Wheel Chat - Your Go-To Mobility Podcast

Wheel Chat: Episode 13 – Smarter wheelchair driving with Michiel Van der Bauwhede

• Wheel Chat • Season 1 • Episode 13

Share episode

In this episode of Wheel Chat, hosts Anton Mitchell and Justin Boulos are joined by Michiel Van Der Bauwhede from CoMoveIT to explore breakthrough thinking in alternative wheelchair controls - specifically for individuals with complex movement disorders such as cerebral palsy.

Michiel shares the story behind CoMoveIT’s head and foot steering system - an adaptive control solution born out of university research and driven by a mission to restore confidence and mobility for users who are often overlooked by conventional joystick or switch options.

What’s in this episode:

  • Why traditional switches and joysticks don’t work for many people with cerebral palsy
  • How adaptive algorithms can “learn” a user’s movement patterns for smoother control
  • The importance of closed-chain positioning in reducing tone and increasing function
  • When to consider head and foot control systems - and what signs to look for
  • The difference between switch, proportional, and adaptive controls
  • Gaming, independence, and access to digital worlds through alternative drive methods
  • The role of posture, support, and tone management in enabling safe powered mobility

Whether you're a clinician, assistive tech provider, or someone supporting a user with complex physical needs, this episode offers a detailed, practical, and inspiring look into what's possible when technology adapts to the user - not the other way around.

https://comoveit.com/en/

Email us :
We’d love to hear from you. If you have any questions about this podcast, please email us at wheelchatpod@gmail.com

Follow us : TikTok : https://www.tiktok.com/@wheelchat_podcast

Instagram : https://www.instagram.com/wheelchat_podcast/

Disclaimer: The views and opinions expressed in this podcast are solely those of Anthony and Justin.

Anton: Hello everyone and welcome back to another episode of Wheel Chat. You're listening to Anton Mitchell and Justin Boulos. Justin, how are you pal? 

Justin: Doing fantastic as always over here and I'm very excited for today's guest who was someone I met when I was in Germany who just violently attacked me randomly.

I was walking around Rehacare in Germany last year with my beautiful wife and all of a sudden some random person just comes up behind me and hugs me and I didn't really understand the context, but it was because I was wearing a shirt 'free hugs' and under it it says 'and wheelchair advice.' And then this handsome gentleman who looks like Heath Ledger, I was just like very taken aback. And then he introduced himself and he works for CoMoveIT and I was excited to meet him then, and I'm excited to be reintroduced to him by Anton today. 

Anton: I am absolutely delighted to have Michiel on from CoMoveIT, who will explain everything and we'll introduce Michiel in a minute but I'm absolutely delighted. He's a brilliant guy. Great guy just to know in general, but really, really skilled in what he does so it'll be great to have a chat about that. But he's just a cool guy! And yeah Heath Ledger probably, I don't know, I don't want to put anyone else down on the podcast but he could be the best looking guy we've had so far; no doubt about it. But yeah on no further ado, let's bring Michiel in. Michiel, how are you? 

Michiel: Well, now I'm feeling absolutely fantastic with all these beautiful words said about me.

Thank you very much. 

Anton: It's absolutely, it's brilliant to have you on. Thanks for joining us. And for the listeners or watchers they won't realise fully but tell us where you currently are in the world? 

Michiel: So I'm in Belgium, very close to the French border. At home in my wife's beautiful salon, as you can see, because my baby's awake already. I wanted to find a bit of a calm spot. 

Anton: Yeah, yeah, no, that's cool. Salon. Tell us a bit about that. Are you getting a haircut cut later or in a minute? What, what's happening? 

Michiel: No, I'm just letting it grow out a bit. I've got a couple of, as you know, Anton, I'm quite into marathon and ultra running.

Anton: Yeah.

Michiel: So I've got a big event coming up in March and in April where I'll do a hundred kilometres twice and so I'm letting it grow out for that because you know, it's, it looked great on, on photographs and on video. 

Anton: Yeah. Yeah.

Michiel: And I don't have to be fast when I'm running that fast, so it'll get cut afterwards.

Anton: That's so cool. Listen I know you're a pretty, you know, humble guy, but you did recently, I mean last year, have an amazing result in the marathon in Bruges or was it in Bruges or... 

Michiel: Yes.

Anton: Yeah.

Michiel: Yes, that was, that was late 23 where I managed to win it. Yeah.

Anton: That, I mean, it's amazing! We've not had a marathon champion on yet, have we Justin?

Justin: No, not at all! Mate, well done mate. A marathon; that's just such a psychological game mate so-

Anton: Yeah

Justin: You've also got a brilliant mind and we're excited to explore it in terms of what you're doing even outside of, outside of marathon running as much as we want to have it as a marathon podcast, what I guess we really want to chat about is  CoMoveIT . And so for those, well why don't you explain it Michiel: what is  CoMoveIT and why should anyone listen in right now? Keep listening to what we're about to talk about? 

Michiel: Yeah, well  CoMoveIT is a relatively young company from Belgium. So we were founded in late 21. And it's actually a result of a big, big research project at the KU Leuven University

in which two of my colleagues, and you talk about my mind but theirs is on another level still, they actually developed a specific steering, so a head and foot steering system for electrical powered wheelchairs that has been specifically designed for people with cerebral palsy in mind. So of course when we're talking about cerebral palsy, there's a big chunk of people who can still walk, who can still talk easily, who don't need a wheelchair. But there's a specific group in there as well who, you know, doesn't have any hand ability or very limited hand control or has to use a lot of spasticity and all kinds of different movements, which makes powered wheelchair control very, very difficult even though cognitively they're quite strong; they can be quite strong. So for those people, you know, they developed a system that actually works specifically for them by, and I try not to be too technical, but what they've done is they've, or one of my colleagues has written an algorithm that actually adapts the way the wheelchair is going to react to the movements

of the person. So they've got a lot of uncontrolled movements, either very big hand movements or they can't really, you know, push to either the one or the other side very controlled so they're softer; very often do it in an interrupted way. So like they push right, right, right, right, right instead of just one long right press. And what the algorithm is actually going to do, it's going to learn from that and the way a person moves and it's going to automatically adapt the wheelchair steering, the reactions of the wheelchair to the users

way of moving so that they can still find confidence, self confidence in driving without having to look for all these kinds of extreme positions into what they find some kind of control. 

