PURPOSE OF A COMFORT WHEELCHAIR

Get up from bed and be more healthy

Long term passive seating is dangerous. A comfort wheelchair is a good solution in many cases. The wheelchair user must have

variation and the user should avoid pain like bedsore and decubitus which is very painful. The treatment is also very expensive

Get stability for the body and variation in the seating position. Avoid additional consequential damages like posture damage and deformities in the back, legs, head position and so on

Relief of the user and relief of the nursing staff’s workload, like less repositioning after sliding, easy transfer situations and so on

Improve vital body functions like breathing, blood circulation, heart and digestion

Increase mobility for the user

Be able to participate in social life: See something, commu-nicate with others, perform activities in the daily life like eating,

shopping and move around

Increase quality of life and more social participation

USUAL CHALLENGES OF LONG TERM SEATING WHEELCHAIR USERS:

Skin integrity issues Decreased functionality and participation Inability to change posture Deformities Discomfort and pain Difficulties regarding digestion and other Vital body funtions

FEEDBACK AND ANSWERS FROM DISCUSSIONS WITH HEALTH PERSONNEL

PURPOSE OF A COMFORT WHEELCHAIR

PURPOSE OF A COMFORT WHEELCHAIR

Kjetil Gausel is CEO of Netti by Alu Rehab, a comfort wheelchair manufacturer and comfort wheelchair specialist. Mr. Gausel started his job career in Netti 25 years ago. The company was established in 1989, and the head quarter is located in Norway with divisions in Denmark and China, inclu-ding sales in more than 30 countries. All companies within Netti by Alu Rehab Group is certified according to European medical standards: ISO-9001 and ISO-13485 Medical devices.

CEO KJETIL GAUSEL EXPLAINS FOLLOWING GOOD REASONS TO CHOOSE A NETTI COMFORT WHEELCHAIR:

Netti wheelchair products are Norwegian design, and the Netti quality concept is reflecting the Scandinavian concept of well-being and dignity for all people

European and Asian clinical findings show significant improve-ments in health conditions and activity daily life for long term seating wheelchair users, when using Netti comfort wheelchairs. This is our motivation for being a comfort wheelchair specialist, and we know we enable joy of life for many people.

Netti by Alu Rehab has worldwide experience in seating com-fort, and we were one of the inventors of comfort wheelchairs in the 1990’s

The Clinical Test Protocol and “5 seating steps” we are committed to, is designed according to best practice guidelines and current, updated research findings about long term seating.

These concepts are developed by Bart Van der Heyden. He is a physio therapist and an independent, inter national seating expert in Europe and USA. We are happy to support with sponsoring contributions of clinical test programs, education and training which is conducted by Mr. Bart Van der Heyden and other seating experts and health institutions in Europe and Asia. We are updated with current knowledge about good seating solutions and we are eager to develop more solutions for the future.

On the next pages you can read more about the clinical test approach, the 5 Seating Steps and also find some examples of research and findings about clinical eviden ces and international agreed best practice guidelines.

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Hans Sagen is director of sales and business development in Netti by Alu Rehab. He explains more about the clinical test protocol:

BACKGROUND AND PURPOSE OF A CLINICAL TEST PROTOCOL Netti by Alu Rehab has committed to the clinical testing for its products and has conducted clinical studies together with users and clinicians on a wide range of our products: Netti Dynamic System, Netti III, Netti 4U wheelchairs, Netti Vision and Netti Mini. So far, these clinical tests have been conducted in Norway, Denmark, Germany, France, China, the Republic of Korea and Japan.

The clinical test protocol is developed to measure out-comes when using different types of seating interventions or specific seating strategies for specific users or user groups. Measuring outcomes helps to determine which Netti models, accessories and adjustments can benefit the wheelchair user most.

ABOUT THE CLINICAL TEST PROTOCOL The specific clinical test protocol and the assessment form has been developed by Bart Van der Heyden, physio thera-pist and an independent wound care, seating and mobility specia list. More info: www.super-seating.com.The clinical test protocol can be used to collect data and measure outcomes when using seating and positioning sy stems and helps documenting seating interventions. The form will ask questions to get a better understanding of the client’s situation, clinical challenges and goals and will try to document seating and/or clinical interventions and record their impact of the client's seating situation and comfort.

