PM OSTURE & OBILITY G POSTURE & MOBILITY Vol 22.pdf · Posture & Mobility is published by the...

POSTURE &

MOBILITY

GROUP

www.pmguk.co.uk

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22Posture and Mobility

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33 Vol 22 Spring 2006

CCOONNTTEENNTTSS

AAggeennddaa ffoorr CChhaannggee ssuurrvveeyy eexxppeerriieenncceess DDaavvee CCaallddeerr//EEmmmmaa SSttaacceeyy 66PPoossssiibbllee aalltteerrnnaattiivvee ffuunnddiinngg ooppppoorrttuunniittiieess aavvaaiillaabbllee ffoorrmmoobbiilliittyy eeqquuiippmmeenntt bbeeyyoonndd tthhee NNHHSS RRooss HHaamm//PPaattssyy AAllddeerrsseeaa 99

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DDHH LLeeaarrnniinngg && lliisstteenniinngg eevveenntt –– LLoonnddoonn RRooss HHaamm 3399BBSSII rreeppoorrtt AAlliissoonn JJoohhnnssoonn 3399NNHHSS//PPAASSAA,, eettcc DDaavvee LLoonngg 4400PPAASSAA AAnnddyy GGuuddggeeoonn 4411RRAADDAARR uuppddaattee CChhrriiss BBrraaccee 4422AAssssssiissttiivvee TTeecchhnnoollooggyy FFoorruumm JJaann 3311sstt RRooss HHaamm 4422AAsssstteecchh wwiikkii MMaarrccuuss FFrriiddaayy 4433EEUU rreevviissiioonn ooff tthhee mmeeddiiccaall ddeevviicceess ddiirreeccttiivvee BBHHTTAA 4444AAbbiilliittyyNNeett JJoo GGrreeeennwweellll 4455

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CCoommmmoonn SSeennssee 2255LLooggoo RReeddeessiiggnn CCoommppeettiittiioonn 2277NNeewwsslleetttteerr wweebb ssiittee ssuurrvveeyy EEmmmmaa SSttaacceeyy aanndd DDaavvee CCaallddeerr 5555DDooeess tthhee uussee ooff aa kknneeee bblloocckk iinnfflluueennccee hhiipp ddeeffoorrmmiittyy,, ffuunnccttiioonnaall aabbiilliittyyaanndd ppaaiinn iinn nnoonn aammbbuullaanntt cchhiillddrreenn wwiitthh bbiillaatteerraall cceerreebbrraall ppaallssyy?? DDaavviidd PPoorrtteerr 5566

CCoonnffeerreennccee 22000077 5577CCoonnffeerreennccee PPhhoottooss 22000066 5588

It has been a busy few months for members of theCommittee with the annual training event having takenplace in Blackpool in February. The Bursary winner’sreports are in this edition, as is Stuart Weir’s (the namebadge taken out of the hat at the end of the conferencewinner) report from the Seating symposium inVancouver. Survey results which also took place atPMG are also included but there is still time for thoseof you who did not attend the Blackpool event to alsomake your views know, by completing thequestionnaires and sending them onto Olwen/Patricia(address in the inside cover).

Meetings (CSIP), reports (Scottish wheelchair service)and the DH country wide ‘Listening and Learningevents’ about the wheelchair service continue and formany us attending the London meeting on March 10th,we felt we had been there/heard it all before – and manytimes since the McColl report in 1986! Inequity ofnational provision, lack of trained experienced staff,inadequate budgets, budget freezes, poor management,lack of CPD opportunities, lack of senior managementinterest, people not carrying evidence-based practice,Cinderella service etc came up over and over again.New workers in the service should remember that thereare tomes of excellent material for you to use as starting

points. These include for example, material producedby PMG, the National Wheelchair Managers Forum,BRSM reports, the Modernisation Agency, materialfrom charities (i.e. SCOPE, Whizz-Kidz, MDCampaign), as well as peer reviewed literature as farback as 1986 for example, about powered chairs foryounger children! Past editions of the newsletter will beadded to the web site in the future and so keep lookingthere too. Also managers should start to realise thatthere are many experienced physiotherapists working inthis area too and stop actively discriminating againstthem in adverts. I think there is employment law aboutthis!

Some more members are contributing to the newsletterwithout being ‘tied up’, which is great news for PMGand more are informing the secretariat of any ‘grey’publications, new ISBN publications, new booklets,new useful web sites or meetings, which, whenappropriate, are now being added to the web site asquickly as we hear about them. (If you hear aboutsomething which you feel the rest of the membershipwould benefit from, please, please email Patricia orOlwen directly.) But I have only heard from amaximum of 20 members in the last 24 months. Whaton earth are the other 980 thinking about, reading, or


Posture & Mobility is published by the Posture and Mobility Group, Registered Charity Number 1098297.The views expressed are those of individuals and do not necessarily reflect those of the Group as a whole.

EEddiittoorr:: RRooss HHaammPhysiotherapist, Wheelchair Service,

DSC, St Mary’s Hospital, Milton RoadPortsmouth PO3 6BR.

BBaarreenndd tteerr HHaaaarr9 Cow Lane,

Fulbourn,Cambridge CB1 5HB.

email: [email protected]

JJooaannnnee MMccCCoonnnneellllWhizz-Kidz,Elliot House,

10 -12 Allington Street,London SW1E 5EH.


EEmmmmaa SSttaacceeyyManager/Occupational Therapist,

Newham Wheelchair Service,St Andrews Hospital, Devons Road,

London E3 3NT.email: [email protected]

NNeewwsslleetttteerr AAddmmiinniissttrraattiioonn:: PPaattrriicciiaa MMaarrkkssTel: 01823 252690 Mobile: 07876 705007


PPMMGG AAddmmiinniissttrraattoorr:: OOllwweenn EElllliissTel/Fax: 0845 1301 764 Mobile: 07929 567730


EEddiittoorriiaall TTeeaamm

AAddvveerrttiissiinngg ccoossttss::Full Page:................£600 Quarter page:.......£200Half Page: ..............£360 Loose inserts: .......£200

Contact Patricia or Olwen for further information.

EEddiittoorriiaall

I write this letter as interim chair ahead of the firstcommittee meeting after the AGM, at which time thenew chair will be elected formally into office.

It is a time of change for the committee. I am delightedto welcome Monica Young, Kevin Humphries and NigelShapcott on board – I am sure they will contribute muchto the group in the coming months and years. Ros Hamhas stood down from committee after her three yearterm and will no longer be heading up theCommunications sub-committee, this being her lastnewsletter. She has done a fantastic job of bringing thenewsletter up to date and has put in place mechanismswith administrative support from Patricia Marks toensure the trend continues. Martin Moore has stooddown from his position as chair of the Conferenceplanning sub-committee but remains on committee inoffice as Vice-chair of the group. I would like to takethis opportunity to thank him for sharing the workloadwith me over the last year. I look forward to workingwith the full new committee for the coming year.

We learnt a lot at the national training event in Pontinsin February from presentations, posters, networking andthe exhibition. I hope those of you in attendance felt thesame way - certainly an informal review of the feedbackforms seems to suggest this was the case. There is aphrase about adversity and thriving but it wouldprobably be fair to say that we perhaps preferaccommodation and food more akin to previousconference facilities! We will be in Warwick University

next year and you will be glad to hear that from whatI’ve seen it looks more like the normal standard ofaccommodation for PMG conferences.

I was very pleased that at the AGM it was agreed that theresearch fund will be topped up to match last year’sfinances, subject to confirmation of the final figuresfrom the conference. This aspect of the group has reallytaken off and we owe David Porter a debt of thanks forgetting it off the ground so swiftly. The sub-committeehas really taken off and it looks like there will be similardemand for funding this coming year.

Barend ter Haar has served us faithfully as treasurer formany years but stood down from this office at the AGM.He was formally thanked at the AGM but I would likeeveryone to be clear about the huge commitment he hasput into the group while treasurer. No doubt he willcontinue to be a very active member of the committee.Henry Lumley has very kindly agreed to take on the roleof treasurer and will do so with the assistance of a bookkeeper to handle the everyday financial matters.

I hope you enjoy this newsletter. Have a great spring andsummer.

With best regards

DDaavvee LLoonngg,, PPMMGG CChhaaiirr,, MMaarrcchh 22000066


LLeetttteerr ffrroomm tthhee CChhaaiirr

even doing in their work place? If you do notwrite/share it, it is of little value to themembership/group or development of the speciality.(Who has used the Otto Bock Start Junior forexample?) Those of you who have completed BSc orMSc or even PhD’s know this! No writing, no sharing,no opinion, and then long may the Cinderella servicecontinue.

The Newsletter is now well established (and theBlackpool survey comments will be taken ‘on board’)and my term of office comes to an end with this edition.I would like to thank the sub-group/team for theirefforts in both writing and commissioning articles, themany members who have been coaxed (or not) intowriting an article when caught ‘at a weak moment’ andespecially Patricia and Olwen who have frankly ‘made

it happen’. I wish the new editor every success andwould encourage readers and members to make thetime to contribute to this their newsletter. Too many ofthe members are passive in my opinion and withoutsome spirit and opinion out there, the PMG will nevermove on.

When will we see Cinderella at the next ball? That is upto you!

RRooss HHaamm,, MMaarrcchh 22000066

EDITORIAL

Many thanks to those of you who completed the AfC survey.

Overall 47 complete responses were received and these figures provide a snapshot of initial outcomes across the UK,covering therapists, RE’s and managers.

The tables below gives an ‘at a glance’ picture of the results received. It was difficult to break the professional rolesdown into grades, as generally this information was not submitted. The information has however, been broken downinto the categories of RE’s, Clinicians & Managers.

Generally, the matching results show a positive outcome, however, anyone who is dissatisfied with their result canrequest a review, within 3 months, of receiving official notification of their matching outcome, and should requestdetails of the profile they were matched to and the individual levels their post was awarded in each job evaluationfactor. They should also speak to their manager to gain their agreement that any additional information they intendsubmitting to the review is correct. More detailed advice can be found in section 47 of the Agenda for Change – NHSTerms & Conditions of Service Handbook. This can be accessed via the Department of Health website onwww.dh.gov.uk


AAggeennddaa ffoorr CChhaannggee SSuurrvveeyy EExxppeerriieenncceessDDaavvee CCaallddeerr//EEmmmmaa SSttaacceeyy

ARTICLE – AGENDA FOR CHANGE SURVEY EXPERIENCES

PPrrooffeessssiioonn//GGrraaddee BBaannddiinngg TToottaall GGeenneerraall FFeeeelliinnggssRehab Support Worker 5 1 GoodClinical Technologist trainee 5 1 Very GoodRehabilitation Engineer 5 2 Very PoorRehabilitation Engineer 6 11 OKRehabilitation Engineer 7 1 GoodSenior Rehabilitation Engineer 5 2 Very PoorSenior Rehabilitation Engineer 6 1 GoodSenior Rehabilitation Engineer 7 2 Good

PPrrooffeessssiioonn//GGrraaddee BBaannddiinngg TToottaall GGeenneerraall FFeeeelliinnggssDeputy Head OT 7 1 GoodWorkshop Manager 6 1 Very PoorWorkshop Manager 7 1 GoodRE Manager 7 2 GoodRE Manager 8B 1 GoodHead PT 8B 3 GoodHead OT 7 3 PoorHead OT 8A 1 Very Good

PPrrooffeessssiioonn//GGrraaddee BBaannddiinngg TToottaall GGeenneerraall FFeeeelliinnggssTherapist 6 3 PoorTherapist 7 2 OKSenior Therapist 6 2 PoorSenior Therapist 7 5 GoodClinical Specialist 6 1 Poor

RReehhaabbiilliittaattiioonn EEnnggiinneeeerrss

CClliinniicciiaannss

MMaannaaggeerrss

AGENDA FOR CHANGE – SURVEY

Please spend a few minutes in completing this survey (if not completed in

Blackpool) and mail back to Patricia Marks, PMG Administration, c/o POBox 776, Taunton, Somerset, TA1 9BR

With a lack of national profiles and each Trust matching jobs separately itwould seem that Agenda For Change (AfC) is turning into a national lottery. There does not seem to be any published score card available. So that wecan all best understand the outcome of AfC PMG feel that a 2 minute survey during the conference would help to raise the visibility of AfC results andprovide a scale for comparison.

Q Question Answer �

1 I work in the County of

2 My Job Title is

3 My Profession is

4 Clinical roleIf you assess or prescribe to clients please

tick the box

5 Management roleIf you manage other people please tick the

box

6 Have you been assimilated

If yes tick the box

7 Actual / Target Band 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8a / 8b / 8c / 8d / 9

8 Do you think the band isappropriate for the job

very good / good / ok / poor / very poor

Thank you for your input to this survey.

PMG Editorial Team


�


“Bugzi is fabulous – aquantum leap in theevolution of wheelchairdesign for the specificneeds of young children”

Lawrence Llewellyn Bowen

MMyy 22--yyeeaarr--oolldd ccaann’’tt wwaallkk……

How will he explore his world and play with his friends? How will he learn to beindependent and make choices? Aren’t these things essential for his development?”

What’s the answer?

TThhee MMEERRUU BBuuggzzii!!

It’s a powered indoor wheelchair specially designed for children aged 1 to 5.• Kids love its fun and friendly look – their friends want to play too!• Small and manoeuvrable – fits in at home and in the car• Motivates children to learn and communicate• Suits all ability levels, with switch or joystick controls• Trains kids safely for bigger powered wheelchairs• MiniCAPS seating takes care of children’s posture

Bugzi brings freedom and independence – at last!

MEDICAL ENGINEERING RESOURCE UNITCompany Limited by Guarantee No. 1214125 Registered as a Charity No. 269804

TTeell:: 002200 88777700 88228866 EEmmaaiill:: ppeetteerr@@mmeerruu..oorrgg..uukkWWeebbssiittee:: wwwwww..bbuuggzzii..oorrgg..uukk

BBaacckkggrroouunndd –– TThhee PPrrooffeessssiioonnaall ssttaaffff mmeemmbbeerr..Increasingly staff working in wheelchair services areunable to meet the needs of their clients for a variety ofreasons which may include: advancing technologywhich is beyond the remit of their NHS services,prescriptions beyond the assessed clinical need,requests for more than one item, additional features notsupplied by their NHS service or overspent budgets.

But before staff start to search out suitable sources forfunding, it is important that they are aware of their ownroles within the service in which they work. Are theyfor example aware of their professional role in theservice as stated in the Codes of Ethics and ProfessionalConduct (COT) or Core Standards of Physiotherapypractice (CSP) or other Professional bodies standardsand that of the Health Professions Council? Do theyknow for example that;

• they should be recording unmet need (COT July2000, 3.3.5)? ‘Failure to do so would be consideredunacceptable’.

• clients should be given sufficient information toenable them to make informed decisions (COT2.1.2)

• at times of resource deficiency, the recordedassessment of need should also clearly state thoseobjectives that have to be achieved in order tomaintain a minimum level of satisfactory and safeoccupational therapy service to clients and carers(COT 3.3.6) and that..

• if OT’s feel unable to reach these minimumstandards, the appropriate manager should benotified in writing with a copy to the referrer ifapplicable (COT 3.3.7)

• the physiotherapist demonstrates that they haveconsidered the patients and/or carer’s needs withinthe social context (8.2 CSP 2005),

• the plan clearly documents planned interventionsincluding: timescales, goals, outcome measures, riskassessment. If clinical guidelines, local protocols areused these should be referred to. (8.4 CSP 2005)

• as a health professional, you must protect the healthand wellbeing of people who use and need your

services in every circumstances (Core StandardsHPC 2003)

• staff must act in the best interests of your patients,clients and users. You must not do anything or allowanything to be done that you have good reason tobelieve will put the health or safety of a patient,client or user in danger (Core Standards HPC 2003)

• staff must understand the need to consider theassessment of both health and social care needs ofclients and carers (HPC OT specific 2a.2)

• the specific contribution that physiotherapy canpotentially make to enhancing individual’sfunctional ability together with the evidence base forthis (HPC PT specific 3a1).

SSttaaffff mmeemmbbeerrss rroolleess iinn sseerrvviiccee ddeevveellooppmmeenntt..Staff must also realise their own roles in thedevelopment of the service within which they work.For example in; drawing up, and updating, policy forthe service provision, applying current legislation toprovision, the service eligibility criteria for thepopulation served, in raising the service profile withsenior managers and commissioners, in the servicestock lists of the equipment product ranges availablefrom their NHS service, with searching out evidencebased practice (EPB) and its application to the servicesin which they work, in their own job purpose, indeveloping user group involvement with the serviceand an genuine empathy with service users and theircarers/families.

Staff should also review their Voucher Scheme criteriaand the financial values offered. For example, are theyup to date and would the criteria and amounts stand upto scrutiny? Have they been benchmarked with others?Staff should also ensure that the Vouchers offered areequivalent to the real (and 2006), cost of theprescription and that users are not put into an unrealisticband or restricted in some other means that has not beenannually reviewed.

WWhheenn ttoo ssttaarrtt tthhee sseeaarrcchh ffoorr ffuunnddiinngg..When each staff member is happy that the service inwhich they work is:


ARTICLE – POSSIBLE ALTERNATIVE FUNDING OPPORTUNITIES FOR MOBILITY EQUIPMENT

PPoossssiibbllee AAlltteerrnnaattiivvee FFuunnddiinngg OOppppoorrttuunniittiieess aavvaaiillaabblleeffoorr MMoobbiilliittyy EEqquuiippmmeenntt bbeeyyoonndd tthhee NNHHSS

RRooss HHaamm FFCCSSPP,, PPoorrttssmmoouutthh WWhheeeellcchhaaiirr SSeerrvviiccee,, PPoorrttssmmoouutthh PPOO33 66BBRRPPaattssyy AAllddeerrsseeaa,, CCOOTT,, KKeennddaall,, CCuummbbrriiaa

• appropriate for their client group,

• ‘legal’ and up to date,

• empathetic to the users it serves with active userinvolvement,

• senior management interest and involvement,

• happy to be challenged by users,

and is still unable to meet the needs of their clients, thenalternative funding sources should be sort. Alternativefunding should not be seen as an easy option to notaddressing the current issues that each service faces andnot being up to date.

PPoossssiibbllee rreeaassoonnss ffoorr rreeqquuiirriinngg AAlltteerrnnaattiivvee FFuunnddiinngg..Alternative funding for equipment may be required bya service when, for example:

• the assessed prescription is beyond the service’scurrent agreed eligibility criteria,

• the assessed prescription is of a higher specificationthan ‘standard’ and that generally agreed to besupplied,

• an item that is required is in additional to thatalready supplied,

• the prescribed equipment item prescribed is‘extraordinary’ or one-off,

• for developmental purposes and may not be the finalprescription,

• for trial purposes or

• for usage within a variety of other agencies/settingswhere the clinical need is not the greatestrequirement.

Other examples are found on a daily basis, but the NHSservices have a provision equity responsibility as withall other NHS services and a requirement to meet theneeds of the majority (NWMF 2005).

SSoouurrcceess ffoorr AAlltteerrnnaattiivvee FFuunnddiinngg..Seeking additional funding is not easy and is alaborious process in many cases. Many families do notwant to ‘go to charities’. Some prefer to find the fundsthemselves or they have other sources to approach (egplace of work). Some users are able to apply forfunding themselves and in some cases, families canassist the user in contacting various organisations.Often these alternative bodies require a report ofidentified need from the assessing therapist, others have

long application forms which some users may needhelp in completing. The list attached here may assist thereader and their clients in ‘getting started’ down theroad of greater independence and functionalachievement.

EEqquuiippmmeenntt PPrroovviissiioonn:: AAlltteerrnnaattiivveess ttoo tthhee NNHHSSwwhheeeellcchhaaiirr sseerrvviiccee..

