Programming, Programming, Programming: Fine Tuning electronics to the Consumer's Needs

Transcription

1 Programming, Programming, Programming: Fine Tuning electronics to the Consumer's Needs Jay Doherty, OTR, ATP/SMS Director of Clinical Education Quantum Rehab Learning Objectives The participant will be able to list 2 driving parameters and how significantly these impact the ability of a consumer to control a power wheelchair. The participant will be able to describe 2 reasons that adjusting the throw of a proportional driving method can help a client to achieve independence. The participant will be able to discuss why considering all programming features a manufacturer offers is an important part of the evaluation process. Things to Ponder during this Course How much time do you put into programming? Are you knowledgeable on each manufacturers electronics and how to properly program those power wheelchairs? Even when delivering a chair with a joystick are you adjusting the driving parameters? Are you exploring the maximum capabilities of the electronics to maximize the independence of the individual you are working with? 1

2 Important Parameters for Optimal Control of a Power Wheelchair Driving parameters: Forward speed/forward Acceleration and Forward Deceleration: Going to be significantly different for individuals depending on their trunk and body stability, muscle tone and weakness. When dealing with individuals with high tone or individuals with a startle reflex you want to ensure that the acceleration is lower. This allows a smoother start up in drive profiles with higher forward speeds. Forward deceleration should be lower for individuals with trunk control issues or individuals that a quick jolting stop may cause tonal responses. Forward deceleration should be higher for individuals with slower response times whose response may require the wheelchair to stop quicker. Important Parameters for Optimal Control of a Power Wheelchair Driving parameters: Turning speed/turning Acceleration and Turning Deceleration: This is the parameter that will affect most if the individual likes the way a wheelchair drives or not. If your turning speed is to high then the person using the wheelchair will not feel like they have control over the wheelchair. If you leave the turning speed to low then people will report that the wheelchair feels sluggish. If you turn the acceleration too high the wheelchair will feel like it is whippy when it turns. Especially when turning from a stopped position. If you turn the deceleration too high the chair will feel jerky when it stops turning and if too low then the wheelchair will feel like it glides too much after they release the joystick. Important Parameters for Optimal Control of a Power Wheelchair Driving parameters: Turning speed/turning Acceleration and Turning Deceleration: It is my belief that turning parameters impact the way someone perceives how a chair drives and handles the most. For individuals with reduced or a lack of trunk control be careful with turning parameters since you can really cause instability in the seated position. This is especially true of individuals who will not use lateral trunk supports. With individuals with progressive conditions you may need to increase the accelerations so that the wheelchair reacts better to smaller inputs on the joystick as their disease process progresses. 2

3 Important Parameters for Optimal Control of a Power Wheelchair Driving parameters: Reverse speed/reverse Acceleration and Reverse Deceleration: Many of the factors that we set for forward and reverse are just as important for reverse driving parameters. Keeping the speeds slow but the accelerations higher in reverse is better for driving in reverse. Importance of Labelling Drive profiles Label and relocating drive profiles: Most manufacturers have different ways of labeling drive profiles for the individuals you work with. Options available include text, numbers (ex. D1-D5), icons or symbols. Icons/Symbols and numbers can be really useful for individuals who cannot read text or who cannot read English. There are many options so utilize what is available and best meets the persons needs. Rearrange the drive profiles so they are easily accessible This could include eliminating drive profiles not needed to make the system simpler for the individual. This could include moving the profiles used most frequently earlier in the lineup of profiles. Other Parameters for Driving Latch: Most manufacturers have two or three types of latch Cruise Latch: Works like cruise control on a automobile. With switches the longer you hold it the faster it goes until it reaches the maximum programmed forward speed. 3 Step Latch: Every time a forward command is provided the speed bumps up 33% of the maximum programmed forward speed. 1 Step Latch: The wheelchair user gives a forward command that the wheelchair drives whatever forward speed is programmed at in that drive profile. To Stop: With any latch driving command if the wheelchair user provides a continuous reverse command the wheelchair will come to a complete stop. ** Some manufacturers have commands in latch to slow the wheelchair down instead of just stopping it so check with your manufacturers rep to see which is offered by their company. 3

