Keeping Co-Morbidities at Arm’s Length

When we talk about seating and positioning, we tend to think about big-ticket items, such as wheelchairs and tilt systems. But for clients who need postural support, details such as elbow and shoulder positioning also can be critical.

The Comfort Company’s EAD (elevating, articulating and depth-adjustment) armrest hardware seeks to provide the adjustability to meet a variety of positioning needs. The prototype hardware was demonstrated at the 2008 International

Seating Symposium in Vancouver, British Columbia, and will be available in October.
EAD was born, says Comfort Company Product Engineer David Cramer, from his sales team’s observations: “They were saying, ‘We need a hardware system that can mount to all of our different pads, can do elevating, can do depth-adjustment and all those things… not a new idea in the marketplace, but we need to come out with one that’s better.’”

Cramer’s next question: What did “better” mean? Cramer said he met with therapists in order to research issues related to the arms and shoulders of patients who have multiple sclerosis, stroke, cerebral palsy or other mobility-related conditions.
His findings: “There’s a lot of problems with shoulders and arms. So my ultimate goal was to create armrest hardware that could be easily adjusted and meet various health and physical requirements.”

Such hardware, Cramer says, can benefit patients with a range of mobility challenges. “Often, users suffer from edema, contracture, loss of memory, shoulder subluxation, trunk control, limited range of motion and many safety concerns,” he says. As an example, he notes, “Stroke patients need to have the armrest pad adjusted to maintain the correct pressure on the shoulder joint to prevent subluxation (dislocation) of the humeral head, which can lead to irreversible damage. Many stroke patients need their arm to be in their field of view as a cognitive reminder of its existence. This helps prevent damage from door frames and falling into the wheelchair wheels.”
EAD’s adjustability is considerable.

“The EAD armrest hardware elevates between horizontal and vertical in 10-degree increments, articulates inwards or outwards in 10-degree increments, and slides both forward and laterally four inches,” Cramer says. “The elevating feature is done about an axis located just under the elbow. When the adjustment is made, the palm and forearm are elevated, while the elbow remains stationary. This is important: If the adjustment is made forward of the elbow, the elbow would drop as the palm is elevated, increasing the risk of subluxation and shoulder girdle misalignment.

“The articulating feature is done about the same axis as the user’s humerus. If this adjustment is made forward of the humerus, it will cause the elbow to flare away from the user, again increasing the risk of subluxation and shoulder girdle misalignment.”

Cramer says the EAD hardware is easy to adjust, and durable once adjustments are made.
“The elevating and articulating adjustments are made by the loosening of toggles, which disengage 36 mating gear teeth,” he notes. “When the gear teeth are engaged, a very strong connection is made that will not wiggle or break.”
Adjustments can be made from the outside of the chair, so clients can stay seated during the process (and so their personal space is respected).

EAD hardware — Medicare-coded E1028, Cramer says — clamps onto canes measuring 5/8 inches to 1 1/4 inches in diameter, to further ensure it meets a range of client needs. That’s another detail sure to be appreciated by suppliers looking to control their inventory.

The Comfort Company
851 Bridger Drive
Bozeman, MT 59715

This article originally appeared in the May 2008 issue of HME Business.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at


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