Embed Size (px)
Citation preview
November 2015 • Vol. 14 No. 11
mobilitymgmt.com
Serving the Seating & Mobility Professional
1115mm_Cover1nc.indd 1 10/7/15 12:17 PM
(US) 866-800-2002 | (Canada) 888-570-1113 | www.ilevel.rehab | /quantumrehab
Learn more about iLevel® at www.ilevel.rehab
4 mobilitymgmt.comnovember 2015 | mobilitymanagement
november
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.
© Copyright 2015 by 1105 Media, Inc. All rights reserved. Printed in the U.S.A. Reproductions in whole or part prohibited except by written permission. Mail requests to “Permissions Editor,”
c/o Mobility Management, 14901 Quorum Dr., Ste. 425, Dallas, TX 75254
The information in this magazine has not undergone any formal testing by 1105 Media, Inc. and is distributed without any warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry.
Corporate Headquarters: 1105 Media9201 Oakdale Ave. Ste 101 Chatsworth, CA 91311www.1105media.com
Media Kits: Direct your Media Kit requests to Lynda Brown, 972-687-6781 (phone), 972-687-6769 (fax), [email protected]
Reprints: For single article reprints (in minimum quantities of 250-500), e-prints, plaques and posters contact:PARS InternationalPhone: 212-221-9595E-mail: [email protected]/QuickQuote.asp
This publication’s subscriber list, as well as other lists from 1105 Media, Inc., is available for rental. For more information, please contact our list manager, Jane Long, Merit Direct. Phone: 913-685-1301; e-mail: [email protected]; Web: www.meritdirect.com/1105
On the CoverTweens experience new adventures in independence every day. Cover by Dudley Wakamatsu.
16 Wheelchair Backs Comparo Check out wheelchair backrests for every size, application
and client, including those who need aggressive or
customized support.
21 Seating & Mobility for Tweens They’re not little kids any more! Tweenhood is a time
for physical, social and emotional changes and growth
— along with challenges for everyone, including their
seating & mobility professionals.
volume 14 • number 11
6 Editor’s Note
8 MMBeat
26 Marketplace: Seat Cushions
28 Product Revue
29 New Discoveries: Deep Tissue Injuries, part 3
27 Ad Index
November 2015 • Vol. 14 No. 11
mobilitymgmt.com
Serving the Seating & Mobility Professional
contents
CLIPA
REA |
custo
m me
dia/S
hutte
rstoc
k.com
Tatia
na_K
ost/M
onke
y Bus
iness
Imag
es/A
rto H
akola
/Alex
andr
u Nika
/Melo
dist/L
ena P
an/sh
utter
stock
.com
Monk
ey Bu
sines
s Ima
ges/A
rto H
akola
/Alex
andr
u Nika
/Melo
dist/L
ena P
an//S
hutte
rstoc
k.com
1115mm_Contents4.indd 4 10/7/15 12:22 PM
6 mobilitymgmt.comnovember 2015 | mobilitymanagement
From the very start of Mobility Management in 2002, this magazine has enjoyed the intermittent but essentially persistent presence of guardian angels — industry experts, veterans, heroes who for completely indiscernible reasons have put their arms around MM at various times to help it along.
I have never understood it, why people who have a lot more important things to do take time from their days and evenings and weekends to help out this little maga-zine. But I’ve learned to just enjoy and be grateful for it.
One of these current industry guardian angels is Hymie Pogir, an actual rock star. Hymie is currently with Permobil, but he’s a treasure that the whole industry claims as its own. When I met Hymie in 2002 or 2003, I was utterly scared of him, terrified that he’d see right through to my ignorance. The fact that he has never been anything but gracious and warm, the fact that he is beloved for his self deprecation, only made me worry more that I’d look like a fool to him.
Thankfully, I mostly got over that. Hymie recently began calling me in an impromptu mentorship that has thrilled me down to my toes. This week, our talking point was why so many seating & wheeled mobility clients are at odds with their ATPs — why, frankly, so many consumers think this industry’s providers are the problem, to blame for everything from five-year reasonable useful lifetime rules to reimbursement rates so low they’re sometimes less than the cost the manufacturer incurred to make the product.
Why, Hymie and I wondered together, are consumers and providers so constantly pulling against each other despite the prodigious efforts of consumer and industry orga-nizations to get us to pull together? And what can Mobility Management do to help?
So in 2016, we’ll be regularly profiling local and regional consumer organizations that are making a difference to end users and in so doing, are lifting us all up. I hope that these stories will be resources to you and your clients. And selfishly, I hope that as these organizations work with MM, as they get to know our readership in that process, some of what you truly do will come to light.
If you know an organization that you’d like me to profile, let me know. My e-mail address is written below. Hymie is getting me started with a suggestion or two, but after that, I hope the column will take on a life of its own.
Hymie’s many wise suggestions for growing this magazine go far beyond just this new column (but they’re secrets until he works his magic behind the scenes. Let’s just say a commode and a scrub brush might have something to do with one idea). And his suggestions aren’t the only ones I’m excited to present to you in 2016. New editorial advi-sory board member Steve Mitchell of the Cleveland VA has been talking with me as well, so look for contributions from him next year (code words: ALS and dynamic ultralights).
Thank you to all of my mentors — that means all of you who’ve given an interview, suggested a story idea, explained a concept to me such as shear, deep tissue injury or dystonia. You keep us going, you keep us growing, and in this traditional month of Thanksgiving, I’m profoundly grateful. Thank you for another wonderful year. l
Laurie Watanabe, [email protected]
@CRTeditor
Editor Laurie Watanabe (949) 265-1573
Group Publisher Karen Cavallo (760) 610-0800
Group Art Director Dudley Wakamatsu
Director, David Seymour Print & Online Production
Production Coordinator Charles Johnson
Director of Online Marlin Mowatt Product Development
mobilitymgmt.com
Volume 14, No. 11
November 2015
editor’s note
Guardian Angels
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
Senior Vice President & Richard Vitale Chief Financial Officer
Executive Vice President Michael J. Valenti
Vice President, Erik A. Lindgren Information Technology & Application Development
Vice President, David F. Myers Event Operations
Chairman of the Board Jeffrey S. Klein
SECURITY, SAFETY & HEALTH 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 Ginger Hill
VLAD
GRIN
/shut
tersto
ck.co
m
1105mm_EditNote6.indd 6 10/7/15 3:37 PM
PRO CG Ad Standard Full page 8 x 10.75”
TM Copyright© 2014.Freedom Designs, Inc.All rights reserved.Printed in the USA.
Manufactured in the U.S.A.Patent pending.
Freedom® P.R.O. CG“Precise Rotational Orientation” Center of Gravity Tilt-in-Space Mobility
easy to push and turn
easy to tilt and un-tilt
easy to adjust
easy to use
This lighter weight compact design is so…
✓✓✓✓
“Way Ahead of the Curve”
TM
Its “lighter weight” design (just 34 lbs. in transport configuration)and compact size (base frame is only 21.75” long) and simple adjustments enhance the maneuverability of the P.R.O. CG. Thismakes it easy to push, turn, tilt and un-tilt so it is less cumbersomein small spaces and more adept in transportation. Simply put, itlends itself nicely to virtually any everyday experience.
Freedom Designs Incorporated2241 N. Madera Road, Simi Valley, CA 93065
Phone: 800-331-8551Fax: 888-582-1509
Email: [email protected]
8 mobilitymgmt.comnovember 2015 | mobilitymanagement
mm beat
Ron Turzy Is New U.S. Rehab VP of CRT
NHIC Announces Latest Group 2 Support Surfaces Prepayment Review Results
Medicare’s Jurisdiction A DME MAC, NHIC Corp., has released the most recent results of its widespread prepayment review for Group 2 pressure-reducing support surfaces.
The products involved in the review have HCPCS code E0277, and in the news announcement, NHIC said the review “was initi-ated due to errors identified by the Comprehensive Error Rate Testing contractor.”
The charge denial rate for the second quarter of 2015 was 57 percent for claims dated April 1 through June 30 of this year.
For that period, the review examined 121 claims submitted by 57 different suppliers. NHIC did not receive responses to its Additional Documentation Requests for 33 percent of the claims being reviewed.
Of the 81 claims for which additional documentation was supplied, NHIC allowed 36 and denied 45.
The 57-percent charge denial rate was a significant drop from the January-through-March review period’s charge denial rate of 78.1 percent. Previous charge denial rates included 68.9 percent for July through September 2014, and 70.4 percent for October through December 2014.
U.S. Rehab has named Ron Turzy its new VP of complex rehab.
The industry veteran previously worked as the national complex rehab technology director for Homelink/The VGM Group, and prior to that was an area contracting manager at Numotion.
In the news announcement of the appointment, U.S. Rehab President Greg Packer said about Turzy, “His back-ground as a provider, at a national complex rehab provider,
CGS, Medicare’s Jurisdiction C DME MAC, has a new fax line and address for providers to use for overpayment appeals.
The fax line and address go directly to the DME MAC’s appeals department.
The fax number is (615) 244-5907. The new address is CGS, Overpayment Appeals, P.O. Box 23917, Nashville, TN 37202.
In addition, CGS recommended that providers “immediately
refund the requested amount” to avoid accruing interest, and suggested providers use the online Redetermination Request Form. On the form, providers should select “Yes” in the overpayment appeal portion, then indicate who requested the overpayment, such as the Comprehensive Error Rate Testing contractor or the Recovery Audit Contractor.
Providers can then follow directions to fax or mail in the appeal. l
and in Homelink provides the necessary knowledge base for U.S. Rehab to accomplish our future goals.”
Turzy’s new responsibilities will include working with the U.S. Rehab outcomes program and seeking national complex rehab insurance contracts. VGM said Turzy “has over 13 years in contracting, sales, marketing and upper-management experience in the field of complex rehab tech-nology and DME.” l
The NHIC report said lack of adequate medical documenta-tion was the most common reason for denials. The DME MAC said 28 percent of claims that were denied failed to meet one of three coverage criteria, including the beneficiary having multiple stage 2 pressure ulcers on the trunk or pelvis that haven’t improved in the last month; the beneficiary having large or stage 3 or 4 pres-sure ulcers on the trunk or pelvis; or the beneficiary having had flap or skin graft surgery for a pressure ulcer on the trunk or pelvis in the last 60 days, with the beneficiary also having used a group 2 or 3 support surface just before being discharged from a hospital or medical facility to go home.
Additionally, NHIC said 5 percent of claims didn’t include medical documentation at all, and 1 percent of claims had illegible medical documentation.
Other common reasons for denials included problems with the written order being done prior to delivery, and problems with proving the support surface had been delivered to the beneficiary.
NHIC said it was ending the prepayment review for the E0277 code, “but will continue to monitor billing patterns.” l
CGS Opens New Fax Line & Address for Appeals
Ron Turzy
1115mm_MMBeat815.indd 8 10/7/15 2:44 PM
Now You’re Going Places
TM
COMING SOON
Hi-Low Base for TrekkerTM
#convaidtrekker
10 mobilitymgmt.comnovember 2015 | mobilitymanagement
mm beat
Jim Papac’s Goal for LEVO USA: “It’s All About the Client”
Industry veteran Jim Papac had been on the job at LEVO USA for exactly six days when he talked to Mobility Management, but of course, that number is a bit misleading. His new position — as presi-dent of the standing wheelchair company’s American division — was actually a home-coming. Papac launched the LEVO brand in the United States and Canada in 1996. Now, after tenures with other companies including Permobil, where he worked as National Standing Products Sales Manager, Papac is back.
“We are extremely excited to have Jim join our team because he brings such deep under-standing of our industry and a passion for helping patients,” said Daniel T. Johnson, CEO of Dane Technologies, LEVO USA’s parent company.
