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Assistive Tech > SM - deviations and solutions > Flashcards

SM - deviations and solutions Flashcards

1
Q

what is the most common postural deviation seen and why

A

posterior pelvic tilt

if any impairment in motor control, pelvic typically slumps into post tilt bc that’s the direction of gravity’s pull in sitting

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2
Q

what overall posture results from a posterior pelvic tilt

A
  • “sacral” sitting
  • compensatory L & Tspine kyphosis
  • inc cspine lordosis
  • relative hip ext/IR
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3
Q

what patients will you see a worse posterior pelvic tilt in (2)

A
  • sig loss of motor control
  • lots of spasticity
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4
Q

how can a lack of prox motor control cause to a posterior pelvic tilt deviation

A

pts need to flex forward to bring COG over BOS to gain enough balance for UE mvmt (ie MWC propulsion in quads)

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5
Q

what are 4 physical causes of a posterior pelvic tilt

A
  • limited strength (ie core)
  • loss of ROM - esp tight HS
  • prox hypotonia (related to core)
  • ext hypertonia
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6
Q

how can extensor hypertonia cause a posterior pelvic tilt deviation

A

hip ext and ADD contract while thigh is fixed on the seat –> pelvis tilts

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7
Q

what spinal posture is consistent w a posterior pelvic tilt and why is this problematic

A

flexion (not ext)

pt uses ext at lumbar & tspine and hyper-ext of cspine to right their head/eyes in midline vertical

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8
Q

what are 3 equipment causes of a posterior pelvic tilt deviation

A
  • seat depth too long
  • seat belt on or above ASIS
  • sling seat and back
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9
Q

squeeze vs dump

A

squeeze = back angle to seat to seat to squeeze pt

dump = angle of seat, interacts w gravity

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10
Q

flexible posterior pelvic tilt intervention

A

3 point pressure system:
* seat
* back
* ant strap below ASIS’s, shelf, or “squeeze”

additional pelvic support prn
firm, contoured back support
lumbo-sacral corset

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11
Q

fixed posterior pelvic tilt interventions

A

accommodate - open seat/back angle

correct/accommodate secondary deformity
* tilt back seat/back to inc trunk ext
* have to tilt further back if more severe, but sacrifice some of tilt for function so they can still propel

**maximize function **- compromise seated position as needed to mainatin or inc function

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12
Q

what is a pelvic rotation deviation

A

forward rotation of pelvis on one side

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13
Q

what are 3 physical causes of a pelvic rotation deviation

A
  • lumbar scoliosis w rotational component
  • LBP
  • abnormal/asymmetrical tone
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14
Q

what are 2 equipment causes of a pelvic rotation deviation

A
  • seat depth fitted to longer thigh in pt w thigh length discrepancy (shorter leg shifts forward)
  • improper seat height for pt w hemiplegia -> rotates to functionally lengthen stronger LE for propulsion
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15
Q

what risks are associated with a pelvic rotation deviation

A

integ - skin breakdown
* inc pressure at IT and greater troch

MSK - progressive deformity and pain

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16
Q

flexible pelvic rotation interventions

A

3 point pressure correction
* seat
* back
* ant strap below ASIS, pelvic shelf, or “squeeze”

properlly fitting wc
* seat depth
* seat height

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17
Q

fixed pelvic rotation interventions

A

accommodate: asymmetrical seat depth to maximize support under “long side”
* split seat for full support under both long and short side

correct or accommodate secondary deformity
* medial thigh pad to block hip ADD
* lateral hip pads to block ABD
* if lot of tone, can use thigh pads to block tone from pulling pt forward

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18
Q

what is the second most common pelvic deviation

A

pelvic obliquity

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19
Q

what is a pelvic obliquity deviation

A

asymmetrical height of pelvic crests

20
Q

what is the resulting posture of a pelvic obliquity with the R side lower

A

compensatory scoliosis
* R thoraco-lumbar “C” curve
* inc pressure at R IT and R greater troch

asymmetric position of LEs
* one side - hip flex, IR, ADD
* opposite side (R) - hip ext, ER, ABD

21
Q

flexible pelvic obliquity interventions

A

3-point pressure for correction
- seat (firm/cushioned)
- back (firm/cushioned)
- ant strap below ASIS, shelf, squeeze

may build up under low side to neutralize (but check skin often!)

