9/25d Mobility Lab II Wheel Chair Basics (Examination, Evaluation, Intervention) Flashcards
general physical considerations in manual wheelchair selection for patient transport
- Pt weight (Weight capacity of WC must be > patient weight)
- Pt width (seat width must accommodate pt’s hips w/o pressure from side panels, while allowing comfortable pt armrest use and/or push rim access)
- Pt height / leg length ( want a comfortable 90 degree hip angle in upright sitting; prevent sliding out of chair; appropriate seat depth for skin integrity / comfort)
- Trunk control / needed support (adequate back height for support; high back option; reclining back option)
- LE support needed (elevating vs. non-elevating; swing away vs. stationary; calf pad vs. heel loop/strap; flip up foot plates vs. fixed)
- Transfer status (removable/ flip-up arm rests vs. non-removable arm rests)
Basics of transfers
- Have all the equipment that you may need at hand
- Make sure there is a clear, uncluttered path for transfer.
- Make sure transfer surfaces are as close as possible
- Make sure the patient has appropriate safety measures donned i.e. non-slip socks, appropriate bracing, gait belt
- Make sure the surfaces you are transferring to and from are secure i.e. brakes locked
- Familiarize yourself with the patient’s strength and cognitive status
- Whenever possible, transfers from one sitting surface to another should occur toward the patient’s stronger side
- Know your end goal and have a backup plan ready.
- It’s OK to stop and re-set if it means you are preserving patient safety!
Sit to stand basic instructions
Scoot to the edge of the sitting surface
Feet firm on the ground, legs shoulder width apart, knees bent > 90 degrees (heels tucked back)
Hands placed on sitting surface or arm rests of the chair for push off
Do NOT use a walker to “pull” themselves up as the lack of stability leads to safety concerns
Bend forward at the hips (nose over toes), to help shift weight forward
Bed to chair basic instruction
- Scoot to the edge of the sitting surface
- Slightly angle the body with buttock toward the surface patient is transferring to *(head-hips relationship / see-saw effect)
- Feet firm on the ground, legs shoulder width apart, knees bent > 90 degrees (heels tucked back)
- Consider direction feet are pointed in setup
- Consider LE weight bearing restrictions - Nose over toes
- Promote an anterior trunk lean - Utilize arm rests or stable surface to
push off with UEs
*Never let a patient pull up from their assistive device
Pivot transfer to stand
- Therapist’s hands firmly positioned as close to the hips / buttock as possible
- If patient has a LE weakness, PT and utilize their knees to block the knee(s) of the weaker extremity to further assist the patient - Cue the patient to stand on the count of 3, using their UEs to push off of a stable surface
- Utilize verbal and tactile cues to facilitate anterior weight shift, momentum is your friend! - Pivot your feet to direct the patient toward the
new sitting surface
- Provide the patient with verbal and tactile cues as
needed in order to shift their weight and take
appropriate steps to the chair.
squat pivot transfers
- Consider patient set-up
Utilize head-hips relationship
Set up of transferring surface (angle and height) - Therapist’s hands firmly positioned as close to hips / buttock as possible
- Cue the patient to push up with both UEs on count of 3
- Tactile cues and momentum are helpful
- NEVER allow a patient to hold on to you around your neck!* - Gently guide the patient to sitting on their new surface by bending your hips / knees, maintaining a neutral spine and SHIFTING your body weight briefly backward and then forward
benefits of walkers
- Provide an increased base of support
- Most are able to be folded for easier storage when note in use.
standard and rolling walkers
- Allow for UE platform attachments
- Used for UE weight bearing restrictions, poor UE strength (especially grip) - Allow for tray / basket attachments
- Can be used for all levels of unilateral LE weight bearing restrictions
standard walker vs rolling walker
standard walker
Offers stability during forward body advancement for patient’s with a single LE NWBing status
The patient must be able to pick up the walker to advance it, having all 4 legs leave the ground at the same time and contact the ground at the same time
What does this do to their gait?
rolling walker
Pushed like a shopping cart, maintains contact with the ground at all times
Can be used or patients with a single lower extremity WBing restriction; however, the patient must be able to control the forward movement of the walker to decrease risk of falls
sizing for a walker
Elbow(s) should be slightly bent (15-30 degrees) at the elbow(s)
Grip(s) of AD should match at creases of wrist(s) when relaxed
slide board transfer
- Used to help bridge the gap between two sitting surfaces.
- Pt must have trunk control and be able to use at least one UE.
- Pt must have enough strength to un-weight their buttocks.
anterior/posterior bed to chair and vise versa
Can be used for patients severe compromise of B LE use.
Scoot vs “butt” walking
the two man lift
wheel chair to treatment mat transfers for SCI patients
movement system screen - safe to proceed for lying to sit
lying to sit
- impaired
- speed: may lead to further exam of pain or vitals
- amount of movement: examine strength and ROM in limited areas
- Symmetry
- Control
- Symptom provocation: examine subcomponenets of motion for paint; measure vitals again - not impaired
- continue with screen
movement system screen - safe to proceed for sit to stand
sit to stand
- impaired
- speed: may lead to further exam of pain or vitals
- amount of movement: examine strength and ROM in limited areas
- Symmetry
- Control: examine??
- Symptom provocation: examine subcomponenets of motion for paint; measure vitals again - not impaired
- continue with screen
