october 2015 • vol. 14 no. 10 serving the seating...

October 2015 • Vol. 14 No. 10

mobilitymgmt.com

Serving the Seating & Mobility Professional

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4 mobilitymgmt.comoctober 2015 | mobilitymanagement

october

Mobility Management (ISSN 1558-6731) is published monthly by 1105 Media, Inc., 9201 Oakdale Avenue, Ste. 101, Chatsworth, CA 91311. Periodicals postage paid at Chatsworth, CA 91311-9998, and at additional mailing offices. Complimentary subscriptions are sent to qualifying subscribers. Annual subscription rates payable in U.S. funds for non-qualified subscribers are: U.S. $119.00, International $189.00. Subscription inquiries, back issue requests, and address changes: Mail to: Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866, email [email protected] or call (847) 763-9688. POSTMASTER: Send address changes to Mobility Management, P.O. Box 2166, Skokie, IL 60076-7866. Canada Publications Mail Agreement No: 40612608. Return Undeliverable Canadian Addresses to Circulation Dept. or XPO Returns: P.O. Box 201, Richmond Hill, ON L4B 4R5, Canada.

© Copyright 2015 by 1105 Media, Inc. All rights reserved. Printed in the U.S.A. Reproductions in whole or part prohibited except by written permission. Mail requests to “Permissions Editor,”

c/o Mobility Management, 14901 Quorum Dr., Ste. 425, Dallas, TX 75254

The information in this magazine has not undergone any formal testing by 1105 Media, Inc. and is distributed without any warranty expressed or implied. Implementation or use of any information contained herein is the reader’s sole responsibility. While the information has been reviewed for accuracy, there is no guarantee that the same or similar results may be achieved in all environments. Technical inaccuracies may result from printing errors and/or new developments in the industry.

Corporate Headquarters: 1105 Media9201 Oakdale Ave. Ste 101 Chatsworth, CA 91311www.1105media.com

Media Kits: Direct your Media Kit requests to Lynda Brown, 972-687-6781 (phone), 972-687-6769 (fax), [email protected]

Reprints: For single article reprints (in minimum quantities of 250-500), e-prints, plaques and posters contact:PARS InternationalPhone: 212-221-9595E-mail: [email protected]/QuickQuote.asp

This publication’s subscriber list, as well as other lists from 1105 Media, Inc., is available for rental. For more information, please contact our list manager, Jane Long, Merit Direct. Phone: 913-685-1301; e-mail: [email protected]; Web: www.meritdirect.com/1105

On the CoverScoliosis can present in many clients and require many different approaches. Cover by Dudley Wakamatsu.

16 Understanding Scoliosis It’s a common condition that seating clinicians and

ATPs can encounter multiple times a day. But the

circumstances, combined with each client’s particular

needs, makes working with scoliosis a major challenge.

21 New Horizons Complex rehab technology providers are perfectly

positioned to expand into the accessibility market. This

pictorial has accessibility suggestions and business tips

to make it happen.

volume 14 • number 10

6 Editor’s Note

8 MMBeat

26 CRT Showcase: MAX Mobility’s MX2

28 Marketplace: Pediatric Mobility

30 Ad Index


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2015-08-20 11:52 AM

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Lauren Rosen, PT, MPT, MSMS, ATP/SMS, St. Joseph Children’s Hospital of Tampa (Fla.), once did a phone interview with me from the frozen foods aisle of her local supermarket. It was the only time she was available, since she was jumping onto a plane the next morning. I can imagine the looks Lauren received from other shop-pers as she explained the effects of seated posture on propulsion efficiency for young

children while opening a freezer door to grab a bag of frozen peas.Lauren and her OT/PT/ATP colleagues — that’s you — have been incredibly generous

in sharing your seating & wheeled mobility expertise with me since Mobility Management debuted in 2002. Making time to talk or write to me has meant giving up time during your weekends, vacations and evenings. You’ve done interviews from airports, hospitals and hotel lobbies. You’ve exited highways and pulled into rest stops to chat with me.

When you do talk to me during “business hours,” you know you’ll have to work late to make up the time. And you make time for me anyway.

I’m so grateful. As this October issue heads to press, we’re putting the finishing touches on our

2016 editorial calendar. My boss, Karen Cavallo, points out that 2016 will be Mobility Management’s 15th year in print, so this is an appropriate time to say thank you to every clinician and ATP who’s given me an interview. To thank every product manager and R&D engineer who’s explained how a seating system, mobility base or positioning compo-nent works: I know it’s not easy to explain those concepts to an English major like me. I appreciate every marketing guru who’s submitted a press release and every photogra-pher who’s taken those product beauty shots. And since Karen says that the paper and ink we print with don’t grow on trees (well, the paper sort of does), thank you also to every advertiser who’s invested in Mobility Management so our readers can receive this magazine (and our newsletters and Web site content) for free.

Thank you to every assistive technology consumer who’s shared his/her story with us, and every event manager who’s opened the doors to let me in — because none of you had to do any of that.

I like to think you make these sacrifices because you feel Mobility Management is your magazine. I hope you feel that way, because I do.

Editorially speaking, every so often I have a “more guts than brains” moment, as my mother would say. It happened a few years back, when I naively thought it would be fun to do a cover story on dystonia. That was a “show issue,” and I recall clinicians picking up the issue in our booth, seeing the cover and saying they didn’t think anyone would be foolish enough to try tackling dystonia in a story. I think I may have done it again in trying to cover scoliosis in this issue…though Cindi Petito, Katherine Sims and Jay Doherty were nothing but kind when they heard what I was attempting.

As we approach our 15th year in print, I will continue to occasionally bite off more than I can chew. It’s not intentional, but I figure part of what’s gotten us this far is our willingness to tackle clinical topics at a width and depth (seating pun!) that no one else tries, and with the same determination you bring to work every day. So how about 15 more years?

Laurie Watanabe, [email protected]

@CRTeditor

Editor Laurie Watanabe (949) 265-1573

Contributing Editor Elisha Bury

Group Publisher Karen Cavallo (760) 610-0800

Group Art Director Dudley Wakamatsu

Director, David Seymour Print & Online Production

Production Coordinator Charles Johnson

Director of Online Marlin Mowatt Product Development

mobilitymgmt.com

Volume 14, No. 10

October 2015

editor’s note

Interview in Aisle 3

REACHING THE STAFF

Staff may be reached via e-mail, telephone, fax, or mail. A list of editors and contact information is also available online at mobilitymgmt.com.

E-mail: To e-mail any member of the staff, please use the following form: [email protected]

Dallas Office (weekdays 8 a.m. - 5 p.m. CT) Telephone 972-687-6700; Fax 866-779-9095 14901 Quorum Drive, Suite 425, Dallas, TX 75254

Corporate Office (weekdays, 8:30 a.m.-5:30 p.m. PT) Telephone 818-814-5200; Fax 818-734-1522 9201 Oakdale Avenue, Suite 101, Chatsworth, CA 91311

Chief Executive Officer Rajeev Kapur

Chief Operating Officer Henry Allain

Senior Vice President & Richard Vitale Chief Financial Officer

Executive Vice President Michael J. Valenti

Vice President, Erik A. Lindgren Information Technology & Application Development

Vice President, David F. Myers Event Operations

Chairman of the Board Jeffrey S. Klein

SECURITY, SAFETY & HEALTH GROUP

President & Group Publisher Kevin O’Grady

Group Publisher Karen Cavallo

Group Circulation Director Margaret Perry

Group Marketing Director Susan May

Group Social Media Editor Ginger Hill

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I have traveled all over the world sharing my clinical thoughts about seating and positioning solutions for individuals using wheelchairs as their primary mode of mobility. In all of my talks and interactions, the patient’s pelvis and its relationship with the hips and spine is o� en the anchor of the conversation. Once the pelvis and hip relationship is understood through the hands-on evaluation, the spine, upper extremities, lower extremities, and head are generally easier to understand, and therefore align, in the most optimal way for the client.Recently I was assisting clinicians with hands-on seating and positioning evaluations at a school. We were working with children of all ages, all with di� erent positioning needs, who used all kinds of mobility technologies. The sales rep had brought the Leckey Horizon stander, Mygo stander, and Squiggles stander for evaluative purposes. As we set up the Horizon stander for the size of one of the teens, I noticed that we could adjust the depth and angle of the pelvic pad on the frame. I loved this because of my belief in addressing the pelvis to impact the alignment of the spine when the client can tolerate it. The outcome is o� en immediately visible in both head positioning and in the distal function of the hands. Prior to this support, the client o� en struggles with head alignment and hand function. Sure enough, as we brought the teen up to standing in the Horizon stander, I could loosen the knobs on the pelvic plate of the stander and continue to adjust the pelvis until I had it right where I wanted it to reduce the lordotic curve to the point of tolerance and optimal alignment.

