Seating and Mobility Solutions for Bariatric Consumers of all Ages

1. Seating and Mobility Solutions for Bariatric Consumers of all Ages Presented by Jane Fontein PDG Vancouver, BC, Canada Stephanie Tanguay Motion Concepts Detroit, MI, USA Kathy Fisher Shoppers Home Health Care Toronto, ON, Canada

2. Introduction • History … 20” chair • Get whatever chair is wide enough • Run a marathon in high heels

3. How to contact us Stephanie Tanguay stanguay@motionconcepts.com Jane Fontein jfontein@pdgmobility.com Kathy Fisher kfisher@shoppershomehealthcare.ca

4. Shapes Pear shape - more stable - gluteal shelf Apple shape - fluctuates - recline Bariatricrehab.com

5. Wheelchair and Seating Issues What are the issues that you have found that are challenging when dealing with bariatric clients? Seating Issues: Size options Availability for evaluation Weight capacity Back Supports Mobility Issues: Having a bariatric chair available the correct size Mobility Transportation Weight of equipment Measuring Doorways - accessibility Availability for evaluation Weight capacity Anything else?????

6. The seating assessment process • Pre Mat Assessment/Interview • - true weight • - weight history • The Mat Physical Assessment • Set objectives/ goals • Determine product parameters • Possible product options • Trial of equipment • Prescription and letter of necessity • Delivery and fitting • Follow up

7. Created by: Stephanie Tanguay Jane Fontein

9. Measurement Tools www.wheelchairsquare.com Callipers can make measurements easier and reduce errors. They need to be long enough to accommodate the client

10. Measuring demonstration

17. Severe swelling of the genitalia (lymphedema based, resulting from bariatric status) can limit functional seat depth and presents a unique need for tissue support.

18. Clinical Reasoning Worksheet

19. Goals for bariatric manual mobility and seating • Chair that fits • Easy mobility – by client or care giver • Adjustable for change in weight • Adjustable for fitting ( difficult to measure and or change over time) • Transportable • Safe • Accessibility • Accept seating • Provide seating

20. Mobility Assumption • “ because of the additional weight the chair is difficult to move”

21. Wheelchair Physics 101 Law of wheelchairs The location of the centre of gravity of the person within the wheelchair determines the ease of mobility and the stability of the wheelchair. ( not the weight of the person) The objective: is a trade off between stability and mobility that meets the needs of the person using the wheelchair.

22. Wheelchair Physics 101 Rear wheels Should take majority of the weight Front wheels or castors Directional

23. Wheelchair Physics 101 As the Centre of gravity (c of g) moves back with respect to the rear wheels, the chair becomes easier to move but less stable. As the c of g moves forward the chair becomes harder to move but more stable

24. Maneuverability Seating issues: Maneuverability of the chair Posture Footrests ( Break issue)

25. Maneuverability Typical Posture

26. Maneuverability Difficult for the staff to maneuver and tilt the wheelchair

27. Maneuverability Look at where the weight is located!

28. Maneuverability

29. Wheelchairs in General • Inexpensive – like standard chair – upholstery • Same in bariatric

30. Bariatric Centre of Gravity • Rear wheels forward reduces load on casters and makes rear wheels easy to reach • Casters forward reduces caster load and improves stability Pierre

31. Bariatric Centre of Gravity

32. Kevin is a 41 year old man with Transverse Myelitis at the T7 level Current weight 410lbs Mobility Issues: Difficult to push – developing shoulder and elbow pain Outside mobility limited (unable to do wheelies) Change in weight

33. Mobility

34. Power Base Stability • Anterior vs. Posterior • Centre of Mass • Addition of Power Seat Functions

36. Weight Capacity • Ole weighs 715 pounds Weight capacity is critical but not the only property that should be addressed

39. Adjustability Matters • Original measurement was 38” wide • Upon delivery … Oops! She measured 26” • “Width adjustable!” Suzanne

40. Seat Depth • Difficult to measure • Changes over time • Multiple users

41. Transfers • Height of the chair is critical for transfers • Foot propulsion

42. Front Rigging

43. 38” wide wheelchair, with centre mount front rigging

44. Rigid Frame Vs folding • High Strength • Lighter weight • Improved tracking • Easy to push or self propel Folding does not necessarily mean transportable Jay in a 28” wide chair

45. Transportation

46. Seating features • Back support – contact • Positioning of the lower extremities • Weight capacity • Dimensions

47. Barbara • Weight greater than 400 lbs. • Current chair 24” wide, 18” deep Challenger. • Hip width 28.5” • Max. width for house access 30.5” • Funding: Medicare/Medicaid

49. New Chair: Big Bounder • 28” wide • 22” deep • Solid back posts • Custom back • 28” wide x 8” • Weight upgrade • to 700 lbs

50. Gloria • Initial pelvic fracture secondary to MVA • One year post, lost 100 pounds • Pear shaped • Leg length discrepancy