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