Chapter 03 Wheelchairs Flashcards
A \_\_\_\_\_\_\_\_ evaluation is also done to determine joint angles (hip, knee, or ankle), to assess postural deformities (e.g., joint contractures, pelvic obliquities, spinal kyphosis, or scoliosis), and to assess the effects of \_\_\_\_\_\_\_\_ on sitting balance. The following components are needed as part of a comprehensive WC and seating evaluation: • Medical history • Home environment • Method of transportation • Employment/school requirements for mobility • Functional/sensory processing skills • Communication • Sensation/skin issues • Current seating/mobility • WC skills • Patient measurements ◦ Hip/trunk/shoulder width ◦ Knee-to-seat depth ◦ Knee to heel ◦ Shoulder height ◦ Axilla height ◦ Top of head ◦ Range of motion
A mat evaluation is also done to determine joint angles (hip, knee, or ankle), to assess postural deformities (e.g., joint contractures, pelvic obliquities, spinal kyphosis, or scoliosis), and to assess the effects of gravity on sitting balance. The following components are needed as part of a comprehensive WC and seating evaluation: • Medical history • Home environment • Method of transportation • Employment/school requirements for mobility • Functional/sensory processing skills • Communication • Sensation/skin issues • Current seating/mobility • WC skills • Patient measurements ◦ Hip/trunk/shoulder width ◦ Knee-to-seat depth ◦ Knee to heel ◦ Shoulder height ◦ Axilla height ◦ Top of head ◦ Range of motion
Frame – Folding frames are easier to transport but may be ________, be less ________, and require ________ energy to propel. Rigid frame chairs are more durable and energy efficient during propulsion, but may be more difficult to transport. Rigid frame WCs are not particularly useful for ________ patients because they do not typically come with swing-away footrests, making it difficult for them to perform sit-to-stand transfers.
Frame – Folding frames are easier to transport but may be heavier, be less durable, and require more energy to propel. Rigid frame chairs are more durable and energy efficient during propulsion, but may be more difficult to transport. Rigid frame WCs are not particularly useful for ambulatory patients because they do not typically come with swing-away footrests, making it difficult for them to perform sit-to-stand transfers.
Axle – ________ placement is advantageous for users with poor trunk control, amputees, and reclining/posterior tilt WCs, but increases turning radius, rolling resistance, and the difficulty in doing wheelies. ________ placement decreases rolling resistance and improves maneuverability (decreased turning radius and easier wheelies), but also increases the risk of tipping over backward.
Axle – Posterior placement is advantageous for users with poor trunk control, amputees, and reclining/posterior tilt WCs, but increases turning radius, rolling resistance, and the difficulty in doing wheelies. Anterior placement decreases rolling resistance and improves maneuverability (decreased turning radius and easier wheelies), but also increases the risk of tipping over backward.
Molded Plastic (Mag) versus Wire-Spoked Wheels – Mag wheels are slightly ________ but more ________ than spoked wheels. Spoked wheels are preferred in most ________ chairs, but require more maintenance and are less safe for some individuals whose fingers may get caught in the spokes.
Molded Plastic (Mag) versus Wire-Spoked Wheels – Mag wheels are slightly heavier but more durable than spoked wheels. Spoked wheels are preferred in most sports chairs, but require more maintenance and are less safe for some individuals whose fingers may get caught in the spokes.
Pneumatic versus Rubber Tires – Pneumatic (air-filled inner tube) tires offer a comfortable ride on ________ terrain but are susceptible to going flat and have a higher resistance to propulsion. ________ rubber tires may be preferred if the WC is mostly to be used indoors (e.g., office work, hospitals, and nursing homes) due to the easier propulsion and low maintenance.
Pneumatic versus Rubber Tires – Pneumatic (air-filled inner tube) tires offer a comfortable ride on uneven terrain but are susceptible to going flat and have a higher resistance to propulsion. Solid rubber tires may be preferred if the WC is mostly to be used indoors (e.g., office work, hospitals, and nursing homes) due to the easier propulsion and low maintenance.
