2. Wheelchair Flashcards

Question

Axle, where to put? Anterior vs Posterior Wheel Positions.

Answer 1

**1. FIXED AXLE** * Appropriate for someone who is not using the wheelchair as a primary means of mobility. (i.e. transfer inside hospital or for infrequent outside ambulation) **2. ADJUSTABLE AXLE** **POSTERIOR AXLE - REAR WHEEL** **Advantages** 1. Increase wheelchair stability (amputee) **Disadvantages** 1. Greater the rolling resistance 2. More energy required for propulsion 3. Greater the turning radius 4. Increase repetitive stress injuries **ANTERIOR AXLE - REAR WHEEL** **Advantages** 1. Less the rolling resistance 2. Less energy required to propel 3. Relieve shoulder pain 4. Smaller the turning radius 5. Facilitates “wheelies” 6. Shorter rear wheel access **Disadvantages** 1. Decreased wheelchair stability

Answer 2

**Specs** * Wheel angle against the vertical axis * Negative camber is when bottom of the wheel is out further than the top of the wheel. * Usually kept at 5 degrees of camber **Advantages of Negative Camber** 1. Brings wheels inward and closer to the body, which enables the arms to access more of the pushrim 2. Reduces shoulder abduction because the wheels are closer to the body 3. Increases lateral stability 4. Easier to propel (especially at higher speeds), pushrims more ergonomically for propulsion (it is more natural to push down and out). 5. Helps to protect the hands, because bottom of the wheels will hit the obstacle first 6. Decrease rolling resistance 7. Increased maneuverability yaw axis control **Disadvantages of Negative Camber** 1. Increased overall width of the chair, keep width \< standard doorway (28 inches) 2. Difficult to maneuver indoors 3. Increased tire wear on the inside part of the tire 4. Diminished traction Cuccurollo 4th Edition Chapter 12 Wheelchair pg885 Braddom 6th Edition Chapter 13 Wheelchair pg272 Box 14.2

Answer 3

💡 Average size is 5-6 inches: good indoor maneuverability and outdoor performance **Posterior caster placement** 1. Decrease the turning radius 2. Increases maneuverability 3. Decreases stability. **BIG 8 INCH** Pros * Easier to negotiate uneven surfaces or curbs * More stable and secure, less risk of tipping forward Cons * Larger turning radius * Less maneuverability * Increased strain on the upper extremity to perform frequent small adjustments to maneuver in tight areas indoors. * Increase rolling resistance (Bonus) **SMALL 4 INCH** Pros * Lighter * More maneuverability (tight indoor environments, or sport wheelchair) * Small turning radius Cons * Performs poorly on outdoor surfaces and on carpets (get stuck in cracks) Cuccurollo 4th Edition Chapter 12 Wheelchair pg886

Answer 4

**1. FIXED FOOTREST** * Maintain a patient’s paralyzed lower extremities * Lighter * Safety concern for individuals who perform sit-to-stand transfers. **2. SWING-AWAY FOOTREST** * Allow for safer allow for safer transfers, as they swing out of the way of the feet. * Preferred for an active patient for preforming transfer and ADLs * Increased portability of the chair * Heavier than fixed due to the additional components needed **3. ELEVATED FOOTREST** **TOO LOW** * Increase pressure over the lower posterior thigh * Hit the floor on uneven surfaces **TOO HIGH** * Places the knee higher than the seat * Shifts the patient posteriorly * Increases pressure over the ischial tuberosities and sacrum. * Places the knee higher than the seat * Shifts the patient posteriorly * Increases pressure over the ischial tuberosities and sacrum. Cuccurollo 4th Edition Chapter 12 Wheelchair pg887

Answer 5

💡 Can’t move his leg & need to keep it straight. **Advantages** 1. Decreasing dependent edema 2. Below-the-knee amputation 3. Post operative (immobilization of knee) 4. Severe knee arthritis with compromised flexion 5. Knee-extension contractures **Disadvantages** 1. Significantly increased weight of the leg rest 2. Elevating mechanisms require frequent repair 3. Increased overall length of the wheelchair Cuccurollo 4th Edition Chapter 12 Wheelchair pg887

Answer 6

1. Padded Calf Pads 2. Calf Strap 3. Comfort Calf Protector

Answer 7

**Dimension** * Smaller than the wheel, making the chair easier to propel * Larger diameter for easier grasping and propulsion, but increases the weight. **Modifications to increase comfort and limit friction of hands:** 1. Natural fit (oval-shaped handrim) 2. Vertical, horizontal, or oblique projections to improve propulsion 3. Gloves & Coating

