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Semester 5 PMNM Exam 10 > Positioning > Flashcards

Positioning Flashcards

1
Q

Why is mobility necessary

A 
To be functional
QOL
ADLs and IADLs
Work
School
Community
Home mobility 
Social interaction
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2
Q

Mobility is very important for learning across the lifespan

A

If children are not provided with a means to move and explore, then how can they have an understanding of the world around them

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3
Q

If someone is limited in their mobility - then…

A

an assisted means is necessary - whether it be through the use of an aid or a wheelchair

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4
Q

Wheelchair vs. Seating System - Wheelchair

A

Mobility base

- Frame between the wheels

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5
Q

Wheelchair vs. Seating System - Postural Support System is the

A

Seating system
Based on medical necessity
Interface between the individual and the frame

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6
Q

Wheelchair vs. Seating system

A

A lot of things can cause for change in the seating postural support system - pressure sores, posture, communication and feeding needs

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7
Q

Indications for a Wheelchair - with or without a seating system

A

Non ambulatory
Unsafe or unsteady
Non functional ambulatory
Weakness/poor endurance
Infant/child with special healthcare needs
Orthopedic concerns
When an ambulatory is limited to short distances

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8
Q

Indications for a seating system

A 
Issues with comfort/decreased tolerance for sitting
Prevention of pressure sores
prevent deformity 
Accommodate ortho deformity
Dec pain
Inc sitting stability
Improve Resp Func
Enhance mob/function
May improve body image
Min influence of abnormal mm tone
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9
Q

When we say insurance only covers new wheelchair every 5 years for adults (3-5 for kids) we are talking about

A 
The base (the frame)
The seating/support system is based on medical necessity 
The seating system may change over time due to med necessity
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10
Q

What are your goals when seating and positioning - SAFE

A

Providing individual with SAFE mobility

Providing them with alternative seating options

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11
Q

What are your goals when seating and positioning - Pressure relief

A

Neutral alignment to WB

Prevent sheer forces

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12
Q

What are your goals when seating and positioning - independence

A

Provide them a new level of independence
For young - allow exploration
Brings child up to peer level
For older - might provide pain free mobility

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13
Q

What are your goals when seating and positioning - ACCESS

A

To their environment - work, school, home, community

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14
Q

What are your goals when seating and positioning - Communication

A

To level of peers for social interaction

Placement of adaptive communication equipment

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15
Q

What are your goals when seating and positioning - Psychological benefits

A

Interaction with peers
View of self as mobile
Confidence of abilities
Overall improved QOL

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16
Q

What are your goals when seating and positioning - Postural support and ___

A

Inhibit reflexive movements or increased mm tone

Extensor thrust example

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17
Q

What are your goals when seating and positioning - ROM

A

Maintain attainable ROM

You can support them into a position that they currently can obtain

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18
Q

What are your goals when seating and positioning - ROM - remember not to

A

Stretch the individual into a new position!!!

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19
Q

What are your goals when seating and positioning - ortho deformities

A

Can be utilized to dec/delay the progression of ortho deformities by providing postural support

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20
Q

What are your goals when seating and positioning - motor control

A

Suport motor control by increasing stability

By supporting trunk you can gain better control of head and arm - and support neutral alignment throughout the day

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21
Q

What are your goals when seating and positioning - medical benefits

A

Facilitate breathing through upright posturing
GI constipation
Urinary
Feeding/digestion - prevent/reduce reflux

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22
Q

What are your goals when seating and positioning - tolerance

A

Improve tolerance of activity
Endurance
Toleration of upright activity by providing support

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23
Q

What are your goals when seating and positioning - Power vs. Manual

A

Power - they are driving it

Manual - they propel it or have someone propel them

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24
Q

Before the exam - need to know

A

What DME provider will be used
Is the DME provider going to be present
Do you have enough time allotted for the evaluation

