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A Minimalist Approach to Custom Seating |
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| Christy Malonzo, a private practice therapist from Huntington Beach, CA, had already meet with Amy regarding issues relating to low back and shoulder pain and had also discussed complications relating to her multitude of failed mobility bases and seating components. It seems that none of the systems were built to Amy's functional requirements and were in fact exacerbating her physical discomforts. So, Christy made a few calls and assembled a team of experts. I first met with Amy at Christy's office along with Tom and Paul from Pro-Med. We looked at three of the five mobility systems she had received over the past twelve years and discovered that although she was not happy with it, she preferred using the third oldest of the five. Furthermore, the newest one (not even a year old) was just sitting in her home along with the others, taking up valuable space. After 90 minutes of discussions and note taking the team decided to take a reverse approach to finding the perfect solution; build a seating system to the satisfaction of Amy and then design a wheelchair around the seating system. This solution came in part from the dealer's perspective that if the seating specialist couldn't position Amy to both her liking and physical needs then it made no sense to build yet another wheelchair.
Next came the fabrication process, trial fitting and finally,
with all thumbs up, the recording of tailored specifications for Amy's new
wheelchair. As for the new wheelchair, that part of the project was monitored
with the assistance of Ernie from Colours as the new frame was also slatted
to be the debut of a brand new design concept from the manufacturer dubbed the "Razorblade."
At the trial fitting Amy indicated right away that the backrest relieved the stress and pain associated with her spinal deformity and the seat provided more stability and pressure relief than the previous gel cushion. Still, she was able to identify two improvements; remove foam from the right perimeter of the backrest to allow for greater arm movement and secondly, add in a bit more contact support over the relief for the downward protruding trochanter. The chronic shoulder pain would be addressed by the new wheelchair specifications which would allow for easier and more efficient stroke movement, transfers and equipment transport. It wasn't until the delivery that Amy had her first
opportunity to try out the full configuration of the
new seating system and wheelchair. As usual, and
after a few adjustments, we had her go through some
trial maneuvers to ensure that everything operated
as intended. Her reactions were both immediate and
tremendously Foam-only seating systems can be built for many purposes. We've used this technique to fabricate positioning aids for use inside vehicles, school chairs and other support surfaces. We also custom fabricate many foam-only seats for wheelchairs which already include a seat pan. In every case the goal has been to provide maximum lightweight support and stability in a posture of optimal functional alignment. For the consumer who self propels there is a tremendous weight reduction advantage with a foam-only seating system when compared to a rigid design which must be mounted with suspension hardware. This weight reduction can translate in significant savings of physical energy both during self propelled mobility and in efforts to disassemble the system for transport. Amy's system weighed less than three pounds when installed and she performs independent transfers to the driver's seat of her van. You might ask why we don't use foam-in-place or foam-in-box techniques to produce such products. No doubt that we could have completed the project in less time using these techniques but I'm a strong believer in reproducibility. From my prospective, if you can't replicate the finished product then neither the technique nor the process can be taught or tested. The problem with FIP is that you cannot regulate foam density or selectively amend density at sites of your choosing. With FIB you can exercise many more controls to conform the shape but still can't selectively amend nor regulate foam density.
Collaborators: |
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Our next meeting took place at my office so that no time restrictions
would be placed on finding Amy's preferred posture and optimal functional
alignment. The meeting concluded with the creation of a body mold;
using a vacuum bag seating simulator. Creating and aligning a body
mold for a person who independently propels their wheelchair is
an entirely different process than that for a person who uses a
powered w/c or is dependant upon other for propulsion. So, in this
part of the assignment, Amy controlled the entire impression capturing
process. This approach allowed Amy to demonstrate what was bad about
the other systems and articulate what she was ultimately trying
to achieve. The process also highlights the old adage for seating
specialists, "I might be the expert at making seating systems, but
the consumer is the expert at living in them." Once she was totally
content the mold was set.
Its uniqueness comes from the compound bend at the seat rail and leg hanger
union and the single teardrop extrusion weld for the front casters. 
The fabrication process for the seating system was in no way typical
because this was not simply a full-body foam-only seating system.
For this project the backrest was designed to fill just the asymmetrical
voids created by Amy's extensive spinal deformity and the seat cushion
consisted of only enough material to support her pelvic obliquity
and provide relief for her downward
protruding left trochanter. The overall shape of the 
system was
intended to have an "organic" feel to it, which in this case meant
no wood or plastic base and no suspension hardware; just the bare
essentials.
