Mobility and Transportation Flashcards
Benefits of Standing Frames
- Reduced incidence of pressure ulcers
- Improved bladder and bowel function
- Alleviation of orthostatic hypotension
Proportional Control
The greater the displacement, the faster the chair moves. (ie: joystick control)
Prone Standers
- Most common
- Support on anterior
- Weightbearing on long bones
- Tilted forward to use gravity
- Does not move to seated position
Supine Standers
- Less common
- Supports posterior side
- Harder to use hands and sight (due to angle)
- For poor head control
Upright Standers
• Complete weightbearing on LEs
Mobile Standers
- Wheelchair to standing position
- Can be manual or power-driven lifters
- May not be mobile in upright position
Increase in use of mobility systems related to:
- Rising rates of obesity
- Accessibility legislation
- Increasing proportion of older adults in many countries
Most often use Scooters:
Marginal ambulators and those who need to conserve energy (ie: COPD)
Powered Wheelchair Controllers Offer:
- Short throw adjustment (degree of ROM required)
- Programmability
- Momentary or latched control
- Sensitivity (ie: tremor dampening)
Leading group of mobility device users:
STROKE (leading in US, 11.1%)
also top users: CP, Muscular Dystrophy, SCI
Marginal Ambulators
Able to move independently in their environment but function only at a slow rate or for short distances.
Benefits of powered mobility for young children:
- Social
- Cognitive
- Physical
Needs specific to older adults and mobility devices:
- Safety, increased function, and a feeling of security when moving in their environment
- Loss of motor and sensory abilities that make it difficult to propel a manual wheelchair.
Independent Manual Mobility Systems used for:
Individuals who are physically able to propel a wheelchair.
Supporting structure of wheelchairs include:
- Frame
* Attachments to it
Bariatrics
Medical field concerning individuals who are obese
Important elements of person’s functional abilities evaluation:
- ADLs/IADLs
* Wheelchair skills
Tilt
The ability to rotate a specific seating position around a fixed axis.
Recline
Changing the seat-to-back angle, resulting in a seat-to-back angle greater than 90˚.
Article 9 from UN Convention on Rights of Persons with Disabilities (2009)
“When an individual is denied the ability to travel to the location of a desired occupation, she is clearly unable to engage in that occupation. Lack of accessible transportation limits employment, education, recreation and civic occupational activities.”
3 Key Activities Related to Transportation
1) Occupant Protection
2) Vehicle Accessibility
3) Driving
Occupant Protection
- Seat Belts
- Car Seats
- Wheelchair Tie-Downs
What is Required for Use of Seat Belts?
- Trunk control
- Hands-free sitter
- Joint contractures/casts may limit function
- Cognitive impairment may result in unsafe behavior
Car Seat Varieties
Commercially Available: accommodate children under 65 lbs (sometimes up to 100 lbs)
Specialized: For children with casts or in need of abduction support; for children with low tone who cannot hold upright head; for children who may exhibit unsafe behaviors
Wheelchair Tie-Down Securement
Must include 4-Point Strap Tie-Down system AND 3-Point Occupant Restraint System to be safe!
• Seatbelt that comes with w/c is NOT rated motor vehicle safe
• Tie-down secures w/c to vehicle, seatbelt must secure person.
Vehicle Accessibility Considerations:
- Ramps
* Handles
Driving Modifications
- Primary Driving Controls: steering and pedals
- Secondary Driving Controls: turn signals, parking brakes, lights, horn, ignition, temp control, wipers
- Handled separately since secondary controls differ by vehicle.
Steering Wheel Modifications
- Tri-Pin (for driver with minimal grip strength or wrist stability)
- Fork/V or Palm Grip
- Spinner knob
- Amputee Driving Ring (for prosthetic hook)
Driving Pedal Modifications
- Left Foot Accelerator
- Pedal Extensions
- Hand Controls (accelerator and brake)
Safest location for Child in Vehicle
Center rear seat. If not available, seat that borders road shoulder is 2nd best.
Contexts for Mobility Devices
PHYSICAL: indoor/outdoor; accessible environments; size of doorways, layouts; floor surfaces; portability of device; climate
SOCIAL: family, peers, and others in social environment influence choice of device; peers can share knowledge; others can pressure decision; accommodations at school/work/etc.
