Focal Meditech Papillon head support User manual

Manual
Papillon head support

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Contents
Introduction 5
Who is the modular Papillon head support designed for? 6
The principle of how the Papillon head support works 7
The Papillon head support 8
The components of the Papillon head support 8
Use of the Papillon head support 11
Assembling the Papillon head support 13
Configuring the Papillon head support 15
A few commonly mistakes 19
The lateral support pads 21
Description 21
Assembling the lateral support pads 21
Configuring the lateral support pads 23
The dynamic forehead strap 26
Description 26
The versions 27
Assembling the dynamic forehead strap 27
Configuring the dynamic forehead strap 28
When not to use the dynamic forehead strap 29
Common mistakes when configuring the dynamic forehead strap 30
Important! 31
Warranty conditions 32
Conformity with standards 36
Contact details 37

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Introduction
This is the user manual for the modular chair- or wheelchair-mounted
Papillon head support system. The Papillon is supplied by Focal Meditech
BV, a company specialising in body support systems. This manual provides
you with information about the product, its use and the consequences of
its use. The aim of this information is to enable the user to get the best and
safest use out of the head support in the long term. This way, you will know
what you should and shouldn’t expect, learn how to configure the main
settings of the head support, and know what to look out for when using.
For your safety and comfort, read the information carefully. You should also
tell people close to you about the main features of the head support, for
example, the person who looks after the wheelchair or those who help you
with transfers. Get them to read the manual too!
In particular, when you read the manual, take note of the
instructions which relate to safe use. A warning symbol has been
put alongside important passages in the text about safety. In
particular, you should take note of the safety instructions for the
dynamic forehead strap if you intend to use this.

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Who is the modular Papillon
head support designed for?
The Papillon head support is intended for use by all persons who need a
head support when sitting in a chair or wheelchair. Normally, users will
have a moderate to severe impairment in the region of the neck or head.
The need for this support may have different causes, for example, spasticity,
muscle weakness or postural defects. The need for comfort when sitting
and for a reduction in physical exertion may also play a role.

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The principle of how the Papillon head support works
The name ‘Papillon’ reflects the butterfly design
of the the modular head support when viewed
from the front. This butterfly shape has all to do
with the working principle of the support: it
is made of three parts and shaped to fit the
underside of the head. The basic version of the
Papillon is composed of three cushions. The three
individually adaptable support cushions are designed to suit heads with
a diversity of shapes. The two elongated, wave-shaped pads (the so-called
suboccipital support pads) offer support under the ear and along the base
of the head. This shape gives a good deal of comfort and, because they are
somewhat funnel-shaped, the pads cushion the head. On the other hand
however, the head can be easily tilted if you want to adopt a more forward
posture. Whilst support is more or less automatic, it’s not always necessary.
The ends of the suboccipital support pads, which come in Small, Medium or
Large versions, curve noticeably outwards. Their shape is to ensure that the
head of the user doesn’t get stuck behind the head support. The third pad
is the so-called occipital support cushion, which occupies a higher position
to support the back of the head. This cushion provides extra support behind
the head and acts as a safety measure to cushion any backward movement
of the head. The occipital cushion should not allow the head of the user to
be pressed forwards from the suboccipital support pads. Together, the three
pads - if mounted correctly - should leave the ears and the shoulders free.
The system has a modular design: elements can be added or otherwise
adjusted as required. This modular design enables users to have their head
supported in the right places and in the correct manner. Likewise, the
modular design allows the head support to be adjusted if there are any
changes in the basic posture. Furthermore, the modular head support can
be easily mounted on another wheelchair.