ABOUT THE CLINICAL TEST PROTOCOL: The specific clinical test proto col and the assessment form has been developed by Bart Van der Heyden, physio therapist and an independent wound care, seating and mobility specia list. More info: www.super-seating.com. The clinical test protocol template consists of 10 pages and is easy to use for care givers. Please, contact us or check www.my-netti.com if you want to learn more about the sequences of the clinical test.

CLINICAL TEST PROTOCOL FOR COMFORT WHEELCHAIRS

EXAMPLE USING THE CLINICAL TEST PROTOCOL:

Analyzing the impact of Dynamic Seating Components on the wheelchair user’s seating position: MAIN DIAGNOSIS - CEREBRAL PALSY

BACKGROUND AND PURPOSEDynamic seating systems or dynamic components enable distal movement, creating an open kinetic chain (1), which may help to stabilize proximal segments and increase core seating stability and postural alignment. The purpose of this clinical evaluation was to analyze the outcomes of using dynamic seating components with users with cerebral palsy.

METHODOLOGY 4 Netti Dynamic System cases have been reviewed over a 3 to 6 months period. A seating assessment was performed with each wheelchair user prior to using a dynamic seating intervention. Tone, range of motion, posture, skin integrity and ADL status were assessed and S.M.A.R.T (Specific, Measurable, Achievable, Relevant and Time related) goals for the dynamic seating intervention were set. Posture, tone, range of motion and ADL status were checked immediately after the dynamic seating interven-tion and each month following the dynamic seating intervention. The seating outcomes were measured by evaluating the initial S.M.A.R.T goals for a period up to 6 months post dynamic seating intervention. One of the four case reports about dynamic seating is shown on the next page.

(1) Reference / Source: Ellenbecker, T.S., and Davies, G.J. (2001). Closed Kinetic Chain Exercise: A Comprehensive Guide to Multiple Joint Exercises, (1st ed.). Champaign, Ill.: Human Kinetics.

S pecific M easurable A chievable R elevant T ime related

SEATINGCUSHIONS ACCESSORIES

ERGONOMICAL FRAME CONSTRUCTION

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RESULTS

CLINICAL TEST STUDY

We are committed to using and collecting the data from the clinical evaluations in an ethical way. Mr. M.O. is one of the wheelchair users that was a part of the clinical studies regarding Netti Dynamic System. Please note that photos of M.O. and personal data are described in details as a part of the clinical test. However, we don't use these photos and personal data of the user in marketing publications, according to our ethical guidelines. We only use these data and photos at seminars with professional attendants.

FINDINGS SEATING EVALUATION CLIENT: M.O. FEB. 2014:

18 years 75 kg / male Assistive independent living center resident CP / Spastic Diplegia Very strong tone Cognitive impairments Extension tendency right lower extremity C- Scoliosis convex right Symmetric tonic neck reflexes, Athetosis Functional upper extremities Hip flexion limitation 90 degrees left and right Tight hamstrings Windswept hips to L

POSTURAL GOALS

Controlling movements & spasticity frequency Decrease repositioning after sliding: now every 10 min Decrease sliding: now every 10 min when seated Address wear and tear of the wheelchair and accessories Improve symmetry to increase manual wheelchair

propulsion ability

SEATING INTERVENTION: Netti Dynamic CED

SEATING OUTCOMESJULY 14TH, 2014:

Controlled movements & spasticity frequency: Client has less tone and sits more aligned and stable even after spastic episodes.

Address wear and tear on the equipment: No visible signs of wear and tear after 5 months of use

User sits in the chair from:8-11 am12-13 pm15-18 pmrepositioning is need 5 to 10 times a day – before the seating intervension, it was up to every 10 min when seated.