Anton: This really such a intuitive system from myself obviously working with it quite a bit. Just tell us a little bit more in terms of... so why would we use  CoMoveIT? Like there's other products on the market traditionally, things like switches so they would be essentially switches that were placed within a headrest that have like maybe a left, a right and maybe a back pad with a switch. What makes  CoMoveIT so unique? Obviously we've listened to the algorithm but in a practical side what, how does that help somebody with maybe cerebral palsy more than what the traditional products that have currently been on the market been? 

Michiel: Yeah well the best of all you can, the best way to see it is to see it in a, on a video and make like a comparison. But if I would have to explain it... so if you use a normal, you know, switch system, the way it reacts our  CoMoveIT is also like a switch system, which means that as soon as you make contact you get one constant speed that either turns the wheelchair or you go drive forward. 

Anton: Yeah. 

Michiel: So what you would do with a normal switch system that's built in into a headrest is you'd press it and you go into one direction then you'd stop. You press another one, go into a different direction, you'd stop. Then you'd press back to the head again for example drive forward again. Whereas... and also if you would press a little bit interrupted, let's say I press to the right, but I 'bump, bump, bump', my wheelchair's going to drive very bumpy as well. So it's going to get a very direct reaction. So you get like a 'bump, bump, bump', very interrupted movement to the right. 

Anton: Okay. 

Michiel: Whereas if you look at what the CoMoveIT system does, if you were to press in the same manner to the right and you've got that interruption, because of the algorithm what you'll get is instead of this very bumpy ride, is actually a very smooth way of turning. So that's one of the things it does. You can also easily combine both directions so that if you want to, you know, make a big veer instead of just driving forward, stopping, turning, driving forward again, you can make contact with two of the sensors at the same time and then you can combination of those two movements.

Anton: Okay.

Justin: Okay. So, so, oh, so I was gonna say, just to confirm with, when we're doing this, so we've, you've got traditional switches where you put your head on it and while you are activating the switch, so while you are activating the button, the chair will move. And in terms of this one, this one is a bit different in that it's not necessarily a switch, but more of a... of a sensor that's learning what you're doing. So if you're trying to, are you saying that if you try to go straight but because of your uncontrolled movements, so rather than putting your head on the back pad to go straight, if you are like coming off and on the pad, it's not gonna read that as literally what you're doing. Whereas on switches it, it's, a literal read right? So it's either switch on / switch off so you know, we go forward or we, well we're not going. But if someone can't control that and they come in off and on all the time, it won't just stop them. Is that what you're saying? 

Michiel: Exactly. Exactly. So it learns the way your, what your movement pattern is in a way, and then translates that to a, you know, to a, to the actions of the wheelchair which of course for those people who lack control, gives a massive amount of self-confidence because, you know, even though they do everything they can if they would use a normal switch system, they'd get into some kind of uncomfortable way of driving. Whereas with the interpretation that the  CoMoveIT system makes of their movement, the wheelchair's actually doing what they want it to do. 

Anton: I find I, I find it really, really interesting how we've got to this and how, you know, the inventors as such, which we'll talk about in a moment came to that. Tell us one of the main key differences again, Michiel, is that this is a head and foot steering system, right? This is not just a head system. So tell us a little bit about that and the theory behind that. 

Michiel: Exactly. So just for complete information Anton, what we've got is either a head system or a head and foot system. So it's very much you can switch it up and change the configuration on the go really based on what the capacities of the users are going to be. So where does the whole foot part come from is that when you look at cerebral palsy, you've got a load of different ways to classify it. And one of those classifications is based on the way people move. So one of those styles is like 'dyskinetic' cerebral palsy. So in contrast to spastic cerebral palsy where people find very stiff movements and get kind of stuck in the middle of a movement which would mean like arms flexed in a 90 degree angle or knees flexed in a 90 degrees angle, people with dyskinetic cerebral palsy, they've got massive uncontrolled movements. So you would see their arm flying out either to the left or to the right, see legs kick out far away for example, just to give you a little bit of a very easy sketch of what it would look like. But what the researchers have found is that when you get these people in some kind of closed chain, which means you install them into a wheelchair, you make sure they're properly seated, they've got a belt on and then you strap the feet,

what they found is that people with dyskinetic cerebral palsy actually in this closed chain, have really good foot control. So they wanted to check, well, if they've got that good foot control, do you reckon they could use the foot as well to drive forwards on or backwards or use whatever function you want to with those feet? And the results from that research were yes, yes you can without asking these extra spastic movements or extreme positions to find the control. Now why is that interesting as well? We've talked about the head switches earlier in which you do everything with the head, so that asks for really good coordination of the head as well, because you have to be able to push to the back and at the same time to the right or the left if you want to make a veering movement; or you have to push to the right and then stop and then turn to the right. So you need a really, really good head control which is something very basic, which most people have. But you could make it a lot easier, so you could use the foot to drive forward then use the back of the head to rest against the back pad because it doesn't have a function at this point in time and turn to the left and turn to the right, which in a coordination, in a coordinative way, it could make it a lot easier.

Anton: Right. Okay. 