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The Papillon head support
The components of the Papillon head support
Below is a description of a standard Papillon head support that is ready for
use. The system you have been supplied with may come with additional
components or other non-standard components. However, the basic version
of the Papillon is almost always supplied with the following components:
•Viewed from behind, the first thing you see
is an adapter. This adapter enables you to
attach the head support to the wheelchair. The
adapter should be positioned at the top of the
wheelchair’s backrest on the rear.
•An assembly plate
is attached to the adapter. The assembly
plate ensures that the head support can be
removed or folded away easily when the
user wants to make a transfer in and out of
the wheelchair.
•A vertical bracket is attached in the adapter
with the assembly plate. This bracket makes it
possible to fit the head support at the correct
height.

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•A horizontal bracket is attached to the vertical
bracket. This horizontal bracket makes it
possible for the head support to be fixed in
the correct position (depth) in relation to
the backrest. The frame of the Papillon head
support is attached to this bracket.
•The frame of the Papillon is attached to
the horizontal bracket by means of a
clamping ring, a metal connecting ring in
which the ball of the horizontal bracket can
be fixed. The ring surrounding the ball is
partly responsible for the adjustability of
the Papillon head support.
Fixed Adjustable
•The frame of the Papillon is available in
two versions. One version comes with fixed
assembly sockets for the suboccipital support
pads (this version can be used only with the
smallest size of suboccipital support pads).
The other version comes with individually
adjustable assembly sockets for the
suboccipital support pads.
•A wave-shaped support pad is attached to
each of the assembly sockets on frame of
the Papillon head support, one on the left
and one on the right. These support pads
are mounted in such a way that they take on
an outstretched shape. Together they help
cushion the weight of the head in both a
backwards and lateral direction. They are referred to as the suboccipital
support pads as ‘suboccipital’ is the Latin name of the part of the skull
they protect. In other words, a support pad that supports the base of the
back of the head. These suboccipital support pads are available in three
sizes.

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•A bracket for attaching the upper cushion
behind the head is also fitted to the frame
of the Papillon head support. This bracket is
available in two sizes, S and L.
•The upper cushion is attached to this
bracket. This cushion provides support to the
backwards movement of the head. This is
referred to as the occipital support cushion as
‘occipital’ is the Latin name of the part of the
skull they protect. In other words, a support
pad that supports the back of the head. It is
available in three sizes.
The section above describes the standard version of the Papillon head
support. However, in the event of individual requirements it might be the
case that the shape of the pads on the standard set need to be modified.
On top of this, additional components might be needed to get the ideal
configuration. There are a number of additional components possible:
•Lateral support pads. Additional lateral
supports can be attached on one or both sides
to support the side of the head. This lateral
support pad, positioned above the ear, comes
with its own bracket. This support pad can be
attached in a fixed or foldable position, and
the pad can likewise come in different shapes.

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•Switches. Switches can also be attached to the
head support, likewise by means of brackets.
•The dynamic forehead strap. One special
accessory is the dynamic forehead strap. The
forehead strap is designed to stop the head
dropping forwards involuntarily and keep the
head in an upright position. The system uses
pulleys which move the strap according to
the movements of the head. These pulleys are
situated on the rear of the system.
Using the Papillon head support
A Papillon head support which is correctly mounted and used in the proper
manner will provide optimum support for the head. Because of the head
support’s modular character, plus the many accessories, highly complex
posture and support problems can also be solved. You may ask yourself
what is meant by ‘optimum support’ and when you use the support a
number of basic rules need to be taken into account:
•You need to be realistic in your expectations. Head support is part and
parcel of overall body support and so the former depends partly on the
quality of the latter.
•Using the head support should not lead to a correction in the overall
body posture. The head support is additional to the support of the torso
and cannot compensate for a qualitatively poor or deficient support of
the torso.
•For successful use of the head support, it is advisable to carry out an
investigation of the problem of posture in general, both at rest and

