Saturday, 19 July 2014

Pain (…and more)

Pain is an unseen disability.  It can rob you of your life! 
 Yet nobody will know...

It takes a second…….Furnace purrs into consciousness..  Streetlight filters through  fluttering curtains,  Neon numbers tell me its 3:12 am.  Awake…..and there it is.  Years have passed since my injury but every waking moment is greeted by pain..  It will be there tomorrow, the next day, the next year…..and for the rest of my life.  Not a happy prospect.  Not when you unintentionally find yourself praying for a shortened lifespan..

Neurogenic pain.  Intensely burning pins & needles from the knees down.  Periodic sensations such as the calves begin to swell up to twice their size and are filled with swarms of angry bees, stingers ramming the insides, trying to get out,  Instantaneous shocks that may be as minor as a repeated pin-prick to the thigh or as startling as an instantaneous electrical shock to a toe -every bit as intense as if you had stuck your appendage into a 120V electrical socket.  Such a startling reflex brings stares from those around.  What happens in your spine - at that point of injury, that suddenly decides to trigger this response?

Spasms!!, my God, spasms!!…  Just when I think I can relax and unwind from the day, my right leg, or left hip might decide to start jumping.  (funny, never together - must be some biological basis for that)  It starts off slow, the tension can be felt building - then it fires!  A jerk…followed by another, and another, and another…..on and on often for hours.  Leg flops around on the bed like a fish that has just been landed!  So strong that any individual spasm can lift me off the bed.  If my leg would be tied down, I swear the physical action could snap a bone.  My leg may involuntarily and repeatedly raise up off the bed a foot or more, over and over and over again until once again, inexplicably, it slows and stops.  A change of position, application of pressure, exercise, a massage -sometimes they seem to help but most often not.  The spasms mockingly seem to come on more frequently in the evening, as I said, just when you think you can relax.  What is it that triggers this?  Body chemistry?  Is it a neurotransmitter that has accumulated and now “drips” repeatedly, making contact with the receptor below?  Is it some rogue electrical signal, a spark that discharges across a junction repeatedly until that particular biological battery runs dry?  Is it the body trying to pump blood - contracting and relaxing muscles in order to get blood coursing through the legs? Yet as I said, exercise doesn’t seem to discourage these spasms.  Is there some biological purpose to the spasms or is it like a power transmission wire that has torn free during a storm and now lies on wet pavement, dancing and shimmering until power is cut?

Tone - that incredible tightness that no amount of stretching and exercise can counter.  Always stiff from the level of my injury in my back, to my toes.  How much is pure tone and how much may be contractures or adhesions, I can’t tell.  Tone always quickly returns soon after stretching or exercising.  Some elastic bands, you can stretch them out repeatedly but when you put them down on a surface, you can see it tighten up a bit more -that’s tone!  I feel that my torso is wrapped in elastic material which constantly resists my twisting and turning at the waist.  A secondary, related sensation is like “the outside of my insides are glued to the inside of my outsides“.  No other real way to describe it.  Layers just don’t slide smoothly over each other, but stick and “ratchet” (stick, release, stick, release, stick, release, and on, and on…)  Creepy!!

I’ve come to the conclusion that the total inaction, due to my six months of hospital bed rest, did as much damage as the injury itself.  Tendons and ligaments may tighten or loosen due to inactivity.  Layers of skin and flesh fuse to each other, as if glued  Contractures and/or adhesions are formed making what once were two surfaces, now one.  Achilles tendons shorten and retract causing toes to point downwards.  It’s a “catch-22” situation where you have to be on your feet almost constantly to stretch them out, yet you can’t be on your feet constantly because you are paralyzed!  A runner may stretch out their Achilles by doing a few stretches braced against a wall - all that is necessary between short sedentary periods.  But for those immobilized for prolonged periods, trying to stretch out the Achilles tendon is like trying to rejuvenate dried out, cracked leather and trying to make it soft and supple once again.  All but impossible!

Of course, once the “high priests” of medicine - the doctors, have come into your room and after a quick glance up and down your chart, they’ve coldly proclaimed that you will never walk again, it becomes written in stone!  It is a fact that shall not be contested!  It would be a sacrilege to argue, to deny. From that point on, any therapy almost appears to be doled out grudgingly, as if a wasted effort, rather than “lets try everything to maximize your chances”  “Come on buddy, prove me wrong -walk”.
I seized right up with the half hearted, one hour per day, (weekends excluded) therapy I received - often administered by unsupervised students.  Aggressive therapy soon after surgery might have helped -however, there is no money in the health care system for that - and that is the bottom line.

I’ll finish this post as how I started -  a few more thoughts on pain.  Pain is subjective.  I’m not sure if there is any absolute method to measure it.  Individuals exhibit different tolerance levels to pain.  Different injuries result in different pain.  Identical injuries caused by different means might elicit different levels of pain.

How might a spinal cord injury produce pain if produced by a crushing injury, or a severing (cutting) injury, or a biological injury (bacterial infection & their toxins, as was my case.)   If at the same level, does a crushing injury cause more pain than a severing injury?  Do the unattached, severed ends of the spinal cord still cause pain?  Or where the transmission is cut rather than altered, are absolutely no signals transmitted.  Do the loose, “dangling” ends below the cut, themselves generate pain.  Something I don’t know but I’m sure some of you out there can answer.  For me, bacterial growth with the production of various toxins and enzymes, damaged my spinal cord -plus whatever damage the surgical drainage itself did to it, causes an immense amount of pain.

My neurogenic pain is constant and so intense that, as I’ve explained before, I cannot  go for more that perhaps one minute before my mind is drawn to the pain again, and then again, a minute later.  That distraction, and diversion of focus from other matters in you life, in fact robs you of your life and may even result in dangerous inattention.

My spinal cord injury created an unperceivable (so slight, not apparent to anyone else) muscular imbalance in my back, torso, or buttocks, which has resulted in tremendous sciatic nerve pain.  Not like being stuck with a knife.  Consider it this way - Get a hardwood stool with no cushion and then sit on it.  Comfy?  Now get a pebble, about an inch in diameter and place it on the hardwood chair surface directly under your hip bone (joint).  Now sit there equally balanced. Still comfy?  Now sit there for a minute. Now sit there for an hour, a day, a year….for the rest of your life…  The sciatic nerve runs along side a blood vessel and with every beat of my heart, the nerve throbs and throbs and throbs!  On bad days I squirm in my seat, however no position can release the pain. An eight plus hour workday is spent with my attention diverted to the burning leg pain and the throbbing hip.  Nothing helps, not even lying on my stomach as the throbbing continues.  The only thing about the sciatic pain is that it does fluctuate somewhat.  Some days are better than others and it seems to cycle about every third day or so.  I believe on the days that it is bad, my squirming and tensing stretches out the muscle in the hip so that it sits properly for a day or two until it once again contracts and pulls the hip ever so slightly out of alignment, resulting once more in pain.  It is always there, just some days are worse than others

No drugs, no medication, seems to help in the least, yet I continue to take them as a desperate attempt to do something.  Exercise has helped to improve on strength but has had no effect on the alignment or pain.  Live with it I’m told.