And Papac’s return comes at a time when standing technology may finally be getting the respect and attention its advocates say it’s always deserved.
Standing As a Healthcare SolutionGreg Wenthe, VP of Marketing & Business Development, agreed this is an exciting time for standing wheelchairs.
“We’ve seen lots of activity from the interest standpoint,” he said. “Obviously, our bodies are meant to stand, so I think it’s reasonable for people to conclude that standing leads to a healthier life. Our mission is providing our clients with the ability to regularly stand. There are a number of clinical benefits: improvement of digestive, cardiovascular, and respiratory function, as well as improved range of motion, muscle tone and reduced spasticity. The one that we’ve noticed, though, has really been the clinical benefits regarding pressure ulcers.”
Part of the attractiveness of using a standing wheelchair to relieve pressure, Wenthe believes, is that it can happen as a natural part of the user’s daily activities.
“Therapists have been recommending a variety of pressure relief techniques, but they’re not always convenient or practical,” Wenthe said. “It’s been proven that individuals who use a standing wheelchair have a simple and very effective solution for relieving pressure and its associated risks.”
In addition to the many clinical benefits, Wenthe added that standing technology could be additionally supported by the trend toward a more holistic view of healthcare costs — for instance, not just calculating the cost of a standing wheelchair, but also factoring in the
money saved by preventing pressure ulcers and the expensive treatments they require.
“[Veterans Affairs] says that what they term a full-thickness tissue-loss — also known as a stage 3 ulcer — takes about $70,000 to fully treat,” Wenthe said, adding that other sources, such as the American Journal of Surgery, have quoted costs of upwards of $124,000 to treat stage 4 ulcers. “The VA also talks about pressure ulcers being a primary reason for readmission. The trend in healthcare right now is to really push healthcare providers into reducing readmissions and better managing the total cost of care.”
A Standard of CareWhile Papac’s presidency is still very new, he’s had plenty of time to think about his priorities moving forward — and they were a mix of “big picture” and “everyday reality.”
“Over the next 12 months, LEVO is celebrating its 40th anniver-sary,” he noted. “Our long focus on standing mobility has resulted in the most complete line of stand-up wheelchairs. While the LEVO name is extremely well known around the world, I don’t think we’ve had the visibility in the United States that LEVO deserves.
“At 10,000 feet, that’s my first goal: To raise the visibility of the company and the products and let people know the history of the company. Our expertise and the breadth of our solutions have been the foundation of our success in Europe and around the world. We want to bring those benefits to our clients in the U.S.”
As far as what he intends to tackle first, Papac said, “When you get down to the day-to-day activities that I’m going to make priori-ties, it’s all about the client. LEVO will continue to be the champion for standing. Over the years, I’ve broken it up into basically four bene-fits of standing: the health benefits, functional, social and vocational benefits. Those are all very real benefits. So that’s the first cause: LEVO will champion standing as the standard of care.”
Papac is well aware of the funding beliefs — some true, some not — that people have about standing technology, and he’s ready to take on those as well.
“There’s a perception out there that standing chairs are very diffi-cult to get funded or don’t get funded at all,” he said. “We’re well aware of the challenges, and we’re well aware of how to address those chal-lenges, starting with clients and families. They have to be their own best advocates. We need to assist them in understanding the process
Jim Papac, new president of LEVO USA.
1115mm_MMBeat815.indd 10 10/7/15 2:44 PM
mobilitymgmt.com 11 mobilitymanagement | november 2015
mm beat
most complete line of adult and pediatric standing wheelchairs, with a proven and trusted track record around the world. Clients in the United States can feel very comfortable that we are laser focused on standing, and we are uniquely focused on our clients. It’s the client first, with standing as the standard of care whenever possible. Standing wheelchairs are the standard of care throughout Europe, Scandinavia, Australia, New Zealand and many countries in the middle east and Asia. We want to make standing wheelchairs the standard in the U.S.
“The message we want to share with ATPs and clinicians is we’re here as a resource for them, helping them do the right thing for their clients. LEVO has the expertise and the best range of solutions to match the needs and standing mobility goals of their clients. If their client would benefit from a standing wheelchair, we are there to help them make it happen.”
LEVO USA currently offers power and manual standing chairs (with power-assisted standing available) in sizes to fit clients from pediatric to adult, and in configurations to fit clients with moderate to high-end seating & mobility needs. As this issue went to press, the company was planning to launch two more models — the Summit M and Summit EL — at REHACARE in Düsseldorf, Germany, in October. Existing models are the C3, Combi and Combi Jr., LCEV (plus LCEV Kid and Junior), and LAE.
“LEVO has the broadest product offering over any other supplier out there,” Wenthe says. Partially, that’s because of our laser focus; we’re not diversified into a bunch of other power chairs. We’re 100-percent focused on standing, and because we’ve done that, we’ve developed a very broad product range. We’re going to have the right product at the right price for a given user.”
Papac is looking forward to getting settled in and working with the LEVO team. “There’s a very good team assembled. It is going to be exciting and a lot of fun to take the next steps in our plans to grow in the U.S. Our objective is to get as many qualified clients as possible who can benefit from a stand-up wheelchair, into a stand-up wheel-chair. After all, it’s the standard of care.” l
— Laurie Watanabe
and give them direction and back them in their efforts all the way up to and including support if it gets to a fair hearing situation with the funding source. There’s also this perception by the dealer that [standing chairs are] too difficult to get funded or are not able to get funded at all. And I can assure you that over the years, the sale of standing wheelchairs in the States has grown significantly.”
Papac’s, and now LEVO USA’s, strength lies in his decades of exper-tise in the standing arena. Wenthe referenced a phone call fielded by Papac a few months earlier from a desperate mother scheduled to participate by herself in a fair hearing in two days. Her teenage son had been injured in a car accident, but his standing wheelchair claim had been repeatedly denied. Papac advised her to contact the court and ask for a postponement on the grounds that she hadn’t yet attained the legal counsel she was entitled to. Papac’s next phone calls focused on finding the woman and her son a local attorney through the National Disability Rights Network and others who could build a team to support her. With that accomplished, mother, son and attorney attended the fair hearing with their complex rehab provider, who brought along a standing wheelchair. Using the chair, the boy stood up in front of the judge hearing the case.
And that was that. The judge approved the chair.Referring to other users and their families that could benefit from
a standing wheelchair, Papac explained, “They’re not aware there are resources out there to help them obtain a standing wheelchair and all the health benefits of standing. We want to make sure clients know a standing wheelchair is a viable option and that they can get funding for a standing wheelchair if they are qualified and stay committed to the goal.”
What to Expect from LEVO USAOf course, once consumers, ATPs and clinicians are aware of standing technology — not just its benefits, but the fact that standing wheel-chairs can get funded — Papac wants them to think of LEVO USA. He points to the company’s history.
“As far as product and expertise, LEVO invented the first standing wheelchair in Switzerland 40 years ago,” he says. “This line is the
Motion Composites Ultralights Get Medicare Codes
Motion Composites’ Veloce and Helio ultralightweight manual wheelchairs have received Medicare coding, the Quebec-based manufacturer has announced.
In its Sept. 17 newsletter, Motion Composites said the Veloce, a folding chair made of carbon fiber, and the Helio, a folding chair available in aluminum or carbon fiber, have been assigned the K0005 code for seat
widths and depths of 15 inches or larger. Veloce and Helio chairs with seat widths/depths of less than 15 inches will have the E1236 code.
Motion Composites bills its 7000 series aluminum chairs as “the lightest available in their category.” The Veloce has a total weight starting at 17.6 lbs. and a transport weight of 11 lbs. The transport weight of the carbon fiber-framed Helio C2 starts at 12 lbs. l
Motion Composites’ Helio C2 carbon fiber chair is newly Medicare coded.
1115mm_MMBeat815.indd 11 10/7/15 2:44 PM
12 mobilitymgmt.comnovember 2015 | mobilitymanagement
EZ-ACCESS Acquires Worldwide Mobility, Launches New External Lift Line
EZ-ACCESS has acquired Worldwide Mobility, a longtime wheelchair and scooter lift manufac-turer based in Mesa, Ariz. In making the acquisition, EZ-ACCESS also announced it would be introducing a new line of external lifts to transport wheelchairs and scooters outside of automotive vehicles.
The new lift series is called HAULWAY, and at press time, it was scheduled to be officially introduced at Medtrade in October in Atlanta.
The HAULWAY line, EZ-ACCESS said in a news announcement, will be “available in multiple sizes with an array of options. The lifts feature simple installation and operation, and they adjust to most vehicles and models of power chairs and scooters.”
To help accessibility dealers show off the new line, EZ-ACCESS
mm beat
added that display racks will be avail-able for showrooms.
“Over the past 30 years, EZ-ACCESS has made every effort to offer our dealers the highest quality and most complete line of residential, portable, threshold and modular ramps,” said EZ-ACCESS CEO Don Everard. “With the introduction of the PASSPORT Vertical Platform Lift in 2014 and now the addition of the HAULWAY, we remain committed to offering our customers a complete line of products
for all access solutions.”Everard indicated the HAULWAY line is just the beginning of an
expansion of EZ-ACCESS product lines, with the goal being to ulti-mately offer solutions to meet the entire range of consumers’ accessi-bility needs. l
Don’t just look
for a better job.
Look for a
better career.
800.500.9150 numotion.
Our Assistive Technology Professionals
help maximize our customers’
independence. Our ATP Development
Department helps our ATPs lead
better careers. With over 1,800
contracts in place, we have the most
payer contracts in the complex rehab
industry.
We provide extensive support for our
ATPs, letting them concentrate on
doing what they do best.
Put your career in motion at
numotion.com.
EZ-ACCESS’s new HAULWAY external vehicle lift.
1115mm_MMBeat815.indd 12 10/7/15 2:44 PM
mobilitymgmt.com 13 mobilitymanagement | november 2015
Learn more at easystand.com
In October, Savaria Corp. purchased two Silver Cross franchises in St. Catharines and Toronto, Ont. The acquisitions follow the purchase of an Ottawa Silver Cross franchise in September. In a news announcement, Savaria CEO/President Marcel Bourassa said of the new additions, “As a follow-up to its purchase of Silver Cross Ottawa [in September], Savaria is pleased to continue on its path to own corporate stores in key Canadian markets. Ontario is home to almost 5 million seniors, many of whom will need our products in the coming years in order to maintain mobility in the home. We want to be their go-to source and we will work hard for their business and loyalty.” Both of the newly acquired franchises will sell stairlifts, wheelchair lifts, elevators, wheelchair-accessible vehicles and other DME… The Joint Commission has named Brian H. Enochs, JD, its new executive VP of busi-ness development & marketing. A news announcement said Enochs will “oversee all business development and marketing efforts for The Joint Commission and its strategic business units, including oversight of external relations and state relations.” Enochs takes over for Chuck Mowll, who retired in May. Enochs’s has a pharmaceutical industry background, having previously worked for Intarcia Therapeutics, Abbvie Pharmaceuticals
briefly…and Eli Lilly & Company… A new report from the University of Colorado Anschultz Medical Campus and AAA Foundation for Traffic Safety studied how healthcare providers can “play a key role” in discussing the often emotional and challenging topic of safe driving and driving retirement with seniors. The report — “Older Adults’ Preferences for Communication with Healthcare Providers About Driving” — said that routinely discussing safe driving and alternative transportation methods with older patients can be more effective than waiting to talk about it until driving has become a problem. The study suggested that healthcare providers include questions about driving as part of regular check-ups, but that clinicians be aware of and respect older drivers’ personal and unique circumstances, including how cultural influences may impact their beliefs on driving and independence. The study referenced 22 published studies that worked with more than 500 older drivers. l
Toa5
5/sh
utter
stock
.com
mm beat
1115mm_MMBeat815.indd 13 10/7/15 2:44 PM
14 mobilitymgmt.comnovember 2015 | mobilitymanagement
mm beat
Investor AB Purchases BraunAbilityNick Gutwein: “It Is an Exciting Time for Us”
Even in an industry that’s become well accustomed to acqui-sition news, this particular announcement was very intriguing: In late September, Investor AB acquired BraunAbility, one of the best-known names in the adaptive automotive world.