When the trial was complete, the young client was able to stand in a more neutral alignment and therefore needed less head support than what the client usually needed in the wheelchair and in the other stander. The whole team, including the family, immediately noticed this.I have been practicing in this � eld for almost 30 years, and I never get tired of these “aha” moments!The Mygo, Squiggles, and Horizon standers all provide pelvic positioning through depth-adjustable and angle-adjustable pelvic plates and/or derotational belts. The Mygo stander can also accommodate hip � exion and knee � exion contractures up to 25 degrees, which for some kids is critical for comfortable standing once the pelvis and spine are optimally aligned.Pelvic alignment is a major ingredient for standing and seating positioning. The children I see o� en have weak abdominals, shortened spinal extensors, weak gluteals, and shortened hamstrings with tight hip � exors as a result of sitting all day in wheelchairs and o� en because of their diagnoses. Having a standing device that allows me, as a therapist, to accommodate or correct a client’s pelvis, spine, and hips in standing is one factor for successful standing for a client with low tone to high tone who presents either with contractures or with full range. I invite you to contact your local Ottobock Sales Rep (800 328 4058 in the US or 800 962 2549 in Canada) and ask him or her to bring out a demo stander so you can see for yourself the bene� t adjusting the pelvis can bring to your child.

~ By Sharon Sutherland (Pratt), PT

Standing What’s the scoop? Why it’s important to bring the pelvis back into standing.

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In time for National Complex Rehab Technology (CRT) Awareness Week in August, NCART introduced a video that contains a powerful message about the importance of seating & wheeled mobility equipment.

The video, narrated by former Sen. Tom Harkin (D-Iowa), is called “Complex Rehab Technology: 25 Years After the Americans with Disabilities Act (ADA).” The film drives home the message that despite ADA legislation, full access to their homes, communities, schools and workplaces is impossible for people with disabilities unless they have appropriate assistive technology to support them.

CRT consumers Melissa Mitchell and Sarah Schwegel describe how their custom-fitted power wheelchairs and seating systems make it possible for them not only to live actively and independently in their homes, but also to work, pay taxes, and contribute to their communities.

“We need to provide access for all people with disabilities who need complex rehab technology in order to fulfill the promise of the ADA,” Harkin says in the video. “So I’d like to encourage members of Congress to pass legislation and support policies that help America achieve that goal.”

In the video Schwegel, diagnosed with spinal muscular atrophy, says, “If I didn’t have my wheelchair, I would be stuck in bed. I wouldn’t be able to go to school and take notes in class. I wouldn’t have graduated with my bachelor’s in rehab services. I would be living at home, not being a productive member of society, not paying taxes.”

She explains why she needs the power chair’s many positioning elements, noting, “My lateral supports help me sit up straight and

breathe. The standing feature keeps me healthy; I get to weight bear, and it helps with digestion. The tilt feature allows me to shift my weight. I can’t reposition myself during the day, so the tilting allows me to avoid pressure sores. If I don’t sit right, I can’t do anything. I can’t even breathe.”

Schwegel also touches on her permanent need for her power chair, thus differentiating CRT from generic, off-the-shelf durable medical equipment that’s needed only for short periods: “My spinal muscular atrophy isn’t just going to disappear tomorrow. I’m always going to need a very complex power wheelchair.”

NCART Executive Director Don Clayback said in a news announcement about the video, “As we battle negative federal and state policy changes that are taking away access to CRT, this video is a great reminder that the ADA was passed in 1990 to promote inclu-sion and accessibility. Sadly, 25 years later people with disabilities are finding it harder to access the specialized equipment they need to realize the benefits of the ADA.”

In alerting NCART members and industry stakeholders to the video’s debut, Clayback acknowledged the contributions of Melissa Pickering, executive VP of payor relations at Numotion, to the concept and production of the seven-minute film.

“We appreciate the commentary from Sen. Harkin and Melissa and Sarah,” Pickering said. “Their voices will help deliver the needed reminder to Congress that the principles of access were embodied in the ADA, and Congress must be sure federal and state policies don’t undermine those principles and hurt people with disabilities.”

To view the video, go to https://vimeo.com/136364121. l

New NCART Video Promotes Importance of CRT

Stacey Mullis Is Comfort Company’s New Director of Clinical Education

Stacey Mullis, OTR/L, ATP, has been named Comfort Company’s new director of clinical education.

Mullis had been the seating & positioning manufacturer’s North Carolina region territory manager. Eric Murphy, Comfort Company’s VP of marketing, said in a news announcement that Mullis “made an imme-diate impact on her territory and held her

place as one of the highest performers within Comfort Company’s

sales team.”Murphy added, “In two short years of managing her territory,

Stacey proved to be a tremendous resource to her customers and our company. Her new role will provide her the avenue to use her experi-ence and passion to make a much larger impact on our industry.”

Mullis has been an occupational therapist for more than 20 years and has worked in sub-acute rehab, long-term care, pediatric and home health settings. She earned her bachelor of science degree in occupational therapy from the University of Western Ontario in London, Ont. l

Stacey Mullis

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Caroline Weaver Is New Permobil Regional Director of Marketing

RESNA Updates Position Paper on Tilt, Recline & ELRs

Permobil has announced Caroline Weaver is its new regional director of marketing & product development.

Weaver’s previous experience includes tenures with Johnson & Johnson Medical Product Division, Singer Sewing Machine Company, Fisher Price’s electronics division and Graphic Controls Medical Products.

Permobil President Larry Jackson said in a news announce-ment, “With Permobil’s strategy to become a leading healthcare company, providing innovative advanced rehabilitation solutions for people with disabilities, we wanted to increase our bench strength in marketing, and Caroline has an exceptional track record of leading

The Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) has released a new position paper about the tilt, recline and elevating legrests used on complex seating and wheeled mobility systems.

“The Application of Tilt, Recline & Elevating Legrests Literature Update” follows RESNA’s protocol of reviewing and revising its position papers every five years to stay up to date with the most recent research findings and best practices in the industry.

In a news announcement about the new posi-tion paper, the association said, “RESNA’s posi-tion is that these features are often medically necessary, as they enable certain individuals to realign posture and enhance function; improve physiological processes, such as respiration, bowel and bladder function; redistribute and relieve pressure; and manage edema, to mention just a few of the many medical benefits.”

Proper application of these positioning options requires the involvement of “a licensed medical professional (such as a physical or occupational therapist), preferably with a specialty certification,”

RESNA added.Lead author Brad Dicianno, M.D., University of Pittsburgh’s

Department of Physical Medicine & Rehabilitation, said of the new paper, “Since the original publication in 2010, there’s been additional scientific evidence for various functional uses for tilt, recline and elevating legrests. For example, additional evidence is presented for specific uses of tilt and recline angles for pressure relief.”

