The Adremo wheelchair is an electric wheelchair fitted with specially combined head/foot controls.

This wheelchair can be completely adapted in a very short time to the shape of a persons body and to his or her motoric abilities. A standard box for manual operation is mounted for the attendant on the back of the wheelchair; both control methods can be regulated separately.

The Adremo wheelchair has been developed for quadriplegic children and adults with such a degree of spasticity and/or athetosis, that manual controls are impossible or undesirable. Quadriplegia (also known as tetraplegia) is mostly caused by brain damage in the early childhood (Cerebral palsy) or later on in life by a stroke, accident or other defect.

A specially constructed adjustable head support enables steering by way of a slight head movement. If the head is moved to the left the wheelchair will turn left and a head movement to the right will turn the wheelchair right. The wheelchair is fitted with two movable pedals, one of which is used mainly to regulate the speed, to stop and reverse; the other to switch the wheelchair on and off and for various other functions. By depressing the pedal with the toe the wheelchair starts to move. If, from the neutral position, the heel is pushed down first and then the toe, the wheelchair will move back­wards. To start going forwards again the heel should be pushed down again.

Either the left or the right foot can be used for speed regulation. If the left foot is used for speed regulation the right foot is automatically used for the other functions. There is also the option of switching the wheelchair on and off with either the toe or the heel. This is done with the pedal that is not used for the speed regulation. Steering and "accelerating" can be trained separately. E.g. by locking the "accelerator".

A switch has been mounted under the seat of the wheelchair. This switch is on as long as the person in the wheelchair is seated. If he stands up ( e.g. caused by an extension-spasm) the wheelchair will stop immediately. If the person sits down the wheelchair will move again ( feed-back mechanism).

Adjusting

The wheelchair is tailor-made for the user but as the various components can be adjusted, it remains easily adaptable. This is especially important for growing children. During practice the wheelchair can continually be adjusted to changes in position, movements and motor functions.

1. Position

The wheelchair is easily to adjust to

• The position of the head
• The required body size and the torso position
• The length of the lower and upper legs
• The position of the hips, knees and the feet ( changing flexion and extension )

2. Movement control

All movements required by the user to operate the wheelchair -steering and driving - are controlled by freely adjusted suspension. So you will create a balance between the left and right side of the body and between extension and flexion patterns.

3. Speed

This can be determined by both the movement of the pedal and the speed regulator. Even a minimal foot movement (approx.. 1.5 mm) will be sufficient to drive the wheelchair. The more you depress the footpedal the faster the wheelchair will go. With the speed regulator you adjust the maximum speed you want. This is special important during the learning period.

Possibilities besides driving

The wheelchair can be connected, by means of a cable or infrared transmission, to all kinds of electric and/or electronic equipment such as:

• computer (Commodore, msx, p.c.)
• communication equipment- (Tiny-Talker, My Voice, Bliss-voice) - toys (train)
• simple musical instruments (electric drum, electric triangle)
• educational equipment (page-turner, memory, "clock")

To operate the above equipment the same controls are used as are required for driving and steering the wheelchair. Once the user has improved his driving abilities, the control in operating other equipment also improves.

Therapeutic influences

The concept behind the wheelchair is to provide people with severe spasticity mobility and communication, by requiring a minimum amount of movement and strength. Large movements intensify spasm, resulting in less body-control. The construction of the steering mechanisms of the wheelchair allows, even forces the person to make minimum, controlled movements. Every "wrong" movement will not give the right result, the wheelchair will not do what the person wants, ( e.g.. by standing up, the switch under the seat will stop the wheelchair, turning your head too much (A.T.N.R.), the left and right switch in the headsupport will be activated at the same time so the wheelchair will not steer).

Because of the fact that persons in the wheelchair have to use their head for steering, they continuously train the position of the head and so obtain a better head control. Training the feet improves controlling them. By training with head and feet together they obtain more and more dissociation of movements, resulting in increased control over spasm and a corrective effect at posture.

The training is stimulated by the fact that the disired movements give result. Also you have to learn just a few movements, every time from the same position.

Emotional control

Emotions influence the patterns of movements of all people, as well as the patterns of movements of persons with cerebral palsy, but by them the influence of emotion upon movements is much stronger. Most of the children and adults are captured in their body, they can't speck, have no other way of communication and they always hear and experience their impossibilities.

Quite a lot of them are clever enough to understand what happens around them but cannot give answers, so that the world around them treats them often as mentally disabled people. All reasons for them to get angry and to develop a behaviour, which parents and other caring people often don't understand and drive them to despair and sorrow. With all our therapy we were not able to give them mobility or to take away their reasons to get angry. Most of them had therapy for years without really results for themselves. All expressions of emotions influence the motor patterns, so the persons have to learn to control emotion. If they go "beyond the border", emotion will influence the motorpatterns movements which they need for steering/driving the wheelchair, in such a way that the wheelchair will not "listen".

Trust

Before you can change behaviour as mentioned above you need ( as a trainer ) to have complete trust in the possibilities of the person you train and make her to trust in you. You have to speak with her as you do to any person of her age, to tell her that the wheelchair will help her, that it takes a lot of time of practise and that concentration and listening to the trainer, as in any other sport, is very important. Emphasize her possibilities and do not focus too much on her impossibilities. The sooner she feels that the way she has to behave ( emotionally / motor patterns) gives results ( e.g.. moving away,) she will change her behaviour which leads to a better control over her movements of the body.

Conclusion

Because the Adremo wheelchair is generally used for people with an extremely complex handicap it will often take a lot of time and patience before the use is mastered well.

Thanks to the many possibilities of the chair and the combined effort of paramedics, parents, group leadership and instructions by the physiotherapists of Adremo a great deal can be achieved.