Investor AB, of course, already owns Permobil thanks to a 2013 purchase. And that raised interesting questions about possible collabo-rations across two different mobility industries that serve the same end user, as well as what to expect from BraunAbility moving forward.
A Time of TransitionThe past few years had been a time of change for BraunAbility, even before Investor AB came calling.
Ralph Braun had built his first power wheelchair as a teen and later progressed to inventing wheelchair vehicle lifts to stay independently mobile as his spinal muscular atrophy progressed. He founded Braun Corp. in 1972, and his company grew to become one of the leaders in the wheelchair-accessible vehicle market. The Braun Corp. became known as BraunAbility in 2008.
Ralph Braun remained at the heart of the company until he died in 2013.
“Obviously, we’ve had a very rich history with Ralph Braun, what he built in the company, and then we had a very challenging change to us when Ralph passed away,” BraunAbility CEO/President Nick Gutwein said, speaking with Mobility Management a few days after the official acquisition announcement. “But prior to that, he had the vision to set up an ownership structure, and it’s worked well for us for three and a half years. He knew that he was going to be dealing with this terminal cancer, and it motivated him to recapitalize back then. So we were very happy, and things have been going quite well with our current ownership structure, and really we had no intention to sell. We were not actively out trying to sell our company at all.”
So when Investor AB — and their New York-based Patricia Industries division — contacted BraunAbility this spring, Gutwein admits being “kind of cautious” and wondering what Patricia Industries had in mind.
Imagining the Possibilities But by the time Patricia Industries representatives officially reached out, they knew BraunAbility quite well.
“They had done a lot of homework on BraunAbility,” Gutwein says.
“They had a pretty good two-and-a-half-year run and were very happy with their Permobil acquisition, and so they knew us well and knew our brand well, and felt that they could help us to grow, could help us outside of North America, and within our operation. And they also were very clear that their strategy or their investment approach is ‘long-term hold.’ So they’re not your traditional private-equity buyer that will buy and then lever up the company and then recapitalize in five to seven years. We did not want to do that. We were totally against that kind of approach.”
Instead, the involvement of Investor AB has BraunAbility looking down the road and wondering at the possibilities. Asked what his hopes are for future, Gutwein says, “Really to help to accelerate the plans to grow the company, entering new markets and new product lines, and then also we have some ideas to invest in our operation in Winamac, Ind.”
And then of course, there could be possible collaborations with another member of the Investor AB family. The possibilities would have been interesting enough had Investor AB’s mobility portfolio only included Permobil. But in 2014, Permobil acquired ultralight-weight wheelchair manufacturer TiLite. This year, Permobil added seating manufacturer ROHO Inc.
Asked if he’s contemplated future collaborations, Gutwein said, “We sure have. We were not at all pursuing a sale of the company. But the Permobil connection was one that really kind of solidified our interest once [Investor AB] showed how strongly they were interested in us, and we started doing a little bit of study on Investor AB. We have a tremendous admiration for Permobil and its brand, and yes, we have thought about that. Nothing concrete, but you can imagine a company that knows power wheelchairs — and now manual wheel-chairs with TiLite — and has an understanding of needs from a chair perspective, and if you marry that with our leadership in the area of transportation for people with disabilities, you can see maybe some design collaborations, some marketing work together. It seems very interesting, but nothing concrete yet.”
Management Will Stay in PlaceAs for day-to-day operations, Gutwein indicated it will largely be business as usual — in part because he and other BraunAbility execu-
Nick Gutwein
1115mm_MMBeat815.indd 14 10/7/15 2:44 PM
mobilitymgmt.com 15 mobilitymanagement | november 2015
New Symmetric Designs Site Highlights Free Form Seating
Symmetric Designs has long had its SymmetricDesigns.com Web site to market its seating & positioning components, including its well-known Savant headrest and the Axion Rotary Interface that enables headrests to freely rotate to accommo-date the unique needs of each user.
Now, Symmetric Designs has launched a second Web site — FreeFormSeating.com — to highlight its Free Form Seating system.
“We felt that Free Form needed a dedicated Web site of its own to really showcase the product and what it can do,” Symmetric Designs’ Sam Hannah, ATP, told Mobility Management. “It’s such a versatile product that can be applied in many ways. One page on our company Web site wouldn’t do it justice.”
Symmetric Designs describes the Free Form system as “custom seating, simplified.” Providers and clinicians can order Free Form backrest or full-body kits, which can be adjusted to accommodate such conditions as kyphosis, scoliosis or lordosis. The modularity of the system also allows the seating team to make adjustments to account for weight gain or loss, growth or changes in condition.
Positioning components such as chest harnesses and headrests can be added to the full-body seating system via hardware that includes clamps and extended screws.
Backrest kits are angle, depth and height adjustable and include a
cover, attachment hardware, extended screws for accessory attach-ments and a free-form shell that can be adjusted to give support where it’s needed.
The Free Form site includes closeup photos showing the abundant possibilities for this system, from relatively standard configurations to configurations that are highly customized to accommodate asymme-tries — but can still be easily changed.
“The gallery page will be a good tool for us to show clinicians and dealers the different configurations, and they can take guidance from that when doing their own fittings,” Hannah said. l
tives are partial owners of the company themselves.“Investor AB, Patricia Industries, will be the majority owner for
sure,” he explained. “But myself and our other senior executives will not only be there to stay in our current jobs — so I’ll stay as CEO, Tom Eastman will stay our CFO, everyone will be in place — but we also have ownership. We have a sizable investment ourselves in the company, so we’re excited by that, too.”
Though Investor AB is headquartered in Stockholm, Sweden, Patricia Industries is headquartered in the United States, and “We are their first foray into buying a U.S. company,” Gutwein noted.
Mobility dealers working with BraunAbility won’t notice anything different, Gutwein added. “I think that they’re going to see things pretty much the same as we’ve been operating. We have a great rela-tionship with our dealer network, and nothing will change. Our name won’t change, the ordering process won’t change. Investor AB is buying us because we are a strong brand and a healthy company, so fundamentally, they won’t be changing our operational approach to the business. It’s more so just helping to drive growth and add product lines and expand our portfolio.”
He said expansion and acquisition are very likely, “but it’s kind of multi-dimensional. For example, I think part of that is looking at the
global market for our products and opportunities, so there could be some there. Acquisitions would likely be a part of our thinking going forward, but it’s very early to tell where and what direction we’re going to go with that. But clearly, you’ve seen that in Permobil, and you will see that with us if we feel like there are complementary products or markets we can extend into through acquisition. We’ll certainly consider those.”
An Exciting TimeGutwein said the things he’s excited about include the belief that Ralph Braun’s inspirational history is in good hands with Patricia Industries and Investor AB.
“[For] about 45 years the company will have had its track record largely built on the legacy of Ralph Braun,” he said. “So what I’m most excited about is our people in Winamac, Ind., who I believe now will have an investor and a partner that will be a decades-long company, a long-term owner — [one] that is interested in continuing that legacy of Ralph Braun and also in extending that to the industry, to our dealer network. I see this as a way to solidify that for the long term. That’s what excites me the most.
“I think it’s wonderful for our industry, and I think it’s a wonderful industry to be in.” l
mm beat
1115mm_MMBeat815.indd 15 10/7/15 2:44 PM
16 mobilitymgmt.comnovember 2015 | mobilitymanagement
How to Read This ComparoMobility Management invited manufacturers and distributors of aftermarket wheelchair backrests to submit photos and infor-mation about their products.
Information in this comparo was self selected and reported by the manufacturers. • If information does not apply or is not available, N/A is noted.• HCPCS codes were accurate at press time.• Weights of wheelchair backs and the backs’ weight capacities (i.e., the
maximum weight of the patient using the back) are given in pounds (lbs.). • Back heights and widths are given in inches. In some cases, the heights
or widths are followed by another measurement, which refers to the size of the back for which the height or width is given.
• The first of the height measurements refers to the height of the back at its highest point. The second height measurement shows the range of heights currently available in that model of back.
• The first of the width measurements refers to the width of the back at its widest point. The second width measurement shows the range of widths currently available in that model of back.
• Back angle/recline measurements are stated in degrees.• Construction refers to the materials used to create the wheelchair back,
including shell and cushion.
2015 Wheelchair Backs Comparo
• Cover construction refers to the materials used to create the back’s cover, as well as the cover’s properties.
• Accessories available refers to positioning accessories that the back can accommodate. Accessories listed may be included with the back or avail-able at a separate cost.
• Hardware refers to the type and the properties of the hardware that attach the wheelchair back to the wheelchair.
• Adjustability refers to the different height, width, depth and angle adjustments or changes that can be accommodated by the back and its hardware.
• Intended applications refers to the targeted demographic or end user who could benefit from this seat back. Manufacturers were asked to supply brief examples, and other applications beyond those listed may be possible.This Wheelchair Backs Comparo is intended to be a starting point and
reference for seating & mobility suppliers and clinicians as they consider different back possibilities.
Submissions were edited for style and to fit in the space allotted. For more complete wheelchair back information and additional specifications and details, please consult the manufacturers directly using the Sources
Guide. l
CLIPA
REA |
Custo
m me
dia/sh
utter
stock
.com
1115mm_BacksComparo1620.indd 16 10/7/15 12:08 PM
mobilitymgmt.com 17 mobilitymanagement | november 2015
Back
Wt./
W
t. Ca
pacit
yHC
PCS C
ode
Back
Ht./
Ht
s. Off
ered
Back
Wid
th/
Wds
. Offe
red
Back
Ang
le/
Recli
neCo
ntou
red?
Back
Co
nstr
uctio
nCo
ver
Cons
truc
tion
Acce
ssor
ies
Hard
war
eAd
just
able
?In
tend
ed A
pplic
atio
ns
2015 Wheelchair Backs Comparo
Man
ufac
ture
r/M
odel
Yes (
heigh
t and
wi
dth)
Mas
onite
board
ca
n be r
emov
ed
to ac
com
mod
ate
reduc
ed lo
rdot
ic cu
rved b
acks
Fully
adjus
table
in all
posit
ions t
o ac
com
mod
ate m
ost
patie
nts
Easil
y adju
sted f
or gr
owth
(4" d
epth
), an
gle (4
0°) a
nd
rotat
ion. A
djusta
ble
mou
nting
pins
allow
fit
to ch
airs s
ame o
r 1"
wide
r tha
n bac
k
Yes,
with
clam
ps
20° b
ack a
ngle,
2"
seat
dept
h, +
or -1
" ba
ck w
idth
N/A
E261
1, E2
612
E261
1, E2
612
E261
5
N/A
E261
5, E2
620
7 lbs
./400
lbs.
N/A;
N/A
N/A;
350 l
bs.
1.9 lb
s. &
up;
150 l
bs.
N/A;
N/A
4.6-7.
8 lbs
. de
pend
ing on
size
; 30
0 lbs
.