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during activities. You should take into account any undesirable factors,
such as the lack of any posture support, support which is in the wrong
place, and attempt to prompt reflex activity whilst sitting.
•Likewise, the use of any major back adjustments, lateral movements of
the torso, or slouching will affect the position of the head in relation to
the head support. This is not desirable; the system will perform better if
the user adopts more or less the same posture over a period of time. If
regular variations in sitting are frequent, you should consult the supplier
of the seating system.
•If the user regularly experiences problems keeping the head in the
correct position, there is an optional electrical head support adjustment
mechanism. This enables the user to move the position of the
head support dynamically. Focal supplies head support adjustment
mechanisms in a variety of models.
•The position of the head support is usually determined on the basis
of the ideal torso position. As a result, this might mean that the head
support has to be fitted slightly off-centre in relation to the (wheel)
chair’s backrest.
A
B
C
•Once installed, the head support should not
exert any pressure on the following: A the
temple; B the lower jaw; C the bone behind the
ear and the ear itself.

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•Before making a transfer by lifting, the head support first needs to be
removed or swivelled to one side.
•The best position for the head support needs to be determined on the
basis of a careful assessment of the sitting posture. This assessment is
usually carried out by the user in combination with his or her therapist.
Assembly of the Papillon head support
Before assembling and configuring the head support, make sure
that the user adopts the best posture for sitting in the chair or
wheelchair.
Use the special Torx keys supplied for all assembly work.
•The adapter, together with the assembly
plate in its default position, is mounted to the
backrest in a position aligned with the centre
of the head. The adapter is positioned as high up as possible.
•Remove the head support, take the vertical
bracket and insert this into the receiving tube
of the removable assembly plate.

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•Fit the horizontal bracket onto this by
tightening the screws on the clamping ring
with the Torx key supplied.
•Attach the frame of the Papillon head support
to the ball on the horizontal bracket.
Correct Incorrect
•When tightening the two screws of the
clamping rings, make sure that they are
tightened in equal measure. This way you will
avoid the one half of the clamping ring being
askew with the other half, as a result of which
the frame of the Papillon head support might
move in relation to the (ball on) the horizontal bracket.
•Attach the upper (occipital) support cushion
onto the frame of the Papillon.
•Attach the occipital support cushion This is
done by loosening the middle screw on the
rear of the support cushion with the Torx key.
Position the ball on the rear of the support
cushion in the socket of the support for the
upper cushion. Tighten slightly using the

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Torx key. It must be possible to move the cushion in the socket when
subjected to a slight degree of pressure with the hand.
•The right-hand suboccipital support pad is
then attached. This is done by loosening the
middle screw on the rear of the support pad
with the Torx key. Position the ball on the rear
of the support pad in the right-hand socket on
the frame of the Papillon head support. Next,
tighten the middle screw with the Torx key.
It must be possible to move the pad in the socket when subjected to a
slight degree of pressure with the hand.
•Repeat the same steps for the left-hand suboccipital support pad.
The head support has now been assembled, but is not yet ready for use.
Some careful fine-tuning is necessary first. We therefore recommend you
read the configuration instructions carefully:
Configuring the Papillon head support
The head support needs to be configured by at least two persons
when the user is comfortably seated in the (wheel)chair after
having adopted the preferred basic posture beforehand. One person
ensures that the user’s head adopts the right position, whilst the
other configures the head support.
•By supporting and turning the user’s head, simulate the best position
for this. Bear the following in mind when you do this: the degree to
which the head is properly balanced; the movement of the head; and any
possible reflex activity that may occur.

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•Select the required height of
the head support and tighten
the vertical bracket using the
clamping ring on the removable
assembly plate.
•Select the required depth
(longitudinal adjustment) of
the head support and tighten
the horizontal bracket using the
clamping ring on the removable
assembly plate.
•Ensure the frame of the
Papillon head support is in the
right position and tighten the
clamping ring onto the ball on
the horizontal bracket.

