0900117 (Shape Sensor)
Contents
1. With back sensor folded flat 30 5 W x 48 L x 35 H Base frame 30 5 W x 37 L x 11H folded flat for transport Seat sensor module 25 W x 32 L x Back sensor module 26 W 32 L x 12 H Fully assembled Shape Sensor weight Frame 50 Ib Back sensor module 68 Ib Seat sensor module 46 Ib Features Direct measurement and recording of total posture Tilt in space adjustment for more accurate simulation Seat depth adjustable Sturdy 8 wheels and 5 casters with brakes and rota tional lock Removable arm rests and foot rests 98 110 T E C H N C A L 5 INVACARE CORPORATION 6 1200 TAYLOR STREET 6 Ohio 44036 2125 6 Phone 1 800 333 6900 INVACARE CANADA 6 5970 Chedworth Way 6 Mississauga Ontario Canada L5R 3T9 Phone 905 890 8300 1 800 668 5324 Fax 905 890 5244 Form No 98 110 Part No 0900117 Rev B 5 99 Printed in USA2. Jammed Data Panel This condition can be averted by always confirming the panel is seated properly in the receiving channels before pushing it into the im printer When ajam does occur firmly grasp the stuck end of the panel with a pair of pliers and pull it out If you pull too hard on the cord style handle it could break away from the panel If this technique does not work then the sensor should be returned to the factory Plunger Disconnected When a plunger becomes disconnected simply snap it back over the ball end of the cable If the cable is pressed down into the foam then depress the foam cell around it and pull it back up If the ball end of the cable is broken or missing then it will have to be replaced If the damaged cell is located in a nonessential area then notify this on the order form and cushions can be produced A stuck or broken sensor is easy to find on the screen of the com puter and its position can be adjusted 98 110 22 Seat Depth Lock If the seat depth can t be locked and the knob keeps spinning then remove the back sensor panel and slide out the side In spect the carriage bolt that attaches the knob to the side plate Chances are the edges of the bolt have worn and a new one should be installed TECHNICAL NOTES Periodic maintenance of the Shape Sensor and Sil houette seating systems is recommended Informa tion regarding the care of the cushions and interfacing should be
3. SHAPE SENSOR USER MANUAL SPECIAL NOTES SPECIAL NOTES WARNING CAUTION notices as used in this manual apply to hazards or unsafe prac tices which could result in personal injury or property damage As regards restraints seat belts it is the obligation of the DME dealer therapists and other health care professionals to detemine if a seating restraint is required to ensure the safe operation of this equipment by the user SERIOUS INJ URY CAN OC CUR IN THE EVENT OF A FALL FROM A SHAPE SENSOR It is also Invacare s position that the SHAPE SENSOR be in a proper transport posi tion and secured before transporting the shape sensor in a vehicle of any type NEVER transport the back sensor panel unless it is locked in the retracted position or the back sensor panel removed and position standing up or on its side DO NO position the back sensor panel on its front side w pnnted When transporting the shape sensor ALWAYS loosen the clamp blocks at the front of the frame and fold the support legs T E S DO NOT OPERATE THIS EQUIPMENT WITHOUT FIRST READING AND UN DERSTANDING THIS MANUAL IF YOU ARE UNABLE TO UNDERSTAND THE WARNINGS AND INSTRUCTIONS CONTACT AN INVACARE REPRESEN TATIVE BEFORE ATTEMPTING TO USE THIS EQUIPMENT OTHERWISE IN J URY OR DAMAGE MAY RESULT 98 110 2 SAFETY SUMMARY SAFETY SUMMARY WARNINGS DO NOT use unauthonzed parts accessones or adapters othe
4. Confirm measurements with the client still seated in the Shape Sensor Cushion length Retract the back sensor lever to create a flat panel and measure from this sur face to the place on the clients thighs that the cush ion is to end What you are measuring is the ac tual cushion length not the clients seat depth Take into account the wheelchairs available depth Sil houette seat cushions are produced with a rounded rear section that allows them to be fully inserted into the wheelchair with minimum inter ference from the back push handles Issues such as the clients activity level and propulsion method should be taken into account when determining the cushions length If the client has their knees pulled into a tucked position for improved maneu verability then the cushion may be quite short If the client propels using their lower extremities then clearance should be provided for the calf to allow sufficient movement rearwards Lengths can be produced from 8 22 FIGURE 11 INDICATING BACK HEIGHT 98 110 18 Back height The individuals back height is de pendent upon activity level and the need for pos tural support There is no magic rule for determin ing back height In order to promote upper extrem ity function the scapula area should be free from interference This can be accomplished by stop ping the back height below the scapula or flatten ing the area behind it The number printed on the back grid is used t
5. 10 Install the footrests by placing them on the front vertical frame tubes The footrests hook around these tubes and are held in place by friction 11 Install the armrests by sliding them into the receiv ing sockets located on the left and right side plates Knobs are used to adjust the height of these arm rests TRANSPORTING 12 Install the Back Imprint Handle into the threaded hole on the back imprinter Figure 7 Be careful not to cross thread the handle while screwing it into place The handle should screw easily into the threaded receptacle FIGURE 7 INSTALLING THE BACK IMPRINTER TRANSPORTING The Shape Sensor can be transported either fully as sembled or in parts What method is chosen is de pendent upon the type of vehicle to be used and ifa portable ramp is available The Shape Sensor should be secured in a manner that will prevent it from shifting around while the vehicle is moving and from becom ing a projectile if an accident should occur Locking the back sensor panel Anytime a client is going to transfer onto the Shape Sensor or whenever it is transported disassembled the back sensor panel must be locked 1 Make sure all of the plungers are flattened out and that the back sensor lever is pushed all of the way to the most rearward position Figure 8 FIGURE 8 PUSHING IN THE SENSOR LEVER 98 110 5 O R T N A N 9 p O R T N 98 1
6. SILHOUETTE SYSTEM 14 Take the back shape Gently place one hand on the individuals sternum while pulling the back sen sor lever all of the way forward Tell the client they may feel a slight pressure against their sacrum buttocks during this phase Figure 8 15 Quickly visually check to make sure that all of the extended plungers are touching the client in the areas desired The clinician can manually ex tend or depress the plungers to fine tune the shape Figure 9 The area behind the scapula should be flattened to reduce interference with up per extremity movement unless protraction of the shoulders is a desired feature Figure 10 If for any reason the client s posture or the back s shape does not seem right then retract the lever and start over Make sure the shapes are right before recording them E A T G A S l L H 0 U E T T E 5 5 T E M FIGURE 9 EXTENDING THE PLUNGERS FIGURE 10 FLATTENING THE AREA BEHIND THE SCAPULA 98 110 C R E A T N G A S L H 5 5 T E M CREATING A SILHOUETTE SYSTEM 16 17 Record the back and seat shape by pulling the imprinting handles across the data panels Pull each imprinting handle only once A baseline and a contour line should now be printed on each data form If the base line was not recorded it can be taken once the client transfers out of the Shape Sensor