11.. EExxaammpplleess ooff VVoolluunnttaarryy SSeeccttoorr CCoonnttaaccttss::

UUKK wwiiddee

i. Meningitis Trust. Fern House Bath Road Stroud Glos.GL5 3TJ www.meningitis-trust.org. ‘discretionarysupport grants to enhance the quality of life for thosewho may have been affected by meningitis ormeningococcal septicaemia’.

ii. MS Society, National Centre 372 Edgware RoadCricklewood, London NW2 6ND 020 8438 0700.www.mssociety.org.uk/grants. ‘does award grantstowards wheelchairs for people with MS whose needsare not met by standard wheelchairs provided by theNHS’. Apply to applicants nearest MS Society branchfor an application form.

iii. Association of Charity Officers. 01707 651777www.aco.uk.net an umbrella organisation with links tocharities or grant giving trusts who do provide grants toindividuals.

iv. Parkinson’s Disease Society, 215 Vauxhall Bridgeroad, London SW1V 1EJ. 020 7932 1336.www.parkinsons.org.uk. Grants to value of £250 fromMali Jenkins Fund for people with Parkinson’s disease.

v. Muscular Dystrophy Campaign, 7-11 Prescott PlaceLondon SW4 6BS 020 7720 8055. www.muscular-dystrophy.org Grants available through the JosephPatrick Trust

vi. Motor Neurone Disease Association, PO Box 246Northampton NN1 2PR 01604 624726www.mndassociation.org. Grants available to value of750 available from local branch. Application needs tobe supported by a Health or Social Care professional

vii. Whizz-Kidz, Elliott House, 10-12 Allington Street,London SW1E 5EH 020 7233 6600 www.whizz-kidz.ord.uk. Funds individual applications for mobilityequipment for under 18 year olds and mobility ispermanently restricted.

viii. Ataxia-Telangiectasia Society IACR, Rothamsted,Harpenden, Herts. AL5 2JQ 01582 760733www.atsociety.org.uk Support grants for families of



children/adults with A-T. Each case treated on anindividual basis.

ix. Mobility Trust, 50 High Street, Hungerford, RG 170NE 01488 686335 www.mobilitytrust.org.uk

x. Action For Kids 15a Tottenham Lane, London N89DJ 020 8347 8111 fax: 020 8347 3482www.actionforkids.org. Funds specialist mobilityequipment (not available from NHS) and other aids tochildren and young people with disabilities up to theage of 26. ‘This equipment creates opportunities,freedom, self-reliance and greater opportunities’.OT/PT assessment/supporting report required.

xi. Family Fund 0845 130 4542 Unit 4, Alpha Court,Monks Cross drive, Huntington, York Yo32 9WNwww.familyfund.org.uk . Funded by the fourgovernments of England, Northern Ireland, Scotlandand Wales to provide grants to families caring forseverely disabled or seriously ill children aged 15 andunder.

xii. Association of Wheelchair Children 0870 121 0053Fax 0870 121 005 www.wheelchairchildren.org.ukProvide equipment and training programmes forchildren in wheelchairs to help them moveindependently and with confidence.

xii. ACT (Association for Children with Life-threatening or Terminal Conditions and their families)Orchard House, Orchard Lane, Bristol BS1 5DT Tel:0117 922 1556 www.act.org.uk ACT a national charityseeking to promote excellence and equity of provisionof care and support for all children and young peoplewith life-threatening conditions and their families. ACThas an information database of any support services thatmay be available for families and professionalsworking with them, which includes any organisationsthat may be able to help with funding for the provisionof wheelchairs for children.

xiii. Variety Club Children’s Charity 93 Bayham StreetLondon NW1 0AG 020 Tel: 0207428 8100 Fax:0207428 8111 www.varietyclub.org.uk Supply tochildren & young people up to age of 18 years.

xiv Lady Hoare Trust www.ladyhoaretrust.org.uk.Helping children and their families with arthritis orlimb disabilities by providing them with practical ,financial and emotional support.

EExxaammpplleess ffoorr IInnddiivviidduuaall ccoouunnttrryy//aarreeaa::

i. Chest, Heart and Stroke Scotland 65 Castle StreetEdinburgh EH2 3LT. Tel:0131 225 6963

www.chss.org.uk. Towards the cost of some mobilityequipment for Scottish residents

ii. Barnwood House Trust. For people with disabilitieswho live in Gloucestershire. The Manor House, 162,Barnwood Road, Gloucester GL4 3JX. Tel: 0145261122 www.barnwoodhousetrust.org

UUsseeffuull ppuubblliiccaattiioonnss aavvaaiillaabbllee ffrroomm rreeffeerreennccee sseeccttiioonn ooffPPuubblliicc LLiibbrraarriieess::

1. Director of Grant Making Trusts CAF ISBN 0-903991-58-7

2. The Voluntary Agencies Directory 2005 ISBN 0-7199 1645-3

3. Charity Choice (Edition 13 2005) Waterlow ISBN1-85783-035-0

4. Charities digest 2005 Waterlow ISBN 1-8578 30059

Association of Medical Research Charities. Previouslyproduced a handbook annually but now the informationis on the web site. www.amrc.org.uk/about ourmembers

22.. PPrriivvaattee PPuurrcchhaasseess::

i. Exchange and Mart Adverts

ii. Reputable Dealer: Serviced second-hand models

iii. Notice boards at Mobility Centres

iv. Local papers, newsagent’s boards/windows

33.. MMoottaabbiilliittyy:: TTeell:: 0011227799 663355999999

For those people who are receiving one of the followingbenefits;

• Higher rate Mobility Component of the DisabilityLiving allowance

• War Pensioners’ Mobility Supplement.

The person should expect to receive the allowance forthe full length of the agreement chosen.

A new or used powered wheelchair or scooter on hirepurchase, over a term of one to three years, or a new orused powered wheelchair or scooter on contract hirelease for up to three years is available from Motability.Wheelchairs and Scooters are available from two typesof dealers; local dealers who are accredited throughMotability or Direct sellers who are also accredited. Formore details about the Wheelchair and Scooter Scheme


1111 Vol 22 Spring 2006

It is common sense that wheelchairusers need to take care on thepavement and crossing the road, asobstacles and weather can maketheir wheelchair unstable. But theBritish Healthcare TradesAssociation (BHTA) is alsoconcerned about a user unwittinglyaltering the stability of theirwheelchair through mechanicalmeans (such as adding cushions),making it hazardous. This is why ithas launched a new ‘Get Wise’leaflet for manual and poweredwheelchair users called ‘How tomake sure your wheelchair remainsstable’.

Produced with the support of thegovernment’s Medicines &Healthcare Products RegulatoryAgency (MHRA), the leaflet simplyand clearly sets out all the elementsthat can affect the stability of awheelchair. A wheelchair is onlystable if the combined centre of massof the wheelchair and user is withinthe wheelbase of the wheelchair.

Comments BHTA director generalRay Hodgkinson: “I think manywheelchair users will be surprised athow easy it is to cause theirwheelchair to become unstable, with

potentially dangerous consequences.We hope this leaflet will help allusers.”

Users can reduce the stability oftheir wheelchair by adding cushionsand seating systems; adding weight(e.g. shopping bags, oxygencylinders) will also cause instabilitywhen climbing a slope or ramp. Theeffectiveness of brakes too can bereduced when the wheelchairapproaches its stability limits forexample, going down a slope, as cananti-tip devices.

For example, ramps andslopes, steps, kerbs and softground should only benegotiated after reading themanufacturers’ wheelchairinstructions – they will listsuch things as the maximumsafe slope to negotiate and toavoid soft ground if thewheels are small.

A lack of maintenance canlead to wear or failure ofcomponents which will causethe wheelchair to changeposition unexpectedly, or eventip over. The BHTA says usersshould always use a qualified

technician to service or repair thewheelchair. Tie-downs fortransportation must also be approvedby the manufacturer (or they maynot work properly).

You can obtain copies of the leafletby sending an A5 sae to BHTA,Suite 4.06, New Loom House, BackChurch Lane, London E1 1LU. Tel:020 7702 2141, email bhta@bhtaand website www.bhta.com whereyou can see a full list of BHTApublications.

HHooww SSttaabbllee iiss yyoouurr WWhheeeellcchhaaiirr??BBHHTTAA,, NNeeww LLoooomm HHoouussee,, SSuuiittee 44..0066,, 110011 BBaacckk CChhuurrcchh LLaannee,, LLoonnddoonn,, EE11 11LLUU

TTeell:: 002200 77770022 22114411 FFaaxx:: 002200 77668800 44004488

contact route2mobility 0845 60 76260 or down loadinformation from the web site www.motability.co.uk

44.. AAcccceessss ttoo WWoorrkk ((AAttWW)) provides advice and practicalsupport to disabled people and their employers to helpto overcome work related obstacles resulting fromdisability. Examples of the amounts are as follows:100% costs for people starting a job, self employedpeople and those in work for less than 6 weeks. Forothers AtW pays a proportion of the costs of support i.e.cost of less than £300 –nil, between £300-£10,000 80%

of costs over £300 and over £10,000, 80% of costsbetween £300 and £10,000 and 100% cost over£10,000.

For example: London Region Windsor House, 185Ealing Road, Alperton, Middlx HA04LW 020 82182710 (London boroughs), South East Region 01272364750 (Berks, Bucks, Hants &IoW, Oxon, Sussex,Kent &Surrey), East of England 01206 288788 (Essex,Beds, Herts.) www.jobcentreplus.gov.uk



IInnttrroodduuccttiioonnIt was surprising to read that ‘standing wheelchairs’have been available for twenty five years (Lifestand usa2005) as their availability on the UK market is muchmore recent. Most are purchased privately because, asyet, they are not considered part of statutory serviceprovision and could be considered luxuries when manyservices have restricted budgets. However, puttingfunding aside, it is important to be aware of newdevelopments within the field of mobility assistivetechnology and to consider the evidence for their use.Internationally standing wheelchairs are gainingrecognition as a useful therapeutic intervention.

Currently, much of the evidence to support theprovision of standing wheelchairs is anecdotal orindividual case studies found within manufacturers’information. However this evidence should not bedismissed as an independent satisfaction study by Dunnet al (1998) found that 79% of users would also highlyrecommend the use of standing wheelchairs. Whizz-Kidz has noted an increase in demand for standingwheelchairs, with some applications raising questionsof suitability. Therefore with limited evidence availableit was considered prudent to consider the evidence foruse of standing frames and tilt tables. This articlepresents a summary of the evidence identified thatcould inform the use of standing wheelchairs and thedevelopment of practice guidelines to ensureappropriate prescription and the best use of resources.

TThhee IImmppoorrttaannccee ooff SSttaannddiinnggUsers of standing wheelchairs describe how ‘to stand isto see life through the eyes of our peers’ and how theworld and ‘our bodies are made to stand’ (Lifestand usa2005). Consequently the ability to stand has manyphysiological, psychosocial and functional benefits.Stewart (1998) considers that the physiological benefitsaccrued by passive standing include:

• Prevention or reversal of osteoporosis• Prevention of contractures and improvement in joint

range of movement• Reduction of spasticity• Prevention of pressure ulcers• Improvement in renal and bowel function• Improvement in circulation

No studies have specifically identified the psychosocialand functional benefits of standing, although a positiveimpact on self esteem, self image and morale and aperception of improved well-being and health werereported by Dunn et al (1998) and Kunkel et al (1993).Beattie (2001) has documented the possible functionalbenefits to children of static standing, but perhaps thereis an assumption that the functional benefits of standingand moving are obvious (Finke and Muldoon 2003).Experience has shown that users of standingwheelchairs value small functional skills such aschanging position for comfort or standing to sing in thechoir, while carers value the reduction in manualhandling and the financial savings from reduction inmultiple equipment. Examples of these benefits aresummarised in Table 1 (see overleaf).

For many users and their families standing wheelchairscan appear to be a practical solution to many of thedifficulties experienced using a standing frame andliving in a world designed for standing people (Finkeand Muldoon 2003). These aspirations can often behindered by the quality of the stand required orachieved, but how to define this is difficult.

TThhee QQuuaalliittyy ooff SSttaannddiinngg RReeqquuiirreeddWhile the complications that arise from immobilisationand lack of standing are well documented, evidence toquantify the quality of the standing required to have apositive effect to reverse or stall the effects of notstanding are few (Stuberg 1992). Therefore, theevidence or professional opinions available will bediscussed in relation to posture, time, position, functionand practical issues.

PPoossttuurreeThe Association of Paediatric ChararteredPhysiotherapists (APCP) (2001) recommended that anoptimal standing posture for children was one thatpromoted load bearing through vertical femurs and flatfeet, with knees that were slightly flexed, but able toextend, the pelvis in an anterior/neutral position and theshoulders protracted. However, contraindications arenot so clearly defined, although Lifestand usa (2005)advised consideration should be given to establishedcontractures, serious orthopaedic disorders, hip andknee flexion of more than 20 degrees; - in other words,clinical reasoning should guide practice.

1133 Vol 22 Spring 2006

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ARTICLE – STANDING ISN’T A LUXURY: REVIEW OF THE LITERATURE

TTiimmeePoutney et al (2004) consider that the purpose forstanding guides the frequency of standing. Followingstudies investigating bone mineral density (BMD),Stuberg (1992) recommended standing for 60 minutes4-5 times a week to gain an improvement. HoweverCaulton et al (2004) found that while longer periods ofstanding resulted in significant increases to thevertebral BMD, it did not significantly increase tibiaBMD and concluded that longer periods of standing areunlikely to reduce the risk of fractures. Perhaps theoverall recommendation is that standing should beencouraged as Stuberg (1992) and Chad (1999) reportthat decreases in BMD could occur even after notstanding for two to three months. This supports theneed for a method that is easy for users and carers to usein their daily environments and for prospectiveplanning to ensure that when equipment is required,there is continuity of provision during periods ofclinical change.

Poutney et al (2004) suggest that hourly sessions, threetimes a week could reduce the risk of hip dislocationand control hip flexion contractures, as research hasindicated that standing in children with Cerebral Palsypromotes the development of a more stable hip joint(Gudjonsdottir 1997). However Tardieu et al (1988)and Lespargot et al (1994) recommend passivestretching of 6 hours per day for maintenance of musclelength. They considered that stretching less than 2hours per day leads to progressive contractures and thata 6-8 week period of non-stretching in the majority ofcases will also lead to contractures. This would placeunreasonable demands on carers if using a static

standing frame, therefore stretching in a standingposition using a standing wheelchair could offer clientsan independent and practical means of achieving this.Standing and moving would also enable clients toparticipate in everyday activities. This is limited whenusing a static standing frame within the ‘ordinary’workplace, school or home. However it isacknowledged that for some clients a static frame mayoffer better posture and position and may be their onlymethod of achieving standing when taking intoconsideration other physical, cognitive or emotionalfactors.

PPoossiittiioonnResearch has also suggested that weight bearing canreduce lower limb muscle tone in spastic paraplegia(Oedeen and Knutssoon 1981). Some studies haveconsidered the angle of the standing frame in relation tothe amount of weight bearing achieved. Miedaner(1990) found that children with Cerebral Palsy, whohad poor head and trunk control, achieved best weightbearing of 74% of body weight when standing at aprone angle of 20 degrees from the vertical. Daniels etal (2004) found that the highest percentage of bodyweight (60-91%) was borne when standing at a verticalangle of 900 or 950; however these results are notnecessarily consistent across all makes of standingframes. Further research is required to investigate howthe features of standing frames and standingwheelchairs impact on weight bearing, the role ofsecondary points of weight transference and perhapswhether weight bearing varies between static ordynamic positions.



Possible Benefits from Using a Standing WheelchairsPhysiological gains Psycho-social gains Functional gains Financial Savings

Change of position forpressure relief

Eliminates undignifiedtransfers into standing frames

Integrated standing intoevery day activities

Reduce manual handlingto stand

Reduce risk of contracturesSocial status through equal

heightStand for choir

Reduce devices used,multi-functional

Reduce bone mineral loss& risk of fractures

Personal choice of when/where to stand

Access work surfaces iekitchens, labs

Reduce assistance to changeposition

Improves bladder function& aids digestion

Self esteem and confidence(stand tall)

Men access toilet unaidedReduce need to modify

school, work place or home

Reduce spasticity Interaction at equal eye level Stand at bar with matesLess storage space required

for equipment

Improve respiratory function Comfort within own bodyReach shelves/till in shops,

librariesEliminate repeat of devices

in different settings

Improves circulation Improve well-being Reach whiteboard at school Increase participation

TTaabbllee 11:: TThhee PPoossssiibbllee BBeenneeffiittss ffrroomm UUssiinngg aa SSttaannddiinngg WWhheeeellcchhaaiirr

FFuunnccttiioonn aanndd PPrraaccttiiccaall IIssssuueess Bush (2003) found greater weight bearing variability inthe more active child and recommended that standingshould be carried out during occupations that activelyinvolved the individual. This is supported by the workof Thompson (2000), who considered that it is theactive participation by the individual, with intermittentloading of the long bones during dynamic standing andmuscle activity which increases the strain on the bone,as opposed to increasing the time of a staticprogramme. This is a clear advantage of using standingwheelchairs, as a standing position can be achieved bythe user actively going a through a sit-to-standmovement to carry out functional tasks such asreaching cupboards or standing and talking at eye-level.

Moving through sit-to-stand may not be possible for allusers; however some users have reported improved hipand knee extension to achieve a standing position byusing standing wheelchairs that have a lie-to-standmotion. This was also suggested by Daniels et al (2005)who found that moving from supine to standing asopposed to being hoisted into a standing positionachieved straighter legs for weight bearing.

There is little evidence to support when standingwheelchairs should be considered an option to gainmaximum benefit. Frequently this is when othermethods of standing have failed or becoming toodifficult for carers to manage. Perhaps considerationshould be given to the achievement of autonomousstanding much earlier, as some users have consideredthat the ability to adjust their own position in standingor between standing and lying is beneficial for comfortand increased tolerance, compliance (Shields &

Dudley-Javoroski 2005) and personal control (Daniel etal 2004). Clinical experience has shown that standingwheelchairs lend themselves to ease of use in the home,mainstream senior schools, higher educationestablishments or the workplace. Finke and Muldoon(2003) suggest that ‘standing wheelchairs may also bebeneficial to clients who are able to stand, but who arenot capable of sustaining the standing position longenough to successfully manage a functional task due tolack of balance, safety, lack of strength, medical need touse energy conservation techniques, lack of motorcontrol, or inability to control tone’. Perhaps, thisindicates that more emphasis needs to be given to howclients carry out everyday tasks and achieve autonomyor for these factors to be considered of equalimportance to physiological factors when developingstanding programmes.

TTyyppeess ooff SSttaannddiinngg WWhheeeellcchhaaiirrss Giving personal control and movement is reflected inthe availability of an increase range of children’sstanding frames which are motorised or have self-propelling wheels and are readily available on theinternational market (www.standingdani.com).Therefore there is a trend towards providing equipmentthat achieves standing with mobility for use in dailylife, rather than as static exercise. Tables 2 and 3describe standing wheelchairs available on the UKmarket which can meet this need for some users. Theyare available as manual or powered wheelchairs, withthe stand achieved manually or powered, using a sit-to-stand motion or a lie-to stand motion. (Contact detailsof manufacturers and dealers are provided in theAppendix.)


1155 Vol 22 Spring 2006

Manual Standing Wheelchair

Dealer /Make How Stand Achieved Sizes Available

Manual stand Powered stand From 7yrs Teenagers/Adult

Balder no no no no

Cyclone (Lifestand) yes yes yes yes

Easy Care Ltd (Genie) no no no no

Gerald Simonds (Levo) yes yes yes yes

Permobil no no no no

TTaabbllee 22:: MMaannuuaall SSttaannddiinngg WWhheeeellcchhaaiirrss

Standing wheelchairs for small children are notcurrently available because of difficulties solvingengineering problems regarding size and the need forgrowth. When purchasing these devices, considerationmust always be given to financing the continualadjustments required especially for growing children orfor adults with changing clinical conditions. Thesewheelchairs can provide disabled people with a ‘tool’ toaccess their everyday environments, therefore it isimperative that issues of funding are consideredcreatively and opportunities for joint funding, whetherwith other statutory services, charities or individuals,explored.

FFuuttuurree WWoorrkkFrom considering the literature there is much evidenceto support the physiological benefits of standing,however there is little evidence to support thepsychological and functional benefits described byclients and their families (Finke and Muldoon 2003).With the ICF (WHO 2002) promoting the evaluation ofparticipation and activity, and social policies promotinginclusion and life opportunities for disabled people(Prime Minister’s Strategy Unit 2005), life stylechoices need to be given more consideration. Furtherresearch is required to understand; • how standing wheelchairs are used during everyday

activities, • how benefits are accrued to justify the cost of such

equipment and,• how to make sure prescriptions are user-led and

appropriate.

CCoonncclluussiioonnStanding wheelchairs have the potential to make a

difference to the lives of disabled people, but furtherresearch is required to understand the benefits accruedand how functional needs can guide prescription.

RReeffeerreenncceess::Beattie K (2001) An evidence basis for standing as partof a therapeutic programme for children with cerebralpalsy. British Association of Bobath Trained TherapistsVol.40 p.24-28

Bush, S. (2003) An Investigation into the Transmissionof gravitational Force During Standing in a ProneStanding Frame. APCP Journal June 2003 UK.

Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JEand Mughal MZ (2004) A randomised controlled trialof standing programme on bone mineral density in non-ambulant children with cerebral palsy. Archives ofDisease in Childhood 89: 131-135

Chad K, Bailey D, McKay H, Zello G and Synder R(1999) The effect of a weight-bearing physical activityprogramme on bone mineral content and estimatedvolumetric density in children with spastic cerebralpalsy Journal of Pediatrics Vol 135;1 (July) ;115-117

Daniels, N., Gospill, C., Armstrong, J., Pinnington, L.,Ward, C. (2004) MHRA 08149 An Evaluation ofStanding Frames for 8 to 14 year olds. Uk Departmentof Health.