Read more about Netti Dynamic System and the comprehensive range of Netti comfort wheelchair solutions: www.my-netti.com

NETTI DYNAMIC SYSTEM INTERVENTIONS WHICH ENABLE DISTAL MOVEMENTS BY CREATING AN OPEN KINETIC CHAIN, IMPACTED:

The stability of proximal segments Seating time Sliding Repositioning frequency Tone Pain Equipment wear and tear

… On the wheelchair users with Cerebral Palsy

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OUR GOAL

TO CREATE A GOOD SEATING INTERVENTION BY USING BEST PRACTICE EXPERIENCE AND CURRENT RESEARCH ABOUT SEATING

Netti can support partners with user assess-ments, or seminars on seating assessments techniques and the use of:

Clinical test protocol Seating interventions on specific clinical cases Seating interventions on specific clinical

diagnosis Postural and mobility management of different

diagnosis with specific seating challenges

ALL PEOPLE ARE UNIQUE, AND HOW CAN WE USE GUIDELINES TO ACHIEVE GOOD SEATING SOLUTION TOGETHER WITH EACH USER?

INDEPENDENT RESEARCH RECORDEDIMPACT ON THE FOLLOWING SEATING RELATED ISSUES BY USING TILT, RECLINE AND ELEVATING LEG SUPPORTS:

POSTURAL REALIGNMENT AND FUNCTION (Lange, 2000b; Sommerfreund & Masse, 1995).

PHYSIOLOGICAL IMPLICATIONS (Lacoste, Weiss-Lambrou, Allard, & Dansereau, 2003; Nwaobi, 1987)

ORTHOSTATIC HYPOTENSION (Bradley & Davis, 2003)

VISUAL ORIENTATION, SPEECH, ALERTNESS, AROUSAL, RESPIRATION, AND EATING(Kreutz, 1997; Lange, 2000a)

BOWEL AND BLADDER MANAGEMENT (Wyndaele, 2002)

TRANSFERS AND BIOMECHANICAL ISSUES(Bayley, Cochran, & Sledge, 1987)

SPASTICITY(Kreutz, 1997) CONTRACTURES AND ORTHOPEDIC DEFORMITIES(Lange, 2006)

EDEMA (Kinzer & Convertino, 1989)

PRESSURE RELIEF (Aissaoui, Kauffmann, Dansereau, & de Guise, 2001; Hobson, 1992; Vaisbuch, Meyer, & Weiss, 2000)

WHEELCHAIR PUSH-UPS FORWARD AND SIDE LEANING(Coggrave & Rose, 2003; Henderson et al., 1994; Hobson, 1992; Vaisbuch et al., 2000)

PAIN, FATIGUE, AND SITTING TOLERANCE(Kolich, 2003)

DYNAMIC MOVEMENT (Reinecke, Bevins, Weisman, Krag, & Pope, 1985)

SOURCE:RESNA - Rehabilitation Engineering & Assistive Technology Society of North America, April 2008. www.resna.org

4Create the

seatingsolution

3Seatinggoals &

strategies

2 The user’s possibilities

1Understandthe postural

influence

シーティングコンフォートフラワー

5Outcomes

& newpossibilities

A MIND MAP of keywords we can discuss with you when we have a dialogue about a seating solution or a seminar, using the 5 seating steps approach:

We consider the best way to use and utilize the 5 seating steps is a dialogue between you, our local dealer and possibly with support from Netti by Alu Rehab training staff or a seating expert. We can discuss challenges and a good strategy to find a seating solution and reach your goals.

On the next pages we describe a few examples of independent research about clinical benefits on some of the comfort wheelchair features, and information about how to learn more about these topics.

The 5 seating steps is an approach developed by seating expert Bart Van der Heyden according to his best on-field practice and his consideration of current research and findings.

We consider 5 seating steps to be a good way to consider and create good Netti sea ting solutions.

Step 1: Understand the postural influence

Step 2: Assess and observe to understand the wheelchair user’s possibilities

Step 3: Set seating goals and determine strategies

Step 4: Create a seating solution to fit around the wheelchair user

Step 5: Measure outcomes: Measure if seating goals and seating strategies of step 3 are met

5 SEATING STEPS

ASK OUR STAFF To give you information about training and seminars, and possibly a demonstration of the Netti comfort wheelchairs and features.

Or you can visit our website: www.my-netti.com

COMFORTCOMFORT

OBSERVE

SMART GOALS

WhatEQUIPMENT

would meet goals?

Did IMEET MY GOALS?

GravitiyFatigue

Postural TendenciesWheelchair Interaction?

What do I see?When do I see it?

Why do I see it?