7. digitized to produce the custom contoured cushion The first mechanical shape sensors Figure 2 were designed to record only the shapes of seat cush ions The technology quickly proved its worth and was expanded to include a back sensing panel When a client is seated on a Shape Sensor gravity is the only force necessary to produce the seat con tour Gravity can t be used to form the back cush ion and a mechanism was developed that gently pushes the plungers around the individuals back Along with the development of the Shape Sensor Invacare has created software SeatMaker inter facing hardware and the machinery used to pro duce the cushions A good idea has become a com plete system APPROPRIATE APPLICATIONS OF THE TECHNOLOGY FIGURE 3 ACTIVE USERS BENEFIT FROM ENHANCED SIBILITY APPROPRIATE APPLICATIONS OF THE TECHNOLOGY The first step in producing a Silhouette System is de termining if the client is an appropriate candidate The following information on disability types and contraindications is meant only as a general guide line The decision whether or not to proceed with this technology requires that the clinician have suffi cient background information and a solid under standing of the clients physical needs A mat evalu ation should always precede the fitting of the client in the Shape Sensor This assessment will help determine the basic parameters of the support surfaces Client Profiles and
8. floor to seat height Rail cuts on the back will allow the cushion to ex tend between the push handles helping to increase seat depth with maximum surface contact main tained to the back Rail cuts will require that the clinician provide the necessary mounting materi als Leg Length Discrepancy client has a leg length discrepancy then the cushion will need to be cut back for the shorter leg The overall length of the cushion should be measured with the longer leg This will be the cushion length recorded on the order form The length of the discrepancy for the shorter leg should then be indicated on the op tions portion of the order form Solid Insert A solid insert consists of a 1 4 thick panel of rigid plywood cut to be 2 less than the width of the cushion This panel is meant to be used with a seat cushion that is placed directly upon the sling upholstery of the wheelchair This can be a low cost alternative to a drop seat or modular shell An insert should only be used by individuals that can independently regulate the placement of the cushion within the chair Lateral supports When a cushions lateral trunk supports require additional depth or strength then auxiliary supports should be considered The op tional trunk supports are made with a quick release feature and can be purchased with varying degrees of offset The offsets are available in 1 2 1 1 1 2 out and 1 2 1 1 1 2 in and straight c
9. from the users ishial tuberosities an area prone to tissue breakdown to the thighs an area better suited for weight bearing Invacare saw the potential for this technology as a natural progression of the company s already strong focus on customized contoured seating and tech nology transfer process was initiated The electronic shape sensing apparatus along with the necessary computer interface and software made this tech nology difficult and expensive to apply A group of people including Colin Mclaurin Clifford Brubaker Dave Brienza Stephen Springle Peter Axelson Michael Heinrich Eric Jan Ginder and Michael Silverman worked to develop a relatively low cost and simple process The idea was to change 98 110 ton FIGURE 2 THE MECHANICAL SHAPE SENSOR the electronic sensing unit Figure 1 into a mechani cal measuring device that could be interfaced to a central computer using simple paper forms The in dividual would still sit upon a blanket of individual plungers but their position would be recorded me chanically in a manner similar to a credit card im printer When a plunger is moved it pushes a cable This cable is attached to a pointer whose position is recorded when a pressure roller is moved across its surface The pointer presses against a carbonless form making a mark that corresponds to the depth of the plunger at that location The imprinted form can be then faxed to a central location where it is
10. or on its bottom side The frame can 12 be stored as a complete unit or disassembled into a more compact package If the most compact package is desired then proceed as follows 6 Optional Loosen the clamp blocks at the front of the frame and fold the support legs When reas sembling the frame make sure these clamps are fully engaged 7 Optional Remove the gas cylinder clevis pins and fold the frame Reinstall the pins into the clevis to help prevent loss Do not misplace these pins Transporting an assembled Shape Sensor The Shape Sensor can be transported fully assembled in a van A ramp with a full width platform should be used to make this process a safer procedure The back sensor panel can be folded forward or reclined to improve access and handling The method used will be dependent upon the available head room in the van Folding the back sensor forward 1 Lock the back sensor panel Page 10 Never transport or lift the back sensor panel without it locked in the retracted position 2 Place cardboard on the seat sensor to protect the sensors Loosen the back angle adjustment knobs and rotate the back sensor panel forward Figure 10 until the stop blocks index into the receiving notches located on the front of each side plate p rear ra npc wu 2 4 TAN FIGURE 10 FOLDING THE SENSOR FORWARD 3 Lift the back sensor upwards just enough to mov
11. should be sufficient background information to determine if the client remains seated on the sling at all times Re move the footrests and armrests before starting the transfer 98 110 5 F 5 C R E A T N 5 L H E T T E S Y S T E M CREATING A SILHOUETTE SYSTEM Stand and Pivot Only assist with this maneuver if you have been trained in the process and you have a second person avail able as a spotter Follow steps 1 4 above Two person lift Once again only perform this style of transfer if you have been trained and understand the use of proper body mechanics Before attempting to transfer in or out of the Shape Sensor every precaution should be taken to reduce the gap dis tance Tum both casters toward the object you are transfering onto When transfering to and from the Shape Sen sor ALWAYS ENGAGE BOTH WHEEL LOCKS NOTE This activity may be per formed independently provided you have adequate mobility and upper body strength A NOTE TO WHEELCHAIR ASSISTANTS When assistance to the client is re quired remember to use good body mechanics Keep your back straight and bend your knees CREATING SILHOUETTE SYSTEM The process of creating a Silhouette System is a com bination of mechanical adjustments measuring cli ent posturing interfacing and paperwork The Quick Start guide Page 5 is a condensed version of this
12. skills and solicit any help needed to complete this important procedure When necessary assist the client in moving across the Shape Sensor s seat so as not to disengage the plunger caps Once the transfer has been completed make sure that the client is stable and secure upon the surfaces before letting them sit independently Independent If the client normally performs independent transfers then the clinicians role is to help prepare position the Shape Sensor and spot the client during the process The client knows best how to prepare their own chair and the clinician may be asked to remove or position accessories Remove the footrests 2 Remove whatever armrests the client requests Some clients may prefer that the armrest furthest away from them be left in place as a point of stabi lization and support Other clients may require both armrests be left in place 3 Position yourself in a location that will allow you to assist in the process if the client is experiencing diffi culty Keep close but don t inhibit the maneuver 4 Reinstall footrests and armrests With a sliding board Follow steps 1 3 above 5 Help keep the sliding board from moving away from the support surfaces and assist with its removal when the transfer is complete With a mechanical lift aid Only use a mechanical lift aid if you have been trained in its operation and have all of the necessary compo nents to safely complete the task There