Dunn RB, Walter JS, Lucero Y et al (1998) Follow-upassessment of standing mobility device users. AssistiveTechnology ;10(2):84-93

Finke, G. Muldoon, K. (2003) In Good standing. TheInterdisciplinary Journal of Rehabilitation 16 (9) 32-5

Gudjonsdottir B, Mercer VS (1997) Effects of a



Powered Standing Wheelchairs

Dealer/Make Movement into Standing Sizes Available

Sit to stand Recline / lie to stand From 7 yrs Teenagers/adult

Balder yes yes yes yes

Cyclone (Lifestand) yes yes yes yes

Easy Care Ltd (Genie) yes no yes yes

Gerald Simonds (Levo) yes no 10+ yr yes

Permobil yes yes yes yes

TTaabbllee 33:: PPoowweerreedd ssttaannddiinngg wwhheeeellcchhaaiirrss

dynamic versus a static prone stander on bone mineraldensity and behaviour in four children with severecerebral palsy Paediatric Physical Therapy;14;1;38-46

Kunkel, C.F., Scremin, A.M.E., Eisenberg, B., Garcia,J.F., Roberts, S., Martinez, S. (1993) Effect of‘standing’ on Spasticity, Contractures, andOsteoporosis in Paralyzed Males. Archives of PhysicalMedicine and Rehabilitation 74: 73-78

Lespargot, A., ranaudin, E., Khouri, N., Robert, M.(1994) Extensibility of hip adductors in children withcerebral palsy. Developmental Medicine and ChildNeurology 36 (11):980-8

Lifestand usa (2005) Mobile standing frame. Availableat www.lifestandusa.com/Index . Accessed 2 February2005.

Miedaner (1990) An Evaluation of Weight BearingForces at Various Angles for Children with CerebralPalsy Paediatric Physical Therapy 2;(4): 215

Oedeen, I., Knutsson, E. (1981) Evaluation of theeffects of muscle stretch and weight load in patientswith spastic paraplegia. Scandinavian Journal ofRehabilitation Medicine 13: 117-121.

Poutney, T.E, Mulcahy, C.M, Clarke, S.M, Green, E.M.(2004) The Chailey Approach to Postural Management.East Sussex. Chailey Heritage Clinical Services.

Prime Minister’s Strategy Unit (2005) Improving thelife chances of disabled people.http://www.strategy.gov.uk/downloads/work_areas/disability/disability_report/pdf/disability.pdf (accessed 27January 2005).

Shields, R.K., Dudley-Javoroski, S (2005) Monitoringstanding wheelchair use after spinal cord injury: a casereport. Disability Rehabilitation 4:27(3) 142-6.

Stewart TP The physiological aspects ofimmobilization and the beneficial effects of passivestanding. AMI Easystand RETEC USA 1989: 30-33

Stuberg WA (1992) Considerations related to weight-bearing programs in children with developmentaldisabilities. Physical Therapy 1992; 72 (1): 36-40

Tardieu, C., Lespargot, A., Tabary, C., Bret, M.D.(1988) For How Long Must the Soleus Muscle beStretched Each Day to Prevent Contracture.Developmental Medicine and Child Neurology 30, 3-10.

Thompson, C.R., Figoni, S.F., Devocelle, H.A., Fifer-Moeller, T.M., Lockhart, T.L., Lockhart, T.A. (2000)

From the field. Effect of dynamic weight bearing onlower extremity bone mineral density in children withneuromuscular impairment. Clinical Kinesiology 54(1):13-18.

WHO (2002). Towards a Common Language forFunctioning, disability and Health ICF. Geneva, WorldHealth Organization.

AAppppeennddiixx1. Easy Care Products LtdPark Lane Old Park Telford Shropshire TF3 4TETel: (01952) 610300Email: [email protected] Page: www.easycareproducts.co.uk

2. CYCLONE MOBILITY AND FITNESS LTDUnit 5, Apex Court, Croft Business Park Bassendale RoadBromborough, Wirral, CH62 3RETel: (0151) 346 2311; free 08001804850Email: [email protected] Page: www.cyclonemobility.com

3. SIMONDS, GERALD HEALTHCARE LTD9 March Place, Gatehouse Way Aylesbury Buckinghamshire HP19 8UATel: (01296) 380200Email: [email protected] Page www.gerald-simonds.co.uk

4. BALDER UK Ltd24 Murrell Green Business ParkLondon Road, Hook, Hampshire, RG27 9GRTel: 01256 767 181Email [email protected] Page: www.balder.co.uk

5. PERMOBIL LTDUnit 4 West Vale Building Wakefield RdBrighouse HD6 1PETel: (01484) 722888Email: [email protected] Page: www.permobil.com


1177 Vol 22 Spring 2006

PPaarrtt ooff aa ppaattiieenntt’’ss nnootteess……

“She enjoyed talking to people hereand said that she had more conversation here

than she did with her husband (she alsocommented that she had more conversation

from her parrots than from her husband,and one of her parrots is stuffed).”

This years Aldersea lecture (alwaysa highlight of the PMG conference)was given by the renowned andwidely respected Pauline Pope.

Pauline aimed in her lecture, to givethe audience a little insight into herlife and experiences in the field ofpostural management and thepathway and motivations behind hersuccess in this specialist area, as wellas her views on the current positionand potential for future progress.

Shortly after graduating as aPhysiotherapist, Pauline married aman who’s career would take themall over the world to a variety ofcountries, in often very rural andunder developed areas includingPakistan and Argentina. Thisenabled Pauline to experience workas a physiotherapist in localhospitals, in some very humblingconditions. During this period oftravel Pauline learnt some veryvaluable lessons from herexperiences that she would takeforward and would remain with herthroughout both her career andpersonal life.

On returning to the UK shecompleted an MSc in Biomechanicsand then started work at the‘Hospital for Incurables’, nowknown as The Royal Hospital forNeuro-Disability (RHN) in Putney,London. At this time the RHN hadapproximately 300 residents withsevere and complex disabilities,many had severe pressure ulcers andwere bedfast with severe jointcontractures. These residents werebeing forced to live under a rigidregime enforced by hospitalmanagement (including restrictedtoileting times). Paulineunderstandably found this situation

to be intolerable and refused toaccept that these conditions were aninevitable result of their severepathologies.

It was the preconception of hospitalstaff that rehabilitation and therapistinput was a waste of time for theseindividuals as previous interventionhad had little effect. Paulineidentified that a change in emphasiswas required with the focus oftherapeutic intervention beingplaced on the physical managementof these individuals rather thantrying to specifically treat them.

In 1985 she published a paper whichhighlighted the need for thismanagement to be a multi-disciplinary approach and shecampaigned tirelessly to involvenursing and care staff at all times, toensure that they would be on boardas the main care providers (thisincluding working all manner ofshifts to reach all staff). During thistime at Putney, Pauline identifiedhuge inadequacies in the wheelchairand positioning equipment that wascurrently available for thesecomplex individuals. Together withher Engineering and Therapycolleagues, she studied thepresenting postures and problemsthat these individuals had andworked on designing moreappropriate equipment that wouldprovide the level of support that theyrequired. These designs included thePutney Alternative Positioning(PAP) chair, the SAM seat and bedpositioning equipment.

The PAP chair is unfortunately nolonger in use due to a lackmanufacturing interest and so manyof its unique features that worked sowell, are not available even on some

of the most advanced chairsavailable on the current market. “Ithad features that allowed the chair toaccommodate hamstring shortening,a common problem that is difficultto accommodate with today’schairs”.

The SAM seat was rather moresuccessful commercially; it took itsoriginal design inspiration from theposition that is adopted by amotorbike rider and proved to bevery successful in providing afunctional and controlled positionfor many individuals for whomseating in other positions did notfacilitate functional enhancement.The SAM is still available on thecommercial market, however it iscurrently having it’s own difficultieswith manufacturing issues which arethreatening it’s future availability.Pauline and her team were alsoinvolved in developing some of thefirst bed positioning equipment(mainly because she was one of thefirst people to acknowledge theimportance of 24-hourmanagement), the now widely usedT-roll and log roll are some of hersimple yet effective innovations.

In the 10 years that she was atPutney, she implemented significantchanges which were all beneficial tothe overall care and management ofthese previously ignored individuals.She saw at the RHN a decreasedprevalence of pressure ulcers andtissue viability issues during thistime (a decrease from 13% to 5%), areduction in the magnitude of jointcontractures and deformities andfewer patients were considered to bein a bed fast state.

Following this successful ‘shake-up’at the RHN, Pauline moved into a


CCoonnffeerreennccee RReeppoorrtt:: TThhee PPaattssyy AAllddeerrsseeaa LLeeccttuurreeSSppeeaakkeerr:: PPaauulliinnee PPooppee

CONFERENCE REPORT: THE PATSY ALDERSEA LECTURE

CONFERENCE REPORT: THE PATSY ALDERSEA LECTURE

community based setting at theWhite Lodge Day Centre, where shediscovered that community workingpresented itself with a new range ofchallenges for her. Pauline identifiedthat residing in their own homeappeared to be empowering for theindividual and they were lesscompliant with therapist-imposedregimes and equipment than in ahospital setting. The homeenvironment appeared to facilitateassertiveness and highlighted thatpeople’s priorities in the communitywere different. She learned avaluable lesson that an agreedapproach is essential and thatcompromise will nearly always beinevitable, unless the prescribedequipment and regime is deemednecessary by the individual and fitsin with their desired lifestyle then itwill not be successful.

It was around this time that Paulinebecame pro-active in the setting upof three special interest groupsincluding what is now the PMG.She also began work to highlight theneed for specialist seating provisionwithin the NHS. Much has beenachieved through the dedicatedwork of campaigners such asPauline with postural managementbecoming increasingly widelyrecognised, with specific coursesnow being available to trainprofessionals even at Masters level.Pauline, however is keen that we donot complacent with what has beenachieved and feels that there isconsiderable scope forimprovement. Amongst the areasthat she feels need improving are:

• Mandatory training – physicalmanagement of such complexindividuals is still not recognisedin general graduate trainingcourses, there is no standardrequirement that Cliniciansworking in this field need toattain, therefore there is

c o n s i d e r a b l escope fori n a p p r o p r i a t eprescriptions tobe made whichas well aspotentially beingdetrimental theindividual willinevitable resultin wasted fundsand resources.

• The nationwideservice providedis stillfragmented withanomalies inequipment provision, knowledgeand skills base and it is stillsegregated from other healthservices. In order to improve thiswe need to look at unitingservices in order that we considerthe physical management of thewhole person within his/her ownlifestyle.

• The need to develop regionalcentres of excellence in order toprovide these most complexindividuals with the specialistskilled and knowledgeableclinical input that they requireand deserve. These centres wouldassist in facilitating research anddevelopment that is essential forequipment and knowledgedevelopment. Pauline also feelsstrongly that these centres are amore efficient use of resourcesand would facilitate a reductionin prescription error.

• The development of specialistday services/centres that caterspecifically for these complexclients, with staff who have thespecialists skills to support andtrain carers, monitor conditionsand enable equipment trials -which again would wean out thedegree of prescription error seen.

• Further support needs to be inplace for the carers and assistantsof these individuals to ensuremaximum compliance withmanagement regimes andequipment.

• As health professionals we needto be more pro-active inproducing evidence to supportour clinical decisions and provethe efficacy of our interventionsin order to not only ensure we areproviding the best care for ourclients but to highlight and enticethe need for funders to invest inthese services.

Pauline’s parting thoughts to end herthought provoking talk was tohighlight the need for clinicians toaccept that not all of the problemsthat present themselves in clinicshave realistic and achievablesolutions. Compromise has and willalways be inevitable. Unless we ashealth professionals accept this, thenwe are lining up ourselves, and ourclients, for failure anddisappointment.

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TThhee RRooyyaall HHoossppiittaall ffoorrNNeeuurroo--DDiissaabbiilliittyy,,

PPuuttnneeyy,, LLoonnddoonn

1199 Vol 22 Spring 2006

Pauline Pope delivering the Lecture.

Treloar College is a national specialist college ofFurther Education for young people aged 16+ who havephysical disabilities. It is based in Alton, Hampshireand has space for 180 students, the majority of whomare resident during term time. It offers a range ofcourses including skills for life, vocational andindependent living skills and course to advanced level.

This presentation illustrated how a co-ordinated multi-disciplinary approach enabled a student to use anintegrated system to independently access driving apowered chair, communicate and use other electronicequipment.

Coral Smith opened this session with an introduction toTreloar College and to introduce us to Hannah, a 19-year-old student who’s journey towards using anintegrated system on her powered wheelchair, was toform the focus of this wake-up session.

Hannah has a diagnosis of Cerebral Palsy with bothspastic quadriplegia and athetoid movements. She isalso dysarthric, but is a very keen communicator usingnon-verbal, eye pointing, a wordbook and a TELUScommunication aid. For mobility she sits in a CAPS 11seat on a manual base.

Whilst at Treloar School, Hannah had tried driving apowered wheelchair using a head switch as part of apilot project. This had been unsuccessful as it gaveHannah neck pain and backache. However she waskeen to try again as she wished to gain independentmobility and she suggested trying a chin switch as shehad used this in the past to play playstation with herbrother. Her family were also certain that anyequipment provision should be via NHS wheelchairservice, as they were not in a financial position to affordmaintenance and repair costs if it should be charityfunded.

Mike Loxley then spoke of the rehabilitationengineering challenges to providing a chin switch foraccessing powered mobility:

Potential problems:• Obtrusive• Can obstruct care routines – Hannah is hoisted for

all transfers and eats orally.• Client can change position in seating both

intentionally and unintentionally and so problem ofaccurately and repeatedly positioning joystick.

• Hygiene – as Hannah salivates a lot• Safety – due to spasms.

Advantages:• Joystick provides speed, proportionality and

spontaneity when driving• Commercial range available

An assessment Spectra powered wheelchair was set upwith a chin switch using a Daessy mounting system.This mount was chosen as the mounting tube hingesand folds behind the wheelchair so it will not interferewith care routines and also has a positive safety lock soposition is secure. Treloar College currently have 35 ofthese mounting systems being used and so far they haveproved reliable.

The trial was a success as Hannah was so motivated andshe was able to drive the powered chair, withsupervision, by end of one school term. The skinaround her chin reacted, but she used a barrier creamand this resolved the problem. Attention turned to hercommunication methods, as Hannah used a TELUSsystem, with a head-pointer and used a computer foreducational work, again using a head-pointer. This wascausing concern as Hannah had neck pain and she wasalso finding the head-pointer set-up not to be veryelegant for a young fashion conscious girl! Anintegrated system was considered to allow the option ofinterfacing switches for communication and thecomputer with her chin control.

Mike urged caution in using integrated systems for thefollowing reasons:

1. Potential problems:• Can be overly complex• Problems with reliability• Difficult to alter and system may need to ‘grow’

as needs change• Based around power chair and common access

method, so there is a single point of failure


““DDrriivviinngg,, CCoommmmuunniiccaattiinngg,, LLiivviinngg””SSppeeaakkeerrss:: MMiikkee LLooxxlleeyy,, RReehhaabbiilliittaattiioonn EEnnggiinneeeerr aanndd CCoorraall SSmmiitthh,, OOccccuuppaattiioonnaall TThheerraappiisstt,,

TTrreellooaarr TTrruusstt AAllttoonn,, HHaammppsshhiirree..

CONFERENCE REPORT: “DRIVING, COMMUNICATION, LIVING”

2. Advantages:• Uses hardware, so no setting up for carers,

everything is there ready for client.• Wireless connections

Hannah’s Requirements were:• To drive her powered wheelchair• To operate a TELUS communication aid• To access the class computer for her college

courses• To operate the computer for leisure• To control her environment potentially in future.

The technical specification for an integrated system forHannah were to be:• Versatile, reliable, affordable• Robust and able to withstand inevitable knocks• Easy for non-technical people to understand• Able to be supported beyond Treloar College.

Early trials were initiated using a WiseDX system. Mikepointed out the obvious advantages of a collegeenvironment as staff were able to make adjustments atany time to make the system perfect for Hannah.

As the trials continued with the integrated system, thetherapists contacted Hannah’s local NHS wheelchairservice to discuss her case, as it was felt she nowneeded her own powered wheelchair. As she hadpreviously has an old RMS Gill Junior poweredwheelchair, this was exchanged for a Barrett GEMEPIOC with an interface for a CAPS 11 seating system.A Radcliffe Shadow tilt-in-space manual base was alsoprovided to increase her comfort in a manual chair.

Hannah was now able to drive independently on thecollege campus and she wrote:

“Thanks so much. It has given me freedomand feels like flying. I can go round College

with my friends and go to the disco.”

The Occupational Therapist and Physiotherapist nowturned attention to Hannah’s posture and comfort in herwheelchairs. Hannah preferred to sit in her CAPS 11 onthe manual Tilt in space base as she experienced backpain and increased spasm in her powered chair. Drivingwithout footplates allowed more accuracy of control

and less spasm in her body, but she required moreramping in her seat cushion. Seating was discussedwith her NHS wheelchair service and a moulded seat ona TIS EPIOC was agreed. A Invacare Spectra PlusEPIOC was provided and the moulded seat provided anincrease in both her stability and comfort. This was setup with the integrated switch system and the mountingsystem for her joystick.

So how was all this funded?• NHS Wheelchair service funded Invacare Spectra

Plus EPIOC and moulded seat insert• IMPact grant of £2500, (a fund set up for

independent mobility by therapists at TreloarCollege) helped the NHS wheelchair service fundthe equipment.

• The Learning Skills Council provided £2000 to fundthe WiseDX system. (This is an educational grantfor equipment needed for college, as the computerwas part of integrated system).

Hannah is now learning to acknowledge when she isunable to manage the driving, for instance, if she hasparticularly bad spasms or a cold. She is learning tomanage her disability and direct carers to assist her ifrequired. The equipment has been handed over to beused by care staff, class assistants, tutors at the collegeand her family, after a training package was devised toenable them to use system easily. Support materials, inthe form of easy to read laminated sheets, wereproduced to be kept with the wheelchair. These sheetscover the use of the integrated system, poweredwheelchair and ‘trouble shooting’ sheets. A technicalmanual has also been compiled to cover wiring andtechnical details which will go with Hannah and herchair, when she leaves Treloar College.

The session ended with the audience seeing pictures ofHannah using her powered wheelchair and integratedsystem to good effect. The session was enthusiasticallypresented and received and certainly a good start to theday!

NNaattaalliiee DDeeaann,,OOccccuuppaattiioonnaall TThheerraappiisstt,,

NNoorrtthh && WWeesstt BBeellffaasstt HHeeaalltthh&& SSoocciiaall SSeerrvviicceess TTrruusstt

2211 Vol 22 Spring 2006

CONFERENCE REPORT: “DRIVING, COMMUNICATION, LIVING”

The Posture and Mobility GroupAnnual Learning Event was held thisyear at Lytham, Lancashire onFebruary 7th and 8th. Among thelectures and presentations was aninformative and enjoyable talk givenby Alison Baxter and NatalieWoodman, Senior Therapists withthe Posture, Independence andMobility Service at the OxfordCentre for Enablement.

With the difficulties and challengesthat Therapists often encounter whenassessing stroke clients for seating,the lecture focused on theperceptual, cognitive andbehavioural changes that can occurand how these changes can effectseating needs. Using theirconsiderable experience in this field,Alison and Natalie then providedstrategies for helping to overcomethese problems.

A Stroke occurs when the bloodsupply to the brain is disturbed insome way. The resulting loss ofoxygen to brain cells leads to thedeath or damage of some of thesecells. The effects can be catastrophicand may result in lasting problemswith physical functioning (motorand sensory), communication andlanguage as well as cognition,perception and behaviour. This inturn can lead to fatigue, depressionand anxiety, mood changes, pain,incontinence and sleep disturbance.

It is useful at this stage to defineCognition and Perception. Cognitioncan be described as ‘all the mentalprocesses that allow us to performmeaningful behaviour’. Perceptionis ‘The process by which the brainreceives information from the

senses, the integration of thesesensations and the organisation ofthem in association with pastexperiences to make a meaningfuland functional whole.’ Seating canbe defined as ‘’appropriateequipment within the wheelchair toprovide comfort, postural support(correction and accommodation) andpressure relief withoutcompromising function.’

All facets of Perception andCognition, if damaged by a Stroke,can have an effect on seating.Memory difficulties, a commoneffect of Stroke, may leave the clientwith difficulty recalling why acushion or support is needed and theway it should be fitted. If Attentionand Concentration are effected, theassessing therapist should be awareof the client’s inability to followinformation, as well as the client’spossible difficulty in keeping alertall the way through what may be along appointment. Difficulties withinsight, or self awareness, can causeproblems with understanding,compliance and safety issues.Isolating a shape or object from itsbackground, figure ground, or to beable to judge depths and distancesare areas of perception that whendamaged by a stroke, can lead toproblems transferring, as well asmoving within the environment.Locating brakes or a seat belt could,for instance, become a problem.

Unilateral neglect, failure to respondto stimuli on the side of the bodyaffected by the stroke, may lead todifficulties moving or transferringsafely in a chair or to lack ofawareness of posture. A client withIdeational Dyspraxia would have

problems sequencing due to a lack ofunderstanding of the concept of thetask while someone with IdeomotorDyspraxia, although understandingthe task, would be prone to clumsymovements and even perseveration,a constant repetition of certainmovements. Dysexecutive Syndromein which the persons ability to plan,organise and monitor thinking andbehaviour is affected can result indisorganised, slow thinking andimpulsive behaviour.

Behaviour was defined as ‘the wayan individual responds or interacts tothe environment in response to aninternally or externally drivenstimulus’. Changes in facialexpression, refusal to cooperate,anger and agitation are allmanifestations of ways clients couldcommunicate problems with theirseating through their behaviour.Carers saying that the client is a‘different person in bed than in thewheelchair’’, he is ‘naughty’ anddeliberately slides out of the chair,he ‘refuses’ to get up and that heexhibits challenging behaviourduring moving and handling, couldall be examples of behaviourindicative of seating problems.Behaviour such as the client onlywanting to sit out for short periods,constant shouting or rocking orgenerally being non-compliant areother examples. This kind ofbehaviour can be divided into thatwhich results in physical or verbalaggression and sexuallyinappropriate behaviour, and thatwith the more passive behaviour ofavoidance, non-compliance andreduced volition and drive.