4 Other Parameters for Driving Latch Reverse: All manufacturers also have a reverse latch available that can be utilized. Use it very sparingly and only with individuals who truly have a strong knowledge on their electronics and using latch. Latch Timeout: This is a safety feature that only allows latch to run for a given amount of time. If a forward, left or right command are provided it resets the length of time before latch will timeout. Other Parameters for Driving Power: Some manufacturers provide the capability to reduce the amount of power that can be received by the motors. This cuts down on the power the motor can supply and therefore be used to reduce the risk of injury to drivers learning to control their power wheelchair. Torque: Some manufacturers provide a torque setting which reduces the power a wheelchair has to get over an object. Trying to keep someone driving proportional as long as possible is very important. Proportional allows someone to have the greatest level of control over speed and direction, so we want to maintain it as long as possible. There are many parameters that most manufacturers have to allow us to prolong proportional control over a wheelchair. Some of these parameters are: Three direction proportional Joystick Throw Center deadband or neutral zone Tremor suppression Assign Directions 4

5 Three Direction Proportional: Allows the joystick to be used with either forward or reverse to control forward driving and reverse driving of the power wheelchair. This works very well for individuals with a progressive condition who are having difficulty maintaining a forward joystick command or maintaining a reverse command. When three direction profile is enabled typically a reverse joystick deflection controls forward driving, then a quick reverse command is given which flips the directional arrow to reverse and the person can now deflect the joystick in reverse direction and drive reverse. Also works well with individuals who have higher spinal cord injuries and may find maintaining a reverse command difficult. Joystick Throw: Allows the person programming to set how far the wheelchair user has to move the joystick in order to accomplish maximum speed in the direction they would like to drive. This can be moved as low as 30% of maximum throw in every direction on most manufacturers chairs. Throw can be reduced in one direction and the other directions can be left at a higher amount of throw. Advice: When the joystick throw has to be reduced to 60% or lower, start looking for proportional alternatives. It doesn t typically take a person very long to decline down to 30% and then they will be left unable to drive in that particular direction in no time at all. Center Deadband: Defines how far the joystick must be moved (deflected) from center for a command to be recognized by the system. This value corresponds to the diameter of a circle around the joystick center position (the neutral position). No command is provided until the joystick moves outside of this circle. It can be used with a person who hits the joystick constantly when placing their hand on the joystick (athetoid movements), tremors when sitting still and they leave their hand on the joystick, or for a person with spasticity that has difficulty stabilizing before driving. Beneficial if a consumer has excessive movement when trying to place their hand on the joystick. Some diagnoses you may find this helpful with are: Athethoid or Spastic CP, Brain Injury, Huntingtons Chorea, Someone who has intention tremors Min center deadband Max center deadband 5

6 Tremor Suppression: Suppress a possible tremor on the joystick. 0% tremor suppression is off, 100% maximum tremor suppression This feature increases the time (in very small increments) it takes for the joystick to initiate a turn command while driving. Tremor suppression is only active while the wheelchair is moving. Use for a person who has intention tremors. Use for the person that has upper extremity weakness and the joystick keeps veering when they are going over a variety of terrains. Assign Directions: The assign directions parameter is used to select which direction the joystick has to be moved for forward/reverse and left/right steering movements of the power chair. Keep in mind that right/left and forward/reverse must always be opposite of each other. This may be used with a person who has tone or weakness that interferes with their ability to deflect the joystick in a certain direction or maintain the deflection of the joystick in a certain direction. Example: Person can hold the joystick deflected in reverse easier than forward. Reassign the forward and reverse direction on the joystick. Now when the person holds it in the reverse direction they are providing a forward command. Remember that all of the joystick parameters for the typical proportional handcontrol are also applicable to more specialized proportional input devices. You really must fine tune the driving parameters with any non-proportional input control. Know what each manufacturer can provide pertaining to programming for the individuals needs with input devices and separate switches. 6

7 Double Commands: Being able to provide double command on the input device allows the individual who cannot access a separate switch the ability to change the drive profiles they have access to. Check on the different manufacturers because you may want to be able to provide the individual you are working with the option of a right or left double command. Most manufacturers allow a double command in almost every specialty input device. This can also be useful with proportional input devices such as an expandable joystick. Many manufacturers have a way to set the timing either manually or the individual you are working with can teach the command during the fitting of the wheelchair. Add Extra Separate switches when needed: How many extra switches can or are needed to be added to the system to improve the individuals independence. Can you customize what switches perform what command. Can you assign multiple commands to one single switch Short command Double command Long command Some things to custom program Sleep, mode, toggle, emergency stop, power on/off, Seat profile, etc.. Options to allow control of a power wheelchair without the need for extra switches to change drive profiles: Standby select Provides a way to be able to change drive profile or modes without accessing the commands with a separate switch or alternative command like a double command. Standby select is entered by a set amount of time passing by and the unit goes to the standby select screen to allow the individual to navigate the menus to the drive profile desired. 7