13. 10 TRANSPORTING 2 Push the back sensor lever s attaching block in wards towards the center of the back sensor panel This will release the handle from its plunger mov ing position into its locking position With the attaching block depressed push the le ver forward until it rests against the stop block The handle should pop back out and lock the back sensor into position If the handle does not pop back out and the back sensor does not lock then re peat the above steps Transporting a disassembled Shape Sensor Lock the back sensor panel into its retracted position See above Never transport or lift the back sensor panel without it locked in the retracted position Figure 9 sy e oe E 75 Wan oe ae sae A G TG 18 y gt 3 ors ES bine es a5 w Na Ni 0 P FIGURE 9 ROTATING THE IMPRINT HANDLE TO THE LOCKED POSITION 2 Depress the tilt adjustment lever and position the Shape Sensor in the fully tilted position Depress ing the gas cylinders will help create the smallest frame package Remove the back sensor and store it either stand ing up or on its back side Do not store the back sensor on its front side The side with the grid printed on it Remove both side plates Remove the seat sensor panel and store it either standing up
14. Disability Types Seat only The seat cushion can promote stability and balance Figure 3 and provide good pressure relief for indi viduals with the disability of Paraplegia Quadriplegia low level Amputee Seat and back A system will provide a pressure relieving seat cush ion that promotes stability and balance along witha back cushion that supports and aligns the trunk This can be used by individuals who have the dis ability of Quadriplegia low high level Cerebral Palsy mild moderate CVA Arthritis Spina Bifida Geriatric Multiple Sclerosis Muscular Dystrophy early stages Contraindications Open skin ulcers unless the client clinician and caregivers have carefully designed the cushions sur face to reduce pressure in this area are able to care fully monitor the wound site and understand that the cushion may require additional modifications or replacement High or fluctuating tone that would collapse the cushions support surfaces Severe orthopedic complications that require maximum support and accommodation Significant effort is required during the simulation to maintain the client in the desired posture The sup port to the client that is provided by the clinician should be gentle in nature and able to be maintained during the recording process The client can not shift their position independently or be placed within the seating system consistently by Caregivers The client is either to
15. anels and fill in the requested information on each section date dealer name and number client name contact person and phone number Copy the Shape Sensor s serial number onto the order form There is a separate serial number for the back and seat This is a very important step Each Shape Sensor has its own ity that assists in fabrication and this is recorded by Invacare in their computer system The cush ions can not be produced without this number 22 Determine the necessary cushion modifica tions and options and write this information on the order form Additional changes in the cushion are available to the clinician if they are using SeatMaker software and can modify the cushion on screen before sending the data to Invacare Cushion density There are two choices for cush ion density soft or firm Soft foam is generally cho sen for instances were maximum pressure relief is desired Firm foam will provide increased sta bility and support Cushion thickness Cushions are available in 4 5 7 thickness The thickness of the cush ion is determined by the overall depth of the con tour and the functional characteristics desired A 7 cushion can only be provided if the clinician uses SeatMaker software to design the cushion Cushion width The cushions width is determined by the clients width and the dimensions of the wheelchair Widths can be produced from 10 22 Cushi
16. array of sensors the amount of displacement at each point was recorded by computer The data was later used to fabricate a cushion through the use of a three axis milling machine that carved a block of HR high resilience foam This electronic shape sensing system and computer assisted manufacturing process was the start of the Silhou ette System used today 98 110 T R O D U T HISTORY FIGURE 1 THE ORIGINAL ELECTRONIC SHAPE SENSOR HISTORY CONTINUED High quality polyurethane foam was chosen for cus tom carving because of its low cost low maintenance and dynamic qualities Pressure against the foam is equalized due to the contouring of the surfaces which makes fatiguing of this mate rial less of an issue Beta site testing was conducted at five separate facilities to help prove the effective ness of this technology The centers included The Institute for Rehabilitation and Research Houston Texas Helen Hayes Hospital West Haverstraw NY Newington Children s Hospital Newington CT Na tional Rehabilitation Hospital Washington DC Rancho Los Amigos Medical Center Downey CA Some of the results of this Beta site testing were presented by Anita Perr OTR L Andrew Lincoln MS and Thomas McGovern MS from the Rehabilita tion Engineering center of the National Rehabilita tion Hospital The conclusion of their study was that the Silhouette cushion effectively shifted pressure
17. ates so both pointers are locked at the 18 98 110 10 FIGURE 3 ASSEMBLED BASE FRAME Lock the rear wheel castors Carefully lift the seat sensor panel using the pro vided handle and position the forward locking clips under the front horizontal support bar Make sure the rear rubber bumpers are seated forward of the rear horizontal support bar Figure 4 The seat sensor panel is not overly heavy 46 pounds but its overall size 25 x 32 x 9 can make handling the unit somewhat awkward until the process of assembly has been practiced a few times Please be cautious and practice good body mechan ics when lifting this component into place SKIDS EEE al NY Cy NG Ni WA FIGURE 4 REAR RUBBER BUMPERS Carefully lift the back sensor panel and place the backs pivot pins into the side plate receiving notches Figure 5 This may require two people as the back sensor is slightly larger and heavier than the seat Use the provided handles and once again practice good body mechanics FIGURE 5 ALIGNING THE PIVOT PINS 9 Install the back angle adjustment knobs through the back angle adjustment slots into the threaded receivers mounted on the back sensor panel Fig ure 6 Tighten these knobs to position the back at the 95 degree angle mark FIGURE 6 INSERTING THE ADJ USIMENT KNOBS
