SM - goals of seating and mobility Flashcards
what are the 3 goals of a seating system
- optimal postural alignment
- optimize dynamic stability
- optimize functional ability
all related to each other:
postural alignment -> dynamic proximal stability -> functional mobility
what goal of the seating system trumps the other two
optimizing functional ability
might sacrifice some postural alignment and stability to allow for function
what are 4 goals of a mobility system
- provide compensation for inability to ambulate
- permit functional speed and distance
- account for limitations in endurance
- accommodate various terrain
what are 4 things that you have to make compromises for in your seating/mobility system
- health and safety
- function
- comfort
- style/image
is someone isn’t comfortable (physically or mentally) w wc, they won’t use it
what are 3 basic goals of a seating and mobility system
- correction
- accommodation
- compensation
when do you correct vs accommodate
correct = flexible postural deformities
accommodate = fixed deformities
what 4 systems do you screen
NM
integ
MSK
CVP
what are the 3 main goals in addressing the NM system
correcting abnormal tone when possible
* normalize when possible
* refer to medical intervention
compensate for loss of motor/sensory function
account for differences in static vs progressive disorders
what position should you assess tone in
important to assess in sitting
* will change depending on position they are in
* test in sitting bc that is where they will function
how does a pt having a progressive NM disease impact the seating/mobility system
if progressive - build into system in the instance of worsening conditions
what are 2 considerations with seating/mobility systems if the patient has strong extensor tone when sitting/excited? why?
- put dynamic footrests and backrest to move w the pt and then when tone relaxes, can return to midline shape
* if not dynamic -> can snap leg over time
* dynamic prevents skin breakdown by limiting friction
2.minimize noxious stim that triggers that posturing
what are the 3 main goals in addressing the MSK system
- correct flexible deformities
- accommodate rigid or semi rigid deformities
- compensate for funcitonal impairments
why do you accommodate for rigid deformities instead of correcting them
the amt of force needed to correct would cause skin break down so you support the posture where it is
what are the 2 main goals in addressing the integumentary system
- accommodate existing skin breakdown
- protect from future damage
where is a common location for skin breakdown and why
sacrum
* post pelvic tilt is a common posture (esp if tired) –> shifts weight onto sacrum
ischial tubs are next big risk
breakdown over bony prominences
what did she say about the utilization of pressure mapping and when does she use it
not essential
* she uses it more as an educational tool or as justification for a really expensive cushion
what are the 2 main goals in addressing the CVP system
- compensate for any loss or absence of function
- maximize available endurance
what measures do you use to assess the CVP system’s response to a wc and why
O2 sat, HR, RR
looking at energy expenditure w mobility
good measures for justification
what are 5 common presentations for seating
- requests for replacement
- postural changes
- pain
- skin breakdown
- loss of function
requests for replacement are easier
postural changes are more difficult
pain is a big reason pts come in
what is the order of progression when determining the appropriate seating/mobility system
seating –> mobility
* if get seating right, can go on whatever you want (manual or power)
correction –> accommodation
proximal –> distal
* all ab BOS, head problem could originate from pelvic obliquity
less restrictive –> more
least costly –> more expensive
simplest solution is often the best
where do you start when looking at pt’s alignment
pelvis!! always
what is the most common postural deviation seen
posterior pelvic tilt
what is the ideal alignment for the pelvis (most stable)
neutral rotation
neutral obliquity
slight ant tilt
how is the pelvic alignment supported
3 point system of control
1. post from backrest
2. ant from pelvic belt (inf and ant to ASIS)
3. inf from seat (sloped or cutout)
- using gravity w seat slope (“dump”) to lock pelvis in place
what should you think ab if added a pelvic belt to the chair and where should it fall
think ab angle of pull
keep below axis of rotation
* if goes around belly (above/across ASIS) –> pulls pelvis into a post tilt
what is the ideal hip alignment that will give the pelvis the best support
