ACT Now 2023

Assessing an end user for power mobility can be an intimidating task. Decisions that are made will have an impact on the individual’s quality of life, functional mobility, physical well-being, and social interactions. When the end user is not able to utilize a standard joystick, then the task can become even more intimidating. There are many considerations and factors including driving/input method, mounting of driver controls, postural control, power positioning, programming, and environmental access/control. This workshop will review many of the considerations that must be examined when recommending alternative controls. Case specific examples will be utilized to elucidate the often-delicate interplay between alternative control access and complex seating system needs.

Course Objectives:

1. Describe 3 considerations for proportional alternative drive control selection and set-up​.

2. Describe 3 considerations for digital/switched alternative drive control selection and set-up.

3. Describe at least one factor on how tilt and recline can affect access to each drive control option​.

Drivability is defined as “the degree of smoothness and steadiness of acceleration”. When considering drivability in the terms of power wheelchair management, it is not only an extremely important factor for an end user’s safety in controlling the power wheelchair, but a huge consideration in the satisfaction and comfort of using the device. When evaluating an end user for a power mobility device, much consideration is given to the mobility base, seating components, and drive controls, but there are other features to consider as well. This course will look at these important additional features including programming options, drive wheel configuration, suspension, and tracking technology.

1. Participants will be able to distinguish 2 advantages of each drive wheel configuration type that will facilitate environmental access for the end user.​

2. Participants will distinguish 3 drive parameters used to improve control and safety when managing the power wheelchair. ​

3. The participant will be able to list 2 reasons tracking technology should be considered for users of switch drive controls.​

When an individual presents with asymmetrical destructive postural tendencies, or a unique body shape, the mobility team must look at custom molded options. Recent advances in custom molded seating interventions based on orthotic and prosthetic sciences utilize lighter, adjustable, less bulky materials which significantly expands the potential for successful custom seating applications. The Ride Designs product lines offer cost effective solutions for common skin, posture, growth and functional mobility needs of the complex mobility client.

1. State understanding of 2 key differences between immersion and envelopment, and orthotic and prosthetic product design. (Section 1, 20 min)

2. Properly identify loading and off-loading surface areas of orthotic style products. (Section 2, 20 min)

3. Identify two important factors that contribute to appropriate simulation of an orthotic based custom molded cushion. (Section 3, 25 min)

4. Identify two essential factors that contribute to an adequate simulation of an orthotic based custom molded back support. (Section 3, 25 min)

This course is designed for clinicians to enhance their knowledge and clinical application of the subject matter. This course provides an overview of the mobility base with a focus on power mobility and alternative drive controls. Additionally, the course will review considerations based on physical impairment and functional ability of the client, with the goal to maximize participation and independence. Identify 3 pieces of equipment that can be incorporated into a daily routine.

1. Participants will identify 3 types of power mobility bases.

2. Compare and contract power seat functions.

3. Identify 2 alternative drive controls available to provide access.

Every manual wheelchair user would like their chair to be a high-performance machine. Performance is impacted by principles involved in translating human movement into movement of a wheelchair and factors that contribute to energy loss. In order to help end users achieve maximum performance, persons involved in the wheelchair selection process need to have a fundamental understanding of how people use their wheelchairs, and how those wheelchairs function.

This presentation will examine the real-world behaviors of manual wheelchair users and discuss the mechanical principles and factors that affect propulsion efficiency. In addition to explaining some details of the science involved, we hope to inspire participants to think critically about their current understandings and beliefs on this topic.

Course Objectives:

1. Participants will be able to cite 2 examples of how end users move about in wheelchairs during everyday life.

2. Participants will be able to describe 3 physical principles that impact propulsion efficiency of a manual wheelchair.

3. Participants will be able to describe 3 component selections that impact propulsion efficiency of a manual wheelchair.