18. be tricky procedure and caution should be taken so that asymmetries are not introduced Transfers The ability to transfer must be considered when screening a candidate for a Silhouette seat The ease of transfer will be dependent upon the type of cover used and depth of contour The depth can be adjusted for individuals whose abilities may be com promised by a deeper cushion TROUBLESHOOTING The process of producing a Silhouette seating sys tem using the mechanical Shape Sensor quickly be comes an easy and rewarding method of intervention The tools are durable and simple in design but as with all things problems may arise Refer to this trouble shooting guide for answers to some of those prob lems Bent Cable If a cable becomes bent attempt to straighten it If the bend can t be sufficiently repaired to allow operation then it will have to be replaced Ifthe bent cable is located in a nonessential area then note this on the order form and cushions can be produced A bent cable is easy to find on the computer and its position can be adjusted Data Form put into Wrong Imprinter This really isn t a problem Make sure to indicate on the form which sensor made the impressions Footrest Length There can be times when the foot rests can t accommodate the clients leg length Use any surface available such as books or boards to sup port the feet The feet need to be supported for the legs to be positioned properly
19. e the stop blocks forward into the second receiving notch Figure 11 The stop blocks attaching bolts will then rest into both receiving notches FIGURE 11 MOVING THE SENSOR TO THE FULL FLAT POSITION 4 The back angle adjustment knobs now be re moved and reinserted into the second threaded receptacle to lock the back into position Figure 12 FIGURE 12 REINSERTING THE KNOBS TO LOCK THE SENSOR BACK WA RNING Extreme caution is advised when it is necessary to move an UNOCCUPIED Shape Sensor Invacare recommends using two 2 assistants and making thor ough preparations Make sure to use ONLY secure nondetachable parts for hand hold supports DO NOT attempt to lift the Shape Sensor by the seat sen sor back sensor armrests or legrests Use the base frame for lifting purposes by means of the removable de tachable parts of a Shape Sensor may result in injury to the assistants or dam age to the Shape Sensor 13 TRANSFERS TRANSFERS Care must always be taken whenever an individual transfers onto or off of the Shape Sensor The Shape Sensor s back panel and the rear castors must both be locked before attempting a transfer There are sev eral methods of transfers and what style is used should be determined by the client and or caregivers The ability to transfer can vary from total independence to total dependence Never assist in a transfer unless you are completely confident in your
20. e adjustment knobs are securely locked in place To maintain stability and safety make sure the client is propery positioned in the Shape Sensor before reclining or inclining reverse recline When adjusting the back angle DO NOT remove the back angle adjustment knobs as they help secure the back sensor to the frame When retuming the client in the Shape Sensor to the full upnght position more body stength will be required for approximately the last twenty 20 degrees of incline reverse recline Make sure to use proper body mechanics use your legs or seek assistance to avoid injury The Shape Sensor has a weight limit of 300 Ibs 3 98 110 TABLE OF CONTENTS TABLE OF CONTENTS SPec NOTOS 2 B Eeee ea e 3 L Hi Introduchion TO ING 5 o Waskita aa a aa a a Nan 5 5 8 Appropriate Applications the Technology na nenen nenung na nenane 7 Client Profiles and Disability 7 Terminology and Paris Description 8 Unpacking and Assembly 9 TAPAS BONING e
21. e data panel one at a time with care taken to make sure the form is attached as flat as possible Figure 3 FIGURE 3 APPLY THE DATA FORMS 15 T CREATING A SILHOUETTE SYSTEM Insert the data panels into the imprinters The imprint handle must be all of the way to one side for the data panel to have access into the chan nels Care must be taken at this point to make sure the data panel is properly inserted into the channels The clinician should have a clear view of the panels and the channels during this opera tion Do not force the data panels into place and make sure they enter evenly Some resistance may be felt but the panel should advance smoothly into position Figure 4 FIGURE 4 INSERT THE DATA BOARDS Take a baseline for the seat and back The base line is the starting position for the shape sens ing plungers In order for depths to be recorded there must be a reference point This reference point is produced by sliding the imprinter handles all of the way across the data panels This should be performed with a smooth continuous move ment and a slight resistance may be felt at the beginning of the stroke If the handle does not move check to make sure the data panel is in serted fully Figure 5 98 110 C R E A T N G A S L H 0 U E T T E S Y S T E M CREATING A SILHOUETTE SYSTEM Check for pelvic obliquity Accommodate if fixed and correct if flexible Check for
22. ed 1 75 apart and move approximately 4 P Seat Depth Adjustment Knobs Are located on the side plates directly behind the armrest sockets They lock the side plates into the slotted seat rail and control the placement of the back sensor panels position Q Seat Imprint Handle This is a flat handle located at the rear of the seat sensor and is used to move the imprinter across the data panel R Seat Sensor The seat sensor panel consists of 100 cable driven plungers housed within a section of segmented foam This component is used to capture the shape of an individuals seat UNPACKING AND ASSEMBLY S Side Plates The side plates are used to connect the back sensor panel to the seat sensor panel They slide into the slotted seat rails and are made in a left hand and right hand configuration T Stop Blocks The stop blocks are black plastic components located on both sides of the back sensor panels These blocks are used to help store the back in a forward folded position The stop block on the left side also controls the back sensor lever s forward po sition U Tilt Adjustment Lever The tilt adjustment lever is located at the bottom rear of the frame This lever controls the tilt angle of the Shape Sensor The lever is retractable allowing it to be stored underneath the frame UNPACKING AND ASSEMBLY Note Please refer to the Terminology and Parts De scription portion of this manual to assist in identifying t
23. hanging the onentation of the Shape Sensor modules person is unique and there are always exceptions When adjusting the seat depth make sure the adjustment knobs are securely locked in place To maintain stability and safety make sure the client is propery positioned the Shape Sensor before reclining or clining reverse recline When adjusting the back angle DO NOT remove back angle adjustment knobs as they help secure the back sensor to the frame Adjust the seat depth with the clients pelvis ori ented to the desired tilt and the thighs fully sup ported Do not cause posterior pelvic tilt by over extending the seat depth If there is a significant amount of thigh that remains unsupported even with the seat depth set to the maximum amount then the remaining surfaces can be produced at the factory by extrapolating the cushions shape forward This willbe covered more fully in the mea surements section FIGURE 6 POSITIONING THE CLIENT ON THE SEAT Center the client on the Shape Sensor so that an equal amount of cushion shows on both sides Asymmetries of the client may not allow for equal space on both sides Check pelvic tilt and position the client with a neu tral to slightly anterior orientation Use your thumbs and forefingers of each hand to gently hold the cli ents pelvis The need for excessive force to posi tion the pelvis may require that smaller adjustments be made A neutral to anteriorly
