Lecture 10 - Assistive Devices and Standing Frames Flashcards
If child / family doesnt like the assistive device and says they won’t use it than don’t even try
Posterior Walker - often called a kaye walker (brand name)
What it does:
* Improved gait efficiency - this is our goal for everything
* Normalized stide length
* Upright posture during ambulation - better than anterior for this
* Decreased O2 consumption rate (becaue its more efficient)
* Improved step length
* Increased single limb support time
* Flexion angles of the trunk, hip and knee lower using
* Energy conservation
So we want them to stand upright opposed to anterior walker where they might lean forward and flexed
main difference is that the walker is more behind them
can do harnis system. works when they’re modified wt bearing
this alters gait pattern quite a bit so don’t use if you don’t have to
Anterior walkers
* these are more for short term issues.
* used for someone like a 5 year old who breaks there leg and doesnt have the balance and coordination to use crutches, but this isnt a perminant thing
* The posterior walker is more of a perm solution
Gait Trainers
Indications:
* Used for people who do not have functional gait skills or postural control to safely and independently use a standard walker
* Not yet able to consistently bear full wt through legs
* Postural control developing
* Cognitive skills and motivation to move - they want to be able to move
Varied levels of support and modular accessories
Address pre-ambulatory skill development
* form of safe independent mobility in standing position - HOWEVER ITS NOT WALKING, DOES NOT PROMOTE A TYPICAL GAIT PATTERN, will build postural strength / reciprocal LE movements / improve endurance / upright promotes that social interaction
Form of sage, independent mobility in the standing position
* Build postural strength and stability
* Alternating / reciprocal leg movements
* Improve overall endurance
* Promotes social interactions
* Not “typical” gait pattern
Do gait trainers promote a typical gait pattern
Nope
No research to show that they transition to functional gait
they’re big and not functional
Arm Platforms: can wt bear through it
Arm Prompts - guide you not fully support you
Both addons to gait trainers and others
espeically when they start to sit to walk they lose that typical normal gait pattern
Keep the legs where they’re supposed to be so they cant scissor or cross midline
Tray for communcation device
Good for kids who are in the walking range but have developmental delay and arent actually walking yet.
Assist w/ learning how to walk
Supine Stander:
* pt goes on the stander on the back - for more medically complex pts.
* Significant msk weakness
* Help w/ inital standing
* NOTE: They arent always in supine, they start in supine and then are rotated up to the standing position
YOu have to worry about OH, because they’re going from lying down to standing up
Worried about lack of head control - could flop all around - their head is controlled w/ these
What does the prone stander add that the supine did not?
Added challenge of working turnk / neck muscles (because head is unsupported) against gravity for better postural control
Prone stander:
* Working on hip extension / incraesed ROM
* Upright social interaction
* For improving head and trunk control
* Minimize extensor tone - if you’re touching the extensors your incressing extensor tone
* Pressure relief - if they’re in a wheelchair all day in standing and now they’re in prone all that backside of their body is unweighted
typically have a tray so they can rest their arms - sometimes chin promt
So this greatly helped w/ that knee extension, hip extension, DF (opposed to a wheelchair)
* then you don’t have to use your therapy session on that passive stretching - can utilize it for better things
Mobile Stander - it moves and pt is upright
- vertical posture
- Self propelled exploration and freedom - they can push the wheels
- For social interaction
- For independent mobility
- To improve weight-bearing
- To improve weight-shifting and postural control
- To improve trunk contorl
- To improve ROM
different kind of mobile stander for bigger pts
Upright stander:
* Can provide varying levels of support and stability
* Can be used to slowly increase ROM
* Can facilitate social interaction
* Can have removable tray for activity
* Many levels of adjustability
Supine stander = least social itneraction because you’re kind of looking into it
Power mobility = powered wheel chairs
We need to check their cognitive status
* These chairs are heavy!
Don’t have to have great vision now to use them (AI)
Know where they’re going to use it (think small house w/o much turn radius)
Access Point = how you’re going to access the device
* How you’re going to drive it
* One option is.a joystick (this is standard)
* If you’re going to do anything other than a joystick you’re going to have to justify it
Other equipment - so things attached to the pt
* Lines, leads, tubes
* Adaptive communication
* Ventilator
Transfers - need to make sure they can get in and out of the chair
Seat cushion - standard - do not provide pressur releif, just some pressure redistribution
Positioning Features
* think Tilt
What is tilt?