As I already mentioned, it is hard to quantitate pain -the perception between individuals and same, but different injuries,  There is the Wong-Baker Pain Scale, shown below to which individuals can point out their level.  What those faces truly capture, I’m not sure but I would say my pain would sit at level 8 on most days.


It is the knowledge that this pain will be with me day in and day out for the rest of my life, that really hurts.

Friday, 4 July 2014

Permobil M300 Poor Arm Alignment

I discussed the flimsy arms that were standard on my Permobil M300 in the previous post but I though that one more short video clip would demonstrate the issue more clearly.

For those who have not read the previous post and are unfamiliar with this issue, briefly, at the time of purchase I mentioned to the vendor that the side arms had an extensive amount of side to side play and that they seemed to be rather flimsy.  They promised that a new model of arm would be coming out shortly and would swap them out when available.  I have since learned that there were no other arm models under development and that this was a ploy to convince me to purchase the chair.  With so much lateral movement, even at the time of purchase, I found it to be unacceptable and added some of my own 'after market' washers in an attempt to stabilize the arms.  The arm when raised and released would just drop down with force and bang against the catch mechanism.  To try to add some friction, slowing the drop if the arm should slip from my grip,  I sandwiched a rubber washer between the arm and a larger diameter metal washer which extended the surface area holding the arm perpendicular to the chair chassis.  (Does that make sense?)  Check the photo below.

Permobil M300 -my aftermarket addition of washer in an attempt to stiffen the arm and reduce the lateral play. The chair was sold with arms that had a good amount of side to side movement -the service department would not address the issue,so I had too try something.  The arm mechanism comes with a leaver (top) and knurled thumb-nut (bottom) and sliding tin 'whatever' (slotted piece by left red arrow) - an overly elaborate design which serves little purpose in my view.  Its a bloody hinge!! - why make it so complicated.  What it didn't do was hold the arm steady.
The left arrow points to the rubber washer I installed to dampen the motion of the arm -so it wouldn't drop with a bang!  (now showing cracks and need replacement).  The right arrow points to the oversize metal washer I installed, sandwiching the rubber washer to the arm.  Without the large washer the arm rests against the bolt head alone, providing the attachment but very little support.

video

In the previous post, I tried to show the excessive side to side (lateral) play of the arm from a different angle.  What it didn't show was the misalignment of the post to the catch mechanism.  Watch and see how much the 'post' can miss the 'catch'.  While the chair is now just short of being 2 years old, the poor alignment was about the same when bought -an issue which I raised in concern.  My fault is in trusting the vendor in lying to me about replacement arms. 
The entire Permobil arm construction is flawed, from thin, prematurely cracking faux-leather (Naugahyde?) material covering the arm cushion, to the single square post holding the arm cushion to the arm mechanism, to the overly complicated hinge mechanism which allows arm wobble, to the poorly aligned multiple component arm catch and tin spring which offers "hit or miss" locking of the entire arm assembly, to no surface to which a bag or pouch can be attached to to hold personal items.  Bad, bad design!!

Sorry Permobil, I'm not buying any future wheechairs from your company!!
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Sunday, 29 June 2014

Permobil M300 Problems -A Visual Tour

Permobil M300 Power Wheelchair Problems
(and a few solutions)

My Permobil M300 is now about 2 years old but problems began to reveal themselves just before the first year.  I do wonder if it will hold together until I'm eligible to apply for assistance in purchasing a new model.  You can be sure it won't be a Permobil, nor will I be doing repeat business with my current wheelchair provider. (more on that later)

I wrote about some of the features and some of the problems with the Permobil M300 a few posts back (Permobil M300 Update) but rather than go back and insert photos, I just though I'd reiterate my frustration here in a new post.  Since that post I have heard from others (electronically & verbally) with similar Permobil problems.

The Permobil M300 is a good looking chair - that may be its best selling feature.  Headlights, turning signals, hazard flashers -wow.  While my understanding is that these are mandatory in Europe. not so here in Ontario, Canada.  So, they are wired but not connected.  To save money, I was told, they order one model of joystick/controller from the manufacturer in China, and then mount this standard unit on every model of chair where appropriate.


Here is the Permobil 300M controller that came with my chair.  It has an inoperable headlight switch, hazard flasher switch &turn signal buttons in addition to the standard on/off switch, an power selection switches.  The standard switches are operation but I was told that to activate the other features would cost an additional $1000 Cnd.  The are partially wired or powered already as they indicator lights within the switch will light up when activated unintentionally.  This can be distracting when activated unintentionally, momentary thinking some error has occurred.

 

(Above) Nonoperational headlight/reflector found on the Permobil M300.  (Below)  Rear reflectors & turn signals.  Turn signals are also nonoperational. While required by law in Europe, it is optional where I live and costs an additional $1000 Cnd to activate if desired.  A money grab no doubt - a thousand dollars to turn the lights on, really?



Structural Problems:

When I was first considering purchasing the Permobil M300, I was concerned by the rather flimsy side arms.  They had a side to side displacement of up to 2 inches (5 cm) -that is up to 1 inch or 2.5 cm to either side off center.  If you have limited use of your legs, naturally you compensate by using your arms.  Hold the arm to stabilize and shift your bottom from the surface you are on, to the chair.  The Permobil sales person observed how I transferred but raised no concerns.  I however was concerned and pointed this out.  The salesperson assured me that the arms were strong enough for my use but that in three months a new model, under development, would be released.  He promised that I could swap out my arms for these new ones that would be "rock solid" (I remember his description) at no charge.  I asked that this be written on the sales invoice.  I have subsequently learned that Permobil only has two arms for this model chair and both were available at the time of my purchase.  There was no "Rock Solid" are being developed.  I feel this was an outright lie to make the sale.

The arm rest is attached to the frame by means of a single square post that is attached to a curved bar.  The bar itself has a hinged attachment at the lower rear of the seat pan near at the a backrest.  The other point of attachment is in a 'multi-component' latch point nearer to the front of the seat pan frane.  The single square post allows the arm rest to twist.  The attachment points at the seat pan/frame are both responsible for the large degree of side to side play of the arm.  I remedied the problem to some degree by purchasing some large washers from the local hardware supplier.  The larger radius helped somewhat but can't cure a poor design.


(Above) Why go complex when simple is better?  This photo shows the complex hinge mechanism at the arm's rear attachment point.  A knurled knob, a thin tin sliding mechanism and a chrome coloured latch.  Not sure what each is specifically for though I have played with each.  A simpler, more effective and stable mechanism would suit this chair better.  After all, it is basically a hinge to raise and lower the arm.  The KISS principle - Keep It Simple Stupid.!!!
The red arrow points to the larger washers I added to provide additional support.
Note: the amber side reflectors are a practical feature for this chair -all around reflectors do provide visibility in the dark even if lights are not operational.


(Above) This photo shows the forward attachment point of the arm.  When the are swings down from the rear hinge, the post drops into the center of this mechanism and latches.  The multi-component assembly of this 'catch' seems excessive for its intended purpose.  A catch cast or machined from metal makes more sense to me.
Red Arrows from top to bottom: (1) Spacers -scalloped to attach to the tubular frame and flat on the opposite side whee it meets a somewhat oval shaped metal plate (2).  This plate lies flat against an almost identical plate (3), which has a notch for the latch to catch.  (4) Short tubular spacers which are the diameter of the arm tube which it will receive and latch on to when lowered.  (5) (6), the same as (2) & (4) in reverse.  Six components X 2 (front & back) plus two bolts and nuts (front & back) to secure the mechanism to the chair frame.  That's 16 separate pieces of hardware to make up the front arm catch (one per side).