24. he components referred to in this section Unpacking The Shape Sensor will come shipped in three boxes These boxes should contain the following 1 The lower frame 2 The back sensor panel 3 The seat sensor panel 4 Two data panels clear plastic panels with handles 5 One back sensor panel handle 6 Two pins for attaching the gas cylinders 7 Data forms for the seat 8 Data forms for the back 9 One pair of footrests 10 One pair of armrests 11 Two Side plates and right 12 Two back angle adjustment knobs To remove the contents first open the boxes and lay them on their sides Slide the components out of the boxes and make sure you have all of the parts listed above before discarding the packing materials 98 110 U N C K 5 5 E M B L Y A 5 5 B L ASSEMBLY Assembly 1 Install the gas cylinder clevis pins through the frame clevis and gas cylinder receiving sockets Figure FIGURE 1 INSERTING THE CLEVIS AND HAIR PINS 2 Lock the pins in place using the hairpin clips Fig ure 2 FIGURE 2 TIGHTENING THE CLAMP BLOCKS 3 Position the round lower frame tube underneath the two semicircular clamp blocks and tighten down the clamping knobs 4 Install the left and right side plates into the slotted seat rails with the blue pointer positioned at the front of the frame 5 Tighten down the adjustment knobs on these side pl
25. ing these same surfaces The Quick Start section will allow those with previ ous Silhouette experience to confirm the neces sary steps to successful completion of a system It can also be used by everyone as a checklist to make sure steps and information are not left out of the process The clinician has a responsibility when using the Silhouette System as there is a process involved not just a product This process al lows for increased flexibility and versatility but if not fully understood and practiced it can lead to misapplication Please read this manual at least once cover to cover Do this before the first client arrives Hope fully most of your questions will be answered but if they aren t call the customer service staff at Invacare 1 800 451 3553 Good luck using the Silhouette system QUICK START Lock castors at the rear of the frame 2 Check the seat and back surfaces for flatness and plunger position 3 Lock the back sensor panel Depress the handle and pivot forward 4 Set and lock the seat depth Makes sure both pointers read the same Set and lock the back angle Apply data forms to the data panels Insert data forms into receiving channels Take baseline for seat and back OND OH Transfer client to Shape Sensor 10 Orient client on Shape Sensor surfaces INTRODUCTION QUICK START CONTINUED 11 Readjust surfaces to fit client 12 Adjust footrests and armre
26. lign the back sensor panel The pointers should read the same num ber on each side before locking the back sensor panel into position The location of these pointers is a critical part of the requested information on the order form F Back Pivot Pins The back pivot pins are found on both sides of the back sensor panel and are used to suspend the back within the side plate receiving notches G Back Sensor Lever This lever is located on the left side of the back sensor panel and is used to push the back plungers forward This lever has a second ary function that locks the back sensor panel in place H Back Sensor The back sensor panel contains 100 cable driven plungers that are used to capture the shape of an individuals back Casters These are the rear wheels which can be M locked to prevent rotation or rolling FIGURE 1 TERMINOLOGY AND PARTS DESC RIPTION J Clamping Blocks The clamping blocks are lo cated at the bottom front side of the frame and are used to hold the folding legs into a locked position Data Forms These are carbonless pressure sensi tive forms that attach to the data panels using self ad hesive strips There are separate forms for the seat front and back Not Shown 98 110 8 DO NOT use unauthonzed parts acces sones or adapters other than autho nzed by Invacare K Data Panel Receiving Slots The data panels are indexed into these slots to insure proper alignment with the impri
27. lotted rail Once in place the blue pointer found at the front of the side plates should indicate the same number on both sides of the frame Tighten the knobs securely to help prevent un wanted movement of the back during transfers 5 Set and lock the back sensor angle There printed graduations on the back panel to assist in accurately recording this measurement It is sug gested that a setting of 95 degrees be used initially and that the final angle be determined with the cli ent in place The back angle is adjusted by loos ening tightening the back angle adjustment knobs Make sure this adjustment is tight before transfer ring or adjusting tilt and depth The knobs used to adjust back angle and back sensor placement must be tightened sufficiently to prevent any unwanted movement during the simulation process This is especially important when the system tilt angle is changed Armrest tightness requires checking as these components can become critical places of stability and support during transfers Apply data forms to the data panels There are different forms for the back and for the seat The forms are clearly marked and can only be applied to the data panels in the correct orientation The data panels have short metal pegs that line up with holes prepunched in the carbonless data forms Orient the forms holes to match the data panel s pegs and apply the form using the adhesive strips The strips should be placed on th
28. naa aa nan 11 LOCKING the Back Sensor PANG 11 Transporting a disassembled Shape Sensor 12 Transporting an Assembled Shape Sensor 12 TRAN SIONS akeni piaraan EE EE a aaa b 13 13 13 Va NEC Mane aE AO 13 SEE ne FY OU E E E nga Ba A a E E E EE E EE E 14 TVO POLSO 14 Creating a Silhouette System cccccssssscsssssssssseseneseceeseecesseseessesseeseeseesaesausenseessnesnesneeeneaess 14 Commonly Asked Questions 21 Troubleshooting 22 Technical Notes 22 98 110 4 INTRODUCTION TO THE MANUAL A user centered approach is needed to meet the unique needs of each individual The use of this manual requires that the clinician have an under standing of their own needs as well as the clients they are serving Individuals with good clinical skills may find the sections on Orienting the client on the surfaces to be common sense and be totally baffled by some of the more technical aspects The techies may shy away from manipulating someone s pelvis with their hands but be right at home electronically digitiz
29. nters The panels are clear plastic de vices that hold the data forms within the imprinters These panels have short indexing pins that match holes prepunched into the data forms The panels are fitted with a flexible handle to assist in removing them from the receiving slots Footrests The footrests attach to the front vertical frame members and are held in place by friction Not Shown L Frame The frame is the lower tubular portion of the Shape Sensor M Gas Cylinders The gas cylinders are used to change the tilt angle of the Shape Sensor They are lockable anywhere along their travel giving an infinite adjustment range between 0 20 degrees Both gas cylinders must be operational and adjusted properly BEFORE using adjustable back DO NOT operate the adjustable back if only one 1 of the gas cylinders is operational or adjusted propery N Imprinters These devices are located within the back and seat sensor panels and are used to record the position of the plungers onto the data forms They operate in a similar fashion as a credit card imprinter Plunger Caps Each plunger is attached to a cable using a snap fitting cap The end of the cable is shaped like a ball with the cap formed as the receptacle These caps are replaceable if necessary Not Shown O Plungers The plungers consist of a section of cable and the snap fitted caps There are 100 plung ers for the seat and 100 plungers for the back They are locat
