Nienke is the first person in the Netherlands to receive a WMO reimbursement for the WheelAir Slingback, which she uses to help prevent skin rash caused by heat.
In this case study, we ask Nienke about her journey to find a solution to this with her wheelchair provider and why they chose WheelAir.
Nienke, who lives in Rotterdam, is 29 years old, has a Bachelors in Medicine and is completing a Master’s in Epidemiology. She has used a wheelchair permanently since 2012 as a result of damage to her balance organs and to the dorsal horn of the spinal cord. She has an ADL chair and a sports chair.
Can you tell us a bit about your experience with heat and moisture?
I mainly suffer from heat rashes on my skin which show up as red bumps. Additionally, I often become limp or unwell when I am hot. The heat rash is made worse due to the heat generated from leaning against the wheelchair backrest. The big problem is that I also have to deal with these bumps on the lower back and buttocks, where they tend to open easily, which leads them to getting infected.
What products or treatments have you previously used?
For the heat rash, I was prescribed antibiotics and corticoid cream. This helped a bit, but in warmer weather they come back anyway. I also get very sick from oral antibiotics so that is not really a solution for me.
With my previous wheelchair I was fitted with a Tarta back system for more support, which happened to also be more permeable due to the structure, but eventually did not provide the support I needed. I then got a new wheelchair fitted with an ILSA back, which now provided the right support but was no longer permeable to air. The first suggestion was to switch chairs regularly as well as my positioning. Then it was tested whether it would be better with a new back cushion with a 3D spacer fabric fitted to the ILSA system, but this was not successful. I also tried cooling vests, but these only worked for a few hours and resulted in half my wheelchair being wet.
Were you the one responsible for finding a solution?
I quickly realised that the wheelchair was part of what was causing the issues, due to the breathability of the backrest. My first chair was under the PGB (Dutch Personal Wheelchair Budget) so I was responsible for finding a solution myself. However, I received a new chair as part of WMO in Natura (municipality provides the chair) and so the provider of the chair, in this case Meyra, was responsible for finding a solution as well as the payment of that solution.
Reason for considering the WheelAir product?
I knew that air supply and cooling worked in helping to prevent heat rash, not only from my own clinical experience, but also because I had already tested the WheelAir Slingback a few years earlier. So I knew it helped and was a real tangible solution. The fact that I was able to test the product earlier also helped in the decision for reimbursement approval.
What factors contributed to the reimbursement decision?
In addition to my own clinical experience and positive testing of the product, WheelAir’s clinical evidence – in the form of literature reviews, a combination of clinical indications, case studies and external studies – also substantiated the science behind the product. Therefore, there was clear proof that this solution could work for me.
Has WheelAir been successful in addressing the initial problem/issue?
Absolutely. Summer hasn’t returned since I started using the Slingback, but neither has my rash. I look forward to updating you in summer! I used to suffer from heat related issues such as becoming limp, nauseous and dizzy regularly and this has significantly improved. These issues are of course comfort related, so weighed less in the decision for reimbursement. My skin rash was a tangible medical need, however.
Has there been unintended impacts on other health factors since using WheelAir (positive or negative)?
Other than no longer feeling limp, nauseous and dizzy I also notice that I have more energy. For example, when you enter a store after being outside you can quickly turn on the WheelAir for that transition, limiting your exposure to big temperature changes.
Have you experienced an overall reduction in time allocated to personal and healthcare condition management with WheelAir?
Yes, I have to worry less about heat and moisture related issues. However, I don’t necessarily visit the hospital less frequently. I do think in summer it will mean that I no longer have to use crèmes or antibiotics.