Is It Time To Replace Your Cushion?

Guest blog post by Bob Vogel

“How do I know when it’s time to replace my cushion?” This is an important question that frequently comes up at consumer shows, a question that has a several answers.

The first and foremost reason to replace your cushion is if you have a change of medical condition that effects your skin such as weight gain, weight loss or if the cushion you are on is showing signs that it isn’t doing an effective job protecting your skin— if you start to notice your skin remaining red after a long day of sitting–insurance should pay for a new cushion with the proper seating evaluation.

This is why it is crucial to check the skin on your butt with a mirror every evening and morning—taking a few moments to do a mirror-skin check gives you the best odds of catching a potential skin problem early, before it progresses into a serious pressure ulcer.  If you start seeing a red area at the end of the day, it is important to tell your doctor and ask for a referral for an evaluation with a seating clinician—as soon as possible. Don’t wait!

This recently happened to me.  I’m 52 and in my 27^th year as a T10 paraplegic and except for one tiny pressure ulcer right out of rehab I’ve had healthy skin.  But as we age our skin gets thinner. Lately I’ve noticed some redness on my left ischium during my evening mirror checks. I have a pelvic obliquity; my left ischium is slightly lower than my right. I tried readjusting the pressure in my cushion and doing extra weight shifts but the redness would return by evening. Although the redness blanched—turned white when I pushed on it with a finger and would disappear within 30 minutes– I knew I shouldn’t have any redness at all.

I took this very seriously. I know way too many wheelers that “never have skin issues” and felt they didn’t need to do mirror skin checks anymore.  Then somewhere 15 or more years after their injury they end up with a pressure ulcer, skin flap surgery and 3-month hospital stay.

The usual protocol in my case would be to phone my physician right away and get a referral to the first possible seating clinic. AND have the doctor emphasize, “there is compromised skin”.  This should get a timely seating clinic appointment because a new, properly fitted cushion is much cheaper than hospitalization and a skin flap.   If the seating clinic determined the cushion I was currently on was not adequate and I needed a new cushion, I would be sure to have them write that my skin is “compromised” on the Letter Of Medical Necessity.  As always it is important that the Letter Of Medical Necessity and cushion prescription say the exact seating needs; for example, ROHO® HIGH PROFILE® Single Compartment Cushion (4-inch).

I went through this once—26 years ago—with a tiny pressure ulcer due to the wrong cushion.  Because of the pressure ulcer I got a timely appointment at a seating clinic and Medicaid quickly approved payment for a ROHO cushion–an upgrade from the inadequate memory foam cushion on which I had been sent home from rehab.

In my current instance I was fortunate that I know a physical therapist that is an expert in seating and positioning. She took all of my seating information into account and suggested I switch to a ROHO® QUADTRO SELECT® HIGH PROFILE® Cushion, that has deeper cells than the ROHO QUADTRO SELECT that I was currently on. This would give me deeper immersion sinking into the cushion to provide more support in the areas surrounding my ischiums, and allow me additional depth to adjust the cushion so the left rear quadrant is significantly lower than the right without bottoming out—thus taking weight off of my ischium.  A disclaimer: Since I am in the ROHO elite program I didn’t have to get insurance approval.  Several weeks ago I received my ROHO HIGH PROFILE QUADTRO SELECT.  Evening mirror skin checks reveal success!  At the end of a long day my skin looks fine!

Another important reason to get a new cushion is time.  Every brand, make and model of cushion will break down over time. When this happens the cushion no longer supports and protects your skin the way it was designed—putting you at risk of a pressure ulcer.  Even if the cushion you are using is working fine, it is important to replace it before it starts to break down!

How often funding sources will reimburse a new cushion varies from one type of insurance to another.

In order to get a new cushion before your current cushion breaks down it is important that you are the squeaky wheel and ask about getting a replacement cushion. The way to do this is contact your local DME (durable medical equipment) supplier and tell them you need a new cushion. They will be happy to guide you through the step by step process of getting a new cushion, based on your seating needs, including gathering your insurance information to let you know how often your insurance will reimburse a new cushion.

If you don’t already have a working relationship with a DME supplier, locating one is your next step. ROHO makes this easy. To find a DME supplier go to www.therohogroup.com/where_to_buy.jsp and click on Buy from an Authorized Retailer Near You.