For individuals who use a manual wheelchair as a primary means of mobility, the performance, including propulsion efficiency, of that manual wheelchair is of significant importance. There is ample research that has identified a number of factors involved in manual wheelchair selection, component selection, and equipment configuration and adjustment that will influence the performance of the manual wheelchair for an individual. For many professionals within the complex rehab technology (CRT) industry there are some long held opinions regarding relative importance of some factors that are not well supported by recent research. Recognizing that many occupational therapists are involved in evaluation for and prescription of individually configured manual wheelchairs, providing education on the foundational science and physics of how manual wheelchairs work, and what research has revealed pertaining to these factors that affect performance is vital to informing clinical decision-making regarding equipment selection, set up and adjustment.

Imagine a meticulously configured ultralightweight rigid manual wheelchair, set-up for the user’s anatomic measurements, postural support needs, and skill level. The wheelchair has an aggressive axle position and is stripped down of secondary components, such as anti-tippers, armrests or even wheel locks. The end user is expecting a highly efficient, high-performance wheelchair. Now, imagine the chair being issued equipped with mag wheels and pneumatic tires with flat-free inserts.

Research is giving us new insights into the impact of wheel and tire selection as a critical influencer of performance. Are we considering the right factors and context when it comes to wheel and tire selection? Wheel and tire selection on manual wheelchairs often comes down to choosing the standard, no-additional-cost option, or may be based on an assumption that a user is not able or willing to maintain wheels and tires that require it. Are we providing end users an explanation of what to consider, and giving them the options to determine how much maintenance they are willing to accept?

An understanding of materials, and the physical and performance characteristics of wheels and tires, can contribute to improved decision making regarding the selection of a critical aspect of wheeled mobility: the wheeled part. This presentation will address the science of wheels and tires and review current research findings on the impact of selection and setup on wheelchair performance and propulsion efficiency. Attendees will be provided practical considerations to equip them to make appropriate wheel and tire selection when configuring manual wheelchairs.

Course Objectives:

1. Participants will be able to list two characteristics, each of drive wheels and of caster wheels and explain how they influence manual wheelchair propulsion efficiency.

2. Participants will be able to explain the importance of drive wheel diameter as it relates to rolling resistance.

3. Participants will be able to list two examples of manual wheelchair propulsion maneuvers where rotational inertia has significant influence and describe a strategy for each to lessen that influence.

For individuals who use a manual wheelchair as a primary means of mobility, the performance, including propulsion efficiency, of that manual wheelchair is of significant importance. There is ample research that has identified a number of factors involved in manual wheelchair selection, component selection, and equipment configuration and adjustment that will influence the performance of the manual wheelchair for an individual. Two of the most critical factors influencing manual wheelchair performance have been identified as distribution of system mass on the wheelbase, and wheel and tire selection.

Wheels are of course a necessary component of a wheelchair, but some professionals involved in the prescription process may simply select a standard wheel and tire without giving much thought to the wheel type, the tire type, the environment of use, and many other factors that may affect propulsion effort. Occupational therapists are often involved in evaluation for and prescription of individually configured manual wheelchairs, and the selection of components, including wheels and tires. Providing education on the foundational science and physics of how wheels work, and what research has revealed pertaining to wheel and tire choice can help inform clinical decision-making regarding this critical and influential component of a manual wheelchair.

Professionals involved in manual wheelchair prescription must work with end-users to create a configuration that achieves optimum results for comfort, postural stability, function, and propulsion efficiency. As professionals involved in manual wheelchair prescription and fitting, the value we bring to the process is directly related to our knowledge. This knowledge should always be evolving with integration of new research evidence. Without this requisite knowledge, we are ill-equipped to contribute to the quality of life of manual wheelchair users. This presentation will dive into the details of wheelchair set-up factors that must be considered to optimize postural stability and propulsion efficiency for end users. Factors include horizontal axle position, vertical axle position, seat height, seat angle, back height, back angle, and front frame angle. Consideration will be given to the relationship between these factors and the current research supporting optimization of each factor. We will address how to make prescriptive decisions while providing for potential changes in clinical need and the value of implementing follow-up to reoptimize the wheelchair over time.

