……….Wheelchair Services have offered my son a Salsa M electric wheelchair. How do you find this wheelchair, and what postural set-up do you use?The parent of a boy with muscular dystrophy asking on a forum for young disabled people
I was given this wheelchair by wheelchair services, so I offered to write a comprehensive review of my experience with it to help this lad and his mother decide whether this wheelchair was appropriate for them.
When wheelchair services are giving you a wheelchair, it will often be one from the Quickie Salsa range. In the past I had a Jive M, which is the big brother of this chair, but my current chair is the Salsa M2.
In this range, M stands for ‘mid-wheel’ drive, and describes a chair that has its main drive wheels in the middle, rather than driving from the back. In general, a mid-wheel drive chair is smaller to turn and more useable indoors, while a rear-wheel drive chair has a lot more ability to climb kerbs and tackle obstacles.
I live in a part of London which is very flat, and has very good dropped kerbs, which means that I don’t need the power provided by the rear wheel drive as much, and I live in a flat, which means that I need the manoeuvrability provided by the mid-wheel drive. I haven’t had much trouble getting around with this chair in general, it does most dropped kerbs and most ramps happily, and will tackle a small bump without any real trouble. That said, when I do venture out of London, I really struggle to get the chair to climb more difficult kerbs or temperamental streets.
The range are very programmable, and in my area wheelchair services set a maximum speed at 4mph. I find this really frustrating because I used to love the ability (from my old chair) to go for a jog with the dog, or to run for a bus. This top speed is one of my two least favourite things about the chair – the other being the braking. The stopping distance from letting go of the controller to being at a standstill is far longer than it could safely be for me. I’m hoping to go back to wheelchair services for them to alter this, but I don’t get on well with it as it is.
Overall, it’s a manoeuvrable, nippy chair which adequately manages most of the challenges set in its way, but I struggle to be more positive about it than that. If it were slightly better at climbing kerbs, slightly faster, and had slightly better braking I would be far happier with it – but then it would be the Jive M anyway!
I’m not sure whether the braking delay is an issue with the chair, or whether it actually comes from the controller. The chair has the R-NET controller with a LCD display, and I’ve noticed it’s a lot less rapid in its responses than my previous chair was. It takes a frustratingly long time to boot from being switched off also. Once I’m using it though, it’s really good. It has 5 profiles, each one with 5 different speed levels within it, which allows you to use one profile indoors and another outdoors, and know that your maximum speed will be appropriately set. I think I’d benefit from this more on an 8mph chair though, as in practice I always have it set to the maximum speed anyway. The controller also allows me to alter the position of the backrest, tilt angle, and leg rests by cycling through the options. It also shows me the time (saves me checking my watch and appearing rude), my speed, and how far I’ve travelled since I last reset the trip counter, which is fascinating.
With the controller I have a mushroom joystick. This is designed to meet my hand where it’s at and allow me to drive the chair with my hand resting on the joystick, without having to manage a grip, which is great for me.
The other good thing about the RNET controller is that it’s very future-proof. If my needs change in future, it’s easy to swap in other joysticks and microjoysticks depending on what my needs are at the time.
I have the powered leg rests, which are controlled from the screen/joystick. I have the standard individual footplates, then calf supports and pads at the outside of my knees, which helps to keep my legs in alignment. The calf supports are slightly padded. On the footplates I have ankle-huggers, which clip my feet in at the ankle and again keep me aligned. The leg-rests have a quick-release swing-away function, which allows you to bring the chair far closer to a toilet, or for transferring (if you’re not hoisted). With this, they swing right out to the sides, allowing you to get the body of the chair as near to where you want to be as possible, without the legrests being in the way.
The footplates twist very easily, such that bumping into things slowly changes the angle to point the footplates further and further upwards, until your feet are at ridiculous angles and they start to catch on the ground and on kerbs. It’s really important to reset the angle of the footplate regularly, and to make sure those alan keys are completely tight.
The actuators on the leg rests seem pretty resilient. One of the leg rests got damaged by a door which bent it slightly and made it not work as well as it had been – it stops at a slightly lower height than it really should. Despite this, it still works, which I’m impressed by.
The cushion I have is the Jay 2 deep contour cushion. I asked for a cushion that would support my pelvis at the hips because my posture tends to twist where there’s the least resistance due to muscle weakness. I was very sceptical of the cushion they gave me because it didn’t seem to offer that, but actually it’s great. It’s a very deep-channelled cushion where my legs are guided into separate trajectories, with me seated on gel. It was a difficult decision whether to go for that, or for air (which is better for pressure but worse for pain and discomfort) and we eventually decided on this cushion.
From the photo, you can see the shape of the cushion, which is designed to support my pelvis in perfect alignment and I get on surprisingly well with it. It supports and cradles my pelvis and hips, which has become increasingly important as I’ve struggled increasingly with weight loss, and it feels like it provides adequate pressure protection. While the image shows the cushion looking very creased and in need of smoothing over, it is possible to see the deep channels in the cushion that hold my legs at the right angle.
