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Orthotic Study > Seating > Flashcards

Seating Flashcards

1
Q

Why its important

A

Can be closely related to fit and function of prosthetic/orthotic devices

Ex. Amputee may require modifications to footrests to accommodate prosthesis

Children with reciprocating gait orthosis will have moveable pelvic laterals which can easily be adjusted to change in pelvic width

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2
Q

General Principles

A

Comfort
-enable person to sit in upright position for several hours at a time

Function
- allows person to participate in home/school/work related activities

Practical
- provides easy access to home, toilets, car, and environment

Physiologicial

  • decrease progress of deformity and dislocation, prevent trauma
  • improved respiration, bowel, and bladder function, upper extremity control

Mobile- maximize independence

Cosmesis

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3
Q

Mobility Devices

A

Stroller

Manual Wheelchairs

Midrange chairs

Ultra lights and Sports chairs

Electric Wheelchairs

Scooters

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4
Q

Headrests

A

Different types and combinations

Most common is flat headrest mounted to backrest to prevent injuries in transit

Tilting can also help maintain head on headrest

Can be difficult component to fit, often fitted last once the trunk is stabilized

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5
Q

Henzinger Collar

A

Foam roll structure which fit around neck with 2 extensions which rest on the chest wall to support the chin

Can be mounted on plate so it can be attached to backrest

Good for children with moderate head control

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6
Q

Ottobock Contoured Headrest with Forehead support

A

Occipital Support and Lateral wings combined into headrest

Forehead support has a metal structure covered in soft rubberized foam

Straps attach the two together and prevent head from falling forward and reduce neck hyperextension

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7
Q

Backrests

A

Help maintain trunk in a upright position over the pelvis and prevent any lateral leaning

Also serve to remind person to return the trunk to upright/midline position and can be used to help distribute any forces evenly over bony locations

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8
Q

Contoured backs

A

Most common

Has slight concave bend to it so that it wraps around persons chest wall and provides moderate support

More complex backs can accommodate spinal deformities, custom molded from cast of person

Low tone children will require more support

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9
Q

Bean bag vacuum method

A

Air is evacuated out of the bag the rubber bladder can be pulled and shaped to target areas of required support

Afterwards cast of the bladder is made and cushions can be created from this

Often method used for custom seat cushions

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10
Q

Seats

A

Provide stable base of support

Help distribute total body weight over broader area

Help reduce risk of pressure sores

Style and construction dependent on person’s ability to detect, adjust to any discomfort after prolonged sitting

Most fabric slung seats not suitable for prolonged sitting

Replacement with flat rigid base to support seat cushion helps person feel more stable and secure

Custom seats also take into account contractures and deformities that might be difficult to fit with off the shelf seats

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11
Q

Cushions

A

Gel, air and foam cushions useful in prevention and management of pressure sores

Total contact nature of cushion re-distributes forces away from the sacrum and ischial tuberosities

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12
Q

ROHO high profile dual compartment cushion

A

4 inch (10cm) interconnected air cells provide exceptional therapeutic properties

Dual compartments can be adjusted independently to increase positioning and stability for either side to side or front to back

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13
Q

JAY cushions

A

Provide floatation effect by splitting up the bladder into 3 compartments

Left and right thigh sections and 1 in the sacral area

Prevents fluid (clay and oil mix) from being driven out of one location and increasing the risk of a pressure sore

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14
Q

Foot Rests

A

Properly supported legs prevent pelvis from being pulled out of the seat and reduce any pressure along anterior edge of seat

Foot rests can also be used by some children as aid to transferring to and from ground

Important they they area set at right angle and elevation for the legs

Elevating leg rests must also be able to accommodate for changes in leg length as it moves from flexed to extended

Individual foot pods pods can help control foot and leg position and use foot straps helps to secure the foot in stable position while operating the chair

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15
Q

Strollers

A

Often first mobility device that child uses

Light and simple to transport

Easy for parents to use

Accepts a seating insert

Adult models available

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16
Q

Manual Wheelchair, standard/institutional wheelchair

A

Very sturdy

Heavy steel tubing 30-40lb

Simple in design

Limited adjustable features

Gets you from A to B

Rental units

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17
Q

Midrange Chair

A

Alloy tubing for lighter frames

Different wheel assemblies and sizes

Precision wheel bearings

Better seat and back support

Removable armrests

Various Footrest angles and plates

Requires more maintenance

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18
Q

Ultra Lights and Sports

A

Very light and maneuverable

Custom designed for sport application

Not normally used as primary chair

Very high maintenance

Increased camber on wheels help align wheels with arms and provide more stability