The importance of seating in


TThhee IImmppaacctt ooff PPeerrcceeppttiioonn,, CCooggnniittiioonn aanndd BBeehhaavviioouurroonn SSeeaattiinngg cclliieennttss FFoolllloowwiinngg aa SSttrrookkee

SSppeeaakkeerrss:: NNaattaalliiee WWooooddmmaann,, SSeenniioorr PPhhyyssiiootthheerraappiisstt aanndd AAlliissoonn BBaaxxtteerr,, SSeenniioorr OOccccuuppaattiioonnaall TThheerraappiisstt

CONFERENCE REPORT: THE IMPACT OF PERCEPTION, COGNITION AND BEHAVIOUR FOLLOWING A STROKE

CONFERENCE REPORT: THE IMPACT OF PERCEPTION, COGNITION AND BEHAVIOUR FOLLOWING A STROKE

behavioural management can beshown in several ways. It potentiallyenables the client to change hisenvironment and be stimulated bythis change. With the rightequipment the client can do andlearn more and different seating canbe used for different functions. It cangive vital access to social interactionas well as community and leisureactivities.

SSttrraatteeggiieess ttoo uusseeAlison and Natalie then focused onthe strategies that can be used to helpovercome these difficulties,emphasising that it was based ontheir clinical experience.

When assessing a client withm e m o r y / a t t e n t i o n / e x e c u t i v efunctioning/communication andbehavioural difficulties it isnecessary to be fully prepared. Theenvironment should be quiet andundisturbed with one person to leadthe assessment and if possible afamily member present to provideinformation and to reinforce spokenpoints made by the therapist. If agood rapport can be obtained thiswill lead to mutual trust and enablegoals to be negotiated. It is importantfor the therapist to be aware of his orher own safety while maintaining aposture and position that is nonthreatening to the client. Thetherapist should dress appropriatelyand stay calm and speak calmly.

A client with dyspraxia would needto be given clear instructions whilethe therapist should be prepared torepeat them until the client is able tocarry out the task. The use ofmarkers can be useful to helpovercome problems of positioningassociated with unilateral neglect orinattention while the therapist shouldalways be aware of his or her ownposition when dealing with such aclient.

For a wheelchair user withperceptual problems, repetition,step-by-step instructions andprompts are needed while, ifpossible, the beneficial effects ofdifferent coloured equipment shouldbe assessed.

It is important to remember asgeneral points, that a client centredapproach is vital and that adequatetime is devoted both to thepreparation and to the assessmentitself with interdisciplinaryteamwork being essential. Strokepatients/clients often become tiredvery quickly, so fatigue managementis important. Verbal and visualreinforcement can be used, perhapswith the involvement of Speech andLanguage Therapists. Basic seatingprinciples, including 24-hourposture management, unilateral

movement, symmetry and spasticitymanagement should be observedwhile recognising that compromises,especially between comfort andfunction, are often necessary.

Alison and Natalie ended theirpresentation by recognising theongoing challenges presented bylack of resources and low staffinglevels as well as that of thebehaviour of clients themselves,issues of restraint and function of thewheelchair. The whole process wassummed up using the four ‘C’s;Complex, Comprehensive (in termsof the information gathering exerciseneeded), Challenging andCompromise.

NNiicckk SSeewweellll,,OOccccuuppaattiioonnaall TThheerraappiisstt,,

IIssllee ooff WWiigghhtt WWhheeeellcchhaaiirr SSeerrvviiccee

2233 Vol 22 Spring 2006

WWoorrddllyy WWiissee1. ARBITRATOR – a cook that leaves Arby’s to work at McDonalds2. AVOIDABEL – what a bullfighter tried to do3. BERNADETTE – the act of torching a mortgage4. BURGLARIZE – what a crook sees with5. CONTROL – a short, ugly inmate6. COUNTERFEITERS – workers who put together kitchen caxx7. ECLIPSE – what an English barber does for a living8. EYEDROPPER – a clumsy ophthalmologist9. HEREOS – what a guy in a boat does10. LEFTBANK – what the robber did when his bag was full11. MISTY – how golfers create divots12. PARADOX – two physicians13. PARASITES – what you see from the top of the Eiffel tower14. PHARMACIST – a helper on a farm15. POLARIZE – what penguins see with16. PRIMATE – removing your wife from in front of the TV17. RELEIF – what trees do in the spring18. RUBBERNECK – what you do to relax your wife19. SELFISH – what the owner of a seafood store does20. SUDAFED – brought litigation against government of xxx

I have worked in the field of Posture and Mobility for18 months and although I have seen only static seatingin clinical practice, I have developed a healthy interestin dynamic seating. My interest started when I attendedthe Posture and Mobility Conference in Exeter in April2005. J.M. Malborg gave a presentation regarding hiswork on dynamic seating and the variety of solutionsthat he had provided for his clients. The presentationillustrated how typical current solutions had beenadapted to allow movement within the system.

I was pleased to see that this year’s conference hadmade provision for dynamic seating so I attended theWake up Session on Dynamic Seating to Reduce LowerBack Pain.

Carmen A. Platvoet, the session presenter, is anEngineer for B-Seated who are based in Helmond in theNetherlands. B-Seated was founded in 1996 and theyprovide high quality dynamic seating solutions to aEuropean customer base. The session focused on the‘Flow’ range of dynamic cushions aimed at the ageingpopulation suffering with lower back pain, particularlywhen statically seated.

Carmen began the presentation with a brief overview oflower back pain and how prevalent the condition is inNetherlands. I was taken aback by the fact that up to85% of people in the Netherlands will suffer with lowerback pain at some point in their lives. The incidence ofthis condition increases in industrialised areas of thecountry. A large majority of the population is affectedand it costs the Netherlands government an estimated 5Billion US dollars per annum.

The core of the presentation was based around Leo vanDeursen’s thesis, Low Back Pain and EverydayActivities (Deursen, 2003). Leo van Deursen’s researchconcentrated on the influence of axial spinal rotation onlower back pain. A chart was shown illustrating painexperience while performing some common physicaleveryday activities of sitting, standing, lying down,walking and cycling. The lowest level of back pain wasreported for cycling and the highest level of pain wasreported when statically seated. A second chart wasshown illustrating torsion rates at the lower spine inrelation to activity. The chart illustrated that the highesttorsion rate occurred when cycling. In conclusion, itwas said that the lowest level of pain was recorded atthe highest rate of torsion.

The torsion in the lower spine was measured using atechnique common to gait analysis. Markers that reflectinfrared light were placed on the relevant points of thebody. Cameras that record infrared reflections wereused to record the movement of the markers and mapthe lower spine rotation from vertebrae L4 to T8.

Even with all the developments in mobility products,typical levels of physical activity are still low. The B-Seated ‘Flow’ cushion aims to provide an evidencebased approach to reducing actively lower back pain inline with one of the conclusions of Leo van Deursens’sresearch, that it is not solely intradiscal pressure thatcauses lower back pain but a lack of axial spinalrotation.

The cushion consists of two plates that move laterallyand a 10 cm polyurethane foam cushion top. The twoplates are located side by side and move in a linearforward and reverse motion. A motor, which is locatedunder the plates, provides the power to create the linearmovement. The motor is powered from a rechargeablebattery in the base.

Each plate moves 5 mm individually and in theopposite direction to each other. This creates acumulative movement distance of 10 mm. B seateddescribe the movement as “Longitudal ContinuousPassive Motion” (LCPM®). The frequency ofoperation is 6 cycles per minute. The movement of theplates when the cushion is in use causes between 1 and2 degrees of lower axial spinal rotations.

Carmen explained and discussed the methods used todetermine how the B-Seated ‘Flow’ cushion canprovide a significant decrease in oedema and asignificant increase in blood perfusion of the skin,particularly in the area of the ischial tuberosities. Thecushion provides constant stimulation of the muscles,ligaments and discs of the lumbar and lower thoracicregion of the spine. The constant spinal torsion creates“alternating pressure gradient between the centre andperiphery of the intervertebral disc” (Deursen, 2003).The consequence of this ‘Pumping’ action promotesincreased disc height and a-vascular nutrition.

Static seating has developed to provide increasedsupport and pressure relief. This is reflected throughsolutions involving pressure relieving foams, air filledcushions designed to mould around the contours of the


DDyynnaammiicc SSeeaattiinngg TToo RReedduuccee LLoowweerr BBaacckk PPaaiinnSSppeeaakkeerr:: CCaarrmmeenn PPllaattvvooeett,, EEnnggiinneeeerr,, BB--SSeeaatteedd

CONFERENCE REPORT: DYNAMIC SEATING TO REDUCE LOWER BACK PAIN

body and powered seating functions, which have nothistorically been in use for a long period time. Dynamicseating takes the principles of static seating, andintroduces movement to create varied support andallow a higher degree of user freedom. The principlesconveyed by Carmen represent a new approach inevidence based dynamic seating; to reduce lower backpain through movement induced by the seating.

I tried the cushion. The sensation of movement is verysmall and not unpleasant. I do not suffer from lowerback pain and could not give a definitive answer onwhether it would help relieve any kind of pain. I mustadmit prior to trying the cushion I was rather sceptical.However, the evidence presented in this workshop,together with references given below, suggest that thisapproach would be effective in helping to treat lowerback pain due to prolonged seating. The principlesdiscussed by Carmen are definitely food for thought.

RRiicchhaarrdd RReeaaddiinngg,,WWeesstt MMiiddllaannddss RReehhaabbiilliittaattiioonn CCeennttrree,,

9911 OOaakk TTrreeee LLaannee,, SSeellllyy OOaakk,,WWeesstt MMiiddllaannddss BB2299 66JJAA

RReeffeerreenncceessAndersson GBJ (1999) Epidemiological features ofchronic Low-back pain

Deursen v, DL (2000) Lumbar disc mechanics indynamic sitting

Deursen v, L (2003) Low Back Pain and EverydayActivities (Available from: http://www.b-seated.nl/page.aspx?page_id=73) www.b-seated.nl

Goossens, RHM (2004) Blood perfusion of the skinwhen seated on a translating cushion

Jensen, CV (1992) Spontaneous movements withvarious seated-workplace adjustments

Nachemson AL, Johnson E.(2000) Neck and BackPain: The Scientific Evidence of Causes, Diagnosis andTreatment

Snijders, CJ et al (2000) Effect of continuous passiveseat pan movements on physiological oedema of thelower extremities during prolonged sitting

Taylor H, Curran NM (1985) The Nuprin Pain Report.New York

CONFERENCE REPORT: DYNAMIC SEATING TO REDUCE LOWER BACK PAIN

2255 Vol 22 Spring 2006

OOnnee mmiinnuuttee ooff ssiilleennccee……....

Today we mourn the passing of a beloved old friend, Common Sense, who has been with us for many years.

No one knows for sure how old he was since his birth records were long ago lost in bureaucratic red tape.

He will be remembered as having cultivated such valuable lessons as knowing when to come in out of the rain,why the early bird gets the worm, life isn’t always fair, and maybe it was my fault.

Common Sense lived by simple, sound financial policies (don’t spend more than you earn) and reliableparenting strategies (adults, not children, are in charge).

His health began to deteriorate rapidly when well intentioned but overbearing regulations were set in place.

Reports of a six-year-old boy charged with sexual harassment for kissing a classmate; teens suspended fromschool for using mouthwash after lunch; and a teacher fired for reprimanding an unruly student, onlyworsened his condition.

Common Sense lost ground when parents attacked teachers for doing the job they failed to do in discipliningtheir unruly children. It declined even further when schools were required to get parental consent toadminister paracetamol, sun lotion or a sticky plaster to a student; but, could not inform the parents when astudent became pregnant and wanted to have an abortion.

Common Sense lost the will to live as the Ten Commandments became contraband; police forces becamebusinesses; and criminals received better treatment than their victims.

Common Sense took a beating when you couldn’t defend yourself from a burglar in your own home and theburglar can sue you for assault.

Common Sense finally gave up the will to live, after a woman failed to realise that a steaming cup of coffeewas hot. She spilled a little in her lap, and was promptly awarded a huge settlement for her injuries!

Common Sense was preceded in death by his parents, Truth and Trust; his wife, Discretion; his daughter,Responsibility; and his son, Reason. He is survived by three stepbrothers; I Know My Rights, Someone Elseis to Blame, and I’m A Victim.

Not many attended his funeral because so few realised he was gone.

Three speakers gave their uniqueperspective of personal experiencesof wheelchair services. This sessionwas of particular importance being aHealth Care Professional workingwithin the field of wheelchair andspecialist seating. Time constraintsand large caseloads make it difficultto listen and discuss with serviceusers their views.

It was an enlightening and beneficialsession that encouraged discussionfrom the floor and individualreflection on one’s own practice.

11.. LLiinnddssaayy DDuuttttoonnLindsay started by stating she hasbeen a wheelchair user since 1972.Her experiences as a child are rathernegative. Her wheelchair wereheavy, cumbersome, noisy (lots ofclunking) and continuously requiredrepair. Consequently, she sufferedlong-term damage to her wrists,upper limbs and shoulders as a resultof fifteen years as a full-timewheelchair user.

The wheelchair service implied shewas at fault for the high level ofrepairs needed. In reality, Lindsayfelt she was trying to be an activeteenager wanting to go to college,university and travel. On occasion,repairs could not be carried out untilthe following day, leaving herimmobile. She felt she had nocontrol and no confidence with thewheelchair given or serviceprovided.

Lindsay therefore, privatelypurchased a wheelchair as she feltthis was her only option. This proved

to be an excellent experience and thewheelchair never let her down.

Lindsay lost touch with thewheelchair service authority untilshe heard about the VoucherScheme. She then purchased anactive user wheelchair with alightweight rigid frame and foundthe change to be extremely positive.It highlighted to her how much shehad been held back previously.

Lindsay meets many wheelchairusers in her work at Salisbury. Shegets frustrated by the wheelchair‘postcode lottery’. There appears tobe no standard criteria for provisionacross the country. She concludedthat a well built, well designedwheelchair that meets anindividual’s clinical needs should beprovided across the board and not bedependant upon where you live.

22.. DDaavviidd TThhoorrnnbbeerrrryyDavid believes he has had favouredtreatment due to his job and place ofwork and therefore not had ‘normal’provision. He has obtained hiswheelchair in the following ways:private purchase; Access to Workand N.H.S. wheelchair. His mainexperience is with poweredwheelchair as he has never been ableto effectively self-propel. He statesthat as health care professionals weshould be aware of potential changesin individual’s roles, responsibilitiesand attitudes if their disability isprogressive.

David’s first wheelchair was astandard self-propel manual withquick release wheel. He needed the

wheelchair for casual use. It wasused on a family holiday to Norfolkwhere there were lots of hills. Hesaid his role had changed. He wentfrom being independently mobile toa dependant person. He was passivebut a willing passenger pushed byhis 5ft. 2” wife. Her role had alsochanged.

David knew early on that he wouldbe likely to require help for futuremobility and independence. Heinvestigated electric poweredwheelchairs. There was limitedfunding at his service therefore hebought privately.

From his experience, he gave thefollowing advice about the privatemarket:• visit a retailer with sufficient

variety of stock andmanufacturers,

• preferably visit several dealers; • know the space limits within your

home,• know what you want wheelchair

to do,• if you are unable to get a timely

assessment through thewheelchair service, a privateOccupational Therapyassessment may be an option,

• avoid week-end newspapersupplements due to their limitedrange and possibility of no‘come-back’ in some instances,

• be cautious of charity sources(not charity funding) as provisioncan be inappropriate,

• wheelchair users should considerhow their wheelchair will betransported -plane, train, car,van?


““LLeett mmee iinnffoorrmm yyoouu”” –– UUsseerrss’’ vviieewwssSSppeeaakkeerrss:: LLiinnddssaayy DDuuttttoonn,, PPaattiieenntt EEdduuccaattiioonn CCoo--oorrddiinnaattoorr,, NNaattiioonnaall SSppiinnaall IInnjjuurriieess CCeennttrree,,

SSttookkee MMaannddeevviillllee HHoossppiittaall DDrr.. DDaavviidd TThhoorrnnbbeerrrryy,, CCoonnssuullttaanntt iinn RReehhaabbiilliittaattiioonn MMeeddiicciinnee –– DDiissaabblleemmeenntt SSeerrvviicceess CCeennttrree,, PPllyymmoouutthh

RRuutthh EEvveerraarrdd,, SSoolliicciittoorr,, LLoonnddoonn

CONFERENCE REPORT: “LET ME INFORM YOU” – USERS’ VIEWS

CONFERENCE REPORT: “LET ME INFORM YOU” – USERS’ VIEWS

• insurance is also important,especially third party for outdoorelectric wheelchair provision,

• funding can be obtained viavarious sources,

• Motability provide electricwheelchair but most people tendto chose cars with theirallowance,

• there are a number of goodcharities who fund equipmentsuch as ‘Whizz Kidz’ forchildren,

However many individuals have torely on their Disablement Services

Centre and may be restricted by thewaiting list and criteria.

David concluded by stating thatprovision of a wheelchair should bean enabling event. His quality of lifegreatly improved with his electricwheelchair. He could access shops,theatres, pubs and so forth.

33.. RRuutthh EEvveerraarrddRuth said that a disabled personmust put in more effort to have thesame experience as an able-bodiedperson. She was born to an engineerfather and a social worker mother

who were keen for her to experienceas many ‘normal’ life events aspossible. They believed she shouldbe mobile at the age a child withoutdisabilities would be. She was issuedwith a powered wheelchair at twentymonths and qualified recently as aSolicitor. Her parents own thecompany Dragon Mobility and sheuses one of their wheelchairs with ariser facility.

NNiiccoollaa TTaammsseettttOOccccuuppaattiioonnaall TThheerraappiisstt

NNoorrtthh BBrriissttooll TTrruusstt

2277 Vol 22 Spring 2006

PPMMGG LLooggoo RReeddeessiiggnn CCoommppeettiittiioonnDesign a new Logo for PMG and WIN £100

PMG need’s a new up-to-date modern logo that represents what the organisation stands for.

Here are samples of the logos we have had in the past:

Criteria: The logo design’s finished size to be no more the 3cm x 3cm in size.

All entries to be submitted no later than the 30th June 2006.

Submissions to be made either by mail to:Patricia Marks, PMG Administration 2006, PO Box 776, Taunton, Somerset TA1 9BR

or via e-mail to: [email protected]

All entries to be judged by the PMG Committee.

The winner will be notified in writing no later than 31st July 2006.

The Bioengineering Section is responsible for theapplication of engineering expertise in clinicalmedicine to improve patient care. In addition to theRegional Centre, facilities are available at theCleveland, Cumbria and Durham Units. This ensures alocal service with regional support. The Sectionprovides both bioengineering and mechanicalengineering support to other Sections and Units of theDepartment, ensuring quality assurance for themechanical aspects of the Department’s activities. TheSection has strong links with Communicate at theRegional Rehabilitation Centre and the Centre forRehabilitation Engineering Studies (CREST) at theUniversity of Newcastle Upon Tyne.

RReeggiioonnaall RReehhaabbiilliittaattiioonn EEnnggiinneeeerriinnggRegional Rehabilitation Engineering, consisting of theMobility Service (RREMS) and the Technical AidService (RTAS), provides engineering support to a widerange of District, Sub-Regional and Regionalrehabilitation agencies within the former NorthernRegion. Good links are maintained with the Medicinesand Healthcare products Regulatory Agency (MHRA)at the Department of Health and, in particular, with theWheelchair Evaluation Centre at Blackpool. A new anddeveloping service, Gait Assessment in the North(GAiN), is being increasingly recognised as importantin the area of Clinical Audit. Compliance withinternational regulations has high priority and theSection has developed its procedures in line with theMedical Device Directive and is a registered (CE)manufacturer of Class 1 rehabilitation equipment.

RReeggiioonnaall TTeecchhnniiccaall AAiidd SSeerrvviiccee ((RRTTAASS))This service has been available for almost thirty yearsand is nationally recognised as an appropriatemechanism to deliver Assistive Technology to peoplewith disabilities. The combination of local cover andregional structure means that all technical problems canbe referred to the service and an appropriate solutioncan often be found. Staff in the Section have developedconsiderable expertise in the assessment of clientability especially concerning communication, computeraccess and mobility. The service provides technicalsupport to Communicate at the Regional RehabilitationCentre, Newcastle and important developments havetaken place in this arena. Although Communicate offer

a short term loan service to establish the value ofcommunication aids before purchase, this is oftenfrustrated because special mounting kits have to beobtained to provide the optimum operational position asdetermined from the RTAS assessment. We now holdversatile mounting kits that can be used on short termloan allowing complete systems to be tested by clientsbefore a commitment to purchase is made. Thisconsiderably enhances the overall level of serviceprovided to clients.