Answer 8

**Push Rim** 1. Larger-diameter pushrim 2. High-friction surface "grip cover" 3. Pushrim with angled projections **Extra Modification** 1. Pushrim lever 2. Hand cycle or hand pedal 3. Motorized (Complete or added strokes)

Answer 9

**Wheelchair Propulsion** 1. Semicircular (most efficient). 2. Arc. 3. Single loop over (most common in paras). 4. Double loop over (figure eight). **Best type : Semicircular** 1. Lower stroke frequency 2. Better biomechanics **Contact Phase** When the hand is in contact with the pushrim applying forces **Recovery Phase** When the hand is off the rim and preparing for the next stroke Ref: Braddom pg 379.

Answer 10

**POWER ASSIST WHEELS** **1. E-Motion (Alber)** **Types of power assist** 1. Proportional to the patient’s effort “Assist Mode” 2. Preset ahead of time “Throttle Mode” like E-Motion and Twion wheels (Alber) **Advantages (Heart, Energy, Injuries)** 1. Lower oxygen consumption (energy demand) 2. Decreased heart rate on outdoor course 3. Decreased stroke force required for propulsion 4. Reduce the risk of upper limb injury, neuropathy, and fatigue **Disadvantages** * Assistance required to load/unload wheelchair in/out of a car **POWER ASSIST DEVICES** 1. **Twion (Alber)** * Automated with preset setting, patient activate and deactivated it via on-buttons. 2. **Smart Drive via Bluetooth band tapping** * Power wheel mounted on the rear of the wheelchair and the patient will have a wristband on that communicates via Bluetooth to the wheel. * Patient taps his or her arm with the wrist band twice to turn on the wheel, then taps once to set the speed as it accelerates up.

Answer 11

**Safety Equipments** 1. Pelvic belts or Y Belts 2. Wheel locks 1. Low mount and scissor type: minimizes the risk of a patient hitting his thumb on the wheel lock during wheelchair propulsion 2. High-mounted locks are easier to negotiate but may interfere with transfers, for patients who cannot reach from the ipsilateral side (hemiplegia from a stroke) 3. Grade aids 4. Anti-tippers 5. Life-support 6. Communication aids **Not having wheel lock leads to** 1. Excessive strain on the upper body to stop WC by grasping and stoping the tire. 2. More difficult to keep stable when transferring to and from the wheelchair. 3. More difficult to stop the wheelchair in uneven surface. (up or down hill) Cuccurollo 4th Edition Chapter 12 Wheelchair pg888-889

Answer 12

**Mechanism** * Important to remember that shear forces are increased as an individual is being reclined and unreclined in the wheelchair. * The seat of the wheelchair stays in the same position relative to the floor while the back support is adjustable. **Advantages** 1. Independent pressure relief 2. Postural support from gravity 3. Pain relief 4. Allows for PROM of hips and knees — not a substitute for a PROM program. 5. Easier to perform bladder catheterization 6. Can help with dressing/undressing 7. Can help mobilize secretions 8. Can maintain items on lap tray during a weight shift 9. Can maintain position under table or desk during “pressure relief” 10. Can transport in car with a large trunk **Disadvantages** 1. Increased shear forces can result in shearing pressure injuries 2. Can increase spasticity due to the hip position change 3. Less maneuverability due to increased turning radius 4. Patient does not maintain an “ideal” seated position after several weight shifts Cuccurollo 4th Edition Chapter 12 Wheelchair pg882

Answer 13

**Mechanism** * The angle of the seat and back does not change when the seat is tilted back. The patient remains in the same position, but orientation in space changes. This allows pressure to be redistributed from the seating surface to the back support. Since there is no movement of the back away from the seat, shear forces are minimized. * In order to redistribute sufficient pressure for a weight shift, the system must tilt at least 45 degrees **Advantages** 1. Independent pressure relief 2. Postural support from gravity 3. Can assist in orthostatic episodes 4. Minimizes shear 5. Diminishes effects of spasticity during position changes 6. Maintains seating position during weight shifts 7. Helps mobilize secretions 8. Smaller turning radius, more maneuverability than a reclining wheelchair **Disadvantages** 1. No passive ROM (PROM) benefits 2. May not offer as much pressure distribution relief as a recliner to 180 degrees 3. Urine may run backward in the tilted position (antireflux valve can manage this) 4. Difficult to maintain items on a lap tray when tilted 5. Need to come away from desk or table to perform weight shift 6. More difficult to perform catheterization 7. These systems do not disassemble sufficiently for transport by car Cuccurollo 4th Edition Chapter 12 Wheelchair pg883

