Rationale for Manufacturing the Flo-Tech Solution Xtra

Category: Specialist cushions

Evidence suggests that uncorrected postural abnormality can have profound consequences for physiological function and also that musculoskeletal development can be directly influenced (Farley, Clark et al 2003). Adaptive positioning systems can provide active maintenance or correction of posture and appropriate seating serves an important foundation for function (Swee Hong & Wheeble 2005). It is imperative therefore that OTs have adequate choice and variation of product that can be adapted to the individual to meet these needs.

The Flo-Tech Solution Xtra was envisioned to address a number of common postural problems encountered in wheelchair seating through providing a bespoke stable base for the End User. Radar et al (1999), state that the goal of individualized seating is to provide stability, whilst Bull (2001) outlines the need for a balanced and upright position to be gained from the seated base to allow freedom of the trunk and upper limbs through optimal muscular function.

The seating problems identified to be addressed by the Solution Xtra modular system were:

Fixed and Correctable Positions.

  • Pelvic Tilt (Posterior & Anterior)
  • Pelvic Obliquity
  • Pelvic Rotation
  • Reduced Hip Flexion (Uni & Bilateral)
  • Hip Abduction
  • External and Internal Rotation
  • Windsweeping

These were chosen in accordance to standard leg and pelvic patterns incurred through wheelchair seating as indicated by Engstrom (2002).

Clinical Evaluation

The Royal Hospital for Neuro-Disability (RHND) in Putney, London was approached to carry out trials with the Solution Xtra cushion and modular system as they are well renowned for their clinical expertise within the postural management sphere.

Lead clinical specialist Jane Harding, from the in-house posture clinic led the trials. The trial data has been taken from the information supplied by RHND.

Seven subjects were identified by the posture team at Putney and also three independent clients were trialed by Invacare across the country and the results formulated as one.

Methodology Summary

A small controlled sample population was used to trial the cushion and chosen via clinical assessment from the Postural Management team with the following variables:

  • Neurological diagnosis
  • One or more of the mentioned positioning problems
  • Currently using a positioning cushion

The method used was a mixture of qualitative and quantitative data in the form of a questionnaire that highlighted the following:

  • Clinical Opinion of the Cushion’s Positioning Properties
  • Clinical Opinion of the Cushion’s Pressure Reducing Properties
  • Client’s Perception of Comfort
  • Clinician’s Rating of the Cushion

The cushion’s were then used over a period of 12 weeks and reviewed regularly by the Clinical Team and the results were then recorded and a summary submitted to Invacare.

Summary of Results

During the recruitment period ten End Users were identified (seven by RHND and 3 by Invacare Ltd’s Clinical Specialist) for their suitability in this trial. All were assessed by a qualified Therapist and their postural problems recorded. Following is a brief summary breakdown of the:

  • Diagnosis Distribution
  • Postural Problems Encountered
  • Solution Xtra Component Parts Prescribed by the Therapist
  • Clinical Rationale

Diagnosis Distribution

As previously stated only neurological conditions were considered for the trial and those with the following conditions were proved to be suitable:

Diagnosis

Percentage

Brain Injury

60%

Cerebral Palsy

10%

Spinal Muscular Atrophy

10%

Spinal Injury

10%

Retts Syndrome

10%


Postural Problems Encountered

Following a thorough assessment of the Client’s seated posture, using the current BHTA assessment form as a base for clinical evaluation, the clients presented with the following;

problems-chart.png

Flo-Tech Solution Xtra Component Parts Prescribed by the Therapist

Sizes: The sizes varied from client to client and held no bearing on the outcome of the effectiveness of the cushion.

Composition: All prescribed cushions were made of the same basic compositions of the foam base, gel sac and extendable cover.

Component Parts: As each cushion is modular and bespoke to the user, the component parts were chosen by need and the distribution of the prescribed parts was as shown on the following chart:

theraputic-chart.png

From the data supplied the rigidizer was also used in 30% of the cases. Due to the complexity of the client group at RHND, it is presumed that most End Users are in powered or tilt-in-space chairs where there is a tendency to have a solid base surface and therefore no need for a rigidizer.


Clinical Rationale

Clinicians involved in the trial were requested to identify the suitability of the cushion in respect to the therapeutic aims set out to address the pressure and postural requirements of the End User. The following results were collated:

components-table.png


Where the therapeutic aims were not met the reasons were given as:

Posture:
Client required a firmer base with less contouring
Client potentially required custom made seating

Pressure:
Client became unwell during trial and had increased risk of pressure care due to lack of nutrition and existing tissue damage.

Comfort rating was requested from the End Users in relation to their current cushion. Even though comfort is difficult to define and the results gained were subjective, the cushions had been used over a significant period of time to allow for user adjustment (Turner 2006).

Where there was no response, the Client was unable to respond due to low awareness levels or no data information was available.

90% of the clinicians rated the cushion as either excellent or good,

10% requested further clinical evaluation.

More Comfortable

40%

Same Comfort

10%

Less Comfort

10%

No Response

40%


Cushion Rating

Even though recognition is given of the small study sample, the findings indicate that the Flo-Tech Solution Xtra has been favourably received by the therapists who have seen and used this product. Possibly this could be due to the active therapeutic involvement throughout its development and the clinical rationale which has increased the positive application of the cushion design. Rating of the cushion showed that the clinician’s felt it worthy of a place in their portfolio and that it sat well within the current market place. With the ever demanding need for evidence based practice, there is no surprise that some clinicians were cautious in rating the cushion.

References

Bull M (2001) Pressure area care for wheelchair users. British Journal of Therapy and Rehabilitation. 8(6): 234-235

Engstrom B (2002) Ergonomic seating a true challenge. Posturalis Books, Hasslby, Sweden

Farley R, Clark J et al (2003) What is the evidence for the effectiveness of postural management? International Journal of Therapy and Rehabilitation 10 (10):449-455

Radar J, Jones D, Miller LL (1999) Individualised wheelchair seating: reducing restraints and improving function. Topics in Geriatric Rehabilitation. 15(2): 33-47

Swee Hong C, Wheeble J (2005) A guide to choosing children’s daily living equipment. International Journal of Therapy and Rehabilitation. 12 (12); 554-557

Turner C (2006) A Review of Days Healthcare wheelchair seating products and their application. International Journal of Therapy and Rehabilitation. 13(1) 42-46

Walker M, Fall A (2006)Any Colour So Long As It’s Beige. Occupational Therapy News. 14(3): 18-19