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POWER WHEELCHAIRSMichelle L. Lange, OTR/L, ABDA, ATP/SMS

What we are Covering• Mobility Series

• Augmented Mobility• Dependent Mobility• Manual Mobility• Power Mobility

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Learning Objectives:1. The participant will be able to compare and contrast

clinical indicators for scooters and power wheelchairs. 2. The participant will be able to list 3 readiness indicators

for power mobility. 3. The participant will be able to list 3 power wheelchair

alternative drive methods.

Power Mobility Devices• Power Operated Vehicles (POVs)/Scooters• Power Wheelchairs• Provide independent mobility using a motorized mobility

base

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Power Mobility Devices• Goals of use include:

• Providing independent mobility to a client who:• Is unable to self-propel any manual wheelchair• Is unable to self-propel any manual wheelchair efficiently

• Safely• Timely• Without undue fatigue• Without undue cardiopulmonary effort

Power Mobility Devices• Who uses this technology?

• Clients with the diagnosis of:• High level spinal cord injuries• TBI• CP• Muscle diseases

• DMD• SMA

• Neuromuscular diseases• ALS• MS

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Assessment• Assessment is typical done with a wheelchair supplier• Many Power Wheelchairs are Complex Rehab equipment• Complex Rehab is typically recommended by a

professional who is a certified:• ATP: Assistive Technology Professional• SMS: Seating and Mobility Specialist• These are obtained through RESNA

• Rehab Engineering and Assistive Technology Society of North America

Assessment• Assessment includes:

• Determining readiness• Determining the best power mobility base as well as

• Seating• Driving method• Power seating• Other features

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Power Operated Vehicles

• POVs: aka Scooters• Features vs. power wheelchairs

• Consumer Preference• Transport• Maneuverability• Stability• Distance, power and speed• Motoric requirements

Scooters• Pros:

• Doesn’t look like a wheelchair• Transportability

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Scooters• Cons

• 3 wheel scooters are more maneuverable, but also less stable and may tip

• 4 wheel scooters are more stable, but have a very large turning radius

• Seating is limited• Access

• Tiller• Grip

• Transfers• Less power, speed, distance

Power Wheelchairs• Drive wheel configuration• Power seating• Driving methods• Programming• Built-in features• Interfacing• Training

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Power Wheelchairs• Consumer Level

• Standard captain’s seat• Joystick access• Limited power seating

• Complex Rehab Level• Full range of seating • Frame growth and adjustments• Full range of driving methods• Full range of power seating options• Advanced features

Drive Wheel Configuration

• Front• Mid• Rear

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Rear wheel drive• Pros:

• Stability on all terrains• Will handle downhill speeds with better

control• Wide range of choices • Good for heavy outdoor use• Fastest speeds• Greatest suspension available

Rear wheel drive• Cons:

• Largest turning radius of the three configurations available• Due to front caster placement, many front rigging options are

limited (center mount)s

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Front Wheel Drive• Pros:

• Drive wheels pull the weight instead of push• Improved obstacle climb capability• With no front casters, can pull footplates closer to the body• Small front turning radius

Front Wheel Drive• Cons:

• Less stable downhill• Tendency to “fishtail” at faster speeds

(downhill) or when being pushed by attendant

• Forward tippy when client climbs on footrests

• Limited speeds unless compensated for in electronics

• Limits caregiver assist over curbs• Limited suspension

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Center wheel drive• Pros:

• Smallest possible footprint and turning radius• Considered to be the most “intuitive” driving platform to some• Very stable

Center wheel drive• Cons:

• May have challenges traversing through aggressive outdoor terrain

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Power Actuators• Tilt• Recline• Seat Elevator• Elevating Legrests• Standing• Other

Power Tilt• All angles stay the same: pelvis, knees, ankles• Entire seating system tilts rearward (posterior), forward

(anterior) or sideways (laterally) in space

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Position in Space: Tilt• Pros

• Redistributes pressure • Maintaining angles may inhibit muscle tone and maintains posture• No shear forces• Other assistive technology devices remain in position relative to the

client• Allows gravity to assist with trunk and head control

Power Tilt• Pros, cont.

• Tilt systems accommodate contoured positioning systems and positioning systems with fixed seat to back angle

• Range of motion limitations are accommodated• Increases comfort for increased seating tolerance• Provides a position of rest to address fatigue and post seizure

management• May provide an improved position for swallow, visual regard or

functional tasks

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Power Tilt• Cons

• Pressure relief not as great as with recline systems

• Must move away from a work surface to tilt• Items left on tray will slide and fall• Maintaining the hips in flexed position can

constrict the bladder• A leg bag can leak during a tilt

Power Tilt• Cons, cont.

