Seating and Mobility Flashcards by Demond Fleming

what are the 3 posture tendencies?

posterior, anterior, lateral

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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

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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

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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

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where do the majority of pressure injuries occur?

sacrum, coccyx, ITs, GTs, calcaneus, lateral malleolus

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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

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what are 3 other factors that can influence skin breakdown?

moisture
heat
medical issues ex. nutrition, DM

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what are some things to educate your patient about regarding skin breakdown?

risk factors
daily skin inspections
stages
pressure reliefs
cushion maintenance

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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

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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

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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

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how often should your patient do pressure reliefs?

at least every 20-30 minutes and more often if they have skin breakdown

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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

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what are the 4 types of seating and back supports?

general use
positioning
pressure relieving
pressure relieving and positioning

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list types of materials in seating supports

air
gel
foam
combination products
offloading
pressure redistribution vs. offloading

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list some supports to correct deviation

obliquity pads
abductors
adductors
trunk laterals
hip belts, chest harnesses

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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

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what are limitations of interface pressure mapping?

only measures pressure, does not measure friction, shear, heat or moisture

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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

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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)

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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