Adjus
table/
11
-16"
and 1
7-21
", adju
stable
17-19
"/17"
, 19"
16"/1
6"
10.5"
(10"
ba
ck)/7
", 10"
, 12
", 14"
N/A/
10", 1
2",
14", 1
6", 1
8", 2
0"
12-2
2"/1
2", 1
4",
15", 1
8", 1
9", 2
2"
16", 1
8", 2
0", 2
3"/
16", 1
8", 2
0", 2
3"
16-2
2"/1
6", 1
8",
20", 2
2"
16-2
0" &
22
-26"
/16-
20" &
22
-26"
10" (
10"
back
)/10-
14"
14", 1
6", 1
8",
20"/1
4", 1
6",
18", 2
0"
18" (
18"
back
)/14"
, 15"
, 16
", 17"
18",
19", 2
0"
90°
None
Fully
adjus
table
in all
posit
ions
40° (
-20 t
o 20°
)
Up to
35° (
for 4"
co
ntou
red ba
ck)
and u
p to 2
0°
(for 2
" con
tour
ed
back
) ang
le ad
justab
ility
20°
No, b
ut ba
ck is
ad
justab
le
Has l
umba
r su
ppor
t
Can
acco
mm
odate
ky
phos
is,
rotat
ion,
scolio
sis
3" co
ntou
r dep
th
2" co
ntou
r (10
-14"
heigh
ts) an
d 4"
cont
our (
16-2
0"
heigh
ts)
3" re
gular
or 6"
de
ep
Cube
Akto
n poly
mer
overl
ay
Mem
ory f
oam
& M
ason
ite bo
ard to
pr
even
t slin
g-ba
ck
ham
moc
king
1" th
ick hi
gh-
dens
ity fo
am
pad f
or pr
essu
re red
istrib
ution
and
com
fort
Light
weigh
t, du
rable
alum
inum
back
shell
desig
ned
for ea
sy at
tachm
ent
of op
tiona
l later
al su
ppor
ts an
d he
adres
t
Fully
adjus
table
alum
inum
shell
back
wi
th pa
dding
for
whee
lchair
s
3 heig
hts &
2 de
pths
av
ailab
le in
each
siz
e. Ins
ert m
ateria
l is
.75" p
olyur
ethan
e ov
er .25
" clos
ed-c
ell
foam
s; alu
minu
m sh
ell
Stretc
hable
polye
ster,
brea
thab
le fab
ric
Brea
thab
le, flu
id-res
istan
t cov
er
Brea
thab
le, flu
id-res
istan
t cov
er
Kid*a
b*ra,
Pink
Lo
llipop
and B
lizza
rd
Blue c
overs
are
water
resis
tant a
nd
brea
thab
le
Doub
le-de
nsity
pa
dded
cove
r mad
e of
long-
lastin
g, so
ft, fle
xible
Verg
e m
ateria
l
Brea
thab
le po
lyeste
r sp
acer
fabric
lam
inated
to va
por
perm
eable
ureth
ane
None
None
Stand
ard ca
rry po
cket
on ba
ck
Stand
ard ad
justab
le lum
bar-s
acral
supp
ort
pad;
optio
nal s
wing
-aw
ay pe
diatri
c late
ral
supp
orts
N/A
Flexa
-just
stays
(1 pa
ir sta
ndard
), pelv
ic wed
ges
(1 pa
ir stan
dard)
, fixe
d & s
wing
-away
later
al tru
nk su
pport
s w/fl
at or
curve
d pad
s, priv
acy fl
ap,
head
rest m
ounti
ng pl
ate
Tens
ion-a
djuste
d ba
ck w
ith ho
ok-
and-
loop s
trapp
ing
syste
m, pa
dded
ca
ne po
sts th
at fol
d wi
th ch
air
Secu
re to
sling
wi
th bu
ckle
strap
N/A
Mini
Set, q
uick-
relea
se ha
rdware
ins
talls/
adjus
ts in
minu
tes. S
mall
attac
hmen
t poin
t for
minim
al int
erfere
nce
on ba
ck ca
nes
Brac
kets
have
lat
eral a
djustm
ents
to ac
com
mod
ate
vario
us ca
ne w
idths
, sco
liosis
, kyp
hosis
Quick
-relea
se
mou
nt w
ith
dyna
mic
mov
emen
t
Action Products Drive Medical Drive Medical Invacare/Motion Concepts New Solutions Ride Designs
Twist
er
Cush
ion w
ith Lu
mba
r Su
ppor
t
Tens
ion Ad
justab
le
Matr
x Mini
Back
Genis
ys Al
uminu
m Sh
ell
Java
Ideal
for ac
tive u
sers;
users
with
no
rmal
to se
vere
kyph
o-sco
liotic
ve
rtebr
al m
isalig
nmen
t
Gene
ral-u
se ba
ck w
ith lu
mba
r su
ppor
t help
s whe
elcha
ir use
rs m
aintai
n tru
nk st
abilit
y by
prev
entin
g ham
moc
king
Gene
ral-u
se ba
ck fo
r mild
po
sition
ing ne
eds
Pedia
tric p
ower
or m
anua
l wh
eelch
air us
ers
Man
ual o
r pow
er ch
air us
ers
For t
hose
need
ing su
ppor
t &
adjus
tabilit
y, Jav
a's bi
omec
hanic
al de
sign p
rovid
es fle
xibilit
y to
simply
& ac
curat
ely fit
the t
runk
an
d pelv
is for
supe
rior s
uppo
rt,
com
fort a
nd m
obilit
y
2015
Whe
elch
air B
acks
Com
paro
1115mm_BacksComparo1620.indd 17 10/7/15 12:08 PM
18 mobilitymgmt.comnovember 2015 | mobilitymanagement
Back
Wt./
W
t. Ca
pacit
yHC
PCS C
ode
Back
Ht./
Ht
s. Off
ered
Back
Wid
th/
Wds
. Offe
red
Back
Ang
le/
Recli
neCo
ntou
red?
Back
Co
nstr
uctio
nCo
ver
Cons
truc
tion
Acce
ssor
ies
Hard
war
eAd
just
able
?In
tend
ed A
pplic
atio
ns
2015 Wheelchair Backs Comparo
Man
ufac
ture
r/M
odel
1" w
idth;
1" fo
rward
/ba
ckwa
rd de
pth
adjus
tmen
t; 15°
an
terior
/pos
terior
tilt;
back
is fli
ppab
le for
tw
o fitm
ent o
ption
s
1" w
idth;
1" fo
rward
/ba
ckwa
rd de
pth
adjus
tmen
t; 15°
an
terior
/pos
terior
tilt;
back
is fli
ppab
le for
tw
o fitm
ent o
ption
s
1" w
idth;
1" fo
rward
/ba
ckwa
rd de
pth
adjus
tmen
t; 15°
an
terior
/pos
terior
tilt;
back
is fli
ppab
le for
tw
o fitm
ent o
ption
s
1.25"
dept
h ad
justm
ent, 1
" +/-
widt
h adju
stmen
t, 20
° ang
le ad
justm
ent
with
appli
cable
ha
rdwa
re
1.25"
dept
h ad
justm
ent, 1
" +/-
widt
h adju
stmen
t, 20
° ang
le ad
justm
ent
with
appli
cable
ha
rdwa
re
2- &
4-po
int
hard
ware
is an
gle,
widt
h & he
ight
adjus
table;
Lite
Mou
nt is
widt
h &
heigh
t adju
stable
E261
5, E2
620
E261
5, E2
620
E261
1, E2
613,
E261
5, E2
620
E261
3, E2
615
K010
8
E261
3, E2
614,
E261
5, E2
620
4.75-
7 lbs
.; 30
0 lbs
.
3.25-
6.75 l
bs;
300 l
bs.
3.25-
6 lbs
; 30
0 lbs
.
2.18-
5.45 l
bs.
(bas
ed on
back
s to
fit 16
" cha
ir);
250 l
bs.
1.89-
3.575
lbs.
(bas
ed on
back
s to
fit 16
" cha
ir);
250 l
bs.
Starti
ng at
2.3 l
bs
with
Lite
Mou
nt
hard
ware;
300 l
bs.
(12-2
0" w
idths
) &
500 l
bs. (2
2-26
" wi
dths
)
18" s
hell
mea
sures
21"
with
foam
/16"
, 18
", 20"
16" s
hell
mea
sures
19"
with
foam
/10"
, 13
", 16"
, 18"
, 20"
16" s
hell
mea
sures
19"
with
foam
/10"
, 13
", 16"
, 18"
12.75
", 15.7
5",
18.75
", 20.7
5",
22.75
"/10"
, 13"
, 16
", 18"
, 20"
(h
eight
base
d off
of su
ppor
t su
rface
)
12.75
", 15.7
5",
18.75
"/10"
, 13"
, 16
" (he
ight
base
d off o
f su
ppor
t sur
face)
6.5-2
4"/lo
wer-
(6.5-
9.5"),
m
id- (1
2-15
"),
uppe
r-tho
racic
(16.5-
19.5"
), and
sh
oulde
r heig
ht
(21-
24")
15" (
18"
back
)/14"
, 16"
, 18
", 20"
15" (
18"
back
)/14"
, 16"
, 18
", 20"
15" (
18"
back
)/14"
, 16"
, 18
", 20"
16" w
ide ba
ck is
14
.75" a
t wide
st po
int/1
0-20
"
16" w
ide ba
ck is
14
.75" a
t wide
st po
int/1
2-19
"
N/A/
12-2
6" in
2"
increm
ents
15° a
nteri
or &
poste
rior t
ilt
15° a
nteri
or &
poste
rior t
ilt
15° a
nteri
or &
poste
rior t
ilt
10° f
ore,
10° a
ft wi
th ap
plica
ble
hard
ware
optio
ns
10° f
ore,
10° a
ft wi
th ap
plica
ble
hard
ware
optio
ns
+20°
to -2
0°
7" of
dept
h
4" of
dept
h
2.5-3
" of d
epth
de
pend
ing on
m
odel
2.5", 4
", 6";
custo
m co
ntou
rs als
o ava
ilable
2.5" &
4.5"
; cu
stom
cont
ours
also a
vaila
ble
Poste
rior, p
oster
ior
& lat
eral, p
oster
ior
deep
, pos
terior
&
deep
later
al; an
d po
sterio
r & de
ep
conto
ur sty
les
avail
able
Alum
inum
shell
, Zy
tel br
acke
t, alu
minu
m pin
s; foa
m pa
d w/fr
ont
layer
of hig
h res
ilient
po
lyuret
hane
foam
Alum
inum
shell
, Zy
tel br
acke
t and
pin
s; foa
m pa
d w/
front
laye
r of
high r
esilie
nt
polyu
retha
ne fo
am
Alum
inum
shell
, Zy
tel br
acke
t and
pin
s; foa
m pa
d w/
front
laye
r of
high r
esilie
nt
polyu
retha
ne fo
am
Light
weigh
t airc
raft
alum
inum
shell
, 1"
open
-cell
foam
with
at
tache
d .25
" EVA
ba
cking
; cus
tom
foam
/air i
nser
t op
tions
avail
able
High
-qua
lity c
arbon
fib
er sh
ell, 1
" op
en-c
ell fo
am w
ith
attac
hed .