Answer 14

**Manual WC** 💡 Looks cool, easy to pack and fix * Aesthetics: Less appearance of disability * Transportation: Easy to transport without special vehicles * Maintenance: Can be worked on independently * Exercise: Theoretical benefit to the user from using own force to propel **Power WC** 💡 Climbing high mountain faster with ease * Distance: Can travel long distances without fatigue * Speed: Can travel at higher speed without fatigue * Terrain: May be able to traverse rougher terrain * Protect the arm: Avoid repetitive strain injuries that are due to manual wheelchair propulsion DeLisa 5th Edition Chapter 78 Wheelchair pg2106 Table 78.3

Answer 15

1. poor judgment. 2. blindness. 3. inability to control lever/switch to move wheelchair safely. 4. involuntary motions/inattention that might activate switch unintentionally. 5. irresponsible. Ref: Tan pg 327.

Answer 16

1. Joystick Control 2. Head & Chin Control 3. Sip 'n' Puff 4. Brain Interface 5. Scan Switch Control

Answer 17

**REAR WHEEL** Advantages * Naturally tracks straight, appropriate for high-speed applications. * Preferred for reduced fine motor coordination * Stability with tilt feature * Preferred for special input devices (chin joystick, head array ..etc) Disadvantages * Limited obstacle climbing by the small front casters * Largest turning radius among the three drive locations. **MID WHEEL** Advantages * Good Maneuverability for indoors (smallest tuning radius) Disadvantages * Getting stuck in front or rear casters when riding on uneven terrain or curb * Bumpier ride (eg. people w back pain don't tolerate) **FRONT WHEEL** Advantages * Very stable for uneven terrain and hills * Best capability to climb forward over small obstacles * Turning radius is smaller than rear wheel drive but larger than mid wheel drive Disadvantages * Tendency for the back of the chair to wander side to side (“fishtailing”) * Directional instability * Requires steering corrections Braddom 6th Edition Chapter 13 Wheelchair pg280-282

Answer 18

**Advantages** 1. Lower cost 2. Easier to assemble and disassemble for transportation 3. Better than some chairs at rough terrain 4. Less perceived stigma of disability **Disadvantages** 1. Less stability 2. Require greater arm strength and control to drive 3. Fewer seating options 4. Poor turning radius 5. Must transfer out of chair for many activities 6. Limited control options DeLisa 5th Edition Chapter 78 Wheelchair pg2112 Table 78.5

Answer 19

**Increase Maneuverability** * Moving the seat rearward **Factors Affecting Rolling Resistance** 1. Solid tires have lower rolling resistance than pneumatic tires 2. Narrower tires have less rolling resistance than wider ones 3. Wheel alignment (camber) have less rolling resistance 4. Hard and smooth ground surface have less rolling resistance 5. Weight distribution between the front and rear wheels Practical manual of physical medicine and rehabilitation, P296

Answer 20

1. Hemi-height for foot propulsion: seat closer to the floor, to allow the unaffected leg to propel the chair. 2. Remove footrest on strong side 3. Leg rests elevating on Hemiplegic side (Improve edema) 4. One-hand-drive chair (increased potential of a repetitive stress injury from the patient’s one functioning upper extremity performing a repetitive task → power wheelchair is often the best) 5. Lap tray board (Reduce sublimation and UL edema) 6. Excellent pressure relief cushion 7. Full-length arms (Improve transfer) 8. Footrest with heel loops (prevent planter flexion contracture) 9. Brake extension on hemiplegic side

Answer 21

1. More posterior wheel axel for added stability 2. Increase seat angle “posterior seat slope.” 3. Rear anti-tippers for added stability 4. Pelvic (seat) belt for added stability 5. Amputee board on amputated side to limit knee flexion contracture & Edema control 6. Full-length arms if patient has difficulty transferring 7. Lightweight or ultra-lightweight Cuccurollo 4th Edition Chapter 12 Wheelchair pg893 Table 12-7

Answer 22

ESSENTIAL 1. Lightweight frame 2. Low back support 3. More negative camber of rear wheel 4. Small castors OPTIONAL 1. Wheel locks are low mounted or scissor style 2. Armrests are usually removed 3. Footrests are rigid footplate with leg strap 4. Pelvic (seat) belt 5. 5th wheel (anti-tipper) 6. Increase slope angle or seat dump