SM - seating options Flashcards
what is the standard seating system
sling seat and back (naugahyde, padded nylon)
standard seating system
what is main advantage and disadvantage
**advantage **= easy to fold up
disadvantage = lacks ability to counteract gravitational forces to achieve optimal seating alignment
what position does the standard seating system place the pt in and what is the implication of this
puts pt into post pelvic tilt, leg IR, and ADD
* lends to unstable pelvis
what are 4 components to meet basic postural needs
- needs to be safe (protect soft tissue)
- comfortable
- align optimally
- distribute WBing forces across largest area
what are 6 benefits of proper seating
- comfort and safety
- self esteem
- visual perceptual ability
- respiratory status and GI function
- B&B elimination
- prevent postural deformities
all these benefits are justifiable to insurance
what are 5 impacts of a cushion being placed on the chair
- alters relative seat to floor measurement
- transfer
- clearance for knees
- alters available back height
- alters seat to foot rest distance
what is prioritized over all things when picking a cushion
function
* want to assess how they look seated in it and also how they function/transfer
* will sacrifice things for function even if the pressure relief is good
why might a pt have some instability in a cushion
cushion adds a dynamic component, if pt has poor trunk control it can be more difficult to transfer out
how can the cushion impact transfers
material - can make it hard to slide onto SB
contour - hard to get out of
what is cushion wear a clue to
WBing
what does symmetrical cushion wear at the back of a cushion indicate
pt sitting properly back and center in the cushion
* this is what we want to see
what does asymmetrical cushion wear indicate and what is the concern with this
asymmetrical WBing (ie pelvic obliquity)
* inc WBing inc the risk for skin breakdown under that IT
think ab where you would build up the cushion depending on if obliquity is flexible or fixed
what does cushion wear at the front of the cushion indicate
pt possibly sliding forward, can indicate sacral sitting
* now sitting at front edge in post pelvic tilt
* ITs have slid forward and the majority of weight is there
what is pressure mapping
flat piece of material w sensors that measure pressures (biofeedback machine)
what is a major limitation w pressure mapping
only gives you information on the interface pressure
* don’t know what is happening at a capillary level, what is truly happening w blood flow
what are 5 clinical uses for pressure mapping
- effectiveness of wt shifting interventions
- wc configuration set up
- comparison of support surfaces (help you pick a cushion)
- clinical validation (educational purposes)
- documentation and funding (justification to insurance)
how is pressure mapping used with insurance
rank cushion for medicare and place in different categories for payment (ie pressure relief, skin protection, positioning, combinations)
what does is an important consideration even if a cushion is advertised as “pressure maps well”
need to pressure map to individual, doesn’t mean will pressure map well for your pt
pressure mapping is also only one factor in pressure ulcer prevention (shear, moisture, heat)
what are 5 cushion properties
- density
- stiffness
- resilience
- dampening
- envelopment
what is the density of a cushion and when is this a significant consideration
weight to volume
more imporatant in manual wc - adds added wt to chair for pt to propel forward which inc strain on shoulders
not really a consideration for PWC bc motors are doing the work of moving the wt
what is the stiffness of a cushion and how is this a consideration for pts
give under load
if too stiff, pt might not be comfortable
stiffness is personal preference (like type of mattress you like to sleep on)
what is the resilience of a cushion and why is this significant
ability to recover shape
when transferring, pt won’t land on cushion exact same place –> good resilience makes sure they don’t end up on a lump
what is the dampening of the cushion and why is this important
ability to soften on impact
role in the global function of the pt bc impacts them depending on how heavy they land on cushion when transfer
think ab how SCIs plop into chairs
what is the envelopment, how does it work, and what is a challenge w this characteristic at times
sink into cushion and cushion surrounds
* pressure relief bc you have inc surface area
* the challenge is that it can be hard to get out of if you sink deep in
open cell vs close celled foam and the drawbacks of each
open cell = couch cushion foam
* when gets wet, starts to disintegrate
closed cell = memory foam
* can build up heat an dmoisture in certain clients
open cell foam is seen commonly with the “general cushion” that comes w wc rentals
foam cushion
what is one thing that insurance companies actually do slay with this
insurance companies recognize that foam cushions lose resilience after about a year and will let you replace
foam cushion
2 characteristics
2 cons
comes in variety of thickness and densities and pressure relief characterized by cell structure
* lighter weight
cons:
* lose resilience >1yr
* inc heat and moisture
brock composite foam
how does this work
completely suspends ITs w/o them getting any WBing
* puts weight thru PSIS
brock composite foam
why does insurance suck
can only get approval after getting pressure injury under IT or if had some surgery for IT shaving down
