chapter 13 seated mobility adl exam 3 Flashcards
Orthosis
device applied to body to stabilize of immobilize or assist with function
wheelchair
a type of orthosis.
wheelchair fit
must be fit and selected by pro. 68% of patient’s wheelchairs are not right for them. seat, back UE LE supports wrong position for their condition.
condition and wheelchair needs can change over time.
Besides measurement fits, what are some other concerns about selecting the right wheelchair?
- goals and desires
- frequency of use, longevity of use, durability needs environment
- cognitive sensory and cardiopulmonary abilities
- psychosocial concerns
- environmental
- financial
- care partner availability
- community and social resources
Manual wheelchair
lighter more prtable
Battery powered wheelchair
Heavier and harder for portability
Pushrim-activated power assist wheelchair
(PAPAW) - Smart Drive - can be much lighter.
Two main types of wheelchair seats
flexible “sling” or ridged. - both often have padding.
seat slope
“Dump” front of the seat is higher than the back. slope affects stability of pelvis.
Pressure map
pressure sensors placed on seat and back of wheelchair to guage comfort and when patients lack sensory cues.
wheelchair back support
standard 90 degree
Some (tilt in space) recline without changing the angle to the seat re relieve pressure.
Armrests
decrease weight on butt 5% for tetra 9% for para.
for menuverablility, may be omitted.
Front rigging
foot and calf supports
swing away foot and calf supports
facilitate transfers and allows manuverability.
elevating legrests
keep knee flexion over 90 degrees. Must have calf pad.
legrest and edema
tilt body back 30 degree or legs 30cm above heart can manage edema.
footrests for athletes
may be at slight inward angle for meneuverability.
wheelchair frame old
tubular steel (hospital wheelchairs)
New types of wheelchair frames
aluminum, titanium, airplane steel, carbon fiber
Fixed box frame
sturdier - top fold over seat. less energy to propel
cross brace frame
can fold up for storage better shock absorption - more energy to propel
frame of battery power wheelchair
ridged 85 to 300 lbs.
Pediatric wheelchair
often aluminum. expand
Integrated standing wheelchair
can move from sitting to standing while still supported by the chair.
Axel postion
Determines drive wheel position and stability and meneuverability.
axel postion back
more stable less meneuverable
axel position forward
less stable more meneuverable
Power chair axel postion
front, mid or rear drive
Rear wheel drive chairs
move more rapidly - less effective at inclines.
Front wheel drive chairs
good inclines and better at curbs.
mid wheel drive chairs
tight turning raidius. can get stuck over obstacles.
Drive wheels
push wheels 22,24,26 inch
spoked drive wheels
light weight, require meaintenance.
Mag wheels
light weight but not as light as spoked. six to 8 strutts. magnesium.
Camber
top of wheel angled in. Improves stability and agility.
Pushrims
handrims. rings outside drive wheel.
can have projections
can be ergonomic.
casters
small wheels for atability and direction change. turn and can extend BoS.
large casters
more stable but harder to propel
small casters
less stable but more menuverable
electric wheelchair 3 wheel
power-operated vehicles - more menuverable
electric wheelchair 4 wheel
less menuverable.
tires
pneumatic, foam filled solid
pneumatic tires
better shock absorption and better outside. harder to propel.
solid rubber tires
easier to propel. better indoors.
foam filled tires
extra weight not consideration for electric
puncture resistant
sometimes spring on rear.
wheel lock breaks
most common is a lever that presses on tire of drivewheel. Most are push. One or two pushes.
Power wheelchair breaking system
brakes are integrated into controls.
power disengaged electric wheelcharir
The brakes also disengage allowing “free wheeling” for push.
PAPAW brakes
tapping pushrims activates brakes.
Wheelchair options
should be chosen based on advantages and disadvantages and patient’s needs/circumstances.
Armrests
Advantages: support arm;therefore trunk.
Disadvantages: width; harder to propel
Need: lap tray
Desk arms
advantages: arms fit under most desks/tables; help with floor to wheelchair transfers.