I have the Jay 3 deep contour backrest with mid-lateral supports. Previously I’ve had laterals as an attachment, whereas this has them built into the back. This makes it a lot less supportive than if it had separate laterals, but the separate ones dug into my back very badly at the base, and were causing nerve compression. This backrest doesn’t dig in as far as the other laterals did, but is less supportive as a result. The technicians also placed a lot of rolls and chunks of foam between the backrest and the backrest cover to make my chair more supportive. Not having full laterals would make the chair pretty unuseable if not for the harness and seatbelt, but with the harness and seatbelt it works really well.
The seatbelt is padded, and is designed to hold my pelvis back in the chair. As I have a suprapubic catheter this causes problems for me, because it puts pressure on that area. Despite that, it’s very necessary, so I’ve learned to get used to it. The harness is slightly elasticated and clips down at four points – shoulders and above my hips. This really works for me in terms of holding me in position comfortably, but the issue I have with it is its lack of adjustability. The points at the shoulders can be easily adjusted, but not the ones above my hips. A harness set to work for me when I’m in my winter coat is no good in a t-shirt. I’ve tried to find a compromise length for the straps, but it’s non-ideal.
The headrest I have is the standard Jay contoured cradle headrest, but I’ve had a lot of trouble with it, it’s been the peskiest part of the chair for me. I spend a lot of time with the chair tilted and reclined a bit, and the setup I was left with after wheelchair services meant that I was staring at the ceiling a lot of the time. I’ve flipped the swan-neck pole on the headrest round in order to have the headrest a lot further forward than it appears to be designed to be. People around me say that I’ve got the headrest in a position that looks abnormal, but for me it allows me to see where I’m driving, which is essential!
I’m hoping to be seen at wheelchair services again soon, and one of the key issues I’ll raise is about what they can do about headrests that are more supportive than this one but also are better positioned to hold my head at a driving angle.
The armrests I have are amazing. They’re made by Otto Bock and they’re channelled armrests, in which my arms lie in a padded halfpipe. I have a lot more use of my arms with the elbows supported, and I find that the armrests support my elbows, giving me the use of my forearms without having to use an uncomfortable wheelchair table. These armrests are very broad, especially with the left-hand side where I’ve got a spread out pad to support the whole of my left hand. What saves these armrests is that they’re mounted on a system that runs round the back of the chair and allows the armrests to be pushed in. This makes getting around my house possible, as it stops the chair being too wide for standard doors.
The armrests also flip up and away, making them far better for things like catheter changes where the nurses need access to the suprapubic catheter set into my abdomen.
The only annoying armrest thing is that the pad for the right had didn’t fit with the joystick so they left it bare metal. I cut a piece of foam to put there to protect my hand from touching frozen or hot metal, and that seems to have worked fine where placed.
My positioning in this chair can be altered through three elements, leg rests, tilt-in-space, and backrests (four if you count each leg rest separately).
The backrest recline function tips the backrest back and forward relative to the chair. This helps you lean forward (useful if you’re lucky enough to be able to stand) and back, which changes the angle you’re sat at. I usually drive sat leaning back quite a long way, which is why I brought the headrest so aggressively far forward. This recline is also really helpful for repositioning me and altering where my bodyweight is in the chair. I struggle with dizziness if I’m sat up for very long periods, so really benefit from the recline function.
The tilt function tips the whole chair back on its axis. The angle of backrest to body to legs remains the same, but I’m tilted further back. The degree of tilt on the chair is more than I can safely use, but the tilt is crucial to me repositioning regularly while in the chair, so I wouldn’t be able to spend long periods in it without the tilt.
This also means that while the recline doesn’t actually look like it reclines that far, once you combine that with the tilt, you can be practically horizontal without leaving the char.
The leg-rests have motors in to raise them up so your legs aren’t always hanging directly below you, which can be really bad for some conditions and for healing wounds. They’re also really important generally for helping reposition and change where weight was bearing on the person’s skin (especially if worried about sores). I had hoped they’d bring the legs up to flat, but they don’t, so if I need my legs flat in front of me I use a chunk of foam on top of the raised leg-rests. The actuators on the leg rests seem pretty resilient. One of the leg rests got damaged by a door which bent it slightly and made it not work as well as it had been – it stops at a slightly lower height than it really should. Despite this, it still works, which I’m impressed by. The trouble with the leg-rests being up, I find, is how hard they make steering. If you’re trying to drive your chair round tight corners, be warned, your legs may gouge out chunks of those corners.
As far as wheelchair services chairs go, this is a pretty good one, and the postural support on it can always be altered and improved to meet me whatever my needs are. I wish it was a faster chair with better braking, and I wish that it was better with kerbs, but overall I’m happy with it, and would probably recommend it to other wheelchair users.
What have you found useful in wheelchair positioning? Do you have any recommendations for things I missed?
If you have any questions about these, or any other product, (or have recommendations of your own) just comment, email me at firstname.lastname@example.org, or tweet @jamierhale
To see the other reviews in this series, go to Adaptive Product Reviews
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