The paper’s other authors were Jenny Lieberman, MSOTR/L, ATP, Mount Sinai Hospital, New York; Mark Schmeler, Ph.D., OTR/L, ATP, University of Pittsburgh; Ana Elisa Schuler P. Souza, Ph.D., PT, Recife-PE, Brazil; Rosemarie Cooper, MPT, ATP, University of Pittsburgh; Michelle Lange, OTR, ABDA, ATP/SMS, Access to Independence, Arvada, Colo.;

Hsinyi Liu, Ph.D., PT, University of Pittsburgh; and Yih-Kuen Jan, Ph.D., PT, University of Illinois at Urbana-Champaign.

Download the new paper at resna.org/position-papers.Other RESNA position paper topics include pediatric power, ultra-

lightweight manual wheelchairs and seat elevation. l

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brand strategy and integrated marketing programs globally. We look forward to her bringing best-in-class marketing expertise to support our vision to reshape the market for complex rehabilitation.”

The news announcement said Weaver has focused on training, education and new product launches in the past. She also has experi-ence in working with clinicians and providers in healthcare.

“In my over 20-year career, I have never seen a company with so much heart and passion to meet the needs of the people they serve,” Weaver said in the news statement. “I am truly inspired by their extraordinary commitment to product innovation, user customiza-tion and customer relations. I am excited to bring fresh insights and leverage my marketing experience to help further distinguish the Permobil brand worldwide.” l

Caroline Weaver

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Barry Steelman Joins Stealth Products

CMS Extends PMD Demonstration Project

Stealth Products: We’ll Expedite Orders for ALS Patients

The timetable for progression among clients with amyotrophic lateral sclerosis (ALS) is among the most challenging that a seating & wheeled mobility clinician or ATP will face. The disease can move with such swiftness — and also with such a high level of unpredictability — that providing the right equipment at the right times to constantly support clinical needs and client independence is difficult.

To make the situation a little more manageable, Stealth Products has announced it will now expedite the handling of all orders that are marked for patients with ALS.

In the news announcement, the company said the move demonstrates “Stealth’s continued commitment to the continued fight against ALS and those that are currently fighting this disease.”

Industry veteran Barry Steelman has joined the Stealth Products team as the manufacturer’s new director of marketing.

Steelman has been in the complex rehab technology industry for more than 14 years and previously served as Permobil’s marketing manager.

“I’m thrilled to have Mr. Steelman join the Stealth team,” Stealth President Lorenzo Romero said in a news announcement. “He brings a strong résumé and years of experience in this industry. He fits nicely with our vision of taking Stealth to

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another level of excellence.”Gabriel Romero, Stealth Products VP, said in the news statement,

“We are excited about Barry joining the Stealth family and look forward to increasing our marketing base with his experience and creativity. Barry’s vast knowledge expands the opportunities that we are looking for in growing our business for the customers and clients we serve.”

“I am honored and blessed to be joining the Stealth Products team,” Steelman said. “I look forward to bringing over 20 years of marketing and communications experience to help take Stealth to the next level in their marketing creations. They currently have a great team in place, and I look forward to being a part of the team.” l

The Centers for Medicare & Medicaid Services (CMS) has extended the power mobility device (PMD) demonstration project, which uses a prior authorization process.

The demo will continue till Aug. 31, 2018, in the 19 states that were already participating. The project began in September 2012 for California, Florida, Illinois, Michigan, New York, North Carolina and Texas. An October 2014 expansion added 12 more states to the list of participants: Arizona, Georgia, Indiana, Kentucky, Louisiana,

Maryland, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee and Washington.

While CMS indicated states were chosen “based upon their history of having high levels of improper payments and incidents of fraud related to PMDs,” industry funding experts have largely lauded the program for helping providers to determine Medicare beneficiaries’ eligibility for PMDs before providers actually purchase and deliver the vehicles. l

Stealth Products President Lorenzo Romero added, “At Stealth, we understand the struggles facing patients fighting ALS and the rapid pace at which this terrible disease can progress. Because of this, Stealth wants to take this step to help get ALS patients the medical devices they need quickly to help make their lives as comfortable and manageable as possible.”

Orders that are indicated as being for ALS patients will receive expedited fulfillment as well as delivery, said Director of Operations Cesar Perea. “Our new commitment,” Perea said, “will have us completing

ALS orders within 48 hours and custom orders within three to five days, depending on the complexity. We will also expedite shipping to arrive within two busi-ness days.” l

Stealth Products’ i-Drive alterna-tive driving controls for power wheelchairs could be helpful to ALS patients as the disease progresses.

Barry Steelman

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Drive Medical Buys HurryCane BrandThe acquisitions continue for Drive Medical, as the DME manufacturer/distributor announced Aug. 25 that it had completed its purchase of the HurryCane brand.

In its news announcement, Drive described HurryCane as “one of the best-known and most-respected consumer brands in the healthcare market” and “the number-one-selling cane in the United States.”

Billed as an “all-terrain cane,” the HurryCane has a three-point base that pivots, enabling the cane to stand on its own and to provide greater traction than traditional single-point canes. Some models fold for more convenient storage and transport.

“HurryCane is a terrific brand with a breakthrough product that

already offers security and stability to millions of customers across North America,” said Harvey P. Diamond, Drive Medical’s CEO. “We believe that along with that brand recognition comes a huge market for HurryCane products, and with Drive’s extensive manu-facturing and distribution capabilities, these products will soon be sold all over the world, as will the many new HurryCane products soon to be introduced.”

In addition to its HurryCane purchase, Drive Medical this year has purchased Columbia Medical, manufacturer of high-end bath safety, positioning and transfer products and manual positioning wheelchairs, and DeVilbiss Healthcare, manufacturer of respiratory and sleep products. l

Savaria Corp. Buys Silver Cross Ottawa, Plans More Silver Cross Stores

RESNA Welcomes New Board Members

Savaria Corp., a Canadian manufacturer of automo-tive and home accessibility products, has purchased the Ottawa location of Silver Cross accessibility stores, which specialize in home accessibility products and used DME.

In an Aug. 27 news announcement, Savaria indicated the Ottawa acquisition was just the beginning.

“Savaria will pursue the opening of corporate Silver Cross stores in all key markets in Canada to complement our existing franchise locations,” Marcel Bourassa, CEO/president of Savaria Corp., said in the announcement. “With the success of our store in Oakville, it is clear that the rapidly growing seniors market wants what we

Five new members have joined the board of directors for the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA).

The three board members elected by the membership of RESNA will serve three-year terms, while two additional board members who were appointed by RESNA President Ray Grott, MA, ATP, RET, will serve one-year terms.

The elected board members are Mary Ellen Buning, Ph.D., OTR/L, ATP/SMS, assistant professor, Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Ky.; Carmen DiGiovine, Ph.D., ATP/SMS, RET, rehabilitation engi-

neer and clinical associate professor, occupational therapy divi-sion, School of Health and Rehabilitation Sciences, Ohio State University; and Meghan Donahue, MS, ATP, rehabilitation engi-neer, Stout Vocational Rehabilitation Institute, University of Wisconsin Stout.

The two appointed board members are Doug Gayton, MMM, CD, RCA, ATP, who is now retired but has extensive experience in facility- and community-based rehabilitation focused on spinal cord injury and acquired brain injury; and Cindi Pichler, ATP, CRC, assistive technology specialist at Independence First, an inde-pendent living center in Milwaukee. l

offer: great mobility products backed by excellent customer service. We will invest in more stores, including larger stores that will showcase more products, including home elevators and accessible vans. Our goal is to truly cater to the mobility needs of the aging population.”

Silver Cross currently has 16 franchise locations in Canada and the United States and two corporate locations in Ontario.

