Position Joystick in Every Client’s Natural Hand Position
Because of the multiple benefits of customized joystick positioning for every PWC user, every PWC client deserves the opportunity to drive at a central location, not just those who have difficulty driving in the armrest location.
Custom positioning of the joystick optimizes the Power Wheelchair (PWC) user’s:
- Operational performance
- Long term comfort
- Driving confidence
- Satisfaction with their PWC.
The ErgoReJoy system includes a step-by-step assessment methodology which yields the documentation for submission of third-party payor claims. A full assessment of the client’s driving abilities and postural positioning takes approximately 20 minutes. Not tools are required to position and lock the joystick and JoyPad ergonomic wrist support in place.
Medical and Functional Benefits of Joystick Positioning
- Improves hip and shoulder symmetry
- Upright upper body positioning helps improve respiratory capacity
- Helps prevent pressure ulcers and muscular skeletal syndromes due to improved posture
- Maximizes the function of seating products
- Helps reduce fatigue and shoulder/back muscle pain by offloading weight of the upper extremity with the JoyPad forearm support
Ergonomic Removable Joystick Platform Drive Control
Ergonomics is the science of fitting a specific task to an individual, rather than forcing the individual to accommodate to a specific task. Successful power wheelchair (PWC) seating and positioning assessments utilize ergonomic principles to allocate and adjust seating products such as pressure relieving cushions, armrests, leg rests, and even headrests, to adequately support and accommodate each individual’s personal anatomy and biometrics.
Ergonomic injuries are commonly caused by obstructed circulation as a result of awkward, static postures, especially when combined with contact stress, force, or repetitive movements. Operating a PWC control requires sustained repetitive motions, making the achievement of neutral positioning of the wrist, arm and shoulder critical to injury prevention. Furthermore, due to the prevalence of upper extremity contractures in PWC users, the more lateral position of the standard armrest-mounted joystick is often difficult to access without causing a sequelae of postural adaptations.
To achieve neutral postures in a wheelchair, the elbows should rest on the armrests of the chair with the joystick or drive control positioned at a similar height to the armrests. The driver should be able to access the joystick with their arm in as close to 0° of shoulder flexion as possible. When positioned closer to the core of the body, within the ergonomic “power zone,” the driver can better operate the wheelchair due to improved alignment and comfort.
The positioning of a client operating a wheelchair is analogous to the position of a person performing computer input tasks in an office chair. A recent study by Goncalves, et. al. determined that the primary way to decrease upper trapezius and anterior deltoid activity (which frequently leads to musculoskeletal overuse injuries) is to provide adequate arm support through office chair armrests and forearm and wrist supports which help maintain neutral wrist and hand postures. The second most significant factor in reducing muscle activity in the absence of armrests, is determined by the shoulder flexion angle, which demonstrates the least amount of anterior deltoid and upper trapezius activity at 0° of flexion, and sequentially increasing activity relative to the angle of shoulder flexion.
Despite the generally recognized importance of ergonomics in PWC seating, the critical task of operating the PWC drive control in an ergonomically considered location is often overlooked. One reason for this paradox is a lack of effective joystick positioning options.
The ErgoReJoy ergonomic removable joystick platform is a newly designed tool for clinicians and providers to easily and efficiently offer power wheelchair users a variety of joystick positioning options. The ErgoReJoy allows the PWC user to select a joystick position that optimizes their seated symmetry and pressure distribution, while promoting neutral, ergonomically correct positions for the upper
extremity. The removable joystick platform is mounted tothe armrest and provides unlimited
positioning options on either side of the PWC, starting at the standard armrest placement, and migrating inwards to midline. When assessing the client in different positions, it is advised that they are initially assessed in the most lateral position to determine a baseline, before assessing within the two progressively inward locations.
Optimal seating combined with ergonomically sound joystick placement options may help to prevent and amend musculoskeletal disorders caused by misaligned input controls. The ErgoReJoy multi-adjustable joystick platform offers the versatility that allows solid ergonomic principles to be applied in symmetry with the PWC seating and positioning products.
