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Mobile Arm Supports

Download this page:MAS justification (163 kb) [doc]

One of the most frustrating and debilitating aspects of certain muscle wasting conditions is the lack of arm strength. For some people this can be overcome by the use of mobile arm supports, which support the forearm and allow the arm to move in a horizontal plane, thus eliminating the effect of gravity.

However, when a lack of arm strength is coupled with an inability to raise the arms, these standard arm supports are of limited use. This severely limits the independence of someone who retains good manual dexterity.

This page looks briefly at standard mobile arm supports and then describes the Neater Arm Support. This is a new powered device (often attached to the back of the wheelchair) which supports the user’s forearm in a sling. It enables the user to raise and lower their arm, using a switch. This facilitates functional activity, because the hand can be correctly positioned, using the user’s own muscle power. The Neater Arm Support increases independent upper limb function, as it provides this enhanced reach. It can also help maintain range of movement at the shoulder.

Contents:


Fixed height arm supports

The majority of mobile arm supports operate on a single horizontal plane only, so that the user's hand stays at this one height. While they may enable people with weak shoulders but with sufficient hand function, to write or to use a computer keyboard, they do not permit any significant vertical movement.

For example, when the user wishes to eat then their food would have to be placed in front of them on a level with their mouth and the arm support set up accordingly. Mobile arm supports can be fitted to a wheelchair, clamped to a table, or be used on a stand (as in the photos below). This type of arm support works well for certain users, and should not be overlooked. Ergorest by QED © QED
Wheelchair mounting ergorest by QED © QED
For further details users should contact their occupational therapist.




Suppliers include:



What makes the Neater Arm Support special?

The Neater Arm Support is the only height adjustable arm support; its advantages can most clearly be demonstrated by comparison with the other models available. The powered Neater Arm Support permits frictionless, gravity-eliminated movement, which allows the arm to move at various heights. By pressing a switch, the user can raise and lower their arm, and this facilitates functional activity, because the hand can then be correctly positioned, using the user’s own muscle power. Its design and geometry give the user a very wide reach, increasing the range of tasks it can be used for.

What does the powered arm support consist of?

The powered arm support was developed by engineers at Bath Institute of Mechanical Engineering and Cambridge University (UK), in conjunction with the Muscular Dystrophy Campaign; it is now supplied by Neater Solutions Ltd, as the Neater Arm Support. It consists of a canvas sling (or gutter) for the forearm, which is linked via a series of three lightweight metal arms to a vertical column. The forearm sling and the metal arms make up the moving part of the arm support, which will travel up and down the vertical column. The column has a custom made support to fit it to back of the wheelchair. The arm support is powered directly from the wheelchair battery.

This photograph shows the assessment model.Assessment model Neater Arm Support by Neater Solutions © Neater Solutions

Is it always fitted to a wheelchair?

No, the powered arm support can also be fitted to a special freestanding base - for an ambulant user, or where it is not practical to fit it to a wheelchair. In this case it would be powered by a separate battery box. The user would sit (or stand) to use the arm support; for example it could be situated by an easel to assist someone to paint.

Who could benefit from the powered mobile arm support?

  • Users with reduced range of movement (ROM) at the shoulder, but who retain sufficient distal upper limb function and manual dexterity to be able to undertake daily living activities. Users still require adequate passive range in the shoulder girdle muscles.
  • Timing of the supply is important; if it is supplied too early (whilst users can still carry out tasks) it will be more of a hindrance than a help. Conversely if it is supplied too late then the user may have already lost passive range of movement.
  • Users must have adequate sitting posture and trunk stability, so that their arm is free to use the mobile arm support. It may not be suitable for those users who rely on their upper limbs for sitting balance. For example some young men with Duchenne muscular dystrophy maintain their sitting posture by propping their elbows on their wheelchair armrests; they have reported that the powered arm support can unbalance them.
  • They must be motivated to use new technology, with a wish to gain some functional independence.
  • The client group includes people with most types of muscular dystrophy, including Duchenne muscular dystrophy, limb girdle muscular dystrophy and facioscapulohumeral muscular dystrophy, and other related conditions, such as spinal muscular atrophy. Experience has shown that younger boys with Duchenne md are benefiting, and that use of the powered arm support enables them to maintain shoulder ROM for longer periods of time. Following surgery for spinal fusion boys often report an apparent loss of upper limb function (they can no longer flex forward when feeding), but prior use and familiarity with the powered mobile arm support can overcome this.

