Michelle L. Lange, OTR/L, ABDA, ATP/SMS
Phillip is a mover and a shaker – literally! This adult with intellectual disabilities likes to move. He lives at a residential facility in Delaware. Years of rocking in his manual wheelchairs have left a trail of destruction. He has broken seating systems, mounting hardware, and wheelchair frames as a result of repeated and often strong movements. Phillip is currently using a tilt in space manual wheelchair with a linear back and an off-the-shelf cushion. When he rocks, he tends to move the entire chair across the room, so the staff lock the wheels. The result? He rocks with such force that the solid tires have repeatedly broken where they contact the wheel locks!
The supplier working with Phillip ordered a Dynamic Back to address his need to move and to protect the wheelchair from further damage. However, the Dynamic Back selected was not durable enough to endure Phillip’s forceful movements. The elastomer in that Dynamic Back had been replaced with a Seating Dynamics elastomer, which was more durable but not designed to be used with this hardware. In light of Phillip’s movement needs, the entire Dynamic Back hardware needed to be more robust. He also has a Dynamic component on the footrest hangers, however this spring (mounted between the footrest hanger and the footplate) is designed to capture forces exerted when the feet are pivoted outward and provides minimal movement.
Phillip likes, and needs, to move. By moving against static surfaces, he is constantly experiencing strong forces against various areas of his body, particularly his posterior trunk and head. This could lead to discomfort and even injury. Why would he move if it hurts? Many clients move to provide sensory input (i.e. vestibular, proprioceptive), to calm agitation, and to increase alertness.
I recommended a Seating Dynamics Dynamic Rocker back, Dynamic Footrests, and Dynamic Head Support Hardware to accommodate Phillip’s movement. You can watch a video of him in this new equipment below. He loves all the movement these components provide – and his team loves reduced wheelchair repairs and replacement!
Phillip rocking in his current wheelchair (used with permission)
Phillip banging on his current head support (used with permission)