The ErgoReJoy was created by Active Controls founder, Mike Flowers with collaborative input provided by ergonomist, physical therapist, and assistive technology professional, Allison Sevillano. Dr. Sevillano has extensive experience conducting assessments and implementing solutions for ergonomic and assistive technology clients across a wide range of settings and populations. This experience has provided her with unique insights and perspectives when applying ergonomic design principles to power mobility. Mike Flowers has a passion for developing and marketing products to improve the power wheelchair user-experience
Tips Before Initial Assessment
Custom positioning of the joystick optimizes the operational performance, long-termcomfort, and safety of the PWC user, while increasing confidence and improvingsatisfaction with their seating system. One of the important goals of the ErgoReJoyuniversal positioning assessment system is to facilitate assessing the client’s ideal joystick location. The evaluator is encouraged to provide every PWC client with the opportunity to drive at a central location during an evaluation, not just those who have difficulty driving in the armrest location.
A full assessment of the armrest and midline locations should take approximately 20minutes once the evaluator has become familiar with the ErgoReJoy assessment and positioning system. No tools are required to position and lock the joystick and JoyPadTM ergonomic wrist support in place.
The basic joystick positioning assessment requires comparing the client’s driving
abilitiesand postural positioning while operating the power wheelchair (PWC) in two joystick locations: the standard armrest-mounted position (refer to Figures A and B), and a central location (refer to Figures C, D, E and F).
Seating and positioning products often affect PWC joystick or alternative drive
control positioning. In addition, positioning the joystick or other controls in a central locationwith forearm and wrist support has been clinically validated to compliment PWC seating products. As a result, it is recommended that the seating and positioning assessment be performed prior to the drive control positioning assessment.
The ”, ” and ” extension arms will be used in three different joystick locations the
armrest (3”), at midline (8”), and if needed, in another central (5”) location. The 3” arm installs on the .” ball under the joystick platform located in its center. The 5” and 8” arms install on either the left or right ball on the side of the joystick platform and the ball attached to the top of mini-mast (refer to Figures A-F).
IMPORTANT: Always turn off power to the joystick control after each test drive or beforeadjusting the position of either the joystick or the JoyPadTM ergonomic wrist support toavoid accidental engagement of the joystick control.
When positioning the ErgoReJoy joystick platform and JoyPad™ ergonomic wrist support, multiple components of the Active Controls universal positioning system will require adjustment. Familiarization with making the following adjustments will facilitate the assessment:
Removing the ErgoReJoy joystick, platform and positioning arm from its receiver socket: To become familiar with removing the joystick assembly from the PWC, the evaluator can practice moving the modular system from the right side of the PWC to the left side. It’s so simple, that it only requires approximately 10 seconds. There are no brackets to remove, or electrical connections to unplug, reroute and reconnect. (One tip for familiarizing the client with the modular connection, is to ask about hand preference BEFORE installing the ErgoReJoy joystick assembly in the receiver socket. If possible, try to involve the client in process of inserting the assembly into the receiver socket to orient them to the simple process of installation.)
- The joystick’s proximity to the user in the armrest location can be adjusted by moving the socket bracket medially or laterally using the quick release adjustment handles under the armrest (refer to figure G).
- After the joystick’s baseline armrest assessment, the socket height must be raised for central assessments. Loosen the adjustment handle behind the socket, and raise the socket to the top of the slot of the socket bracket (refer to figure G). Tighten the adjustment handle firmly to eliminate any socket movement.
Note: for large adults, add the 3” extension arm positioned upward at a 90° angle to clear the thigh. Then, use the double ball adaptor to attach the 8” arm to the 3” arm (refer to Figure H). To attain a midline location in pediatric clients with narrow PWC’s, move the 8” arm from the ball on the side of the joystick platform to the one under the joystick platform (refer to Figure I).
By loosening the adjustment knobs of the extension arms, the lateral position, angle, and pitch of the joystick control can be adjusted for each client. When installing the extension arms, keep the adjustment knobs on the outside away from the client for ease of evaluator adjustment.
In the central joystick locations, the JoyPad™ gel wrist support should be positioned using the small 3” extension arm and 1” balls to rest supportively
under the user’s wrist, with the wrist aligned with the forearm in a neutral position (approximately 0° of extension/flexion and radial/ulnar deviation) (refer toFigure J).
While not every client will qualify for third-party reimbursement of a midline mounting accessory (despite its preventative benefits in pressure distribution and musculoskeletal alignment), most clients will benefit from central positioning of the joystick control, and may opt to pay out-of pocket for it.