Michiel: Or if you look for example, and I'll, I'm going on a bit but just because we've got a couple of really good examples, we also had a girl here in Belgium who had a really fixed position in the neck. So she'd been in a, not even in a push chair, in a push chair, just you know, in a really big seating orthosis, staring wherever all day. So she had a really fixed neck position, which means she couldn't turn to the left anymore. So all she could do was press her head to the back or a little bit to the right, which of course we stuck to two functions that you can't properly trial. So what we trialed is to get her to push to the back with her head and turn left and right with both her feet, which worked magnificently. So it gives you a bit more wiggle room to play with, with coordinate- coordination and the way you set the system up. 

Anton: That's fabulous. 

Justin: That's good. I've got a few questions. So just with what you said with, so which which cerebral palsy do you find that there's a good, still good use of the feet? Which one did you say it was? 

Michiel: Dyskinetic cerebral palsy. 

Justin: Dyskinetic, okay, so with dyskinetic. And when you said there's like a closed chain, like do you, like explain to me a bit more, does that mean that just the foot is good or its foot's good when you use your head? Like, can you just clap that out for me because I missed that.

Michiel: Yeah so what the closed chain actually means is that you get them into some, I don't want to say trapped position, but you make sure that they're strapped within the wheelchair. So they, you know, usually with people with cerebral palsy you would put on a belt at the hips so they don't jump up or out of the chair when they've got an extension spasm.

But what I see because I work internationally quite a lot, is that sometimes in loads of countries the feet are left hanging. So they've got either no foot support or they're not strapped, which means that if they want to use a foot that very often you see a leg extension happening, so people just stretch their legs out.

What a close chain would mean, Justin, is that you actually strap the foot on the foot plate. It doesn't have to be a proper fixation and like if you would use an ankle hugger, which gives them still some motion or motion, or the ability to move their foot a bit, that's what you mean within a closed chain. So because they don't have all the movements that are free so you help them actually; it's exactly what we do as healthy people. So if we want to move our arm we fixate with our muscles, first our trunk then we would fixate our shoulder, then move our elbow, to pick up let's say spoon I've got lying here. I fixate my trunk, my shoulder, my elbow and then I start using my wrist. So I create my own closed chain. What we are doing is creating a closed chain for them so they can control that in dorsal and plantar flexion movement . 

Justin: And so what happens is, so if we don't close that chain, when they try to send the message through their, you know, if we think about like electrical system they've got wires and they're trying to turn on the muscles, when they're sending electricity to their feet, is it that it's you know, they overextend or you know, they extend to it. They don't have that control to do it nicely, but that way if we hold down the thighs, the legs, wherever they can still, like it mitigates that, that movement so they can still control with their foot. Is that what you're getting at there? 

Michiel: Yeah. That's basically what it comes down to. And you've got it in the load of different gradations of course, depending on the person who's using it. Some of them would really stretch their legs. Others would have, find a bit more difficulty to find the spot where they have to control the sensor. But it's more basically what you say. Yeah. 

Justin: And there are foot, there are proportional foot controls that exist already.

Michiel: Yeah.

Justin: What does this do that the proportional. So when I say for all our listeners, proportional foot control meaning that you push it a little bit, it goes a little bit, you push it more, it goes more. And when we're referring to switch, it's black or white / on or off. So switch on means speed at one kilometre an hour and speed off means zero kilometres.

Whereas proportional we can go half a kilometre, one kilometre, two kilometres, you know we have that control. So in that case, so that product already exists. What was the need for the CoMoveIT? Like where does the  CoMoveIT differ? Or was it just the algorithm that is really the most unique part of it?

Michiel: It's a combination of both Justin, so you've got the algorithm who does the interpretation a bit like I said. But also when you look at the cerebral palsy people and then I'm talking about the rather severe ones, so you know, the ones that can't handle a joystick, what you see very often is that when you ask for that proportional control, and once again this is of course case by case, I've got, I don't have a client because she was that good with a portion of foot control. But when you look at the really the severe cases like the GMF CS levels four and five, so that's a classification for the severity, you see very often that when you ask proportional control, you ask some kind of fine motor control. And for a lot of these people, because of the brain lesions they have that caused the palsy, they don't have that control. And if they want to look for it, they look for an extreme position. Why? Because as I said, they started work in that closed chain. So how did they create their own closed chain? They find that complete, well I'm moving backwards, but they find some kind of position in which either all the muscles or the joints are fixed because that's where they find that control. Like if you would use a foot joystick, like you say, I could really imagine very well somebody getting into an extension spasm a little bit, trying to completely stretch out the leg to then find that control in the foot right? And that might be functional, but what we're looking at then is not right now, not tomorrow, not the next year but in a period of five or maybe six years, because they're always driving in that very extreme position is that they are going to evolve in a lot of pain complaints because they're always stretched out, so they get a higher stress on the joints. They get, you know, because they're always stuck in there, they get a bit of deformities musculoskeletal and because of those deformities, they create pain. And of course when they have to drive around with that pain, they stop.

And every time they want to drive, they have to find that fixated extreme position again. And they drive again. And they need to use the pain and the extreme position to be able to drive. So we, they get into some kind of wheel of suffering because every time they drive, they're in pain. But if they're not driving, they're losing their independence. So they want to drive, so they get into pain, et cetera, et cetera. And the whole, one of the whole big ideas behind what we're trying to do is to, you know, break that wheel and make sure that they can use it without big movements, without big control, just with very low forces and with a limited range of motion.

Justin: So you're saying the biggest difference is whilst you can, oh, we need a, better word than tie down... we, whilst you can... restrict the movement, you know, in order for them to get control, you can do that on both a regular proportional foot control or the  CoMoveIT, the main difference is that when you lock people down with the  CoMoveIT, it is what? What's the main difference between when you do it for a proportional or a  CoMoveIT? Is it that you need smaller movements, that you can do it with smaller movement? Is that the unique thing from, if you had two people, they're both strapped down or locked down, you know, highly supported on one chair with a proportional joystick, one chair with a  CoMoveIT, what would they experience differently on the CoMoveIT?