Disadvantages: more expensive; less forearm support
need: removable and reversable.
Swing-away or removable legrests
Advantages: removable helps with trans; can use LE for propulsion
Disadvantages: may swing back against leg. May be lost.
Need: “different options combined meet needs”
Elevating legrests
Advantages: Needed with long leg casts
Disadvantages: increase length/width
Need: different options combined can meet needs.
Large Casters
Advantages increase stability and ability to go over large obstacles.
Disadvantages: less meneuverablility greater length width.
Need: outdoor
Pneumatic tires/tread
Advantages: lighter/ increased propel on rough terrain; shock absorption; grip
Disadvantages: blowout; maintainence; more energy to propel
need: prefered by active and for outdoor.
Pneumatic tires with solid inserts
Advantages: compromise between pneumatic and solid rubber; puncture-proof; maintain inflation
Disadvantages: somewhat heavier than air-filled pneumatic tires
Need: increasingly common for active; good for outdoor.
Solid Rubber Tires
Advantages: Not subject to flats; sturdy; less energy to propel
Disadvantages: less shock absorption; may get stuck on terrain
Need: Longer life/cost efficient; selected for indoor use.
Sling seat:
Advantages: Less expensive; light weight
Disadvantages: promotes hip internal rotation; increases pressure on focal areas
Notes: Change in sling seat position with the patient sitting on it must be considered when measuring fit.
Manually powered wheelchair
advantages: portable; less expensive; can build strength; less subject to damage;
disadvantages: Can fatigue the patient and contribute to overuse injuries; occupies both hands for propulsion.
notes: Allows maneuverability for wheelchair athlete
Electrically powered wheelchair
advantages: independent mobility; frees one hand; propulsion can be controlled by other body functions.
disadvantages: more expensive; difficult to transport; charging; no wet
notes: functional interaction inside and outside the home.
Standard manual wheelchair
for users less than 300lbs. lift 45lbs or a caregiver who can.
Maneuverable with multiple methods of propulsion
overuse in shoulders. physically demanding.
Lightweight manual
weighing less than 300lbs.
lift 34 lbs.
easier starting stopping. less to propel. easier trans.
Less durable.
lightest wheelchair available
less than 25-30 lbs. ideal for active. better ergonomics.
may not provide enough support for less active.
Power or electric
battery motors. stick controlled. Less demanding to operate.
Heavy outdoor use can damage.
POV or scooter
three wheeled - tight turns. less expensive.
Heavy not portable
few attachments.
Power-assist (PAPAW)
advance pushrims activates motor. Decrease in exertion and injury. increases function independence.
add weight and width. More difficult to trans.
bariatric wheelchair
heavy duty - 300-1000lbs
overweight persons.
heavier to trans.
accessibility challenges.
sport wheelchair
rigid frame
few additional options
used by many patients other than athletes.
light maneuverable
Not as durable and only for light fit people.
Pediatric wheelchair
sized for child - adjustable for growth - manual or electric
customizable for child’s needs
child may need multiple chairs before adulthood.
hemi wheelchair
unilateral use of uninvolved side - removable leg rest for LE propel.
hand or lever crank possible
difficult to guide in a straight line with one arm without crank.
amputee wheelchair
person with LE amputation.
rear axel set further back to offset change in CoM.
decreased maneuverability.
Reclining wheelchair
back reclines
legs may or may not elevate
additional wheel locks.
pressure relief. respiration assist.
may be difficult to return upright.
tilt in space wheelchair
back rest reclines
constant back/seat angle
assists with pressure relief
heavier- less stable - less maneuverable.
Integrated standing
Seated to standing with power
Improves ADL - pressure relief - ROM -Bone density
Improves bowl/bladder
reduces spasticity/tone and contractures.
Expensive and need LE weight bearing.
Tricycle
less stress - different terrains.
increased turning radius. harder to purchase and repair.
ASIS and PSIS
should be level with each other
Anterior and posterior pelvic tilt
pelvic rotation
one ASIS is more anterior than the other.
postural screeen
determines fit of wheelchair.
