Complex seating and positioning issues? Our Libella Seat Varia can help you with that!
22. 6. 2022
Mrs. Michaela Macnerová has lived since birth with the effects of a developmental defect stemming from spina bifida. She was completely paralyzed from the thoracic spine down, and as her body continued to grow, it tilted and rotated her pelvis, causing severe asymmetry with a backward shift (anteversion). Rotoscoliosis of the spine also resulted in an atypical position of the buttocks. She has length discrepancy at the level of the thighs, her lower limbs are guided apart (abduction) with the right leg falling to the side (external rotation), and her ankles impede foot support. The situation is made even more uncomfortable by the spasticity of her lower limbs, which affects the already complicated posturing in the wheelchair.
This is why Mrs. Macnerová turned to Libella Design with hopes that the Libella Seat Varia might alleviate her problems.
Until then she had used a honeycomb cushion, which, because it was devoid of any correction or anti-decubitus protection, significantly reduced her sitting endurance. In addition, she had to place the cushion in the wheelchair upside down, because the correct position caused her even more pain. Because the backrest on her wheelchair was too high, we recommended a fixed backrest with additional support on the right side.
Mrs. Macnerová on her original seat: the blue line indicates a deviation of the spine and pelvis. Pressure mapping on the original seat: yellow and orange indicate excessive pressure in places that need to be corrected.
In agreement with the client, ergo therapist Veronika Liďáková decided to try for the greatest possible correction in the new Libella Seat Varia, even though she knew it might cause discomfort during the testing phase.
Because of the client’s loss of sensitivity at the site of the lesion and the risk of decubitus ulceration, she chose to use mainly softer, lower-density 3D printed elements for the test cushion, so as to ensure a more gentle pelvic support. She used parts with a higher profile in the front part of the assembly, and straight lateral and middle elements to optimize thigh alignment. The client’s pelvic tilt was reduced thanks to contouring in the back right corner of the cushion, and she used a higher profile on the right side to correct the rotation. Pressure mapping showed the highest pressure spread over a larger area in the middle of the seat on the right (asymmetry of the pelvis with an atypical displacement of the right buttock), so she designed an individual tailor-made part with a hole at the site of the pressure point. She then selected a standard 5 cm-thick latex for the top layer and the inserts on the right side for further alleviation.
Assembling a 3D printed layer from individually designed elements.
Mrs. Macnerová took the newly assembled seat home for testing. In spite of the considerable discomfort and pain she experienced during the first phase of testing, she was excited about the effects. The stiff, shortened muscles of her trunk and pelvis, accustomed to a certain posture, slowly started to stretch, her spine straightened, the stability of her whole body improved and her internal organs shifted. The rewards were multiple: positive, visible changes in posture, confirmed by the client's physiotherapist, improved breathing and cardiac activity, relief from spasms, elimination of bruising and spinal blocking, and overall improvement in quality of life.
At the check-up following the first phase, the ergo therapist selected a different carbon base, shaped at the front so as to support each lower limb individually. The dimensions of the test cushion bothered the client because of the position of the armrests and when transferring into and from the wheelchair, so we even produced a special, atypical cushion for her so that she could have the best possible fit.
Individual adjustment of the Libella Seat Varia anti-decubitus seat. Detail of the individual layers of the Libella Seat Varia.
Mrs. Macnerová on her new, adjusted Libella Seat Varia: the blue line indicates reduced spinal and pelvic deviation. The pressure mapping measurements show pressure compensation without any areas of excessive pressure.
Once these adjustments were made, Mrs. Macnerová left for the next round of testing. Due to the client's full satisfaction, there was no need to modify the second version. Mrs. Macnerová has not yet acted on our recommendations regarding her backrest, but the partial adjustment of her seating thanks to the Libella Seat Varia has brought many positive changes and she can no longer imagine life in a wheelchair without it.
You can find out more about the possibilities of individual adjustments at www.libelladesign.cz. You can also contact us by e-mail at info@libelladesign.cz, or by phone at 606 607 101.