Permobil logo
Permobil logo

Case of Excellence: John

“It's always been important to be as free as I still can be.” 

When we meet John, he shares with us that he has been experiencing limitations in his health and function related to his seating and wheeled mobility solutions. Through a collaborative approach between John, his clinical team and Permobil, adjustments were completed to his existing set-up and new equipment was installed. We followed John along this journey and here are the results of what he shared with us.  

John is a 43 year old artist, welder, athlete, and world traveler who resides in Belgium. He is extremely independent and has always placed high value on being self-sufficient since his accident in 2005 which resulted in paraplegia of the trunk and lower extremities. He does have a medical history of recurring pressure injuries on his sacrum and spine as well as fluctuating levels of pain in the upper extremities.  

Just as many individuals experienced, the global pandemic resulted in a reduction in activity level and travel for John. As a result, he experienced a variety of physiological and psychological changes. 

It was hoped that new seating and wheeled mobility would aid in his healing and function, however, he still had the following limitations in body functions and structures, activities and participation.

”I was out all the time before. I was doing miles everyday and now I feel like I can’t do it anymore because if I would go out today and just ride with my wheelchair, tomorrow my shoulders would be completely wrecked.. I would wake up at night having to move my arms for two minutes for the pain to go away.”  

Comparison table of John's pre and post intervention

Pre-intervention limitations
  • Body functions and structures

    • Loss of muscle mass impairing his sitting posture and comfort 
    • Pain in both the right and left shoulder 
    • Decreased upper extremity range of motion  
    • Sleep-related issues due to pain 
    • Category II [Stage 2] pressure injury on the left ischial tuberosity (IT)
    • Reducible postural asymmetry: Left pelvic obliquity, right pelvic rotation, posterior pelvic tilt, left trunk deviation (lean), thoracic kyphosis and cervical hyperextension 
  • Activities 

    • Unable to complete typical activities of daily living due to limited overhead reaching
    • Challenges with using his wheelchair for grocery shopping as he is unable to propel the distance required
    • Limitations in his physical exercise activities, as every day propulsion results in pain and fatigue
    • Stability in his chair was limited as his pelvis tended to slide forward with activity throughout  the day.  

    “Before I would easily do 10 km per day. I would get the groceries, then at noon I went to the forest where my friends were. I would then go back to eat and take a long walk with my dog and then back to my friends to go to the beach to sit there for the sunset.”   

  • Participation  

    • Limitations on how long he can work on his art and welding due to challenges handling the tools required
    • Decreased involvement in social activities as he is not able to propel the distance required
    • Limited travel opportunities 

Outcomes 2: Activities

  • Ability to propel the distance needed to go to the grocery store
  • No limitations in overhead reaching
  • Regular workouts for strength and endurance
  • Improved stability as pelvis does not slide out as much during activities
  • Improved propulsion stroke.

"The most important [thing] to me is to move because I feel that if I am not moving, I am suffering more from my shoulder."

Front view comparison
  • Pre-intervention

    Note left trunk lean, pelvic rotation and pelvic obliquity
  • Post-intervention

    Reduced trunk lean, pelvic rotation and thoracic kyphosis
Lateral view comparison
  • Pre-intervention

    Note thoracic kyphosis, posterior pelvic tilt and cervical hyper extension.

  • Post-intervention

    Post-intervention: reduced thoracic kyphosis, posterior pelvic tilt and cervical hyper extension


Research shows
  • Mobility base:

    • When individually configured allows individuals to perform wheelchair skills.
    • Reduces shoulder pain when individually configured.
    • By reducing the onset of repetitive strain injury, a individually configured chair can reduce shoulder pain and dysfunction.
  • Seating system:

    • Reduces shoulder pain by providing postural support and control 
    • Promotes skin and soft tissue protection and provides an environment for wound healting when a cushion provides optional off-loading of the ITs 

Outcomes 3: Participation

  • Increased frequency and opportunity to socialize with others, especially outside of the home
  • Sitting tolerance improved to where he felt comfortable and stable to support returning to his artwork
  • Gained employment working with heavy machinery polishing materials.

All seating and mobility goals reached.