7/27/2012 TiLite Wheelchairs Australian Distributor for TiLite SDL (Seating Dynamics Ltd) Clinical Practice Guidelines • Published in 2005 • A consortium of professionals including practitioners, researchers, and educators • Consolidates research findings and relates them directly to clinical practice Why are they important? • Upper extremity pain and dysfunction is a significant secondary complication related to manual wheelchair propulsion – More wheelchair users – Longer time manual propelling – SCI persons living longer (phew) • It helps guide Evidenced Based Practice • Provides justification for prevention and interventions 1 7/27/2012 Free Download: www.pva.org Impact of no prevention… • Significant costs – To the user • Loss of work • Loss of function • Psychosocial implications – To the health care system • Leads to costly medical interventions • Costs of replacement equipment or power mobility The ideal prevention… • Start early with: – Adequate positioning – Rotator cuff strengthening – Proper equipment configuration – Client training on propulsion biomechanics 2 7/27/2012 Intervention is Multifaceted • Full orthopedic examination • Treatment plan that may include: Modalities Therapeutic exercise programs Positioning programs Functional retraining/modifications • Transfers • Propulsion – Equipment modifications – – – – Predisposing Factors for Injury • Poor sitting posture • Muscle imbalance • Wheelchair configuration • Rear wheel position • Improper fit Guideline #7 • Provide manual wheelchair users with SCI a high‐ strength, fully customizable manual wheelchair made of the lightest possible material 3 7/27/2012 What is Custom? • Custom Configuration – Offered by TiLite and other manufacturers • Able to select specific options and components • Configured to best meet the client’s needs – TiLite offers the widest range of options available. What is Custom? • Custom Configuration – TiLite offers the widest range of options available. What is Custom? • TiFIT – Exclusive to TiLite – Tailored to fit the specific client 4 7/27/2012 What is Custom? • TiFIT – Exclusive to TiLite – Tailored to fit the specific client – The frame is fabricated to exact measurements (we don’t bend a tube until we get an order) What is Custom? • TiFIT – Exclusive to TiLite – Tailored to fit the specific client – The frame is fabricated to exact measurements (we don’t bend a tube until we get an order) – Each tube is formed to a full scale drawing TiFit – Made to Fit the User 5 7/27/2012 Front Castors • TiFit – CAD Designed to set for maximum stability. • Inside the width of rear wheels •Functional Considerations: •Transfers – wide set will inhibit ability to get close for transfers •Wide set will tend to damage car paint and cupboards •Access Front Castors • Every chair checked to ensure the front caster will not interfere with the footrest or frame when seat to footplate height is adjusted. Designs Unlimited A list of many of the more common truly custom designed options: http://www.tilite.com/assets/pdf/TiLite_Designs_unlimited.pdf 6 7/27/2012 Fit Matters Fit Improves Function TiFIT Starts from Scratch! • TiFIT – Exclusive to TiLite • All Titanium and Aero Z TiLite Wheelchairs are TiFIT 7 7/27/2012 Guideline #8 • Adjust the rear axle as far forward as possible without compromising the stability of the user. • To counteract perceived stability issues: – Skills training – Teach fall and recover – Stability is relative to the user Guideline #9 • Position the rear axle so that when the hand is placed at the top dead‐center position on the pushrim, the angle between the arm and forearm is between 100 and 120 degrees. Recommendation #10 • Educate the patient to: – Use long smooth strokes that limit high impacts on the pushrim. – Allow the hand to drift down naturally, keeping it below the pushrim when not in actual contact with that part of the wheelchair 8 7/27/2012 Anticipated Outcomes: Reducing the Prevalence of Pain and Injury • Ease Stress on the Arms through Propulsion Training • Better Customization and Optimization of Wheelchair Selection • Facilitation of Reimbursement for the Appropriate Equipment • Positive Economic Impact of Reducing the Prevalence of Pain and Injury • Improved Quality of Life TiLite Wheelchair Range Rigid Titanium Frames TiLite ZR TiLite ZRA 2 TiLite TR TiLite YG TiLite Wheelchair Range Folding Titanium Frames TiLite 2GX TiLite TX 9 7/27/2012 TiLite Wheelchair Range Aluminium Frames TiLite Aero R TiLite Aero X TiLite Aero Z Rigid Folding Rigid TiLite Wheelchair Range Aluminium Frames • THE NEWEST MEMBER OF THE TILITE FAMILY! TWIST GOOD THINGS COME IN SMALL PACKAGES! • Sized from 8x8 up to 15x16 – Up to 2 inches of growth in width – Up to 3 inches of growth in depth • No parts or growth kits to buy! • Crash Tested transit option available • One inch 6061 Al tubing to accommodate seating and positioning needs 10 7/27/2012 TILITE INNOVATION: Tru‐Fit Clamp on Components Unique caster mount means simple FSH adjustment! Clamp COG bracket and backrest allow for infinite rear wheel positioning! Tilite Innovation: Adjustable Caster Mount • Maximizes Lateral Stability • Quick STFH adjustment • No need to adjust caster angle every time TILITE INNOVATION: Abduction/Flared Frame Option • 2 inches of flare in the front frame • Starts at the end of the seat sling • Accommodates abduction due to: – Long leg braces – Positioning devices – Pelvis/hip socket development • No need to widen seat depth for LE positioning! 