Michiel: Yeah, so, so you need less control because you've only got, you know, the contact with the sensor that you have to make. But what you really have to undertake into account, they don't have to control a fine motor movement because using a fine motor movement is like sending a lot of different electrical signals to the muscles on a lot of different nerves, to a lot of different small muscles. And that is something that with cerebral palsy, which is just part of the disorder is, well, impossible to, to do it without finding... even if you are strapped down or properly supported, that fine motor control is something that always is going to be difficult and you'll always see, even when functioning they're fantastic, you'll always see some kind of extreme position or tension somewhere because they have to be able to control a fine motor movement. 

Justin: So, so on the CoMoveIT- Oh sorry. I was gonna say the, on the CoMoveIT you don't need as much fine motor control. 

Michiel: No.

Justin: Because- what is it? It's not a, it's not a joystick? It's just a pad right? 

Michiel: Exactly. So it's a flat pad with a sensor worked in there, or a sensor array. And that sensor array then captures the pressure that's on the sensor. 

Justin: Is that variable in terms of like the more put pressure you put, the faster it goes? Or is it a switch on / off binary situation? 

Michiel: It's a switch on / off. Yep. 

Justin: Okay, so you get to control the speed- again you've got the speed through the programming. You pick your speed you want, switch on, bang, drive forward. 

Michiel: Exactly. 

Justin: And then if your foot is coming off and on because you don't have good control over years, five years, you know, probably doesn't take that long. But over the years as your condition changes, it will understand that, hey, this person's foot's coming off, it's coming back on. It's clearly trying to go forward, so we're not gonna disrupt it like a regular switch that you could just put a button on there to go forward. 

Michiel: Yeah. 

Justin: We're gonna do something different.

Michiel: Yes, exactly. So it, it does, it starts calculating that instantaneously and you can see the effect after, let's say five seconds. 

Justin: Yeah, it's cool. 

Anton: So from my experience of using it as well and other head controls by the way, which you know, I think that's one of the important things Michiel, you're not saying... well, from my understanding  CoMoveIT, they're not saying that what's out there before  CoMoveIT wasn't doing, you know, a job for people; that's not what people were saying. It's looking at what the best solution is for that individual. And what you felt, from my understanding was there was an, the current head array, so the switches that were currently out there, and there's some cool other stuff which we can discuss you know, like the Head Way three switch control. There's products like Munevo or Vigo and things like that, that are currently out in the market that uses more like, what visual interaction, which we can come to. But this system was and is, what they're, because... they discovered that there, what that you could use a head and foot? That, that functioned really well because there wasn't that combination available, right, so you couldn't make it both? And also.... yeah, so tell us a bit about that and also what is the difference, because my understanding is that the sensor, the pad that's essentially within either the foot or the head, they are more intuitive or can be seen as more intuitive, would you say Michiel? I don't know. 

Michiel: Yeah. Yeah. Like you say, Anton, there's a lot of good systems on the market. I mean, yeah, if you look at the Munevo or the Vigo Gyro set like you talk about, they're fantastic for some people. Yeah, absolutely right! If you get a person with tetraplegia, for example, who's got fantastic head control, who can manage that proportionality and who's really strong cognitively Yeah, please go for it. I mean- 

Anton: Yeah. 

Michiel: If it, for them, it's the right solution, yeah. But we saw that for cerebral palsy there was a gap, so either loads of people couldn't drive or they, you know, would drive in what we would call a clinically very unsound way. Or have, you know, a bit of limited because they've got limited motor control. That's just the way it is. So what we try to do is to, is develop, or, and I'm going to sound a little bit American but what we manage to do, is find a system that helps mitigate the difficulties they have by adapting the system to the user through a combination of sensors and software which makes it more intuitive because they don't need that con, that massive amount of control. They don't need to find that tension to be able to drive it. You know, they can just be who they are with the disorder, with the difficulties of moving and manage to drive a wheelchair in the way they would want it to, which means with less extreme movements, and with less effort. I'm not gonna say that it makes everything magically work, but what we've seen is that come 60% of our clients, for example, are people who never managed to drive a wheelchair before and who have tried a lot of different things. So switch systems, joysticks, whatever you name it. So we do manage to help a lot of people out who before had no option with mobility, which I think is, you know, fantastic.

Justin: Yeah. I think that would be such a powerful like, I mean, that's what I love about my job, right? And this, those kind of moments. And I feel like with, with your line of work, you know, I think when by the time people come to you, maybe they've exhausted a lot of things... yeah I don't know how it works? People are coming to you for, it's probably not a first point of contact, right? There's always the preference to use some sort of proportional control because that's where you get the most control. And I think when they come to you, maybe they've tried switch driving or head array driving and it'd just be so frustrating if your mind was sound and you knew you wanted to go somewhere and just the bloody wires are not, you know, you're afraid wires or whatever and they're just not sending the signal the way you want it. And I think to be able to give people that access to, to move the way they intend to, would be such a powerful part of, of your role. And Anton, I'm sure you probably feel the same when you do that as well.

