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BR 3rd Ed > Ch 12 - Wheelchairs > Flashcards

Ch 12 - Wheelchairs Flashcards

1
Q

What is a major contributing factor to increased deformity and pressure ulcer development?

A

Inaccurate measurements during WC seating system measurements

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2
Q

How should seat width be measured?

A

Measure across the widest point of the hips (with clothing and any braces or orthoses)

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3
Q

What should the seat width be for manual WC users?

A

Same as max hip width or up to 1 inch greater than the patient’s measured hip width

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4
Q

What should the seat width be for power WC users?

A

Up to 1 inch wider than their hip width but utilize hip guides to ensure maximum alignment is maintained in the pelvis with scoliosis

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5
Q

What are complications of too narrow WC seat widths?

A

Transfers will be more difficult

Inc risk of pressure ulcer on the greater trochanters

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6
Q

What are complications of too wide WC seat widths?

A

Trunk support is compromised l/t scoliosis, back pain, and difficulty with WC propulsion

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7
Q

How is seat depth measured?

A

Dorsal buttocks to the popliteal fossa, and subtract 1/2 inch from this measurement
Subtract backrest cushion measurement

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8
Q

How are seat depth measurements changed for patients propelling WC with feet?

A

1 to 2 inches subtracted

Cushion is beveled back to allow the knee adequate flexion to propel the wheelchair.

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9
Q

What are complications of too shallow WC seat depths?

A

Dec distribution throughout the femurs, resulting in Inc pressure on the ischial tuberosities

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10
Q

How is seat height measured?

A

Lower leg length from the bottom of the heel of the shoe to the posterior thigh. Subtract the height of the “compressed” seat cushion from the measurement, and then add 3 to 4 inches to allow for adequate leg rest clearance

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11
Q

How are seat height measurements changed for foot drive or hemiplegic height WC?

A

Seat closer to the floor, to allow the unaffected leg to propel the chair

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12
Q

Where should WC back rest be in patient’s who use their arms for propulsion?

A

Inferior angle of the scapula

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13
Q

Where should WC back rest be in patient’s who has no UE strength and poor trunk control?

A

Spine of scapula

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14
Q

How is head support for WC measured?

A

Bottom of the buttocks to the top of the cranium, add the height of the “compressed” seat cushion and adjust down by 2 to 4 inches depending on the patient’s support preference

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15
Q

How are armrests for WC measured?

A

Bottom of the patient’s bent elbow at 90° and add the height of the compressed seat cushion

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16
Q

What is the MC prescribed armrest?

A

Removable desk length armrest Of ~10”

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17
Q

How are footrests for WC measured?

A

Distance from the heel of a patient’s shoe to the posterior surface of the thigh at the popliteal fossa
Footrest at least 2 inch clearance from floor

18
Q

What is the most important reason for tilt and recline seating systems?

A

Provide patient or caregiver ability to perform adequate weight shift for pressure redistribution to minimize the risk of pressure ulcer and to provide a patient with postural support from gravity for upright

19
Q

What degrees of reclining can be added to a WC?

A

Semi: 120°
Full: 180°

20
Q

What does a tilt-in space system allow for?

A

Pressure to be redistributed from the seating surface to the back support

21
Q

What degree of tilt should a tilt-in space system allow to redistribute sufficient pressure?

A

Tilt at least 45°

Most systems provide 45° to 60° of posterior tilt

22
Q

What are advantages of a tilt-in space system?

A 
– Independent pressure relief
– Postural support from gravity
– Pain relief
– Assist in orthostatic episodes
– Minimizes shear
– Diminishes effects of spasticity during position changes
– Maintains seating position during weight shifts
– Helps mobilize secretions
– Smaller turning radius
23
Q

What are the standard size WC wheels?

A

3-to 8-inch (diameter) front caster wheels

24-inch (diameter) rear wheels

24
Q

When is a fixed axle appropriate?

A

Someone who is not using the wheelchair as a primary means of mobility

25
Q

How can an adjustable axle be moved?

A

Moved forward to position the center of gravity underneath the client to allow for improved rear wheel access and more
efficient wheelchair propulsion

26
Q

What does a forward axle position facilitate?

A

“Wheelies” to transition up/down curbs

27
Q

What does a posterior axle position facilitate?

A

Inc WC stability to compensate for the change in the location of the COG

28
Q

When is a posterior axle position essential?

A

Absence of legs in a bilateral amputee patient and with a reclining back or tilt-in-space WC

29
Q

What happens with more posterior rear wheels?

A 
– Inc rolling resistance 
– Inc energy required for propulsion
– Inc turning radius 
– More stable the chair 
– More extension needed at GH joint, which can inc stress/injuries at the shoulder
30
Q

What happens with more anterior rear wheels?

A

– Dec rolling resistance
– Dec energy required to propel
– Smaller turning radius
– Less stable chair
– More maneuverable (easier to perform a “wheelie”)
– Relieve shoulder pain during manual propulsion

31
Q

What is the best tire for carpet?

A

Pneumatic tires are best because carpeting increases the rolling resistance by a factor of 4

32
Q

What does WC camber with lower wheel further out than top of wheel allow for?

A

Better biomechanical location to the shoulder joint
Easier to propel (especially at higher speeds)
Inc stability
Easier to turn

33
Q

What is the camber of everyday WC uses?

A

2° to 5°

34
Q

Which patients use one-hand-drive WC?

A

Plexus injury
Upper extremity amputation
Hemiplegia

35
Q

What does a smaller caster allow for?

A

Smaller turning radius but performs poorly on outdoor surfaces and on carpets because it can get stuck in cracks on sidewalks and in uneven contours of an uneven surface

36
Q

What is the standard castor size?

A

8-inch diameter on a basic WC

37
Q

What castor size allows for the best overall indoor and outdoor performance?

A

5 or 6-inch diameter

38
Q

What does moving the castor more posteriorly cause?

A

Dec turning radius
Inc maneuverability
Dec stability

39
Q

What are the types of WC cushions?

A 
Viscous fluid
Air
Gel
Viscoelastic foam
Foam
40
Q

Describe the controls of a sip and puff WC.

A

Hard puff: forward
Soft puff: right
Soft sip: left
Hard sip: stop, once the WC is stopped, it can also be a reverse command

BR 3rd Ed (92 decks)

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