25" E
VA
back
ing; c
usto
m foa
m/a
ir ins
ert
optio
ns av
ailab
le
Light
weigh
t alu
minu
m sh
ell,
1.5" e
xtra-
soft
foam,
clos
ed-c
ell
foam
for Sp
ine
Align
posit
ioning
co
mpo
nent
s
Front
is
polye
ster, b
ack
is po
lyuret
hane
-co
ated n
ylon w
ith
polyu
retha
ne-c
oated
po
lyeste
r; brea
thab
le &
durab
le
Front
is
polye
ster, b
ack
is po
lyuret
hane
-co
ated n
ylon w
ith
polyu
retha
ne-c
oated
po
lyeste
r; brea
thab
le &
durab
le
Front
is
polye
ster, b
ack
is po
lyuret
hane
-co
ated n
ylon w
ith
polyu
retha
ne-c
oated
po
lyeste
r; brea
thab
le &
durab
le
Brea
thab
le Ai
rMes
h co
ver fo
r mois
ture
resist
ance
Brea
thab
le Ai
rMes
h co
ver fo
r mois
ture
resist
ance
Micro
clim
atic o
uter
cove
r with
3DX
Spac
er Fa
bric
& Ly
cra
outer
laye
r; opt
ional
mois
ture-
resist
ant
inner
cove
r
Lum
bar s
uppo
rts,
Thera
fin he
adres
t, un
iversa
l hea
dres
t ad
apter
plate
, larg
e ca
ne cl
amps
, priv
acy
shiel
d
Later
al su
ppor
ts,
lumba
r sup
ports
, Th
erafin
head
rest,
unive
rsal h
eadr
est
adap
ter pl
ate, la
rge
cane
clam
ps, p
rivac
y sh
ield
Later
al su
ppor
ts,
lumba
r sup
ports
, Th
erafin
head
rest,
unive
rsal h
eadr
est
adap
ter pl
ate, la
rge
cane
clam
ps, p
rivac
y sh
ield
Optio
nal la
teral
supp
orts,
foam
PSIS
posit
ioning
blo
cks, l
oop h
andle
, rem
ovab
le pri
vacy
flap,
stand
ard in
tegrat
ed ho
le pa
ttern
for un
iversa
l he
adres
t mou
nting
Optio
nal la
teral
su
ppor
ts, fo
am
PSIS
posit
ioning
blo
cks,
loop h
andle
, rem
ovab
le pr
ivacy
flap
Stand
ard Sp
ine Al
ign
posit
ioning
, van
ity
flap (
stand
ard on
24"
& 26
" bac
ks), o
ption
al W
hitmy
er he
adres
ts,
Crad
leU la
teral,
anter
ior
trunk
supp
orts
Quick
-relea
se or
fixed
(fix
ed on
16" h
igh
Max C
ontou
r only
). Zy
tel ha
rdware
w/
alumi
num
sliding
he
ight a
djustm
ent
bar
Quick
-relea
se or
fix
ed (fi
xed
avail
able
on
10", 1
3", 1
6"
AGILI
TY
Mid C
onto
ur)
Quick
-relea
se or
fix
ed (fi
xed
avail
able
on 10
", 13
", 16"
AGILI
TY
Minim
um Co
ntou
r)
Multip
le op
tions
inc
lude 2
-poin
t PR
O, qu
ick re
lease
, 4-
point
PRO,
widt
h-ad
justab
le EL
ITE,
basic
relea
se
Multip
le op
tions
inc
lude F
ixed E
LITE,
2-po
int PR
O, qu
ick-
relea
se, 4
-poin
t PRO
, wi
dth-
adjus
table
ELITE
2-po
int &
4-po
int
quick
relea
se an
d Lit
e Mou
nt fix
ed
ROHO ROHO ROHO Stealth Products Stealth Products Sunrise Medical
AGILI
TY M
ax Co
ntou
r
AGILI
TY M
id Co
ntou
r
AGILI
TY M
inim
um Co
ntou
r
ADI A
L Seri
es
ADI C
F Seri
es
JAY J
3
For u
sers
who r
equir
e sign
ifican
t po
stural
supp
ort, a
re m
ore
depe
nden
t with
tran
sfers,
ne
ed m
axim
um tr
unk s
uppo
rt an
d con
trol, w
ant t
o mini
mize
wh
eelch
air w
eight
For u
sers
who n
eed p
ostu
ral
supp
ort, a
re ind
epen
dent
or
som
ewha
t dep
ende
nt on
as
sistan
ce w
ith tr
ansfe
rs, ne
ed
mini
mal
trunk
supp
ort, n
eed
adjus
tabilit
y to e
nhan
ce ra
nge o
f m
otion
and m
obilit
y
For u
sers
who r
equir
e pos
tural
su
ppor
t, per
form
indep
ende
nt
trans
fers,
have
good
trun
k con
trol,
need
adjus
tabilit
y to e
nhan
ce
range
of m
otion
and m
obilit
y
For t
he us
er de
man
ding h
ighes
t-qu
ality
alum
inum
back
supp
ort
with
a wi
de ra
nge o
f heig
ht,
widt
h, co
ntou
r and
hard
ware
optio
ns
For t
he us
er de
man
ding h
ighes
t-qu
ality
back
supp
ort w
ith th
e gr
eates
t com
binati
on of
weig
ht
reduc
tion,
clean
aesth
etics
and
func
tiona
lity
Acco
mm
odate
s use
rs wi
th a
wide
ran
ge of
poste
rior p
elvic
stabil
ity
need
s, lat
eral s
tabilit
y nee
ds, b
ack
angle
requ
irem
ents
& ac
cesso
ry ca
pabil
ities
2015
Whe
elch
air B
acks
Com
paro
1115mm_BacksComparo1620.indd 18 10/7/15 12:08 PM
mobilitymgmt.com 19 mobilitymanagement | november 2015
Dealer Cost $465
Back
Wt./
W
t. Ca
pacit
yHC
PCS C
ode
Back
Ht./
Ht
s. Off
ered
Back
Wid
th/
Wds
. Offe
red
Back
Ang
le/
Recli
neCo
ntou
red?
Back
Co
nstr
uctio
nCo
ver
Cons
truc
tion
Acce
ssor
ies
Hard
war
eAd
just
able
?In
tend
ed A
pplic
atio
ns
2015 Wheelchair Backs Comparo
Man
ufac
ture
r/M
odel
Tens
ion ad
justab
le
VariL
ock h
ardwa
re ac
com
mod
ates
heigh
t, widt
h, de
pth
& an
gle ad
justm
ents
with
one t
ool w
hile
clien
t is se
ated
E261
1, E2
612
E262
0
3 lbs
./350
lbs.
6.4 lb
s. (18
");
300 l
bs.
16" a
nd 12
"/16"
an
d 12"
21.75
" (18
" ba
ck)/1
7-23
.6"
14-2
4"/1
4-24
"
17.4"
(18"
ba
ck)/1
4", 1
5",
16", 1
7", 1
8", 2
0"
N/A
+/- 2
0°
No
Air-f
oam
cush
ion
is co
ntou
red to
sh
ape o
f the s
hell
Stim
ulite
hone
ycom
b
Powd
er-co
ated
alum
inum
with
int
egrat
ed
ergon
omic
hand
le;
air/fo
am cu
shion
wi
th tw
o-wa
y air
relea
se va
lve
Nylon
outer
cove
r &
brea
thab
le po
wer
mes
h cov
er
Cove
r roll
s ove
r the
to
p and
faste
ns
on in
ner s
hell.
User-
facing
mate
rial
is br
eath
able
spac
er kn
it fab
ric
Supr
acor
lumba
r su
ppor
t ava
ilable
with
us
e of b
ack
Deep
later
al su
ppor
t sh
ell in
clude
s su
pplem
ental
lat
eral s
uppo
rts an
d PS
IS blo
ck of
clos
ed
cell f
oam
N/A
Quick
-relea
se
VariL
ock h
ardwa
re us
es 2
point
s of
attac
hmen
t & ca
n be
perm
anen
tly
attac
hed w
/1 sc
rew
Supracor VARILITE
Tens
ion-A
djusta
ble
ICON
Deep
Back
Activ
e use
rs wh
o nee
d mor
e su
ppor
t tha
n foa
m an
d/or
have
iss
ues w
ith he
at an
d mois
ture
Deep
cont
our p
rovid
es ex
tra la
teral
supp
ort fo
r max
imum
supp
ort fo
r us
ers w
ith po
or tru
nk co
ntro
l; ide
al for
thos
e usin
g sec
onda
ry su
ppor
ts or
a tilt
and r
eclin
e sys
tem
2015
Whe
elch
air B
acks
Com
paro
1115mm_BacksComparo1620.indd 19 10/7/15 12:08 PM
20 mobilitymgmt.comnovember 2015 | mobilitymanagement
Action Products954 Sweeney DriveHagerstown, MD 21740(800) 228-7763actionproducts.com
Drive Medical99 Seaview Blvd.Port Washington, NY 11050(877) 224-0946drivemedical.com
Invacare Corp./Motion ConceptsOne Invacare WayElyria, OH 44035-4190(800) 333-6900invacare.com
New Solutions4321 Alamo St.Riverside, CA 92501(800) 429-9600newsolutions1.com
Ride Designs8100 SouthPark Way, C400Littleton, CO 80120(866) 781-1633ridedesigns.com
ROHO, A Permobil Company100 N. Florida Ave.Belleville, IL 62221(800) 851-3449roho.com
Stealth Products LLC104 John Kelly DriveBurnet, TX 78611(512) 715-9995stealthproducts.com
Sunrise Medical2842 Business Park Ave.Fresno, CA 93727(800) 333-4000sunrisemedical.com
Supracor2050 Corporate CourtSan Jose, CA 95131(800) 787-7226supracor.com
VARILITE4000 1st Ave. SWSeattle, WA 98134(800) 827-4548varilite.com
sources guide
Contact ROHO today for more information on Smart Check 800-851-3449 | roho.com/smartcheck
CONFIDENCE, INDEPENDENCE & PEACE OF MIND:
of Smart Check users report they were more confident using their ROHO cushion with the addition of Smart Check.89%
A ROHO Cushion is so easy to set up with Smart Check, that
of users successfully set up and maintain their cushion without clinical assistance.93%
said they trusted Smart Check toset them at the correct inflation level.88%
of Smart Check users report that they check their cushion more frequently now because checks are so much easier.93%
We listened to what you wanted in the next generation of ROHO cushions, and developed Smart Check for maximum skin and soft tissue protection!
With Smart Check, clinicians set and save their recommended inflation setting for their clients' needs. Then clients check their cushion - whenever, where ever and as often as they like.
By recommending ROHO cushions with Smart Check, you’ll have the confidence that your clients are following your treatment directions and getting the very most from their ROHO cushion.
Smart Check™ by ROHO®
Means C�fidenceFor You and Your Clients.
C
M
Y
CM
MY
CY
CMY
K
SmartCheck ads_clinician_mobmgmt.pdf 1 10/5/15 10:51 AM
1115mm_BacksComparo1620.indd 20 10/7/15 12:08 PM
mobilitymgmt.com 21 mobilitymanagement | november 2015
#TweensRuleBack when middle school was still called junior high, there was no distinctive name for the period starting approximately in fifth grade and going through eighth grade, even though develop-mentally, it was a time of such change. Remember? What your friends thought suddenly became much more important than the opinions of Mom or Dad. Teachers expected you to move among different classrooms throughout the day while carrying the correct books from a locker whose combination you kept forgetting. You had a little more freedom, but everyone expected so much more from you, too. And you had to negotiate all of it while experiencing the rather bewildering and sometimes embarrassing symptoms of puberty.
Of course, all of that is still true, but now there is a name for those kids — tweens, a shortened form of between, as in between childhood and adolescence, and also a play off the word teen. It’s a loosely defined period starting at about age 9 and ending when the young person
becomes a teenager, though sometimes tweens are considered synon-ymous with middle-schoolers, who can be 13 or 14 years old.
Thanks to changing bodies, changing expectations, changing envi-ronments and evolving social, emotional and cognitive skills, tween-hood is a transformative time in young people’s lives. All those factors can also make it a challenging time for tweens, their families and, in the case of tweens who use seating & mobility equipment, the profes-sionals who work with them.
