L11 W/C Flashcards
steps to prescribing a w/c
1.determine the need
2. examine the pt
3. select a positioning device and pressure relief
4. Determine funding
5. Document medical necessity
6. Evaluate the pt with new w/c
7. Re-assess and follow-up
Team members for prescribing w/c
Patient
Caregivers
Referral source
Pt/OT
ATP
manufacturer reps
insurance reps
Equipment needed to prescribe w/c
high/low mat table
measuring tools
transfer equipment
camera
pressure mapping system
How long does a w/c eval take?
90 to 120 minutes
How long does a w/c fitting appointment take?
60 to 120 minutes
Subjective eval for w/c
Medical status and hx
living situation (w/c accessibility)
current functional level
transportation
cognitive issues
visual/perceptual deficits
time spent in current w/c, current measurements
Mat evaluation
- posture
- sitting balance
- ROM
- Strength
- Tone
- Measurements
- Skin check
- Functional Eval
Posture eval
measure in the 3 following situations:
1. In current w/c
2. Edge of mat
3. Supine
helps you to see with gravity, gravity eliminated, and how equipment impacts it
In all 3 positions of posture, look at
balance
pelvic tilt, rotation, obliquity
lego position
lumbar lordosis
thoracic kyphosis
scoliosis
shoulder position
head position
Windswept deformity
describes the appearance of abnormal valgus deformity in one knee in association with varus deformity in the other
named for the lower ASIS
Pelvic obliquity
frontal plane deformity and is always named for the lower ASIS
Posterior pelvic tilt is associated with
thoracic kyphosis
ROM that should be measured for w/c
Hip
Knee w/hips flexed
Ankle w/knees flexed
Hamstring length
UE
Strength eval
necessary to note grip strength, UE, and LE
Functional Eval includes
transfer ability
balance assessment
gait
pressure relief
manual w/c propulsion
power w/c driving
Types of manual w/c
Standard weight
Bariatric
High Strength Lightweight
Ultralight
Tilt in space
Standard weight
least expensive
designed for infrequent, short duration use
little adjustability
Bariatric w/c
accommodate users over 250 lbs
accessibility is an issue because of wider seat widths
High strength light weight wheelchair
justified for a full time user of w/c
height is adjustable
flip back armrests
limited vertical axle adjustability
Ultralight w/c
fully customizable
typically under 25 lbs
must have features that match anatomical dimesions of individual and functional ability
Customizable features of ultralight w/c
- seat surface height at front and rear edge
- seat plane angle
- seat width and depth
- back support height
- seat to back support angle
- foot support to seat height
- leg to seat surface angle
- horizontal and vertical position of rear axle
- rear wheel camber
- wheel and caster type/size
More forward axle on ultralight w/c
decreases overall rolling resistance, allows easier negotiation of variable terrain, limits the risk of UE strain or injury over time
ideal set up is to have fingertips reach the hub, with the hub directly behind the shoulder
Too far forward axle on ultralight
injury from tipping backwards
Tilt in space manual w/c
dependent user who typically does not self-propel
needs pressure relief with tilt in space
can tilt from 0-50°
pediatric ones can adjust for growth changes
Power assist systems
with the first stroke, the motor engages and keeps the chair going until the user decides to stop or needs to stop
medicare requires at least 1 year in a manual chair prior to this
good for patients that wants a manual w/c, but has power w/c needs
Power w/c types
Scooters
Group 2 power
Group 3 power
Scooters
typically used for outdoor use only, houses don’t have enough room for them
difficult to get covered by medicare
Group 2 power w/c
rental
medicare rents these for 13 months
lower end power, used mostly for mobility for little need for specialty seating
Group 3 power w/c
most common of power w/c
can be set up with speciality seating, custom seating, power seat functions, specialty controls
When will medicare cover a Group 3 power w/c?
if mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity
Power drive wheel configurations
rear wheel
front wheel
mid wheel
Rear wheel drive configuration
used to be most available
have large turning radius and accessibility issues
Mid-wheel drive configuration
majority of current w/c are this
is most maneuverable, tightest turning radius, and smallest turning circumference
Front wheel drive configuration
navigate tight corners better due to small front end. difficult to turn 360° due to long back end
large drive wheels at front let you traverse obstacles, can do variable terrains
Things to help with safety for power w/c
improved suspension systems
tracking tech
lights
charging ports
bluetooth
Power seat functions
- power tilt in space
- power recline
- power elevating leg rests
- power seat elevators
What are power tilt in space used for?
at least 45° of tilt for pressure relief
anterior tilt for transfers
What are power recline capabilities used for?
cathether
Uses of power elevating leg rests
edema
power seat elevators use
transferring
Recline vs Tilt
Medicare requirements for power seat functions
- user meets all coverage criteria
- speciality evaluation was performed by licensed professional
- a RESNA certified ATP had direct in person involvement with w/c selection
Seat elevators
allows for seat to rise up to 14 inches
Alternative Drive controls
head array
sip/puff
speciality joysticks
chin control
Cushion types
general use
pressure relieving
positioning
positioning/pressure relieving
positioning/pressure relieving/adjustable
custom
Other positioning needs
backrests
head rests
armrests
hip guides
abductor wedges
side guards
footrest configuration
Plan AFTER w/c eval
trial at home
follow up clinic appointments for custom seating
home health or outpatient therapy to work on driving
fitting at home or in clinic
Letter of medical necessity
speciality letter versus through eval documentation that includes medical justification of w/c
includes summary, measurements, recommendations
