How do you know when to recommend a Broda Chair over a Geri Chair?
As occupational therapy practitioners, sometimes making the recommendation for a wheelchair can be hard, especially for a person that doesn't quite fit the norms of a standard seating and positioning.
So I went right to the source and teamed up with Broda to help answer this question!
But first, let's define what each of these are.
What is a Broda Chair?
Broda is a wheelchair company that traditionally offers tilt-in-space positioning chairs with the Comfort Tension Seating® system which prevents skin breakdown through reducing heat and moisture for people in any type of healthcare setting, but commonly used in long term care/skilled nursing facilities or home care.
Many times, I choose a Broda chair product for people that need a high level of positioning or special adaptations due to things such as severe scoliosis, knee contractures, skin breakdown, Huntington's or if they have had repeated falls.
Broda products are classified as Durable Medical Equipment (DME) Class1 Mechanical Wheelchairs (IOR), which means in some cases and jurisdictions Broda chairs and wheelchairs are available for funding! Because they are categorized as DME, they require premarket clearance based on a much more extensive validation, established guidelines and standards, ensuring high safety, mobility and patient outcomes.
Example of a Broda Product: The Synthesis Tilt Recliner
Broda's Comfort Tension Seating® System
What is a Geri Chair?
Conversely, Geri Chairs (like the Drive Medical Recliner) are classified as mechanical chairs (INN) which does not require FDA clearance or testing based on consensus standards. It is designed to allow someone who is mainly in bed, to be able to sit comfortably in a variety of positions while being fully supported.
Many times I may recommend a Geri chair because the patient may need a more substantial, and many times less restrictive, seating platform than is provided by a conventional wheelchair.
For clients that are non ambulatory, Geri chairs can be comfy, roomier, recline and are easier to "lounge" in.
Example of a Geri Chair: Clinical Care Geri Chair Recliner
by Drive Medical
Let's go through some of the times you would want to use Broda wheelchairs vs a Geri chair and then I will highlight some of the features that I love about Broda:
When to Recommend a Broda Chair:
1. Change in Condition
As the patient’s condition progresses/changes, it is important that they are reassessed to assure they continue to use equipment that will meet their needs, provide them comfort and keep them safe. The need for reassessment can be identified by:
- A decrease in sitting tolerance
- Increased risk for/or development of pressure ulcers
- Decreased ability to self-ambulate and/or self-propel
- Implementing use of restraints to keep patient seated safely, including seatbelts, soft belts, lap trays, etc.
- Increase in postural deviations such as; head drop, lateral lean, slumping and sliding forward while seated
Broda's Synthesis Tilt Recliner with Huntington's Special Padding
2. Change in Medication (dosage, frequency, etc.)
Patients that are utilizing equipment that no longer meets their needs can result in symptoms and conditions that may cause a change in the use of medications. This can be identified by verbal and non-verbal cues such as:
- Increased reports of pain
- Complaints of new pain
- Behavior changes due to discomfort, pain, and inability to verbalize need
- Increased symptoms such as; swelling of the upper and lower extremities, numbness of the upper and lower extremities, back pain and hip pain
- Increase in use of pain, psychotropic and other medications due to the above
Broda's Synthesis Transport Chair
3. "Behavioral" Changes
Prolonged discomfort can cause increased pain and exasperate other symptoms facilitating a change in the patient’s behavior. For patients who are unable to verbalize their needs, these changes may show in the form of frustration or aggression. This can be identified by verbal and non-verbal cues such as:
- New or increased signs of aggression
- New or increased episodes of frustration
- Increased attempts to exit the chair increasing fall risk
- "Behavioral" changes such as aggression, crying, frustration, yelling etc.
- Implementing use of restraints to keep patient seated safely
- Increase in use of psychotropic medications (to calm patient)
Broda's Encore Pedal Rocker
4. Increased Time in Bed (Decrease in ADLs and Social Participation)
The patient’s sitting tolerance and ability to socialize may change due to using a wheelchair that no longer meets their needs. Over time, modular seating systems no longer provide the comfort they once did. When patients become uncomfortable sitting in their wheelchair they begin to spend more time in bed potentially increasing their risk for pressure ulcers, fall risks, and other issues. This can be identified by verbal and non-verbal cues such as:
- Increased pain
- Increase in use of pain and psychotropic medications
- More time spent in bed, inability to socialize (resulting in isolation and depression)
- Postural changes such as slumping, sliding and lateral lean while seated
- Increased symptoms such as; swelling of the upper and lower extremities, numbness of the upper and lower extremities, back pain and hip pain
Some of my Favorite Broda Features:
- Ability to drop seat height much more than a traditional wheelchair to get the person's feet in a good position on the floor if they are a "foot ambulator.”
- The Encore Pedal Rocker provides a caregiver activated gentle rocking motion for people that need the sensory input to reduce agitation. I have also used this feature to compensate for fluctuating rigidity or spasticity since it "moves" with the patient.