On Aug. 6, Savaria Corp. announced that the second quarter of 2015 was the best in its history, with revenue of $24.4 million. That’s more than 11 percent better than the company’s revenue for the second quarter of 2014. l

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mobilitymgmt.com 15 mobilitymanagement | october 2015

Ride Designs is making a move in October. The new address for its corpo-rate office will be 8100 SouthPark Way, Suite C400, Littleton, CO 80120. Phone numbers will remain the same. And if you haven’t seen the seating manufac-turer’s video relocation announcement starring founders Joe Bieganek and Tom Hetzel (with an assist from large quantities of “Java”), treat yourself: bit.ly/1hOzwz7… Mobility Management will be sharing Booth 1301 with sister publication HME Business at Medtrade in Atlanta, Oct. 26-29. This is your chance to sign up for your very own free subscriptions to the magazines — choose print or digital editions — and news-letters. Already have a subscription? You can also renew them in our booth (yes, you have to renew once a year, but renewals are also free). If you’re in Atlanta, stop by our booth during expo hall hours — from 10 a.m. to 4 p.m. on Tuesday and Wednesday, Oct. 27-28, and from 10 a.m. to 1 p.m. on Thursday, Oct. 29. Medtrade is taking place at the Georgia World Congress Center in Building C this year…Researchers at UCLA have reported that a 39-year-old man who sustained a spinal cord injury four years ago has been able to don an exoskeleton and, in combination with non-

briefly…

invasive spinal stimulation, “voluntarily control his leg muscles and take thousands of steps.” According to researchers, including senior author V. Reggie Edgerton, a UCLA professor of integrative biology and physiology, neurobiology and neurosurgery, spinal cord injury patient Mark Pollock’s movements marked “the first time that a person with chronic, complete paralysis has regained enough voluntary control to actively work with a robotic device designed to enhance mobility.” A news announcement from UCLA noted that Pollock was actively assisting the exoskeleton with the movements being performed. Edgerton said he believes “it is possible to significantly improve quality of life for patients with severe spinal cord injuries, and to help them recover multiple body functions”… October is National Physical Therapy Month. Thank the PTs in your life. l

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This isn’t the Java in Ride Designs’ “We’re moving” video.

Medtrade is in Building C of the Georgia World Congress Center.

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By definition, practically every primary condition you’ll encounter as a seating & wheeled mobility clinician or ATP will be statistically rare, no matter how familiar it seems to you and your colleagues. Visit the National Organization for Rare Disorders (NORD) database (rarediseases.org), and you’ll find among its list-ings ALS, cerebral palsy, multiple sclerosis, various forms of muscular dystrophy, spina bifida and spinal muscular atrophy.

But one of the secondary conditions you’ll encounter in your clients is so common it doesn’t make the NORD list. Scoliosis is, in fact, commonly seen not only among your wheelchair-using clients, but also among the able bodied, some of whom might not even realize they have it, and may do little or nothing to treat it.

For the wheelchair user, however, scoliosis can be a condition that increasingly interferes with their lives, putting overall functionality at risk and negatively impacting other bodily functions.

The General Incidence of ScoliosisJay Doherty, OTR, ATP/SMS, senior clinical education manager, Eastern U.S., Quantum Rehab, calls scoliosis “absolutely something that we often see with seating & positioning.”

He adds, “Scoliosis is basically a curvature of the spine. Typically when we’re talking about scoliosis, we’re talking about a lateral curva-ture of the spine, but scoliosis can also have a rotary component to it with the spine. So the spine can be rotated.”

Generally speaking, scoliosis affects two to three percent of the population, according to a 2007 report from the American Association of Neurological Surgeons (AANS). That added up to between six and nine million people in the United States, though only a small fraction of those people were actually treated for their scoliosis via such interventions as braces or surgery.

The AANS report added that the most common age for scoliosis

This Common Condition Among Wheelchair Users Has an Uncommon Ability to Impact Fit & Function

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onset was from 10 to 15 years of age, and that scoliosis occurred equally in boys and girls, though girls were eight times more likely to require medical intervention.

But those general statistics and rates of required intervention don’t hold true for the clients you see every day.

Scoliosis & the Wheelchair UserScoliosis — its causes, severity and progression — can be a very different story for people who use wheelchairs.

“By the time a patient is dependent on a wheelchair and a seating system for support, they already have some muscle imbalance,” says Cindi Petito, OTR/L, ATP, CAPS, president of Seating Solutions in Florida.

“Many of the folks we’re seating are actually folks with muscle imbalance or weakness,” Doherty says, “and gravity is constantly working on their bodies. So because of that, scoliosis tends to be fairly prevalent over time.”

So while scoliosis usually isn’t the reason your client is in his/her wheelchair, it is likely a side effect of the primary mobility-related condition.

“Scoliosis in my experience has always been a secondary complica-tion to a primary problem,” Doherty says. “So whether it’s a progres-sive neurological condition, muscle imbalance or tonal issues like you have with cerebral palsy and traumatic brain injury, it’s typically

a secondary complication of the original primary diagnosis. It can range from someone with a spinal cord injury that doesn’t have tone and muscle function below a certain level, but has scoliosis because of gravity, all the way to somebody who has tone, and the muscle tone is actually causing the scoliosis to progress.”

Divergent PathsFrom there, scoliosis can diverge in how it presents and progresses, and many different factors can impact severity.

“The folks we work with are dealing with a disability or maybe even a disease process, and because of the weakness and the changes they have, [scoliosis] manifests itself in so many different ways,” Doherty says. “Where the scoliosis affects the spine is quite often different with each person. It could be a C curve throughout the spine. A lot of times we see an S curve, where you have a curvature in the lower spine — but then our natural tendency is to right ourselves to a more straight position, and to right yourself when you have a curvature, you create a curvature in the cervical region in the oppo-site direction.”

As with most mobility-related conditions that seating specialists will see, scoliosis can look very different from client to client, even if clients have the same or similar primary diagnoses.

“You can have a man and a woman with similar tonal issues,” Doherty says as an example. “They’re both probably going to develop

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Understanding Scoliosisa curvature over time, although they may also be impacted by the treatment that’s being followed, by the doctor or the therapist. So one person might have more severe scoliosis than another because maybe it’s not being addressed as well.”

Scoliosis InterventionsRegardless of what caused the scoliosis, intervention is critical because curvatures of the spine can interfere with so many other bodily systems.

“A more severe case of scoliosis, where increased curvature, pain and disfigurement result, can cause difficulties walking and breathing,” Petito says. “If you are not properly supported you will likely develop postural deformities. The choice of seating system to support your body shape is absolutely critical in preventing the onset or progression of scoliosis.”

As scoliosis progresses, Doherty notes, it can impact digestion, respiration and circulation, in addition to mobility and the musculo-skeletal system.

“Somebody could come in and they’re having trouble with breathing, and maybe they’re prone to chronic bronchitis or some-thing along those lines,” he notes. “The medical team may need to look at whether the scoliosis is impacting their respiratory capacity — is that part of the issue?”

Scoliosis can even raise the risk of skin breakdown for wheelchair users.

“Scoliosis can be a precursor to a pressure ulcer,” Doherty says. “You’ve got a curvature of the spine; that often transfers down into the pelvis position, so a rotational scoliosis may cause problems on one side of the rib cage over the other.”

Scoliosis interventions can range from drugs to orthotics — and as part of the seating evaluation, seating specialists should ask which if any interventions are being used, since they can impact seating equip-ment choices.

“They could be on a medication to manage tone,” Doherty says. “That’s going to have an impact on the scoliosis. When you’ve got younger kids and teenagers, they may have a TLSO — a thoracic lumbar sacral orthotic or a body jacket, as a lot of folks call it. You have to decide: Are they going to be wearing it in the seating system or not? Because the seating system often has to be adjusted for one or the other. Where I used to work, we would do a quick review of the medical charts and say, ‘Oh, they’re wearing a body jacket. We need to let Mom and Dad know that they need to bring the body jacket.’

“The seating system has to be adjusted with the body jacket or without it. It’s very difficult to fit the seating system correctly for both because that body jacket takes up some space between the laterals and the person. And your approach is very different. Without it, you’re

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going to be doing more correcting through the lateral trunk supports; with the body jacket, you’re going to be providing more balance than correction, because the body jacket itself is then providing the correction.”

