Wheelchair Medic and a Kessler therapist integrate their skills in a complex venture to fit a client to two new mobility devices.
By Rob Ingraham
Working together with United Spinal Association’s Wheelchair Medic division and a talented occupational therapist at the Kessler Institute for Rehabilitation, 52-year-old quadriplegic Jim Sinocchi experienced life-changing improvements in his mobility and an inspiring new appreciation for modern technology, as well.
Sinocchi, Director of Workforce Communications for IBM Corporation and a longtime advocate and popular public speaker for people with disabilities in the workplace, suffered a C-5, 6 spinal cord injury at age 25 while surfing in Puerto Rico. At the time of his injury, Sinocchi was working in sales at IBM’s New York City office, and after his rehabilitation at The Rusk Institute, IBM welcomed Sinocchi back to work in their White Plains, New York, office as a technical writer and editor, which accommodated his limited mobility.
But, as sometimes happens after spinal cord injury, Sinocchi developed syringomyelia, potentially life-threatening cysts on the spinal cord itself that required surgery in 2006. While successful, the operation resulted in some loss of function in his arms, which made operating the manual adaptive controls on his van impossible.
Sinocchi knew that he had to invest in modern adaptive controls for his van but it wasn’t as simple as he thought. “The new technology is very sophisticated and much easier to operate, but would have cost as much as $50,000 to install. It just wasn’t worth investing that much to retrofit an old vehicle. So I had to get a new van.”
At the same time, Sinocchi realized he’d need a new wheelchair, too. He had been using a Marathon powerchair manufactured by Everest & Jennings, a firm that had gone out of business some years ago. Wheelchair Medic, a division of United Spinal Association, had been servicing Sinocchi’s chair for almost 20 years and Director Ray Grim suggested that, since parts were getting almost impossible to find and the chair was about 15 years old with significantly outdated technology, it made more sense to replace the wheelchair along with the van.
The challenge then became getting the right chair, correctly fitted to Sinocchi’s body type, lifestyle, and mobility requirements, while making sure that the new chair fit and worked smoothly with the new vehicle. And both the new van—a Toyota Sienna, outfitted with modern, digital adaptive controls—and the new chair—an Invacare 3G Arrow MK6i—were light years ahead of his old equipment, technologically. Together, the entire package would cost about $100,000. While insurance covered some of the cost, “I had to refinance my house,” Sinocchi said. “Unfortunately, I’m not independently wealthy.”
Brushless and Gearless Motor
One of the primary advantages of the new Invacare wheelchair is that it is “brushless and gearless.” Brushless motors are simpler, quieter, more efficient, easier to cool-but they’re also computer-controlled and more expensive. Grim explained that changes in power needs required for hills, curbs, unpaved roads, or simply maneuvering around the house- as well as specific controls such as accelerating, turning, braking, forward, reverse, etc.—are all programmed into a computer module that communicates with the two motors, one controlling each of the rear wheels.
Eliminating the gear case is another big advantage. “They were always dripping grease, you had stripped gears, worn out bearings and all sorts things that had to be fixed or modified,” Grim said. “The old chairs also had motors in the front of the chair with a pulley connected to the rear wheels via a belt and pulley system. Those were problematic. If the belt got wet, it would slip, if it got worn it would slip. A friend of mine got her dry cleaning bags tangled in the belt two or three times and I had to go rescue her to get out of her van.”
Grim explained that the chair has four programmable drives and “each can be programmed individually for a certain driving parameter. For example, the ‘A’ drive might be a slower, indoor mode, but when you get up to the ‘D’ drive, it’s full speed-up to seven miles an hour-with tremendous power so you can go over grass and gravel. You can actually program it to do a ‘wheelie’ to get over a curb: It sends all the power to the rear wheels and lifts the front end up like a dragster. It’s scary if you’re not used to it. Feels like you’re going over backwards. And they’re very, very quiet because there’s fewer components to break down.”
Fitting Man to Machine
The complex job of fitting the chair to Sinocchi’s body type, lifestyle, and mobility needs was up to Mary Shea, an occupational therapist and clinical manager specializing in wheelchair seating and positioning at the Kessler Institute or Rehabilitation in West Orange, New Jersey.
Shea said the challenges were fivefold: decreasing neck strain and pain from constantly looking up at people to interact with them; ensuring that Sinocchi could independently perform pressure relief to cut the risk of pressure sores; minimizing the wheelchair’s overall “footprint” for maneuverability in the home and work environment; increasing postural alignment and better back support; and ensuring that the wheelchair was low enough to provide Jim with physical access to the van door, visual fi eld for driving, and physical access to get under standard tables and desks for work tasks and eating.
