June 20, 2008
Assistive technology expert traces evolution of wheelchair innovations
By Susan Christensen
Health and Research News
Physical therapist Allison Fracchia confesses to being a bit of a geek on the subject of wheelchair technology.
The coordinator for Methodist Rehabilitation Center’s Assistive Technology Clinic loves talking about advances in the field and has even served on national focus groups for wheelchair design.
As one of but a few certified assistive technology practitioners in the state, Fracchia has the expertise to evaluate the needs of wheelchair users and recommend the best equipment to enhance their lifestyle. She is involved with the Clinicians Task Force, which is composed of approximately 32 professionals from around the nation who specialize in wheelchair evaluations, seating and positioning.
Here’s her take on some of the issues affecting the wheelchair industry and the assistive technology field.
Have-It-Your-Way Wheelchairs. Not that long ago, wheelchairs were practically one-size-fits-all. “It didn’t matter if you were 6-foot-2 or 5-foot-1, there was only one seat to floor height,” Fracchia said. Ditto for the angle of footplates, the design of back rests and the size and position of the wheels.
If a wheelchair user needed more than standard fare, Fracchia said it fell to therapists and suppliers to fabricate modifications. But when pay sources began limiting reimbursement for this time-consuming process, the push was on for manufacturers to provide easily adjustable and customized equipment.
As a result, users now have a dizzying array of choices in both fit and function – from chairs that accommodate 850-pounders to those that can handle a variety of terrains. “People who received a chair 8 to 10 years ago often have no idea what’s available now,” Fracchia said. “I feel like one of my main responsibilities is to educate people about the options and discuss the pros and cons.”
Electronics Evolution. Fracchia said the electronic capabilities of power chairs have exploded over the past two years. “Several major manufacturers of power wheelchairs have electronics options that can be placed on the chair to allow patients to control any infrared or Blue Tooth technology in their home.”
The result is renewed independence for people who once had to rely on others to change TV channels or control lighting in their rooms. Some companies even make it possible for users to upgrade such systems via a simple computer hook-up.
An Eye Toward Injury Prevention. “There is a study that says approximately 70 percent of long-term wheelchair users develop carpal tunnel syndrome (CTS) or rotator cuff impingement problems,” Fracchia said.
With that in mind, wheelchair manufacturers are hot on the trail of strategies to make the mechanics of wheelchair propulsion less burdensome on the body.
One option is power assist wheels, a system that uses motors and batteries to amplify the force applied to the wheelchair’s pushrim. This reduces strain on the arm joints by lowering the force needed to propel the chair. Another option is to replace the standard pushrim of a manual chair with an ergonomically designed pushrim. This reduces pain in the hands and wrists.
Fracchia said therapists also can turn to a special pressure mapping system to determine whether a gel, foam or air cushion would best distribute the weight of their wheelchair clients and help prevent pressure sores.
In an effort to address back pain, manufacturers also have looked at the role that vibration plays on wheelchair users. “The trucking industry started looking at the effects of vibration on a driver’s spine and wheelchair manufacturers used some of that data to begin their own studies,” Fracchia explained. “That has helped medically justify things like shock systems and special frame metals that afford a smoother ride.”
Lightening the Load. The wheelchair industry has long looked for ways to reduce the weight of chairs without sacrificing durability, beginning with a move away from heavy metals. “The use of metals such as aircraft aluminum, carbon fiber and titanium was a huge breakthrough because they are light, yet strong,” Fracchia said.
Creating solid back rests out of products like carbon fiber also has helped reduce the weight of chairs, as has borrowing lightweight, durable spoke designs from the bike industry.
Wheelchairs for Work and Play. In the past five years, Fracchia has seen a bigger push for wheelchairs that allow users to stand, a trend powered by vocational concerns and research that supports the medical benefits of standing and weight-bearing. “These are typically for people who need to reach for things beyond a seated surface at work or home,” she said.
Manufacturers also have addressed demands for a lower seat height for power wheelchairs, a modification that allows better access to computer workstations and tabletops. “The American with Disabilities Act has made people more aware that wheelchair users still want to be productive and active in their communities,” Fracchia said.
They also still want to play, and the industry has answered that desire with specialized chairs for activities such as road racing, quad rugby, tennis and hunting. One company even markets a chair with bulldozer-style treads that can climb hills, traverse beaches and navigate rough terrain.
Evidence-Based Evaluations. As pay sources continue to crack down on suppliers who provide wheelchairs to patients who don’t qualify for the equipment, Fracchia predicts a stronger demand for the kind of evidence-based evaluations offered by certified assistive technology practitioners.
“We have the expertise to back up our recommendations and put in writing what a person needs from a medical or functional standpoint,” she said.
It’s an approach that ultimately benefits patients, some of whom have been misled by unscrupulous vendors. “People often have no idea about their benefits or how their choices affect their future mobility needs,” Fracchia said. “Quite a bit lately I’ve seen power chairs ordered for paraplegics who clearly did not qualify. Then when it comes time for them to get a new manual wheelchair, they have a tough time being approved by their funding source because the power chair vendor has presented them as someone who can’t push a chair.”
Physical therapist Allison Fracchia, coordinator for Methodist Rehabilitation Center’s Assistive Technology Clinic, works with Tennie Lindsey to custom fit her power wheelchair.