Entire chair tilts back
Angular repositioniong of the seat AND back relative to upright
Changes seat orientation in space
Assist with positioning, pressure relief, and posture
Full tilt system tilt at least 45 degrees
Incremental
Manual or electronic
Benefits of tilt: - great for pressure relief
* Accomodate for muscle weakness
* Accommodate for paralysis
* Accommodate for fatigue of neck and trunk muscles
* Provide neutral head/neck position for safe swallowing and saliva control
* Gravity assisted positioniong for rest
* Safety for traversing challenging terrian
* Minimum 45 degrees tilt for pressure relief/pressure redistribution
* Minimize shear forces of recline (nothing really moves under w/ tilt)
What is recline?
The back of the wheelchair goes back (not the seat like tilt)
allows for change in position
increase hip angle for more ROM
Does not provide pressure relief on bottom
Gives you a new position for self catherization that allows for better hygene / cahnging clothing in
Recline:
* Gravity assisted positioning
* Accommodate hip extension contracture or cast
* Stretching
* Minimize risk of contracture or pain
* Weight relief / pressure redistribution
* Functional tasks w/o transfering out of chair
* Status post surgery
* Spica cast
* Halo
*. Longest wheelbase
* Largest overall turning radius
* Accessibility and maneuverability challenging
How many degrees of tilt do you need for pressure relief?
45 degrees
If chair has tilt or recline it will have a head rest
can have tilt and recline
Standing wheel chairs
* Sitting to standing position
* Are VERY heavy
* Stand, stretch, reach, and work without needing to transfer
* Needs huge BOS so it does tip over = heavy
Transport chair: little wheel chairs that have 4 little small wheels that pt cannot move themseleves
* Short term chair often in hospitals
* Four small hweels
* light wt
* easily folded and lifted
* Short term use
* Someone else pushes them
Strollers
* Pediatric and adult adapative strollers
* Light weight
* normally have a hard seat
* Minimal support
* Folding and ease of transport
* Some have positioning features, including tilt, recline, and combination tilt/recline
* many meet transportation crash test standards
* Integrated transit option may be required
* Client cannot independently propel
need to think about this stuff
if they’re clsoe to the wt capcity going to run the battery a lot faster
durability = normally will only cover new one ~5 years
* need a chair that will last
Integrated power wheelchair
* combines the seating system and drive system
* Cannot be separated
* Limits sizes
* Cannot be retrofitted with different seat frame systems
Powerbase wheelchair
* Modular system
* Separate base contains
* Drive control system
* Batteries
* Motors
* wheels
* Can be separated from seating system
* Modified or replaced
NOTE: to use a scooter you need trunk control
Drive Wheel Configurations:
* Reer drive
* Center/mid drive
* Front wheel drive
* Learning curve when changing configuration - driving a chair w/ a front wheel drive is much different than reer
Below the big wheel is the one that does the driving
Rear wheel drive bases
* Fixed drive wheels in reer
* small front casters
* Good contorl
* Drive in a predictable manner in response to joystick input
* Accurately maneuver in different situations and environments
* Individuals can see where they are going
* Able to watch feet to avoid walls, doors, or other items
* Cannot position feet close to body
* Unable to get close to objects from the front (Desk, sink, counter)
Which chair type has the smallest turning radius?
Mid wheel drive
- makes a ton of sense if you think about it
- would be good for mobile homes
Center and mid wheel drive bases
* Fixed drive wheels in center or middle of chair
* Small casters in front and rear of chair
* Turn from the center
* Smallest turning radius
* Intuitive to operate
* Center of mass is closest to center of mass of wheelchair
* LE can be positioned clsoer to body than RWD w/o interfering w/ casters
they turn where you think they’re going to turn
If you’re driving on different surfaces which type of chair is best?
Front wheel drive chairs
Front wheel drive
* Fxied drive wheels in front of chair
* Swiveling caster wheels in reer
* Outperforms other 2 in multiple performance categoies while retaining many of the benefits and eliminating disadvantages
* Excellent stability
* Incline transition
* Obstacle handling
* Manerbreability
* Positioniong feet positioned close to body with no caster clearance issues
* learning curve
* Back end moves first - not intutitive
* Care to ensure sufficient posterior clearance
* Allows clsoer access to tables and sinks
Variable positionoing features for power wheelchairs
* Any access site or integrated into the drive system
* Power tilt
* Power recline and power elevating legrest system
* Edema: Best with elevating leg rests, tilt and recline - get rids of swelling by draining back to heart
* Power seat elevation
* Power standing - need to really be able to justify lots of these
* Adjustable height foot plate
if you have recline you need leg rests to balance it out
showing pressure relief
smart chair that won’t let you push it to the point where it won’t let you tip it over
power elevation entire seat goes up
Power Assist Wheelchairs
turns normal wheelchairs into power chair
Great because power chairs to very heavy and hard to transport
will increase velocity
good for people that want to use some manual and get this for that little extra boost