The Muscular Dystrophy Campaign has drawn up a list of questions to consider, to try and identify those for whom the Neater Arm Support may be suitable, and to avoid disappointment and a failed assessment. Click here to download the questions. PMAS screening tool.doc (38 kb) [doc]

  • Although beyond the scope of the Muscular Dystrophy Campaign, it is worth noting that the powered mobile arm support could possibly also benefit some people with motor neurone disease, cerebral palsy, spinal cord injuries or CVAs (strokes).


What can the powered mobile arm support be used for?

Any activity where the hand needs to move in three dimensions, ie vertically as well as on a horizontal plane, for example:

  • eating and drinking
  • self care and grooming tasks such as shaving, make up, blowing nose, combing hair
  • holding phone to ear
  • using computer keyboard
  • leisure activities (painting at an easel, playing cards, meal preparation)
  • even light dusting and housework
  • operating lift and road crossing buttons
  • reaching light switches
KMAS arm support © KMAS

This photograph shows the prototype Neater Arm Support.

Other features of the powered mobile arm support

  • The joint between the forearm gutter and the first linking section is pivoted, and is individually adjusted at the time of supply to ensure that as the arm is raised, the elbow will drop and the wrist & hand elevate, and vice versa.
  • There is no mechanism under the forearm to foul a table or keyboard.
  • The sizes of the gutter, the sling and the middle linking section are determined by the needs of the individual user and the dimensions of the chair.
  • The arm support offers no resistance to horizontal movement
  • It has a very smooth vertical movement, with a slower start and stop
  • Whilst it can be successfully fitted to most chairs with a tilt in space or recline facility, it must only be used when the chair is in an upright position.
  • Has a cut-out feature, so it will not damage the wheelchair battery
  • Comes with a 3-year guarantee. No servicing is required


The Neater Arm Support © Neater Solutions Ltd

This photograph shows the colour scheme of the final version of the Neater Arm Support.

Are there any disadvantages?

  • Although the arm support can be fitted to the vast majority of powered wheelchairs there are one or two models which do not have a suitable strut to fit it to.
  • Fitting a Neater Arm Support to a wheelchair will usually make the chair a little longer (rarely wider), and users will need to get used to this. If the size of the wheelchair is extremely critical, then the arm support may not be appropriate. A point to consider is the size of any vehicle used to transport the wheelchair.
  • For users with more than one chair (at home and school etc) it can only be fitted to one chair (unless a second vertical column is purchased and fitted to the 2nd chair).
  • It cannot work with wheelchairs where the user can lie flat.
  • Assistance must be available to fit the moving part of the arm support to the chair.
  • Whilst many users will independently be able to slide or lift their forearm into the sling (whilst the arm support is in the “parked” position), others will require help with this. The “parked” or secure position is when the powered mobile arm support is lowered so the forearm is resting on the armrest of the wheelchair.
  • Users report concern that their arm support may be knocked or damaged whilst they are in a crowd, eg changing classes at school. Some children prefer to take the moving section to school in a bag and have it fitted on to the support column as required, for individual lessons. See safety considerations below.
  • Although most people find the appearance of the Neater Arm Support is acceptable (especially since much of the mechanism is positioned at the back of the wheelchair), it may not be aesthetically pleasing for all users.


Safety considerations

These include, but are not limited to:

  • The powered mobile arm support can be fitted with minimum and maximum heights of travel, which can be useful in preventing a user going beyond their passive range of movement.
  • Maximum speed of vertical travel can also be set, as required
  • The forearm is fully supported, and is very unlikely to fall out of the sling unless it is raised to an excessive height. Straps to keep the arm in the sling are unlikely to be needed, but can be supplied if required. (They would then prevent someone lifting their arm in independently)
  • As above, the “parked” or secure position is when the powered mobile arm support is lowered so the forearm is resting on the armrest of the wheelchair. In any situation where there may be a risk, eg on a crowded street, close to traffic, or when passing through a doorway, the powered mobile arm support should always be in its secure position, to avoid any potential danger of the users arm, or part of the arm support, getting caught or trapped, or knocking other people.
  • When the Neater Arm Support is in use the user should not be able to move their powered wheelchair. Conversely if the wheelchair is in motion then the powered mobile arm support should not be used; any attempt to use the  vertical movement of the arm support will result in the chair coming to a halt.
  • The powered mobile arm support should not be used when the chair is on a slope, as the tilt of the chair could make the arm swing in a direction that the user cannot control.
  • Wheelchair users will require a headrest, to ensure that their head does not hit the main vertical column, eg if the chair is jolted.
  • The powered mobile arm support has not been crash tested. The set up can vary in each individual case so it is not possible to predict what dangers the powered mobile arm support could pose if attached to a wheelchair in a moving vehicle. At the very least, when transporting the powered mobile arm support in a vehicle, ensure that:
    1. The powered mobile arm support (vertical column) is very securely attached to the wheelchair.
    2. The whole of the moving arm is completely removed from the main column.
    3. For users travelling in their wheelchair, it is essential that the chair is fitted with a proper headrest, to prevent the user’s head hitting the main column of the powered mobile arm support in the event of an accident. (In any case there should be a headrest to prevent whiplash injury).
    4. The wheelchair is securely fastened to the vehicle, in such a way that the combined weight of the wheelchair and the powered mobile arm support will not move the fastenings in the event of an accident.