• Lack of movement at hips and knees can lead to range of motion losses

• Some tilt systems have a higher seat to floor height than recline systems which can affect transfers and clearance under tables

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Anterior Tilt• Anterior tilt can be used to provide an anterior slope to the

thighs which in turn promotes pelvic stability and a slight anterior pelvic tilt

• Anterior tilt can be used to accommodate very limited hip flexion without the client leaning back too far

• Anterior tilt can be used to assist with transfers

Lateral Tilt• Lateral tilt can be used when a weight shift is required but

the client cannot tolerate the head moving rearward past upright

• Lateral tilt can also be used to dynamically accommodate significant pelvic obliquity

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Power Recline• Open seat to back angle• Typically includes a shear reduction feature which lowers

the back as the back also reclines• Often used in combination with elevating legrests• Often used in combination with tilt

Power Recline• Pros

• Easier catheterization, access to G-tube, diapering, clothes change• Pressure redistribution• Can do weight shifts at work surface• Tray remains parallel to floor• May relieve orthostatic or postural hypotension

• Decrease in blood pressure relieved by lying down• May relieve autonomic dysreflexia/hyperreflexia

• Increased blood pressure and other symptoms• Treatment: weight shift, but keep head elevated

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Power Recline• Pros

• Passive range of motion at hips and knees• Transfer may be easier• Increased comfort, resulting in increased seating tolerance• Provides a position of rest to address fatigue and post seizure

management• Allows gravity to assist with trunk and head control• May provide improved position for swallow, visual regard or

functional tasks

Power Recline• Cons

• Shear forces can disrupt alignment• Reclining increases pressure over sacral area• Opening seat to back angle can set off spasms• May lead to a loss of seated position, making return to upright

difficult• Cannot be used with contoured positioning system• Cannot be used by positioning systems with fixed seat to back

angle

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Power Recline• Cons, cont.

• Clients with limited ROM at the hips or knees may be pulled out of position

• Reclining may affect the client’s ability to access other assistive technology devices

Tilt/recline• Tilt and Recline can be combined

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Tilt and recline• Pros:

• Helps maintain posture, particularly on return to upright, while providing greater pressure relief through recline• Client “tilts” while reclined to flex hips before coming forward from

recline

Tilt and recline• Cons:

• More weight• More cost• More complexity• Client needs more control to operate these features than a single

function

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Power Elevate• Seating angles remain the same• Seat to floor height increases• Driving usually possible while

elevated• Driving speed may be reduced

while elevated

Power Elevate• Pros

• Extends functional reach• Allows adjustment of seat to floor height to optimize transfers to

various height surfaces• Provides access to a variety of height work surfaces• Vision• Social interaction/participation

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Power Elevate• Cons

• Challenging funding• Limits power wheelchair base options• May raise seat to floor height, depending on base

Power ELRs• Usually used in combination with recline• Can be programmed to move simultaneously with recline

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Power ELRs• Pros

• Passive range of motion to the knees• May improve circulation and reduce edema

• If used in combination with tilt to raise legs above level of heart

Power ELRs• Cons

• Can pull pelvis forward into posterior pelvic tilt if hamstrings are tight

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Power Stand• Hips and knees extend partially or fully

Power Stand• Pros

• Many physiological benefits of standing• Standing from a wheelchair:

• Extends functional reach• Improves visual field• Improves social interaction/participation• Increases compliance with a standing program

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Power Stand• Cons

• Client must have adequate range of motion• Client must have medical clearance for standing

• Risk of fracture • Autonomic issues

Driving Methods• Proportional • Digital

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Proportional Access • Joysticks and a few others• Requires grading of force and distance of movement• 360 degree control • Speed control

Digital Access• Basically, using 1-5 switches to control the direction of the

chair

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Programming

• Optimizes drive performance and efficiency

• Enables control of other features such as speed, reverse and actuators through the drive control

Built-in Features• Newer electronics offer built-in features:

• IR transmission• Mouse emulation

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Interfacing• Using the access method to control other assistive

technology devices, such as a speech generating device, laptop computer or EADL.

Pediatric Power Mobility• Research has demonstrated that early mobility is key to

overall vision, cognitive and psychosocial development• Augmented mobility

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Mobility Training• Pre-mobility training develops skills required to use a

power wheelchair• Mobility training optimizes driving skills

Take Home Message:• Power Mobility can be complicated• Assessment is a team effort, including the supplier• Power mobility can provide independent mobility to clients

who otherwise are dependent or inefficient in their mobility• There are many driving methods to meet a client’s needs

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Resources• RESNA Position Papers:

• The Application of Pediatric Power• The Application of Seat Elevating Devices• The Application of Tilt, Recline, and Elevating Legrests for

Wheelchairs• The Application of Wheelchair Standing Devices

• RESNA Wheelchair Service Provision Guide• www.RESNA.org

Resources• Access to Independence Resources

• Indoor Power Mobility Criteria• Outdoor Power Mobility Criteria• Pre-mobility Training Guidelines• Mobility Training Guidelines• Complex Rehab Power Wheelchair Electronics Comparison Chart• www.atilange.com/Resources

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Hands-on Activity• Contact a Seating and Mobility Clinic in your area• Arrange to observe a power mobility evaluation

Thank You!

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Contact Information• www.OccupationalTherapy.com• 866-782-9924

• Michelle L. Lange, OTR/L, ABDA, ATP/SMS• MichelleLange@msn.com• www.atilange.com