brock composite foam
2 characteristics
2 pros
1 consideration
2 cons
lightweight, specifically molded to individual
pros: suspends ITs
* porous for air flow and wicking moisture
consideration: watch for breakdown on PSIS
cons: expensive
* need certification to fit client
honeycomb cushion
what 2 pt populations would you especially consider this in and why
- MS - air flow capability
- spasms & clonus triggered by moving over uneven ground - shock absorption
honeycomb cushion
characteristics
3 pros
1 con
“can see thru it to daylight”
pros: air flow, lightweight, shock absorption
cons: firm feeling
honeycomb cushion
how are modifications made
use heat knife to scoop material out if want to do modifications for pelvic obliquity
viscous fluid filled cushions
how does temperature play a role in viscosity
heat dependent
* gel is best at room temp
* summer/heat: IT can sink down
* winter/cold: gel more solid and takes a sec for heat to warm it up for transfers
viscous fluid filled cushions
what is viscosity and what quality of the cushion does this play a direct role in
degree molecules move against each other
* important to pt’s envelopment
viscous fluid filled cushions
4 pros
2 cons
pros: dampening, thermal properities, pressure relief, envelopment
cons: heavy (consider w MWC), moisture build up
viscous fluid filled cushions
why does this cushion slay for pts w asymmetrical WBing
have some good firmer things you can stick into it for adjusting w pelvic obliquities
air filled floatation cushions
how do they work
distributes pressure from high pressure areas like ITs by all the little air cells communicating w each other
air filled floatation cushions
what determine amt of inflation the cushion should be for ideal envelopment
depends on pt sitting on it
air filled floatation cushions
what is the proper way to size these and what do you want to avoid
you over inflate the cushion, have the sit on it and slowly let air out
* want to be able to deflect 3/4’’ under it (2’’ if high profile ROHO) so you envelop them w/o bottoming out
air filled floatation cushions
what pt population is this great in
wound healing (for pressure redistribution)
air filled floatation cushions
1 pros
1 consideration
2 cons
pro: allows for adjustment in person’s body mvmt to allow for changing pressures
consideration: need knowledgeable user to inflate properly
cons:
* difficult to correct postures
* difficult w transfers if not good trunk control
hybrid cushions
characteristics and how does its composition contribute
combination of previous cushions
* air = pressure relief
* foam = positioning
hybrid cushions
how can this impact function depending on pt population
better w transfers if pt has poor trunk control
what are the 3 functions of cushion covers
promote air flow
easy to clean
limit moisture buildup
what happens if the cushion cover is too small for the cushion
“hammock” effect” – pt ends up sitting on cover and not getting full benefits of the cushion’s properites
what happens if the cushion cover is too large for the cushion
wrinkles and shear forces on pt
why is she anti anything over the ROHO ever (even if pt is incontinent)
no chuck or lift pad underneath, pt on cushion directly
cover is mean for dealing w moisture w incontinence –> you put anything over the cushion and you don’t get those benefits anymore
she advocates for multiple cushion covers in pts w incontinence so you can have one when you launder the chair
where should the pelvic belt fall on a pt
anterior and inferior to axis of rotation
* aligns with over the tops of the femurs
how many points of control do pelvic belts have
4
what happens as a result if the pelvic belt falls superior to axis of rotation over the pt’s belly
pull pt into posterior pelvic tilt
what are the 3 major considerations with pelvic belts
watch for Gtubes/ostomies
padding over bony prominences
think ab line of pull
what are the 4 main LE accessories
hip guides
ADD pads
ABD pads
knee blocks
all of these things are removable
what is the main function of hip guides
acts as another point of control
when would you see knee blocks used
pts w strong ext that hip position and gravity weren’t enough to combat
what does ADD pads often look like
pommel cushion
what is an important consideration with ADD pads
want to keep it clear of groin bc if go into posterior pelvic tilt the pommel will rub on groin
as a result she limits the use of this
what is the function of ABD pads
pads to hold pt into ADD
what are the 2 main kinds of foot supports
ELR
footrests
ELR = elevating leg rests
what is an important consideration when using ELRs
make sure pt has the HS length
* don’t have HS length –> pulls pelvis into posterior tilt
since she doesn’t use ELRs often, when would she mainly use this (2)
if using recline function
fixed LE cast
what is the problem if the ELR is too low
inc popliteal pressure
what is the problem if the ELR is too high
inc weight to pelvis and ITs
* promotes posterior pelvic tilt and inc kyphosis
what test does she do to figure out the right height for the ELRs
knee wiggle
* too much = lower leg rest
* not enough = raise the leg rest
what pt population is the likely to get a pressure ulcer d/t poorly aligned leg rests and why
joint replacements in elderly
* pts don’t move bc it hurts
* people don’t spend time to look at wc
* ortho pt pop can fly under radar for this bc usually think ab SCI and TBI
what is a con of ELRs besides implications of improper sizing
adds a lot of weight to chair
