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Assistive Tech > SM - goals of seating and mobility > Flashcards

SM - goals of seating and mobility Flashcards

1
Q

what are the 3 goals of a seating system

A
  1. optimal postural alignment
  2. optimize dynamic stability
  3. optimize functional ability

all related to each other:
postural alignment -> dynamic proximal stability -> functional mobility

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2
Q

what goal of the seating system trumps the other two

A

optimizing functional ability

might sacrifice some postural alignment and stability to allow for function

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3
Q

what are 4 goals of a mobility system

A
  1. provide compensation for inability to ambulate
  2. permit functional speed and distance
  3. account for limitations in endurance
  4. accommodate various terrain
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4
Q

what are 4 things that you have to make compromises for in your seating/mobility system

A
  • health and safety
  • function
  • comfort
  • style/image

is someone isn’t comfortable (physically or mentally) w wc, they won’t use it

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5
Q

what are 3 basic goals of a seating and mobility system

A
  • correction
  • accommodation
  • compensation
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6
Q

when do you correct vs accommodate

A

correct = flexible postural deformities
accommodate = fixed deformities

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7
Q

what 4 systems do you screen

A

NM
integ
MSK
CVP

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8
Q

what are the 3 main goals in addressing the NM system

A

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

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9
Q

what position should you assess tone in

A

important to assess in sitting
* will change depending on position they are in
* test in sitting bc that is where they will function

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10
Q

how does a pt having a progressive NM disease impact the seating/mobility system

A

if progressive - build into system in the instance of worsening conditions

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11
Q

what are 2 considerations with seating/mobility systems if the patient has strong extensor tone when sitting/excited? why?

A
  1. 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

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12
Q

what are the 3 main goals in addressing the MSK system

A
  • correct flexible deformities
  • accommodate rigid or semi rigid deformities
  • compensate for funcitonal impairments
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13
Q

why do you accommodate for rigid deformities instead of correcting them

A

the amt of force needed to correct would cause skin break down so you support the posture where it is

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14
Q

what are the 2 main goals in addressing the integumentary system

A
  • accommodate existing skin breakdown
  • protect from future damage
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15
Q

where is a common location for skin breakdown and why

A

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

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16
Q

what did she say about the utilization of pressure mapping and when does she use it

A

not essential
* she uses it more as an educational tool or as justification for a really expensive cushion

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17
Q

what are the 2 main goals in addressing the CVP system

A
  • compensate for any loss or absence of function
  • maximize available endurance
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18
Q

what measures do you use to assess the CVP system’s response to a wc and why

A

O2 sat, HR, RR

looking at energy expenditure w mobility

good measures for justification

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19
Q

what are 5 common presentations for seating

A
  1. requests for replacement
  2. postural changes
  3. pain
  4. skin breakdown
  5. loss of function

requests for replacement are easier
postural changes are more difficult
pain is a big reason pts come in

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20
Q

what is the order of progression when determining the appropriate seating/mobility system

A

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

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21
Q

where do you start when looking at pt’s alignment

A

pelvis!! always

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22
Q

what is the most common postural deviation seen

A

posterior pelvic tilt

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23
Q

what is the ideal alignment for the pelvis (most stable)

A

neutral rotation
neutral obliquity
slight ant tilt

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24
Q

how is the pelvic alignment supported

A

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)

  1. using gravity w seat slope (“dump”) to lock pelvis in place
25
Q

what should you think ab if added a pelvic belt to the chair and where should it fall

A

think ab angle of pull

keep below axis of rotation
* if goes around belly (above/across ASIS) –> pulls pelvis into a post tilt

26
Q

what is the ideal hip alignment that will give the pelvis the best support

A

flex to 90deg or more
neutral to slight ABD
neutral to slight ER

27
Q

what is the ideal knee alignment

A

flexion 70-90deg if available

28
Q

what is an important consideration with the knee alignment and why

A

hamstring length
* if HS don’t have the length, elevating leg rests will pull pelvis into post tilt

29
Q

what is ideal ankle/foot alignment

A

neutral DF/PF, INV/EVE
plantargrade foot supported

want foot flat on foot plate

30
Q

what is a consideration with added foot straps

A

if adding more than 1 or 2 straps to foot rest, think ab an AFO to maintain position