(Above) Photo shows the arm "nested" in the catch.  The Red Arrow points to a thin metal spring which provides the "springiness" or tension needed to lock the arm in the catch.  This mechanism is intended to lock the arm in place and keep it secure, however I have found that sometimes several attempts have to be made before the latch catches and locks.  The spring itself is no thicker than the walls of a soup can.  A simpler design with a coiled spring would be more effective.
The two silver bolt heads visible on the outside plate are what I'll discuss next.

Okay, the arms are flimsy, moving side to side with up to a 2" or 5 cm total displacement.  So every time I lean on an arm, brace myself against it, or push on it to stand up, or use it to transfer, the arm is pulled or pushed to it's extreme position.  Repeated "wobbles" from side to side appear to score or etch a mark around the circumference somewhere along the length of the bolt.  Just like cutting glass, you score a line to weaken the glass/metal and then you snap it along this defect you created.  Or perhaps it is simply repeated flexing -micro bends, which weaken the metal.  That's what this design allows to happen to the bolt.  If you use the arm for anything but daintily resting your wrist upon it, the bolts will break!

Now, the bolts have broken numerous times in the past and on each occasion, after a few swear words, I went down to my local hardware supplier and purchased replacement bolts, of even a higher tensile strength.  Still the poor design has them break.  On the last occasion the bolt had broken without my notice.  It decided to fall apart while riding on a transit bus.  The bus driver saw the parts rolling around under the chair and handed what he could to me.  It wasn't until I reached home that I realized the bus driver had not retrieved all my parts as the rolled about on the floor.  I was missing the crucial spacer between the plates.  I suppose I could try to sandwich a number of washers together to make up the distance, but I was fed up and after much difficulty, sent it to the shop (more on that later too).
video
(oops, sorry - left the TV sound on)
(Above) This short video clip shows the amount of play in the arm which still exists after my adding extra larger diameter washers to stiffen the hinge attachment point.  The wobble will eventually weaken the bolts and cause them to break.  A broken bolt may result in the spacer being lost as happened to me.  A paraplegic relies on his arms for support and transfer.  The wheelchair arms should be able to stand up to this amount of stress without major damage!


(Above) Photo shows the Permobil M300 arm Assembly.  The cushioned Arm Rest (AR) is supported by a square post (P) which allows for height adjustment.  The square post is attached to a curved arm (A) which is hinged at the rear of the chair and latches in the catch mechanism (discussed in previous photos).
The entire arm mechanism does not provide a usable surface on which to attach a bag, pouch or other such container in which you can secure your personal property (wallet, keys, etc.) that may not be safe in a backpack hung on the back of the chair.

My solution was to remove the arm cushion and sling some straps over the bar supporting the arm cushion, then re-attaching the arm cushion, thereby sandwiching the straps between the bar and the cushion.  The straps can be stitched to a zippered bag, which I found in a local hardware store.


(Above) Difficult to see but there are two straps (1), forming loops, which extend from the zippered bag and loop around the metal tube which supports the arm cushion.  The cushion is removed by loosening two screws underneath, then replaced sandwiching the strap material in between.  (2) Points to premature cracks developing in the faux-leatherette material covering the spongy arm rest.  Cracks after a year and a half of normal use for a chair that is intended to last 5 years before replacement.  This chair was not built to last!


(Above)  Another view of the cracks developing in a chair just two years old.   I have to ask, if this was happening to your two year old car seat, or your living room sofa, would you consider your item well built.  Is this really what we should come to expect of today's "quality"???  Am I alone in thinking, that things should last longer?


(Above) This photo shows two solutions, one mine, one the wheelchair service company's.  (1) shows my solution for the left side of my chair.  Again a bag is sandwiched, as described above, in order to provide some storage capacity to my chair.  This bag happens to be the one that came off of my old Quantum power wheelchair.  On the Quantum, the bag slings over one bar and is held by velcro after going around a second bar.  This provides a secure storage compartment which can be easily removed for cleaning etc.  The people at Permobil haven't given this storage issue much thought.
(2) Shows the solution my current wheelchair service provider came up to prevent broken bolts in the arm attachment mechanism.  The solution, arrived at without my consultation, was to just not use the arm for transfers.  A second bar with a grip is shown.  Attached directly to the frame, it is suppose to offer better stability with less flexing and therefore should not break, at least not as rapidly.  This seems to work well except for two issues.  Firstly the new transfer arm blocks the old arm from being raised.  The new transfer arm (2) must be removed before the original arm can be raised.  This is not a major issue with me as I generally transfer without having to raise the padded hinged arm.  The other problem is that the new transfer arm is lower than the original arm.  If you want to raise yourself up (and over), it is difficult to raise up by grabbing onto something lower or at the same height that where you are currently at.  Regardless, it does seem to work for me.

Cosmetic Problems and Minor Annoyances:


Unlike my old Quantum wheelchair which had a one piece cushion back, with the rigid frame sandwiched in the cushions, my Permobil has a plastic? or fiberglass frame to which the cushion is attached by double-sided sticky tape and velcro.  In less than a year the tape dries up, releasing the velcro and the cushion.  Cheap!!  The protective band which covers the edge of the frame is also unraveling.  Not major problems, but annoyances.  Quality would not show this deterioration so soon after purchase and after reasonably gentle use.


(Above) The canes quickly deteriorated in appearance.  The cushion covering of the cane handle to the right was quickly shredded as the one seen on the left.  This was from my repeated slinging a backpack over the handle and perhaps understandable.  The left one has never been used for this means, nor have they ever been used for pushing the chair.  Why it too is falling apart is beyond me.  Note too that the plastic end caps, covering the rough, if not sharp metal tubing.  I have had people run after me with plastic caps, bolts and screws in hand -telling me these have fallen off my chair.  Quality workmanship?  How much more would it cost to put a proper dense rubber handle covering on the cane or a metal end-cap secured with with set screws?  

Manufacturer be warned!  Your product is your most effective advertising.  A sloppy looking product is equally effective advertising -of your company's lack of concern and dedication to cutting corners.

A couple more personal solutions:

The reason a chair has a moveable footrest is to allow one to put their feet on the ground when not in motion.  This is more comfortable while sitting at the same place for extended times.  What I discovered was that the bare set screws would catch the back of my shoe's heels and nibble & tear at the rubber/leather.  The screws protrude out from the chassis a per-determined distance and act as a 'stop' to hold the footplate at the proper angle when lowered.  However, the bare screw heads act as tiny hooks, grabbing onto any edge and when the chair or foot is moved, a piece of the shoe can be removed.  