CULTURAL: culture affects w/c use and recommendations based on: values related to cultural inclusivity; availability of technology (remote community?); access to technology (funding mechanisms?).
INSTITUTIONAL: criteria for funding; eligibility; restrictions on where device can be used; requirements for client performance.
Underlying Factors in Classification of Manual Wheelchairs
- Type of frame (rigid or folding)
- Adjustability of the position of the axle of rear wheel
- Material used to construct w/c frame
3 Common Frame Styles
1) Box (rectangular, strong and durable base)
2) Cantilever (lighter weight, box replaced by single bar betw wheels)
3) T or I Frames (T=similar to cantilever but single bar connects to single front caster; I=similar to T, but with 2 front casters)
Stability and Maneuverability of w/c is affected by:
Position of the axle of the drive wheel relative to the user’s center of gravity. Make positioning adjustments based on needs/activity level of user:
• Center of Gravity FORWARD of the axis of drive wheels makes it more stable but harder to move
• Center of Gravity ABOVE axis of drive wheel, or behind, decreases stability but increases movability
Most common w/c drive wheel type?
Rear and Mid Wheel Drive are most common styles.
Locations of Casters and Anti-Tip Wheels on Different Wheel Styles:
Rear Wheel: Casters in front, anti-tip in back
Mid Wheel: Casters in front and back, anti-tip in back
Front Wheel: Casters in front and back, anti-tip in front
Sip-n-Puff
Common w/c control for SCI. Small tube near mouth. Good oral motor control required to use.
Hard Puff = Forward
Hard Sip = Backward
Soft Puff = Right
Soft Sip = Left
*Includes “Latch”: direction continues until changed by user.
Head Control
W/C control in headrest. Three-direction control.
Back Push = forward Right Tilt = right Left Tilt = left Head Forward (off headrest) = stop
Factors to Consider When Selecting a Wheelchair
- Client profile (disability, date of onset, prognosis, size, weight)
- Client needs (activities, contexts of use, preferences, transportation, durability, cost)
- Physical/Sensory skills (ROM, motor control, strength, vision, perception)
- Functional skills (transfers and ability to propel)
Adjustments to w/c that help user comfort, safety and performance:
- Axle position
- Wheel camber (angle of wheels toward body)
- Wheel alignment
- Seat angle
- Back height/angle
- Leg/foot rest height/angle
Occupant Protection (define)
Refers to structures provided by the original equipment manufacturer (OEM)—such as seatbelt assemblies and airbags—and those added to the vehicle—such as child restraint systems and w/c securement systems—that contribute to the protection of vehicle occupants during regular transportation and in the event of a crash. Secure and safe positioning; and limiting excess movement during a collision.
Vehicle Ingress vs. Egress
Ingress = Act of entering the vehicle
Egress = Act of exiting the vehicle
Present for both private and public transportation vehicles. Includes with/without another type of AT (ie: mobility device). Includes prevention of unintentional egress (ie: cog impairment cannot open door while car moving).
Primary vs. Secondary driving activities
Primary = Acceleration/deceleration, stopping, steering
Secondary = Activation of turn signals, setting parking brake, operating lights, entertainment/nav systems, temp control, turning ignition on/off.
Types of legislation that affect AT use related to transportation
1) Occupant protection (seat belts, child restraints)
2) Standards related to crash-testing
3) Policies related to licenses to drive a vehicle (vision requirements, health conditions, “graduated” licensing)
Requirements for Child Restraint System
Most jurisdictions require:
• Children <40 lbs must be secured in restraint system
• Use of booster seat for betw 40-80 lbs
3 Types of Child Restraint Systems
- REAR-facing infant seats (from birth to 12 mo/22 lb-Note many reach 22 lb first, but should still be rear-facing! Some rear-systems now go up to 45 lbs.)
- FORWARD-facing infant seats (for long-term use; up to 40 lbs/40 inches; proper installation is crucial!)
- BOOSTER seats (children > 40 lb/40 in.; positions so seat belt fits properly. Must be ~80 lb/4’9” to use regular seat).
Hand Controls for Accelerator/Brake Design Approaches:
• Push-pull • Push-twist • Push-right-angle-pull • Push-tilt (For all: First half is the brake, 2nd is the acceleration).
When released, returns to off position.
Usually operated with left hand/right for steering, but opposite is available.