Anton: Yeah, no, I fully agree with you Justin. I think for the users, the listeners, that are on hopefully listening to us, I want to just like put  CoMoveIT as a product aside just for a second, because Michiel your experiences within lots of things I mean... but I think let's just come back a little bit to the beginning. If we saw somebody trying, because we have lots of, I mean, Justin you'll see this out in Australia and from your experience Michiel you'll have seen this obviously within the job, you see a lot of users being able to control a wheelchair. They might not control it that amazing in terms of against... so somebody with cerebral palsy you said that they obviously, as we know, have a lot of involuntary movement. They might get excited, upset, emotional, and therefore that kind of dictates how they're holding onto the traditional wheelchair controller. So the little stick that you would hold onto traditionally, or ball or whatever we're going to make it so that somebody can hold onto it better. And sometimes we even have mounting on the middle of the chair, like within the tray or, you know, so we can mount the controller in different positions to help somebody. But what we are seeing is that that is not working for people, so they're not able to hold onto the controller, would be fair to say. If they can, it's for limited amounts of time because of that involuntary movement. Can you just explain again, just probably a lot better than me Michiel, why somebody, if somebody was listening, maybe an OT, a physio, maybe even a parent, an individual, an end user right now going, 'ah' would a head- forget CoMoveIT- but would a head or foot system be something that I should look at? Explain maybe just what we would maybe look for or recognise to go, 'ah, maybe we can do better for you.' 

Michiel: Yeah, that's something I run into, exactly. And I just wanted to come back before answering your question, Anton, to what you said Justin. It's exactly that. When you know, you meet somebody who's exhausted all their other options and then you manage to find something for them. That's absolutely the best part of my job. Absolutely! No doubt about it. But what you exactly also see is people who are very functional with a joystick. And there's a great side-by-side comparison movie on our website, which will maybe you know, can if you're interested, you can look it up. But we've got people who are very use, very good with a joystick and you see it either mounted on the side or in the middle of a tray, which is I think a general and an internationally way where it's being done. So I see that in Germany, see that in France, I see that in Belgium and the Netherlands, more or less everywhere. And sometimes the people are very, very functional. But what we then see, is that the way they're moving in the chair or the way they hold onto the joystick is they either hold on to it, they grasp it really strongly and they've sometimes got difficulties with letting it go, or they find a very extreme movement or they smash their hand against it. Why? Because, you know, you know that fine motor control is a bit difficult, you know, they just use their arm to use the joystick, for example. Or you can find that they are hanging a bit outside of their wheelchair when they're trying to grab hold of the joystick. So they are looking for a position that's not, either not natural or not comfortable to be able to manipulate the joystick. So if you run into that or you find that it's very difficult to let go in some situations or that, in some situations, you know, you get emotional and you lose control. You want to brake and instead of braking, you push very hard to the full forward and somebody needs to, you know, turn the wheelchair off. Those are a lot of signs that it might be time to look for something alternative, whether it's a foot joystick, something else. Usually what we see is just that using a lot of tension or big, very big, big movements to, to manipulate something that's made to use with a finger. 

Justin: Can I ask a question Michiel? Why do you think some people have more control with their head and their feet? Like if you were to thread a needle right, you've got so much more use of your hand, you know, like I'm thinking like a link through a needle, right? It'd be so hard to do it with your head right? If you had something strap to your head, you've, what I mean is that the control is so much less without gross motor movements, like, you know, more gross movements like moving your head as opposed to moving your little phalanges, your little fingers. So why is it that people who have, who are struggling with the easy stuff, why would they have more control with a head or a foot? 

Michiel: Ah, but there you are looking from your perspective or, our perspective Justin. So you say using the fingers is the easy stuff. You know, I've got a little baby daughter running around here but you know she's not running yet. But getting that fine motor control which for us now comes really natural, is a process that actually takes years to develop. So first we learn, and the other hand using the head. Very first thing my baby Olivia did was move her head a little bit to find the breast to be able to drink. It's a very basic basal movement that everyone has a modicum of control over. And if we will talk about using our hands and our fingers and, you know, do the fine threading, the needle thingy, you have to take into account that we went through a development phase of a couple of years. So first thing we used was moving the head. Then we learn how to sit straight, then we learn to crawl.

After learning to crawl, we start grasping things a little bit, but then we learn how to run and then we really start to use bi manual function, yeah? Let alone writing, because when do we learn writing? Anywhere between the ages of five and seven. And then at the beginning, if you look at the writing exercises I did when I was a kid I mean its illegible. And over the years you develop this fine motor control and all these nerve endings that go more and more to your fingers. So what for us feels like something very natural is because, why does it feel so natural? It's because it took us years to learn it. Whereas that basic head control is very much easier. And looking at cerebral palsy because they've got these lesion, the development of that fine motor controls is limited. 

Justin: Mate that was such a good answer. Linked it in with your little daughter it made so, that makes so much sense. Yeah, that's, that I've never had someone explain it as well as you just did, mate. So I appreciate you doing that for me and for our listeners. Anton, did you learn something there? 

Anton: What's that? Sorry? 

Justin: Ant, did you learn something there as well?

Anton: No, totally. I was just, I was enthralled by the little movement of the hand actually. I was still... that was 5, 4, 3, 2, 1 for everyone. Yeah I... I just find the whole, I think where I find head controls or foot controls in general just really something so interesting that I think is almost not overlooked, I think that's unfair. Because I don't think it's coming from a bad place that people don't consider it. just think the education around it is not necessarily there at this moment. And companies like  CoMoveIT are obviously passionate about their own product. But what I can see is that they're passionate about education, and that really comes from the people who actually invented it, right? So Elegast... I mean can you just Michiel, just tell us a little bit about him? Because I know he is not here. But I think what it does is it just gives a little bit more of a better understanding of how it... where it comes from. It's not just a... this is not a commercial generated sort of invention, if you want to call it that. This was, this comes from somebody who has over 30 years experience, and has had - and has - a passion, and has a passion for, my personally knowing him, to change how we think and how we, how people manage themselves with cerebral palsy or other diverse, neurodiverse issues. So yeah... please tell us. 

Michiel: Yeah. So he doesn't quite have 30 years of experience yet. He is not that old.

Anton: Sorry! Sorry El-Elegast. You do look young. I promise you if you're listening to this, you do look... I'm doing a disservice, sorry! 10 years, five years!

Michiel: No, 25, you're not- 

Anton: 25. All right. All right. 