SpecificMeasurableAchievable

RelevantTime specific

CompensationsAssymmetries

WheelchairInteraction?

Head PositionBack support

Adjustment

ToneOpen vs. closed kinetic chains

STABILITY FUNCTION

TIMESTEP 1:

UnderstandPostural Influences

STEP 2:Assess

STEP 3:Set seating goals

STEP 4:Create a seating solution

STEP 5:Measure outcomes

5 SEATING STEPS

Netti By AlurehabMy-Netti.com

Bart Van der Heyden, PT = SuperSeatingwww.super-seating.com

MINDMAPCOMPLEX SEATING

MANAGEMENTBART VAN DER

HEYDEN, PT

MORE INFO

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CLINICAL EVIDENCES ON COMBINING TILT WITH RECLINE

To use a separate tilt and recline function is well documented regarding to decrease the risk of «shear» and «sliding forward».

START USING TILT BEFORE USING RECLINE TO REDUCE SLIDING

“For many persons with neuromuscular diseases it is necessary several times during the day to reduce the negative influence of the gravity forces on the spine by resting backwards in the wheel chair. To reduce the risk of sliding of the body when getting into resting position, always start using tilt in space and then use recline. And when returning to upright sitting position always start with recline and then tilt in space.”

Source:Best Practice Guidelines (BPG13) Tilt, Recline and Elevating Leg rest for Wheelchairs prior to workshop at the 4th International Interdisciplinary Con-ference on Posture and Wheeled Mobility; SECC, Glasgow, 7 – 9 June 2010

WHEN RECLINING, FIRST TILT THEN RECLINE TO REDUCE SHEAR FROM SLIDING FORWARD“Note on Shear: Shear/friction are necessary to keep the person from sliding out of the chair — the key is to avoid having that shear/friction where normal forces are highest (i.e., not on the bony prominences). The solution is to make the coefficient lowest where the pressures are highest, and highest where the pressures are lowest. Taylor found that when you control shear, you can significantly reduce pressure at a decubitus ulcer by a factor of six.”

Source: Taylor V. Pressure Mapping Clinical Protocol. 1999 ISS Handbook.

Learn more about prevention and treatment of pressure ulcers and international agreed Best Practice

PRINTED COPIES OF THE ENGLISH VERSION OF THE QUICK REF-ERENCE GUIDE can be ordered, and PDFs downloaded, from the following websites:

NPUAP npuap.org EPUAP epuap.org Australian Wound Management Association (AWMA) awma.com.au Hong Kong Enterostomal Therapists Association Society www.etnurse.com.hk New Zealand Wound Care Society (NZWCS) nzwcs.org.nz Wound Healing Society Singapore woundhealingsociety.org.sg International Pressure Ulcer Guideline internationalguideline.com

The Quick Reference Guide by EPUAP/NPUAP and other organizations listed below presents a summary of the recommendations and excerpts of the support-ing evidence for pressure ulcer prevention and treat-ment. The goal of this international collaboration was to develop evidence-based recommendations for the prevention and treatment of pressure ulcers that could be used by health professionals throughout the world. An explicit scientific methodology was used to identify

and critically appraise all available research. In the ab-sence of definitive evidence, an expert opinion (often supported by indirect evidence and other guidelines) was used to make recommendations.

THE QUICK REFERENCE GUIDE is intended for busy health professionals who require a quick reference in caring for individuals in the clinical setting.

Source:National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance.Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: OsbornePark, Western Australia; 2014.

THE USE OF NPUAP/EPUAP/PPPIA material does not imply endorsement of products or programs associated with the use of the material.

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FEEL FREE TO CONTACT US OR VISIT My-Netti.com

NORWAYAlu Rehab ASBedriftsveien 23 NO-4353 Klepp stasjon

Tel: +47 51 78 62 20 post@My-Netti.com

CHINA Alu Rehab (Xiamen) Co., Ltd. Xiamen City, Haicang Industrial DistrictWeng Jiao Road 289Haitou Kechuang Center Building 3Floor 1-2 361022China Tel: +86 592 651 7680 80

DENMARKAlu Rehab ApSKløftehøj 8 DK-8680 Ry

Tel: +45 87 88 73 00Fax: +45 87 88 73 19info@My-Netti.com

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