Michelle L. Lange, OTR/L, ABDA, ATP/SMS
Carl is a 44 year old man with the diagnosis of cerebral palsy. He drives a power wheelchair with a head array and has accessed a computer keyboard using a head stick. He is verbal, though is difficult to understand. Carl manages the website for HandyCapable Network, a group which refurbishes donated computers and then offers these at a low cost to seniors and low income families. He is also a part of Bell campus which is an “arts and technology community with the goal of improving the quality of life for “differently-abled” participants and the aging.” Carl works with Doug Cobbs, ATP, CRTS of Healthcare Equipment, Inc. in North Carolina.
Carl has a lot of tone and extraneous movement. When he extends, his pelvis slides forward into a significant posterior tilt. When this occurs, Carl is no longer in alignment with his seating system or the Head Array that he drives with. Despite his significant tone, Carl can consistently drop his head forward to stop the wheelchair when driving.
Carl has a Permobil M3 power wheelchair with power tilt, as well as the head array. He has an OBSS molded seat and back. He experiences leg cramps and relieves these by pulling his legs upward. As a result, he does not have any strapping over his feet. A recline was not used as opening the seat to back angle increases his overall extension and he would lose his positioning upon return to upright. He does sit in a very open seat to back angle secondary to limited range of motion.
“Even though my current seating system was custom molded to assist me with keeping a good posture, I still have challenges with keeping my hips back in the chair. No matter how many times I tilt the chair back in a short amount of time to allow gravity to help get my hips back, I lose the posture I need to make contact with the side pads on my head array to turn [the power wheelchair]. I also have a lot of tone in my upper body. So, if I get excited when communicating with someone, my body tightens up which causes me to slide even more. I guess because there’s no “give” in the back I currently have.”
Carl recently received a Permobil M1 power wheelchair with a Contour U custom molded seat and back. He also has a power tilt and Head Array. This time, the wheelchair includes a Seating Dynamics Dynamic Rocker Back interface (DRBi).
Doug’s goal was to provide movement to maintain postural alignment and reduce overall extension. Per Carl, “My hopes in having a dynamic back are being able to have more support for my upper body and my lower back when I hyper-extend and not feel like I’m sliding down due to my hips not being able to bend at 90 degrees. So, I’m hoping that the dynamic back will assist me with positioning.”
The Dynamic Rocker Back interface (DRBi) was challenging to mount on the Permobil base because of mounting issues, but Greg Peek, designer of the DRBi and owner of Seating Dynamics, was able to work directly with Permobil engineers to ensure a working solution. The armrests are typically mounted to the back, but the Dynamic hardware would interfere with this. Instead, T bar style armrests were employed which mount to the seat rails. Although not on the order form, these are listed under Permobil parts.
In the new power wheelchair with the Dynamic Back, Carl’s posture is much improved. He is more comfortable and feels better than when sitting in the prior base. Now that he is no longer sliding forward, he can readily access the head array for driving. Major quality of life improvements for Carl are not only increased independence in driving, but he can now control his computer from a seated position. Previously Carl had to lay down on a mat to use the computer keyboard via a head stick. He now uses the head array to control the computer utilizing the built-in Bluetooth of the power wheelchair electronics.
Carl, what are your future goals?
“One of my future goals [is] to finish earning my certificate in Web Development which will be next year, unless I want to go further in the program, and to move to a bigger city that has more services and opportunities for people with disabilities.”