- They are pretty indestructible - I have had some of my most physically challenging patients use a Broda product because they have destroyed some of the other wheelchairs due to hypertonicity and severe tremors.
- You don't need additional cushions! The Comfort Tension Seating feature provides all the pressure relief required.
- It can recline flat! This can certainly come in handy when a carepartners needs to assist in individualized toileting needs.
- Great for people that are difficult to position such as someone with severe kyphosis or chorea due to Huntington's Disease.
When To Recommend a Geri Chair:
1. Comfort is Top Priority
When no other wheelchair can create the comfort required, a Geri chair is a good option. It is comfortable for long periods of time and perfect for patients that would otherwise spend most of the day in bed.
2. Cannot Tolerate Sitting Upright
If a wheelchair is not comfortable, even in a reclined position, a Geri chair provides a carepartner to get the person out of bed, be comfortable and enjoy socialization out of the bedroom setting. It's use is mainly in long term care facilities.
Comments 11
I found this article to be very helpful as a new graduate. I’ve been working in a SNF for 2 weeks now and currently have a resident who has not been out of bed in over 2 weeks because she says the Broda chair is uncomfortable, especially on her backside when in it. She also has a ROHO cushion and says that is uncomfortable too. When I looked at it, it appears to be very deflated so I think I might have to put more air in it as she could be sitting on her coccyx. She also has a stage 4 pressure ulcer of her sacral region which is most likely why it is uncomfortable out of bed. At the time of eval, nursing staff couldn’t get her out of bed because it was close to a new shift starting, so I am hoping to see her soon. Do you have any experience of back cushions for Broda chairs or in general back cushions?
THANK YOU!
Author
Hi Brittany – it sounds like there is a lot of things going on with your patient! In general, you aren’t technically supposed to utilize a pressure relieving cushion with a Broda due to its tension system. Also, ROHO cushions are great for pressure relief, BUT they NEED to be regularly checked for adequate air aka not “bottoming out.” You may be able to call the Broda rep for some suggestions as well!
Are you a Learning Lab member? I have a lot of resources on how to check ROHOs and alternatives depending on your patient.
Hello Mandy!
Thanks for your reply! I just saw this today, but I actually did apply a small air cushion with holes in it for her backside and she says it is more comfortable. But, you said above that because of the tension system, we are not supposed to do that.. I’m not sure what else to do besides get a completely different chair. I was thinking of a different Broda chair? She says, “I hate this chair.” She also has a windswept deformity in her lower extremities that appears to be fixed and says that she has pain in her legs. She has a thigh abductor/wedge, although says it hurts when I place it in.. I was thinking I could try rolled up towels?
I am not a learning lab member but I would like to be!
Thank you!
Attempting to purchase 3 Broda Geri Chairs
Author
ooooh – good luck!
Do you have any insight into how to get a facility to order a new wheelchair for a patient? We have multiple Broda chairs and Geri chairs, but they are in use for LTC residents. So when another resident experiences decline I have to go on a scavenger hunt for some chair that *might* be appropriate. Brodas are so expensive, so we’ve never ordered a new one.
Also any insight into Rock N Go chairs? I use them very often as an only option for declining patients.
This article was very helpful and made me feel more confident in the decisions I was already making for pts positioning!
Author
It is so hard sometimes! I think sometimes you have to advocate HARD or talk to your DME provider to see if there are any options for insurance to purchase a wheelchair. When someone lives in a SNF, it is their home and so it is the facility’s responsibility to provide the basic needs of the resident. It is a grey area where the facility starts deciding what is “medically necessary.” Some states’ (I have heard) medicare/medicaid systems are different, so it might be helpful to be educated on your state’s rules and regs regarding wheelchair purchase in SNF.
I do not have experience with the Rock n Go wheelchairs – does anybody else have insight into these? Do not know about the pressure relieving features, but I am glad that you are able to have something that makes the patient comfortable and more mobile.
I work as a nurse in Hospice and found this article very helpful.
Author
Great Julie! So glad it’s helpful 🙂
High back chair with elevating legrests will allow for multiple position changes and are more cost effective. They do not have a tilt in space function which could be approximated with a wedge cushion.
Keep in mind that tilt in space function can/has been considered a restraint just like a seatbelt and you will need documentation to use it.
Difficulty with gerichairs is that nobody fits into them and they are impossible to push. There are multiple chairs on the market that have the tilt in space function, and reclining back. Wheelchairs are included in the reimbursement rate for nursing home patients so most facilities have a one size fits all consequently fits none.
But to answer your question simply based on ease of propulsion if both are available I’d take the easier to propel one but advocate for a well fitted one.
Author
Thanks for the insight! I will definitely admit I am not a Broda wheelchair expert, but I do know that Broda does have tilt in space wheelchairs in their line of products, like this one: https://www.brodaseating.com/products/synthesis-tilt-recliner/ But I think you are completely right, there is no one size fits all and we need to find the product that fits our patients!