Positioning in Long-term Care Flashcards
Who provides assessment guidelines for wheelchairs?
The Rehab Engineering and Assistive Technology of North America (RESNA)
What are the three RESNA wheelchair assessment categories?
1) Body structure and functions
2) Activities and participation
3) Environment and current technology
What is the wheelchair assessment and intervention process?
- Patient interview: do they feed themselves; has there been weight loss or swallowing issues; neurological history; tone; subluxation?
- Postural observations while seated and supine
- Patient’s mobility status: how does the patient currently ambulate; do they need assistive devices; do they currently have positioning supports; are they working?
- Sitting balance: while supported by therapist and unsupported; used to assess if person is stuck or if the person can move out of position
- Supine assessment: used to assess if person is stuck or if the person can move out of position when gravity is eliminated
- Skin integrity: are there pressure areas or a history of sores?
- Trial of positioning solutions if available
- Provision of devices
- Training and follow-up
What does a mat assessment entail?
- Sitting balance
- Observation of posture when supported by therapist and unsupported
- Supine assessment to assess what the posture does when gravity is eliminated and how moveable the body is, especially the pelvis
- Can the person achieve a neutral pelvis?
What are the different terms for sitting balance?
- Hands free
- Hands dependent
- Propped sitting
Why is it important to fix the pelvis first?
- It is the COG
- It is the anchor of the skeleton
- Its position affects everything proximal and distal
- The goal is to achieve a neutral pelvis
What is needed when someone has an anterior tilt in the pelvis?
- Is the pelvis fixed or reduceable?
- May need lumbar support secondary to increase in lordosis and pressure on the ischial tuberosities it produces
How does a posterior tilt in the pelvis affect a person?
- Increases pressure on coccyx and sacrum
- Leads to forward head, kyphosis, and forward/rounded shoulders
- Limits UE ROM
- A position commonly seen in foot propellers
What can hard surfaces cause?
- Often causes local pressure on ischial tuberosities
- Does not allow stability
What do wheelchair slings create?
- Posterior tilt
What is pelvic obliquity?
- One side of the pelvis is higher than the other
What is pelvic rotation?
- One side of the pelvis is rotated forward compared to the other side
What is kyphosis?
- Varying levels
- Posture may be the result of osteoporosis can lead to fixed kyphosis
- Posture may be the result of posterior tilt in pelvis
- A reclined wheelchair may be needed for someone with severe kyphosis so that they can socialize, breathe, swallow, and have reduced muscle strain
Why are angular measurements important during a wheelchair assessment?
- ROM of the body is relative to the person’s seating posture
- Different than standard goniometry because both the proximal and distal joints are measured while seated. The proximal joint is not always in neutral when measuring
- Goal is to measure the client’s body angles in the best position of function
- May be different than the 90, 90, 90 rule
- May include a tilt to the seat
What are the dimensions of a standard wheelchair?
- Sitting surface: 16 inches
- Depth of seat should be 2 inches from popliteal fossa. Should be able to fit hands on sides of greater trochanters
- Back height: 1 finger width from inferior angle
