Seating and Mobility Flashcards
what are the 3 posture tendencies?
posterior, anterior, lateral
the goal is to reduce or eliminate negative postural tendencies for:
loss of ROM, skin breakdown, structural scoliosis, poor head alignment, impaired breathing support, impaired swallowing
if the postural tendency is happening because of _____, what should your intervention be?
- ROM
- hypertonicity/spasticity
- hypotonia
- visual/perceptual
- intervention should not be setup at end range deviation
- need setup for tone management strategies
- critical to position against gravity
- critical to give lateral support of trunk
an area of damaged skin usually found over a bony prominence that generally comes from prolonged pressure, friction, shear, heat and/or mositure
pressure injuries
where do the majority of pressure injuries occur?
sacrum, coccyx, ITs, GTs, calcaneus, lateral malleolus
what are the two primary factors that influence skin breakdown?
give two functional examples of this?
- friction –> force that resists motion of two objects sliding against each other
- shear –> distortion from opposing forces at the surface of the skin
examples: sliding down in bed and in wheelchair
what are 3 other factors that can influence skin breakdown?
moisture
heat
medical issues ex. nutrition, DM
what are some things to educate your patient about regarding skin breakdown?
risk factors
daily skin inspections
stages
pressure reliefs
cushion maintenance
what does a stage 1 skin breakdown look like?
red area that does not go away after 15 minutes of getting off of it
–> look for difference in skin color for darker skin
what should you do if your patient has stage 1 skin breakdown?
if related to the wheelchair: contact wheelchair vendor for modifications and/or to be evaluated by PT and reduce time in w/c until modifications can be made
what are 3 techniques used for pressure reliefs?
why do you need to be able to sustain these techniques for at least 2 minutes?
wheelchair pressups
forward and lateral leans
powered options –> power tilt and power recline
need to maintain for 2 minutes as that is the time needed for blood reperfusion to the skin
how often should your patient do pressure reliefs?
at least every 20-30 minutes and more often if they have skin breakdown
what are considerations when determining your seating intervention?
angles on w/c
orientation of w/c frame
materials needed for pressure relief, postural control, or spasticity management
postural support needed
client’s back shape or corrected shape
what are the 4 types of seating and back supports?
general use
positioning
pressure relieving
pressure relieving and positioning
list types of materials in seating supports
air
gel
foam
combination products
offloading
pressure redistribution vs. offloading
list some supports to correct deviation
obliquity pads
abductors
adductors
trunk laterals
hip belts, chest harnesses
primarily what population is interface pressure mapping used with?
those at high risk or past/current history of breakdown
it provides feedback to clients on effectiveness of pressure reliefs
what are limitations of interface pressure mapping?
only measures pressure, does not measure friction, shear, heat or moisture
what are some considerations when selecting a seat and back support?
- they must use a w/c to get funding for a cushion
- will it impact balance and transfers?
- can pt or caregiver manage it like taking off/on backrests
- will they be transported on the w/c on a bus? –> specific materials are needed
where should you start when selecting equipment for your patient?
know what posture correction you need and what you want for managing pressure risk
–> custom w/c need a certified ATP (help your pt find a good one)
a patient has a mobility limitation if they cannot get from point A to B _____ (3)
- cannot get from point A to B independently
- cannot get from point A to B in appropriate amount of time
- cannot get from point A to B independently as needed throughout the day
insurance only considers _______ when choosing to fund a w/c or not
what is the exception?
mobility limitations inside the home (not community limitations)
exception is school-based mobility in pediatrics
mobility is not ______ and a w/c is not _____
exercise
a piece of exercise equipment
what are the primary manual wheelchair codes?
funded based on _____ rather than ____
K0001, K0002, K0003, K0004, K0005
function ; diagnosis
what are the power wheelchair codes?
funded based on _____ rather than _____
Group 1, Group 2, Group 3
diagnosis ; function
hospital type wheelchairs are categorized as ______
they are not appropriate for what population?
K0001-K0003
neuro patients due to minimal customizations
what are K0004 wheelchairs?
lightweight
–> not typically stocked due to reimbursement
what is the most appropriate long term manual w/c for a neuro patient?
K0005
custom ultra-lightweight
K0005 w/c come in folding and rigid. why would someone choose a rigid frame over a folding frame?
rigid is lightest in weight and provide the most options for seat slope and balance needed for SCI population
what are considerations of each category for manual wheelchair setup?
- seat slope
- back angle
- wheel access
- center of gravity
- front hangar
- front seat to floor ht vs. rear
- ideally with increased slope, close back angle to vertical position
- for long term propellers. elbow angle 100-120 deg when hang is at top of wheel
- further back the axle the more difficult to obtain wheelie and negotiate curbs
- 70-90 deg –> must have ankle ROM for 90 deg
what are considerations when making manual w/c recommendations?
- just because they can propel doesn’t mean they should
- region (flat vs mountain, accessibility)
- are they a student? (bus, campus)
- long term UE propulsion (overuse injuries)
when are powered wheelchairs indicated for a pt?
when they cannot functionally self propel any level of manual w/c in the home throughout the course of a day
using a joystick-like a gas pedal to control movement of a power w/c is ______ control
proportional
what does your patient need to use proportional control?
ability to grade movement
ability to move on/off joystick
faster processing and reaction times
switches (mechanical or electronic) to control movement of a power w/c is ______ control
non-proportional
what motor control does your patient need for non-proportional controls
ability to consistently access, activate, and release the switch
veer requires 2 switches at once
amount of force varies for switch type
what is the primary use for a powered tilt w/c? secondary?
1: pressure reliefs
2: sitting balance, posture control for UE activities
what angle does the powered tilt w/c tilt to? what do you need to consider for your patient?
~50 deg
fear of tilting
what is the primary use for a powered recline w/c? secondary?
1: intermittent catheterizations, spasticity, pressure relief that is not effective with tilt alone
2: dressing, cathing, assist with non-traditional transfers
what should you take caution with if getting your pt a power recline chair?
sacral skin breakdown, breath support, swallowing
can be a problem with extensor spasms/spasticity, can contribute to patients sliding down in chair
what is the most effective pressure relief chair?
power tilt and power recline
what is the primary use for a power elevating legrests (ELRs) w/c? secondary?
1: LE edema, loss of knee flexion ROM
2: dressing
what must your patient have to get a ELR?
adequate hamstring ROM with hips flexed to 90 deg
–> ELRs move LEs from 85deg knee flex to full knee ext
what is the primary use for a powered seat elevate w/c? secondary?
1: transfers
2: active reach to counters, cabinets, refrigerator, etc
powered seat elevate w/c elevate to _____ inches so you must take caution with:
12-14”
driving on terrain, inclines at full elevation, funding
what is the primary use for a powered anterior tilt w/c? secondary?
1: reach
2: come to stand (progressive diagnoses)
what are the two angle options for a powered anterior tilt w/c?
1: 10 deg ant tilt –> reaching
2: 20 deg ant tilt –> requires knee blocks with LE paralysis
what is the primary use for a power stand w/c? secondary?
1: medical benefits: spasticity, bone density, LE ROM, digestion
2: participation in ADLs from standing position
what are red flags for power stand w/c?
poor LE bone density for standing
hip joint dislocation
ROM limitations at hip, knee, ankle
smart drive and smoov power assist are the two most popular options for _____ w/c
power assist
when writing a letter of medical necessity advocating for a pt to get a wheelchair, what must you include/take into account?
reviewer likely doesn’t have a medical background
state the obvious
explain why cheaper equipment will not work
how will the recommended equipment assist with mobility, ADLs, posture and positioning, & management of secondary effects