22
Q

what determines the type of intervention in a fixed pelvic obliquity

A

position of head and upper trunk (midline or listing to lower side?)

23
Q

fixed pelvic obliquity interventions if the head and upper turnk are listing to the lower side

A
  • build up under high side to meet & support
  • use accommodative materials to prevent breakdown
24
Q

fixed pelvic obliquity interventions if head and upper trunk are near midline

A
  • “build up” under high side to equalize Wbing
  • protect soft tissues under IT on low side
  • support thighs prn
  • support spine prn
25
Q

what are hip/thigh positioning strategies for maintaining optimal pelvic alignment

A
  • adjust seat to back angle
  • correct, block, or accommodate undesired hip positions
  • seat cutouts/contours
26
Q

hip and thigh positioning impacts what alignment

A

pelvic

27
Q

knee positioning impacts what alignment

A

pelvic
thigh/hip

28
Q

what do you use to determine the optimal position of the LE if the pelvis is properly positioned

A

HS length (it dictates the hanger angle)

29
Q

why don’t we want to place HS on stretch when in position in wc

A
  • not comfy
  • won’t want to use wc
  • pulls into posterior tilt
30
Q

what support is needed for upper body positioning if pt has good trunk control w no asymmetries

A

chair height can be low, but at least tall enough to catch PSIS

need to have something that catches PSIS

31
Q

what support is needed for upper body positioning if pt has fair trunk control w no asymmetries

A

chair height little higher - thoracic level support
* lower than inferior border of scap (esp if propelling)
* can have some contour

32
Q

what support is needed for upper body positioning if pt has poor trunk control w no asymmetries

A

person not propelling or in PWC, full chair height

consider tilt - manual, power, static
lateral trunk supports

33
Q

who is static tilt appropriate for and how does it work

A

people who can kinda shift their weight but over time need help, as they propel gravity helps them keep their pelvis in good position

34
Q

how does lateral chair supports change between fixed and flexible scoliosis

A

in flexible - aren’t symmetrical, correcting off center

fixed - looking to hold pt there

35
Q

what support is needed for flexible scoliosis

A

3 point pressure system:
* lateral: apex of C curve
* lateral: as high as 1/2’’ below axilla
* lap belt/pelvic pad

36
Q

what is a consideration with lateral supports seen in the pressure system used in scoliosis

A

can get into axilla, but be careful of brachial plexus injury

37
Q

what support is needed for fixed scoliosis

A
  • 3 point system to prevent progression
  • total contact if severe for skin protection
  • consider spinal orthosis
  • custom contour seating (foam in place, spinal orthoses) - severe scoliosis w rotational component
38
Q

what support is needed for flexible kyphosis

A
  • consider tilt for gravity assistance pending trunk control
  • chest strap/ant support
  • if good trunk control firm back at apex kyphosis
39
Q

what support is needed for fixed kyphosis

A
  • custom contoured back
  • tilt or recline to accommodate and keep eyes in horizontal
40
Q

what are functions of UE supports and what aren’t and what is a con

A

functions:
* prevent subluxation at shoulder
* assist w wt shifts

not a function: upper body support

con: impede access to wheels

41
Q

when is a head rest indicated

A
  • insufficient strength and endurance to hold head in neutral
  • always when tilt/recline used
42
Q

who reviews LMNs and why is this relevant to us

A
  • don’t have background in DME prescription
  • part of job is to keep outfloo of funds under control and save money
  • following policy manual
  • doesn’t know you or your pt

changes how we write the LMN so that we can maximize the coverage we get

43
Q

what should be the general appearance of a LMN

A
  • appropriate letterhead white paper
  • date and signed
  • neat and proofread
    * impress upon reader it was written by professional who’s opinion should be valued
44
Q

what are 5 key principes to writing LMNs

A
  1. prioritize info - state objective right off the bat so they know what you want
  2. stay focused on one issue at a time
  3. educate reader ab the pt and their needs
  4. strive for clarity - break into chunks w headings
  5. limit opinions to area of expertise
45
Q

what are 6 commonly included/needed categories in a LMN

A
  • med and social hx
  • clinical and functional exams
  • identified problems
  • trials/simulation outcomes - tried this less expensive equipment to show it had to be r/o
  • recs
  • detailed medical justification of all recommended equipment

Assistive Tech (17 decks)

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