You can find Medicare DME provider(s) in your area by going to www.medicare.gov. On the main page pull down Resource Locator, scroll down to Medicare Supplier Directory, from there, type in your zip code and click submit. On the next page check Wheelchair Seating/Cushions and hit view results. The “default” setting on View Results is 10 miles — to find more DME supplier options it is helpful to expand the View All Suppliers Within (on the right side of the page) to a larger distance in order to find a Medicare DME provider that is also a ROHO authorized retailer.

It’s much better to be a proactive “squeaky wheel” and work on getting a replacement cushion while the cushion you are sitting on still provides proper support for your skin than waiting too long and risk developing a pressure ulcer because your cushion gets so old it is breaking down.  Plus, getting a new cushion while your old cushion still provides proper support means you now have a back up cushion—one you can use while cleaning your new cushion and/or to use on the seat of your car for extra skin protection while driving.  If your cushion is getting replaced, be sure that all of your paperwork specifies the exact manufacturer, model and size of the cushion you were fitted for.

Keep doing daily mirror skin checks and replace your cushion before it breaks down.  Stay healthy my friends!

 

___________________________________________

Push Girls—So Far, So Good!

Guest blog post by Bob Vogel

There was a huge amount of press coverage leading up to the June 4 debut of Push Girls–a 14-episode reality TV show about the lives of four women with SCI (spinal cord injuries) airing on The Sundance Channel, Monday evenings at 10:00pm—including an in-depth cover story in New Mobility magazine.

Like it or not, media plays a huge impact on the way in which people view the world, and all too often wheelchair users are portrayed as two dimensional characters in film or on TV–usually falling into stereotypes of “heroic inspiration”, “bitter victim”, “evil villain” or in the case of “Artie” on the TV show Glee—a caricature.

My background includes a BA in broadcasting, with an emphasis on television production. I don’t get the Sundance channel, so I’ve popped for the $2.99 per episode on iTunes to view the five episodes that have aired to date and critically viewed them, pausing to take notes, and replaying to look for flaws—I’ve been pleasantly surprised and entertained.

The reality of reality TV is that an editor can only fit so much into a 25-minute show, including  bringing it to some type of conclusion.  The show is done well, starting with camera angles that are set at the women’s eye level or below (wheelchair height—rather than shooting from standing height looking down).  This is a big deal as it portrays the women as strong and powerful.

The show does a good job blending day to day issues like paying bills, dating and relationships, with SCI issues like transferring into the shower, using a standing frame to help keep bones strong, transferring a chair into and out of the car and answering questions that wheelchair users hear all too often like “can you have sex?”. I love Tiphany’s answer “Yes, lots and lots of sex.” By the way, that question isn’t always unwelcome, in fact it is quite inviting when asked by a person you find attractive!

The five episodes thus far have covered a lot of ground, from a ball room dance competition—with Auti showing very cool dance moves, both individual and  with her partner–break-ups, speed dating, to Auti and her husband going to a fertility specialist as she tries to have a child at 42—yes, women with SCI can and do have children.

The key to the show is the power of friendship–the four women support each other, have each other’s backs and provide honest feedback to one another.  It is also cool to see the way they help mentor a 5^th Push Girl, Chelsie, who is still learning the ropes as she approaches her 2^nd year as a para.

When it comes to media portraying people with SCI, my biggest pet peeves are two all-too-common “sensationalized” and incorrect headline themes “Not being able to walk and using a wheelchair is terrible, the end of the world.” and “A person with SCI can walk again if they have the willpower and work hard enough.”  The “Walking again” headlines fail to mention that the a person that is finally able to walk had an incomplete injury, meaning there still is still some sensation and/or voluntary movement below the injury and that sometimes people continue to get more functional return over time. With enough return,  intensive therapy and hard work can enable a person to walk. But in a person with a complete injury—meaning there is no sensation or movement below the level of injury—all the willpower and hard work in the world isn’t going to create more muscle movement, much less result in walking.  By neglecting to report this information, the general public is left with the idea that “If you aren’t walking, it’s because you don’t have the willpower and aren’t trying hard enough”.

The impact of these stories becomes evident in episode 3 “You Don’t Get It” when Mia (at 32, has been a para since age 14 when a blood vessel ruptured in her spinal cord) is visited by her mom for the first time in 3 years.  Her mom is a recovering alcoholic and the two have had a difficult relationship.  At the beginning of the show, Mia’s mom says “When I heard that Mia may not walk again I just wished she’d die because I didn’t know what her life was going to be like.”