Seating As an InterventionSo when you’re creating a seating system for a patient who has scoli-osis, should your strategy be to accommodate it or to try to prevent it from worsening?

“Any time you’re working with someone who has a curvature of the spine, you have to find out what their goals are,” Doherty says. “Often, there’s a give and take in the process, just as there is with any seating & positioning. You can hold them in place to correct the scoliosis to be better aligned, but are they going to be able to tolerate that position? Are they going to be functional in that position? If you’re holding them that securely, are they going to be able to do the things they have to do? Or have you just reduced their function? So there’s a lot of weighing of pros and cons of different approaches.”

Different seating strategies include custom-molded systems that fit the client very closely, to specialized backrests and positioning components that work to accomplish something similar.

“The more intimate you get the seating system with the individ-ual’s body, the better the support is going to be,” Doherty says. “So you’ve got a body jacket: A body jacket is going to be the most intimate

fit. Then you’ve got a custom-molded seating system; that’s going to be a good, intimate fit. And then you’ve got using a curved back with laterals on it. You’re certainly going to get support from that, but are you going to get the same level of support as possibly a custom mold or body jacket? No.

“Another piece you have to look at is the amount of force being put on the seating system from the curvature, because pressure ulcers can form from lateral trunk supports that are requiring too much force on the body. And will the hardware hold up? Those are all the sorts of parameters that you have to be looking at.”

Among the newer strategies — at least to American therapists and ATPs — is adjustable seating that can be altered to fit the wheelchair user as he/she loses or gains weight or experiences postural changes (see sidebar).

Best Practices for Working with ScoliosisAs with seemingly all other complex rehab seating & mobility condi-tions, scoliosis is a situation that will vary from client to client. For instance, when asked if scoliosis typically causes pain, Doherty says, “My experience has shown me it depends on the individual. I’ve had some individuals with pretty significant curves that don’t really seem to have pain, and I’ve had others who’ve had significant curvatures and do have pain on and off. It could be that a nerve is being pinched. It could be any number of things. Orthopaedic changes will happen

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Understanding Scoliosis

ATP Series

The question of whether or not scoliosis can be “cured” with the right wheelchair seating is a critical one because of how common the condition is among wheelchair users, how frequently it progresses, and its potential impact not just on posture, but also on multiple systems within the human body.

So can the right seating equipment — with the usual complex rehab technology caveat that no single component or system is the perfect solu-tion for every client — stop scoliosis in its destruc-tive tracks? Furthermore, can the right equipment choices reverse scoliosis that already exists?

Reversing the Trend?Katherine Sims, VP of communications for Matrix Seating USA, says yes — that certain types of seating products can cure scoliosis.

“Adjustable micro-modular seating (AMMS) is utilized to provide superior seating and positioning for complex rehab wheelchair users,” Sims says. “AMMS is being used as an orthotic in Europe to decrease the progression of scoliosis and has been proven to correct it. This is the way of the future for custom-molded seating in the United States.”

As an executive of a company that provides just that type of seating system, Sims is naturally biased. So she points out a study by Steve Cousins and Ron Clarke, both from the Royal Hospital for Neuro-Disability in London. (The study and other research and media reports are available on the matrixseatingusa.com Web site in the Publications section.)

Cindi Petito, OTR/L, ATP, CAPS, president of Seating Solutions, a Florida-based occupational therapy practice, acknowledges that the idea of correcting conditions such as scoliosis is a new one in the United States.

“Considering the possibility that spinal and postural deformities can be corrected with the use of a seating system is a new methodology in the United States,” Petito says. “Steven Cousins, Ph.D., BASc, MASc, PEng, in collaboration with an orthotic engineer in Sweden, began exploring the possibili-ties of using AMMS for corrective positioning in the late 1990s. As this methodology is better under-stood through case studies and research in the U.S., custom-molded seating will eventually become utilized to decrease the progression of scoliosis and

other diseases where they may be present.”

A Proactive ApproachSims says the possibility of being able to halt scoliosis would be welcome news for people like Lelia Ginder, Gainesville, Fla., whose son, Dale, has Duchenne muscular dystrophy and uses a power chair.

Sims says Lelia Ginder “hopes the AMMS system he is using will help keep him supported so that he does not develop severe scoliosis, which can be an issue for Duchenne boys as they lose muscle. [She] feels like she is being proactive with their choice of seating system. The fact that AMMS can be adjusted and will grow with Dale means that he will always have the correct postural support.” l

Can the Right Seating Technology Cure Scoliosis?

over time, and that certainly impacts internal organs. So pain is a very real potential aspect.”

So if scoliosis is such an individualized experience, can any best practices be recommended at all?

“Understanding clients’ disease process is the most important advice I can give,” Petito says. “No one has a crystal ball, and we need to be able to understand every client’s functional needs and their goals. The client has to be a part of the team. Always watch and listen to them. Education is also very important. Educate the client about the risks of developing scoliosis, proper posture, and the secondary health risks that can occur with the onset and progression of scoliosis.”

While many seating professionals work mainly with clients who have long-term conditions rather than older clients who are aging into a disability, Petito says it’s important to educate both populations.

“In general, the majority of scoliosis diagnosis is congenital or neuromuscular,” she says.“There are, of course, many individuals within our aging population who do not have a congenital or neuro-

muscular disease that develop scoliosis due to poor posture over time. Oftentimes, because of the way elderly people are sitting in their wheelchairs or their recliners throughout their aging years, they develop muscle imbalance and weakness, and inevitably their posture declines. One solution to prevent the progression of scoliosis is to ensure every wheelchair user and our aging population have proper support for correct posture that will prevent scoliosis.”

Doherty recommends starting by finding out the client’s functional goals, and then working from there.

“Truly the best practice is to address the scoliosis up front and decrease the progression as much as possible,” he says. “You have to look at function, you have to look at every aspect of that person’s life. With diagnoses that are affected by tone, certainly scoliosis is a very big factor that we have to keep our eyes on. But with any kind of weak-ness, it can rear its ugly head. If somebody’s developed a curvature over time and you don’t address it, it’s probably going to get worse. There’s a lot of complications that can come from not addressing a curvature of the spine adequately.” l

Lelia and Dale Ginder



CRT providers build, fit, grow, repair and adjust complex seating & wheeled mobility systems per each client’s highly specialized and often progressive needs. They know which wheelchairs their clients use, what sorts of additional complex rehab technology they own, and what they’re likely to need in the future.

That puts ATPs in prime position to also provide the accessibility equipment — ramps, lifts, bathroom products — that can optimize clients’ independence and the long-term safety of both clients and caregivers. CRT providers intimately know the particular challenges that their clients face — for instance, that one spinal cord injury client with paraplegia can quickly and easily wheelie down a ramp, but that

Accessibility Products Can Open Doors for CRT Clients — & Offer Retail Revenue for Providers

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New Horizonsanother with a similar injury level has more trouble due to wrist pain. Or that with some equipment support, a client with Limb Girdle muscular dystrophy would be able to execute transfers by himself. ATPs even know the lengths and widths of wheelchairs, and how nimbly they turn. That’s valuable information when determining the sorts of accessibility equipment that would work best at home or in other environments.

In this pictorial, we look at a range of accessibility equipment that could open new doors for your CRT clients, and could also open the door to retail revenue for your business. It’s a win-win situation, but also check out the manufacturer tips (see sidebar) to help you maxi-mize your sales opportunities. — Ed.

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New Horizons

One of the greatest benefits of adding accessibility products to your complex rehab technology (CRT) busi-ness is their turnkey nature. Unlike CRT, accessibility products for home, environment and automotive vehicles typically require few or no customized modifications or specialized fittings. Another big benefit is the straightforward business transac-tion between you and the consumer: Accessibility products offer the opportunity for cash revenue in an industry otherwise driven by medical justifications, clinician notes, HCPCS codes and audits.