Michiel: You're not that far off. It's... it's like he said - of course we're a commercial company now, but the way it was founded, like I said at the very beginning, we actually are the result of a research track about five years at the University of Luin. So, Elegast is a professor in physiotherapy, who from the start was very interested in people with these very complex movement disorders. So when he started off working as a PT, when he was I think 22 years old or 23 years old, he worked from the start - from the get go - with these very severe cerebral palsy patients.

And one of the first things, and I always remember that because he tells it quite often also when we are giving out training or educating, he says, one of the very first experiences I had, I had this kid that was seated on my lap, and I didn't know how to treat him because, you know, he just kept movement in all these kind of different directions.

So I went to my most experienced colleague and I asked, "Hey, what can I do with this kid? Because, you know, I'm lacking the experience." She said, "Well, Elegast, motorly, motor-wise - on the motor plan - you can't educate these kids. You can't point." 

And that came from a woman who at that time had 30 years of experience.

So that was a bit of a shock for him. So, you know, he bit into it, you know, set his teeth and his mind to trying to find a solution. Because he recognised that these people cognitively, they've got a lot of options and possibilities. So he's very passionate about being able to improve their lives in every kind of way.

And from that, he started to go to the university, take a PhD in everything cerebral palsy, became a professor later on and in his experience he met, you know, when he was working at that very specific school, he saw some people being able to drive with a wheelchair and others had difficulties. 

And from that passion of wanting to, you know, starting off and trying to evolve the condition of the person or the people and improve it, he said, "Well, let's try to find a system". Because he saw everything. He saw very old mechanical head and foot steering systems. Then Permobil came with their head array and he thought, "Oh, Permobil head array. Awesome. We've got something for these people!" That then worked with proximity sensors, who then don't manage to capture these involuntary movements. So it was a disappointment again. He said, "Okay, now I'm a professor I can, you know, give a direction to where my research track goes", and said, "Why not try to find something that, you know, can help these people? Why not try to find out what a proper steering system would look like?" And that's where they started off. So they had a collaboration with the industrial engineering department, the bioengineering department and the physical rehabilitation department to try and find it. So they, you know, did a lot of research into the clinical movements, the clinical movement patterns, what excites cerebral palsy, what keeps it down, and then try to measure everything.

And out of these measurements they saw that using a specific kind of sensor that we are using right now, they could not only measure, but they could also send a signal back to the wheelchair. And it's a bit more of an acci- I'm not going to say it was a bit of an accident, but realising that they could, you know, send a signal back whilst they were measuring how somebody was moving, they could actually develop a system that worked really, really well and that could adapt itself automatically to these person's movements.

And then they made a first prototype and because the result of it was, you know, that impressive so you saw a lot less dystonia, much lower excitation of the cerebral palsy issues like spasms and movements and everything we've talked about earlier, that they had the idea, "Okay, well we've actually created something that works better than whatever's out there for people with cp. Why not try and make it a product so we can help people, not just, you know, within the research track that we've now done, but all over Belgium, all over the Netherlands, all over Europe - And preferably all over the world?!"

Anton: That's so cool. I actually, just want to chat about maybe like a secondary benefit, not just specifically to the CoMoveIT. Again, it's really important that people take on board that what the head controls can offer but, you know, we have a lot of young users, younger users that, that sounds wrong because you know, everyone game... I'm talking - about to talk about gaming and things like that. So I'm not a gamer myself. Justin, are you a gamer?

Are you a gamer? I know, Michiel are you a gamer? I don't actually... Yes, he's a gamer. You look like a gamer actually. 

Michiel: Don't know if that's a compliment or- 

Justin: What a crazy combination of gamer / marathon first placer. 

Anton: Yeah, yeah. 

Justin: Yeah, they don't often go hand in hand.

Anton: Actually you're breaking the tradition. He's breaking the tradition. Because mostly you think of a gamer like couch potato, no offense to any gamers listening, but you know, you think they're - but actually you're completely not that, you know. Your wife's amazing how you're finding the time for all this Michiel! 

Michiel: ADHD. It's one hell of a drug I always say! 

Anton: Yeah, no, there's something in that for sure. Anyway, I'm coming back to gaming. So, what we've obviously noticed is, and I'll just be honest, I go, Justin, you'll be the same, go to a lot of houses, meet some unbelievable families, wonderful children, adults and they're... let's just talk about children for a second.

But, you know, typically I'll go and my client will be sitting watching their brother or sister play the game on the Xbox, PlayStation, whatever and they, you know, they're just, they're able to watch, but they're not able to really fully engage in that. What I've noticed with the head controls is that's actually opening up a world of opportunities for them to play and have that interaction.

Tell us a little bit about that, because for me thats, that's huge. That's not just about now driving a wheelchair, which is massive obviously, giving independence but... what else can that bring somebody, right? 

Michiel: Yeah. Oh, there's so much, there's so much to tell. So, so for everybody- 

Anton: Do it in to 30 seconds. Thank you. 

Justin: Yeah. Do it in a good 30 seconds!

Michiel: 30 seconds! Everybody who wants to know what the value of gaming can be, open up Netflix and look up the story of 'The Magnificent Story of Ibelin', and you know, you'll find out why it's so important. But it allows people to have fun in their own way and there's, it's not only about head control. So for people with CP, of course it's head controls, but you also find people with tetraplegia who've got very limited hand control using Xbox adaptives or the PlayStation ones. We've got a lot... a couple of really beautiful companies here in, in the Netherlands and Belgium who focus solely on, you know, making gaming more accessible.

Because it's a window to the world. It's about hanging out with like-minded people, you know, in, in the world that you want to, and whether you are an assassin who's scrambling up the roofs of Florence, or whether you are shooting somebody down with a massive rocket in Fortnite or, you know, do whatever in Minecraft or World of Warcraft or whatever.