30. o determine back height Fig ure 11 Do not measure the back height with a tape measure but write down the number printed on the front of the back sensor grid Leg length This measurement is taken to help determine footrest height and desired floor to seat height This is especially important for individuals who propel using their feet or who transfer using the stand and pivot technique Back Angle The back angle measurements are printed on the side of the back sensor panel Tilt Angle The tilt angle can be taken using an inclinometer or bubble level This angle will assist with setting up the clients finished system When retuming the client in the Shape Sensor to the full upnght position more body strength will be required for ap proximately the last twenty 20 degrees of incline reverse recline Make sure to use proper body mechanics use your legs or seek assistance to avoid injury 18 19 20 21 Transfer the client off of the Shape Sensor and position them in their own wheelchair Make sure the back sensor panel is locked before the trans fer and that the client is supported properly and all belting strapping is secured in their chair Remove the data panels from the imprinters The data panels have a flexible strap to assist with their removal Make sure the imprinters are all of the way to one side to allow the panels to be pulled out of their channels Remove the data forms from the p
31. o large or too small to fit on the Shape Sensor 98 110 A T E A L C A T 5 O F T E C H N O L O G Y TERMINOLOGY AND PARTS DESCRIPTION TERMINOLOGY AND PARTS DESCRIP TION FIGURE 1 Armrest Receiving Sockets The armrest receiv ing sockets are located on the left and right side plates These sockets act as receptacles for the armrests The height of the arm rest is adjusted by loosening and tightening the knob attached to this receptacle The armrests index into the receiving sockets and can provide a surface that the client can use to reposition themselves or to help with balance and pressure re lief The armrests are height adjustable B Back Angle Adjustment Knobs These knobs are used to change the back to seat angle The back angle adjustment knobs travel in these slots providing angle adjustability to the back N O L O G Y A N OZ0O aAdDV DOOMO C Back Grid This grid is printed on the back sensor panel to assist with determining back height and client symmetry D Back Imprint Handle This handle is located at the top of the back sensor panel and is used to move the imprinter across the data panel This handle screws into the imprinter E Back Location Pointers These blue pointers are located on the left and right side plates just forward of the armrest sockets and are used to help a
32. on fabric Cushion covers are available in four different styles but only in one color black The variety chosen is dependent upon the clients function and the environment where the individual resides Consideration should be given for the pur chase of a second cover as they are custom made If an additional cover is desired at a later date then the dimensions of the cushion would have to be sent back to the factory to serve as a pattern Lycra The smooth texture of this fabric can make transfers easier It should be used if the client is incontinent Waterproof Lycra This cover has a layer of thin stretchable material bonded to the lycra making it waterproof The top surface of the cover can still absorb moisture but fluids can t pass into the cush ion If the cover does become wet it can be dried easily This cover would be appropriate for indi viduals that experience incontinence on a periodic basis Stretch Vinyl The waterproof coating is on the outside of this cover making cleanup a much easier task This is the suggested option for persons who are incontinent Polartec This fabric is a polyester fleece mate rial commonly used for jackets and sporting ap parel Itis very durable and comfortable to sit upon It is not waterproof 19 CREATING A SILHOUETTE SYSTEM Rail Cuts Rail cuts can be specified if a cushion needs to drop between the seat rails of a wheel chair in order to create a specific
33. onfigu rations Itis best to have all of these brackets avail able to assist in the fitting process The hardware used to attach the supports to the cushion is mounted inside the modular shell The support can be moved along an extruded rail within the shell to adjust the desired height The metal support bracket can be bent to create a curved surface The bracket can only be bent with significant force applied and requires that the padding be removed The padding will slide off of the bracket once the locking dot has been pressed out of position Fig ure 12 Headrest There are many clinical reasons for using a headrest This can vary from helping to reduce neck hyperextension to providing a surface upon which to rest the head when the individual is tilted back There are three styles of headrest pads available small large and two step The mount ing hardware is removable and adjustable 98 110 C R E A T N S L H 0 U E T T E 5 5 T E M CREATING A SILHOUETTE SYSTEM ions on sling modular shells KwikFit and cus tom Cushions on sling The Silhouette cushions can work quite effectively in some instances when placed directly on sling The most common ap plication is when a seat cushion is used by active user in an ultra light base It is beneficial if the sling is tight and matching Velcro is available on the slings fabric Additional firmness of support can be achieved b
34. ough the cover Custom mount ing is an easy process for those that have the nec essary equipment for fabrication 24 Fill in order form and fax to Invacare at 1 800 870 4928 COMMONLY ASKED QUESTIONS The following should address some of the common questions that clinicians and clients may have regard ing the Silhouette System Unfortunately not all situ ations or applications can be predicted and some ques tions may still remain If this is the case then please feel free to contact Customer Service 1 800 451 3553 Cushion Life The life of a Silhouette cushion de pends upon the type of environment and the use it is exposed to There is a 60 day unconditional guaran tee and a two year replacement warrantee Growth How much growth a Silhouette cushion can accommodate is dependent on what kind of growth is experienced If the growth is linear then the back can be shifted in the wheelchair One method of extending the life of a seat system is to purchase the interfacing modular shells or custom oversized with the addi tional foam extending underneath the back When a new cushion is made then the interfacing can still be used This method of accommodating growth is lim ited by the type of wheelchair being used When growth is actually weight gain then the amount that can be accommodated is proportional to the individuals size The cushions are soft in their construction and some accommodation is possible The cu
35. passed on to the client Shape Sensor Keep the slotted seat rail free from debris If the Shape Sensor is used to make ContourU cush ions then plaster should be prevented from getting into any moving parts and surfaces kept clean Replace the gas cylinders when they no longer lock in position Check before each fitting that the clamping blocks used to fold the frame are securely tightened Do not store objects on top of the Shape Sensors seat Cushions and Interfacing Wash the covers in cold water and tumble dry on low heat Do not immerse the cushions into water as they are made from open cell foam and will soak up water like sponge The urethane coating does make the foam waterproof only water resistant If the cushion must be immersed then squeeze out the excess wa ter and dry thoroughly before returning to service Periodically check the fasteners that hold the interfac ing hardware and tighten if they have become loose Data Forms The data forms are used to record the contour of the client and are clearly marked for installation onto the data panels There is a form for the seat and a form for the back There is a front and back to the back form and a top and bottom to the seat form Inspec tion of the data form will show 50 rows along the Topshape and 50 rows along the Bottomshape Each one of these rows corresponds to one of the plungers A finished data form should have imprinted upon it one ba