Accessibility products usually sell best, however, when CRT providers implement a separate sales strategy. You already know which of your clients could gain from bringing accessibility equip-ment into their homes. Now, accessibility manufacturers offer tips on how to connect your clients with the equipment that can further their independence.

Focus on Affordability — Healthline MedicalCRT clients and their families might not be completely aware of the costs of complex seating & wheeled mobility equipment that’s paid for by insurance providers. But clients will become more mindful of price tags when they are the ones paying for accessibility products, which is usually the case. So Healthline Medical suggests focusing on a product’s affordability — that means not just the bottom-line price, but what the consumer gets for that price, such as plenty of stan-dard product features and positioning functions in its rehab shower commode chairs. Those standard features add up to provide extra value for the consumer.

Use Visual Aids — Aquatic AccessTake advantage of the visual marketing aids that manufacturers offer and use them in waiting areas, lobbies or other places your clients visit. Aquatic Access provides pool lift brochures and posters for coun-ters and walls, as well as video loops that can be played for potential customers. Ask accessibility manufacturers what marketing materials they can provide you.

Look for versatility and for commercial applications as well as traditional in-home applications — Aqua CreekYes, your first potential sales targets for

accessibility equipment will likely be the seating & wheeled mobility clients you already serve.

But are there other opportunities in your community? Aqua Creek offers pool lifts, for example, that work with indoor and

outdoor pools, and they are appropriate for privately owned pools as well as pools in commercial or public settings — hotels, schools,

gyms, community or senior centers. Choosing accessibility products that work in multiple settings could expand your potential sales reach.

Keep an Eye on Inventory & Delivery Costs — EZ-ACCESSAs a CRT provider, you’re accustomed to building each seating system and wheelchair to fit one specific client — so your facility probably doesn’t have warehouses’ worth of storage space for inventory you hope to eventually sell. But if you work with vendors who can ship product quickly, you can maintain manageable delivery times to consumers without wasting a lot of your money on excess inventory. EZ-ACCESS can deliver portable ramps to locations in the United states in three days or less, so you can order product when you need it and count on it to be available quickly enough to keep customers happy.

Show, Don’t Just Tell — Pride Mobility ProductsYour product display space might not be cavernous, but carving out some dedicated space to show off demo products is vital in the mobility and accessibility realms, says Pride Mobility Products. That’s because showing off a product’s abilities is exponentially more effec-tive than just telling a consumer or caregiver how it works. Being able to show off a product’s attributes is especially important if you can demonstrate how a product — such as Pride’s Milford Person Lift — can make life safer and easier for both client and caregiver.

Emphasize Ease of Use — HandicareFinally, demonstrate that the accessibility products you’re offering are convenient, easy-to-use solutions — not just for CRT professionals showing off equipment at the providership, but also for caregivers and clients in real-world situations at home. In the case of the MiniLift160 patient lift, that means demonstrating that the lift is easy to operate even for non-professionals, and easy to store as well. l

The Business of Accessibility

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Ezee LifeThese aluminum rehab shower/commode chairs are available in 18", 20" and 22" seat widths, and the smaller two sizes are available with posterior tilt for clients who need seating support. Standard features include flip-up armrests and footrests; padded seat, arms and back; removable seat; anti-tippers; belt; and commode bucket. Convert the chairs into wheelchairs via a quick-assembly kit and 24" wheels, which are avail-able for all models.Healthline Medical(800) 987-3577healthlinemedical.com

HAULWAY Vehicle LiftMaking its debut at Medtrade, the HAULWAY scooter and power chair lift line is available in multiple sizes and with a range of options designed to make transporting power chairs and scooters quick and efficient. HAULWAY models are built to be able to adjust to most mobility vehicles as well as automo-tive vehicles. EZ-ACCESS will offer a display rack to suppliers so they can show off a demo model in their office locations. EZ-ACCESS(800) 451-1903ezaccess.com


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New Horizons

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Milford Person LiftA highly adaptable and versatile transfer solution, the Milford Person Lift is designed to safely and conveniently move its user between a car and a wheelchair or other destination. The Lift works in a variety of vehicles and can be used in the driver’s, front passenger’s or back seat areas. Slings are available in sizes extra small to extra large; an amputee sling is also available. Use the Smartbase option for mobile applications.Pride Mobility Products Corp.(800) 800-8586pridemobility.com

MiniLift160Designed to replicate a comfortable, natural sit-to-stand pat-tern of movement, the MiniLift160 features a stable anti-flip footplate with lower leg supports and a lifting arm that can be adjusted to fit every user optimally. Used with appropriate lifting accessories, the consumer is supported under the feet, front of the lower legs and behind the back for a secure, yet active experi-ence. The MiniLift160 collapses for easy storage.Handicare(866) 276-5438handicare.com/us

ARMADA Ramp SystemA residential modular ramp system built to be extremely light and flexible, ARMADA ramps can be easily moved or reconfigured after initial installation. These ramps are constructed of all-welded, high-strength aluminum and are fully anodized for a durable, attractive finish. Ramps assemble easily with a .5" wrench, feature fully adjustable heights and slopes, and are ADA and ANSI compliant. AlumiRamp Inc.(800) 800-3864alumiramp.com

Transfer BenchFor people who experience lower-extremity weakness or difficulty standing for any length of time, stepping into a bathtub or shower can be challenging and possibly unsafe. The Maddak Adjustable Transfer Bench can eliminate the need to step over barriers. It’s height adjustable from 15" to 23", and legs, back and armrests are removable for easy storage and transport. The bench features a built-in soap tray, a hand-held shower holder and a slit for the shower curtain. Assembles without tools.SP Ableware (Maddak)(800) 443-4926maddak.com

Scout 2 Pool LiftThe new and improved Scout 2 pool and spa lift features an adjust-able seat pole, updated base and upgraded electronics with a higher weight capacity of 375 lbs. These added features create a more versatile lift that allows up to 25" of wall clearance on a 16" wide profile when using the pull-out legrest. Plus, 360° of rotation provide optimal versatility in a range of environments.Aqua Creek Products(888) 687-3552aquacreek.com

MV-1Here’s a vehicle that complies with Americans with Disabilities Act (ADA) accessibility requirements as soon as it rolls off the assembly line. An extra-wide passenger door opening, an integrated in-floor ramp and a floor-to-ceiling height nearly 5' tall make the MV-1 ready for wheel-chair users from day one. Mobility Ventures’ 2016 MV-1 models are now available.Mobility Ventures(877) 681-3678mv-1.us



Commercial Northstar MinivanThe first ADA-compliant minivan from Vantage Mobility International designed for commercial applications is the Toyota Northstar E360. It’s based on a Sienna platform and features a side-entry, in-floor ramp. Thanks to a deep floor drop, the E360 has a tall door opening and plenty of interior space to welcome the many different mobility vehicles it will encounter. Vantage Mobility International(855) VMI VANSvantagemobility.com l

Multifold RampAvailable in lengths of 5', 6', 7', 8', 10' and 12', the Multifold ramp is easy to handle and set up wherever portable accessibility is needed. In storage mode, it can be carried like a suitcase. But it unfolds to create a solid platform with an edge-to-edge traction tape surface that’s ideal for wheelchairs or scooters regardless of wheel configuration. A built-in visual aid helps to determine if the ramp is on a safe slope prior to use.Prairie View Industries(800) 554-7267pviramps.com

Pool Lift IGAT-180Aquatic Access’s water-powered pool lifts work with in-ground and above-ground pools and spas, with the lifts’ up/down motions provided by water pressure from a hose to a faucet or plumbed-in line. Standard lifting capacities are 300 to 400 lbs., but higher weight capacities are available for customized models. No electricity, batteries, charging, complex electronics or heavy maintenance is required. Accessories/options include upper/lower seat belts, flip-up armrests and footrests, and adjustable headrests.Aquatic Access(800) 325-5438aquaticaccess.com

Shower BenchCreated to provide security, stability and comfort in the bathroom, this shower bench features removable padded armrests (no tools required), a blow-molded bench with drainage holes, and a lightweight, durable and corrosion-proof aluminum frame. Leg height adjusts in 1" increments for comfortable sitting. Drive Medical(877) 224-0946drivemedical.com


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Everybody loves a winner. And that was a good description for MAX Mobility’s first SmartDrive power-assist system, the MX1. It was a compact two-piece wonder consisting of a battery pack and a motor. Attach them to a manual chair, and the MX1 could be activated on demand to assist consumers, particularly in tough propulsion environments such as thick carpeting, hills or ramps. The MX1 reduced the number of strokes that self-propellers had to make, thus lowering their exertion, but put the chair user firmly in command of when to use or not use the device.