When Mia opens the door for her mom, one of the first things her mom says, in a disappointed voice  “You mean you’re not walking yet?” We see Mia’s uncomfortable look of disbelief (she has been injured 18 years).  Next Mia gets into her standing frame and her mom says “Can you still move your toe? Did you get any other movement back?” Mia responds flatly “I can move two toes.”  Then her mom says, “I would think that Mia would want to walk if she could but it’s like that is all closed off to her.”  Insinuating that Mia isn’t trying. She starts telling Mia she keep reading about the progress they are making in SCI research.  We see Mia say “My mom has this misconception that if you can’t be walking then there is no possible way you can be happy or live a fulfilling life.  So I need to show her that I am living a fulfilling life.”

Throughout the episode there is difficult discussion back and forth—Mia brings up how difficult her mom’s alcoholism was on her.  Strain is evident in Mia’s face as different issues are brought up.

Mia takes her mom on a day of errands and shopping—at one point Mia does one of the coolest up-a-set-of-two stair transfers (going from her chair, up to a patio chair then back to her wheelchair) I’ve seen–to show her that she is leading a fulfilling life.  While this is going on we see the other women buying a cake and getting ready for Angela’s 10^th “Celebration of Life” (celebrating 10-years since her accident) party.  Later Mia and her mom join the other Push Girls for lunch, as Mia’s mom meets the women for the first time she says “As I walked into the restaurant I was amazed at how glamorous her friends were.”  By the end of lunch it appears that for the first time Mia’s mom gets the big picture and lets go of focusing on the wheelchair.  Mia says “The girls had an amazing effect on my mom, I could see it. I could feel her energy change, like a sense of relief.  It was amazing progress to make with my mom in one trip.”

As I write this I am anticipating tomorrow nights episode, which says “takes on one of the most controversial topics of our times” and will feature Chelsie’s continued pursuit of dreams of walking.  Trailers show Chelsie doing physical training at a SCI clinic designed to help maximize functional ability. And she is considering stem cell treatments, which are only done in other countries, are extremely expensive and scientifically unproven.  For an in depth story on stem cell treatments see New Mobility magazine.  It will be interesting to see how the episode plays out.

As the show progresses, I hope we learn more about how the women make ends meet.  Thus far, we have seen Mia in her job at a graphic design and branding firm and Angela is trying to re-start her modeling career.

It is apparent from the comments on the Push Girls website, they are connecting with fans.  I hope the show continues to grow in popularity and gets picked up for another season.  Perhaps a spin-off, Push Guys?

___________________________________________

Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at online.relations@therohogroup.com.

SCI, Scuba Diving and the Art of Cognitive Restructuring

Guest blog post by Bob Vogel

In my pre-SCI (spinal cord injury) days I competed on the professional freestyle snow skiing circuit. Vying for the upper echelon of the sport, I soon discovered the difference between top athletes is as much mental as it is physical. I also had a few hurdles to overcome, not the least of which was that I would be overcome with severe anxiety before the start of a competitive run. I worked with a sports psychologist, and one of the tools she taught to help me overcome this was cognitive restructuring, a technique in which you change negative self talk and turn it into positive self-talk. A technique that worked! After much practice, I was able to convince myself the more nervous I was, the better I would ski. I welcomed the nerves – the tougher the competition, the better I skied.

When I broke my back and was going through SCI rehab, I discovered cognitive restructuring could be a very helpful tool in dealing with the daily routine and rigors required to maintain a healthy body with SCI.

During the acute phase of my SCI, I got hit with a pulmonary embolism (blood clot in the lung). As part of the therapy for the embolism, I had to operate a device that consisted of inhaling through my mouth to keep a little ball raised in a tube as long as I could—long deep breaths—five times every hour, which the time seemed like torture. Even tougher, twice a day the respiratory therapist came in with a torturous machine that with each breath, by mouth, would force saline-misty air into my lungs as I inhaled.  The forced salty air had a horrible taste and would cause me to almost puke. I dreaded every treatment.  However, I also understood the treatments were vital to helping me open and strengthen my lungs to prevent pneumonia.

As awful as the breathing machine felt—there was also something vaguely familiar about it.  Then I figured out the connection—the saline mist was coming from the machine had a similar taste as ocean water, a taste I often encountered when I was scuba diving – a sport I loved!  I used this connection to cognitively restructure my thoughts about the breathing treatments.  Each time I struggled to keep the ball raised on my breathing device I would imagine I was floating on the surface of the water looking down through my dive mask and taking a deep breath on my snorkel before descending as deep as my breath would allow.  During the forced air treatments, I would close my eyes and imagine I was diving in crystal clear water near a colorful coral reef.  Using cognitive restructuring, the previously unbearable treatments became pleasant daydreams.