Camber – (typically range from 3° to 5°) Increasing camber ________ turning radius, improves side-to-side and forward ________, decreases rolling resistance at high speeds (no effect at normal speeds), and protects user hands during sports. Disadvantages include difficulty in tight spaces due to increased overall WC width, increased tire/wheel-bearing wear, and decreased rear stability.
Camber – (typically range from 3° to 5°) Increasing camber decreases turning radius, improves side-to-side and forward stability, decreases rolling resistance at high speeds (no effect at normal speeds), and protects user hands during sports. Disadvantages include difficulty in tight spaces due to increased overall WC width, increased tire/wheel-bearing wear, and decreased rear stability.
Handrims – Small-diameter handrims (________ WCs) increase the distance covered with each stroke, but require greater force. Pegged handrims (“quad knobs”) improve ease of use for tetraplegics and users with hand deformities but increase risk of trauma during attempts to stop and may limit accessibility.
Handrims – Small-diameter handrims (sports WCs) increase the distance covered with each stroke, but require greater force. Pegged handrims (“quad knobs”) improve ease of use for tetraplegics and users with hand deformities but increase risk of trauma during attempts to stop and may limit accessibility.
Casters – Small (≤5″ diameter), narrow casters are appropriate for ________, ________ surfaces and are less likely to shimmy. Smaller casters are more likely to get caught in sidewalk cracks and elevator thresholds.
Large (≤6″ diameter), wide casters are advantageous in rougher, outdoor terrain, but have ________ rolling resistance on smooth surfaces and are more likely to shimmy.
Casters – Small (≤5″ diameter), narrow casters are appropriate for smooth, level surfaces and are less likely to shimmy. Smaller casters are more likely to get caught in sidewalk cracks and elevator thresholds.
Large (≤6″ diameter), wide casters are advantageous in rougher, outdoor terrain, but have increased rolling resistance on smooth surfaces and are more likely to shimmy.
Cushions – Foam cushions are lightweight and inexpensive, but are not washable and dissipate heat ________. These cushions do not offer adequate pressure relief. They are appropriate for ambulatory patients with ________ sensation.
Gel/foam combo cushions (i.e., Jay and Jay-3) consist of a firm gel emulsion enclosed in a nonbreathable plastic that provides good postural stability. They are durable, are easy to maintain and clean, and offer a high capacity to dissipate skin heat buildup, but are expensive and heavy, and the contouring can interfere with transfers. The new Jay-3 has “memory,” which maintains optimal configuration. This is good for patients with ________ pelvic/trunk control and ________ skin.
Air-filled villous cushions, such as the Roho, consist of multiple balloonlike air cells that assure maximum skin contact and provide the ________ pressure relief. The design is favorable for pressure ulcer prevention or healing. These cushions are lightweight, good at heat dissipation, and easy to clean and transport, but expensive and poor at providing postural stability. The cells also need constant maintenance to maintain the air pressure and repair punctures.
Cushions – Foam cushions are lightweight and inexpensive, but are not washable and dissipate heat poorly. These cushions do not offer adequate pressure relief. They are appropriate for ambulatory patients with intact sensation.
Gel/foam combo cushions (i.e., Jay and Jay-3) consist of a firm gel emulsion enclosed in a nonbreathable plastic that provides good postural stability. They are durable, are easy to maintain and clean, and offer a high capacity to dissipate skin heat buildup, but are expensive and heavy, and the contouring can interfere with transfers. The new Jay-3 has “memory,” which maintains optimal configuration. This is good for patients with poor pelvic/trunk control and insensate skin.
Air-filled villous cushions, such as the Roho, consist of multiple balloonlike air cells that assure maximum skin contact and provide the best pressure relief. The design is favorable for pressure ulcer prevention or healing. These cushions are lightweight, good at heat dissipation, and easy to clean and transport, but expensive and poor at providing postural stability. The cells also need constant maintenance to maintain the air pressure and repair punctures.
