Growing Up with Seating and Mobility

In the past 25 years, a lot has changed in the wheelchair seating and positioning industry. Not only has there been an influx of technology and new equipment, but also advances in medical care have changed the face of the populations we serve. All of this, combined with new funding challenges and a more educated consumer mean that we, as equipment and service providers, have much more to consider when providing mobility equipment for the end user.

The first challenge lies in addressing a new population of users who may have more complex needs. Changes and advances in medical care and treatment have resulted in a growing population of people who are living longer than ever before and requiring more services as they age. To further compound the functional issues faced by an aging population, we also have a large number of clients who are aging with a chronic disability. For example, there are an estimated 1.4 million people using wheelchairs in the United States, and more than one million of them are over the age of 45, with a significant increase in wheelchair use after the age of 75 years. As the average life expectancy increases, so does the proportion of people with disabilities and the complexity of their needs.

Physically, the aging process itself puts us at greater risk for functional decline. As we all age, there are unavoidable physiological changes that occur. We lose muscle mass resulting in fatigue and loss of strength, skin loses its tensile strength, blood flow and circulation are limited, balance and equilibrium responses are altered leading to increased risk for falls and we may experience joint dysfunction from osteoarthritis, osteoporosis and over use. Imagine further complicating this by adding a chronic disability into this picture. The functional challenges are compounded when we look at chronic overuse of the upper extremity, chronic pain and the risk for secondary disabilities including respiratory changes and skin breakdown. For example, statistics show that a majority of clients with a spinal cord injury (SCI) acquire a pressure ulcer at some time and the incidence of upper extremity pain or dysfunction significantly increases with years post injury. A classic example: the manual wheelchair user who has been self-propelling for 20 plus years has upper extremity pain, fatigue and a newly acquired pressure ulcer of unknown origin. While he or she may have been utilizing proper equipment, his or her needs are changing due to the aging process.

Our advances in technology also have presented us with some unique challenges over the past 25 years. First, consumers have more access to product information and are more educated than ever before. With the advances in information technology and access to the Internet, more consumers are demanding high-quality products and state-of-the-art technology. In the past, consumer product selection occurred in the clinical setting with a supplier and clinician making many of the decisions regarding product choice. Today, many clients are prepared with a list of questions, desired options and product choices; much like the preparation that goes into purchasing a new car. They are playing a larger role in the selection process to ensure that the equipment meets their individual needs. Advances in technology also have broadened our client base. Many people with severe disabilities are not only living longer, but advances in technology have allowed them to be more independent in a variety of settings. From drive controls to communication devices, more clients are able to enjoy independent mobility and attain functional levels that were once set by the limits of our equipment interventions. These clients require more high-tech interventions, which mean that we as suppliers and providers need to be more educated regarding our equipment choices and how we interface those choices with the end-user.

So how has the industry evolved with the changing times? Suppliers and manufacturers continue to improve the design and development of products and frequently turn to the experienced user to provide realistic feedback. While it isn?t always a perfect process, the industry as a whole has made great strides to stay on the cutting edge of technology and provide realistic options for the end user.

  • Product design is focused on functionality as well as durability and cost-effectiveness.

  • The end user plays an increasing role in product development and design.
  • The industry continues to share well tested technology from other successful industries such as electronics, aerospace, automobile manufacturing, cycling and sports equipment.
  • Use of state-of-the-art materials is on the rise; from carbon fiber to titanium, products are more durable and functional than ever before.
  • Manufacturers, suppliers, clinicians and end users are actively involved in improving access to technology.
  • All of this has happened while keeping one thing in mind: how can product development and design ensure that the end-user maintains the highest quality of life over the longest period of time? The products available in today?s market are focused on function--both maintaining and improving function. Particular changes include:

  • More custom options for wheelchair frames.
  • It has always been my belief (and that of others) that a wheelchair should fit like a good pair of shoes, not too big as to cause fatigue, friction and shear, and not too small as to be uncomfortable and un-wearable for long periods of time. While you still come across standard-sized wheelchairs, many manufacturers pride themselves on providing custom built chairs that will fit the unique anatomical and functional needs of the user. This allows manual chairs to be configured to decrease shoulder dysfunction, maintain accessibility through custom frame lengths, and decrease the overall weight through the use of lightweight materials and the use of few adjustable components.

  • A wider range of seating options.
  • When I was attending PT school, I was told by a professor that in regards to seating and positioning you had two to three options for wheelchair cushions. Foam (custom or standard), air and fluid. Today, there are virtually hundreds of standard and custom options, sometimes from just one supplier. As our knowledge of seating and positioning has evolved, so have the product choices. The design of seating surfaces incorporates new and tested technologies to provide the best combination of function, protection and stability for the end user.

  • End-user design and product development.
  • Todd Hardgroeder from ADI Inc. is an example of where form and function become personally important. Hardgroeder, an end user for more than 15 years started developing products to meet his specific needs and realized that his products could benefit others as well. From transfer boards to the carbon fiber JetStream Pro back, Hardgroeder?s designs incorporate the specific needs of the end user. Most large manufacturers also focus on customer feedback and employ designers and engineers who have first hand knowledge the requirements that best fit the needs of the user.

  • Coalitions have been developed between suppliers, researchers and customers.
  • These coalitions not only aide in product development, but help to justify the use and appropriateness of equipment. By learning from each other working together for appropriate access to equipment, we have been able to bridge the gap between academia, clinical realities and suppliers in a way that benefits all groups.

    In 25 years we have come a long way. But even so, some things remain the same: This industry's commitment to quality products that benefit the end user, the struggle between medical necessity and functional necessity, the conflicts over reimbursement and funding and the transfer of appropriate technology from research and development into the real world setting. These will always be issues we struggle with--and they are issues that continue to make the industry stronger and more cohesive. Overall, the industry continues to maintain a focus on professional integrity and how to best serve our customer.

    This article originally appeared in the November 2004 issue of HME Business.

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