Ch 12 - Wheelchairs Flashcards
What is a major contributing factor to increased deformity and pressure ulcer development?
Inaccurate measurements during WC seating system measurements
How should seat width be measured?
Measure across the widest point of the hips (with clothing and any braces or orthoses)
What should the seat width be for manual WC users?
Same as max hip width or up to 1 inch greater than the patient’s measured hip width
What should the seat width be for power WC users?
Up to 1 inch wider than their hip width but utilize hip guides to ensure maximum alignment is maintained in the pelvis with scoliosis
What are complications of too narrow WC seat widths?
Transfers will be more difficult
Inc risk of pressure ulcer on the greater trochanters
What are complications of too wide WC seat widths?
Trunk support is compromised l/t scoliosis, back pain, and difficulty with WC propulsion
How is seat depth measured?
Dorsal buttocks to the popliteal fossa, and subtract 1/2 inch from this measurement
Subtract backrest cushion measurement
How are seat depth measurements changed for patients propelling WC with feet?
1 to 2 inches subtracted
Cushion is beveled back to allow the knee adequate flexion to propel the wheelchair.
What are complications of too shallow WC seat depths?
Dec distribution throughout the femurs, resulting in Inc pressure on the ischial tuberosities
How is seat height measured?
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
How are seat height measurements changed for foot drive or hemiplegic height WC?
Seat closer to the floor, to allow the unaffected leg to propel the chair
Where should WC back rest be in patient’s who use their arms for propulsion?
Inferior angle of the scapula
Where should WC back rest be in patient’s who has no UE strength and poor trunk control?
Spine of scapula
How is head support for WC measured?
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
How are armrests for WC measured?
Bottom of the patient’s bent elbow at 90° and add the height of the compressed seat cushion
What is the MC prescribed armrest?
Removable desk length armrest Of ~10”
How are footrests for WC measured?
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
What is the most important reason for tilt and recline seating systems?
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
What degrees of reclining can be added to a WC?
Semi: 120°
Full: 180°
What does a tilt-in space system allow for?
Pressure to be redistributed from the seating surface to the back support
What degree of tilt should a tilt-in space system allow to redistribute sufficient pressure?
Tilt at least 45°
Most systems provide 45° to 60° of posterior tilt
What are advantages of a tilt-in space system?
– 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
What are the standard size WC wheels?
3-to 8-inch (diameter) front caster wheels
24-inch (diameter) rear wheels
When is a fixed axle appropriate?
Someone who is not using the wheelchair as a primary means of mobility