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•As indicated previously, one
option is to choose a Papillon
frame which has adjustable
sockets for the suboccipital
support pads. These can be
adjusted by loosening the two
Torx screws on the rear of the
frame of the Papillon. Position
the assembly sockets correctly
and then tighten the Torx screws.
•Adjust the settings of the
suboccipital support pads
by carefully rotating and
swivelling them. Try to maintain
a good contact with the head,
in particular with the inner,
rearmost part of the pad. The
support pads should follow
the contours of the head and
the contact area should be
maximised.
The neck should not be constricted by the support pads. Do not
attempt to apply any lateral pressure on the jaw.

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Good Incorrect
•Ensure that the join (on the
inside) between the two
suboccipital support pads is
smooth and even. The two pads
should be flush with each other
and not overlap. If not, the head
support will not be comfortable and pressure points may develop.
•Slide the support for the upper
cushion, including the upper
support cushion, gently forwards
and find the support that best
fits the natural form of the
back of the head. Do not push
this support cushion forward
too much – contact with the
suboccipital support pads
(mounted underneath this) may
otherwise be lost.
•Once the support cushions/pads have been positioned correctly, the
screws need to be carefully tightened. Make sure that the support
cushions stay in place when you do this.
•Pay close attention to the body posture of the user and to the position of
the head in a forward and lateral direction. Check the following:
•Is the head support still in the same position as it was when it was
initially set by hand?
•Does the user feel the problem has been solved?
•Is the head sufficiently in balance?
•Does the head continuously have to resist the forces of gravity?
•Is there a risk of the user’s head getting stuck behind the head support,
without the user being able to correct this? If necessary, the Papillon
S or L suboccipital support pads should be used. By getting these to
point outwards, it’s possible to prevent the head sliding behind the
head support.

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•Is the head able to move to the right and left sufficiently?
•Is the user able to breathe, eat and swallow without any problems?
•Go through all these questions again if any of them have been
answered with a ‘no’.
•Readjust the system if there is any redness or irritation of the skin.
Stop using the head support if problems persist after readjusting
the settings.
A few common mistakes
Experience and adeptness play an important role in configuring and using
the system correctly. Below are a few of the common mistakes. These
mistakes will reduce performance.
Has a proper sitting posture been adopted prior to use?
The torso must be properly and fully supported before assembly and
configuration. If this is not the case, you should expect poor results for
supporting the head. Before using, analyse the orthopaedic and functional
aspects of sitting. The user and his or her carers should be fully informed
about all aspects of sitting.
In the event of transfers made by third persons, the
head support is not removed or swivelled.
For all transfers made out of the (wheel)chair where the user needs to
be lifted, the trunk makes a simultaneous movement both forwards and
upwards. The presence of the head support can impede this movement
quite severely. Before making a transfer by lifting, the head support first
needs to be removed or swivelled away to one side.
Use of the Papillon head support suddenly becomes uncomfortable.
Use of the head support can suddenly become uncomfortable for the user.
It’s possible that there have been changes in the user’s bodily functions

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For example, the user might start to slump more than previously. It might
also be useful to check whether the configuration of the head support has
changed in relation to the original configuration. A change in the original
configuration might be due to parts of the head support having been
(unwittingly) displaced by impact or damage.
The suboccipital support pads point outwards too much
The user will be able to turn his or her head more easily if the suboccipital
support pads point outwards too much. In this case, support function of
the system will no longer work properly.
The suboccipitale support pads are too close to the neck
If the suboccipitale support pads are positioned too closely to the neck, this
may lead to some discomfort. It will also restrict movement of the head.
Physical injury may be caused as a result of restricted circulation to the
carotid artery if the neck remains constricted for too long. Care should be
taken to ensure that an inordinate amount of pressure is not exerted on
areas where the arteries are located.
The screws of the head support have been damaged
as a result of non-original tools being used.
Torx screws are used with the Papillon head support. A special Torx key is
supplied by Focal for this purpose. Do not use any other tools for loosening
or tightening screws; this will otherwise result in the screws becoming
damaged. If you happen to lose a key, do not hesitate to ask Focal to
provide another suitable Torx key.