Transferring from the acute SCI bed to the rehab ward and trying to learn the endless list of daily tasks from when to empty the bladder, how much liquid to take in, bowel training, weight shifts, skin checks, and on and on, with no physical sensation to remind us was daunting to say the least.

I remember having a similar, overwhelming feeling during my first scuba classes thinking of all the things a diver needs to monitor during a dive – depth, amount of air pressure in the tank, length of the dive, decompression status, navigation, buoyancy control, planning a slow controlled ascent and safety stop – seemed just as daunting and there is no physical sensation to help out.  Yet with time and practice it became second nature.  An accomplished diver consistently checks these systems in a relaxed manner and it becomes a source of pride.

Once again, I turned to cognitive restructuring. In rehab, I decided learning how to keep track of the way my body works and learning to manage and monitor all of the systems I could no longer feel, including weight shifts and skin checks would become akin to checking systems in scuba diving.  I worked hard in rehab and got the basics down.  I’ve also found that learning how to keep a body with SCI healthy is a lifelong, ongoing process.  I’m fortunate to have many friends with SCI and we often trade “SCI health and maintenance” ideas. For the friends I roll with, monitoring and taking control of the unique ways our bodies work with SCI is second nature.  We trade stories about keeping ourselves healthy, and dodging (or getting hit with) skin, bladder or shoulder problems the way divers talk about their scuba expeditions.

My cognitive restructuring comparing scuba diving to life with SCI extends to my equipment as well. I take as much pride in my chair and cushion as I do in my scuba gear.  I keep my chair clean and in perfect condition.  Same goes for my ROHO^® QUADTRO SELECT^® Cushion. As I’ve mentioned in previous blogs, I wash and change my cushion cover every few days and every week or two I take my cushion into the tub and wash it with bath soap and give it a good rinse to make sure my equipment doesn’t acquire odors that I may not be aware of.  For more information on cushion cleaning, see Resources.

 As I’ve also mentioned in previous blogs, people do notice when you take pride in your health and your equipment. The woman I married said one of the things she noticed about me when we first started dating was that I kept my chair clean. She also noticed that I did weight shifts—granted she was a nurse.  To her, taking care of my body and my equipment is a sign of self-confidence and comfort with my disability. She found this attractive!

Stay healthy, my friends!

Resources:

Cleaning and Disinfecting ROHO DRY FLOATATION Products

How to Keep Your Equipment Clean

___________________________________________

Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at online.relations@therohogroup.com.

SALE: $10 Off The ROHO Store

In honor of the unveiling of the ROHO® AGILITY™ Back System, The ROHO Group is offering a sale at The ROHO Store*. Take $10 off your total purchase at The ROHO Store, March 5–7, 2012, with the code AGILITY12. Start shopping now.

*The ROHO AGILITY Back System is not available for sale on The ROHO Store. The ROHO AGILITY Back System is expected to officially launch in the summer of 2012.

 

Don’t forget to tune in to The ROHO Group’s Facebook Page or Twitter account to see photos and video from the unveiling.

You can also sign up to receive information on the ROHO AGILITY Back System by visiting agility.therohogroup.com or by scanning the QR code.

Try Out a New Adaptive Sport this Winter Season

Guest blog post by Bob Vogel

Winter is here, temperatures are falling and so is the snow. This is Mother Nature’s way of telling wheelchair users “I’ve covered the outdoors with an amazing accessible blanket of snow and ice. Switch from wheels to skis or skates, and come out and play!”

Adaptive gear for winter sports has evolved to the point where people with almost any disability level can actively participate. It’s time to grab your warm clothing, choose your preferred method of gliding, skating or sliding and play in the winter wonderland. Here are some ideas.

Adaptive Downhill Skiing

For enjoying a dance with gravity in stunning mountain surroundings, adaptive downhill skiing is the ticket. There are several types of adaptive skis for wheelchair users. One option is a bi-ski — a molded bucket-style seat mounted to a frame attached to two, wide, specially designed skis — enables anybody to ski. For skiers that have hand movement, bi-skis can be turned using outriggers — forearm crutches with small skis attached at the tip used for balance and for turning. Bi-skiers are usually “tethered” — a stand-up skier holds a tether made of climbing webbing to assist speed control and turning — and also assisted on and off the lift. If you have the ability to move your head you have the ability to turn a bi-ski and enjoy the slopes.