31
Q

what does ideal ankle/foot alignment avoid

A

reflex activity

32
Q

what is ideal spinal alignment

A

plumb line posture
slight thoracic kyphosis
slight lumbar lordosis
slight cervical lordosis

33
Q

how are lateral support systems for the trunk set up in the chair

A

3 points of control
* 2 on concave above and below curve (upper ribs and pelvis)
* 1 centered on convex (lower ribs)

34
Q

what is ideal UE alignment

A

shoulder neutral position
UE relaxed free for propulsion
should slight post to rear axle in MWC

35
Q

when relaxed, how should fingers align to a well fitted chair

A

at axle of chair

36
Q

what purpose can armrests serve w UE alignment

A

support UE and dec shoulder strain

37
Q

what is ideal head/eye alignment

A

head in midline
eyes horizontal
vision/hearing unobstructed

when using lateral supports, make sure out of visual field and not obstructing hearing

38
Q

what are 3 goals of a SM system in both CP and MS

A
  1. maximize functional level
  2. accommodate changing needs w cost effective choices that can be modified
  3. skin and soft tissue protection
39
Q

why might skin and soft tissue protection be an especially important goal in a certain type of CP

A

if athetoid mvmt - need good padding

40
Q

what might be a deciding factor between a MWC and a PWC in CP

A

cog ability

41
Q

how does the type of CP (spastic, athetoid, ataxic) impact the wc

A

leads to different seating components

42
Q

what are impairments of CP

A

motor control
growth
joint changes
inc responsibilities
comorbidities associated w aging

43
Q

what are 7 impairments of MS

A

motor control/coordination
speech
vision
cog
balance
sensation
B&B control

44
Q

what are characteristics of MS

A

fluctuating periods of exacerbation/remission
unpredictable course
function dec over time

45
Q

what type of wc is appropriate for a thoracic/lumbar SCI and why

A

full use of UEs

lightweight, K5, rigid manual wc
* protect wrist/shoulder joints bc high risk for shoulder impingement, tendinitis, etc.

46
Q

what are the 2 main goals of a wc in thoracic/lumbar and lower cervical SCI

A
  1. optimize prox support to max UE function
  2. skin and other soft tissue protection
47
Q

what type of wc/adaptations is appropriate for a lower cervical SCI and why

A

partial use of UEs
* lightweight wc
* power assist

might not have full grip
* tacky rim, spokes

48
Q

what type of wc is appropriate for a mid cervical SCI and why

A

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

49
Q

what are the 2 main goals with a mid cervical SCI

A
  1. optimize prox support to max remaining UE
  2. postural support and skin protection to maintain MSK and integ health
50
Q

what impairments might be seen in upper cervical SCI

A

C3 and up - ventilator
neck strength may be impaired

51
Q

what type of wc is appropriate for an upper cervical SCI

A

PWC
* tilt and recline system
* drive - sip/puff, tongue touch
* room for ventilator

52
Q

what are the 2 main goals with upper cervical SCI

A
  1. careful assessment of appropriate drive mechanism
  2. maximize independence thru externally powered: seating, mobility, environment control, communication
53
Q

what type of wc is appropriate for a CVA

A

manual - method of propulsion
* lower seat to floor height to allow LE propulsion

power if unable to manage manual

54
Q

why does medicare suck with wc in amputees

A

makes it hard for both prosthetic and chair to be covered

55
Q

what impairments are seen if the amputation is a complication of DM

A

vascular insufficiency
inc risk for skin/soft tissue breakdown
peripheral neuropathy
weakness
loss of sensation

56
Q

what are 3 common etiologies of LE amputations

A

complication of DM
traumatic
congenital

57
Q

what is an important consideration for the wc if the amp is a complication of DM

A

really focus on skin protection
* special attention to residual limb to make sure has enough padding

58
Q

how does a B LE amputee impact the configuration of a manual wc

A

axle position/plate is further back to prevent tipping over since the COM changed

59
Q

what are reasons you might see a TIS in PD

A

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)

Assistive Tech (17 decks)

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