves during a neighbour-hood pick-up game of touch football . From that moment when he sustained a spinal cord injury, L.B.’s l ife changed dramatically.Thi r ty years la te r L.B. presents as a remar kably produc t ive , se l f-di rec ted m an. He i s em ployed as a com pute r p rogram mer andenjoys a nu mber of se r ious hobb ies (ga rden ing, cooking, and comm ittee work to nam e a few). His res idence i s the Rehabi l ita tionInstitute of Toron to. Without a dou bt L.B.’s rem ark able qu ality of l ife is attributable to his outstandin g perso nal qu alities comb inedwith the availabili ty of state-of-the-art po wer m obility, seating, and environm ental contro l units. In 1994 after u sing certain equ ip-ment for many years, L.B. decided that his needs were not being fully met and the long process was begun of assessing and pre-scribing tech nology that would help h im ach ieve his goal of access to a wider ran ge of activities.
CLINICAL CONSIDERATIONS:Since L.B.’s physical capabili ties have been un chan ged for dec ades an d are well-kno wn to ther-apists at the Rehabili tation Institute of Toronto, the focus was not on the usual obligatory careful motor assessment. The cervicalcord was injured at the level of 4 and 5 and there is no active movement or sensation below the level of injury. Spasticity is pre-
sent in lower extrem i ties and edem a i s observed in both fee t and han ds . He has had episodes of respi ra tory dis tress due to weak-ened ches t musc les . Due to weakness of t runk musc les he wears a cus tom fi rm corse t to mainta in upright body posture . Skinbreakd own over his le ft i schia l tubero s i ty has been a r ecurr ing pr oblem o ver the years .
TREATMENT/APPROACH:The Queen Elizabeth Hospital Seating Clinic was consulted in April , 1994. The team carried out ase ries of t r ial s and tes t s throughout 19 94 and 1 995 and the da ta was col lec ted and organized in tables . In or der to objec t ive lyprove the significant pressure relieving power of combining the recline and ti l t on L.B., computerized pressure mapping tech-niqu es were em ployed. Results of these tests indicated clear ly that only by comb ining the power r ecline, power ti l t , and p ower ele-vat ing legres t mechanisms could the r i sk of skin breakdo wn in longer s i t ting hours be r emoved.
OUTCOME:The client has more control when stopping quickly; the out-of-range system is safer (e.g. the wheelchair automati-cally stops if the driver has a spasm that sends him out of the range of control), and its proportional drive system means that thedriver can accelerate slowly rather that starting at his regular speed. Through the Peachtree head control L.B. operates drive, t i l t ,rec l ine , powerlegs , shear reduc t ion(VSR) and a ce l lula r te lephone . When in his room, the head cont rol becomes an envi ron-mental control unit that controls his l ights, radio, tape recorder, telephone, and call bell . In L.B.’s own words: “I have a wider
range of activities as a result of using the Peachtree and the Action Storm wheelchair.”
EQUIPMENT: The Invacare Act ion Storm power cha i r had s t rong torque for ge t t ing over bumps, and i s lower and narrower,allowing L.B. to get on trains and under tables that were previously inaccessible to him. Furthermore, the desired head control(Peacht ree ) was opt imized for this cha i r and smooth and consis tent dr iving charac te r i s t ic s could only be guaranteed i f thePeachtree was interfaced onto the Storm. The Peachtree head control was selected because it requires l i t t le effort to drive and iseasier on the neck than other head controls. It is very versatile and can interface with all controls from the one area that L.B. canmove, which is his head.
A S S I S T I V E T E C H N O LO G Y / S E A T I N G
E q u i p m e n t
CLIENT:48-year-old Male
CONDITION:Spinal Cord
Injury resultingin Quadriplegia
(1967)
ACKNOWLEDGE
Stephen Tse,
occupational
therapist whoworked extensi
on this case
Lewis Boles
Motion Special
ABOUT THE AUT
Anita Zafrani, O
occupational th
at the Rehabilit
Institute of Toro
Publication supported by a grant from M otion Specialties Inc.