How much does the powered mobile arm support cost?

The current cost of a Neater Am Support is £2,000 (UK). This includes assessment and fitting to the user's powered wheelchair.

Because of the increasing use of the arm support with both arms, eg to maintain range of movement at the shoulder, Neater Solutions have now developed a model which can be used on both left and right arms (not at the same time!). The additional cost is £500 which is cheaper than buying two separate arm supports.

Funding the Neater Arm Support

Because it is a new product which does not fit neatly into one specific category, funding sources so far have been variable and innovative, depending on the intended use of the arm support.

For example, where it has proved more successful than a Neater Eater in assisting with feeding, Local Authority social services/social work departments have purchased it. Now that Local Authorities have to offer direct payments for equipment, this may be a useful option. Other users have been funded by their Health Authority, or by charities. Access to Work purchased an arm support for a disabled employee when she was able to demonstrate that it reduced her reliance on a personal assistant at work. Regional Health Authorities have budgets for Continuing Care and for Assistive Technology, and these can be useful avenues to pursue.
Overall, when therapists see the benefit of the equipment, they need to think creatively when applying for funding, and should also consider possible “partnership” funding, for example via the ICES (Integrated Community Equipment Store) budget.
To support applications for funding, the Muscular Dystrophy Campaign has written a leaflet Justification for MAS.doc (36 kb) [doc]. Individuals, families or occupational therapists may use this in any way they wish. Feel free to photocopy it to submit with requests for funding, quoting the source, if this may help, or to copy any part of the information into individual letters.

I think the powered mobile arm support could help me – what do I do next?

  • If you have an occupational therapist or physiotherapist, or Muscular Dystrophy Campaign Family Care Officer it would be helpful to discuss this with them.
  • It is important to realise that the Neater Arm Support is not suitable for everyone. The Muscular Dystrophy Campaign has drawn up a list of questions to consider, to try and identify those for whom it may be suitable, and to avoid disappointment and a failed assessment. Download the screening questions: PMAS screening tool.doc (38 kb) [doc]
  • Neater Solutions Ltd will make an appointment for an assessment visit (the arm support will not be fitted to the wheelchair for the assessment; it is fitted to a stand that the user can reverse up to).


Quotes from users

“The Neater Arm Support is probably the most useful piece of equipment I have ever used - not only is it very easy to use but it can assist with a wide variety of tasks. I am able to do a number of activities with it which are extremely practical, and make life much more straightforward.” (user Cambridge)

"I can use a mobile phone now!"  (teenage user, Ireland) 

“...The weakness in his arms and this loss of independence is hard for a teenager to bear. Today my son tested the Neater Arm Support…….he was so delighted to move his own arm that it almost brought tears to my eyes. He was able to touch his face, lift his glasses up and freely move his shoulders for the first time. He was able to pick up a sweet and put it in his mouth without calling for me. This sense of freedom brought a huge smile to his face and I don’t think you can put a price on that. The Neater Arm Support is the first product I have seen where the person is able to use their own hands and because of that the product does not feel alien or artificial in any way.”  (Parent, Leicestershire)

"I've had spinal muscular atrophy since early childhood and I've got no movement at all in my shoulders and upper arms. I can move my hands and forearms to some extent. I can't manage to feed myself or do things that involve raising my arms. With the Neater Arm Support I can drink a cup of tea, or feed myself, or scratch my nose, or hold a telephone, or even do some exercises which gives me good stretches in my shoulder and elbow.” (user, Newcastle)

“I use it for exercise………eating and drinking and getting that itch on top of my head.” (user, Cambridgeshire)

"It's brilliant!"  (user's mother, Notts)

Contact details

Neater Solutions Ltd
13 Spencer Road, Buxton
Derbyshire
SK17 9DX

Tel: 01298 23882
Fax: 01298 23883
Email: info@neater.co.uk
Website: www.neater.co.uk

Download a copy of this page

Click here to download this page as a word document: Powered mobile arm supports1.doc (192 kb) [doc]

Download the screening questions

You can download a copy of the screening questions: PMAS screening tool.doc (38 kb) [doc]

Download the leaflet "Justification for the need and provision of the Neater Arm Support"

To download a copy of the leaflet: Justification for MAS.doc (36 kb) [doc]