Mechanical Assessment Tool
The MAT is a musculoskeletal examination of the client’s:
- Range of motion
- Joint flexibility
- Muscle length, and
- Skeletal alignment.`
seat depth measurements taken
supine. knee 90 to 100 degree. Hip 90 degree.
Upper leg popliteal fold to back of hips.
sacral siitting extends needed length.
seat width
measure distance between outer edges of patient’s hips. Use books. measuere between inner edges of books. add 1 to 2 in.
Seat to flooor height for manual wheelchairs
measurement of patient’s lower leg. For greatest accuracy, patient should sit on a cushion. Measurements should be taken on sling seat if sling seat used.
back of knee to sole of usual footwear. If not using foot to propel, add 2 in for clearence.
seat back height
determines level of postural support. measure from seat to inferior angle of shoulder blade or from seat to axilla -4 inches.
armrest measure`
90 degree flexion of arm - olecranon to seat + cushion under arm.
90 90 90
good degree fit body/hips/knees
Assisting through doors that open away from clent
Back into doorway.
use foot and shoulder to keep door open
once completely clear/ let door close and turn in desired direction
Assisting through doors that open toward the client
approach door and go past handle.
One hand opens door, while other supports wheelchair
use foot to hold open door.
Use hands to maneuver chair through door
release door once through.
Running slope of ramp
1:12 max. if the rise is greater than 6 inches or run is longer than 72 inches. Must have handrails
tips and falls
65% to 85% of injuries in wheelchair.
incline rule
never pull the wheel chair up a slope backward with all four wheels in contact with ground. ->patient fall out go boom.
Ascending curb forward.
face curb and tip back.
roll forward until casters are above curb
lower casters to sidewalk
roll forward until drive wheels are against curb
roll forward by lifting up on push handles. lift with legs.
descending curb backward
step off curb
wide stance control drive wheel down curb.
tips char back into wheelie position
once footplates clear curb, slowly lower wheelchair using anti-tip bar for extra control.
Ascending curb backward
rolls back until drive wheels are in contact with curb
tilts chair back
shift weight to back leg and pull chair up curb
maintain position until chair clears curb and then tip back to normal.
descending curb forward
Deep tilt of wheelchair
rolls drive wheels to edge of curb
allows drive wheels to slowly roll down curb. control motion
use anti-tip bars to lower casters to the ground.
Ascending stairs backward (three person job)
two assistants on either side of char and one behind. Use fixed frame handholds not removable parts.
patient in tucked position
wheelchair tipped back and on count of three lifted up first step.
continue up each step on count of three.
At landing wheelchair is secured
patient can come out of tucked position.
Descending stairs forward (three person job
patient in tucked position - assistants -fixed hand holds either side of chair.
wheelchair tipped back.
On count of three - lead allows chair to descend one step at a time.
ensure smooth descent.
forward propulsion
from 10 o’clock to 2 or 3 o’clock and straight back. shorter and more strain.
Shoulder anterior to axis
improves locomotion efficiency.
propulsion using feet
wear good shoes. place foot forward and pull chair toward foot bending the knee. backward. extend knee pushing chair away from foot.
using both UE and LE for propulsion
Normally supplements UE with some LE involvement
Independent must learn wheelie
necessary for some terrain. Must balance CoM over drive wheels. - up and down curbs.
Independent open door away from chair
patient unlatches door and pushes open
one hand holds door while other hand maneuvers through door.
Independent open door toward chair.
as door is pulled open - angle chair ready to pivot
pivot and move chair through door.
use door frame and door to propel forward and hold door further open
quickly propel forward through door.
In case of fall backward
tuck chin toward chest and cross arms with hands on knees.
fall forward
turn head to the side. extend trunk and arms. prevent body from landing on legs.
Falling to side
tucks arms close to chest. rounds shoulders. flexes head away from ground.
maintainence
check for loose bolts
Wash
wax.
tire pressure
lubricate