The MX1 was so efficient that it found fans among wheelchair users who hadn’t originally been in the device’s target demo-graphic. In a case of success breeding success, that led to some interesting issues.

Seeking to Stop Shoulder PainMark Richter, who has a Ph.D. in mechanical engineering from Stanford University, is president of MAX Mobility. Richter has long been interested in wheelchair users who self propel — and in particular, interested in the challenges they face throughout their lives, including shoulder injuries from years of propulsion.

“Almost three out of four manual chair users have shoulder pain already,” Richter says. “It’s really at an epidemic level. If 60 to 80 percent of able-bodied people had the same condition, it would be on CNN every night.”

With a grant from the National Institutes of Health, Richter studied how self-propellers pushed their wheelchairs. In addi-tion to looking at their biomechanics, he studied the efficiency of wheelchair setup and the use of ergonomic accessories, such as pushrims that supported greater efficiency. And they worked.

“Maybe I got 30 percent improvement in efficiency if you combine all those things, which I thought was amazing,” Richter says. “But it turns out that’s like having shoulder pain in 13 years instead of 10. It’s really not enough. I want 40 years of shoulder life, if not more.”

That’s when Richter realized he needed a completely different kind of solution — a motorized one. And the MX1 fit the bill. Users pressed a chair-mounted button to activate SmartDrive, pushed on the rims to go, and pressed the button to stop (since pressing the button turned the motor off).

Richter’s target user demographic for the MX1 was the self-propelling chair user with paraplegia, because shoulder pain is so common with that population, and shoulder pain was what Richter was ultimately trying to prevent. He now says he “assumed it was obvious” that the MX1 was truly aimed at paras. But a funny thing happened along the way.

Next-Generation SmartDrive Seeks Next Generation of Users

“Because it was so small and kind of cool looking, everybody wanted to use it,” he says. “And ‘everybody’ wasn’t who I was planning on.”

Consumers with quadriplegia were among the MX1’s avid fans, despite the MX1 being “not at all quad friendly,” Richter says. Clinicians said their clients with quadriplegia didn’t have enough gripping strength to effectively brake MX1-equipped chairs. So Richter set out to design a device that could be used by a much wider audience. He says a second version of the SmartDrive was “a step in the right direction,” but not exactly right. So he kept working and created MAX Mobility’s latest launch: the MX2.

How the Apple Watch Helped the MX2The MX2 is not merely an MX1 upgrade with a few bells and whistles added. It’s a new creation unto itself.

For instance, there’s no separate battery pack for the MX2; everything is now incorporated into the motor system that attaches to the wheelchair. And the MX1’s press-the-button acti-vation and deactivation methods are gone, too.

“Luckily I’ve got access to some really great engineers, so I can play with some of the latest and greatest technologies,” Richter says. “One thing we’ve always known about was the use of accelerometers.”

Accelerometers are “the kind of sensors that are in your cell phone that navigate and do orientation,” he adds. “We have those same things already in the SmartDrive. And we know if you put one of those on your wrist, you can detect motion and resolve different types of functions. That’s the kind of thing [Apple’s] iPhone uses for the Apple Watch, for turning the screen on and turning the screen off.”

What the MAX Mobility team has created in the MX2 is essen-tially hands-free operation — because, as Richter points out, wheelchair users’ hands are typically pretty busy already.

“The idea was that we could create a more intuitive interface,

1015mm_Mx5Showcase2627.indd 26 9/8/15 10:36 AM


so more people could use it, and it would be easier for them to use,” Richter says. “So we set off on this quest to try to create a better system basically to access the motor.”

Remember that the MX1 required precise physical input: Pressing a button to turn the motor on, pushing the pushrim to go (and pushing again if you wanted to go faster), pushing the button to turn the motor off.

On the MX2, the buttons that were mounted on either side of the chair have been replaced by a single wristband worn by the wheelchair user. That wristband communicates via Bluetooth with the SmartDrive system. The chair user presses a button on the wristband to activate the unit, then pushes on the pushrim to go. To brake, the user taps on the pushrim — a light pat will work — to stop the motor, then holds the pushrim in a normal braking motion. The user no longer has to find and press a button on the side of the chair to disengage the SmartDrive motor.

When the user doesn’t want to use SmartDrive — such as in tight spaces — a press of the wristband deactivates the unit.

Tapping lightly on the pushrim with a hand requires less fine-motor control than was needed before, when the user had to locate and press a rather small button with a fingertip to disen-gage the motor. Richter says this new control method makes the MX2 much friendlier to use for people with quadriplegia.

“You push how fast you want to go, and it will continue to go there until you lightly tap on the rim to tell it to stop. And that shuts off the motion,” Richter says.

Indications & ContraindicationsAs with any complex rehab technology device, the MX2, as advanced as it is, won’t be the perfect solution for every seating & wheeled mobility client.

As an example, clients with excessive involuntary arm move-ments might have some trouble effectively communicating with the MX2.

“I’ve seen at least one or two cases of users that have such extreme arm motion during normal propulsion that it acts almost like a tap and shuts off the motor prematurely,” Richter says. “So I’m still experimenting with different locations that they could wear the band, like around the elbow.”

If that’s impossible, Richter is open to working out solutions for clients based on specific needs. Generally speaking, MAX Mobility is no longer offering the MX1’s design. But Richter says the MX1’s functionality still exists, so clinicians and ATPs with special requests should contact MAX Mobility to see what can be done.

Meanwhile, the MAX Mobility team is already working on improving the look of the MX2 band, which on first glance currently resembles a Fitbit band.

Convincing people to adopt a “wearable” system like the MX2 took some time, Richter says, adding that the growing popularity of the Apple Watch helped that trend along.

“I thought about wearables about a year ago, but before the [Apple Watch] buzz, people were almost phobic,” he says. “Now you have smart watches that are starting to become more

accepted. Suddenly it’s not so big a deal, but we’re still in that transition people where some people are saying, ‘I don’t wear a watch.’ I want them to wear this because it’s so much better than a button. It’s so much safer, it’s so much simpler, it’s so much more intuitive. And once they’ll do it, they’ll love it. But until they do it, there’s this little apprehension toward wearing something.”

Richter says there’s also been progress in the percep-tion of power-assist devices themselves. In years past, power assist was seen as something of a last resort to be used by long-time manual chair users whose shoulders and arms had already started to give out. Richter says that perspective is changing, thanks largely to a younger genera-tion of users and evolving thought among clinicians.

“I think we’ve finally reached that point where — like the ergonomic rims of five or six years ago — it has sort of been engrained in therapists’ minds that it’s important to preserve the shoulders. So the stage has been set, and the magnitude of the change that’s possible with a SmartDrive versus [an ergonomic] pushrim is quite a bit more evident now. Once you see it, this is obviously a solution to what is a known problem.”

Funding sources still commonly think of power assist as a reac-tive rather than a proactive solution, but Richter says more and more users are considering power assist in a proactive way.

