Surgery to correct scoliosis not only changes a person's body contours but may also necessitate changes in equipment.
Larry Sandler is a wheelchair specialist at Chesapeake Rehab Equipment in Baltimore who's had a lot of experience helping people obtain and learn to use new equipment after scoliosis surgery. Jason Abramowitz is one of his clients and a good example of the kinds of challenges scoliosis surgery can pose (see "Scoliosis Surgery: Before and After").
Sandler first saw Jason at Mount Washington Pediatric Hospital, where he went for rehabilitation after his surgery. "I was right there in his room the day he was being discharged," says Sandler, who helped the family make the transition to the home environment.
Before his surgery, Jason used an Invacare Arrow chair for most of his activities. Afterwards, he switched to an Invacare Ranger X with power tilt.
The power tilt — also called a "tilt-in-space" feature — is often necessary after spinal fusion surgery. It allows the user to tilt back or forward without changing the angle between the seat and the back of the chair, so that weight can be redistributed to either the back or the buttocks.
"Prior to his surgery, Jason was able to perform some pressure relief using his scoliotic posture," Sandler says. "Since he's now rodded [has had rods inserted into his spine], he's unable to perform this any longer."
After surgery, Jason first used a loaner wheelchair with power tilt borrowed from the MDA loan closet. "I had to make some modification to this loaner wheelchair," Sandler recalls, "because it had a different seating system on it, and Jason needed to sit lower to get under his table at home to access his computer."
When the new wheelchair came in, it had a tilting mechanism, but operating the tilt required using an additional control mechanism on the side of the chair.
|The tilt-in-space feature allows Jason to shift his weight to either his back or buttocks.|
"I had to reprogram the wheelchair to allow the tilt to work through his joystick," Sandler says. "Some companies do the tilt through the joystick, but Invacare has it with a separate toggle. The extra piece that it comes with sticks out and makes the chair wider than normal so that it couldn't go through certain doorways in Jason's home. Also, with his decreased arm strength, Jason needed the joystick to be right in front of the armrest."
The back that came with the new chair also wasn't quite right.
"Jason doesn't like a lot of change," Sandler says. "A lot of kids don't. It's hard for them."
As a first step, Sandler put Jason's old wheelchair back onto the new chair but ordered a new back. "The back has to be in the right spot. An eighth of an inch makes a big difference," he says.
Jason likes what's called a J back, which has a slight curve to it. "That's what's comfortable for him," Sandler notes. Sandler tried two other backs, but they affected Jason's reach, a critical factor against them.
How do you get to an equipment specialist? Usually, Sandler says, the doctor makes a referral to a physical therapist, who in turn contacts the equipment specialist in the community.
"The wheelchair specialist works hand in hand with the physical therapist," Sandler notes — at least ideally.