Recently, IZ Adaptive CEO sat down with WheelAir founder, Corien Staels to chat with her about the innovative and game changing suite of heat and moisture regulating wheelchair products. Corien founded WheelAir in 2016 at the University of Glasgow, after a research project on overheating and moisture related issues for wheelchair users. She has spent the last six years expanding the award winning WheelAir product line, creating awareness around the issues wheelchair users face when it comes to heat and moisture related symptoms, and has recently expanded WheelAir to have an office in both Glasgow and Rotterdam.
Benedict:
So for those of us who've never heard of WheelAir, can you describe in your own words what the WheelAir is, and how it benefits wheelchair users?
Corien:
The WheelAir is a ventilation technology device that's integrated in different types of wheelchair seating. It helps with temperature, and relative humidity control and regulation for wheelchair users. This is often an issue. For example, heat can trigger epilepsy seizures. Skin integrity is affected by heat and moisture. We have a lot of people with neurological conditions who experience a lot of fatigue who are unable to regulate the temperatures of their bodies themselves, and that's what we are for: heat and moisture regulation.
Benedict:
And can it be used with both manual and power chairs?
Corien:
Yeah. I've designed the product so it can be used with any type of wheelchair. We have a sling back available, which is a back rest for manual chairs, or light power chairs, with tension-adjustable straps. We also have a cushion cover, which fits over any wheelchair cushion. And then the biggest element of our business is WheelAir Care, which is our technology. So that would be the channels, nozzles, the fan box, etcetera, that we sell to powerchair, or custom seating and cushion manufacturers who integrate it into their own product lines. Whichever product or type of wheelchair you have, either you have the finished solution that you can fit right on your wheelchair, or you can have a custom solution that's integrated by the manufacturer.
Benedict:
Wow. That's really exciting. When was the first one manufactured? Can you tell people a little bit about the original story?
Corien:
I designed it when I was still a student at university in Amsterdam studying fashion, which was very unrelated. There I made the first prototype, and then I decided to create a business after moving to Glasgow. I decided to make it a business, but I had no funding. So that was the first hurdle to get over. Once I secured funding through business competitions, we started a fresh development of the product to make sure that we were tackling all of the right elements and making it as fit for purpose as possible. Then we went to actual manufacturing of the first units in April, 2017. It was a really small production run to test everything and do the first user testing in the field. So yeah, that was about five years ago.
Benedict:
What inspired the initial prototype in fashion school?
Corien:
I had a supervisor at my university who was a wheelchair user. As her and I were brainstorming, she mentioned that overheating is a common issue for wheelchair users, and that was completely new to me. I found it very intriguing. Soon after I learned that if you have a spinal cord injury, you're unable to sweat below your lesion, which can very quickly lead to overheating. It means people can’t participate in certain activities. They can't sit in the sun, have to wear ice vests, use water sprays, have wet towels etc. I thought, if cars have ventilated car seats, why can't wheelchair users have a version of that as well? And that's kind of what inspired it. Originally, she suggested making a cooling clothing line, but by that point in my fashion studies, I wasn't necessarily that interested in the fashion aspect anymore, but I was interested in medical and technical textiles, and it kind of just snowballed from there.. However, I did end up making a t-shirt with it as well (laughs) to keep it in line with fashion for school.
Benedict:
Was it a cooling t-shirt, or just a t-shirt that said something on it?
Corien:
No, it was a cooling t-shirt with special materials that are used in the army that are not only moisture wicking, but once they come in contact with water actually become cool. Then, at the back I had a 3D mesh to help with the airflow of the first prototype of WheelAir, which was a ventilation system integrated in a hand cycle.
Benedict:
Amazing. During the making of that initial prototype, were you consulting your university supervisor about the needs of wheelchair users or some of the science of it at all? Or was it just simply an initial conversation and then you took it and ran with it?
Corien:
I consulted as many wheelchair users as I possibly could. I drove to see retailers, clinicians, manufacturers of wheelchair seating, visited random focus groups where wheelchair users came together to talk about accessibility or different products. I just took my car, drove around Belgium and the Netherlands for six months, and spoke to as many people as I could to really understand the problems. And also, again, not fashion related, but really dove into medical journal articles to understand why this is happening, and how to best mitigate overheating and unwanted sweat build-up.
Benedict:
And from your previous comment, it sounds like this isn't something that just a small portion of wheelchair users experience, but actually anybody with a spinal cord injury, as you said, is unable to sweat below the lesion. So this is something that a lot of people have to be aware of.
