What Every Evaluator Needs to Know

Eva M Richardville OTR, ATP, CDRS, CAPS Therapeutic Mobility Services, Inc.

Anne Hegberg MS, OTR/L , CDRS, CDI Marianjoy Rehabilitation Hospital part of Northwestern Medicine

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DISCLAIMER • The slides which you are about to see are by no

means and endorsement of any one manufacturer.

• Also, it is not inclusive of every piece of AE available. We are providing examples and encourage feedback from attendees.

This slide will self-destruct in 10-9-8-7-6-5-4-3-2……..

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Objectives 1. Identify common positioning problems and

solutions to help facilitate improved functional driving performance and safety.

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2. Identify technology and techniques that can improve client performance and driver training from “day one”.

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3. Create a list of “must haves” for every evaluation vehicle to allow each participant to use creativity for accommodations to meet client needs.

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4. Describe the process, including communicating with the vendor and/or manufacturer, when recommending variations “out of the box” modifications.

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5. Attendees will be able to translate a minimum of three ideas to maximize usability of their individual evaluation vehicle.

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Client issues first

• Positioning and stabilization in wheelchair

• Plans for new w/c

• Positioning in driver seat

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Poor Seating = Poor Vehicle Control

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Positioning in w/c

Many factors must be considered to ensure a client is positioned appropriately and stable when driving from a wheelchair. • Midline trunk position- is needed to allow isolated UE control

– Chest strap – Torso vest – Lateral support in seating system

• Wedge inserts • Molded integrated lateral supports

• Add-on articulating supports (swing-away)

• Headrest is essential for cervical protection • Line-of-site height (eye ellipse)

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• Tri Quality 5840 S Watt Ave, Unit A · Sacramento, CA 95829 Phone 800-567-9090 · Fax 877-388-5933

• torsobelt@ottobock.com

• BodyPoint.com

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Crossit

Body Point

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Careva

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Other Things to Consider • Attaches to the seat

back- driver seat or wheelchair

• Ensures midline stabilization

• Can client don/doff independently?

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Torso Restraint

Keep it snug

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Driving From OEM Seat • Can they personally lift/stow WC

independently, safely, and repetitively for transport (ultralight-K5)? – Example:

• Quickie 2 Folding 27 lbs. • TiLite Aero X Folding 15.6 lbs. • TiLite TX Folding 11 lbs.

• How will they secure it inside the vehicle?

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Driving From OEM Seat

• Do they need assistive technology (AT) interface for vehicle/WC? – Power assist lift (driver side center, rear hatch, or

hitch-mounted) – Hoist (rear hatch, rooftop, or truck bed) – Hitch-mounted pull-behind transport (Bruno Chariot,

Scoot-a-Trailer)

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Driving From Transfer Seat • How will they secure the WC/device once

transferred? – Use OEM seat belt – Manual strap tied downs – Retractable reel tie downs – Powered lock down system

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Driving From Wheelchair

• Power WC vs. Manual WC? • Powered lock down (AWORS)

– Check with lock down mfg. regarding bracketry for compatible wheelchairs

– Manual release and ease of user interface

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Wheelchair Challenges • Transfer from WC (OEM seat or Transfer seat)?

or WC Driver… that is the question? Considerations: – Strength/ROM, Endurance, Efficiency, Safety

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Wheelchair Stabilization

Automatic Wheelchair Occupant Restraint Systems (AWORS)

• Secure the power wheelchair base to the vehicle floor structure.

• Does NOT stabilize a hypermobile seating system typical in complex rehab chair (tilt, recline, elevation)… so what do you do???

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Meet Dustin

• Dx: Polyosteoticfibrodysplasia

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Dustin

• Permobil “Playman” wheelchair not compatible with any AWORS.

• Could not transfer independently into alternative driver seat (height limitation)

• Had to change to a comparable upgraded power WC that was compatible with AWORS.

