SM - Overview Flashcards
what is the function of a seating system
compensates for loss of postural stability
what is the function of a mobility system
compensates for loss of functional mobility
what are 4 goals of a seating system
- extrinsically duplicate waht is intrinsically impaired w/i the patient
- provide proximal stability to enable distal mobility
- restore “normal” seated posture without restricting function
- maximize pressure distribution to prevent tissue trauma
- loss of strength, inc ms tone, etc.
- give them a stable base
what is going to trump everything when you are deciding the appropriate seating/mobility system
function!
what is the leading cause of death and medical issues in wc population and why
tissue trauma
* population can’t really readjust/reposition themselves
we want to provide pressure redistribution for them
what are 3 goals of a mobility system
- restore functional mobility
- enable user to go where they want to go
- move at speeds that approach or exceed walking speed of peers
what are 3 interacting components of the ICF framework to prescribe a seating/mobility system appropriate to the pt’s access and participation
- individual
- environment
- assistive tech
mobility system appropriate to environmental needs
what are individual characteristics to consider when prescribing a seating/mobility system
- age
- gender
- social/vocational roles
- functional status
- psychosocial
- dx/px
- med screening
- PT exam: MSK, NM, CVP, integ
- ADLs
what population is age a more significant individual characteristic to consider and why
pediatric
* insurance expects system to last for 5yr
* have to build in growth into wc system so it will grow w the pt
why is gender an important individual characteristic to consider
born as women - gain weight in hips
born as men - gain weight in belly
pts who lost weight w injury, need to consider their gender when guessing how they will regain that weight
why is social and vocational roles such an important individual characteristic to spend time on
want to create lifestyle tool
spend a lot of time in this area
why is dx/px an important individual characteristic to consider
is the dx progressive, will they get better
in ALS, they could walk in and you will prescribe a power wc
what are 5 environmental factors to consider in prescription
- residence accessibility
- community accessibility
- transportation
- vocational demands
- avocational pursuits (year-round)
year round - want wc to work for them in all aspects and all environments
why is transportation an important environmental factor to consider
power wc is 300-400#
think ab transportation - if need to get wc into family car, is that possible, or do they have access to van transport
what are 4 assistive tech factors to consider with prescription
- match physical needs to lowest cost options available
- consider other types of AT being used (body jacket, aug com, van)
- ease of maintenance
- available resources
you move from least costly option to most costly in terms of insurance
why is ease of maintenance an important assistive tech characteristic to assess
is the pt able to take care of it? do they live alone? what is their support system to help?
what are 6 steps in the prescription process
- collab w clinic team
- explore funding sources
- document medical necessity
- address appeals/problems
- schedule fitting, training, delivery
- follow up
what are 6 considerations when selecting assistive tech suppliers
- type of client and supplier’s experience working w complex clients
- experience custom molding seating
- line of products
- loaner equip provided
- certifications
- insurance limitations
what is the most expensive piece to a power wc
the controller
the computer that can change gears and speeds
why do we care what medicare coverage regulations are
majority of pts will have medicare as their primary
other insurances follow suit
medicare
what 2 things does the pt have to qualify by
- medical dx
- functional level in home
- what their needs are in the house
K0001 - std adult manual wc
pros and cons
pros: durable, cheapest
cons:
* heavy (36-50lbs) - lot of strain on shoulders and wrists
* armrests often fixed - can’t use SB
K0002 - std “hemi” manual wc
justification
medical dx: neuro (ie CVA)
function: lower to ground for foot propulsion
K0003 - std lightweight manual wc
pros, cons, and justification
pros:
* lighter (<36lbs)
* choices of arm/footrest types
cons: standard sizing
justification:
* unable to propel std wt wc bc….
* need to have flip up armrests for SB transfers
K0004 - high strength lightweight manual wc
pros, cons, justification
pros:
* lightweight (32-36lbs)
* armrest/footrest/wheel choices
* some axle adjustability
* specific seat sizing (14-20’’ wide and 14-18’’ deep)
cons: folding frame
justification:
* more custom fit for pt wt redistribution
* ability to get wc in and out of car
* axle adjustability (ie B LE amps)
how does the axle being further back vs further forward change mobility in a manual wc
further back - more stable, less responsive, wider turn radius, more effort needed
* B LE amps COM’s will be further back, so need the axle further back
further forward (under COG) - more responsive, tighter turns radius, better alignment for shoulders to propel
* less shoulder strain and better redistribution of wt
K0005 - ultra lightweight manual wc
pros, justification
pros: lighter than high strength
* fully adjustable rear axle
* rigid or folding frame
* optional quick release tires
justification: can’t propel high strength light-wt wc bc…
* axle adjustability (ie B LE amps)
* need for dec shoulder strain
* active SCI pt pop, traveling full time in wc (ie college campus, going to work)
push rim activated power assist wheels (PAPAWS)
what are they
pros
justification
what: motors augment push on rim 3x or 6x
pros: easier to transport
* inc ease/versatility of community mobility
* dec energy demand and dec shoulder strain
justification: medicare won’t consider unless pt has wc >1yr
* uses pain scale (dec pain EOD w PAPAWS) to justify
* pts who have to travel under time constraint (college students)
smart drive
what is it and why does it slay
creates “cruise control”
clamp that you can drop on so you can be hands off and only have to do course corrections
* works up and down curbs bc will flex w you
* intuitive system - will stop the second you brake