Corien:
That’s right. And spinal cord injuries are by far not our biggest group. It's rather multiple sclerosis and cerebral palsy, and it's a lot of children in custom seating who have epilepsy seizures. With custom seating, everyone is enclosed into a foam mold, which is hot and sweaty. So that's a very obvious one, but every wheelchair user who isn't able to lift themselves up every once in a while to put oxygen on the skin and have some heat and moisture escape is at risk of that heat and moisture building up at the skin surface, which can lead to pressure injury formations. A ridiculously high number of wheelchair users have a pressure injury at some point in their wheelchair-using journey. So, whatever a person’s condition is, it's a concern. Then, with cerebral palsy, the muscles being so active generates more heat. With MS, heat triggers certain symptoms. Muscular dystrophy also has heat regulation issues. There's a whole variety of risks and challenges, and there are a number of conditions and situations where heat and moisture play a significant factor in how comfortable a person is.
Benedict:
Your website says that the WheelAir can reduce the temperature by nine degrees Celsius and the relative humidity by 25%. Is that right?
Corien:
Yeah. That depends on the products that you use it with. With some cushions in combination with our cushion cover, for example, we saw a 40% difference in relative humidity. Sitting against any seating surface, there is always an increase in temperature and relative humidity. We measured those with various products, and then looked at the difference in temperature and relative humidity using those products, but with the Fanbox turned on. When we say a 9 degree difference in temperature, we don’t mean that we make the surface 9 degrees colder, but rather that there is a 9 degree difference between the usual heat-up and the WheelAir lowering the temperature. And that's the key thing: we want to avoid heat and moisture buildup, not make you cold. The threshold for healthy skin sits around 33 degrees Celsius, or 91 degrees Fahrenheit, and we saw that with the back rests, and all the cushions we tested, that limit was always exceeded. Our aim is to - and you can see from the results that we get - keep that below that 33 degree Celsius.
Benedict:
Can you just elaborate a little bit on some of the causes of overheating and how that affects skin integrity, and why it's important to be aware of these things?
Corien:
The way an able bodied person experiences heat can be very different from some people who are wheelchair users. When most able bodied people do some physical activity, they start sweating. That means the body's cooling down via evaporative heat loss, and then they can continue on with their daily tasks. For some people, that process is interrupted, or people don't sweat at all, or they sweat way too much, or the heat makes them feel super tired straight away. It's a very different experience of heat production and heat loss. However, for skin integrity, when you look at the defining factors of pressure injury development, you look at sheer force, pressure and the micro climate, which is heat and moisture.
Right now, a lot of the products out there focus on the posture, which helps with sheer force and pressure, but microclimate is often forgotten. And you can imagine that if you have heat and moisture at the skin surface for a prolonged period of time, there's skin maceration, which makes the skin more prone to injury because it becomes softer. You also have things like moisture-associated skin damage where there's no pressure element necessarily involved, but rather moisture for a long period of time has started to create a breakdown in skin integrity. It's things like that. It looks the same as a pressure injury; it starts with a little red spot which can expand quite rapidly and become more severe and deeper into your tissue. Often moisture-associated skin damage is unrecognizable from a pressure injury. So they're treating it as a pressure injury and solving it with different pressure relieving materials, but the problem isn't going away. So that's where a lot of the knowledge needs to be improved.
Benedict:
Can you explain what maceration is?
Corien:
The way I describe it is that the top layer of your skin is kind of like horizontal bricks held together with cement. And, if you have a prolonged sustaining of heat and moisture, that cement, through maceration, starts to crumble away a little bit, and then you have your bricks starting to point in all directions. If you have that happening over a bony prominence, your skin has a higher risk of inflammation, of injury, and so on.
Benedict:
And then once it occurs, my understanding is that it can be very difficult to heal, and that the chance of recurrence is quite high.
Corien:
Yeah, exactly. And it's also a huge cost and burden to the healthcare system. So that's what we want to help alleviate.
Benedict:
How has the WheelAir changed from those initial prototypes and the initial manufacturing run?
Corien:
It's changed massively. Not just because we went from generation one to generation two - which is a much better and more powerful version - but I think the thing that's changed most drastically is that I started with just a sling back; one backrest for manual chairs. Now we have a product suite, including the cushion cover, the sling back, and also a whole modular system of parts which you can integrate to customize any solution. I think that's the key change: our B2B solution allows us to solve any problem for anyone, specifically when it comes to heat and moisture issues for wheelchair users.
Benedict:
Tell me a little bit about pre-cooling. It is one of the benefits of using the WheelAir prior to exercise. Can you elaborate on that?
Corien:
You have to look at overheating as a mechanism that is very hard to stop once it starts. It can start as feeling a little bit nauseous, a bit fatigued, you're getting muscle spasms, and your muscles start shaking. Very quickly, you can start feeling really nauseous, really tired, vomiting, passing out eventually, and, in worst cases, having an epileptic seizure. Once you've entered that process, it is difficult to stop.