Growing Up OvernightHumans go through two major periods of growth in their lives: from toddler to early school age, then from late childhood to adolescence — including tweenhood.
That’s a challenge enough for parents trying to keep their refrigera-tors stocked and properly fitted shoes on their kids’ ever-growing feet.
The Challenges (& Fun) of Seating & Mobility for Tweens
ATP Series
By Laurie Watanabe
Tatia
na_K
ost/M
onke
y Bus
iness
Imag
es/A
rto H
akola
/Alex
andr
u Nika
/Melo
dist/L
ena P
an/sh
utter
stock
.com
1115mm_Tweens2125.indd 21 10/7/15 3:26 PM
22 mobilitymgmt.comnovember 2015 | mobilitymanagement
Seating & Mobility for TweensBut it’s an additional challenge when the child is a wheelchair user — and when funding sources expect a wheelchair being fit for a fourth grader to still be functional in eighth grade or beyond.
Further complicating the picture is that tweens with special mobility needs may grow differently than typically developing peers.
Michelle Lange, OTR, ABDA, ATP/SMS, says of wheelchair-using tweens, “Part of the challenge is depending on the diagnoses, a lot of children can have either precocious puberty, where puberty starts early, or sometimes puberty can be quite delayed. So sometimes when we’re doing a seating & mobility evaluation at this age range, I need
to rely on the medical team to let me know if they’re noticing onset of puberty — certain physical changes that they’re looking for. And if I think puberty is imminent or just starting, that’s telling me that there’s a really good chance of a sudden growth spurt.”
Angie Kiger, M.Ed., CTRS, ATP/SMS, marketing channel & educa-tion manager for Sunrise Medical, also looks for clues via the client’s family. “It’s helpful to understand how growth spurts impact a client’s body related to genetics, diagnosis, nutrition, etc.,” she says. “For example, having an idea of the heights of parents, grandparents, and/or siblings may help with determining how tall the client may grow. If
Your adorable pre-school or elementary school client — the one who lit up when he saw you at clinic or hugged you after her evaluation — is gone. He or she has been replaced by a taller version who makes less eye contact and is no longer charmed by your ability to sing songs from Frozen.
Welcome to the Tweenhood, a landscape that’s always changing.
Hear Tweens OutAngie Kiger, M.Ed., CTRS, ATP/SMS, says one of the things she enjoyed during her 12-year tenure at a pediatric hospital “was that I was able to watch my ‘kids’ — aka, clients — grow up right before my eyes as they would come back year after year.” But she acknowledges the chal-lenges. “It’s very important to have a basic understanding of physical, social, emotional and intellectual changes tweens go through,” she says. “That Psych 101 class from college came in handy after all!”
Middle school students transform in so many ways. “The tween years are prime time for becoming more self-conscious, experiencing mood swings, and testing the waters in terms of expression,” Kiger notes. So she believes expanding a tween’s role in the seating & mobility decision process can facilitate a more successful outcome.
“While I know clinically speaking there are decisions that need to be made where the client does not have a choice, I would recom-mend trying to provide the client with the opportunity to make a few decisions in the process, especially related to style and color,” she says. “Tweens absolutely pay more attention to their appearance, including the look of their wheeled mobility system. In this day and age, it’s likely that caregivers and tweens have access to online resources and may come into an evaluation with an idea as to what they believe is appropriate. Make sure you take time to hear out the desires of the client and/or caregiver. There may be pieces of what they desire that can be incorporated into final decisions.”
Appreciate the AgeYou and your client no longer bond over SpongeBob SquarePants, but you can find new ways to connect.
“Think outside the box with giving the tween the ability to express himself or herself during the wheelchair evaluation,” Kiger suggests. “For example, consider allowing the client to choose what music is playing during the evaluation. I have stations saved in my Pandora app for artists I only listen to during evaluations. You may be surprised
how relaxed and interactive your tween clients become when you validate their choices. Not to mention you will be upping your karaoke game.” She adds a caveat: “Make sure the caregivers are okay with the music selected.”
Brandon Edmondson, OTR/ATP/CRTS, director of clinical sales for Permobil and TiLite, says, “As an ATP, you have to talk to the kid. I always hear out the parent and hear out the clinician, and if you end up with all of them in one room, it’s going to be a long eval. But I always address my questions to the kid, because I want to hear what they have to say, what’s important to them, what they like about this chair, what they didn’t like. I want to hear it from their perspective, even if Mom or the therapist jumped in. I think it’s just good for the kid to start knowing that his opinion matters at this age.”
Edmondson uses tweens’ interest in peers’ activities — an Oct. 5 CNN study found that some 13-year-olds check social media more than 100 times per day — to highlight some very cool functions of today’s power chairs.
“Definitely one of my favorite things is getting them hooked up on their phones through their power chair,” he says. “So kids who gener-ally have no hand function will have the ability to touch the screen and text. That’s a huge social win for them. They do it right through their drive controls. And it’s pretty cheap: Even if it’s not covered, it’s a couple of hundred dollars for the parents, and once they see what it can do, they generally want it.”
Edmondson has sweetened the pot by expanding a tween’s capa-bilities at home.
“I try to get them to be able to operate the phone, and then I’ll get them started with a couple of apps to give them something at home, like a music player: ‘Hey, if you had a music player in your room, you could just go to the app and your home WiFi and play your music in your room, do your TV.’ They always have their remote with them.”
Kiger says she’s been in evaluations where the seating & mobility team has stepped out to let tween and parent talk privately, and she also knows tweens can be hard work. Still, she believes in including them.
“As difficult as negotiating and explaining things can be with a tween, I much prefer working with a client who is engaged in the decision making,” she says. “There are times when the tween cannot get what he wants, but that’s part of life. My recommendation is listen to the client, validate their desires, and explain what can be done.” l
Being the ATP/Clinician
ATP Series
Lena
Pan/
Shut
tersto
ck.co
m
1115mm_Tweens2125.indd 22 10/7/15 3:26 PM
mobilitymgmt.com 23 mobilitymanagement | november 2015
there is an older sibling of the same sex, ask the caregivers how (onset of puberty, length of time for growth spurt, how much, etc.) that sibling developed during the tween years.”
While adolescence generally means growth both in height and in width and weight gain, Lange says many pediatric wheelchair users experience more of the former than the latter.
“It depends tremendously on the diagnosis,” she says. “I work with a lot of kids who have cerebral palsy, and those kids often just don’t get hips. They stay really, really lean. With kids with muscle diseases, it depends on the muscle disease. If you’re working with someone with spinal muscular atrophy, they have a very different body shape [than kids with other diagnoses].”
What is more often an issue, especially for tweens with cerebral palsy, is the orthopaedic effect, Lange says. “When you have a teen with high muscle tone — teens with cerebral palsy or traumatic brain injury — now you have a child who’s suddenly growing, and their tight muscles can’t keep up with the bones. So typical teens might complain of growing pains because they are growing very rapidly, but the muscles and bones grow together. When someone has tight, tight muscles, those muscles are being stretched as that growth occurs, and it can influence the growth of the bone. So that’s where we get ortho-paedic changes.”
Lange adds that these issues are more common in tweens and teens than in very young children, whose tone often isn’t as severe at that early age. “But during the teen years, that’s when we can see big changes occur at the spine and sometimes at the hip. And that’s where some of those orthopaedic surgeries start occurring, too.”
Growth spurts can also require other changes that aren’t so obvious as seat width and depth.
“Our arms work a certain way to reach out to something like a joystick,” Lange says. “But now I’ve suddenly grown and those little arms have changed. It’s not uncommon at all during the teen years for access to change. I see a lot of teens who used to use one type of access method let’s say for their power chair or for their communica-tion device, and suddenly it’s not working any more. We need to make a change.”
And Lange pointed out another group of youngsters typically expe-riencing major changes in their tweens and early teens.
“The other kids who change during those years are kids with progressive conditions and where the teen years see a lot of action are with guys with Duchenne muscular dystrophy,” she says. “Those boys are, depending on the individual, ambulatory for awhile. Then they might end up in manual mobility for awhile. But during those tween years, they are perhaps going into their first manual chair or moving from a manual into a power chair. And then throughout the teen years, perhaps you’re going from ‘I’ve been able to use a joystick’ to — depending on the boy, sometimes in the teens, sometimes in the late teens — ‘The standard joystick is too hard now, and I need to change to a mini joystick or something different. Maybe I didn’t need power seating before, because I could wiggle around some, but now I do. I might even be adding a venti-lator to my chair base.’”
Growing Ultralightweight ChairsFor tweens propelling themselves in ultralightweight manual chairs — or for younger kids being fitted for ultralight chairs that will need to last into their tween years — the challenge is building in enough growth without hindering independence, says Brandon Edmondson, OTR/ATP/CRTS, director of clinical sales for Permobil and TiLite.
Independent mobility can be a growing challenge for tweens now expected to navigate much larger middle school campuses after typi-cally spending their elementary school days in single classrooms.
“Growth for me has always been more about length,” Edmondson says. “I worry more about length than width. We do a lot of camber, backrest tapers, just a lot of things to keep the wheel presented to the client so they can push.”
Keeping the rear wheels optimally positioned is mandatory to achieving, then preserving efficient propulsion as the child and the chair grow, he adds. Edmondson explains his priority for kids using ultralights: “They have to have 80 percent of their weight on the rear wheels, they have to have a stable front end, and they have to have the wheel where they can reach the handrim.”
As far as building in seat depth, Edmondson says, “Lengthwise, for those types of chairs, everyone focuses a lot on frame growth and how much you can move your back posts back on your depth-adjustable back. There’s [also] the opportunity to double that growth amount with backrest hardware. All of the backrest hardware, it doesn’t matter whose we’re talking about, can be reverse mounted. You’re generally not limited on an adjustable axle on most of these rigid chairs now. So you can push the axle forward as far as you want, keeping that wheel with them. Your 2" of back post movement — you usually have 0, 1 and 2 to grow your depth by 2" — can turn into 5" by just flipping your hardware around and just slowly letting them slide the backrest back.”
As the tween grows and the ATP or clinician makes adjustments over the years, Edmondson adds, the chair’s configuration will begin to look more typical.
“You’ve got to have the frame length so you have front-end stability; it pushes that caster out,” he says. “But you generally kind of butt your seat depth up right to them, not so it hits the back of the knees, but right at the knees, not interfering with their foot positioning. Generally for an adult, you’re going to leave a little more space. So you’ve got [the tween user] butted up, 5" of movement between back and back posts, and once they’re fully back, then they have a little bit of frame length to grow into because you’ve extended that. And even-tually you get an inch or two of space between the seat and the back of their knees, just like you would have an adult fit.”
Building an adjustable system that remains optimally functional throughout is tricky: “The biggest mistakes I see are people who try to do that and they don’t extend their frame length, so they end up with a very forward, tippy chair,” Edmondson says. “Or they pick a chair where you can’t move the center of gravity as far forward as you need to — generally, [folding chairs] that are boxed in by frame uprights. You have two frame uprights in the rear of your folding chair, and you’ll only have about 3.5" of center of gravity [adjustment] in your rear wheel. [With a] mono-tube rigid or a dual-frame rigid, you can
ATP Series
1115mm_Tweens2125.indd 23 10/7/15 3:26 PM
24 mobilitymgmt.comnovember 2015 | mobilitymanagement
slide infinitely forward. The mistakes I see are where [seating profes-sionals] use the back to really grow it, but they don’t extend the front, so they’re forward tippy — if the chair hits a crack, it wants to flip forward. Or you’re boxed in by that rear center of gravity, so you try to push the back forward, but you can’t make the wheel go with them, so now their wheels are really far back.