To accomplish this, Shea and Grim worked closely with four different manufacturers: Invacare for the “base” chair and electronics; Motion Concepts of Concord, Ontario, Canada, for the MaTRxâ„¢ seating system that tilts for pressure relief and elevates the chair by six inches to achieve an 18-inch, seat-to-fl oor height; Sunrise Medical, headquartered in Longmont, Colorado, for the Jay2 Deep Contour seat cushion; and a special headrest from Stealth Products, based in Burnet, Texas.
Shea said that fitting the new chair required dozens of “tweaks” to get exactly right. “Everybody is so different. With Jim we had to tweak an inch here and an inch there, it’s pretty involved, it’s pretty in-depth, but it’s time well spent. That’s something often overlooked because people just assume that ‘a wheelchair’s a wheelchair.’ We tweaked everything to work in terms of making sure the back height and the angle fit him well and was the best for his balance needs and we also wanted to make sure that everything was tight, with the shortest turning radius as possible. All these little things made all the difference. Some of the sessions were a little longer than average, but we were able to finish everything in four or fi ve visits. This sort of tweaking is something that Kessler and Ray Grim do all the time. This is our specialty area.”
Sinocchi noted, “Your wheelchair becomes part of your body and I really had to adjust to it. I was getting little aches and pains of adjusting because I was sitting differently and better. It’s sort of like an American-cut suit vs. a European-cut suit. European-cut suits are more tapered, more proportioned to your body. And it took about six weeks to get used to the power sensitivity of the new chair. It’s also quiet. My wife complains, she says, “I don’t know where you are, you can sneak up on me. ”
Grim noted that, “Mary Shea is really good at understanding people and what makes them tick physically and she’s very good at telling me what she needs to have done. That’s the reason she’s as good as she is. She explains things to people very well and translates it to the guy doing the technical end very well.”
Van Conversion
Grim said the new van is as impressive as the new wheelchair. “The conversion was done by J. Bussani, Inc., Bethpage, New York. I never saw a van like this before. It’s like driving a car with a joystick The guy driving next to him might get scared to death because he’s not holding the steering wheel!”
Sinocchi explained that he has a joystick on one side that controls acceleration and braking and a miniature, wheel-shaped joystick on his lap that he uses for turning. “The standard steering wheel actually moves as I turn the little wheel on my lap. It’s weird.” He added that the computerized adaptive controls can be disengaged and the car can be driven by an able-bodied person after a few minor adjustments.
“The chair is great; now I’ve got to get used to the car,” he said. “I have no trouble steering, I’m having trouble with my touch. It’s really sensitive. You’ve got to remember, I was in a manual, push-pull thing, which is basically a bar attached to a chain that’s pulled on and I could feel it; it’s like when you step on your gas and brake you know when your car’s going to brake and when it’s going to slow. The digital system is totally different, there’s no effort at all. The computer translates the control into the car’s hydraulics. It allows me to maneuver the gas and brake and I never feel the added pressure. There’s no effort. It’s like a ghost, as if you wave your hand over it and the thing moves.”
Lifestyle Adjustments
Sinocchi stressed that the “elevator” mechanism in the seat has made a significant change. “One big thing for me is that I can close windows now, I can get the height. One time my wife left the house and I heard an alarm go off downstairs. It was the microwave and, as I was wondering how I was going to turn it off, I realized that I can raise the chair and get the height. The new elevator allowed me to raise the chair and shut off the microwave button over the oven, which I’ve never been able to do before. I felt like a million bucks. I can also look people in the eye when I talk with them. I tell, you these little changes are unbelievable. The lifestyle difference, it’s great.”
Sinocchi bought the new chair through Wheelchair Medic and while he had to pay more out of pocket because it wasn’t in the network of providers covered by his insurance, he said Wheelchair Medic’s service makes it worth the extra cost. “When asked who I wanted to work with, I picked Wheelchair Medic. I’ve been with these guys for 20 years. They know me, I’m local, they service the chair, and they always come out in an emergency. It’s one thing to get the chair, but once you’re stuck, what do you do? I’m active, I’m working, I’m driving, and I don’t take this stuff lightly. Having somebody that knows the product like Mary and Ray is real important. And having people that know your condition well is important because they won’t give you something a paraplegic needs instead of what a quad needs. I think we did it right and I wanted to do it right because it’s too expensive to make a mistake.”
“I’ve been around wheelchairs for a long time,” Sinocchi said. “Ray and Mary are among the best in the business.”
Rob Ingraham writes regularly for Action.