There's actually a lot of studies done on this. For example, in the UK with Dr. Katie Griggs, they've really looked at pre-cooling and how effective that is to slow that process down, or to prevent it from happening altogether. With some of the athletes that used our products in the Australian open during the tennis championships, the pre-cooling actually made sure that their body was at the lower base temperature to start with so that the process didn’t commence later, or didn't start at all. We focused on preventive cooling so that if a person uses our product from the outset of their day, they’ll hopefully not enter that cycle at all, and just be able to keep their heat and moisture levels at a constant rate.
Benedict:
With skin integrity being such an important thing to be mindful of for many wheelchair users, what can people expect to experience when it comes to skin integrity while using the WheelAir? You have touched on this a little bit already, but could we further summarize it to help give a clear picture for people reading? And obviously people can check out the website later.
Corien:
Sure. A lot of what we see with our current users is that they'll come to us and have some sort of skin rash, red lumps on their back, bum, or on their legs, that has been caused by heat and moisture. And we see that using our product causes those to go away. It helps prevent more severe cases of skin damage, and can also help with heat and moisture management to avoid it from happening in the first place. So, healthier skin that's not macerated and is receiving proper ventilation.
Benedict:
Awesome! And you talked about consulting with wheelchair users and finding out what people needed and what they experienced. Can you share a little bit about the feedback that you've had up to this point in the last five years from wheelchair users around the world?
Corien:
The feedback's been really, really amazing and, as an entrepreneur, that is the thing that keeps you going when times are tough. One of the cases that affected me the most is Rosie in the UK who could only sit for one hour at a time in her custom seat because she would just overheat so much. She was always sweating profusely, even in winter, and they couldn't go anywhere with her because a car ride of an hour wasn't achievable. Then, when we installed the WheelAir, her mom phoned and said she was able to go to the beach for the first time with her daughter in two and a half years because the two and a half hour car journey was feasible.
That's one of these amazing stories that stood out to me. Another time, we were filming a video in a park in Glasgow with several wheelchair users and we were interviewing one person named Jay. She was sitting in the sun and getting really nauseous, so she had to go sit in the shade. Then we thought, “ oh, wait . . . we're filming the WheelAir product! Why don't we put it on your chair?” She turned it on and she was like, “This is the first time in 20 years that I've been able to sit in the sun without being nauseous,” you know? So that was a really emotional moment as well. It's those really powerful stories of people just realizing what they're able to do. We have people who can go out and socialize more in Australia, for example, because they no longer worry as much about getting sweaty and sticky and fatigued quickly.
Benedict:
Thank you for sharing those. I mean, that, that was just a small fragment. It sounds like there are many stories like that, I imagine. It’s fantastic to hear of people's lives changing that instantly.
Corien:
Thank you. And fewer epilepsy seizures as well. We work with a lot of children in custom seating, and epilepsy seizures are really intense. Seeing that we have such a reduction in those as well is also really rewarding.
Benedict:
That's incredible. Does WheelAir have any kind of financing options or ways to help make it more affordable for people who can't afford it initially?
Corien:
It depends on the region, but we do have payment plans. However, in several markets, the products are covered by insurance, by local healthcare reimbursement systems in place. Countries such as the Netherlands, the UK, Australia, and we aim to expand that into different countries as well. Essentially, we're solving a clinical need which means that your product should be covered. That's what we're aiming towards to help people fund the purchase of the product.
Benedict:
Is it available in North America yet?
Corien:
It's not yet available in North America, but we will be entering North America later this year. We are working on a strategy for both reimbursements and making sure that all of our regulatory elements are in order, and then we'll be coming into the US and Canada.
Benedict:
What's the best way for people to stay on top of that and keep in-the-know?
Corien:
I'd say follow our newsletter. If you go to our website, you can enter your email address for our newsletter. We don't send them out too often. They're more like company updates than marketing blasts. People can also follow us on social media: LinkedIn, Twitter, Facebook, Instagram, and we keep everything up to date with what we're doing.
Benedict:
Right. So there'll be updates for the WheelAir entering new areas in the world there, I'm sure.
Corien:
Definitely.
Benedict:
Can people try out the WheelAir before they purchase it?
Corien:
Yes. This is, again, dependent on the country. In certain countries we offer a two week trial, and, if it doesn't work out, you can just send it back. No problem. It depends on the market, and what presence we have, and which distributors we work with. But, as an experience, ventilation is something you have to feel, so we always try to work with a model where the person can try it out first. Absolutely.
Benedict:
Is there anything else that you'd like people to know about that we haven't touched on?
Corien:
Well, 2022 is gonna be a really exciting year. I think for us, we're gonna be developing more products, so definitely keep an eye out for that. We'll be entering a lot of new markets, and I'm really excited to come to North America and explore the market there as well. So hopefully people will see a lot more of us, and I'm looking forward to seeing them!
Learn more about WheelAir at wheelair.co.uk or follow them on Instagram @WheelAir_ and on Facebook @WheelAir.