To solve the problem, or at least reduce it, I cut a section of flexible pipe to just over half it's curvature and punched holes for the screws to protrude through.  The dense rubber hose backs up closely to the screw heads and there is no longer the edge beneath the screw head and screw shaft that can catch the shoe's sole material.  There has been much less damage since installing this.
(Foot rest is in the extended and raised position)

(Below) That same dense wall pipe was split along it's length and added to protect the thin metal edge of the forward seat pan.  While I can stand, I have to brace against something solid like my chair.  The seat pan would cut into the backs of my legs until I came up with this solution.  The hose was acquired from the local home hardware store and is nothing more than a hose section sold as an extension for washing machines to drain their used water into the laundry basin.   It can be split with a utility knife (careful) and held in place using duct tape or, as I used, black electrical tape which more aesthetically pleasing.

 
  (Above) Split rubber pipe leg guard. 

(Above) Rubber guard over thin metal edge of seat pan visible from another perspective
Also the rather elaborate foot support mechanism in the lowered position.

 Permobil M300 - Large 7"+ wheels are standard and vendor claims that they are superior in climbing high curbs and driving over stones & other obstacles.  I have to wonder if this is a necessity for most users.    Unless you live in the country or some other undeveloped area, your town probably has ramped access to sidewalks and you have no need to drive over rocks or excessively high door thresholds, etc.  I have found these off centered wheels, where the center of the wheel extends past the post to which it is attached, to present there own problems in comparison to smaller castors which are closer to the center of the supporting post.  (1) shows how much the wheel comes into the center of the chair.  The purpose of a footrest is that you can use it for support when driving longer distances but to place your feet on the ground when stationary.  (As I can lift my legs, I often just raise them if travelling short distances.)  The problem with these larger, off centered wheels is that depending on how you've parked, often one wheel is pointing inwards, minimizing the area where you can place your feet.  (2) The other wheel, depending on your approach, may point outwards.  I have opened cupboards only to hit the extended wheel with the door and have it bounce back shut.  Is it a major problem? No, of course not but it can be a nuisance.  I have found that smaller castors are preferable to indoor & "civilized" areas.  Consider this when purchasing any chair.

One last problem:  The batteries died on the Permobil M300 after about a year and a half of use where my Quantum's batteries lasted for a full seven years.  More on that in another post.

All that said, the Permobil M300 has run without incident since I've had it. To date, it has always gotten me to where I am going.  But then I expect that from any make an model from any company.

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Saturday, 28 June 2014

SQUEAK!!!!!!

The Permobil M300 Powerchair Squeak!!!

 So I purchased this Permobil M300 Powerchair which sells for the price approaching that of a compact car.  In my possession for just over a year, I begin to notice an annoying squeak coming from beneath the seat.  Okay service people, what gives?  They tighten some bolt which reduced the noise for a couple of weeks -that's all that can be done!...once!  Now it sounds as if someone is choking a duck directly beneath my seat!  Its the sound of an old wooden ship, beams groaning in a typhoon!  The angry, rebellious sounds escaping an old man's stomach after been fed far too much fiber!!  Give it a listen yourself in the short video clip below.

video

Pictured in the short video clip above is the rear view of the Permobil M300 Power Wheelchair.  The central (and only) chrome post can be seen center-left in the bottom third of the frame.

Now, some may say that I'm exaggerating my motion to produce the sound,  NO!!!  Secured in a disability transit  bus, the chair made such noise that the driver stopped driving and came back to examine the restraints holding my chair to the floor.  Thought that something was wrong.  With every acceleration or deceleration, with ever change of angular momentum (turns & curves), with every bump in the road, the chair sounds as if will shortly self destruct!

At work, every time I reach for something to my left or right, I squeek worse than the Wizard of Oz's Tin Man after a rainstorm!  It is just plain annoying for me and for those around me. 

Heads turn when I enter a theater or auditorium.  Don't dare attending church, but then again, maybe I could get the chair exorcised!  Sounds like something evil lives below!

I've become the butt of jokes -"Here's Squeaky!"  "Need some oil?", "You're arthritis sounds bad today"  blah, blah, blah - hah, hah, hah...   And then there is the concerned bystander "are you all right? - can I call someone?"

Now, if this was your year and a half old car, would you put up with it?  Or would you have this down at the dealer demanding it be fixed or exchanged?  If this were your living room chair at a fraction of the price, would you not complain if when your guests shifted in their seats, the noise would try to drown out the conversation?

This is just another poor design feature of the Permobil M300 chair.  (more on the others later)  There is one central pillar or post on which the seat is mounted to the chassis.  Rather than a frame or posts in the corners, one post will do for this company.  There are millions upon millions of desk chairs and stools found in offices around the world, yet they don't squeak.  Why does the Permobil M300?

So this is normal, I'm told.  Live with it fool, you bought it!

Friday, 10 January 2014

Permobil M300 Chair Update

Having had the Permobil M300 now for over a year, I find myself rather disappointed in this power wheelchair and feel that overall, I cannot recommend it.  While the drive assembly has worked flawlessly (I chair has not stopped running and left me stranded), other features have disappointed.

