Mounting 101

The Challenge: Eric Blackstock was an 84 year old, active man, who was injured whilst working - cutting the grass on his riding lawn mower, when he lost control and drove it into a parked truck. He sustained a C5-6 incomplete, central cord lesion, which permanently left his legs stronger than his arms, and yet ineffective for functional ambulation.

The Process: After extensive therapy, Eric could transfer functionally but was unable to walk more than 10 feet, at which time fatigue made him unsafe to continue. The inpatient rehabilitation team - including Mr. Blackstock, decided that a power wheelchair, with a tilt-in-space function (for pressure relief), would be an important assistive technology device for him to use, for maximum functional independence.

The Problem: Most power wheelchairs are turned on with a button, which requires good fine motor coordination and strength to push. They are then controlled with a joystick, operated by the upper extremities. In Eric's case, however, his upper extremities were less functional than his lower extremities, and therefore it was necessary to place the controls in such a way that his lower extremities could control the mobility and tilt-in-space functions of his wheelchair. This is a real patient (name changed to protect identity) that I treated, and the real issues that we faced with him, and this is the reason I chose this article: Mounting 101. Had I know about the variety of methods to mount wheelchair controls, the solutions we devised for Eric, might have been very different - and would have taken a lot less time.

In this article by Edward Hitchcock, the importance of mounting solutions is discussed, and I couldn't agree more. The process of having identified an individuals strengths (and weaknesses), and then having found a solution for maximum functioning capacity can be thwarted by not being able to mesh these two together. The solution often lies in mounting the controls to a device, close enough and in correct proximity to, the individual, so that they can operate it safely, independently, and with minimal energy expenditure.

The article also gives some excellent problem solving tips for challenging wheelchairs, such as: wheelchairs without exposed tubing; tilt-in-space models; or bariatric models - to prevent increasing their already-wide width. One of my patient had fingers amputated because his wheelchair was too wide to fit through his doorways and he kept catching his fingers, so keeping controls within the width of the chair is an important consideration.

To supplement this article, I have a link to the Daedalus site:
Pictures of Daedalus mounting options, in which some pictures of the "s" shaped mounts attached to casters and frame clamp, can be more clearly seen.

Our Solution: Although with this new found knowledge, my solution today would have included the Daedalus locking swing away mount - which can be moved out of the way during transfers, I will conclude by telling you what our team devised. We positioned an on/off switch (with velcro) to the outside of Eric's right thigh (attached to the inside of his arm rest in his wheelchair), with which he could turn his power chair on/off (he had to abduct his right thigh). He had shoulder protraction/retraction, so with a wrist cock-up splint (to stabilize his wrist), and forearm support he was able to steer the wheelchair, using a "T-shaped" control.

Another switch was velroed to the inside of his left armrest, and he used abduction of his left thigh for the tilt-in-space controls of the chair (as he was unable to use his arms for pressure relief, due to his injury).

I am pleased to say that I now have better solutions for future patients!