EEnnvviirroonnmmeennttaall ccoonnttrrooll ccoooorrddiinnaattiioonnBioengineering staff are involved in coordination of theenvironment control service in Newcastle. The role ofthe coordinator is to ensure that the equipment providedin the client’s home meets the needs of the client; thisinvolves the organisation of a case conference, writingof a report, checking the provision and ensuring theinstallation is successful. A RegionalAssessor/Coordinator is now employed by Northgateand Prudhoe Trust who have take over the budget forthe northern region – this has led to increasedinvolvement by RMPD in offshoots from the ECprovision, such as computer access assessments andtechnical aid service referrals.

TTeelleeccaarree pprroovviissiioonnTelecare is a relatively new area of assistive technologyencompassing the remote monitoring of a client’s homeenvironment to give early warning of hazards such asgas escapes, wandering, flooding due to running tapsetc. Bioengineering staff have been advising NewcastleSocial Services on the setting up of a pilot project, inconjunction with the Community Care Alarm Service,to demonstrate the feasibility of provision. This hasbeen in operation for the past 18 months and a fullservice is preparing to go on stream from April 2006.

GGaaiitt AAsssseessssmmeenntt iinn tthhee NNoorrtthh ((GGAAiiNN)) After many years planning the Newcastle gait labopened in December 2004 sharing space with the SportScience Department at the University of Northumbriaon the city centre campus. The lab offers 3D movementanalysis, force measurement, electromyography andenergy consumption measures. The lab is runcollaboratively between the Orthopaedics Departmentat the Freeman and Bioengineering at RMPD with an


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ARTICLE – RMPD NEWCASTLE

orthopaedic consultant, a paediatric physiotherapist anda clinical engineer. Patients who previously had totravel to Oxford or Oswestry can now be seen morelocally and demand for the service is good with patientscoming from around the Northern region.

The equipment previously used for the 2D gait servicein Jarrow has been adapted to provide a mobile videovector service, using three modified electricwheelchairs. The service visits physiotherapydepartments around the region and the clinicalengineers work with the local physiotherapists andorthotists to provide an assessment service forprescribing and tuning orthoses.

EEdduuccaattiioonn aanndd TTrraaiinniinnggThe Section continues to support education and trainingboth within the Department and through contributing toUniversity undergraduate and post graduate teachingprogrammes.

RReesseeaarrcchh && DDeevveellooppmmeennttR & D work has taken place in a number of areasencompassing fundamental new work and commercialdevelopment. A collaborative project, withPhysiotherapy staff at Northgate Hospital, investigatingthe influence of differing care regimes on standingtherapy has been completed and is being written up

An assessment rig has been produced to provide anobjective measure of whiplash injury, in an attempt tocategorise the severity. Load cells are used to measurethe force generated by the neck muscles, to determinewhether there is a link between the measured force andthe level of pain or decrease in function described bythe patient.

Methods of testing hip protectors are being designedand evaluated to help improve the lives of elderlypatients at risk of falling and sustaining a fracture of thefemoral neck. The position and the tissue viabilityaspects of wearing the hip protectors in garments havebeen evaluated, in particular the interface pressures thatmay exist whilst lying in bed.

FFlloooorriinngg rreesseeaarrcchhRetrospective measures such as floor mats, could be putin areas where the elderly are known to fall and breaktheir hip, next to the bed is a common site. However,floor mats present another potential source of trippingand are only transient measures. The underlay, and itsrole as reducing the energy and peak forces transmittedto the hip from a lateral fall onto the greater trochanter,provides a more permanent solution and because it ishidden from view, aspects of texture and colour are notconsidered when floor coverings are purchased. Testson flooring materials using the impact tester for hipprotectors clearly show that the impact resistance ofconventional floor coverings such as the commonVinyls and carpets are not necessarily improved tolevels that would reduce the energy levels and peak


2299 Vol 22 Spring 2006

Interface pressure pad under a rigid hip protector pad

Interface pressures for various designsof hip protector

Reduction in impact forceon different flooring materials

Towards the end of the lastmillennium, as the then manager ofthe Special Controls Service, Ibecame increasingly concernedabout the complex systems we wereimplementing for some of ourclients. Not in terms of theelectromechanical constructiontechniques, but in terms of thepossible adverse effects we may behaving on the electro-magneticcompatibility of the systems wewere modifying, i.e. increasing theiremissions beyond regulatory limits,or reducing their immunity andtherefore their safety and fitness forpurpose.

The Special Controls Service, part ofthe West Midlands RehabilitationCentre, focuses on the needs ofpeople with complex disabilities,with a view to providing a measureof independent powered mobility.This is achieved by an initial

assessment, followed by aclinical/technical report to thereferring or funding authority. TheSCS then undertakes to supplystandard commercial items ofequipment, often in a non-standardconfiguration, to satisfy theparticular needs of that client. Wheresuitable commercial equipment isunavailable, the SCS undertakes tomodify available equipment, ordesign equipment or systems thatwill perform the function required.This often involves modifications tothe existing installed electricalcontrol systems.

Electronic components aresusceptible to Radio FrequencyElectro-Magnetic Interference, but anumber of design principals andcounter measures can be applied toreduce their sensitivity, in order tominimise the risk of the systemmalfunctioning with possible

dangerous consequences.

It is true that risk cannot always bedesigned out of systems, and EMCissues are a particularlyuncontrollable set of risks as sourcesof RF interference can be mobile –vehicle CB radio and police,ambulance and fire service radiosystems – whilst at the same time therecipient systems are also mobile,i.e. manual and poweredwheelchairs. Powered wheelchairsin particular do not have a fail safemode, and if you are driving yourEPIOC across the road, if there wasa fault, would you want the chair tokeep going, or to stop, in the middleof the road!

One approach to this problem is todo the modifications and hope toGod nothing goes wrong. As I had agood knowledge of the regulatoryand technical systems requirements

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forces to safe levels with the pressed rubber foamunderlays that are commonly used.

Thick underlays greater than 15mm may present withother problems such as traction of wheeled devices(Hoists/wheelchairs) and we are currently evaluatingthis effect with these new materials. The force to movehoists and wheelchairs over different flooring materialsare to be evaluated.

EEffffeecctt ooff wwhheeeellcchhaaiirr aanngguullaattiioonn aanndd ffoooottrreessttss oonniinntteerrffaaccee pprreessssuurreess..A wheelchair base was developed that is able to displaythe interface pressures. The frame was angulated at 5degree lateral slopes and footrests raised and removed

to ascertain the pressures under the Ischial tuberosities.A dynamic representation of using the wheels showsthe movement of the interface pressures and could beused to show the effect of wheelchair speed on thegeneration of shear stresses at the interface between theIschial tuberosities and the wheelchair seat.

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ARTICLE – DEVELOPMENT OF AN IN-HOUSE EMC

for EMC and Medical Devices, thisoption was becoming increasinglyimpossible for any professionalengineer to contemplate. And in anycase, if something did go seriouslywrong, and we had made no attemptsto ascertain the EMC compliancestatus of our modifications, we couldbe open to litigation and indeedcriminal proceeding.

It is currently a legal requirement tomake a declaration on the EMCperformance of medical electricaland electronic products that aremanufactured in house. Whilst a riskanalysis can suffice on one or two ofthe simpler products, the majoritymust be tested in order to determineand/or confirm their level ofcompliance. Testing would provideus with a greatly enhancedconfidence that the products andsystems we supply to our clients aresafe for them to use as far as it isreasonably practicable to determine.

By not undertaking the testing ofsystems provided to clients, ourTrust is placing itself at risk. Shouldan incident occur and the EMC

status of the system be called toaccount, the lack of any testing couldreflect very badly on the Trust.

Commercial EMC testing facilitiescharge in the region of £1000 perday for tests of this nature. Thiswould severely limit the efficiencyand effectiveness of the componentsor systems developed by the SCS aswe did not have access to, nor canwe pass on to the localWheelchair Services,costings of this magnitude.For this reason the in-housesystem was considered.

A bid was made to the Trustfor a modest initial sum ofmoney with which topurchase some basic testequipment and to constructwhat one could describe asa “good amateur” chamber.The bid was successful andin 2000 construction began.

The design of the chamberis a simple timberconstruction with a steel tinplate outer shield, and an

inner lining of woven wire meshwhich acts as a partial absorber. Sixtons of timber were used in theconstruction. The design is able tocarry another nine tons of ferriteabsorber which we plan to install asand when funds allow.

The chamber is 9.6m long, 5.8mwide and 4m high. This is bigenough to be upgraded to fullInternational compliance in thefuture by the installation of thecorrect RF absorber.

The steel plate was applied bysoldering two sheets together toform a 4m length and lifting it intoplace like wallpaper. This was thennailed into place with galvanizedbroad headed nails. The sheets areoverlapped to form an effective andcontinuous RF shield which extendsover the top and bottom of thechamber.

The door to the chamber is 1.2mwide by 2m high. The door isdesigned to carry 200kg of absorber,and is big enough to accommodatemost types of equipment suitable fortesting in a chamber this size.

3311 Vol 22 Spring 2006

ARTICLE – DEVELOPMENT OF AN IN-HOUSE EMC

The floor of the chamber is raised bysome 200 mm, which will allow usto incorporate a turntable in thefuture. The turntable is particularlyuseful for easily finding the angle ofmaximum emission for theequipment under test (EUT). Varyingthe height of the antenna is the otherpart of finding the maximumemissions. A full emissions scan cantake a long time to perform and at themoment we tend to take a morepragmatic approach of testing fromthe four notional sides of thewheelchair / EUT.

In subsequent years we were luckyenough to benefit from further endof year monies, allowing us topurchase a professional RF receiver,50W RF amplifier and some otheritems of test equipment whichtogether allow us to beginundertaking pre-compliance testingwith an acceptable level ofrepeatability and reliability.

In terms of the tests we are now ableto perform, we can measureemissions from 150kHz to 2.75GHz,test for susceptibility to ESD andmains transient effects and performsome basic radiated immunitytesting – which was our biggestconcern. We have also constructed awheelchair wheel speed monitoringrig, although this needsimplementing in a more elegant wayby the creation of some in housesoftware to compare the wheel speedreadings and perform thecalculations as per the limits in thestandards for allowable wheel speedvariance.

An emerging theme is that theelectrical noise radiated from theolder powered chairs we are testing,before we have modified them, is

close to or sometimes exceeds thelimits in the regulations.. We don’tyet have a sufficiently largestatistical sample to say if this is asignificant issue, and we know thenoise is predominantly from themotors when they are running. Thisinformation may be useful as apredictor for the life expectancy ofmotors, or for determining if aparticular set of motors needsreplacing. This may be anopportunity for further research.

We have also found that some of thecomputer equipment mounted tochairs is very electrically noisy, andwhile different standards apply forcomputer equipment, what exactly isthe case when that equipment ismounted on a wheelchair in aclinical environment?

We now regularly use the chamberto test wheelchairs which are havingmore complex modifications such asthe mounting of ventilators whichrequire either an on board generatedmains supply, or voltage conversionfrom the wheelchair 24v to 12v forinstance. One area of interest that Iwish to pursue is to be able to

measure the conducted noise beingfed into a ventilator by an on-boardgenerated DC supply, or indeed thelevel of noise being fed back into thewheelchair control loom from such asystem. This requires themanufacture or purchase of a LineImpedance Stabilisation Network –or LISN. This has specificimpedances, inductances and filtercharacteristics, but is normallyemployed for mains measurements. Ihave yet to explore locating asuitable commercial LISN for lowvoltage DC circuit measurement.

The final outcome of this workwould be the provision of an EMCtesting facility meeting all theNational and International fielduniformity requirements, enablingus to test to International Standards.We recognise that this will take aconsiderable amount of time, moneyand effort. The end result however,would be confidence that we aremeeting our regulatory requirementin terms of the electromagneticcompatibility of the work of theservice. This reduces the risk to theTrust, and more importantly to theclients we serve.


The “Learning Journey” was presented at one of theWake-up sessions (CPD – “Are you fit to practice….?”)at this year’s PMG National Trainig Event in Lytham StAnnes. As a result I have been asked to provide a shortsection on ‘what it all means’ for the broadermembership.

The “Learning Journey” was developed by the HealthCouncil of The Prince of Wales’ Disability Partnership.It came into being almost by accident as a result ofdiscussions around the General Medical Councildocument “Tomorrow’s Doctors” (GMC 2002). Whilstconsidering this document, the council commented thatthere was very little discussion about the particularinteractions with patients who are disabled, nor wasthere much acknowledgement about the changingrelationship between doctors and their patients,particularly those with long term or chronicimpairments. Furthermore it rapidly became apparentthat many of the ‘requirements ‘for doctors wereequally applicable to other health and social careprofessionals. The resulting document is actually called‘Learning Journey for Health and Social CareProfessionals who Work with Disabled People’.

I started the process by trying to define what studentsneeded to know at the various stages of their careers,and decided on undergraduate, postgraduate andconsultant. For each of these grades the familiarknowledge, skills and attitudes framework was applied(Miller 1996). However, it was agreed that one of theunderlying themes must be lifelong learning (ratherthan just a linear progression from left to right) with theimplication that if one fails to develop one’s knowledgeit can rapidly become out of date. It was thereforedecided to replace undergraduate with novice,postgraduate with competent and consultant withexpert. As a result the ‘journey’ is more of a matrix withthe potential for someone to have different levels indifferent areas, but with the assumption they are tryingto continually strive for the expert categories, and notslip back to becoming a novice.

The ‘Learning Journey’ was developed by an iterativeprocess amongst the council members, their colleaguesand contacts, and most critically with disabled people.

Although this informal process could be critcised, thematrix was compared with the rigorously structuredDelphi Consultation in Different Differences (2005)and there was a gratifying degree of consensus.However in order to address this weakness, the“Learning Journey” is now being validated anddeveloped in conjunction with Keele University.

Currently the “Learning Journey” can be used in anumber of ways e.g. as a personal tool for assessingone’s own developmental needs; as a template forplanning training rotations; as a framework for settingstandards when working with disabled people.However it is still in a developmental stage and is likelyto be modified with ongoing work.

RReeffeerreenncceess::The General Medical Council (2002). “Tomorrow’sdoctors. Recommendations on undergraduate medicaleducation”.

Miller G E.(1990). The assessment of clinical skills/competence/ performance. Invited reviews AcademicMedicine Vol. 65 (9) September supplement.

The Delphi Consultation in ‘Different Differences:Disability Equality Teaching in Healthcare Education -a document for action’(2005).

Produced by “Partners in Practice”: a collaborationbetween the University of Bristol and the University ofthe West of England and the Peninsula Medical School.

3333 Vol 22 Spring 2006

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ARTICLE – THE “LEARNING JOURNEY”

Inserted in this publication, to accompany this article, is a reference guide to the Learning Journey thatcan be used as a possible aid memoir, future reference resource and potential discussion document.

(Learning Journey guide printed on blue paper).

LLeeaarrnniinngg“What I hear, I forget.

What I see, I remember.

What I do, I understand.”

Confucius

On the 2nd Tuesday of every month,the doors at Newham WheelchairService are open for all to “drop-in”.Clients, carers, families orprofessionals are welcome to discussany matter ranging from newequipment, pressure problems, tosimply having a chat about the‘latest Olympic developments’. Onthis day, the whole team are presentallowing efficient yet friendlyservice, including a cup of tea forthose waiting.

The Drop-In-Clinic evolved directlyfrom clients and staffs’ desire tohave a more accessible wheelchairservice and to reduce waiting times.It enables clients to choose the timemost suitable for them, providingcontrol over their treatment. Notonly can clients be assessed for newequipment, they can access staff foradvice including wheelchair fitness,transport issues & holidays,collection of equipment, trial ofcushions/ wheelchairs and generalupdate/chat.

The Department of Health (DH2004) have identified that byoffering a choice of time it enablesclients to fit their treatment in withtheir life, not the other way around.They also state that if clients are ableto discuss their treatment options,they experience a more personalizedhealth service.

Through discussion with thewheelchair user group, it wasdecided that the best approach wouldbe to offer the same day of everymonth and advertise by letters tothose on the waiting list and flyers toGP’s, social services, Allied HealthProfessionals (AHP’s) and localcharities. Information is alsoaccessible on the PCT website. Theclinic has been running sinceJanuary 2004 and has welcomed 295clients resulting in a reduction ofwaiting times from 52 weeks to just4 weeks.

Every user who attends is sent asimple questionnaire asking them

about their experiences of the dropin clinic and we welcome all views.

Having audited the drop in clinic,99% of people were happy with theservice and felt they had a positiveexperience and over 50% of clientswere issued with new equipment,examples of client comments madeincludes:

“Thanks to everyone for assistingmyself and my family for dealingwith a once living nightmare.”

“Everyone was professional yetflexible enabling me to feel relaxedand comfortable with the transitionof using a wheelchair”

“I am very happy now because I cango out in my chair, this is possiblebecause of the drop in clinic. Thankyou very much!”

It was also discovered that althoughhospital transport is offered toclients, only 17% choose to use thismethod of travel, the majoritychoosing to use public or privatetransport.

As a spin off a group of ladies whofound a slimming club inaccessible,‘drop in’ regularly to “weigh in” as away of watching their weight.

This innovation in service deliverymeans that clients can now ‘drop in’,be assessed and ‘roll out’ faster.

RReeffeerreennccee::DH (2004) ‘Choose & Book’ –Patient’s Choice of Hospital andBooked Appointment. DH Londonpub 40578


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NNeewwhhaamm WWhheeeellcchhaaiirr SSeerrvviiccee

ARTICLE – CLIENTS DROP IN TO ROLL OUT FASTER

‘Easy Access’ in 2006?!?!?

The Wheelchair Centre staff from all the independentDistrict Centre’s in Yorkshire Region discussed thestatement by PASA and the MHRA, “that it is up to thePurchasers (Wheelchair Centre’s) to verify the Safetyand Suitability of the equipment we buy on contract andnot them.”

The outcome from this discussion was a call for theequipment to be independently tested or a full Technicalinvestigation to take place before it is put on contract.Followed by independent testing and technicalinspection during the life of the product.

It was a surprise to hear PASA just look at the chairs,cushions and equipment, they do no technicalinvestigations, do not ask for the Technical file, do notverify the claims made by the companies. In the pastTechnical Assessments were completed by the MHRA’spredecessors (STB & MDA) and creditable, criticalreports were circulated.

It has become apparent that because there is minimalvigilance towards CE Marking prior to the productsbeing placed on the market and during the service life,some manufactures are cutting corners.

EExxaammpplleess ooff eevviiddeennccee ooff tthhiiss sseeeenn rreecceennttllyy::Metallurgic tests show that the steel used in someproducts is both of inferior quality and inconsistentthroughout a single item, so how much could be foundacross the range of equipment. On the market andoffered to the manufacturer’s is steel tubing costing 30pence a metre, some made from recycled steel ofuncertain origins. (Standard steel tubing is £1.10 ametre.) Much this cheaper steel is seam welded, somein an inferior manner where the seam splits when bent.

Where this type tubing is used on in a straight section,the faulty welding would not become apparent untilstressed in use, heavy client or an accident.

A good coat of paint (or not such a good coat of paintanother issue is the quality and varying thickness ofpaint.) covers a multitude of sins. In the past Non-destructive testing was carried out on these productsand the thickness of paint monitored.

Chairs independently crash tested proved unsafe,

despite the manufactures claims they were crash testedand safe for use on transport.

Equipment manufactures that make brackets that clamponto chairs are finding they have to use shims, or grindout the inside of clamps because there is so muchvariation in size of the tube/square section used in onemodel of wheelchair. Indicating poor quality controlwith oversized and undersized tubing used.

Buying cheap sub-standard chairs has been justified onthe grounds they are only used for occasional users.What happens if their use changes and becomesfrequent? What identifies these chairs from a standardchair of similar build in use? What would happen if oneof these chairs got into the general stock whenrefurbished. Would you know the difference?

Consideration should be given to what would happen ifa chair that was sub standard failed and the user wasinjured and sued.

Chair and cushion materials. The Regulations say thatthe upholstery on the chair should be fire Retardant andBio-compatible.

However, when independently tested chairs have failedthe fire Retardant standards and the Bio-compatibilitystandards, despite being CE Marked. Is this an isolatedcase? Think back to the number of recalls we have hadon products from reputable firms. How much is there inservice that would fail?

Documentation : There seems to be a lack of the correctDocumentation. I am finding chairs being deliveredwith out hand books, also recently told by amanufacturer that I could not have Technical and Partsmanual for a new chair on contract, because they havenot been written yet. Life cycle cost that should bequoted in Technical files, we are told that they are eithernot quoted or not verified.

Taking into consideration that the Medical Devicesregulation clearly say that the CE Mark “should not beseen as a guarantee of safety” What steps have youtaken to verify the Manufacture’s claims?

The Manufacture can exclude certain sections of the CE

3355 Vol 22 Spring 2006

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ARTICLE – THE NEED FOR INDEPENDANT TESTING

requirements and testing if they do not think they arerelevant.

WWaass tthheeiirr aasssseessssmmeenntt ccoorrrreecctt??An Example of this is the Regulations say the armsshould either come off or stay on if some one tries to liftthe chair occupied. Some Manufactures make the armso it lifts out. If they make it a tight fit to stop it fromrattling, this allows the chair to be partially liftedunoccupied then separates and could injure the lifter.

The Regulations also say the Manufacture should riskassess to see if any action could lead to an injury. Doyou think the lift out Manufactures have done this?