flex to 90deg or more
neutral to slight ABD
neutral to slight ER
what is the ideal knee alignment
flexion 70-90deg if available
what is an important consideration with the knee alignment and why
hamstring length
* if HS don’t have the length, elevating leg rests will pull pelvis into post tilt
what is ideal ankle/foot alignment
neutral DF/PF, INV/EVE
plantargrade foot supported
want foot flat on foot plate
what is a consideration with added foot straps
if adding more than 1 or 2 straps to foot rest, think ab an AFO to maintain position
what does ideal ankle/foot alignment avoid
reflex activity
what is ideal spinal alignment
plumb line posture
slight thoracic kyphosis
slight lumbar lordosis
slight cervical lordosis
how are lateral support systems for the trunk set up in the chair
3 points of control
* 2 on concave above and below curve (upper ribs and pelvis)
* 1 centered on convex (lower ribs)
what is ideal UE alignment
shoulder neutral position
UE relaxed free for propulsion
should slight post to rear axle in MWC
when relaxed, how should fingers align to a well fitted chair
at axle of chair
what purpose can armrests serve w UE alignment
support UE and dec shoulder strain
what is ideal head/eye alignment
head in midline
eyes horizontal
vision/hearing unobstructed
when using lateral supports, make sure out of visual field and not obstructing hearing
what are 3 goals of a SM system in both CP and MS
- maximize functional level
- accommodate changing needs w cost effective choices that can be modified
- skin and soft tissue protection
why might skin and soft tissue protection be an especially important goal in a certain type of CP
if athetoid mvmt - need good padding
what might be a deciding factor between a MWC and a PWC in CP
cog ability
how does the type of CP (spastic, athetoid, ataxic) impact the wc
leads to different seating components
what are impairments of CP
motor control
growth
joint changes
inc responsibilities
comorbidities associated w aging
what are 7 impairments of MS
motor control/coordination
speech
vision
cog
balance
sensation
B&B control
what are characteristics of MS
fluctuating periods of exacerbation/remission
unpredictable course
function dec over time
what type of wc is appropriate for a thoracic/lumbar SCI and why
full use of UEs
lightweight, K5, rigid manual wc
* protect wrist/shoulder joints bc high risk for shoulder impingement, tendinitis, etc.
what are the 2 main goals of a wc in thoracic/lumbar and lower cervical SCI
- optimize prox support to max UE function
- skin and other soft tissue protection
what type of wc/adaptations is appropriate for a lower cervical SCI and why
partial use of UEs
* lightweight wc
* power assist
might not have full grip
* tacky rim, spokes
what type of wc is appropriate for a mid cervical SCI and why
minimal use of UEs
manual wc if enough function for propulsion
PWC - community distances, over thresholds in home
need tilt/recline system to help w pressure relief/redistribution
what are the 2 main goals with a mid cervical SCI
- optimize prox support to max remaining UE
- postural support and skin protection to maintain MSK and integ health
what impairments might be seen in upper cervical SCI
C3 and up - ventilator
neck strength may be impaired
what type of wc is appropriate for an upper cervical SCI
PWC
* tilt and recline system
* drive - sip/puff, tongue touch
* room for ventilator
what are the 2 main goals with upper cervical SCI
- careful assessment of appropriate drive mechanism
- maximize independence thru externally powered: seating, mobility, environment control, communication
what type of wc is appropriate for a CVA
manual - method of propulsion
* lower seat to floor height to allow LE propulsion
power if unable to manage manual
why does medicare suck with wc in amputees
makes it hard for both prosthetic and chair to be covered
what impairments are seen if the amputation is a complication of DM
vascular insufficiency
inc risk for skin/soft tissue breakdown
peripheral neuropathy
weakness
loss of sensation
what are 3 common etiologies of LE amputations
complication of DM
traumatic
congenital
what is an important consideration for the wc if the amp is a complication of DM
really focus on skin protection
* special attention to residual limb to make sure has enough padding
how does a B LE amputee impact the configuration of a manual wc
axle position/plate is further back to prevent tipping over since the COM changed
what are reasons you might see a TIS in PD
not just bc of postural control
prevalence of OH
* trouble statically sitting for prolonged time w/o BP dropping (also can be SE of meds)
