ASSISTIVE TECHNOLOGY/SEATING

Equipment
Equipment

CLIENT:
48-year-old Male
A Wider Range of Activities
CONDITION:
Spinal Cord Anita Zafrani, OT
Injury resulting
in Quadriplegia CASE HISTORY: It was a cool fall day in November, 1967 when 18-year-old L.B. slipped on a pile of leaves during a neighbour-
(1967) hood pick-up game of touch football. From that moment when he sustained a spinal cord injury, L.B.s life changed dramatically.
Thirty years later L.B. presents as a remarkably productive, self-directed man. He is employed as a computer programmer and
enjoys a number of serious hobbies (gardening, cooking, and committee work to name a few). His residence is the Rehabilitation
Institute of Toronto. Without a doubt L.B.s remarkable quality of life is attributable to his outstanding personal qualities combined
with the availability of state-of-the-art power mobility, seating, and environmental control units. In 1994 after using certain equip-
ment for many years, L.B. decided that his needs were not being fully met and the long process was begun of assessing and pre-
scribing technology that would help him achieve his goal of access to a wider range of activities.

CLINICAL CONSIDERATIONS: Since L.B.s physical capabilities have been unchanged for decades and are well-known to ther-
apists at the Rehabilitation Institute of Toronto, the focus was not on the usual obligatory careful motor assessment. The cervical
cord was injured at the level of 4 and 5 and there is no active movement or sensation below the level of injury. Spasticity is pre-
sent in lower extremities and edema is observed in both feet and hands. He has had episodes of respiratory distress due to weak-
ened chest muscles. Due to weakness of trunk muscles he wears a custom firm corset to maintain upright body posture. Skin
breakdown over his left ischial tuberosity has been a recurring problem over the years.

TREATMENT/APPROACH: The Queen Elizabeth Hospital Seating Clinic was consulted in April, 1994. The team carried out a
series of trials and tests throughout 1994 and 1995 and the data was collected and organized in tables. In order to objectively
prove the significant pressure relieving power of combining the recline and tilt on L.B., computerized pressure mapping tech-
niques were employed. Results of these tests indicated clearly that only by combining the power recline, power tilt, and power ele-
vating legrest mechanisms could the risk of skin breakdown in longer sitting hours be removed.

OUTCOME: The client has more control when stopping quickly; the out-of-range system is safer (e.g. the wheelchair automati-
cally stops if the driver has a spasm that sends him out of the range of control), and its proportional drive system means that the
driver can accelerate slowly rather that starting at his regular speed. Through the Peachtree head control L.B. operates drive, tilt,
recline, powerlegs, shear reduction(VSR) and a cellular telephone. When in his room, the head control becomes an environ-
mental control unit that controls his lights, radio, tape recorder, telephone, and call bell. In L.B.s own words: I have a wider
range of activities as a result of using the Peachtree and the Action Storm wheelchair.

EQUIPMENT: The Invacare Action Storm power chair had strong torque for getting over bumps, and is lower and narrower,
allowing L.B. to get on trains and under tables that were previously inaccessible to him. Furthermore, the desired head control
(Peachtree) was optimized for this chair and smooth and consistent driving characteristics could only be guaranteed if the
Peachtree was interfaced onto the Storm. The Peachtree head control was selected because it requires little effort to drive and is
easier on the neck than other head controls. It is very versatile and can interface with all controls from the one area that L.B. can
move, which is his head.

ACKNOWLEDGEMENTS:
Stephen Tse,
occupational
therapist who
worked extensively
on this case
Lewis Boles
Motion Specialties

ABOUT THE AUTHOR:

Anita Zafrani, OT, is an
occupational therapist
Publication supported by a grant from Motion Specialties Inc. at the Rehabilitation
Institute of Toronto.

COTF CASE STUDY REVIEW