8 Custom Programming features: Some manufacturers have the ability to custom program a switch or button on the system to perform certain functions. Some of these function may be: Power seat functions such as tilt, recline, an elevating/articulating foot platform, Bluetooth mouse clicks, mode functions, etc Explore what each manufacturer offers to best match the needs of your individual to the electronics that will meet their needs best. Changing input device during the day: More needed for individuals who have a progressive condition or fatigue during the day time. Allows the person to switch between multiple input devices throughout the day. This is important to be able to do without having to turn the wheelchair off and back on to choose a separate device. Manufacturers all have different options and different ways of performing this type of function. This may be seen with devices like a proportional hand control and switched head array. Explore what other specialty controls each manufacturer has available to work with their particular electronics. Go through the list of what specialty control options are available and how each could benefit the individual you are working with. Some of the manufacturers have a 1-switch scanning built directly into their electronics and it only has to be turned on in the programming and a switch plugged in for it to function. This can allow someone with a progressive condition a longer time they can drive their chair for as their disease progresses. 8

9 Things to Remember with Power Positioning Power Seat Function Options: Ensure that the individual you are working with can access their power seat functions through the entire arc of motion as the seat function moves. If there are issues consider the following programming options: Utilize latch for the seat functions that are problematic to access throughout the entire arc of motion. If reaching or access to the input device is part of the issue then assign the power seat function to a separate switch and place that switch where it can be easily accessed. Things to Remember with Power Positioning Consider all environments that the individual needs to drive in: Do they need to drive in a certain amount of tilt or recline for stability of their trunk? Do they need to be tilted or reclined to access transportation? Consider programming drive lock out to increase the amount of tilt or recline the individual can drive within. This allows the person to drive into a vehicle which when fully upright in the seating system may cause head clearance issues. Allowing your consumers with decreased trunk control to drive in tilt or recline can improve their independence by allowing them to drive down hills or ramps in the tilted or reclines position to improve their overall posture. Things to Remember with Power Positioning Restricting power positioning: Remember to program the power positioning system to the restrictions the person has in range of motion. If they have hip flexion limitations then setup recline to only come as upright as their body can accommodate. If a person has an adverse reaction to full tilt or full recline then limit how far back the tilt or recline system will go. If the desire is to always have a pretilt of 5-10 degrees, program that so the individual will only come upright to that position. However, remember that this may impact transfers as well. 9

10 Things to Remember with New Technology Available Today Program IR and Bluetooth Can open up many options for independence. Can offer access to a smart phone Can offer access to a computer or tablet for education, work or pleasure Can also offer wireless access to some communication devices (depends on communication device manufacturer) Most systems today offer the ability to pair with the above devices in order to provide the greatest level of independence. Things to Remember with New Technology Available Today Things that can be customized with Bluetooth programming Full control over the items listed on the previous slide can be achieved through programming of mouse control features as well as Bluetooth control over mouse clicks. Android and windows tablets use mouse clicks to activate apps and provide control over one of these types of tablets or phones. Windows and mac laptops and computers can also be controlled through mouse functions ipad and iphones can be controlled through adaptive switch control (an apple accessibility feature). This type of control most manufacturers offer as a Bluetooth access option as well The Technology Available Today Which can be Accessed Through Bluetooth Environmental control is achievable through simply programming a smart device such as a tablet or smart phone and there are apps and hubs today that can allow individuals we work with to control their environment These systems are available in the everyday consumer market for a couple hundred dollars versus what used to cost thousands of dollars. Explore what is available and educate the individuals you work with on what is available Play video here 10

11 Conclusion Remember every chair needs to be programmed even if just for speed parameters. Familiarize yourself with what each manufacturer offers for programming for the individual. Match the individual to the correct product and what features will benefit them the most. A big part of what we do is educate and then setup the power wheelchair to best match the individuals needs. Thank you! Jay Doherty, OTR, ATP/SMS Director of Clinical Education Quantum Rehab jdoherty@quantumrehab.com 11