what is required to be able to navigate the controller of a power wc (2)
consistent volitional mvmt
cognitive capacity
what is the justification for a power wc
cannot propel any wt or configured manual wc because…
have to r/o less costly manual wc - give reason why they can’t propel manual wc even the custom fit ones
what are 4 criteria for funding any powered mobility device
- unable to accomplish MRADLs safely in home
- can’t accomplish MRADLs in reasonable amt of time
- limitations not resolved by cane or walker
- limitations not resolved by optimally configured manual wc
MRADLs = mobility related ADLs
5 considerations in a pt for a power operated vehicle (POV)
- meets PMD criteria
- can transfer to/from
- can maintain postural control while operating
- home is accessible
- 2 functioning UE to operate the tiller
who does she usually see as a good candidate for a POV
someone in a nursing home:
* don’t have endurance for longer walking distances
* nursing home w those distance, medicare would cover bc “in the home”
6 considerations in a pt for all power wc (PWC)
- needs to exceed criteria for POV
- established ability to safely operate
- home is accessible
- PWC sig improves MRADLs
- pt willing and able
- pt within weight requirements
think ab visual acuity (ie neglect) and cog ability to operate PWC
home needs to be accessible bc so heavy
what are the 2 main things that r/o a POV for a pt and elevates it to a PWC
- UE needs
- postural control
PWC: group 1
1 pro, 2 cons
pro: small enough turning radius for home use (unlike POV)
cons:
1. no rehab seating or power seat functions
2. low battery life
PWC: group 2
3 pros, 1 con
pros:
1. improved battery life
2. inc speeds
3. can mount rehab seating
cons: no multi power options
PWCs
if your pt needs/depends on tilt/recline functions for skin breakdown prevention or pressure redistribution, what group do you jump to
3
PWC: group 3
what is the needed justification
need ATP involvement
qualifying dx
ATP = assistive tech professional
PWC: group 3
why does the programming capability of this group slay so much
- if they have a tremor - can talk to controller to disregard tremor and keep course straight
- if they have hand weakness - can adjust throw of joystick so more sensitive
PWC: group 3
4 pros
- higher speeds
- improved battery life for all day use
- programming capability
- power seat functions (can add tilt/recline)
PWC: group 4
what 3 characteristics separates this from group 3
- no compromises (ant tilt, full post tilt)
- improves suspension
- standing/power seat elevation
PWC: group 4
how can you justify a chair in this group
physiologic/psych benefits of standing as well as function in the home
PWC: group 5
3 characteristics
- pediatric
- designed w growth in mind
- pt weighs <125#
PWC: group 5
how can you justify this
to keep up w their peers’ function/ mobility at school, etc.
rear wheel drive
turns, speeds
larger turning radius
* so much of wc frame in front of wheel to turn
higher speeds
all that was available at first
midwheel drive
turns
very tight turning radius
made a huge difference environmentally w turns
midwheel drive
what is a consideration in pts w spasticity and tone
may say they feel like they can feel the bumps in this chair
* even tho the suspensions are pretty good
midwheel drive
location of center and why is this relevant
high center
* if caught, front casters can get up but midwheels can’t catch anything to propel forwards
front wheel drive
turns, obstacle navigation
larger turning radius than midwheel (smaller than rear wheel)
* handles 90deg turns in home better than midwheel
can climb over obstacles
* drive wheels in front of chair and can pull chair along
* front casters don’t get in the way
what is the more intuitive drive configuration in PWCs
front wheel
what is a good thing to ask in PMH when prescribing a wc and why
upcoming surgeries
* can structurally alter what they look like which changes the needs of the chair
why do we care ab the pt’s social hx (beyond the obvious of helping us have a good recommendation)
can paint the picture of a personal touch in letter of medical necessity
* include what person wants to do w seating system
what are 10 things to ask about in the PMH
- CC
- age
- height and weight
- dx
- precautions
- surgeries
- meds
- lifestyle & activity level
- experience w AT
- past failures/successes
what are 6 things to ask about in the social hx
- residence
- caregiver support
- travel needs
- hrs sitting/activity
- age of existing equipment
- goals/desires
what 4 systems should you def screen in your clinical exam
MSK
NM
CVP
integ
clinical exam
what are 5 things to screen in your MSK systems screen
- static/dynamic sitting posture
- strength & ROM
- active vs passive mvmt
- fixed vs flexible
- anthropomorphic measurements
measurements taken in sitting
clinical exam
what are 5 things to screen as part of NM systems screen
- sensory systems (sensation, proprio, hearing, vision)
- perception
- cog
- judgment/insight/impulsivity
- short/long term memory
clinical exam
what 3 things do you screen in your CVP screen
- cardiac limitations (CHF)
- respiratory problems (COPD)
- circulation (PVD)
clinical exam
why is it significant to assess for respiratory problems
postural ms help w breathing, in pts w cardiopulm problems their posture will be sacrificed so those ms can help pt breathe
clinical exam
how can better posture help the respiratory system
deeper breathing and respiration
can also help w hypophonia in PD
clinical exam
what are 4 things to screen as part of your integ systems screen
- wound hx
- physically exam skin (IT, sacrum, trochs)
- protective measures (tilt and recline, pressure redistribution)
- general care (clean/dry)
clinical exam
where is it common for pts to get skin breakdown? and how does posture contribute?
pts commonly sit in post pelvic tilt
* breakdown over sacrum
* if asymmetrical pull, ITs are next
what factor is a huge contributer to pressure ulcers beyond just the amt of pressure
moisture
cushions today sometimes have airflow tech to mitigate moisture building up
clinical exam
what are 5 things to assess in your functional exam
- locomotion/propulsion
- transfers
- MRADLs
- environments
- integration other AT
clinical exam
how do you establish a plan of care
list all functional and structural impairments –> match to seating and mobility solutions