The Regulations say as a Service we should adhere tothe Manufactures maintenance instruction regardingthe chairs and using trained staff and the correct parts. -Failure to do so reduces the life of the chair, invalidatesthe warranty, product liability, and possibly its crashtested status and CE mark. Can we show our RepairContractors are doing this?

Cushion material. Have the claims for Fire Retardency,Biocompatibility and pressure relief beenindependently verified? - Swapping lose covers caninvalidate all the above.

Do Manufactures get it wrong? Remember that we hada big recall on cushions and canvases

EMC Tests: added electrical equipment (power packsfor example) should have and EMC test, because each

different chair frame structure has a different affect onthe emissions of the electrical equipment, that itsManufacturer cannot test for unless they know exactlywhere you are going to fit it on what frame.

Is the Information and Labelling on all chairs andcushions adequate? e.g. are Appropriatedecontamination and washing instructions available?

SSuummmmaarryy CE Marking does not provide or prove integrity.

If you are in any doubt ask to see the Technical file andsatisfy yourself that the product is appropriately CEmarked. • Ensure that the product is issued in accordance with

the Manufacture’s instructions.• Train the user in the appropriate product use.• Ensure that the product is adequately maintained in

accordance with the manufactures instructions,trained staff and correct parts.

• Don’t modify the product without contacting theManufacturer or carrying out your own RiskAssessment.

• Correctly marked CE Products should minimise anyrisk and potential litigation.

• Is the equipment being used for it’s intendedpurpose?

We should not forget about the end user, they deservean included lifestyle using products that do not putthem at risk.

ARTICLE – THE NEED FOR INDEPENDANT TESTING


“No pressure, you can think about itbut if you want to ……………”.“Fantastic, you’ll be absolutelyknackered but while you’re thereyou must ……………” Just a coupleof remarks I was hearing within acouple of minutes of learning I’dwon a trip to the 22nd InternationalSeating Symposium in Vancouver. Ididn’t really take in that it was to beheld in only three weeks! The rest ofmy time in Blackpool and the triphome was a bit of a blur.

Having rearranged a number of workand domestic commitments, spentmany hours on the Internet sortingflights, accommodation and bookingwhich sessions I wanted to attend, tosay nothing of giving the old creditcard anaphylactic shock, I was off onmy travels.

The journey took twenty one hoursdoor to door and with the eight-hourtime difference, it made for a verylong day. The journey wasstraightforward, although we werenot told exactly how a member of theflight crew managed to break herankle during the flight! I’d lay moneythat if she needs a wheelchair, thebaggage handlers won’t trash herslike they do ours! Sitting for almost15 hours was a timely reminder ofwhat some our clients do day afterday, though. Think I’ll take apressure-relieving cushion next time.

Held annually, the InternationalSymposium alternates betweenVancouver and Orlando with 630participants including 60 exhibitorsattending this year. The format of theSymposium is similar to the PMGConference (or should that now be

Training Event) with plenary andindividual sessions, as well as posterdisplays and exhibition held over atwo and a half day period. There wasalso a one day pre-symposiumworkshop I was able to attend.

The pre-symposium workshops Iattended were informative hands-onevents. The morning one was onmaintenance, setting up andadjusting wheelchairs. Although alittle basic, it suited me after theprevious days flight and there isalways something to learn.

The afternoon workshop covered theevaluation of switch selection bymatching users needs and abilitieswith appropriate technology andmounting options. Funding issueswere also discussed, which seem tobe a universal problem. The sessionended with an opportunity to try outsome of the special controls on avariety of chairs. Great fun!

Dr Martha Piper, the keynotespeaker, encouraged everyoneattending to question presenters andexhibitors and think how to applytheir learning and take theknowledge back to their places ofwork. Highlighting the constantchange to service provision and howeasy it is to look back to “the goodold days” ,she pointed out that therewere no “good old days” for peoplewith a mobility problem. She thengave a personal account of howrelatively simple mobility aids havegiven her elderly mother a new leaseof life by highlighting the advancesin design and the number of productsavailable in recent years that madethis possible.

With this in mind I felt prepared.Before leaving home, I’d alreadyasked the question, “What’s thedifference between a Conferenceand a Symposium? - Very littleaccording to my dictionary althoughI liked the definition that stated it’s“a drinking party with intellectualconversation, music etc.” So what’sthe difference between a Conferenceand a Training Event? It’s supposedto be easier to get managers to fundTraining Events.

Here’s just a flavour of presentationsI attended …….

Having cited Karen Kangas whenwriting a study assignment onpowered mobility for youngchildren, I was particularly pleasedto see she was presenting twosessions at the symposium –‘Powered Mobility Training forYoung Children’ and a jointpresentation with Lisa Rotelli on‘Mouse Emulation with MultipleSwitch Access’.

Her humorous “no holds barred”approach was refreshing to listen toand is clearly a champion for youngchildren to be given the opportunityfor powered mobility. The crux ofher presentation was how thethinking behind how young childrenare taught to drive a wheelchairneeds to change. A child is not taughtto walk by setting up a series ofcones and told to walk betweenthem, turn right, turn left etc. so whyshould a child in a wheelchair?Interesting stuff.

The ‘mouse emulation and switchaccess’ presentation used a number

3377 Vol 22 Spring 2006

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ARTICLE – THE VANCOUVER EXPERIENCE

ARTICLE – THE VANCOUVER EXPERIENCE

of case studies to demonstrate typesof switch available and imaginativeways of mounting them. A video of aswitch mounted into the hand splintof a young girl controlling her chairwith her thumb was particularlynovel.

A trip down memory lanedemonstrated just how far specialseating has advanced in the past 30years. Karen Hardwick gave anentertaining and graphical view ofthe journey from early standardchairs with pillows and restraints,early contouring using FIP withrubberised paint, through to TIS andthe use of current day evaluationtechniques using pressure mapping,Doppler ultrasound and pulseoximetry (don’t ask!) She didhowever finish up by sayingsometimes simple solutions are stillthe best.

A video presentation entitled“Pulling It All Together: WheelchairDistribution in Kenya” highlightedhow many teams and organisationsare required to ship the new andrefurbished equipment and then todistribute, set up and trainusers/carers in its use. It was a hugechallenge in a difficult environmentand an example of collaborativeworking making a substantialdifference.

“Keep on Pushing” was apresentation on the pros and cons ofremaining in a manual, as opposed tousing a powered wheelchair. If themanual wheelchair is chosen,prescribed and set up appropriatelyfor each client, then the numeroustherapeutic benefits of manualmobility are possible.

The 6th Chris Bar Research Forumwas a highly entertaining debate.The subject - “This house believesthat client choice takes precedence

over professional judgement”. Thepanel was made up of two teams ofthree plus chairman (GeoffBardsley) all dressed in courtroomattire complete with gowns andwigs. The arguments were madewith great humour and deliberatelyextreme but important and seriouspoints were made and debated. Twovotes were taken. At the start thehouse was almost unanimous thatclient choice should take precedentbut the second vote at the end wasvery close – but client choice stillwon the day.

The networking, as at the PMGConference is always useful and Imet a number of interesting people.With such a short time betweenwinning the trip and going toVancouver, I was unable to arrangeany visits and would have liked tovisit Sunny Hill Health Centre forChildren, one of the symposiumssponsors. Staff I met from there wereboth friendly and helpful, not leastby telling me of places to visit inVancouver.

As can be seen, there werepresentations from across a widespectrum of mobility and assitivetechnology fields and the above isfar from comprehensive. Researchpapers, case studies, best practiceideas were all there. Regarding theindividual sessions, I often comeaway wondering what were thesessions like I was unable to attend.I know there are the abstracts to readbut as the majority of presenters usePowerPoint, perhaps copies of theirslides could be made available todelegates to download after theconference? Just a thought.

The exhibition was similar to that ofPMG. Most of the major players inwheelchair and cushion manufacturewere represented; the maindifferences were those of accessory

manufacturers. There are usually oneor two products that catch the eyeand this was no exception. A productcalled i2i is a head and neckpositioning and support system fromStealth Products. I understand thereis a UK importer, so I’ll look into itas one of our users would benefitfrom such a support although price,import costs and CE Marking maywell be stumbling blocks.

Of course it wasn’t all work. I reallydidn’t want to have travelled all thatway and not see any of whatVancouver has to offer a tourist, so Idelayed my departure for a day anddid a little sightseeing. Vancouverreally is a city worth a visit and Iwould love to have spent more timethere. Perhaps a return trip in 2010 toattend the Symposium and watch theWinter Olympics. Very tempting!

So was it worth travelling over11,000 miles in 7 days? – You bet!Did I learn anything? – A great dealWas I knackered? - Extremely

Many thanks to:• The PMG Committee for making

the whole experience possiblewith special thanks toBarend/BES

• Greenwich PCT for allowingstudy leave and funding the presymposium workshop

• Work colleagues for coveringwhile I was away and listening tome recounting my adventures.

….…….. and just in case anyonewas wondering about the venue. Thesymposium was held in a hoteloverlooking the harbour andwaterfront with views across the bayto Stanley Park, North Vancouverand Grouse Mountain. Suffice tosay, I heard no talk of diggingtunnels and escape committees – as Ihad in Blackpool!


The Care Services Improvement Partnership (CSIP) ofthe Department of Health’s Health & Social CareChange Agent Team, has been running events all overEngland during February and March to try to learn frompeople’s experiences and comments about thewheelchair service. The team have also been looking atother European countries method of service delivery (ieNorway), asking users to complete on line or phonequestionnaires (www LOST at present).

The session in London was held at the Holiday Inn inBloomsbury and the largest number of users was said tohave attended this event compared to any of the otherevents around England – even more disabled loos werecomendeered! (Congratulations to wheelchair servicesfor spreading the word and often for bringing users withthem). The attendees were from a wide variety ofbackgrounds including; users (young people andadults), PA/care staff, teachers and teaching assistants,wheelchair service therapists, RE’s managers,

commissioner (1), Rehabilitation Medicine Consultant(1), charities and numerous DH facilitators. The largegroup was divided into 6 groups (changing at lunchtime so you were with different people), to shareknowledge, discuss experiences, discuss the wayforward and a vision for the future and the usual ‘quickwins’! A novel idea was that of the ‘conferenceillustrator’, who produced flip chart sized cartoonsduring the day, to which the audience were invited toadd their comments of agreement (yellow post it) ordisagreement (pink post it) to the illustrations. (Thesewill be available to us all to use in the future, with nobreach of copyright I gather). The report of the day willbe compiled for the CSIP lead and all attendees will besent copies of this. The report of this ‘Learning day’will be added to the information gained during thewhole exercise and will provide evidence fore theMinister about wheelchair services.

So ‘WATCH THIS SPACE!’

3399 Vol 22 Spring 2006

LLiisstteenniinngg aanndd LLeeaarrnniinngg EEvveenntt –– LLoonnddoonn MMaarrcchh 1100tthh 22000066RRooss HHaamm

The short answer is …….lots!

ISO a worldwide federation of national standardsbodies, BSI is one of these. The work of preparingInternational Standards is normally carried out throughtechnical committees. “Assistive products for personswith a disability” is one of these committees and“wheelchairs” is a sub committee of this.

The work includes reading and commenting on draftstandards, so that the final document is technicallyaccurate and relevant to the subject it refers to. Thecommittee is made up of representatives frominterested bodies such as the MHRA, CSP, BAOT,emPower, wheelchair manufacturers etc and is chairedvery effectively by Alan Lynch from the MHRA.

The main groups of standards discussed will be familiarto many of you, and include 7176 parts 1-26, 16840parts 1-4 and 10542 parts 1-5. These cover manyaspects of wheelchairs including transportation,measuring, crash test dummies, batteries, brakes….thelist is very long!

These standards are used by manufacturers to ensure

the wheelchairs we purchase are safe for our users. Soby now you will be realizing that these standards arevery relevant to those us concerned with the provisionof wheelchairs.

The production of a standard is a long process. Thereare international working groups, made up of peoplewho are experts in certain areas; their task is to draw upnew work items that will be looked at by thecommittees in all countries involved. The documentwill have comments submitted from these countries andchanges made to the original. This is then returned tothe committees for re-reading until it gets to anagreeable format and content. The work is finallyproduced as a FDIS (final draft international standard)and at this stage only editorial comments can beentered. (Literally dotting the “i”s and crossing the“t”s!) From here the standard is voted on and accepted(or not) as an International and/or British standard.There is a time frame that all this has to be completedwithin, and there is nothing more frustrating thancarrying out all this work, only to lose it off theschedule because it has overrun its time.

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Right, now I’ve got your attention I shall explain. Thistopic was discussed in my Chair’s report to the AGM. Itis the NHS (you should know what this stands for …)Purchasing and Supply Agency’s (PaSA) Supply ChainExcellence Programme (SCEP) Customer ConsultationGroup (CCG) for the Pressure Area Care (PAC) nationalframework agreement in relation to products for postureand wheeled mobility i.e. what are commonly called,perhaps unhelpfully, “pressure cushions”, although itnow also extends to back cushions too.

The CCG has five representatives from wheelchairservices who have given input to the development ofthe new cushion specification for the tender exercisewhich is currently underway.

We have been impressing on the PASA team the clinical

importance of these cushions beyond pressuredistribution into the areas of postural and functionalaspects which are so critical to those who use thesedevices.

Following Mike Hare’s report in the last newsletter youshould be aware of the proposal for the possible use ofreverse e-auctions as part of the tender process. This isthe opposite of e-bay bidding and therefore has thepotential to drive prices down, but also has the potentialto squash product choice and innovation which mayultimately affect effectiveness for the user.

As well as contributing to discussion at the CCG on thissubject I also put my thoughts in writing to Val Atwood,who is part of PaSA and is heading up the CCG, and thetext of this letter follows:


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There is a lot of dry reading involved in this committeework. However it has been a chance to make changeand there is a lot to be learnt from these standards. Myintention was to attend a few meetings and find outwhat happens before actually getting involved. I thinkit was half an hour before I began questioning what waswritten and it’s relevance to the world of wheelchairs!

The last year has seen a lot of revisions of standards,whist still working on some new ones. Some of these,e.g. 7179-19, which covers wheelchair tie-down andoccupant restraint systems (WTORS), were not adoptedas British standards first time round, but with therevision comes the possibility of changing it to make itmore acceptable.

5th January 2006

Dear Val

I am writing on behalf of the Posture and Mobility Group executive committee to express concern aboutthe e-auction process and how it might relate to seating cushions.

At the Customer Consultation Group meeting for the Pressure Area Care national frameworkagreement held yesterday in Wolverhampton, we discussed the possibility of some PAC products goinginto an e-auction process. Based on the explanation that an e-auction can only be used for comparableproducts I am concerned how these comparisons will be made.

In all my clinical work I liaise directly with the client to assess for the most suitable cushion. This willusually involve the client trying out a number of cushions to see which they find most comfortable andfrom which they can achieve optimal function, such as propelling and transferring in/out of theirwheelchair.

While for simple blocks of foam of the same size, density, etc, comparisons would probably bestraightforward, it is difficult to see how e-auctions would be useful for more complex cushions. Thereis a lot of variety and I don’t believe conclusive and comprehensive research findings exist to supportthe use of one cushion over another in a particular situation.

It is therefore of paramount importance that the user in need of a cushion continues to have a widevariety of options open to them and that the prescriber is able to find a cushion to meet that individual’sneed. The e-auction process could be extremely detrimental to meeting this need if it is implemented insuch a way that comparisons are not made on equal terms.

If you decide to take the concept of e-auctions further with regard to the PAC agreement I would urgeyou strongly to make reference to the relevant clinical members of the CCG or indeed a wider clinicalaudience with experience in the field. Such a group can advise on the suitability of including anyproduct type in an e-auction thus ensuring we continue to have available choice in the products ourusers require.

I hope these comments are useful. If you would like to discuss anything further please feel free to contactme.

With best wishes

Yours sincerely

David Long, PMG Chair

Clinical Scientist, Oxford Centre for Enablement, Nuffield Orthopaedic Centre NHS Trust

cc (by e-mail). 1. John Cooper, Director for MET, Clinical Equipment and Specialties, NHS PASA2. Neil Griffiths, Lead Category Manager - Clinical Consumables, NHS PASA3. Paddy Howlin, Category Manager for Wheelchairs, CES and EAT, NHS PASA4. Andy Gudgeon, Category Specialist, Wheelchairs, CES and EAT, NHS PASA5. Melissa Gaselee, Category Specialist for Pressure Area Care and Surgical Instruments, NHS PASA6. Ray Hodgkinson, Director, British Healthcare Trades Association 7. Sarah Lepak, Assistant Director, British Healthcare Trades Association 8. Martin Moore, Vice-chair, PMG9. Olwen Ellis, Administrator for PMG

I await a reply from Val but discussions in the interimwith Andy Gudgeon from PaSA, whom many of usknow, are favourable. I therefore have hope that we will

continue to have choice available to us and thatcushions for wheelchair users will not be seen simply ascommodity items like tins of beans.

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4411 Vol 22 Spring 2006

As part of a recent review of the Wheelchairs andAssociated Equipment framework agreement, theWheelchairs, CES and EAT Category has introducedadditional volume based discounts and retrospectiveannual based discounts within the existing nationalframework agreement.

These terms are available to all NHS organisations(including Collaborative Procurement Hubs, SupplyManagement Confederations), Wheelchairs Services,their contracted repairers and maintenance providersand Local Authority equipment services within Englandand the home countries. The new discount structureswhere introduced into the national frameworkagreement on 1 December 2005.

The review undertaken will also see additionalappliances being added to the framework agreement in

February 2006. Further information will be publishedon the PASA website shortly.

A briefing note regarding the recent adaptations to thenational framework agreement can be viewed athttp://www.pasa.nhs.uk/wheelchairs

Organisations wishing to take advantage of the revisedterms introduced to the national framework agreementMUST read the terms and conditions applicable.Detailed information regarding the terms is provided inParts D and E of the briefing note.

For further information, contact Andy Gudgeon on 0777577 7943 or via e-mail at [email protected].

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RADAR will be producing a new practical andindependent Guide which will help disabled and olderpeople find and finance mobility scooters and poweredwheelchairs. Called ‘Get Mobile’, the new Guide willbe published at the end of March 2006. The entireproject has been kindly supported by Motability.

‘Get mobile’ will provide an independent source on thekind of products available, the methods of purchase andhow to finance the purchase as well as advising onoperating costs. The market is still in the process of

raising its standards, so there is also in-depth advice onthe buyer’s rights as a consumer and sources of redressas well as straight forward advice on avoiding anypotential pitfalls.

The Guide will be distributed through the Motabilityand Radar networks.

The website is www.radar.org.uk. The best number isthe switchboard, 020 7250 3222 and to ask for SimonHigginbottom.


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This meeting was attended by approximately 60members including representatives from the followingorganisations: Disability Right Commission, variouscharities, BHTA, BAPO, PMG, BSRM, CORE,DLF,Assist (formerly DLCC), FAST, MHRA, IPEM, NAEP,NHS PASA, RADAR, DofT, Skills for Health. It wasan extremely full day which was I found veryinteresting, useful and well organised. Free too!

The study day began by Keren Down from FAST,reminding the audience of the Audit Commission report(2000) and the AT Forum position paper (Summer2004) which covered 5 Key proposals;• Standards of service delivery,• User Involvement• Service integration• Professional development and Training• Information

Two areas of the key proposals had now been workedon; Standards and Professional development. Thesewould be reported at this meeting.

It was a full prog

nd workforce competencies in assistive technology i. Competency framework for Trusted assessors –

community equipment. (Assist UK formerlyDLCC and South Bank University). MaggieWinchcombe and Dr Claire Ballinger updatedthe group on this work and explained that thishad originated out of the work of the ICES

project and had been supported by a Dept ofHealth Section 64 grant. The work covers a set ofpre-determined competency for the assessmentand provision of equipment – a competenceFramework. There are seven outcomes and theyact as a benchmark for assessor component indifferent roles and sectors and for education andtraining courses. The work is available to bedown loaded from www.tap.assist-uk.org or hardcopies are available from Assist UK

ii. Assistive Technology – an education, a career, apartnership. Keren Down told the group aboutthis document which was published in November2005 and is available from the FAST web site.The document covers;• Documenting indicators of need• Highlighting the agenda to be delivered• Mapping current activity• Establishing an effective approach.The document is available from;www.fastuk.org or [email protected] 020 72533303

iiii. National Occupational standards in AT – apartnership approach. Rav Jayram (Project leadSkills for Health) Skills for Health (SfH) wascreated 2002 as a work force solutions that areflexible in healthcare. Rav spoke about theNational Occupational Standards, NVQ, corecompetencies and optional competencies. Theacademic and vocational pathways, career

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RRooss HHaamm

framework and qualifications frameworks wereall mentioned and the plan is produce ‘buildingblocks’ for the national workforce to acquire. TheSkills for Health are currently mappingoccupational standards for AHP and thecompetencies required to implement the NSF forlong term conditions. SfH are linked to theKnowledge Skills framework which is closelyassociated with Agenda for Change. For moreinformation look at; www.skillsforhealth.org.ukor call 0117 922 1155 oremail:[email protected].