  1. The Side Arm Assembly Mechanics: Understandably, paraplegics rely on their arms to transfer to the chair and therefore the arms should be robust enough to take a bit of stress.  From day one the arms that came standard with this chair were rather floppy with a side to side displacement of about an inch and a half.  In other words, the arm rest cushion at the top of the arm assembly would sway side to side over a distance of an inch and a half.  I attempted to stiffen this by adding my own washers from a hardware store with some success.  The arms also had no 'stop" so when I unlatched the arm and pivoted it upwards and back -out of the way, it wouldn't stop they rotate right around and drop to the floor behind the chair..  Finally when attempting to put the arm back in the "down" position, it is difficult to get it to latch.  Mechanically this arm assembly needs to be redesigned!!!
  2. Arm Assembly Functionality:  The design of the side arms offers no place to attach side pockets or carry bags.  There is virtually no place to hand a pocket securely in which you can place personal items such as a cell phone, wallet, glasses, etc.  I did purchase some small canvas bags with zippered tops as well as retrofitting an old bag from my previous Quantum chair and attached them by unbolting the cushion armrest and slinging the bags over the horizontal post, then re-bolting the armrest back down. Sandwiched between the armrest cushion and the metal post, I now had a place to put my valuables though this was a rather poor and cumbersome solution.  Paraplegics still attempt to lead normal lives - we do have items we need at hand and not dangling from a back pack off the rear of the chair!
  3. Front Wheels:  The front stabilizer wheels are 8 inch in diameter wheels in contrast to the Quantum's castors which are about half the size.  The sales pitch was that they could climb 3 inch curbs with little effort.  While this may be a desirable feature for people that use the power chair outdoors the majority of the time, it is not a necessary feature for home, office or the average residential locale. If you live in a rural setting, a small country town or a developing country where codes for handicap access exist, the large front wheels may be of use.  Not only are the 8 inch wheels rather large, the arm that attaches the axle to the chair is offset such that perhaps six inches of the wheel are on one side and the remaining two are on the other side of the arm.  The problem with these larger wheels is that unless you approach something straight on, one wheel is always turned in, the other out.  As my injury still permits me to stand, I find that the one wheel always turned in is in my way when I attempt to stand.  The large wheels also get in the way when I attempt to open a cabinet door or such.  I tug on the door and and 'bang!', it hits the wheel.  I have to back up and maneuver my self so that I always approach head on.  The larger tires just seem to get in the way!
  4. General construction:  Poor quality metal bolts used to secure the arm post to the chair's arm latching mechanism.  Two have sheared off which I replaced with better quality bolts from the local hardware store.  Seat pan screws which work themselves loose.  I have been lucky enough to catch these rolling around on the seat pan before they rolled off and would have been lost on the floor.  Plastic inserts that are meant to hide sharp edges of pipes (the canes, etc) all pop out on their own.  I have had people run up to me and hand me a part saying "this just fell off of your chair".  A part held by friction is bound to fail sooner or later.
  5. The Back Cushion of the seat:  While this may or may not be a Permobil manufactured component, what I was sold was a seat backrest that was held to the back of the chair by double sided sticky tape and Velcro.  The backrest of the seat has quickly sagged and appears lop-sided.  My only recourse is to find more sticky tape and velcro to try to stick cloth to metal once again.  Certainly there is a better way of attaching the back cushion to the frame!  Of course, improved quality costs more and means less profit for the manufacturer and shareholders of the parent company.  Cynical?  You bet!!
  6. Seat Cushion:  Again, while this may or may not be a Permobil product, it was sold to me as a unit.  The seat just doesn't work well with the chair and I always felt as if I was sliding off.  I went back to my J2 Deep cushion.
  7. The Seat Pan & Foot Rest Combination:  As I can stand, I requested a chair that had a foot rest that could be folded away when not required.  Shoppers Home Healthcare had Permobil design such a unit (I had no idea they had no such unit and had to design and then validate that type of foot rest).  Once the foot rest was installed and folded upwards, it still projected out from the front of the chair such that it, not only was an obstacle to my standing, but cut into my legs when I did attempt to stand.  To remedy the situation the seat pan was moved the the utmost forward position.  However, the back rest cushion, even in the farthest forward position no longer touches my back!  It is not a comfortable ride but these adjustments were made on the day that I took possession of the chair so I had no time to "test drive" and discover the problem.  In addition, having moved the chair seat pan so far forward changes the center of gravity and the suspension collapses if I lean too far forward, especially so if I am carrying a heavier object (backpack) in my hands or on my lap.  Can give you quite a scare!
  8. The Prototype Footrest: which was developed for my needs, other than it protruding from the chair, as discussed above, worked fairly well.  However, the 'stop' which the footrest in the down (functional) position rests against is nothing but two bolts which protrude from the assembly.  The trouble was that the two bare screw heads absolutely "chewed up" and  destroyed the heels of my shoes.  Regardlss of which shoes, the place where the sole is attached to the upper part of the heel would get wedged between the floor and the screw head and any motion by myself or the chair would cause the screw head to nibble away at the material.  Pieces of rubber heel material would litter the floor under my work desk.  Ruined several shoes until I took a piece of rubber hose and backed the screw heads such there there no longer was an edge that acted like a chisel to cut away at the material.
  9. Hand Control Unit/Joystick:  A single model for all chair models is offered.   Made in China, once again to maximize profits for the company and investors, the unit has a number of extra buttons and controls which are unnecessary for my use.  The story is this:  In Europe, by law, the chair must have headlights, turn signals & hazard lights.  Not so in North America -however the chair has all these features and the hand controller/joystick unit comes with switches to activate all these features.  The problem is -if I want them to work, it costs an extra $1000 to activate them.  I'm sure the wiring is already in place, so they're telling me that it would cost a grand to connect the wires to the lights and switches!!!  The switches turn on such that the indicator lights on the controller flash, but they do nothing.  Unintentional activation of the switches cause indicator lights to turn on and flash distracting me - is something wrong???  Momentary panic...  The extra buttons, although sealed, do pick up environmental dirt, oils and such.  How much more would it cost to keep the extra switches off the controller unit or perhaps just attach the wires to the switches and make all the features functional regardless of which continent you are on.
  10. Controller Power Indicator:  The charge indicator is not linear which is a major problem.  There are some 10 LED lights, divided between green (full charge), yellow (reduced charge - caution) and red (low charge -near empty battery).  Well, by non-linear I mean that it may take some six hours for the unit to drop one green light but then in the next 2-3 hours it may drop 4 lights, and in another hour it may drop the remainder and be flashing RED!  Empty!  On my old quantum, half of the lights gone meant half the power was used up.  A three quarter of the lights gone, I had used three quarters of the battery life.  I could predict how much power & time I had left.  With the Permobil, it is a guessing game.  I cannot judge by the lights how much power remains.  Not only that, but with my old Quantum, I could run for almost two days without recharging.  I once forgot to re-charge my chair at night and ran short of power early the next morning.  Not only did the Quantum hold the charge longer per day, I was on the same batteries 7 years later.  The Permobil's batteries don't seem as efficient after just one year.
  11. Squeaks and Groans:  Within a year the chair started to make all sorts of squeaks and groans.  A service call informed me that all the undercarriage & chassis bolts had come loose.  The technician tightened them and all was well for about a month when the annoying noises returned.  A second service call again tried to tighten the bots but they were secure and the technician failed to find the source of the problem.  It is so bad that taxi drivers, co-workers have asked if something was wrong with the chair.  With every bump on the road, and every time I lean to one side or the other, the chair squeaks and moans like an old wooden ship on rough seas.  Very annoying!!  I believe it is that there is only one central post which attaches the seat to the chassis and leaning or bumping around puts stress on this assembly causing it to squeak and quack like a sick duck!!
Well, that's enough griping.  A good number of the problems are inherent in the design of this chair.  Many are annoyances but when you live int he chair for most of the day, and most of your life, they are not trivial.
Some of the problems I outlined where with the matching of the seat & cushion withe the chair.  My own fault was that I didn't badger Shopper's Home Healthcare until the chair was adjusted to my satisfaction.  While the Permobil power chair may be suitable for some, the number of compromises that were made by the supplier to try to meet my needs were excessive and to some extent, unsuccessful

A wheelchair, whatever the make or model, should first and foremost, maximize, and in no way hinder, the user's natural remaining abilities.  They should also provide maximum comfort as well as piece of mind with regard to its reliability..

(I may try to add photos later to better illustrate the issues discussed above) 

Update:  On point number ten, 'Controller Power Indicator', I discovered days later after publishing this post that the non-linearity of the indicator lights was due to failing batteries.  The batteries that came with this Permobil M300 Powerchair failed after about a year and a half of operation.  They are valued at about $600 Cnd,  I was still on my first set of batteries when I gave up my Quantum 6000 for the Permobil.  I'll update this blog on the ridiculous problems I had over the period of a week in trying to get service from Shopper's Home Healthcare.

Sunday, 6 October 2013

Gym -Self Directed Therapy

Well, its been a while since I've added any content to this blog.  I just don't wish to whine about the same issues, but then again, those issues are with me daily and perhaps some others might benefit, sympathize, understand or commiserate.

Disability Transport Strike:
I endured a disability transport transit strike since last writing.  While I considered several strategies to cope with the disruption, in the end there was little impact on service.  Local taxi companies were able to meet the demand and quite often I found that I had better times than with the dedicated disability transport service.  After about six weeks on the picket lines, not much was won or lost by the unionized drivers other than their pay cheques for that period

New Powerchair Update:
Got my new powerchair but can't say I'm totally pleased with it, however I'll leave that for another post.