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25
Patient evaluation
Exam | Trial/Demo (if needed - powered mobility, standing)
26
After exam
Letter of medical necessity (by PT) Physicians order DME provider obtains approval and orders equipment Wheelchair fitting
27
Patient eval - pt hx
Why are they here today What concerns require a wc/seating system Make, model, condition, age of current chair Priority issues/concerns of pt What has/has not worked in past for this pt
28
Patient eval - pt hx - PMH
``` Medical diagnosis Medications Coinciding med conditions Age Gender Height Weight Nutrition ```
29
Patient eval - pt hx - Home needs
What barriers are present, and how has the family made accomodations
30
Patient eval - pt hx - Transportation
How does the pt plan to be transported
31
Patient eval - pt hx- work
what barriers are present and how has the employer made accommodations
32
Patient eval - pt hx - school setting
levels of school, elevator, classroom placement, accommodations
33
Patient eval - pt hx - Current needs
What mobility related ADLs and ADLs need to be performed | Dressing, bathing... Riding a bus (will need brackets!), self propelling or parent propelled, work
34
Patient eval - pt hx - cognition
In addition to mobility issues, are there cognitive issues impacting ADLs, IADLs, or MRADLs Vision
35
Pt eval - Exam
Systems review as it relates to wc assessment | CP, MSK, NM, Integ
36
Patient eval - Exam - Sensory/Skin
Sensory intact? Skin - are they able to perform pressure relief BB issues
37
Pt eval - Functional Exam - Ambulation
Non ambulatory vs. Ambulatory | Household distance vs. Community distance
38
Pr eval - functional exam - propulsion and
transfers bed mobility hand function
39
Pt eval - mat exam
Supine | Function hip flexion ROM
40
Pt eval - mat exam - functional hip flexion ROM
Stabilize pelvis in best corrected neutral alignment Bend the leg up (feeling ASIS) until 90 degrees Idea is that if you are bending and the pelvis rotates before the 90 - degrees, then you know to stop and measure at that point where you feel the rotation - this is the angle you need to set for the back rest to prevent them from post tilting (sacral sitting) in their chair
41
Pt eval - mat exam- 90/90 Hamstring length
With pelvis in neutral position hip at 90 Raise lower leg until feel resistance Capture angle where you feel post pelvic tilt Most wc are 90 angle at hip and 70 hanger at leg rest so if they can't get to neg 70 or beyond then you might need to get a 90 or 80 degree angle leg rest! And you don't want them resting at their end range so be careful if their end range is that 70 degrees!
42
Pt eval - mat exam - What flexibility is sufficient to fit a standard wc
90 hip flexion -70 popliteal angle neutral ankle IF NOT - poor postural support, poor alignment, scooting forward in chair, inc risk of pressure sores
43
Pt eval - mat exam - what else
ROM Strength MM tone Balance
44
Equipment - the eval will determine what you will need for
Mobility base Seating system Features/Accessories
45
Equipment - Mobility Bases - Strollers - Pros
Lightweight Foldable for storage/transport Semi-supportive (can be) Appears normal
46
Equipment - Mobility Bases - Strollers - Cons
Does not put them at kid level - they are at adult level
47
Equipment - Mobility Bases - Manual WC
Standard large wheel for self propelling One arm drive for propelling with one arm Standard small wheel (propelled by caregiver)
48
Equipment - Mobility Bases - Power WC
Unable to self propel At risk for injury/sustained injury from propelling Inefficient to self propel - too much effort, unable to propel household/community distances
49
Equipment - Mobility Bases - Which power wc allows for most mobility in home
Mid wheel drive/center wheel drive
50
Seating systems - your eval will help you determine your seating system needs -
Identify positioning support needs Identify deformities and if they are flexible or fixed Identify possible solutions to address specific problems to specific causes
51
Seating systems - Identify possible solutions to address specific problems to specific causes - address ___ problems first
Proximal first! | Pelvis = BOS
52
Optimal seating position
Head in neutral Same spinal curve as standing Neutral alignment with head over spine and spine over pelvis Neutral pelvis alignment Equal WB on ischial tub Shoulders slightly back from pelvis Femurs parallel to seat cushion and resting on seat cushion Feet flat on footplates - fully supported in neutral
53
Seating systems - sling back support
For somebody who does not need support No pressure distribution Never used for therapy with Dr. C
54
Seating systems - planar back support
Flat support seating option Limited postural support Can add postural supportive features Can add different foam for pressure relief - layered cushioning
55
Seating systems - Curved/Contoured seating system
Supportive | Moderate ortho deformities
56
Seating systems - Custom molded/foam in place seating
Fixed deformities Moderate to severe postural deficits Down side - growing child they will only last a year max Positive - they are so customized since it is a mold of their body
