Mobility and Transportation

Question 1

Benefits of Standing Frames

Answer 1

• Reduced incidence of pressure ulcers
• Improved bladder and bowel function
• Alleviation of orthostatic hypotension

Question 2

Proportional Control

Answer 2

The greater the displacement, the faster the chair moves. (ie: joystick control)

Question 3

Prone Standers

Answer 3

• Most common
• Support on anterior
• Weightbearing on long bones
• Tilted forward to use gravity
• Does not move to seated position

Question 4

Supine Standers

Answer 4

• Less common
• Supports posterior side
• Harder to use hands and sight (due to angle)
• For poor head control

Question 5

Upright Standers

Answer 5

• Complete weightbearing on LEs

Question 6

Mobile Standers

Answer 6

• Wheelchair to standing position
• Can be manual or power-driven lifters
• May not be mobile in upright position

Question 7

Increase in use of mobility systems related to:

Answer 7

• Rising rates of obesity
• Accessibility legislation
• Increasing proportion of older adults in many countries

Question 8

Most often use Scooters:

Answer 8

Marginal ambulators and those who need to conserve energy (ie: COPD)

Question 9

Powered Wheelchair Controllers Offer:

Answer 9

• Short throw adjustment (degree of ROM required)
• Programmability
• Momentary or latched control
• Sensitivity (ie: tremor dampening)

Question 10

Leading group of mobility device users:

Answer 10

STROKE (leading in US, 11.1%)

also top users: CP, Muscular Dystrophy, SCI

Question 11

Marginal Ambulators

Answer 11

Able to move independently in their environment but function only at a slow rate or for short distances.

Question 12

Benefits of powered mobility for young children:

Answer 12

• Social
• Cognitive
• Physical

Question 13

Needs specific to older adults and mobility devices:

Answer 13

• 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.

Question 14

Independent Manual Mobility Systems used for:

Answer 14

Individuals who are physically able to propel a wheelchair.

Question 15

Supporting structure of wheelchairs include:

Answer 15

• Frame

* Attachments to it

Question 16

Bariatrics

Answer 16

Medical field concerning individuals who are obese

Question 17

Important elements of person’s functional abilities evaluation:

Answer 17

• ADLs/IADLs

* Wheelchair skills

Question 18

Tilt

Answer 18

The ability to rotate a specific seating position around a fixed axis.

Question 19

Recline

Answer 19

Changing the seat-to-back angle, resulting in a seat-to-back angle greater than 90˚.

Question 20

Article 9 from UN Convention on Rights of Persons with Disabilities (2009)

Answer 20

“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.”

Question 21

3 Key Activities Related to Transportation

Answer 21

1) Occupant Protection
2) Vehicle Accessibility
3) Driving

Question 22

Occupant Protection

Answer 22

• Seat Belts
• Car Seats
• Wheelchair Tie-Downs

Question 23

What is Required for Use of Seat Belts?

Answer 23

• Trunk control
• Hands-free sitter
• Joint contractures/casts may limit function
• Cognitive impairment may result in unsafe behavior

Question 24

Car Seat Varieties

Answer 24

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

Question 25

Wheelchair Tie-Down Securement

Answer 25

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.

Question 26

Vehicle Accessibility Considerations:

Answer 26

* Ramps | * Handles

Question 27

Driving Modifications

Answer 27

* 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.

Question 28

Steering Wheel Modifications

Answer 28

* Tri-Pin (for driver with minimal grip strength or wrist stability) * Fork/V or Palm Grip * Spinner knob * Amputee Driving Ring (for prosthetic hook)

Question 29

Driving Pedal Modifications

Answer 29

* Left Foot Accelerator * Pedal Extensions * Hand Controls (accelerator and brake)

Question 30

Safest location for Child in Vehicle

Answer 30

Center rear seat. If not available, seat that borders road shoulder is 2nd best.

Question 31

Contexts for Mobility Devices

Answer 31

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.

Question 32

Underlying Factors in Classification of Manual Wheelchairs

Answer 32

* Type of frame (rigid or folding) * Adjustability of the position of the axle of rear wheel * Material used to construct w/c frame

Question 33

3 Common Frame Styles

Answer 33

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)

Question 34

Stability and Maneuverability of w/c is affected by:

Answer 34

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

Question 35

Most common w/c drive wheel type?

Answer 35

Rear and Mid Wheel Drive are most common styles.

Question 36

Locations of Casters and Anti-Tip Wheels on Different Wheel Styles:

Answer 36

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

Question 37

Sip-n-Puff

Answer 37

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.

Question 38

Head Control

Answer 38

W/C control in headrest. Three-direction control. ``` Back Push = forward Right Tilt = right Left Tilt = left Head Forward (off headrest) = stop ```

Question 39

Factors to Consider When Selecting a Wheelchair

Answer 39

* 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)

Question 40

Adjustments to w/c that help user comfort, safety and performance:

Answer 40

* Axle position * Wheel camber (angle of wheels toward body) * Wheel alignment * Seat angle * Back height/angle * Leg/foot rest height/angle

Question 41

Occupant Protection (define)

Answer 41

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.

Question 42

Vehicle Ingress vs. Egress

Answer 42

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).

Question 43

Primary vs. Secondary driving activities

Answer 43

Primary = Acceleration/deceleration, stopping, steering Secondary = Activation of turn signals, setting parking brake, operating lights, entertainment/nav systems, temp control, turning ignition on/off.

Question 44

Types of legislation that affect AT use related to transportation

Answer 44

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)

Question 45

Requirements for Child Restraint System

Answer 45

Most jurisdictions require: • Children <40 lbs must be secured in restraint system • Use of booster seat for betw 40-80 lbs

Question 46

3 Types of Child Restraint Systems

Answer 46

* 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).

Question 47

Hand Controls for Accelerator/Brake Design Approaches:

Answer 47

``` • 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.