“You’ve given them all the growth, but they can’t reach the wheels. They don’t have their weight on the wheels, you’re caster loading, it’s hard to push and turn.”
As for width, Edmondson understands that it’s tempting to build in too much, often because ATPs or clinicians are thinking back to that one case years ago in which a kid outgrew his wheelchair’s width. “But you can’t,” he says. “Usually, you’re leaving a little bit of width room: If you have a kid who’s a 12, you may go with 14. You don’t need a ton. Two inches is plenty, but you have to use camber. You have to present that handrim to them so they can keep their shoulders in tight. I really never worry about width. I worry about being too wide in the beginning.”
New HorizonsBecause of all the additional propelling middle schoolers have to do, Edmondson advocates for power-assist systems.
“I’m a big believer in power-assist when they get to those bigger campuses if they’re really having a hard time and they’re exhausted,”
he says of tween clients. “Mostly what I monitor or what I ask parents to monitor is [kids’] energy levels. A lot of the kids pushing around ultralights, they can do it, but are they completely spent at the end of the day when they have extracurriculars and homework? How much energy are they using?”
Power-assist, perhaps just used in certain circumstances such as at school and in larger areas, can help preserve a tween’s independence.
“I just don’t want kids getting pushed at school,” he says. “I think it goes much deeper. It’s limiting socially. I think power assist is the biggest bridge to that now.”
He also emphasizes the need, especially for kids, to have extremely lightweight manual chairs to propel.
“You don’t have a 200-lb. guy pushing around a 200-lb. chair,” he says, in explaining why he doesn’t want a 70-lb. fifth-grader propelling a chair that nearly equals his body weight once all the seating compo-nents are added.
Lange points out that beyond a newer, probably larger campus, tweens typically experience major changes in their daily routines upon arriving at middle school.
“Younger children usually don’t spend as much time in their wheelchairs,” Lange says. “They’re getting transferred in and out a lot. They’re getting moved to standers, they’re getting moved to gait trainers. They’re in and out because they’re small. As those kids start getting bigger, they all of a sudden go from ‘We used to be able to
Seating & Mobility for Tweens
ATP Series
Go to www.mobilitymgmt.com/renew and use priority code MHR to keep Mobility Management coming to your mailbox. Because if your subscription stops, that would be a real pain.
November 2015 • Vol. 14 No. 11
mobilitymgmt.com
Serving the Seating & Mobility Professional
The clinical term for an ice cream headache (aka, brain freeze) is sphenopalatine ganglioneuralgia.
To keep receiving your free monthly editions of Mobility Management, you need to regularly renew your subscription.
Our auditing agency requires us to annually verify your information and confirm that you wish to continue receiving Mobility Management magazine. Please take a moment now to renew your subscription information.
1115mm_Tweens2125.indd 24 10/7/15 3:26 PM
mobilitymgmt.com 25 mobilitymanagement | november 2015
just have one caregiver transfer them. Now it takes two. It’s just not working.’ And the student has a lot more to do during the day. If I’m in seventh grade, I’ve got to go to math and social studies and science. And I’m getting bigger, so a lot of those alternative positions don’t happen anymore at school, or it’s much more limited.
“I’m convinced that [tweens] spend far more time in their wheel-chairs at one time. Now weight shifts and comfort become really important because I’m not getting out of my chair as frequently and maybe not for as long.”
Kiger suggests that seating professionals ask about their tween clients’ daily routines. “Addressing where and how a wheelchair will be utilized should be brought up early in the evaluation process,” she says. “I have found teacher assistants are especially helpful in these cases, because they are with the clients the entire day, assisting with classroom activities, transitions and for activities of daily living.”
The Age of DiscoveryWorking with tweens as they venture into the larger world can be highly rewarding for their seating & mobility teams — but it’s prob-ably not for the faint of heart. After all, tweens in wheelchairs are experiencing many or all of the emotional and social tribulations that their peers are.
Lange points out that many of her clients are “not as socially aware” as other kids their age, due to cognitive issues or fewer social inter-
actions thus far during their young lives. She worries that inexperi-ence could raise their risk of being sexually harassed or abused, even without their realization. Or sometimes, a kid who literally has diffi-culty controlling his hands due to spasticity or other muscle tone issues is wrongly accused of reaching out inappropriately toward classmates.
And then there are those times Lange gets called by a school administrator or a parent because they’re not sure whether a tween is having trouble operating a wheelchair…or is just being a tween.
Lange remembers a long-ago client in middle school: “She was really excited about all the cute boys at her school, and she was taking a long time to get to her classes. So [school officials] thought she was having a hard time driving her power chair between classes. Actually, she was a very good driver, but every time she saw a boy, she stopped and stared at him. She wasn’t getting to class on time, and what it came down to is that she was much more interested in boys in the hallway than she was in math class.”
Lange laughs good naturedly about the calls she sometimes gets regarding her tween clients, but in the end, she still finds them an intriguing group to work with.
“They’re very energetic, they’re very passionate, they’re not too worried about acting cool like the high schoolers,” she says. “So half the time they’re still acting like little kids, and half the time they’re trying to fit into their big shoes.” l
ATP Series
POSITIONING HARNESSES AND BELTS FOR CONTROL, COMFORT AND DAILY POSTURE MANAGEMENT. Compatible with all wheelchairs and seating systems.
For More Information www.columbiamedical.com | 800.454.6612
or www.drivemedical.com | 800.371.2266
© 2015 Columbia Medical LLC. All trademarks stated herein are the properties of their respective companies. Patent rights issued and/or pending.
Complete line of postural positioning products: pelvic control, upper body and lower extremity positioning
Designed to give optimum control and comfort to assist with daily posture management
Available in both pediatric and adult sizes
All Poziform products come with attaching hardware and complete instructions so they can be used with all seating systems and wheelchairs
Compatible with all wheelchairs and seating systems.
Mobility_Management_November_Poziform.indd 1 10/5/15 4:55 PM
1115mm_Tweens2125.indd 25 10/7/15 3:26 PM
26 mobilitymgmt.comnovember 2015 | mobilitymanagement
SofTech SystemThis fully automatic alternating pressure ulcer treatment/prevention cushion changes pressure points and stimulates circulation. It’s customized to offload under existing pressure ulcers so clients can be in their chairs rather than in bed. Self-contained system has all com-ponents within the cushion; the total system weighs about 4 lbs. The cushion can be built to fit pediatric, adult and bariatric clients; custom sizes are also available.
Aquila Corp.(866) 782-9658aquilacorp.com
Matrix Easy FitIt’s an integrated cushion and washable custom cover: Matrix’s surface module cushions (pads) spread pressure evenly to allow for excellent airflow and to significantly decrease moisture and heat retention. The thermo-elastic polymer cushion is designed to provide superior pres-sure relief and shear reduction. A washable, padded cover is available; it secures in place and does not shift around complex curves, yet can be easily removed for cleaning. Grows and adjusts per the client’s needs.
Matrix Seating USA(800) 986-9319matrixseatingusa.com
Versa XThe newly designed Versa X is a hybrid air/foam cushion created to provide superior comfort and healing opportunities for any stage of pressure wound. It features five adjustable chambers in the rear, and contoured foam in the front. Add or remove air cells as needed to meet the requirements of individual users. The liner is made from a breathable mesh material that promotes airflow and breathability. Choose from Glidewear Technology, Comfort Tek or Stretch Air covers.
Comfort Company(800) 564-9248comfortcompany.com
Synergy TRU-Comfort 2Approved for HCPCS codes E2603 and E2604, this cushion was created for wheelchair users seeking skin protection. The Synergy TRU-Comfort 2 is constructed of viscoelastic foam with a four-way stretch cover. It’s available in widths from 16" to 22" and in depths of 14" to 24". The cushion, which is 3" high, can handle user weight capacities up to 450 lbs.
Quantum Rehab(866) 800-2002quantumrehab.com
Orthopedic CushionsThe open-cell structure of this medical-grade viscoelastic foam maximizes airflow to reduce heat buildup. The cushions are designed to pro-vide just the right level of immersion for optimal positioning and comfort without bottoming out. Eight levels of support accommodate any weight. The cushions can be ordered in stan-dard, sheet or custom sizes, and a waterproof coating or colorful, washable, stretch-fabric slipcovers are optional.
Dynamic Systems Inc.(855) SUNMATEsunmatecushions.com
Java CushionIdeal for users looking for greater sitting stability for improved functional performance, Ride’s Java can help provide improved skin outcomes, with lower tissue distortion and lower long-term skin risk. Java redistributes the forces of pressure and shear away from high-risk areas, while selectively applying the forces to areas more tolerant. The cushion’s design and cover materials help to maintain cool, dry skin. Java offers enhanced sitting performance without the need for regular fit-essential maintenance.
Ride Designs(866) 781-1633ridedesigns.com
cushions marketplace
1115mm_CushionMarket2627.indd 26 10/7/15 12:48 PM
mobilitymgmt.com 27 mobilitymanagement | november 2015
Sensor Ready Cushion with Smart CheckThe Sensor Ready cushion with Smart Check is ideal for users who want real-time feedback to ensure their ROHO cushions are always properly inflated. With the push of the button, the sys-tem also takes the guesswork out of how much air should be in the cushion. Clinicians can store recommended inflation ranges, and the cush-ions can accommodate clients of any weight, so long as the cushions are properly sized.
ROHO Inc.(800) 851-3449roho.com
JAY FusionDesigned for users at high risk of skin break-down who also have aggressive positioning needs, the JAY Fusion features a contoured foam base made of closed-cell foam that’s easy to modify at Sunrise or in the field. Additional positioning is provided by the soft, contoured top layer. Femoral transition and rear wall help prevent fluid migration while gently supporting the trochanters and posterior pelvis. With JAY Flow Fluid or ROHO Dry Floatation air inserts to conform to the user’s unique shape.
Sunrise Medical(800) 333-4000sunrisemedical.com
Meridian CushionTo provide exceptional pressure distribution, positioning stability and comfort, the Meridian has two independently adjustable Air-Foam Floatation chambers for maximum pressure distribution and independent positioning of the pelvis and thighs. The dual chambers work together to correct sacral sitting by creating a pre-ischial ridge that prevents the ischial tuber-osities from sliding forward into posterior pelvic tilt. Combine with the contoured Wave base for added stability. Coded E2624, E2625.
VARILITE(800) 827-4548varilite.com
cushions marketplace
Statement of Ownership, Management and Circulation1. Publication Title: Mobility Management2. Publication Number: 1558-67313. Filing Date: 9/30/154. 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 201515. 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) 8,953 9,604 b. Legitimate Paid/and or Requested Distribution 1. Outside County Paid/Requested Mail Subscriptions Stated 6,073 6,066 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 5 4 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 6,078 6,070 d. Nonrequested Distribution 1. Outside County Nonrequested Copies Stated on PS Form 3541 2,369 2,405 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 409 1,038 e. Total Nonrequested Distribution 2,778 3,443 f. Total Distribution 8,856 9,513 g. Copies not Distributed 97 91 h. Total 8,953 9,604 i. Percent paid and/or Requested Circulation 68.63% 63.81%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 paid print) are legitimate request or paid copies.17. Publication of Statement of Ownership for a Requester Publication is required and will be printed in the November 2015 issue of this publication.18. I certify that all information furnished on this form is true and complete: David Seymour, Director, Print and Online Production
Amysystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Aquila Corp. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Convaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
EasyStand/Altimate Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Freedom Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Healthline Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
MAX Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Numotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Permobil/TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Pride Mobility Products/Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
ROHO Inc . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Stealth Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Wenzelite Re/hab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
advertisers’ indexCompany Name Page #
1115mm_CushionMarket2627.indd 27 10/7/15 12:48 PM
28 mobilitymgmt.comnovember 2015 | mobilitymanagement
EZee Life Shower CommodesThe versatility of EZee Life’s products stood out when I saw them at the National Seating & Mobil-ity symposium in Nashville. The shower commodes are caregiver propelled, but can be turned into self-propelled models by adding the 24" wheels available for all models. Other features include an adjustable-height/removable footrest, a removable insert cushion for use during showering and toileting, adjustable headrest, slide-on/removable commode pail, flip-back arms, calf strap and seat
belt. Lightweight aluminum construction prevents rusting. Tilt models offer 20° of posterior tilt. Weight capacities run from 250 lbs. all the way up to 425 lbs. for the heavy-duty model. The EZee Life line pro-vides plenty of flexible function to meet the needs of both consumers and caregivers.