36. positioning and optimum angle of pull Performance Shaping When aclient is very ac tive and is using an ultra light chair then Perfor mance Shaping should be considered This op tion will maintain the leg troughs produced during the simulation and add an undercut behind the calf to allow for increased flexion of the knees The leg troughs will help to stabilize the lower extremities and the undercut allows for an increased tucked posture that can improve stability and maneuver ability 23 Determine the interfacing of the cushions to the wheelbase There are four basic choices cush ee FIGURE 13 SILHOUETTE MODULAR SHELL 98 110 20 KwikFit The back KwikFit system consists of two aluminum channels connected together with a solid ABS panel This system has all of the ben efits of the modular shell design but is a broader range of sizes The back comes complete with attaching hardware that is adjustable in depth and angulation The seat KwikFit system is a flat ABS panel with hardware that snaps easily onto the wheelchair s seat tubes Both the back and seat KwikFit systems are covered by the fabric of choice Custom Silhouette seat and back cushions can be interfaced into a chair using standard hooks and hangers The seat cushion can be placed directly upon a drop seat The back cushion can be glued to a board that has been prepared with the necessary T nuts The attaching hardware then be bolted thr
37. r form as they give Invacare im portant information regarding the personality of the machine The serial numbers are located on the back of the Shape Sensor SeatMaker SeatMaker is a computer program created by Invacare to input and manipulate the data produced on the Shape Sensor This software can be used by the cli nician to further refine the cushions and as a method to review the data before sending it off for production The inputting of data into the computer is accomplished by touching each of the imprinted data points using a stylus and digitizing tablet The cushions shape can be modified and fine tuned to exactly meet the clients needs Once the changes are made then the data can be sent by modem to the factory 23 TECHNICAL NOTES General Shape Sensor specifications Measuring grid 10 x 10 data grid spaced 1 75 apart Maximum depth of contour measuring capacity 4 5 seat and back Cushion construction HR 32 polyurethane foam with segmented top section Seat sensor depth 17 5 front to back adjustable to 11 Seat sensor width 20 17 5 measuring area Back sensor height 19 5 from top of seat 17 5 measuring area Back sensor width 20 total 17 5 measuring area Seat to back angle adjustment 80 110 degrees Tilt in space angle adjustment 0 20 degrees Wheelchair transfer height 23 5 from floor Weight Limitation 300 Ibs Shape Sensor dimensions 30 5 W x 43 x 57
38. r than authonzed by Invacare Both gas cylinders MUST be operational and adjusted propery BEFORE using adjust able back DO NOT operate the adjustable back if only one 1 of the gas cylinders IS operational or adjusted propery Extreme caution is advised when it is necessary to move UNOCCUPIED shape sensor Invacare recommends using two 2 assistants and making thorough prepa rations Make sure to use ONLY secure nondetachable parts for hand hold sup ports DO NOT attempt to lift the Shape Sensor by the seat sensor back sensor armrests legrests Use the base frame for lifting purposes Lifting by means of the removable detachable parts of a Shape Sensor may result in injury to the assistants or damage to the Shape Sensor 5 F T Y 5 U M M A R Before attempting to transfer or out of the Shape Sensor every precaution should be taken to reduce the gap distance Tum both casters toward the object you are transferring onto When transfering to and from the Shape Sensor ALWAYS EN GAGE BOTH WHEEL LOCKS NOTE This activity may be performed independently provided you have adequate mobility and upper body strength A NOTE TO WHEELCHAIR ASSISIANTS When assistance to the client is required remember to use good body mechanics Keep your back straight and bend your knees ALWAYS engage both wheel locks while changing the onentation of the Shape Sensor modules When adjusting the seat depth make sure th
39. rotation of the pelvis and trunk De rotate if the forces are not excessive and improved posture is realized An apparent leg length dis crepancy may actually be rotation of the pelvis Set the footrest height so each thigh is level and at the same height The footrest height can also control the depth of the leg channels and influences clearance under tables Position the lower extremities in the desired amount of ab adduction taking into account the limi tations of the wheelchair frame and the therapeu tic benefits of the posture Increased abduction can mean more stable posture but may exceed the overall width of the clients chair FIGURE 5 TAKING A BASELINE MEASUREMENT 9 Transfer the client onto the Shape Sensor Please refer to the section regarding transfers Page 13 to assist with this important step Orient the client on the Shape Sensor s seat This orientation process requires that the clinician C R E A T N G A S L H 5 5 T E M Adjust the armrests to help support the upper extremities and trunk Be careful to not elevate or depress the shoulder girdle 10 11 Orient the client to the Shape Sensor back have a strong background in seating positioning and that a thorough mat evaluation was performed Figure 6 It is suggested that the following guide lines be used with the understanding that each WARNINGS ALWAYS engage both wheel locks while c
40. se line and one contour line Always bring duplicate forms to a fitting in case one is incorrectly printed Tear off the side stubs along the perforations and dis card the portion of the foam with the adhesive Separate the Topshape section from the Bottomshape section by tearing along the two perforations Fill in the requested information including Dealer name dealer number dealer phone number contact person date client name and any remarks Make sure the data form s serial number is recorded on the order form Fax the data forms along with the order form to Invacare at 1 800 870 4928 This fax line can accommodate the longer forms Order Form Information regarding the order form and available op tions is presented in the section titled Creating a Sil houette System It is important that all parts of the order form be filled out Within the order form the type of simulator back is requested If the model being used is complete with a Sensor panel then mark Sensor Earlier models of the Shape Sensor were made for producing seats only These models used a strap style back Guarantee Invacare unconditionally guarantees Silhouette cushions for 60 days from the date of shipment The cushions are also covered for a full two years for de fects in materials or workmanship Serial Numbers Each Shape Sensor has a separate serial number for the back and seat sensor These numbers must be recorded on the orde