2. Assistive Technology Service Standards – amapping survey and report.i. Standard setting – the government’s approach.

David Wardle covered the recent governmentdocuments that affect the NHS and the AnnualHealth Check such as NICE, Standards for BetterHealth, NSF’s, Healthcare Commission. Thistalk was a foundation to the standards documenttalk that followed.

ii. Existing standards – a mapping survey andanalysis document launch. This document(Assistive Technology – Standards for ServiceProvision Wardle D, Mitchell M, Down K, FinalConsultation draft January 2006), has beenproduced by FAST and is now in its finaldocument stage. It is available on the FAST website and comments from interested parties arewelcomed. This tome is a very useful collectionof the AT standards and relevant documents that

are out there at this time. It is anticipated thatstaff will welcome this collection of usefuldocuments relevant to their practice. Documentscan be downloaded from www.fastuk.org ordetails from 020 7253 3303 email:[email protected].

3. Centre for Evidence-based purchasing (NHSPASA) AT evaluation. Stephen Harbron updatedthe audience about the work of this departmentwhich ‘replaces’ the old MDA evaluation serviceand links with the MHRA evaluation centres (ieDerby). Evidence/evaluation of products will beclosely linked to the PASA purchasing strategy inthe future and the department covers health andsocial care priorities. Members interested in theevaluation of products should review the site.Further details are available fromwww.pasa.nhs.uk/cep and submitting products forevaluation is through the web sitealso:www.pasa.nhs.uk/cep/evaluation/prose_project

4. Information needs of users and professional DLFdata and SARA update. Nicole Penn-Symonsupdated the group about SARA developments andhow this helps clients/users obtain informationabout basic equipment for independence throughquestions on the web. Useful tips are also given onthe site and users are directed to expert assessmentsfor more complex equipment.

www.dlf.org.uk/sara or call 0845 130 9177 for moreinformation.

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4433 Vol 22 Spring 2006

I’m sure most of you would agree that sharingexperience and contributing to the evidence base forour field is a positive aim. Fellow Clinical Scientists,Simon Judge and Aejaz Zahid, have set up a website forthis very purpose at: www.assistech.org.uk/doku.php

Being a ‘WIKI’ anyone registered can contribute andedit any page on the site. The two main areas are termedthe evidence base and experience base.

Evidence Base – an area describing and reportingresearch and evidence within the field. In this area youcan: learn how to access evidence base tools; read andpublish literature searches; discuss and reviewevidence; brainstorm, develop and publish researchareas; document evidence on aspects of the field.

Experience Base – there is a wealth of experience(rather than evidence) within the Assistive Technologyfield. This area offers somewhere to store and share thisexperience. It’s purpose is to serve as a permanentversion of the well established assistech mailing list –www.jiscmail.ac.uk/lists/assistech.html

The experience base has a section for sharingexperience in the area of powered mobility, so feel freeto contribute to this or any other section. You can alsopost announcements relating to meetings, conferences,calls for papers, training, jobs and new products.

It’s a new resource and all of us have the opportunity tocontribute to its success.

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The EU Commission, having consulted during thespring last year, has now published proposals foramendments to the Medical Devices Directive (which itis obliged to review regularly).

The first meeting of the EU Council to consider theproposed amendments to the Directive, as published on22 December 2005, will be held on 23/24 January 2006.The MHRA will be attending and need input fromindustry so they can go armed with evidence of anyamendments which will cause problems, and why.

The link below will take you to the page from whichyou can access the proposals:http://europa.eu.int/comm/enterprise/medical_devices/revision_mdd_en.htm

If you cannot find your copy of the existing Directive,you can get it at: http://europa.eu.int/eur-lex/en/consleg/main/1993/ en_1993L0042_index.html

The changes that the Secretariat believes may causemembers concern are outlined below, but please look atthe whole thing carefully, as we may have missedsomething!

CClliinniiccaall ddaattaa::The amendments seek to make it very difficult not toprovide clinical data/clinical evidence for all medicaldevices (only Annex X 1.1e gives even a hint of a get-out clause). A new clause (k) has been added to Article1.2 which defines “clinical data”.

We need examples from you of products where arequirement to provide clinical data would beimpractical etc – perhaps product designs which havebeen on the market for many years without significantalteration; or where clinical evaluation would benonsensical because the product is so simple/low value;or where it is not feasible to carry out a proper clinicaltrial because numbers will be too low… the more actualexamples you can send in, the better. The MHRA willthen be in a position to make the case that this shouldnot be a requirement across the board.

New requirement to include on labels “the respectivecode of an internationally recognized generic medicaldevice nomenclature” (Annex II, 13.3 b):

The MHRA already intends asking “why?”; if there is acompelling argument as to why this should be done,they will propose one nomenclature should be used

(they will suggest the obvious one to use – GMDN =the Global Medical Devices Nomenclature).

However, the codes may be too broad to be meaningful,and there may be medical devices which cannot becoded using GMDN. Please let me know of anyexamples where this may pertain (and any compellingarguments why the principle in itself is a bad idea –perhaps in terms of practicality).

Info on GMDN can be found at: http://www.gmdn.org

SSiinnggllee aauutthhoorriisseedd rreepprreesseennttaattiivvee::For those of you who import (and may be an authorisedrepresentative), there are two clauses which you need tolook at. The first is Article 14 (2) where it has beenadded that where a manufacturer who places devices onthe market under his own name does not have aregistered place of business in a Member State, he shalldesignate “a single” authorised representative.

This would mean that for a manufacturer outside theEU, all of their products would have to go through justONE authorised representative. Would this be aproblem? If so, please give examples.

Linked to this approach, Annex II 13.3 (a) says thatinformation to be supplied on the label or outerpackaging or instructions for use shall contain inaddition, the name and address of the authorisedrepresentative “where the manufacturer does not have aregistered place of business in the Community”.

(The thinking behind this is clearly to make it easier totrace who is responsible in the first instance when thereare adverse incidents etc.)

CCuussttoomm mmaaddee ddeevviicceess::Article 4 (2) brings in a new requirement that thestatement called for in Annex VIII (about who themanufacturer is etc) “shall be provided to the namedpatient”.

It has been pointed out that in the case of, for example,dental technicians, they will manufacture the device,but the dentist will fit it and the technician has nocontrol over whether the patient receives the statement.It would therefore be impractical to enforce or police.Would it cause problems for orthotics and prosthetics?

A new Section 5 has been added to Annex VIII whichextends the requirement for post market surveillanceand adverse incident reporting to custom made devices.


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LLiiffeettiimmee ooff aa pprroodduucctt::Throughout the document, new reference is made to thenecessity to keep technical documentation for a periodat least equivalent to “the intended lifetime of theproduct as defined by the manufacturer….” Previously,it simply had to be kept for a period not less than fiveyears. We anticipate that this requirement may presentproblems and we do not think it has been thought outproperly. For example, do you have products out there,which are still going strong many years after they werefirst sold? (Perhaps, for example, a wheelchair frame –all the moving parts may have been replaced over time,but the frame itself is still going strong?) Is the lifetimeof the product entirely dependent on propermaintenance? Please send in any examples where youwould find it difficult to state the intended lifetime of the

product, and/or difficult to keep the technical documentsfor that length of time. (The question has also beenasked, is it intended life from the date of first sale?)

Other additions which, although self-evident, may giveyou pause for thought and perhaps necessitate anoverhaul/revision of all your technical files, are:Annex I 1 – devices must be designed andmanufactured in such a way….”This shall includereducing, as far as possible, risks posed by user errordue to the ergonomic features of the device and itsintended user environment”.Annex I 13.1 – each device must be accompanied bythe information needed to use it safely and “properly,taking account of the training and knowledge of thepotential users…”

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4455 Vol 22 Spring 2006

AbilityNet is a national charity with nine regionaloffices and is the UK’s leading provider of advice oncomputing technologies and disability. We work withdisabled people in all age groups at home, in educationand at work. We have experience of working withpeople and groups with different disabilities and knowwhat obstacles they face in daily life when usingcomputers and what solutions are available. Ourapproach is practical and pragmatic, judging the valueof a solution by its suitability to a particular individualand their needs, rather than by a product’s technicalsophistication.

Technology offers the potential to open up access toinformation and services, for example:

• Being able to fill in information on the computer isbecoming a required skill; it may be the only waysome people can fill in a form and for others withoutassistive software such as voice recognition oradapted keyboards and mice it may be impossible.

• Accessibly designed web sites can be used byvisually impaired users who may have no other wayto access that information.

Our work with individuals includes free advice andinformation available through our national helpline andwhere appropriate, access to remote assessment overthe internet or assessment at an AbilityNet centre. Forexample, individual wheelchair users have been able totry out suitable keyboards and mice that can be used on

a wheelchair tray. Windows Accessibility options canbe tried and adapted to the individual user’s needs andusers can also try out assistive software, such as textprediction to speed up text input or voice recognitionsoftware. This information can be used to adapt anexisting system or to purchase new equipment.Individuals are able to purchase equipment and trainingfrom us if they wish.

Our work with organisations includes work withschools, Further Education (FE) colleges andUniversities, learndirect, UK Online centres, local andnational voluntary organisations, the NHS etc. We havealso advised on the accessibility of IT facilities,supplied adaptive kits with training, carried outindividual assessments, run clinic days etc. We haveadvised on issues faced by wheelchair users whentrying to use a standard height workstation, as well asadaptive hardware and software that can be beneficial.

We also deliver courses to professionals at our centres,or on site at the workplace and these can be tailored tospecific needs. Our accessible website provides awealth of information and advice including over 80factsheets which give detailed information on a widerange of assistive technology, services andorganisations that can help you get the most out of ITfor your clients.

To find out more or for advice and information callfreephone 0800 269545 or visit our website atwww.abilitynet.org.uk

AAbbiilliittyyNNeett,, AAddaappttiinngg TTeecchhnnoollooggyy –– CChhaannggiinngg LLiivveessJJoo GGrreeeennwweellll,, HHeeaadd ooff PPuubblliicc AAcccceessss//SSeeccttoorr SSeerrvviicceess,, AAbbiilliittyyNNeett ((SSoouutthhEEaasstt RReeggiioonn)),, TTeell:: 0011993322 881144 555588

I hope that those of you who wereable to go to the recent NationalTraining Event in Blackpool had agood time. For those who sadlymissed out, you missed a cracker!

The general consensus was that wehad some excellent speakers andpresentations and that theeducational content was of a highstandard.

The venue was a little different towhat we are normally used to but Ihope that any difficulties didn’tcompromise the whole experiencetoo much. I have to say thecommittee was disappointed withthe quality of the food and some ofthe equipment and staff at Pontins,promises were made on several sitevisits and the food at those times wasboth hearty and very tasty. So, sorryfor the disappointing aspects of theevent. Having said that, theconsensus from the feedback formswas that it was an interesting choiceand one we should re-visit in thefuture.

Only kidding!

Still, most of you seemed to enjoyyourselves at the dinner and theshow, some things remain constantno matter where the venue is.

As you will have read and heardbefore, venue finding is both timeconsuming and difficult. Manyvenues can only offer us partialcoverage of our requirements,Pontins were able to cover allaspects and at time of booking werethe only venue able to accommodateour size and budget.

Next year we will be holding theevent at Warwick University, nearCoventry on the 19th and 20th April.

Many of you may remember theconference in 1996, they haveexpanded since and it will be nice tomake a return visit.

The sub committee is going througha little transitional period, I amstepping down as chair, the newchair will be formally announcedsoon. I will still be involved and weare going to focus on running some 1day events around the country. Wehave had many requests for this andwhen we have run courses they havealways been oversubscribed. Thereare many talented presenters outthere and so we will hopefully beable to get some good focused daysfor you to come and enjoy.

If you have any burning topics thatyou want covered or have been on 1day seminars / courses and canrecommend any speakers / tutors,please let me know, my contactdetails are printed below.

Many thanks for your support for theBlackpool event, it was difficult formany of you, what with Exeter in thesame financial year.

Keep your eyes out for trainingopportunities both in the post and onthe website.

Here are some of the feedbackcomments you gave us, thank youfor taking the time to give us these,we’ll bear them in mind when welook at next years event.

Conference quality was high asalways, but the Hi-de-Hi conferencevenue did distract from the content

An ‘interesting’ choice of venue. Wethink somebody has a sense ofhumour! (we appreciate thedifficulty of finding sites)

Many thanks – a very enjoyableconference

Dreadful food, slightly dodgyaccommodation (I won’t come herefor a holiday!!)

Excellent conference content!

Very well organised programme

Excellent conference content – bestfor a while

I am sure the Committee will havebeen disappointed byaccommodation/venue as well, but Ihave now seen a Pontins’Entertainment!

Start time change between both daysis confusing. It would perhaps behelpful to remind us at the end of day1 that start time is ? hour earlier.Unfortunately this resulted in memissing WS6 lecture which I wasreally keen to attend. Agreed it is inblack and white on our timetable,but extra verbal reminder would bevery helpful

In some ways a more low keyconference but I found it morerelevant to day to day practice incontent

Poor accommodation but great easyon site locations for talks, exhibitionand dining facilities

In the many years I have beenattending, it is the first time I havebeen disappointed. It is a pitybecause content was veryinteresting.

However I would like to thank thecommittee for all their hard work – Iam glad that people are prepared todo it…for my benefit! Thank you.


EEdduuccaattiioonn aanndd CCoonnffeerreennccee PPllaannnniinngg SSuubb CCoommmmiitttteeeeMMaarrttiinn MMoooorree,, WWhheeeellcchhaaiirr aanndd SSppeecciiaall SSeeaattiinngg SSeerrvviiccee,, DDSSCC,, SSoouutthhmmeeaadd HHoossppiittaall,, BBrriissttooll,, BBSS1100 55NNBB

TTeell:: 00111177 99559955447744mmaarrttiinn..mmoooorree@@nnbbtt..nnhhss..uukk

SUB GROUPS/COMMITTEES: EDUCATION & NTE PLANNING

A scheme to fund small scaleresearch studies was successfullylaunched during 2005. At the 2005AGM the PMG membership hadagreed to allocate £20k for thispurpose. The scheme was open to allmembers of PMG proposing to carryout a relevant research study and theapplication process involved anoutline proposal followed by a fullapplication which was peer reviewed.

Seven applications were received andoffers were made to fund four studiescovering a range of topics.Summaries of the four studies beingfunded are shown below.

The PMG membership agreed toallocate further funding to thescheme at the AGM this year andtherefore there will be a fresh roundduring 2006. Outline proposals will

be invited during the summer. Pleasevisit the PMG website for moreinformation on the applicationprocess. The new applicationdeadlines will be posted on thewebsite in May.

• visit www.pmguk.co.uk and clickon the Research tab, or

• go direct tohttp://research.pmguk.co.uk/

4477 Vol 22 Spring 2006

RReesseeaarrcchh && DDeevveellooppmmeenntt SSuubb CCoommmmiitttteeeeDDaavviidd PPoorrtteerr

SUB GROUPS/COMMITTEES: RESEARCH & DEVELOPMENT

Dr David Punt, Faculty of Health (AHP), Leeds Metropolitan University

WWhheeeellcchhaaiirr mmoobbiilliittyy ffoorr ppeeooppllee ffoolllloowwiinngg ssttrrookkee wwiitthh ppeerrcceeppttuuaall pprroobblleemmss..

• What is the nature of wheelchair navigation problems in people with unilateral neglect?

• Can affected people benefit from theoretically-driven strategies to improve navigation?

Stroke is the primary cause of chronic mobility problems in the UK and affected people are oftendependent on wheelchairs for their mobility. Some people who could otherwise benefit from a poweredwheelchair are denied this opportunity due to acquired perceptual problems. These difficulties (e.g.unilateral neglect) can reduce their navigational skills such that they are generally considered unsafeunder the relatively strict guidelines for provision. However, recent progress through researchconcerning the rehabilitation of perceptual deficits may offer affected people the opportunity to improvetheir navigational skills and thus offer them the opportunity to take advantage of powered mobility. Thisstudy will aim to harness these promising approaches to rehabilitation that have hitherto been mainlyconfined to measuring performance on laboratory-based tasks and apply them to the real world activityof wheelchair navigation.

Alice Goldwyn, Chailey Heritage Clinical Services, Rehabilitation Engineering Service

AA ssttuuddyy ooff tthhee BBiioommeecchhaanniiccss aanndd KKiinneemmaattiiccss ooff SSttaannddiinngg DDuurriinngg DDeevveellooppmmeenntt aanndd iinn CChhiillddrreenn wwiitthhCCeerreebbrraall PPaallssyy.. AA tthhrreeee pphhaassee ssttuuddyy..

• Is there a recognisable pattern of biomechanical and kinematic activity during set tasks in typicallydeveloping children in standing?

• Is this pattern different for typically developing pre/early walking children and children withcerebral palsy?

• Can the pattern for typically developing children be replicated in supported standing?

This study aims to define the parameters for standing support provision. The study has three phases.This application for funding is to cover some of the costs in the first phase of the study. The first phaseof the study is a cross sectional experimental design using a convenience sample of adults to developthe methodology for measuring the biomechanics and kinematics of standing during set activities. Thiswill inform the protocol used in the later parts of the study.

SUB GROUPS/COMMITTEES: RESEARCH & DEVELOPMENT


The second phase will collect control data from typically developing children and investigate if there isa recognisable pattern of muscle activity and joint position. Children will be tested in free and supportedstanding. The third phase will collect data from children with cerebral palsy and compare this to patternsobtained from typically developing children.

Lynne Hills, Occupational Therapy, Spinal Cord Injury Centre, RNOH

BBaallaanncciinngg mmaannuuaall wwhheeeellcchhaaiirr ssttaabbiilliittyy aanndd ‘‘ ttiippppiinneessss’’ ffoorr ffuunnccttiioonnaall iinnddeeppeennddeennccee..

• Does increased ‘tippiness’ lead to instability?

There have been many studies measuring the static stability of manual wheelchairs but very little ondynamic stability, or how this relates to static stability. A smaller static tip angle has traditionallyindicated reduced wheelchair stability. However, wheelchair users with advanced wheelchair skills canmanage this effectively and increase their functional independence. The aim of this project is to measuredynamic functional performance over different terrains typical of everyday use and make a comparisonwith the wheelchair user’s indicated static “stability”. For 10 experienced SCI wheelchair users theirstatic stability will be measured using a tilting platform, and their dynamic stability determined bymeasurement of the weight distribution using instrumented front castors, and propulsion forces andacceleration using an instrumented wheel (SmartWheel) during standardised functional tasks.

James Hollington, Eastern Region Postural Management Service, Enable Ireland

IIss SSttaattiicc IInntteerrffaaccee PPrreessssuurree MMaappppiinngg RReelliiaabbllee ffoorr RRaannkkiinngg PPrreessssuurree--RReelliieevviinngg CCuusshhiioonnss ffoorr AAccttiivvee((DDyynnaammiicc)) WWhheeeellcchhaaiirr UUsseerrss??

Pressure mapping is a readily available technology to assist clinicians in pressure care assessment.‘Currently, seat interface pressure distributions are measured statically with the patient in a fixed (static)position’ (Kernozek, & Lewin, 1997 &1998). However, seated activities such as wheelchair propulsionhave been shown to be dynamic (Tam, Mak, & Lam, et al’s 2003; Taylor, 1999). No studies have lookedinto whether finding the optimal pressure-relieving cushion through ranking static interface pressuremaps reflects the optimal surface for dynamic sitting.

Active wheelchair users will each have pressure-relieving cushions ranked according to their interfacepressure measurements under static and dynamic conditions. Measurements will be made using an FSAinterface pressure mapping system and a wheelchair ergometer. Agreement between static and dynamicranking will be investigated using the Spearman correlation coefficient.

RReecceenntt PPuubblliiccaattiioonnss

1. Review of Class 2and Class 3 Powered Wheelchairsand Powered Scooters.

Dept for Transport January 2006 PPAD 9/72/89

2. NSF for Children, young people and maternityservices. Responding to domestic abuse. Ahandbook for professionals DH (January 2005)www.dh.gov.uk

3. NSF for Children, young people and maternityservices. Palliative Care Services guide (Nov 2005)

4. DDA update (Dec 05)

5. Older and disabled people to receive virtual moneybox. www.dh.gov.uk/publicationsandstatistics/pressreleases

6. ‘You can make a difference’ Improving hospitalservices for disabled people 40210.(June 2004)

‘You can make a difference’ Improving primary careservices for disabled people 40581.(Sept 2004)

A5 DRC/DH publications for Primary CareServices and Hospital services. 08701 555455 oremail: [email protected]

7. Improvement Leaders’ Guides. (2005) NHSInstitute for Innovation and improvement

From Email: [email protected]

8. SCOPE Free booklets

‘A lot to say’: A guide for social workers, personaladvisors and others working with disabled childrenand young people with communicationimpairments.

‘The good practice guide’ for support workers andPersonal assistants working with disabled peoplewith communication impairments.

9. Harris A, Pinnington LL, ward CD (2005)Evaluating the impact of mobility-related assistivetechnology on the lives of disabled people: a reviewof Outcome measures BJOT 68;(12);553-558.