 

 

Mono-Ski

A mono-ski — a molded bucket-style seat mounted on a suspension system and shock absorber mounted to a standard snow ski — is arguably the ultimate sports prosthetic. Expert mono-skiers shred the entire mountain and back country — from powder, to terrain parks, to extreme steeps and huge jumps the same as stand-up skiers. The learning progression, and length of time it takes to become proficient at mono-skiing is similar to stand-up skiing. Although trunk muscle control makes the sport much easier to learn, I know several low level quadriplegics — including a C6/7 complete quad — that are accomplished mono-skiers.

Nordic Sit Ski

If you are looking to get away from the crowds and glide through the beauty and quiet of nature — nordic sit skiing is for you. A nordic sit ski (also called XC sit ski) is a lightweight molded bucket-style seat mounted on two cross-country skis — the rig is propelled with ski poles. XC sit skis are surprisingly easy to propel, and the polling action helps keep shoulders healthy and balanced by working the muscles in the back of the shoulder. The sport can be as simple as a XC glide over a meadow or through the woods, to multi-day hut trips — skiing from one cabin to the next, to races of anywhere from half-kilometer to 20 kilometers.

Skijouring

A fun addition to XC sit skiing that I enjoy is skijouring, getting towed by one or more dogs. When I’m out XC skiing with my daughter Sarah and Schatzie, my German Shepherd service dog, I attach a tether to Schatzie’s harness and yell “squirrels!” to enjoy a high-speed winter dog tow.

Sledge Hockey

Perhaps hockey is your game. Sled hockey, also known as “sledge” hockey is an international and Paralympic sport with the same the same high-speed excitement as stand-up hockey, but adapted to a sitting position. A hockey sled is a molded bucket seat mounted on a lightweight aluminum frame, mounted on standard hockey skate blades. Players hold a hockey stick in each hand, the bottom of the each stick is fitted with a serrated spikes used to propel the sled. Simple adaptations like duct tape enable people without hand-grip to play. Hockey sleds are easy to propel, and a good player can reach high speeds and carve sharp turns and high speed check stops.

Adaptive Skating

A very cool spin off of sled hockey is adaptive skating. The potential for possible high-speed impact in sled hockey is a bit much for my aging brittle bones — but thanks to sled hockey’s popularity, many ice rinks offer hockey sleds, usually at no cost, or the cost of rental skates. I have a blast going to my local rink, strapping into a hockey sled and skating with Sarah. It is a fun workout and also helps keep shoulders healthy by working the same muscles as cross-country skiing. Ask your local rink if they offer sleds, if they don’t suggest they get one, most will be happy to purchase one since it means more business for them.

Dog Sledding

Dog sledding is another unique activity, ready made for wheelers. I’ve had the opportunity to go dog sledding and it’s an amazing way to travel into the winter wilderness. Riding in a dog sled, the only sounds are the hiss from the runners of the sled and the pitter-patter of dog paws. The tether to the dog team seems to make a direct connection to your senses, and watching ten wagging tails in front of you — running with its pack towing a sled through the snow on a crisp clear winter day, must be a blast for a dog. The experience is sure to put an ear-to-ear grin on your face. Dog sled operations are surprisingly common in snow country and trips range from 45-minute outings, to half day and even full day trips.

So pick a winter pastime, and enjoy mother nature’s winter adaptive blanket. See you on the snow!

Resources:

Adaptive Ski Programs

• Adaptive Adventures: www.adaptiveadventures.org
• Disabled Sports USA Far West: www.dsusafw.org
• Disabled Sports USA: www.dsusa.org
• Adaptive Ski & Sport Programs — Once on the page, scroll down to the map of the U.S. and click on the state where you want to ski: www.sitski.com/pg3.htm
• National Ability Center: www.discovernac.org

Dog Sledding:

• Wilderness Inquiry: www.wildernessinquiry.org
• Wintergreen Dogsled Lodge: www.dogsledding.com

Nordic Sit Skiing:

• Environmental Traveling Companions: www.etctrips.org
• Crested Butte Adaptive Sports Center: www.adaptivesports.org
• National Ability Center: www.discovernac.org
• Northeast Passage: www.nepassage.org
• Ski For Light: www.sfl.org
• Turning Point Tahoe: www.turningpointtahoe.com
• Wilderness Inquiry: www.wildernessinquiry.org

Sled Hockey:

• National Ability Center: www.discovernac.org
• Ski For Light: www.sfl.org
• United States Sled Hockey Association: www.usahockey.com/disable_hockey/default.aspx?NAV=AF_14&ID=62272

___________________________________________

Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog.

Next Page »