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Dustin’s New Wheelchair

• Permobil K450

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Stabilizing Dustin’s Wheelchair

• Elevation to allow line-of-site above the dash resulted in ‘bobble-head’ effect.

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Custom WC Stabilization Bracket

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Custom Stabilization Solution • Custom fabricated seating system stabilization

solution...

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crash test ADED 2016

WC 19-20

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“The standard applies to the securement of wheelchairs by four-point strap-type tiedown systems that are occupied by child- and adult-sized passengers restrained by belt-type occupant restraints. The standard applies to a wide range of wheelchair types and styles, including manual wheelchairs, powerbase wheelchairs, three-wheeled scooters, tilt-in-space wheelchairs, and specialized mobile seating bases with removable seating inserts. It applies primarily to wheelchairs as purchased from the OEM manufacturer, but also has application to wheelchairs that are retrofitted for use as a motor-vehicle seat by the addition of after-market add-on components”.

RESNA WC-4:2012, Section 19 - Wheelchairs Used as Seats in Motor Vehicles

http://wc-transportation-safety.umtri.umich.edu/wts-standards/wc19-wheelchairs

WC 19 • Have at least four permanently labeled securement points

that can withstand the forces of a 30 mph, 20 g impact, • Have specific securement point geometry that can receive a

securement end fitting hook of a specified maximum dimension,

• Be equipped with anchor points for a wheelchair-anchored pelvic belt and recommendations for purchasing a belt if not provided, such that the wheelchair and pelvic belt will withstand a 30 mph, 20 g impact, and

• Provide a standard interface on the pelvic belt to connect to a vehicle-anchored shoulder belt.

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WC-20

• Tested seating systems • Only to be used with WC-19 wheelchairs

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transfer

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Bruno

Veigel

Entering

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Positioning

• Wheelchair – Modifications

• Driver Seat – Modifications

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Handy Bar

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Simple Effective Solutions

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Deluxe Swivel Seat Cushion Car Swivel Seat by Stander

Simple Effective Solutions

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HandyBar Car Transfer Handle by Stander Car Caddy by Stander

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Driver seat

• Seat modifications • Seat belt mods

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OPTIONS • Bellows • Extended Travel • 180° Swivel • Hand pendent

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Simple Effective Solutions

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My-Buckle Mate

http://www.arthritissupplies.com

Simple Effective Solutions

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Spring loaded tongs

Easy Reach Seat Belt Handle http://www.arthritissupplies.com

Seatbelt solutions

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Client securement

• AWORS • Seatbelt

– Drive in – Loopo – Rigid seatbelt

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• Manual w/c • Power w/c • Scooter • Rolling walker • Oxygen tank

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Bracket chart for specific wheelchairs available online on lockdown manufacturer’s websites

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Manual release for EZ-Lock

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Evaluation Vehicle: What is your goal?

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Low Tech? Moderate Tech? High Tech?

VEHICLE CHOICE

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Low Tech: What populations do you serve?

– Ambulatory clients – Limits in mobility, but can transfer

independently – Senior driver fitness evaluations

• Learning, social or attentional deficits. • Mild stable neurological/musculoskeletal deficits • Low vision clients

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Moderate Tech: What populations do you serve?

• Requires use of a manual or power mobility device

• Significant limitations in strength/ROM • Significant limitations in endurance • Potential for physical changes exist • Can transfer, but requires assistive technology • Needs to drive from mobility device due to fall

risk

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High Tech: What populations do you serve?

– Generally drive from power wheelchair – Must have modified power steering or servo-assist

for steering – Electronic primary controls – Electronic interface for secondary controls – Progressive disability or changes from aging will

more significantly impact function. – Extremely limited strength/ROM/endurance

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Let’s Consider The Options For Evaluation/Training Vehicle Types:

Sedans SUVs Mini Vans Full Size Vans Pros: • Least costly, • Greatest MPG • Widest selection

Pros: • Higher visual

vantage point • Ease of entry for

older drivers

Pros: • Larger number of

clients (dx) served, • Average MPG

Pros: • Can accommodate

larger clients/WCs • More passengers

(GVW)