10. DH Our health, our care, our say: a new directionfor community services. A brief guide. (2005) NHS

11. SIA newsletter: ‘Forward’ [email protected]

12. Able magazine Email: [email protected]

13. ASPIRE newsletter. Email: [email protected]

Wheelpower & Step Forward. LimblessAssociation. Email: [email protected]

14. ‘All you need to know… to help and advise yourclients!’ Motability www.motability or 0845 4564566

UUsseeffuull wweebb ssiitteess

1. www.info4local.gov.uk Sign up and receive regularupdates from government departments

2. www.assistech.org.uk

3. Wheelchairnet.org

4. Rehabcentral.com

5. w w w . e a s y s t a n d . c o m / d o w n l o a d s / p d f /Funding_guide.pdf (from Carolien Uddin)

6. Dept for Work and Pensions Media Centre –statistics on Disabled peoplewww.dwp.gov.uk/mediacentre/pressrelease/2006/feb.

7. The Health Foundation www.health.org.uk isseeking applications for the Engaging with Qualityin Primary Health Care. Details from the web site.Deadline 31st March 2006.

4499 Vol 22 Spring 2006

RReecceenntt PPuubblliiccaattiioonnss && WWeebb SSiitteessRRooss HHaamm

RECENT PUBLICATIONS & WEB SITES

CChhaaiirr:: David LongVViiccee--cchhaaiirr:: Martin MooreTTrreeaassuurreerr:: Barend ter HaarMMiinnuutteess:: Patricia Marks (PMG administrator)

AAppoollooggiieess were received from: Penny van Berkel, RussJewell, Joanne McConnell, Ayo Menkiti, David Porter.

Dave Long welcomed everyone to the 2006 AGM.

MMiinnuutteess ooff tthhee AAGGMM 22000055Lone Rose proposed that the minutes of last year’sAGM be accepted. Steve Russell seconded and theminutes were approved unanimously.

CChhaaiirrss RReeppoorrttThe chair thanked all committees and sub-committeespast and present for getting PMG to where it is now – athriving group.

The conference planning sub-committee was thankedfor all their hard work in pulling together another eventand in less than a year.

Financial planning and treasurership – the chairacknowledged and thanked Barend ter Haar for hiswork in supporting PMG in his role as treasurer formany years. Barend is standing down as treasurer at thisAGM.

Communications sub-committee is the result of themerger of the editorial and website sub-committees toencompass all forms of PMG communication. Thechair thanked Ros Ham for her work with thiscommittee, the production of two excellent newslettersand a template for the future. Ros will be standing downafter the production of the spring 2006 newsletter.

Scottish Posture and Mobility NetworkThe Scottish Seating and Wheelchair Group (SSWG)has reformed into SPMN after an internal review andthe aim is that PMG will maintain and develop stronglinks with this group in the future.

CommitteeThe Chair confirmed he would be standing down thisyear by rotation after his three year term in office. He

thanked Ros Ham, Russ Jewell, Charlie Nyein andJacqui Romer for their hard work on committee as allhave now stood down. Ros put a huge effort into thenewsletter, as described above, with assistance fromCharlie in the early days. Jacqui was very active onmain committee and the 2005 international conferenceplanning group. Russ was Chair from 2002 to 2003 andput in place the sub-committee structure which hasflourished and given more time in main committee foraddressing issues other than conference planning.

Robin Luff (also Chairman of ISPO) asked if we weretaking forward the minute from last year’s AGM ofPMG approaching ISPO about joint conferences. TheChair stated that the international conference planningcommittee was in the process of making a number ofapproaches to similar organisations in preparation foran international event planned for 2009/10.

Henry Lumley proposed the adoption of the Chairsreport.

Linda Marks seconded and the Chair’s report wasapproved unanimously.

RReesseeaarrcchh ssuubb--ccoommmmiitttteeeeLone Rose thanked David Porter (sub committee chair)for this hard work in getting the research fundapplication process underway.

Lone reported how the research fund worked. It wasconfirmed that the application standard was very highand that 4 applications received full funding. It wasreported that there was a surplus of £3080.

Questions from the floor for the Research sub-committee:Q: Was research proposed relevant to PMG?A: It was explained that the sub-committee judged

applicants on the basis of relevance to the objectivesof the group, as laid down in the constitution.

Q: Will the research reports be published?A: It was confirmed that publication of the reports was

a condition of the applications. The reports would bemade available to the membership via the website.

Q: Is the research funding exclusive to a PMG topic orcan it be used with matched funding?


MMiinnuutteess ooff AAnnnnuuaall GGeenneerraall MMeeeettiinngg 22000066SSttaarrdduusstt RRoooomm,, PPoonnttiinn’’ss,, LLyytthhaamm SStt.. AAnnnneess,, LLaannccss

88tthh FFeebbrruuaarryy 22000066

AGM 2006

user’s bodies. The membership voted unanimously infavour. Motion carried.

FFuuttuurree FFiinnaanncciiaall PPllaannnniinnggHenry Lumley made a presentation on the futurebudgeting for PMG highlighting the costs of running agroup such as PMG and the requirement for paidadministrative support to support voluntary committeemembers, especially for the purposes of conferenceplanning, membership renewals, day to day financialduties and to support the administration of the researchfund.

It was proposed that the membership fees shouldsupport administration costs, plus the development ofthe website. It was proposed the PMG membership feerise to £25 per annum, the first rise since the group’sinception fourteen years ago.

Chair of ISPO, Robin Luff – indicated that his grouphad the same issue and had to raise their fees. Hesupported the proposal.

Barend ter Haar indicated his support for the £25increase.

The membership were asked to vote on the proposal ofincreasing the membership fees. The vast majority werein favour, three votes against, no abstentions. Motioncarried.

Barend ter Haar also requested that the membershipsupport the committee with the completion of their GiftAid forms. Andrew Frank showed his support.

AAnnyy ootthheerr ccoommppeetteenntt bbuussiinneessssNone.

DDaattee ooff NNeexxtt MMeeeettiinngg 20th April 2007, Warwick University.

DDoonn’’tt FFoorrggeettTThhee PPMMGG LLooggoo RReeddeessiiggnn

CCoommppeettiioonn

SSeeee ppaaggee 2277 ffoorr ddeettaaiillss

A: The content of research criteria to be checked andconfirmed to the membership.

The sub committee proposed that the fund be topped upto £20,000 for the forthcoming year. The membershipwere asked to vote on this with the proviso that theconference would generate surplus and wereunanimously in favour. Motion carried.

TTrreeaassuurreerr aanndd MMeemmbbeerrsshhiipp SSeeccrreettaarryy’’ss RReeppoorrttNo accounts available to be circulated; the accountantswere not able to complete the work in time for theAGM which is earlier in the year than usual. To bepresented at the next committee meeting. The treasurerpresented a brief financial report and proposed thatthere be a postal ballot once the accounts are completefor approval.

The membership were asked to vote on the proposal ofthe postal ballot. The membership voted unanimouslyin favour. There were no votes against or abstentions.

The Chair thanked Barend ter Haar for his excellentservice and for putting the group on a very soundfinancial footing. Barend was presented with a gift onbehalf of the Committee and the membership.

The Chair then announced that Henry Lumley would betaking over the role of treasurer and with themembership’s approval would employ a book keeper –see future financial planning below.

EElleeccttiioonnss ttoo CCoommmmiitttteeeeThere were three nominations to join the committee:

Nigel ShapcottKevin HumphriesMonica Young

All three accepted. No objections were raised.

Martin Moore confirmed that PMG has one spaceavailable on the committee and asked if anyone fromthe membership would like to join as a co-optedmember for one year that they either speak to himself orDave Long at the end of the session.

MMeemmbbeerrsshhiipp EElliiggiibbiilliittyy –– pprrooppoosseedd cchhaannggee ttoo tthheeccoonnssttiittuuttiioonnThe chair then proposed a change in the constitution, asper circulated papers. In essence the change will allowany individual to join. Previously membership was notopen to individual “users” but to representatives of

AGM 2006

5511 Vol 22 Spring 2006


On a more factious note, a sad tale of job applications.

A man went to a job centre and was asked, “What isyour trade?” He replied:

My first job was working in an orange juice factory, butI got canned; I jus couldn’t concentrate.

Then I worked in the woods as a lumberjack but justcouldn’t hack it, so they gave me the axe.

After that I tried to be a tailor but I wasn’t suited for it,mainly ‘cos it was a so and so job.

Next, I had a go working at Kwik Fit, but it wasexhausting.

I wanted to be a barber, but I couldn’t cut it.

Then I tried to be a chief – figured that it would add alittle spice to my life – but I just didn’t have the thyme.

Do you remember when I attempted to be a deliworker? Unfortunately, any way I sliced it, I couldn’tcut the mustard.

My best job was being a musician, but I found I wasn’tparticularly noteworthy.

I studied to be a doctor but I didn’t have any patients.

Next, was a promising job in a shoe factory but mymanager cobbled together some excuse and booted meout.

I became a professional fisherman but discovered that I

WWhhaatt iiss yyoorr ttrraaddee??

PPMMGG CCoommmmiitttteeee MMeemmbbeerrsshhiippMember Profession Date on Date due off Extension

Dave Calder Joint Head of Rehabilitation Engineering Division 2005 2008

Barend ter Haar 2001 2004 2009

Kevin Humphries NHS Commercial Director 2006 2009

Dave Long Clinical Scientist 2002 2005 2008

Henry LumleyAssistant General Manager,

Musculo Skeletal Directorate2004 2007 2010

Joanne McConnell Senior Mobility Therapist 2005 2008

Linda Marks Consultant in Rehabilitation Medicine 2005 2008

Martin Moore Senior Rehabilitation Engineer 2002 2005 2008

Sue Pimentel Senior Occupational Therapist 2004 2007

David PorterElizabeth Casson Trust Reader

in Occupational Therapy2004 2007

Lone Rose Clinical Specialist - Physiotherapy 2004 2007

Nigel Shapcott Head of Rehabilitation Engineering 2006 2009

Emma Stacey Manager/Occupational Therapist 2005 2008

Monica Young Rehabilitation Engineer 2006 2009

Experimentally induced scoliosis was investigated inpinealectomized chickens using pathologic andneurophysiologic means. A total of 90 chickens weretested; 30 served as a normal control, 30 received anautografted pineal body in the intramuscular tissue ofthe trunk, and 30 underwent pinealectomy withoutautograft. Scoliosis developed in all pinealectomizedchickens within 2 weeks, showing gradual progressionduring the next 5 or 6 weeks. At 3 months, the three-dimensional spinal deformity consisted of lateralcurvature and vertebral body rotation, resulting in aprominent lordoscoliosis at the thoracic level. Incontrast, scoliosis developed in only 10% of theautografted chickens. Histologic examination revealedno pathologic change in the brain in either thepinealectomized scoliosis group or in the autograftednonscoliosis group. Cortical potentials in the scoliosisgroup were delayed, thus suggesting conductiondisturbance rostral to the brain stem. Although therelationship between the cause and effect is uncertain,these findings implicate neurotransmitters orneurohormonal systems in the pineal body as a major

contributing factor in this type of experimentalscoliosis.

MeSH Terms: • Animals • Brain/pathology • Brain/physiopathology • Chickens • Electric Stimulation • Evoked Potentials, Somatosensory • Female • Hindlimb/physiopathology • Male • Pineal Gland/physiology • Pineal Gland/transplantation • Reaction Time • Scoliosis/etiology* • Scoliosis/pathology • Scoliosis/physiopathology • Spine/radiography • Transplantation, Autologous

5533 Vol 22 Spring 2006

AAnn eexxppeerriimmeennttaall ssttuuddyy iinn cchhiicckkeennss ffoorr tthheeppaatthhooggeenneessiiss ooff iiddiiooppaatthhiicc ssccoolliioossiiss

MMaacchhiiddaa MM,, DDuubboouusssseett JJ,, IImmaammuurraa YY,, IIwwaayyaa TT,, YYaammaaddaa TT,, KKiimmuurraa JJ,,DDeeppaarrttmmeenntt ooff OOrrtthhooppaaeeddiicc SSuurrggeerryy,, NNiihhoonn UUnniivveerrssiittyy SScchhooooll ooff MMeeddiicciinnee,, TTookkyyoo,, JJaappaann..

couldn’t live on my net income.

Thought I might become a wizard, so I tried that for aspell.

I managed to get a good job working for a poolmaintenance company but the work was too draining.

I got quite a stretching job at a zoo, feeding giraffes, butwas fired as I wasn’t up to it.

So then I got a job in a gym but they said I wasn’t fit forthe job.

Next, I found being an electrician interesting, but thework was just shocking.

After many years of trying to find steady work, I finallygot a job as an historian – until I realised there was nofuture in it.

Then I turned to the wheelchair service and became a:i. Rehabilitation engineer …ii. wheelchair therapist…iii. Clinical scientist…iv. Wheelchair manager…

but……

Abridged from ‘Bodiam, Ewhurst Green, Staplecrossand Cripps corner Parish News’ February 2006

DDoonn’’tt FFoorrggeettTToo ffiillll oouutt BBOOTTHH yyoouurr qquueessttiioonnnnaaiirreess

SSeeee ppaaggeess 77 aanndd 5555

I write this report as an update from the last newsletterarticle as the Care Services Improvement Partnershipconduct “listening” events up and down the country togather the views of “users” and “professionals” onwheelchair services.

I was able to attend the event in Birmingham at thebeginning of March. Of course many people fromwheelchair services were there and knew each otherwell but there was wider representation from users,charities, manufacturers and even someone from thelocal transport service. We had various workshopsthroughout the day, facilitated by Dee Hamilton and herteam (none of whom are DH employees). Theworkshops were designed to generate discussion inorder to gather peoples’ views, feelings and experiencesof wheelchair services. These were recorded on paperfor further analysis by the team. There was also aconference illustrator present who listened in on ourconversations, picked out the most interesting ones andfrom these produced a series of cartoons which we werethen able to support, criticise, disagree with, etc.Overall it was a useful day and seemed to be supportiveof wheelchair services by recognising the pressures weare under and the limitations in resource we have tocontend with.

The steering committee for the wheelchair serviceproject is due to meet again at the end of March / earlyApril and Bernadette Simpson, who is heading theproject, is due to submit her report sometime in theSpring. It is helpful that the PMG has been askedspecifically to contribute to this important project andeven more helpful that there are three other PMGmembers on the steering group representing othergroups (Linda Marks, Henry Lumley and Peter Gage).

I flagged a concern in the last newsletter regarding thepossibility that the expertise needed to prescribewheelchairs might be overlooked by the review. Whileat the very basic level it might be appropriate toprovide wheelchairs as commodity items throughcommunity equipment stores, I believe the steeringgroup has convinced the DH team of the need forqualified assessment of individual, and frequentlycomplex, levels of need with regard to wheelchairprescription.

It will be interesting to see what the final report lookslike and I expect that it will be widely available by thetime of the next edition of the PMG newsletter.


DDoo wwhheeeellcchhaaiirr sseerrvviicceess hhaavvee aa ffuuttuurree?? –– UUppddaattee,, MMaarrcchh 22000066DDaavvee LLoonngg

5555 Vol 22 Spring 2006

PMG NEWSLETTER & WEBSITE - SURVEY

The Editorial committee would like to know what you think about the website andnewsletter

Please spend a few minutes in completing this survey (if not completed in

Blackpool) and mail back to Patricia Marks, PMG Administration, c/o POBox 776, Taunton, Somerset, TA1 9BR

Website:

1. Have you ever accessed this website? Yes No

2. What have you used the website for? bookings, information, membership, research.comments

3. Were you able to access the information you needed? Yes No

Newsletter:

1. In which ways do you find the newsletter useful? comments

2. What other features would you like in the newsletter?

• Courses available Yes No• Regional Update Yes No• Jobs available Yes No• Research features Yes No• Book reviews Yes No

Additional suggestions:

3. Is there anything that you would remove from the newsletter? comments

4. Would you be willing to write an article for the newsletter? comments

5. What are your views on a peer referenced journal? comments

Thank you for your time, if you have any further suggestions/ideas or would like tocontribute to the either the website or journal please contact Emma Stacey [email protected]�

A new study is about to commence that will seek toanswer the above question and in doing so providemuch needed evidence in this area. It is thanks togenerous funding from Remedi and Cerebra that thisimportant project can take place.

A randomized controlled trial will be conducted in twocenters – Oxfordshire and Leeds, over the next 5 years.The subjects, 100 children between the ages of 2 and12, will be randomly assigned into an interventiongroup using a modular seat with knee block and sacralpad or control group, using the same seat but withoutthe knee block and sacral pad.

The outcome measures will be: Hip migrationpercentage, hip joint range of motion, sitting ability on

the Chailey scale, upper limb function, pain and theQuebec User Evaluation of Satisfaction with AssistiveTechnology (QUEST).

Considering the lively debate at the PMG conference in2004 (Nottingham), there is much interest in this area.With this in mind, the researchers would very much liketo hear from clinicians to discuss the project. Theresearch team looks forward to keeping PMG up to datewith findings as they emerge, both through thispublication and at conference.

A research assistant has been recruited for the Oxfordcenter but a vacancy still exists in the Leeds area for a0.5wte researcher. Again, please contact the researchteam if you would like further details of this post.


DDooeess tthhee uussee ooff aa kknneeee bblloocckk iinnfflluueennccee hhiipp ddeeffoorrmmiittyy,,ffuunnccttiioonnaall aabbiilliittyy aanndd ppaaiinn iinn nnoonn aammbbuullaanntt cchhiillddrreenn

wwiitthh bbiillaatteerraall cceerreebbrraall ppaallssyy??LLeeaadd RReesseeaarrcchheerrss:: DDaavviidd PPoorrtteerr ((dd..ppoorrtteerr@@bbrrooookkeess..aacc..uukk)),, SShhoonnaa MMiicchhaaeell ((ssssmm@@mmeeddpphhyyssiiccss..lleeeeddss..aacc..uukk)),,

TTeerrrryy PPoouunnttnneeyy ((tteerrrryy..ppoouunnttnneeyy@@ssoouutthhddoowwnnss..nnhhss..uukk)),,RReesseeaarrcchh AAssssiissttaanntt:: FFrraanncceess WWaaiinnwwrriigghhtt ((ffwwaaiinnwwrriigghhtt@@bbrrooookkeess..aacc..uukk))

5577 Vol 22 Spring 2006

POSTURE &

MOBILITY

GROUP

NNaattiioonnaall TTrraaiinniinngg EEvveenntt 22000077

We would like to invite you to join us atThe University of Warwick for the PMG National Training Event

2007 which will be held from the 18th – 20th April 2007

Keep a watch for updateson the website:

www.pmguk.co.uk

CONFERENCE PHOTOS 2006


The next issue of Posture & Mobility will be OOccttoobbeerr 22000066. The deadline for this issue is the 1155tthh SSeepptteemmbbeerr22000066. The aim of Posture & Mobility is to keep members in touch with current events in the world of postureand mobility and to provide the opportunity to share ideas and learn of new initiatives. Articles should bebetween 500 and 2,000 words. Photos and/or cartoons are welcome as are jokes and mindbenders etc. Pleasesend contributions, preferably by eemmaaiill oorr ppoosstt,, to PPaattrriicciiaa MMaarrkkss at ppaattrriicciiaa..mmaarrkkss@@ppmmgguukk..ccoo..uukk oorr PPMMGGAAddmmiinn,, PPOO BBooxx 777766,, TTaauunnttoonn TTAA11 99BBRR ((sseenndd aallll ppiiccttuurreess iinn tthheeiirr oorriiggiinnaall ffoorrmmaatt,, nnoott aass ppaarrtt ooff aa wwoorrddddooccuummeenntt)). Otherwise post a floppy disk, compact disc, or print in Times New Roman 12pt.

CONFERENCE PHOTOS 2006

5599 Vol 22 Spring 2006

Produced by SPS Communications, Ilford, Essex. Tel: 020 8590 0299

SSoommeetthhiinngg ffoorr EEvveerryyoonneeSSpprriinngg iinnttoo AAccttiioonn

Whether you need a chair for occasional or day longuse the new Action 2000 is ideally suited for both. Thislightweight, aluminium chair is very easy to handle foreither client or carer and has many adjustable features.Available as either a transit or self propel model with amaximum user weight of 120kg, this is a high qualitylow cost chair.

MMaakkee mmiinnee aa PPrroonnttoo!!This well designed, centre wheel power chair willmove you around in comfort and with style. Itscompact base and fingertip precision controls givesoptimum manoeuvrability, and it comes with a 5”seat riser as a standard feature, ideal for thoseawkward objects. No need for a kerb climber as thePronto M61 features Invacare’s unique Sure StepTechnology that allows you to move smoothly overthresholds and kerbs.

SSpprriinngg iiss hheerree wwiitthh tthhee nneeww AAzzaalleeaaFor optimum comfort and adjustability, the newRea Azalea Assist from Invacare has it all. Thismulti-adjustable chair features tilt in space and isideal for clients who require comfort and stabilityall day.

AA LLiigghhttwweeiigghhtt PPeerrffoorrmmeerrInvacare Kuschall have built their name aroundquality, good design and exceptional handling, and thenew K-series is now even better. This lightweight chair(only 9.2kg based on 36cm seat width) has been re-designed to keep all visible parts to a minimumcreating a sleek and dynamic model for everydayliving.

IInnvvaaccaarree UUKK LLttddSouth Road, Bridgend Industrial Estate, Bridgend, CF31 3PYTel: 01656753270 Website: www.invacare.co.uk

PM OSTURE & OBILITY G POSTURE & MOBILITY Vol 22.pdf · Posture & Mobility is published by the...

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