I mean, you're just a normal person between other normal person who love, who loves gaming. 

Anton: Yeah, that's true. 

Michiel: It's about who you are as a person, not no longer who you are with the disorder. 

Justin: Can I ask a question? When you say 'gaming', is that through Bluetooth mouse ambulation or does it, is Xbox and PlayStation available in  CoMoveIT as well?

Michiel: If you look at the  CoMoveIT as it's works right now, you make the Bluetooth connection, yeah exactly. 

Justin: And then you need another switch, like click, so, so you'd have another switch to click and then your foot and head would be the cursor to go forward, left or right and maybe you'd have like another switch, whether it be a switch on your chin, a switch if you've got access to a hand you could hold something in your hand, but something to be left click, right click in order for them to get it out. That's pretty cool, man. That's, that's really awesome. 

Michiel: Yeah, that's one of the options. The other thing you could do is use the input / output module that's on your chair, but then we get into the very technical, nitty gritty stuff.

Justin: It can be done, you know, you can see your local dealer or-

 

Anton: Yeah.

Justin: Email, email Michiel from CoMoveIT and I'm sure they'll work it out. 

Anton: Yeah. 

Justin: Can I ask one, I want to ask one more question before we wrap it up today. We mentioned about, we still don't have a good word for it, but like locking people down. But I want to talk about your - because you work a lot with the CP community - breaking tone and do you have experience with breaking tone? Explaining what that is and, you know, because we, I know we spoke about extensor tone. What are your thoughts on breaking tone? How can it be done and why is it important? Specifically with talking, you know, about a stable base and what we covered earlier. I just wanted to cover that before we wrapped up. 

Anton: Yeah, nice question. Nice question Justin. Great. 

Michiel: Difficult one too. 

Justin: Yeah. 

Michiel: So why is it important? Let's start with the why. It's important because I think I've talked about it a bit earlier. If you keep finding that tone all the time you- 

Justin: Hold on! I might just quickly say... so just to explain to people, extensior tone is what happens when, again the muscles don't fly out the way we want. Maybe we're excited, maybe we're nervous, maybe we're angry and we go turn into reverse banana, you know?

Anton: Yeah. 

Justin: Extend our whole body. If we're sitting down, we're throwing our hips high in the sky and extending our posterior chain. Why does that happen? I don't know. And you may not know this. I wonder why it doesn't happen in inflection ding. Like why does it always happen in extension? That might be an advanced question, but I'm just a curious guy over here. Maybe... 

Michiel: I'm sorry. If you could ask Elagas he'd have a massive answer for about 20 minutes on why. 

Justin: That'd be cool. 

Anton: I think it's more like shock; if you have a shock like if I, if I scared you right now, which way would you go? 

Justin: I can go forward. 

Anton: Yeah, you can go forward.

Justin: I could go like this so I could go 'ahh'. 

Anton: Yeah, right... So it's probably a reaction of that, but you know, anyway- carry please Michiel. 

Justin: Okay. So when people go into the sixth sense, when people go into the sixth sense of tone, obviously there's the issue of being out of position and when you're out of position, you know there's issues with destructive postures. There's obviously issues around being able to drive the wheelchair, you know, your feet being in the right spot. What's your experience with it and how do you prevent people from going to this tone? 

Michiel: Yeah, so it's not only the back, it could also be shoulders, knees, hips and we want to avoid that extension path, that high tone as much as possible because it places unwanted stress on joints and muscles and bones. Yeah. And on the long run, the more you get into this high tone, the higher the pain that you will develop as an individual will be. So that's the big reason, that's the main and most simple reason on why we want to avoid it.

And there's a couple of ways to do it and that's where head control, and specifically from my side of course the CoMoveIT comes into play. So you ask if you want to drive a wheelchair, and I'll get to the positioning as well Justin, if you want to drive a wheelchair, try to do it with a system that is as easy as possible to operate, because if you don't have to control or really control your movements very, very finely, or, you know, you can just do it quite intuitively. And you're not hampered by your lack of control, you'll gain more self-confidence, the wheelchair is going to do what you want to, so you'll be more relaxed. Because there's less stress. Stress is always going to, you know, ignite the tone or excite those muscle, muscles firing. So you want to keep the stress as low as possible.

And then on the other hand, you've got positioning. I talk about strapping sometimes but it's not only that it's a good trunk support, obviously. It's getting a good seating depth but sometimes it's also finding the right kind of tilt within the chair because you'll find that if somebody can relax a bit more to the back and, you know, it doesn't have to work those trunk muscles, they're more relaxed as well.

It's finding a good position. Now for people with CP, it's also very often getting good trunk support, but also trying to find some kind of shoulder support. And why? Because when they're... and I don't want to say enclosed, but properly supported in their joints, so we don't eliminate the movement, just support the movement in some kind of way,

you'll find that they're far more relaxed within their chair and they're less excitable. And when they're less excited they don't really get into the pattern, so you don't get into as high of or as big a movement and the tone stays relatively down. And then the foot strapping is something that I've talked about a couple of times when you would use the feet, and know that's something that can be sensitive depending a bit on the area where you're at or on the person you're talking to.

What I find is that when you manage to do it, you find that they get into the... there's two tracks there. So on the one hand we've got the functionality track and on the other hand we've got the positioning track. 

So what I always try to explain when I'm doing an assessment is the why.

Anton: Yeah. 

Michiel: So I say I want this to do this because on the one hand, if you can stay seated better, you're not going to slide into your chair. You're not going to move a bit forward on the back, you know, your hips stay where they're supposed to stay. So your positioning is better during your time. But on the other hand, if you've got that foot function and it's strapped, you'll find that you, you person in the wheelchair are going to be able to drive better, to move better.