Course Objectives:

1. Participants will be able to describe the influence of weight distribution on manual wheelchair rolling efficiency.

2. Participants will be able describe the relationship of upper extremity position to force application during manual wheelchair propulsion.

3. Participants will be able to list 3 aspects of manual wheelchair setup to assess during follow-up visits.

Occupational Therapists are among the professionals involved in manual wheelchair prescription and fitting, and the value they bring to the process is directly related to their knowledge. It is incumbent on the occupational therapist involved in this prescription and fitting that their knowledge is kept current and is in line with valid and relevant evidence. There are critical factors that must be considered to optimize postural stability and propulsion efficiency for individuals who use manual wheelchairs, with consideration for the relationship between these factors.

With a foundational understanding of the equipment and how it can be selected, configured, and adjusted for optimal propulsion efficiency, the occupational therapist then needs to determine how best to optimize the set-up and consider adjustments of that equipment for a specific individual. They should understand how to make prescriptive decisions while allowing for potential changes in clinical needs and recognize the value of implementing follow-up to reoptimize the wheelchair over time.

The seating and mobility evaluation has been completed and an ultralightweight manual wheelchair (K0005) has been selected as the appropriate piece of equipment. The make and model of the wheelchair has been determined. Now it is time to fill out the order form. How do you compile all of the information from the subjective interview, physical assessment, and equipment trials to determine the final equipment configuration and set up? How do you ensure that the wheelchair will meet the needs of the user now and allow the potential for adjustments over time? This presentation will use clinical examples to demystify the process of translating clinical findings to final equipment prescription, with particular attention to the complexity of rigid ultralightweight manual wheelchair configuration. Consideration will be given to changes in health condition/need as a result of circumstances such as: time post injury or illness, disease progression, and age.

Course Objectives:

1. Attendees will be able to explain the value of adjustability in an ultralightweight manual wheelchair configuration.

2. Attendees will be able to list 3 examples of adjustability to consider incorporating into the prescriptive configuration of an ultralightweight manual wheelchair.

3. Participants will be able to list 3 potential changes in user need during the life of the wheelchair and how they might change the optimal wheelchair set up.

For individuals who use a manual wheelchair as a primary means of mobility, the performance, including postural support and propulsion efficiency, of that manual wheelchair is of significant importance. For occupational therapy practitioners this falls under OT service delivery, as this is facilitating clients’ performance of MRADLS. For practitioners, the ability to apply the knowledge gained from the subjective interview, physical assessment and equipment trials to understanding an order form and making appropriate configuration selections to meet the client’s needs today while also planning for potential adjustments over time is not only vitally important, but many times done with only rudimentary knowledge of the capabilities of the equipment and the capacity for it to adjust over time. Helping practitioners make this connection between the needs and capabilities of the user to the configuration and adjustment capabilities of the equipment can contribute to more successful outcomes.

Occupational therapy practitioners are often involved in evaluation for, and prescription of, individually configured manual wheelchairs, the selection of components, and the individual adjustment and configuration of that wheelchair. Likewise, Physical therapists are often involved in evaluation for, and prescription of, individually configured manual wheelchairs, the selection of components, and the individual adjustment and configuration of that wheelchair. It is incumbent on these practitioners to have a deep knowledge of what affects the efficiency of the manual wheelchairs they’re prescribing and be equipped to help their clients achieve optimal functional outcomes with their mobility equipment.

This course provides an overview of primary support surfaces (back supports and seat cushions). Characteristics of the supports as well as the purpose of the intervention of the seat cushions and back supports will be presented.

Course Objectives:

1. Participants will identify 3 characteristics of support surfaces.

2. Define posterior pelvic tilt.

3. Compare and contrast cushions that provide pressure distribution vs cushions that provide positioning.