Anti-tipper wheels prevent flipping chair backwards

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19
Q

Electric Wheelchairs

A

For patients who lack physical strength or endurance to propel a manual wheelchair

Available sizes
Children 12x12
Adult 36x20

Options include

  • tilt and recline mechanisms
  • zero shear backs
  • elevating leg rests
  • elevating seats
  • light packages
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20
Q

Scooters

A

Easy access to mobility that is only used for distances that person could otherwise not walk

Average speed 5-12mph

3-4 wheel models carries up to 300lbs

25-30 km range on a full charge

Options can be added

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21
Q

Custom seats

A

Insert specifically tailored to fit individual needs of the patient

Can be comprised of many types of materials

Most commonly foam and plywood, foam and plastic

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22
Q

Foam in Place

A

Pour A B foam into plastic bag which the person is sitting on

Fast method of cushion fabrication which can be done at patients home or facility with minimal tools

Doubled up flannel shit protects patient from heat of expanding foam, also acts as spacer which is latter replaced with layer of soft foam

Seat and back would be 2 separate pours

Foam is hard, should be covered with soft layers of foam in high pressure areas

Pros
Static sitters who have severely deformed backs or pelvic deformities

Cons
Require several experienced hands to do
Not good for dynamic sitters as they move within confines of cushion and create areas of high pressure = pressure sores and discomfort

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23
Q

Foam Injected

A

Impression of patients back or seat is taken with beanbag and vacuum pump

Bean bag shape can be altered before cast is taken

Soft foam cushion is produced from the cast

Can be sent to cushion manufacturer (Ottobock, Pin-Dot)

Pros
Good for static sitters
Moderate movers who have severely deformed backs and or pelvic deformities
Can be modified more easily than foam in place style cushion

Cons
Can be bulky/chunky
Limited colours of covers
Difficult to attach straps to
Can’t put any slots in cushions for straps as this is difficult to clean
May have difficulty fitting into chairs with armrests
Have to use interface which comes iwth manufactures cushion
Insert is quite chunky lookin

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24
Q

OTS (Off The Shelf)

A

Several large manufactures offer complete seating systems using modular components

Can be easily assembled with limited tools

Pros
Easy to obtain
Easy to assemble
Easy to adjust

Cons
No seating system is acceptable in all situations
Have to know when to amalgamate different components to create most optimal seating system
Price is not that far off cost of custom fabricated seat

25
Q

CP goals to consider 1

A

Influencing muscle tone

Decrease tone by positioning feet 90 degrees

Knees 90 degrees

Hips 90 degrees

Helps break extensor pattern in some CP children

26
Q

CP goals to consider 2

A

Facilitating motor control by selectively controlling degrees of freedom at various joints

Progressively decreasing degree of external support as control develops

27
Q

CP goals to consider 3

A

Facilitating skeletal development through appropriate weight bearing and balancing of muscle forces

28
Q

CP preventing contracture

A

Preventing contractures through promotion of neutral alignment and counteracting the force of gravity

29
Q

CP goals to consider 5

A

Preventing pressure sore development by distribution of weight through support surfaces and use of materials allowing heat dissipation and moisture absorption

30
Q

CP goals to consider 6

A

Preventing of cardiorespiratory comlications

31
Q

CP goals to consider 7

A

Facilitating perceptual, cognitive, and social development through provision of opportunities for environmental interaction

32
Q

CP Low Tone

A

Child requires full control seating system which totally supports the main trunk and extremities

Head control difficult and tilting the insert 10 to 15 degrees will help

33
Q

CP High Tone

A

Strong extensor pattern present and difficult to obtain a normal seating position

Will require strong seating system (aluminum and foam)

Use of belt restraints to maintain the trunk and legs in the desired position

34
Q

Hands free sitter

A

Can sit for long periods of time without using hands for support

Requires a firm foam cushion for a stable base of support

Simple back with minimal trunk support

Able to transfer from chair independently

35
Q

Hands dependent sitter

A

Because of severe functional or structural deformity

Unable to sit without major modifications to allow for pelvic, trunk and sometimes head and neck support