Gym Rat:
After the hospital's outpatient physiotherapy closed down, I went to a private physiotherapy clinic in hopes of continuing therapy & hopefully progress.  Those who have followed my posts know that what I found in the general community was rather disappointing.  (Read about that here) Most private clinics are geared towards treating sports injuries, home injuries (trips, falls, sprains, motor vehicle accidents, etc.) and have little or no resources, if not experience, in treating patients with serious injuries brain or spinal cord injuries.  While the therapists were quite professional, there was little more they could offer.

Last October (2012) I joined a local gym in hopes of maintaining my strength and flexibility, if not improving on them.  I also wanted a facility that had a pool where I could  use the water's buoyancy to work on my balance and walking.  Finally, with the reduced physical activity associated with being trapped in a wheelchair and the refrigerator always shouting out invitations to your boredom, I wanted to persuade my metabolism to at least try to fight my weight gain.

Facilities:
The Gym I chose is quite impressive!  The first of this franchise in Canada.  58,000 square feet with three swimming pools -one huge outdoor leisure pool for summer fun. and indoor multipurpose pool and the third with lanes for swimming lengths or perhaps buoyancy assisted walking in my case.  Second floor is all gym equipment as far as the eye can see.  Treadmills, stationary bikes, an apparatus for every muscle, free weights, etc, etc.  Top floor has basket ball & squash courts plus special function rooms for group activities.  They have a three story rock climbing wall/structure.  A life lab can monitor your progress through physiological testing.  Pilates, massage, whirl pools and all the rest.  When the body is satisfied, you can reward yourself with an on-site hair salon, nails & facials, and even a small restaurant serving only the healthiest of choices.  Oh, the towels are included as are amenities such as shampoo, razors, shave cream and such.  Beautiful upscale facility

I hired a personal trainer for one session to introduce me to some of the gym equipment that they though I could use.  After that, I made an effort construct a routine primarily focusing on leg strength and flexibility for starters.  The routine takes between 1 & 1/2 hours to 2 hours per session and I try to attend every second day.  While I make an honest effort to attend, life often has other ideas - for the most part I do stick to this schedule.  It can be a bit of a challenge on weekdays when I've already spent eight hours at my job.  Tack on up to three hours more in wait & travel time to and from work although I live only about 12 minutes away from my workplace.  After an 11 hour workday, it is not always easy to motivate yourself to head to the gym for another 2 hours.

Anyways, it has paid off to some degree.  Muscle mass has significantly increased and my wife claims I have lost weight although I fail to see it.  I wanted to gain strength and lose some weight before adding the pool routine. Unfortunately, the increased strength alone really hasn't translated into additional stability.so I will have to add the pool very shortly and see if that will help.

It is quite frustrating!  I can stand.  I can just about take a few steps without holding onto anything.  However the stability is still rather week.  If I feel I'm starting to go over, it is difficult to recover and straighten up to the vertical once more.  I have excellent plantar flexion (standing on toes) but much less dorsi-flexion (turning  foot up at the ankle).  I can even wiggle some toes to some degree -a bit of improvement after being totally paralyzed from the waist down when discharged from the hospital.
Pain however, is another matter.  It remains my constant companion!

Gym Equipment:
Okay, below are some photos taken at my gym of some of the equipment I currently use.  In addition to the pool, I hope to add some upper body equipment to my routine in the following months.

This contraption has no name printed on it and I'm not sure what the proper name of it is.  Regardless, I use this pedal  contraption to warm up.  While you can exercise both legs and arms with it, I tend to use the foot pedals alone.  20 minutes on this, currently at level 9 of 30, raises quite the sweat,

After the warm-up I generally find which apparatus is free and don't worry about the order of the exercise.

With the Seated Leg Curl, you place you legs over the padded bar in the foreground and with the chosen weight, you curl your legs towards the floor.  I won't go into specific anatomy but it strengthens the backs of the legs up to the butt and I even feel it in my lower back.  I currently use it at about 100 pounds resistance and do about 3 sets of 20 repetitions.

Leg Extension Apparatus - This one is kind of like the opposite of the one above.  Place your legs under the padded bar and lift the weight up.  You feel it in your thighs.  I currently use it at about 90 pounds and try to do 3 sets of 20 repetitions.

Abductor Apparatus - On this one you sit on the seat and place your knees against the two pads.  With the weight set you spread your legs, pushing out against the pads with your knees
I have this set at 190 pounds and do upwards of 150 repetitions in total.  These are big, strong leg muscles, even with my injury and I find it rather easy to do at this weight and repetition number.

Abductor Apparatus -This one is the opposite of the one above.  When seated, you put your knees on the outside of the pads and open the pads up so that your legs are spread.  With your chosen weight (resistance), you squeeze you knees together and release.  Again, I set this at 190 pounds and do about 150 repetitions.  I usually do about 75 repetitions to start and then follow with 50 and 25 as I get fatigued.

Calf Apparatus -Simple sit and place feet against the curved metal plate.  Using your calf muscles, you rotate your feet at the ankles and rock the plate forward and back.  I use this equipment to stretch out my Achilles tendons by dropping my feet down towards the bottom of the plate and let the resistance stretch your tendons.  The first time I tried this it felt like someone had lit one of the magnesium Christmas sparklers inside of my calves - fireworks were going off inside my legs.  Felt great!  I have this set at about 120 pounds and really have no set number of repetitions.   I do it for as long as it feels good and time allows.

The Stationary Weights - the arms can be moved up or down, closer together or further apart.  Backing my chair between the arms, I alternate, grabbing one hand grip (dangling from the arm) and using both hands, pull the resistance from the upper left to my lower right (or upper right to lower left with the other arm) -one at a time. I find this helps loosen and strengthen the torso with the twisting action.  I have the weight set at 13.5 which I believe is 135 pounds (?) seems a bit much.  I do 3 sets of 20 repetitions.

I don't have photos of the few other pieces of equipment I currently use.  One is the Inclined Leg Press, where you are seated in a chair on some rails.  Placing your feet on a platform raised directly in front of the seat, you push against it and push your seat up the inclined rails.  Basically, you are pushing your seated weight up hill.

I also use an Abdominal Apparatus where you basically sit and pull on some straps that come over your shoulders - using your abdominal muscles to lift your chosen amount of resistance.  I do three sets of 25 repetitions.  Once in a while I also try out a bicep curl machine and a rowing machine.

Finally, I am new to the gym environment so please forgive me if this equipment has more appropriate names that what I've called them.

Because I am able to stand, any piece of equipment that I can step onto or into, I can use -I just need someplace i can hold onto to stabilize myself.

I really feel this self directed physical exercise therapy is very helpful.  I would urge anyone with a physical disability to join a gym and do, no matter how small, whatever you can do. I know there will be improvement in physical ability and in the mind.


Saturday, 27 October 2012

Time For A New Powerchair


If it were a horse, I'd take my old Quantum 6000 out back and shoot it.   I have a love-hate relationship with the powerchairs.  I'm eternally grateful that in this day and age we have such equipment, yet hate the fact that I'm reliant on such equipment.