how can the back impact UE funciton
impacted if not below scap - in way of propulsion
how can the back impact sizing of a wc
impact on seat depth if mounted in front of back canes
what are the 2 mian goals of back support
- support natural curves of spine
- counteract gravitational pull on spine/pelvis
what is the function of a back support being a higher vs lower height
higher = more support
lower = inc UE ROM for propulsion
what are the 4 main cons to a sling or upholstery back
- minimal postural support
- inc thoracic kyphosis
- dec lordosis
- promotes post pelvic tilt
what are the 2 main pros to general lumbar support tighter to the pt
- dec width of chair - improved alignment of UE for propulsion
- better supports natural curves of spine
what is adjustable tension upholstery and why is this a good thing to push for
straps on back you can adjust to tighten up in various spots to inc support and provide a little contour
* no additional steps to folding
* very lightweight
try to talk people into this if lose education battle for the back you want
what are the 2 main pt pops planar backs may be appropriate for
- individuals who need limited support
- pediatric - accommodates growth
why does she like planar backs
human back isn’t flat
get weight on SPs and scaps
what are the pros to a curved back
more closely matches human shape
inc contact for inc support
what is the process for a molded system (custom contour)
formed around person w bean bag system that air is withdrawn and clinician/RTS shape and computer regen
custom contour seating
what 2 pt pops is a molded system appropriate for
fixed deformities
scoliosis
what is a drawback to a molded seating system
client needs to get put into chair the right way
* which lends to a lack of forgivness w wt gain or loss bc have to get pt back into same spot
what is the process for foam in place seating (custom contoured seating)
foam created by combining chemicals into plastic bag and client is placed against system and foam fills around them
* you trim excess and can send them along w it minutes later
what is the main pro and con to foam in place contouring
pro = easy way to get cutomization to off the shelf back, quick
con = not as supportive as molded system
what are 3 drawbacks to any accessories being added to chairs
- added weight
- can interfere w transfers (need to be removable)
- parts can get lost w multiple caretakes (swing/flip away better)
who is lateral support meant for
individual w dec trunk control
correct/accommodate scoliosis
how many points of control do lateral supports have
3
what is the winter/summer feature available for lateral supports
function that clicks out and in for more/less space
* accommodates varying bulkiness of clothing/jackets -> ensuring laterals in right spots
pts who spend time outside
peds - body jacket
what are 4 cons/considerations for lateral supports
- brachial plexus injuries if pt slides in system/back reclines
- restrict arm mvmt for propulsion
- adds wt to chair
- positioned too close - constrict breathing, impact skin
why/how would you sacrifice lateral supports for function
restricts UE mvmt for propulsion
she would curve te back more instead of laterals
sacrifice form for function
what are 2 functions of anterior trunk supports
- weak trunk ms, prevents client that lists forward
- can assist in keeping shoulders from protracting
what are 2 cons/considerations of anterior trunk supports/harnessing
- watch for Gtubes
- could interfere w breathing - make sure pt doesn’t slide down and get choked
when are headrests utilized (2)
- when insufficient strength or endurance to hold head in neutral (poor stamina in neck ms or unable to hold neck against gravity)
- always when tilt/recline is used
what is a guiding principle for how headrests should look
unobtrustive and as small as possible
“see individual not chair”
what is an important consideration if using an anterior head rest strap
direct supervision w any pt that has forward restraining device (choking hazard)
what are 3 functions of armrests and what is NOT a function
functions:
1. prevent shoulder subluxation
2. use for relaxation to dec strain on neck and shoulder ms
3. assist w wt shifting
not a function = upper body or trunk support
what is a drawback of armrests
can impede access to wheels
full vs desk length arm rests
full - easier to transfer (esp if stand step)
* impede ability to go under table/desk
desk - get under desk/table
* sit further back
what are 4 uses of a laptray
- communication board
- laptop
- snacks/eating
- UE support
what are 2 cons to a laptray and why might these not matter
does impeded access to wheels
* doesn’t matter if they can’t propel anyway
does add weight to chair
* doesn’t matter if PWC
what is an important consideration if putting a lap tray on a PWC
make it clear to that doesn’t impede view of obstacles
what are spoke guards and what pt pop might specifically benefit from this
keeps fingers out of spokes when going to propel
ataxia - fingers would get caught when reaching back
what are push rims and what pt pop specifically benefits from this
makes rim more available
pt who doesn’t have grip or the ability to grasp so can push on the rim w palms
* ex: quad
what is the function of a brake extension and what pt pop benefits from this
lengthens brake so arm could reach across to engage it
hemiparesis - don’t have functional use of one arm but can do (I) transfer, this way 1 functional arm can lock wc on both sides