Benefits form the use of a tray to support the trunk with their hands

36
Q

Spina bifida, goals to consider

A

Stable, “hands free” sitting posture

Patient comfort

Ease of transfer = transfer foot rests with convenient hand grips

Avoid pressure sores = ROHO or Jay cushions

Esthetic acceptability

Accommodation for RGO or standing frame assembly

37
Q

Spina bifida children

A

Generally start with caster cart

Then progress to manual wheelchair

As activity level decreases, children grow in circumference rather than length, accommodation for pelvic width is always a concern

Power wheelchair is final means of transportation with transfers being done by some type of lifting mechanism

Insensitive skin always at risk and should be supported with proper pressure relief cushion

38
Q

Spinal deformities

A

Scoliosis, kyphosis, combined with pelvic obliquity may result in uneven pressure distribution and localized areas of increased pressure over the ischial tuberosities, greater trochanter, or coccyx

May lead to decibitus ulcers

Patient with severe kyphosis are prone to skin breakdown over the apex of the kyphos

Pocket in the back cushion to accommodate the kyphos and decrease the pressure and transfer the pressure to other areas around the kyphos

39
Q

Spinal cord injuries

A

SCI patient seating requirements will depend upon their level of injury and the remaining function

Higher level quads (C1-C4) will need more seating intervention in the way of power chair with tilt and recline and a completely supportive seating system

Pressure sores are #1 problem

Use of low back manual chair to allow better upper trunk function

Tend to be sacral sitters, beneift from chest restraints

40
Q

Pelvic Rotation deformity

A

Caused by

  • asymmetrical tone in hip adductors
  • asymmetrical tone in trunk rotators

Solutions

  • pelvic “y” strap in mild cases
  • pelvic blocks placed below the anterior superior spine on the side of the pelvis which is rotated forward (used in combination with a firm back)
  • appropriate accommodation of leg length discrpancy
41
Q

Pelvic Obliquity

A

Causes

  • spasticity of trunk side flexors
  • unilateral hip extensor spasticity
  • hammock seat

Solutions

  • firm seat
  • lateral pelvic supports
  • pelvic y strap
  • pelvic positioners
42
Q

3 types of sitters

A

Hands free sitter- don’t use hands, can sit without trunk support

Hands dependent sitter- hands or trunk support

Prop sitters- cannot sit unless supported with trunk support

43
Q

4 seating principles

A
  • stable base of support
  • friction prevents slipping
  • managing pressure distribution
  • torso over base of support
44
Q

Main Goals

A

Pressure distribution

Accommodation of deformities

Managing tone

Pelvis as stable base of support

45
Q

Thigh length

A

back of sacrum to popliteal area

46
Q

Tibal length

A

1 inch below popliteal area

Plantar surface of the foot

47
Q

Arm length

A

Top of shoulder to the elbow

48
Q

Forearm Length

A

Olecranon to wrist (more distal if required)

49
Q

Length of the chest laterals

A

Base of the seat to 1 inch below axilla

50
Q

Headrest heaight

A

Top of shoulder to top of the head

51
Q

Foot length

A

Heel to toe

Shoes on shoes off

52
Q

Pelvis Width

A

GT to GT

53
Q

Chest Width

A

Edge to edge of the rib cage 1 inch below axilla

54
Q

Other important widths

A

Width of head

Width of the thigh

55
Q

Pommel Width

A

Distance between medial tibial condyles

56
Q

Ways to prevent IT pressure

A

Distribute pressure on the thighs by wedging cushion anteriorly

TIlt of the sit matches thigh angle- accommodates hip contractures

Pressure underneath the thighs, foot is taking weight as well- not excessive space under the thighs though, or excessive pressure, balance

Pelvis is supported in an accommodated position

57
Q

Ways to prevent patient from sliding out of a chair

A

Seat belt

Posterior wedge the seat (beware of excessive IT pressure)

Posteriorly tilt the chair

Prevents positions that increase tone

58
Q

Ideal position in a chair

A

90 flexed at the hip

90 flexed at the knee

90 flexed at the ankle

Pelvis is level

Back is supported

Orthotic Study (45 decks)

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