And I think that's a, an important one as well to explain why. And even then sometimes it's not accepted and then we'll have to, you know, live with the fact that they don't accept. And... but I try always try to explain why it's so important. And that's because they'll develop pain complaints on the one hand, and on the other hand, they're function-

they could be more functional. 

Justin: Yeah, that's really interesting. So I've... it's funny, like from all that, so you're basically saying the more support you can give them, the less likely they're gonna feel the need to go into extension. And you mentioned one which is quite interesting, which I've always thought - I'm gonna quickly share my screen here - You've mentioned one where maybe something like this. Like I've always thought this was used for kyphosis, for those who just listen in. This is called a shoulder retractor and they're basically two arms that come over the back rest and like two lateral pads that sit on your pectoral, like your pec muscles.

And I've always thought they were like to stop someone coming kyphosis, but I've never thought about using these as like, to give someone like, really almost press them to the back rest. So they really feel that stability on top of their lateral support. So that's, that's quite interesting.

And look, this is probably a topic we could even do a whole thing on about breaking tone, about angles of back rest, you know, closing the angle of the back rest, use of belts, medications, Botox, all that stuff. And I think we're gonna run out of time if we get into that today. But it's just a very interesting conversation, and all these things that we need to think of whenever we're, utilising working with people with quite significant physical needs.

 Alright, so I think the last thing I know I said that was the last thing I've got one more thing I want to do is just like a good takeaway message for everybody, I think is just to- when we spoke about earlier about when to consider head array, is knowing your options before you go to alternative control. I think we all agree here a joystick is the best option as a first pro, point of call. And for me, I think the best thing you can do for that is one, explore if someone can't use a standard joystick, maybe you can look at the position of the joystick. You know, having a little bit more inline or even significantly inline can make all the world of difference for someone. You think about opening a jar of jam, you're nice and strong in your midline, and it might be a bit hard if you've got, have to externally rotate your shoulder to drive it. If that doesn't work, then you can also look at knobs or balls and stuff like replace the knobs to something else to make it a bit easier. From there, you can also look at programming. One programming option is like active throw, which is if someone can't deflect the joystick all the way forward, they just don't have the strength to do it, maybe we can change that program into what we call 50%, which means that 50% of the deflection it reads as a 100%. So someone doesn't have to necessarily go into a mini joystick or something like that before you can start to like do a bit of program; That's just one example. And then we could look at mini joysticks, if someone you know, in the case studies we looked at today, probably not appropriate. They'd probably break, people without control would break mini joysticks, but maybe someone with really reduced fine motor skills, like just not enough strength, mini joysticks can be really helpful. And then once we've explored all those options, I think that's probably a good place to start looking at a variety of alternate controls.

Justin: And we should do a whole episode on different types of alternate controls. Because there is more than one, but I think this one, when you're talking about head arrays seems to be really well thought of and, you know, has a lot of considerations to go with it. So, would you say that's a fair summary of like the steps Michiel you'd look at before or Anton?

Michiel: Well, from my side, if you look into progressive movements, and so I'd say yes, even with some cerebral palsy cases. However, there's one thought I have on that and that's when you know that fine motor control is always going to be a difficulty, it might actually be better to immediately go to a form of alternative control, so you don't go through an enormously long, looking for a solution process, because that can take about, I'd say months, but I've also seen a process of multiple years. So when you know beforehand that handling a joystick is going to be difficult, I'd say you could go through it a bit more quickly than you'd say, but if not then yes, I think that's a really good process. Absolutely. 

Anton: I think from my side, the thing I want to just- because yeah, 100% Justin, yeah, I think if, if there's any sort of assessors out there, that would be a really great process and consideration to make; 100%, or OTs or whoever's working as a professional or going into that client. However, one thing that's very overlooked and something that we're, I think need to educate ourselves more, certainly for, you know, talking myself personally is pain. We are not understanding how much pain our end users, our clients are in. Sometimes they're probably in pain every day and they're just not communicating that because it's probably something that they're used to. So they're benchmarked, they're leveler is much higher. Their pain threshold is higher. They're used to discomfort. They're used to pain. And actually it's only when it gets to a point where it's impeding or it's stopping them from doing something is when we are probably more recognising that. But I think that it's something that we really need to highlight; how we do that? Yeah, it's above my pay grade in terms of education. I'm there. I'm learning. We are learning. The whole point of Wheel Chat is learning. I've certainly seen, CoMoveIT from a products point of view, that's one of their drivers; a huge driver behind it and a huge passion. So, you know what? I think this has been a really, really insightful great Wheel Chat. I hope everyone has enjoyed it. Michiel, thank you so much. I know it was an early start. Thank you to little Olivia as well in the background, we were hearing a little bit of morning activity, a little bit of morning activity, not getting the milk that she wanted or not enough of. But... but no, it was wonderful. Absolutely wonderful. Justin, thank you as always. Hope you're gonna have a smashing week, ahead. Anything beautiful on the cards for you apart from sunshine and beach?

Justin: Nothing but sunshine and beach over here mate. 

Anton: Damn you Justin. 

Michiel: I'm sitting during the freezing cold. 

Anton: Yeah, no, but listen, you know, just grateful for being alive, as I'm sure everyone.

Thank you everyone for listening. Don't forget, Justin, what do people not need to forget? 

Justin: They need to, like and subscribe however they do it on their regular platform that they're listening to. Yeah, I'm going to work out how they do it, 

Anton: Click, like and subscribe. No, honestly guys, it's something that we really would appreciate

if you're happy to do so. Please do leave your comments. We will obviously get back to you as soon as we possibly can and raise them in the next Wheel Chat podcast. Thanks for everyone listening. You've been listening to Wheel Chat with Anton Mitchell and Justin and Michiel from CoMoveIT. Thank you everyone.

Michiel: Thank you for having me guys. 

Justin: You're welcome guys. 'Wheel' chat to you next week.