41. section and can be used as an easily accessible check list once you have familiarized yourself with the follow ing steps 1 Lock the rear castors The rear castors of the Shape Sensor are equipped with a locking mecha nism that stops the swiveling of the castor as well as the wheels rotation Depressing the lever on top of the castor will lock it into position The cas tors should be locked when a client is transferred on or off of the Shape Sensor the Shape Sensor is disassembled or surfaces or system orienta tion is adjusted 2 Check the seat and back for flatness and plunger position This is accomplished by run ning your hand across the surfaces and feeling for irregularities Figure 1 Only minor indentations should be felt The plungers can at times become stuck in a depressed or extended position and a 98 110 14 gentle tug or push will put them back in place With the plungers as even as possible accurate data production can be assured eal ne ee eine eS FIGURE 1 CHECK FOR IRREGULARITIES 3 Lock the back sensor panel Figure 2 by press ing in the handle and pulling it forward Page 11 FIGURE 2 MOVE THE SEAT SENSOR BACK 4 Set and lock the seat depth The back sensor panel should be moved to its most rearward posi tion This is accomplished by loosening the seat depth adjustment knobs and sliding the side plates along the s
42. sed their comfort making constant shifting less of a necessity Shear Shear is a difficult phenomena to measure and quantify The less a surface has to deform the less shear it will exert on the client s tissue The Sil houette surface is contoured to the client s shape and should theoretically cause less shear Shorter Seat Depths When only a seat cushion is being produced then a dense material of known thick ness can be added to the front of the back sensor s surface This thickness will have to be related back to the factory to assist in the fabrication process If the client requires both back and seat then the attach ment hardware holding the seat sensor panel will have to be modified This modification process can be per formed at the factory or written directions can be given The modification will require the purchase of two re taining clips and two bumpers It will also require the drilling and tapping of four holes Small Clients Cushions can be made as small as 10 x 10 and Invacare rates the low end capacity of the Silhouette at 50 Ibs Very small clients do not have sufficient weight to press into the Shape Sensor s seat Some clinicians have had good success in applying additional force onto the client to produce the desired 98 110 C O M M L A S K E D Q U E S T S U B L S H N TROUBLESHOOTING contour This can
43. shions can also be carved by hand to adjust for weight gain and then re coated 21 COMMONLY ASKED QUESTIONS Large Clients How large of an individual can use Sil houette The Shape Sensor is 18 wide and any part of the client that extends over these surfaces will be extrapolated by the computer following the clients re corded curve up to 217 The measuring limits of the Shape Sensor for cushion length is similar but the ex trapolation of leg length is a much more accurate pro cedure The Shape Sensor is rated for up to 300 Ibs Low Floor to Seat Heights When a low floor to seat height is desired the proper chair should first be chosen Custom interfacing using a drop seat may be necessary for extreme conditions or when the op timum chair can t be provided Care should also be taken when specifying the thickness of the cushion Restriction of Movement Clients and clinicians alike may have concerns that a custom contoured seat cushion will restrict an individuals capacity to freely move about Comments such as don t like to sit in just one spot and I like to move around a lot are frequently heard The Silhouette cushion is made from soft polyurethane foam and shifts in position are readily achievable Invacare has found through inter viewing previously skeptical clients that the reason they had moved around so much in the past was that they were often uncomfortable The Silhouette cushion increa
44. sts 13 Stabilize client and pull back sensor lever for ward 14 Modify back shape to fit client Scapula lateral trunk etc 15 Record seat and back shape 16 Confirm measurements for seat depth tilt back height angle 17 Transfer client off of Shape Sensor 18 Remove the data panels 19 Record serial numbers onto order form 20 Determine necessary modifications options and fillin order form Cushion density cushion cover rail cuts leg length discrepancy solid insert lat eral supports headrest pelvic strap Perfor 21 Determine interfacing 22 Complete order form 23 Fax or modem in order HISTORY In the late 1980 s the National Institute on Disability and Rehabilitation Research NIDRR provided grant funds to the University of Virginia s Rehabilitation En gineering Center to study the usefulness of custom contoured cushions by individuals with a spinal cord injury This research was conducted primarily by Drs Steven Sprigle and Kao Chi Chung along with Tom Faisant RPT The results of this research showed that custom contoured foam cushions provided statistically lower pressure distributions than the clients usual cush ions Along with a decrease in pressure the au thors felt that improvements in posture and balance were also realized The researchers used an array of 64 spring loaded plungers that were fitted with linear potentiometers When a client sat upon the
45. tilted pelvis can assist with spinal extension and reduced kyphotic posturing 98 110 Adjust the back angle for the desired comfort level and to accommodate any limitations of move ment The head should be balanced over the 16 12 13 FIGURE 7 ADJ USING THE BACK ANGLE shoulders and hips The client should have a natural forward gaze and not be pushed forward in the system Figure 7 Adjust the tilt angle to help balance the client and to allow gravity to assist in the fitting process The clinician should be aware of the limitations that the clients wheelchair may have upon the ability to tilt Functional issues such as forward reach and swal lowing must also be taken into consideration Center the clients trunk on the back surface using the printed grid as a guide Check the clients trunk for rotation and the shoulders for a level orientation It is impor tant at this time to critically evaluate the amount of force and support an individual will need to main tain the desired posture Only gentle assistance should be necessary to support the client during the fitting phase If significant force is necessary then other intervention strategies should be con sidered Release the back sensor lever from its locked position by pressing it in and moving it rearwards into the plunger activation position Confirm the clients posture from the feet up to the head FIGURE 8 TAKING THE BACK SHAPE 17 CREATING A
46. y using the optional solid insert There are many wheelchair styles that have an integral seatboard as part of the chair This is usu ally a metal pan with Velcro attached to the sur face Modular Shells The modular shells are made to the dimensions of the cushion in 147 167 or 18 widths and between 10 21 length These shells consist of two extruded aluminum channels and two plastic endcaps Figure 13 The channels are used for attaching the mounting hardware and auxiliary supports such as lateral trunk supports The end caps connect the channels and create a smooth and attractive surface The cushions are covered with the fabric of choice and are held into the shells using Velcro The modular shells come complete with all hardware for mounting into the wheelchair C R E A T N G A S L H 5 Y S T E M FIGURE 12 REMOVING LATERAL INSERTS in all directions If it is unknown whether or not an individual requires a headrest then the modular shell for mounting the back cushion should be specified as headrest ready The mounting holes for the headrest will be prepared and then filled with attractive caps Pelvic strap Every seating system should use a pelvic positioning strap This is necessary safety option and will help stabilize the pelvis The variety offered for the Silhouette System attaches to the wheelchair seat rails This will allow for precise
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