Recline/Tilt-in-Space – Reclining and tilt-in-space chairs are helpful for patients who lack the ability to do adequate pressure relief otherwise and for patients with ________ ________. These chairs are frequently prescribed as backups for patients using power WCs. The addition of these features, however, can significantly increase the size and weight of the WC. Users of reclining WCs may be susceptible to increased spasms and shear forces during the reclining motion. Tilt-in-space WCs offer pressure relief w/o shear and also reduce the likelihood of triggering a spasm during the tilt. Backflow of urine in the tilted position, however, may be an issue in patients with indwelling catheters. The patient that uses the reclining or tilt-in-space WC is usually dependent. Manual recline/tilt-in-space positioning and WC propulsion must be done by a caregiver.
Recline/Tilt-in-Space – Reclining and tilt-in-space chairs are helpful for patients who lack the ability to do adequate pressure relief otherwise and for patients with orthostatic instability. These chairs are frequently prescribed as backups for patients using power WCs. The addition of these features, however, can significantly increase the size and weight of the WC. Users of reclining WCs may be susceptible to increased spasms and shear forces during the reclining motion. Tilt-in-space WCs offer pressure relief w/o shear and also reduce the likelihood of triggering a spasm during the tilt. Backflow of urine in the tilted position, however, may be an issue in patients with indwelling catheters. The patient that uses the reclining or tilt-in-space WC is usually dependent. Manual recline/tilt-in-space positioning and WC propulsion must be done by a caregiver.
“Hemichair” – This may be an option for some patients following stroke. The seat height is ______ ≈2″ and a footrest is removed to allow the neurologically intact foot to propel and steer.
“Hemichair” – This may be an option for some patients following stroke. The seat height is lowered ≈2″ and a footrest is removed to allow the neurologically intact foot to propel and steer.
Lower Limb Amputee – The rear axle is moved ______ ≈2″ to compensate for the rearward displacement of the patient’s center of gravity. Turning radius is increased.
Lower Limb Amputee – The rear axle is moved posteriorly ≈2″ to compensate for the rearward displacement of the patient’s center of gravity. Turning radius is increased.
One-Arm Drive – This is for unilateral arm amputees or hemiplegics. Both hand rims are on one side. Turning both rims propels the WC; one rim turns the WC. WC width and weight are ______. Good strength and coordination are required.
One-Arm Drive – This is for unilateral arm amputees or hemiplegics. Both hand rims are on one side. Turning both rims propels the WC; one rim turns the WC. WC width and weight are increased. Good strength and coordination are required.
Standing WC – These chairs have frames that allow the user to passively assume a standing position. The standup position provides pressure relief and weight bearing (which may reduce ______) and can promote improved bowel/bladder function.
Standing WC – These chairs have frames that allow the user to passively assume a standing position. The standup position provides pressure relief and weight bearing (which may reduce osteoporosis1) and can promote improved bowel/bladder function.
Powered WC
Indications – This is for patients with physical limitations not compatible with manual WC propulsion (e.g., C1-4, many C5-6 tetraplegics, or severe weakness) and for those with endurance deficits (e.g., severe COPD and cardiac failure) who must conserve their energy for other functions.
User Requirements – Patients must have at least ______ reproducible movement to access the control system, adequate cognitive and visuoperceptual function, proper judgment, and motivation. Ideally, a trial is given to power WC candidates to see if they can eventually learn how to control the WC.
Contraindications – Failing to meet the user requirements; involuntary motions or inattention that might result in inadvertent activation of the controls.
Powered WC
Indications – This is for patients with physical limitations not compatible with manual WC propulsion (e.g., C1-4, many C5-6 tetraplegics, or severe weakness) and for those with endurance deficits (e.g., severe COPD and cardiac failure) who must conserve their energy for other functions.
User Requirements – Patients must have at least one reproducible movement to access the control system, adequate cognitive and visuoperceptual function, proper judgment, and motivation. Ideally, a trial is given to power WC candidates to see if they can eventually learn how to control the WC.
Contraindications – Failing to meet the user requirements; involuntary motions or inattention that might result in inadvertent activation of the controls.