With the mobility that these power wheelchairs provide, I shudder to think of a time not so long ago when paraplegics were condemned to wheeling about in rickety wooden framed, wicker seated, solid tire, manual chairs.  The occupant of this two-wheeled weapon had to combat the environment - to do battle with sidewalk curbs with no ramped entry, doors with no automated openers, washrooms only built for the ambulatory etc.  Life is better with advances in wheelchair technology as well as a society with some understanding and compassion for disabled citizens.  Yet, life is not easy...

I never thought that six years post injury, I'd still be in a wheelchair.  Then again, I never imagined that I would ever be in a wheelchair, period! Nobody in a chair ever does.... But here I am....

Back to the subject of this post.  My old Quantum 6000 served me well.  It gave me very few reasons to curse it though a few times it did die on me and for a paraplegic totally dependent on a powerchair - there is no opportune time for a breakdown to occur.  A flat tire at the start of a workday, a joy-stick controller which had a mind of its own in determining when the chair should shut off (first time was in a revolving door!).  Bearings in the castors that froze, drive motors which refused to drive, etc. I also contributed to this chairs demise.  I had driven into obstacles and bent the leg rests into the shape of pretzels as well as having destroyed the padded arm rests by driving to close to the bus' chair lift and shredding the foam like cheese on a grater.  I found parts on the ground and had no idea where on the chair they came from!  Yet the chair held together and hauled my ass around for six years,...and still on the original battery!

I decided it was time for a new chair however I had no idea if the government would once again provide assistance in my acquiring a new powerchair.  The Canadian province of Ontario has a program, the Assistive Devices Program (ADP) which eases the financial burden on people with disabilities by paying 3/4 of the price of assistive devices (wheelchairs, walkers, braces etc.).  When I was discharged from the hospital, I was paralyzed from the chest down and so a powerchair with a tilt mechanism was imperative. The powerchair for my paralysis and the tilt to shift my weight so as to minimize the development of 'pressure sores' which can easily become infected.  Now, some six years later, I can move my legs with ease, stand and even move some toes with determination.  Those pressure sores never materialized. However, I still can't walk without assistance.

So, the question was whether I would once again be entitled to government assistance for a powerchair, or any wheelchair for that mater?  With the current state of the economy, most government programs are being cut back. Would the qualifications be tightened as to who could expect government assistance?  Would only those most disabled, the most in need, be granted assistance?  I have great upper body strength.  Would I only be entitled to a manual chair? (which I already have).

The situation was this.  I cannot perform my duties at work with a manual chair as I have to physically move about the workplace frequently and have to carry items.  I cannot carry items in a manual chair as both hands are used in propelling the chair.  With the powerchair I have one had free to carry items while I control the chair with the other hand on the joystick. I need to stand to reach items on shelves.  With my manual chair, I cannot stand up as the brakes are not strong enough to hold my weight when I brace against the seat.  I would push the chair backwards and  fall backwards into it. Only another powerchair would do.

Now, a new powerchair costs between $10,000 and $18,000 depending on type (tilt, etc.) and accessories. I simply cannot afford to pay that on my salary, every 5-6 years.  By the time I would pay down the chair, it would be time to buy a new one!   So the alternatives seemed to be:

  1. The government, through their ADP program would once again assist me by paying 3/4 of the cost of the new powerchair which would then allow me to continue to work, be self sufficient and pay taxes to that very same government.
  2.  The government would decline my ADP request for assistance, leaving me unable to do my job and forcing me to quit.  No longer self sufficient, I would have to apply for government disability and no longer would be paying income tax to the government.
It seems to me, the government would end up paying one way or another  The first alternative seemed the most productive and positive.

Through an acquaintance, obtained the name of an ADP representative who would evaluate my needs and submit the funding application to the government on my behalf.  I was delighted to find the ADP representative to be most professional, friendly and receptive to my dilemma.  Over two meetings she determined the best seating for my needs and put me in touch with the a sales representative colleague who then suggested various wheelchair makes and models which would best suit my needs.

Still, it took about a half year before everything came together.  My only major request was that the chair would have a 'retractable' foot rest which would fold upright, stowed out of the way, somewhere under the seat.  This would replace the two separate foot supports that hung from the front corners of the chair - the ones I always managed to bend.

What I ended up choosing was the Permobil M300 motorized wheelchair.  My 6 year old Quantum 6000 and the new Permobil M300 are pictured below.

Click on Photo to enlarge for better viewing

Above is the old Quantum 6000:  Front leg hangers are removed.  Castors on front an back are bald, the tread worn off years ago.  The seat was partially hard foam at the front edge with a gel bag at the rear which would mould to the butt.  The tilt motor can be seen in the photo on the right.  It died long ago and as I didn't really need it, I opted not to have it fixed or replaced.  Even if covered by my private insurance company, I couldn't justify the price!  Cushion are rests are missing and only the steel tubular frame remains.

Click on Photo to enlarge for better viewing

Above is the New Permobil M300:  I have a one piece cushion seat.  The castor wheels are 8" in diameter, much larger than the enclose round castors on the Quantum in the previous photo.  The photo at the left shows the foot plate in the extended (down) position  The first prototype delivered had a foot plate so large it actually interfered with the turning of the castor wheels.  A new footplate was developed for my need.  The Permobil M400 was developed with European standards in mind and therefore has reflectors all around (2 clear in front (left photo) and four red at the rear (right photo) as well as two amber on the side (center photo).  The control unit has buttons to turn on headlights, signals and hazard lights however these buttons are inactive on my Permobil chair as this lighting package which is mandatory in Europe, is optional in Canada and costs an extra $1000.  So, I have a bunch of dummy switches on my controller which do light up when depressed (activated) but actually do not turn anything on.

Some problems which had to be overcome while others I simply have to get used to;
  • The large 8" radius front castors on the Permobil are great for climbing obstacles, however when the chair stops after a turn, at least one wheel points (extends)  towards the center of the wheelchair and is partially in my way if I want to stand up.
  • The top edge of the foot rest plate cuts into the back of my legs when I stand and put pressure against it.  To minimize this, the seat plate was moved as far forward as possible so that the plate is almost under the seat.  I obtained a rather large, ~2" diameter hose from a local hardware store and sliced one side lengthwise.  I slid this hose over the front edge of the seat pan to further extend it outwards by about a quarter of an inch and it acts as a cushion as well.
  • The old Quantum 6000 had square arm rest frames made from tubular material (round tubes assembled into a square frame).  Pouches or bags could be hung from the horizontal arms of the tubular arm rest frame in which I could keep personal items such as keys or a cell phone, etc.  The vertical tubular armrest supports could be removed and a  ring or clip could be added before replacing the frame.  The rings could be used to secure a wallet which then could be placed into a pouch hanging from the frame. (ie. a removable pouch within another pouch).  The Permobil has a curved armrest frame from which a single rectangular post extends to hold the armrest.  Both the curbed frame and single rectangular post don't offer an easy way to hand personal bags or pouches.  The Permobil website does offer an aftermarket side pouch but the small bag has a price of about $200, far to much for a small bag to hold a wallet.  My only option is to remove an armrest cushion and sling a small "saddle bag" like pouch over the bar, then screwing the armrest cushion back onto the frame.  I've yet to do this so I don't know how feasible it will be.
  • As I mentioned earlier, the controller has extra "dummy" button switches on it for the non-existent European lighting package. These buttons turn on and flash but do nothing.  The may be a entry point for dirt and water thereby shortening the life of the controller.  My main dislike of this controller is that it goes through a self check each time the chair is turned on and that takes about 3 seconds before the chair is moveable.  Now that may not sound like much but just imagine if an able bodied person would have to wait 3 seconds each time - between the time they decided to get up off their chair and start walking.  It would be a major irritant!.  My old Quantum fired up and would move in less than one second.  An important feature if you find yourself having to escape danger quickly!  So my only option is to leave it on all the time which may present a safety hazard if I hit the joystick inadvertently.
Anyways, another long-winded post but I try to get the issues across best I can in hopes that someone else might benefit.