Cons: • Fewer non-

console models, • Limited client fit

(obese, very tall)

Cons: • Less MPG over

sedans, • Console • Can be difficult

transfer if too high

Cons: • Large clients and large w/c harder to accommodate than in full-size vans

Cons: • Poor MPG • Intimidating for some

clients • Higher center of

gravity • Fewer options

available

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Considerations for Evaluation/Training Vehicle

• Driver/Passenger seat excursion • Maneuverability • OEM power steering effort • Console or no console • Floorboard space (driver/passenger) • Steering wheel contour • Trunk Space

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OEM Check out • Low threshold for entry / exit • Digital speedometer (digihud ap) • Easy readability of instrument panel • Check out blind spots (all vehicles have them) • Adjustable or removable headrests

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OEM Equipment Options:

• Power seat • Tilt and telescoping steering wheel • Driver safety assist technology

– ABS – Rearview cameras – Blindspot detection – Stability control

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Additional A/T • Removable vinyl seat cover • Seatbelt extensions • LED light in driver foot area • Brake light on passenger side • Extended sun visors • Mirrors, mirrors, mirrors • Cushions, cushions, cushions

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Additional A/T

• Visual Reference Points • Small Dry Erase Board/markers • Binder of illustrations/photos • Smart phone camera/digital camera • GoPro • Simple, but effective solutions

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Binder with Illustrations/Photos

• To help explain and pre-plan activities • Interstate merging • Round-abouts • Parking maneuvers

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Passenger Side Control Options

• Brake only? What style fits the evaluator best?

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Passenger Side Control Options • Gas/Brake combination?

– Best when working in vehicles with a console – Allows flexibility to isolate primaries – Intuitive for the evaluator/trainer

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Passenger Side Control Options

Separate Gas/Brake Units

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Passenger Side Control Options More Gas/Brake Trainer Options

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Veigel Sure-Grip

Evaluation Vehicle • Manufacturers have complete systems

• Quick release

– Bottom and top – No tools – Easy on/off – Consider storage in vehicle

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Organize

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Left mounted hand Controls

Mechanical Column mounted left/right

• Push/Right angle • Push/Pull • Push/ Rock • Push/ Twist

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Right side hand controls Floor mounted

• Push/Pull • Push/Twist

Column mounted

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Either side

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Hand Controls (High Tech)

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Wells-Engberg System pneumatic

Paravan electronic

EMC driving equipment

Support bracket

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Steering Options

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Video?

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Secondaries

Mechanical

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Secondary Control Options

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Jelly Bean Switches Head Rest Bracket

Secondary Control Options

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Single button with multi-functions.

• EMC Digitone

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Voice Scan by Crescent Industries Step 1 - Activate the scan by pushing the switch. Step 2 - When the desired function is heard, activate the switch again and the function begins [IF specified when ordering can also be set up to scan function by pushing switch and holding. Release when desired function (like EMC digitone)] EMC digitone: 6-8 tones, each activates secondary control upon release.

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Simple solutions

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Creating Interfaces

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Making it Stick

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MOUNTING

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Truck Options

• OEM chassis – powered seat assist

• UVL (under vehicle lift)

– may need truck bed hoist/power bed cap

• Modified chassis – – SVM (no longer available 7/2016) – ATC (All Terrain Conversions) gull-wing style door

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Low Vision Assistive Technology

Low Tech-

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Low Vision Assistive Technology

Digital Speedometers OEM GPS Projection Systems APPs

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Visual Reference Points for Lane Centering/Drift Awareness

Recipe • Foam board- cut into 2” x 4” pieces • Suction cup- 2 ½” • Dry Erase marker • Sharp knife • Gorilla glue-clear • Colored duct tape/black electrical tape

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Visual Reference Points

• Eva’s Definition: ‘a stationary device used to provide visual vehicle alignment feedback’.

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Visual Reference Points

• Establish alignment in stationary setting

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Visual Reference Points

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