11 7/27/2012 TILITE INNOVATION: Swivel Anti‐tip Caster • Allows for safe exploration of environment • Children can learn new skills without worrying caregivers • Maximizes stability 2 Inches of Width Adjustment 3 Inches of Depth Adjustment 12 7/27/2012 Unique High‐Mount Footplate System Maximizes STFH Options - as small as 6 in STFH - no need for risers - no clamp on systems Flip Back Footplate - Safe transfers - Easy to position for gait training MORE CHOICE! • Largest variety of wheel sizes to meet the needs of some of the smallest TiLite users. • Low seat to floor heights to ensure safe and easy transfers • Multiple foot plate options to ensure proper positioning • Variety of seat belts and anti‐tips to keep your pediatric clients safe! A Happy Ending is always the Goal! Jacob couldn’t be happier with his new TiLite Twist and his twin brother Samuel can’t wait to go out and play with him! The First Production Twist Delivered to GTK, Australia, 11/11 13 7/27/2012 Material Considerations In Wheelchair design, we face similar issues to aerospace: Strength versus weight Efficiency Cost Aluminum (aircraft 6061T-6 grade aluminum) • Advantages • Disadvantages – Very light weight – Good strength to weight ratio – Easy to work with; versatile – Good corrosion resistance – Economical – Very poor dampening properties – Poor fatigue life – Requires Coating Wheelchair Frames Aluminum (Series 7000 grade aluminum) • Advantages – Very light weight – Marginally better strength to weight ratio than 6061T‐6 – Good corrosion resistance • Disadvantages – Very poor dampening properties – Expensive – Poor fatigue life – Difficult to work with – Requires Coating 14 7/27/2012 Wheelchair Frames Titanium 3-2.5 • Advantages – Extremely high strength‐to weight ratio (Highest of any metal on earth) – Very good dampening properties – absorbs vibration – Very high fatigue life – Corrosion resistant (no coating required) • Disadvantages – Difficult to work with – Expensive Wheelchair Frames Ti3-2.5 vs 6061T-6 vs Series 7000 Al Note small difference between TiLite 6061T‐6 and 7000 series aluminium! The Weight Debate • Increases propulsion efficiency – Initiation of propulsion takes less force – Shoulders work less • Means less impact on the shoulder – Lifting the equipment – Improved equipment performance • Must be combined with proper configuration 15 7/27/2012 The Weight Debate….. • Anyone can make a light weight wheelchair, strength, flex, durability, range of adjustment, ease of adjustment • Beware the quoted weights – options add weight • Vibration and dampening – users report less fatigue, less lower back pain, better ride • Availability, delivery times, support, warranty…… Opportunities for Adjustments Tracking and Intervention Why is adjustment Important? • Skill acquisition • Recovery and progression of diagnosis – Physical and psychological – Removal of external fixation devices • Community re‐integration 16 7/27/2012 Why order adjustable components? •When do they need to be adjusted? •Who is responsible for the adjustments? When the TLSO comes off…. • COG changes • Balance changes • Skills change – MRADLs (Mobility Related Activities of Daily Living) – Wheelchair mobility – Wheelchair skills – Transfers • Activity changes ZRA2 vs. ZR2 17 7/27/2012 No fear! •Fixed Frame benefits your clients •Weight saving •More durable •Maximum performance •Access to manufacturing support •Internal quality control at order input •CAD drawings available for review •Local rep support Changes are a Transition • Work with what we have at the time – – – – Client function Balance External fixation Demo equipment • We can get from here….. ….to Here! 18 7/27/2012 What’s the Motivation? •Maximize equipment utilization and effectiveness of funding •Improve access to the community and maximize skills acquisition •Ensure best use of equipment •Wheelchair follow up clinic •Annual review of equipment •Integration of existing clinics What’s New? More Frame Colours: Includes clear finish for aluminium frames Tattoo options for aluminium What’s New? Handrims: Q-Grip coated handrim - More grip - More durable - Lighter Handrims: Surge handrim - Ergonomic shape - Inbuilt gription strip - Full or LT Profile 19 7/27/2012 What’s New? Wheel Locks: Scissor Wheel Locks - Easy application - Lighter What’s New? Standard Wheel - Shadow Double rimmed - Black Spokes - Light weight - Strong sports wheel What’s New? TiLite TR3 Wheelchair 20 7/27/2012 The FreeWheel™ Wheelchair Attachment The Problem – Front castors on grass, dirt, loose gravel, rough ground. Cracks in footpaths The Solution – One large front wheel Lift small castors off the ground FreeWheel Opens up Access for Wheelchair Users Reduces the Risk of Falling Out Forwards 21 7/27/2012 FreeWheel Fits onto Foot Plates of Rigid Frame Wheelchairs Once set up the FreeWheel takes seconds to put on or take off. Ideal for rural and suburban areas 22 7/27/2012 Portable – take on holidays Sports Grounds Parks 23 7/27/2012 FreeWheel Storage Perch Included Optional Carry Rack Now Available Optional Carry Rack Now Available 24 7/27/2012 See Videos At our website www.seatingdynamics.com.au FreeWheel - Broaden the Limits Follow up and Follow Through! Thanks for coming! A Seating Resource An on‐line training course in seating, specifically aimed at spinal cord injured but applicable to all seating: http://www.aci.health.nsw.gov.au/networks/spinal‐seating Or Google “Spinal Seating” 25 7/27/2012 SDL Website Product information, images, brochures, case studies, clinical studies, videos www.seatingdynamics.com.au 26