I'll let you know how things go after I've had more time to live with this chair.  Getting used to a new chair after you've lived in one for six years is so much more different than just getting used to a new pair of shoes!

Saturday, 8 September 2012

Summer's Gone

Well, its been a while since my last post for although things still change, it is  far to slow for my liking.  This has been a challenging summer on several fronts.

No Continuing Physiotherapy:
Those who have followed this blog know that I no longer receive physiotherapy.  Not my choice however with all levels of  government crying poverty, funding cuts are passed on to the community.  Community hospitals which once provided the level of expertise in physiotherapy that an injury as severe as mine requires now had to deal with a frozen operational budget.  The provincial government however had the funds to create LHINs (Local Hospital Integration Networks) which were are an "arms length" agency that in a sense does the government's dirty work for them.  They suggest what services should be eliminated from hospitals under the premise that they are already available in the community by private providers.  This in theory would duplication of services available in the community and funds saved could be channeled into core hospital programs.  Of course governments often fail to see the big picture.  Hospitals provided that level of expertise (spinal cord, stroke, brain injury) that private community physiotherapy clinics who deal with primarily with sports injury or minor trauma rarely see.  Expertise developed not only through continuous encounters with people suffering from such catastrophic injuries but also in the acquisition and use of specialized equipment to aid in rehabilitation which smaller private clinics simply can't justify buying.

With the closure of hospital physiotherapy (and other) clinics, patients either terminated their therapy or attempted to find nearby private clinics which would continue their therapy on some level.  It was quickly apparent that the sudden influx of new clients quickly overwhelmed the private clinics.

The irony was that outpatient physiotherapy clinics actually brought outside monies (insurance or self-pay) into the hospital, above and beyond the government funding.  Go figure!

*the private clinic I attended over the winter of 2009-2010 was chosen primarily because of location.(it was nearby).  Perhaps more specialized clinics could be found on the other side of the city or in the next town however travel time was a significant factor, dependant on public disability transportation service scheduling.
The private clinic I attended had no handicapped automatic door opener, had no parallel bars and had to rent a walker for my use.  Hardly equipped for my needs.

Disability Transport Goes On Strike:
As mentioned above, provincial governments have cried poverty and indicated that budgets would be frozen for the foreseeable future.  Yet, at a time when most are grateful just to hang onto their jobs, the union for the public disability transportation service which takes me to and from work each day coerced members into strike action.  So in mid summer they took to the picket line leaving the non-unionized transit management scrambling to meet their obligation.  Rides were quickly outsource to a private cab company that usually just handles the overflow from the provincially funded disability transportation service.  While I was prepared to leave my powerchair at work and have my wife shuttle me back and forth by car with my manual chair, the cab service worked extremely well, so much so that my times were usually better resulting in a shorter commute.  While priority for rides was assigned by necessity - medical appointments, work, and leisure, I never was without timely transportation.   After about six weeks the strike ended with not much being accomplished.  Drivers sacrificed a pay-cheque for this time away however did retain their benefits in the new contract which was a big issue.  The transportation agency probably saved some money on salaries, fuel and  vehicle maintenance but as they had to pay the cab company for service, the savings were probably not substantial.  It was a lose-lose-lose situation between drivers, management and clients...

New Powerchair:
It has been over six years since my injury and my acquisition of an electric wheelchair.  The chair was presented to me while an inpatient at Toronto's Lyndhurst Rehabilitation Hospital.  I had no input as to the vendor, model or specification as with no previous experience, I relied on the hospital's expertise.  All in all, they did a fine job in matching the chair to the person (me) - or perhaps, because I had no previous experience with a powerchair, whatever I was given seemed right.  I had nothing to compare it to.
Well, after six years of use and abuse, my first and current chair "on it's last legs" (no pun intended).  The detachable leg supports have been bent, straightened, re-bent, replaced and re-bent.  They splay out and twist in, stick out and catch on any obstacle, however small, that extends above flat ground.  The arm rests were some of the first luxury items to go,  Shredded off like cheese on a grater while rubbing along the sides of the bus lift.  The tilt motor stopped working years ago - once considered a necessity to shift my weight in order to prevent pressure sores.  Skin issues never materialized and so when the motor stopped operating, I decided against submitting a claim to my insurance company for unreasonable cost of replacing the unit.  The front and back castors rubber treads are all but warn off.  The original battery still takes a charge but loses it much more quickly. The chair creaks and groans but continues to run in spite of the abuse I inflict on it daily.  However, I cannot continue to push my luck  It was time to look into getting a new powerchair.

Am I entitled?
When I received my first powerchair while completely paralyzed from the chest down.  Things have improved greatly since my discharge from the hospital to where now I can even wiggle a few toes to some degree.  As I work at a hospital, I see wheelchair bound people daily, some elderly, some with visible physical deficiencies, yet using manual wheelchairs.  I had to wonder if it was their own choice to propel themselves using their own power, or did they settle for the less expensive manual chair because of their limited finances?   Even with the provincial government's ADP's assistance (Assisted Devices Program), the 25% cost the client must pay can be prohibitive.
Even with my decent income, the full cost of a new powerchair would make it out of reach for me.(my first powerchair with tilt cost $18,000) - A "Catch 22" situation - I would be working only to pay for the chair and I would need the chair only so that I could work.

So the question was;
As I have excellent upper body strength and am able to propel a manual chair with ease, would I still qualify for ADP assistance for a powerchair, in light of many other people with less ability using manual chairs as their sole source of mobility?  I would find it a significant financial burden to buy one without their assistance yet I need a powerchair to do my job.  I need one hand free to carry items and I need the braking mechanism in the powerchair so that I can brace against it to stand up (a manual chair's brakes are not sufficient to keep it from rolling back.
The choices are - would the government prefer to assist my purchase of a powerchair which would keep me a productive taxpaying citizen, or to deny assistance, leaving me unable to do my job which would result on my falling back on disability and having the taxpayers support me.

The Result:
With the help of an acquaintance, I contacted a sympathetic ADP authorized occupational therapist.  She assisted in getting authorization for the ADP assisted purchase of a new chair.  As a seating specialist she also recommended and provided seating much superior to what I currently was using.  She contacted the sales representative for a powerchair supplier and started the process.  I'll have more about my chair selection process in an upcoming post.