“What’s amazing about younger people in chairs: They don’t seem to have that same stigma, that whole ‘Use it or lose it’ mentality,” Richter says. “They just adopt new technology, like ‘It’s an aid for my life, like having a smartphone instead of having a laptop all the time or always being tethered to my e-mail at home.’ They don’t see it as a crutch; they see it as an enabling technology. They can do more, they can go farther, they can be happier in their lives.”

Richter points out that SmartDrive is already being used by “legacy” wheelchair users, so he’d love to also see the MX2 adopted by younger ultralight users as well as other populations such as foot-propellers and clients with hemiplegia.

“The new mantra is ‘Use it, don’t abuse it,’” he says. “Pushing is really not your best form of exercise. Our goal is if you’re using a chair, SmartDrive makes life better.” l

— Laurie Watanabe

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Pediatric SeatingAEL seats and backrests can be made to order to fit any frame width, depth or back height needed for pediatric clients, with sizes typically ranging from 10" to 24". Choose from signature upholsteries, including breathable IsoLogic Air Mesh with Outlast Temperature-Regulating Coating. AEL also offers headrest, lateral, adductor and abductor pads.

Adaptive Engineering Lab(866) 656-1486AELseating.com

WallabyWallaby wheelchairs are bus-transit approved when used with headrest extensions and five-point harnesses. Available in 12" and 14" widths and 12" depths, the Wallaby has a powder-coated steel frame, nylon upholstery, pelvic belt with reversible cover, 22" rear and 6" front swivel rubber wheels, height-adjustable push handles and push-to-lock brakes.

Drive Medical(877) 224-0946drivemedical.com

Mount’n MoverPersonal electronics are only use-ful if they are accessible — which is why Mount’n Mover is indepen-dently movable by the user with no tools required. The system can be easily adjusted due to changes in position or fatigue levels so tablets, speech devices, phones, cameras, and ADL items such as trays stay within reach, but move out of the way for transfers.

BlueSky Designs(888) 724-7002mountnmover.com

F3/F5 BasesPermobil’s new F series chairs, which can be ordered with anterior tilt to help with reach and transfers, start at 17" wide and 14" deep, but Permobil’s hip and thigh supports plus a beefier backrest can narrow the seating so younger/smaller users can benefit from the new positioning options. Ask your Permobil rep for specific pediatric applications.

Permobil(800) 736-0925permobil.com

AllTrack PThe AllTrack Pediatric chair — in mid- or rear-wheel drive — is designed to give the most active kids great access indoors and out. This chair’s modular system makes it easy to build just the right configuration, from basic to highly complex. Seat width starts at 11". An interactive 6-wheel suspension plus seat suspension enhance stability, mobility and comfort.

Amysystems(888) 453-0311amysystems.com

Liquid SunMate FIPSFoam-In-Place Seating is custom contoured to correct/slow progres-sive deformities, and to improve body functions through advanced postural control. Finished open-cell viscoelastic foam distributes weight evenly to reduce pressure and is priced to facilitate replace-ment as kids change.

Dynamic Systems(855) SUNMATEsunmatecushions.com

TrekkerSeparate base and seating module provide Trekker with 180° of reversible seating so the child can face the caregiver or forward to interact with the environment. Adjustable recline opens the seat-to-back angle from 80° to 170° in 10° increments to support pressure relief, respiration and digestion. The Trekker also accepts adaptive and aftermarket seating.

Convaid(888) CONVAIDconvaid.com

Q6 Edge & iLevelNow kids can experience up to 10" of seat elevation at walking speeds up to 3.5 mph thanks to the new Q6 Edge power base and pediatric iLevel technology. Tilt, recline and a power articulating foot platform are other position-ing options available in sizes start-ing at 12x12", giving kids better reach in the classroom and on the playground.

Quantum Rehab(866) 800-2002quantumrehab.com

pediatric mobility marketplace

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Forward CushionThis new kid-sized cushion uses the evidence-based principles of support you’ll find in all Ride De-signs cushions, but with a contour created especially to support the special development and growth of children with mobility impair-ments. Forward cushions combine postural control with skin care and moisture management. The pediatric sizes start at 10x10".

Ride Designs(866) 781-1633ridedesigns.com

TWISTDesigned especially for the grow-ing child, the TWIST encourages active exploration and allows kids to learn critical wheelchair skills while remaining safe. With 2" of seat width/3" of seat depth growth, the TWIST grows with the child without need for growth kits. A 1" aluminum frame design provides easy installation of seat-ing components.

TiLite(800) 545-2266tilite.com

i-DriveAn advanced alternative drive control head array uses Stealth’s tried-and-true head positioning technology. A range of modifica-tions can be made to custom-ize the i-Drive, such as adding switches or embedding speakers into the headrest. Optional advanced programming software offers further individualization.

Stealth Products(800) 965-9229stealthproducts.com

X:PandaThis multi-adjustable dynamic seat offers up to 4" of seat width/depth adjustment coupled with sliding back growth. The child can extend and push against the back, then return to an optimal sitting position. Lock the back during mealtimes and while the seat is being transported. The back can be angled so the child can sit with an open or closed hip angle.

Snug Seat/R82(704) 882-0668snugseat.com

JUNIOR SeriesEngineers used anthropometric data to create these seat cushion and back supports for active kids. The 10x10" seat cushion uses VA-RILITE Air-Foam Floatation, while lightweight JUNIOR back supports are available in mid or deep sizes and a 9.25" height to fit chairs 9" to 11". They also use pediatric-specific VariLock hardware for a secure fit.

VARILITE(800) 827-4548varilite.com

ThevoTwistThis rehab stroller-style chair combines stable and dynamic seating that allows a child to move while supporting a functional seated posture. ThevoTwist has a solid, firm seat base with a flexible, adjustable back and breathable upholstery. Choose from three headrest options especially suitable for kids with poor head control. WC19 crash tested.

Thomashilfen(866) 870-2122thomashilfen.us


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MM EditorialAdvisory Board

Josh Anderson TiLite

Mike Babinec Invacare Corp.

Pat Boardman Astrum Healthcare

Lois Brown Consultant

Beth Cox The VGM Group

Susan Cwiertnia VARILITE

Jay Doherty Quantum Rehab

Amit Gefen Tel Aviv University

Rick Graver Medtech Services

Ryan Hagy Numotion

Chuck Hardy NMEDA

Julie Jackson Invacare Corp.

Angie Kiger Sunrise Medical

Kara Kopplin ROHO Inc.

Karen Lundquist Ottobock

Joe McKnight Access Medical

Steve Mitchell Cleveland VA Medical Center

Amy Morgan Permobil

Julie Piriano Pride Mobility Products/ Quantum Rehab

Lauren Rosen St. Joseph’s Children Hospital of Tampa

Mark Smith Wheelchairjunkie.com

Rita Stanley Sunrise Medical

Barry Steelman Stealth Products

Stephanie Tanguay Motion Concepts

Cody Verrett ROVI

Group Publisher Karen Cavallo(760) 610-0800

Sales Assistant Lynda Brown(972) 687-6710

Advertising Fax (866) 779-9095

ad index

AlumiRamp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Amysystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Aqua Creek Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Aquila Corp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Convaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

EZ-ACCESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Freedom Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Numotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Open Sesame Door Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Ottobock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Permobil Inc ./TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Prairie View Industries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Pride Mobility Products/Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

R82 (Snug Seat) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

Stealth Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Symmetric Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Thomashilfen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

advertisers’ indexCompany Name Page #


Adaptive Engineering Lab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Amysystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

BlueSky Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Convaid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Drive Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Dynamic Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Permobil . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Ride Designs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Snug Seat/R82 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Stealth Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Thomashilfen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

TiLite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

VARILITE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Company Name Page #

1015mm_AdIndex30.indd 30 9/8/15 10:18 AM

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october 2015 • vol. 14 no. 10 serving the seating...

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