57
Seating systems - Otto bock shape systems
Like bean bag chair that sucks air out it as you position the child how you want it to fit - then when air is sucked out, it becomes firm and can be made into a seating system
58
Postural Trunk Support - No lateral
Allows full mobility for actively moving patients
59
Postural trunk support - with laterals
Planar (flat) or curved | Provides some trunk support for people with ec trunk control, mild to mod scoliosis, use with TLSO
60
Postural trunk support - hip guides
Counters lateral support | Assists with pelvic and LE alignment
61
Postural trunk support - Hardware
Planar or curved Attaches accessories to the chair Swing away - allows path for transfers
62
Seat Cushions - Foam
Lightweight Inexpensive Compress over time though
63
Seat cushions - Air
Expensive Lightweight Need adjustment overtime (the Roho is often used in hospitals)
64
Seat cushions - Thermoplastic Urethane (honeycomb)
Lightweight Shock absorbing Equal pressure distribution/beehive formation
65
Accessories to help with either mobility or positioning - Tilt/Recline
Tilt - fixed hip angle and entire chair tilts | Recline - just back reclines backwards
66
Accessories to help with either mobility or positioning - Tilt in space
``` Assist with head/trunk control Respiration Digestion Tone fluctuation Pressure relief Visual field Oral motor/secretion management ```
67
Accessories to help with either mobility or positioning - Recline
back reclines while seat maintains its position Opens hip angle for ortho issues Watch for sheer forces
68
Fixed deformity
Permanent change that has been made to bone, ligament, mm, or tendon that prevents neutral positioning Support the body in this position to prevent/limit further progression of the deformity
69
Fixed deformity - the seating system is designed to
SUPPORT the deformity
70
Flexible deformity
Able to mobilize the body into a neutral, or closer to neutral than normal presentation, position via an externally applied force
71
Flexible deformity - designed to
A supportive force is applied that CORRECTS the positional deformity
72
Pot pelvic tilt - possible physical causes
Lack of hip flexion angle Excessive ext mm tone Tight hamstrings
73
Pot pelvic tilt - possible seating system causes
Sliding out of chair (insufficient support) Lack of femur support (seat depth too short) Lack of trunk support
74
Posterior pelvic tilt - possible solutions
``` Check available ROM/seat depth Inc trunk/lumbar support Change angle of seat or change style of lap belt Anti thrust padding Inc knee flex or hip flex Undercut front edge to accommodate tight hams Open hip angle Provide shoulder support/trunk support ```
75
Pelvic obliquity - what is it
One side of the pelvis is elevated Named for the lower side! Often happens with pelvic rotation too
76
Pelvic obliquity - Possible causes
Scoliosis Asymmetrical tone Hip dislocation/sublux Unsupportive seat
77
Pelvic obliquity - Soluations
Contoured/customized seat cushion to support both ischium
78
Pelvic rotation - what is it
One side of the pelvis is anterior to the other Rotation in transverse plane Named for the forward side
79
Pelvic rotation - possible causes
Scoliosis Hip dislocation/sublux Leg length discrepancy Windswept deformity
80
Pelvic rotation - possible solutions
Provide firm pelvic support with seat belt, 4 point seat belt, right sub ASIS bar Custom seat - to accommodate
81
Adduction/IR - possible causes
Excessive extensor tone May see with post pelvic tilt Hips flexed less than 90 Footrest too high/low
82
Adduction/IR - possible solutions
Fully support thigh Dec ext tone (neutral pelvis) Add abductor pommel (medial thigh support)
83
Scoliosis - causes
May be idiopathic or neuromuscular | As scoliosis progresses, it leads to increased pelvic obliquity and rotation
84
Scoliosis - possible solutions
Lateral trunk support Custom molded seat Recline for support and pressure relief
85
Custom seat - custom molded seating system - used for
Moderate to severe scoliosis Poor trunk control Total contact for pressure relief Fixed pelvic rotation/pelvic obliquity
86
Head support - aimed to
Attempting to obtain neutral alignment
87
Head support - possible problems
``` Excessive mm tone Lack of mm tone Reflexes - ATNR Excessive hyperextension Excessive flexion ```
88
Letter of medical necessity - describes
Patients condition Problems with current seating system or lack there of How position impacts their condition Why each component of the wc is medically necessary
89
LMN - Medically necessary
Explains what the equipment is Explains what impact the equipment will have on the individual May explain what will happen if the individual does not receive the impact
90
LMN should also include info for
How child will use the equipment How it will impact their life Other pertinent info - Use DME provider as a resource!
91
End goals
Family/caregiver education on positioning and wc safety Does the new seating system meet the individuals goals/needs Safe, Prevention, Functional, Mobility in their environments, Resources for maintenance

Semester 5 PMNM Exam 10 (6 decks)

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