— Laurie Watanabe
Healthline Medical(800) 987-3577
healthlinemedical.com
Turny Evo Swivel SeatAutoadapt’s swivel system enables an automotive seat to rotate toward the door opening for easier transfers whether the user is standing or in a wheelchair; the seat lift version enables the seat to exit the vehicle and lower to a suitable transfer height. The new Turny Evo swivel seat is crash tested to traditional automotive standards and beyond, namely a 30-G crash with a 102-kg crash-test dummy. Autoadapt points out that using original automotive seating provides for better seatbelt geometry and effectiveness for the rider.
Autoadaptautoadapt.com
Adjustable Transfer BenchDesigned for consumers with lower-extremity weakness or difficulty standing for any length of time, Maddak’s new transfer bench facilitates getting into and out of the bathtub. The bench is height adjustable (15" to 23"), and legs can be adjusted in .25" increments. Legs, back and arm are removable for easy transporting and a more compact storage foot-print. The easy-to-assemble (without tools) system features a built-in soap tray, a shower spray holder and a slit for the shower curtain.
Maddak/SP Ableware(800) 443-4926maddak.com
BodiTrak LT Pressure MappingAn affordable way to provide the many clinical and educational benefits of pressure mapping to wheelchair users, the BodiTrak LT system is easy to use thanks to its tablet format and app-based software. The system’s two modes are “On-the-Go,” which assesses the consumer’s experienc-es and readings on a seating surface over a range of time, and “Simple Seating Wizard,” which enables ATPs and clini-cians to take and com-pare up to four images of the consumer seated on different cushions.
Comfort Company(800) 564-9248comfortcompany.com
Scout 2 Pool LiftSeveral new features and upgrades make the new Scout 2 pool lift more versatile to make it possible for more consumers to enjoy the many benefits of being in the water. The adjusted seat pole now provides up to 25" of wall clearance on a 16" wide profile when the pull-out legrest is employed. Upgraded electronics have raised the weight capacity of the Scout 2 to 375 lbs. And an updated base is stronger, can accommodate many already-existing anchors and fits a range of applications.
Aqua Creek Products(888) 687-3552aquacreek.com
product revue
Continued on page 30
1115mm_ProdRevue28.indd 28 10/7/15 10:47 AM
mobilitymgmt.com 29 mobilitymanagement | november 2015
new discoveriesBy Laurie Watanabe
Deep Tissue Injury Research, Part III
Pressure ulcers are insidious, but traditional wisdom has said they could be prevented by diligently performing skin checks. At-risk populations and their families/caregivers have been advised to look for the changes in skin temperature, color and texture that can signal skin breakdown. Ischemia, the lack of adequate blood supply to skin under unrelieved pressure, was thought to typically be the cause of pressure ulcers, also known as pressure sores or bedsores.
But new research has pulled back the curtain on pressure ulcers to reveal additional causes and results that are much more difficult to detect. Deep tissue injuries (DTI) happen internally, and therefore don’t necessarily cause the reddened or warmer skin that has been a trademark of a developing pressure ulcer. With this evolution in understanding comes a critical question: What will clinicians, ATPs, seating manufacturers and other stakeholders do with this newly discovered information?
Deep Tissue Injury FormationRecent and ongoing research by Amit Gefen, Ph.D., professor of biomedical engineering at Tel Aviv University, and Kara Kopplin, BSc, the Senior Director of Efficacy & Research for ROHO Inc., has focused on pressure-related deep tissue injuries (see Mobility Management, September 2015).
A mechanical engineer by training, Gefen approaches the problem of pressure ulcers via a different route than that commonly taken by seating professionals. When you talk with him, as Mobility Management did over breakfast for a second consecutive year at the 2015 International Seating Symposium in Nashville, Tenn., the conversation is full of mentions of forces and loads and structures.
“We know that exposures to tissue deformation are putting the tissue at risk, and since we know that the more serious pressure ulcers are deep tissue injuries that start from the inside, we know where to look,” he says. “The highest tissue loads are at the bone/soft tissue interface.”
Taking the ischial tuberosity (IT) as an example, Gefen mentions what has long been understood in the seating realm: When the
IT presses down on the tissue and skin beneath it for unrelieved periods of time, damage can occur.
“It’s the sharpness of the bone which is deforming the tissues,” Gefen says of the rather pointed IT depressing the soft tissue of the buttock. During the discussion, with one hand he held a knife vertically as a visual aid and lightly pressed its point against the palm of his other hand. “It’s like taking this knife here and if I do this, I’ll be able to cut through. And the reason for that is the sharp tip of the knife is focusing all the force I’m delivering with my hand in one very small area.” In the case of the IT, he says, “You have the sharp tip of the bone which is compressing against a very small area of soft tissue, and that’s where you have these great forces.”
Kopplin says the traditional concern of a lack of bloodflow resulting in what’s been called “skin breakdown” is only part of the real issue — which has just recently begun to be understood. “Last year and two years ago, it was still all this talk about isch-emia,” she says. “They were barking up the wrong tree. [DTI] is what is more critical.”
Gefen agrees: “Once you understand deformation, and you connect that with the clinical manifestation of DTIs, then you really understand what’s going on here.”
Applying New KnowledgeHaving come to this new understanding of deep tissue injuries through research that used engineering principles, laboratory-grown tissue cells and computer extrapolations of what happened when those cells were subjected to loads, Gefen’s next question was how the knowledge could be applied to real-world situations. Working with Kopplin and with seating clinicians, Gefen decided next to focus on scar tissue, a too-common trait among wheelchair users.
Gefen and Kopplin referenced a sobering truth about pressure ulcers among wheelchair users: Once a client has one, it’s very difficult to prevent a recurrence.
“They never really heal,” Kopplin says. “We talk about healing from your pressure ulcer; that tissue’s never going
DTIs, Scars & Ramifications
Continued on page 30
1115mm_NewDiscoveries2930.indd 29 10/7/15 1:14 PM
30 mobilitymgmt.comnovember 2015 | mobilitymanagement
to be the same.”So seating professionals have to deal with the resulting scar
tissue, which lacks the elasticity and load-bearing abilities of healthy skin and tissue.
Gefen contends that proper immersion and envelopment in wheelchair cushions — and specifically, his studies focused on ROHO air-celled cushions — are paramount to protecting wheelchair users not just against ischemic pressure ulcers, but also against deformation-inflicted DTIs. So a logical next step was to determine whether immersion and envelopment strate-gies would also work for clients who already have scar tissue — “different types and shapes and sizes of scars that clinicians see in the real world,” Gefen says. “We know based on work that is conducted in Japan, for example, that with simple ultrasound scanning, basically anatomical mapping, you can identify scars, even internally.”
This gives clinicians the chance to not only identify whether a client has a scar, but also its shape and size — and to judge the scar’s attributes not just by what’s visible on the skin surface, but also far underneath it.
“If the scar tissue goes deeper, it concentrates mechanical loads and acts as an additional site for mechanical stress concentrations, much like the bone,” Gefen says. “So we decided we wanted to look at the different scar shapes, scar sizes and locations.”
Borrowing the names coined by Japanese researchers, Gefen says, “SW is sandwich, because [such a scar] has components on the surface and components internally, just like a sandwich. Hourglass (HG) is shaped like an hourglass.” In the cross-section diagram , you can see the whitish shape of the IT, the gluteus muscle directly around the IT, the surrounding fat (yellow) and the scar tissue (blue). In some cases (i.e., “Thin”), the scar tissue is on the surface of the skin. In the SW illustration, scar tissue is present near the IT as well as on the skin. In the HG example, scar tissue is present from the IT all the way through tissue layers to the skin, creating a column-like structure.
The next part of the series will discuss how different scars react differently to loads, how cushions react to those loads, and the importance of adjustability in the wheelchair seat cushion effi-cacy equation. l
Editor’s Note: The first two parts of this series are in Mobility Management’s August and September 2015 issues, viewable at MobilityMgmt.com. Read “Computer simulations of efficacy of air-cell-based cushions in protecting against reoccurrence of pressure ulcers” by Gefen, Kopplin, and Ayelet Levy, in the Journal of Rehabilitation Research & Development (rehab.research.va.gov/jour/2014/518/jrrd-2014-02-0048.html) Mobility Management illustrations by Dudley Wakamatsu, based on research by Gefen, Kopplin and Levy.
new discoveriesDeep Tissue Injury Research, Part III—DTIs, Scars & Ramifications
Continued from page 29
Continued from page 28
Toyota Northstar E360This ADA-compliant minivan designed for commercial use features a side-entry sys-tem with an in-floor ramp for easy and convenient passenger boarding. A deep-drop floor provides a tall door opening with an unobstructed entrance, and the Northstar E360 has plenty of interior space for wheelchairs and passengers to maneuver.
Vantage Mobility International(800) 348-VANSvantagemobility.com
Quickie/Zippie Power Chair OptionsQuickie and Zippie power chairs now have added functional-ity and versatility for consumers thanks to six new options for the QM-7, Pulse and ZM-310 lines. QM-7 and Pulse series chairs can now be fitted with a Power Centermount Legrest for 7.5" of articulation and 3" to 19" of independent lower-leg-length adjustment. New for the QM-7, Pulse and ZM-310 chairs are the PG Drives Advanced Color Joystick, a Retract-able Joystick Mount and new Comfort Reclining Armpads. And adding Switch-It to the manufacturer’s portfolio has resulted in new Switch-It Ctrl+5 Buttons and Toggles so users can access five seating func-tions through either toggle switches or buttons, plus the Switch-It Dual Pro, a propor-tional head array with fine-tuned adjustments to provide intuitive driving experiences.
Sunrise Medical(800) 333-4000sunrisemedical.com
product revue
1115mm_NewDiscoveries2930.indd 30 10/7/15 1:14 PM
Be free.
The NEW SmartDrive® MX2 is a revolutionary power assist device that gives greater freedom and power to chair users than ever before.
www.max-mobility.com
• SIMPLE: Convenient single-unit design with built-in rechargeable battery pack.
• INTUITIVE: Intelligent wrist control senses your movements and knows when you’re ready to stop and when you’re ready to get moving.
• POWERFUL: Dynamic drive system cruises up hills and over thick carpet.
• FLEXIBLE: Innovative design moves with you for wheelies and curbs, and optional mounting bar even makes it compatible with folding chairs.
• LIGHTWEIGHT: So light, you won’t even know it’s there.
Find a dealer near you and take a test drive today.
The Aero X Series 2 brings great value through stellar quality, reliability, and innovation:• Superior rolling dynamics provide rigid-like performance• Modularity for convenient configurability in the field• Redesigned cross-brace geometry for easy, narrow folding• Patented Speedloader front caster housing and two caster position options
The Aero X Series 2 reminds us all that value can be achieved without compromise.
BEATING THE COMPETITION FROM THE GROUND UP.
SERIES 2
