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SM - seating options Flashcards

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1
Q

what is the standard seating system

A

sling seat and back (naugahyde, padded nylon)

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2
Q

standard seating system

what is main advantage and disadvantage

A

**advantage **= easy to fold up

disadvantage = lacks ability to counteract gravitational forces to achieve optimal seating alignment

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3
Q

what position does the standard seating system place the pt in and what is the implication of this

A

puts pt into post pelvic tilt, leg IR, and ADD
* lends to unstable pelvis

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4
Q

what are 4 components to meet basic postural needs

A
  1. needs to be safe (protect soft tissue)
  2. comfortable
  3. align optimally
  4. distribute WBing forces across largest area
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5
Q

what are 6 benefits of proper seating

A
  1. comfort and safety
  2. self esteem
  3. visual perceptual ability
  4. respiratory status and GI function
  5. B&B elimination
  6. prevent postural deformities

all these benefits are justifiable to insurance

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6
Q

what are 5 impacts of a cushion being placed on the chair

A
  1. alters relative seat to floor measurement
  2. transfer
  3. clearance for knees
  4. alters available back height
  5. alters seat to foot rest distance
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7
Q

what is prioritized over all things when picking a cushion

A

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

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8
Q

why might a pt have some instability in a cushion

A

cushion adds a dynamic component, if pt has poor trunk control it can be more difficult to transfer out

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9
Q

how can the cushion impact transfers

A

material - can make it hard to slide onto SB

contour - hard to get out of

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10
Q

what is cushion wear a clue to

A

WBing

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11
Q

what does symmetrical cushion wear at the back of a cushion indicate

A

pt sitting properly back and center in the cushion
* this is what we want to see

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12
Q

what does asymmetrical cushion wear indicate and what is the concern with this

A

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

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13
Q

what does cushion wear at the front of the cushion indicate

A

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

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14
Q

what is pressure mapping

A

flat piece of material w sensors that measure pressures (biofeedback machine)

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15
Q

what is a major limitation w pressure mapping

A

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

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16
Q

what are 5 clinical uses for pressure mapping

A
  1. effectiveness of wt shifting interventions
  2. wc configuration set up
  3. comparison of support surfaces (help you pick a cushion)
  4. clinical validation (educational purposes)
  5. documentation and funding (justification to insurance)
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17
Q

how is pressure mapping used with insurance

A

rank cushion for medicare and place in different categories for payment (ie pressure relief, skin protection, positioning, combinations)

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18
Q

what does is an important consideration even if a cushion is advertised as “pressure maps well”

A

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)

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19
Q

what are 5 cushion properties

A
  1. density
  2. stiffness
  3. resilience
  4. dampening
  5. envelopment
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20
Q

what is the density of a cushion and when is this a significant consideration

A

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

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21
Q

what is the stiffness of a cushion and how is this a consideration for pts

A

give under load

if too stiff, pt might not be comfortable

stiffness is personal preference (like type of mattress you like to sleep on)

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22
Q

what is the resilience of a cushion and why is this significant

A

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

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23
Q

what is the dampening of the cushion and why is this important

A

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

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24
Q

what is the envelopment, how does it work, and what is a challenge w this characteristic at times

A

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

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25
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 ## Footnote open cell foam is seen commonly with the "general cushion" that comes w wc rentals
26
# 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
27
# 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
28
# brock composite foam how does this work
completely suspends ITs w/o them getting any WBing * puts weight thru PSIS
29
# 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
30
# 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
31
# 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
32
# honeycomb cushion characteristics 3 pros 1 con
"can see thru it to daylight" pros: air flow, lightweight, shock absorption cons: firm feeling
33
# honeycomb cushion how are modifications made
use heat knife to scoop material out if want to do modifications for pelvic obliquity
34
# 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
35
# 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
36
# viscous fluid filled cushions 4 pros 2 cons
**pros**: dampening, thermal properities, pressure relief, envelopment **cons**: heavy (consider w MWC), moisture build up
37
# 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
38
# 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
39
# air filled floatation cushions what determine amt of inflation the cushion should be for ideal envelopment
depends on pt sitting on it
40
# 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
41
# air filled floatation cushions what pt population is this great in
wound healing (for pressure redistribution)
42
# 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
43
# hybrid cushions characteristics and how does its composition contribute
combination of previous cushions * air = pressure relief * foam = positioning
44
# hybrid cushions how can this impact function depending on pt population
better w transfers if pt has poor trunk control
45
what are the 3 functions of cushion covers
promote air flow easy to clean limit moisture buildup
46
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
47
what happens if the cushion cover is too large for the cushion
wrinkles and shear forces on pt
48
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 ## Footnote she advocates for multiple cushion covers in pts w incontinence so you can have one when you launder the chair
49
where should the pelvic belt fall on a pt
anterior and inferior to axis of rotation * aligns with over the tops of the femurs
50
how many points of control do pelvic belts have
4
51
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
52
what are the 3 major considerations with pelvic belts
watch for Gtubes/ostomies padding over bony prominences think ab line of pull
53
what are the 4 main LE accessories
hip guides ADD pads ABD pads knee blocks ## Footnote all of these things are removable
54
what is the main function of hip guides
acts as another point of control
55
when would you see knee blocks used
pts w strong ext that hip position and gravity weren't enough to combat
56
what does ADD pads often look like
pommel cushion
57
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 ## Footnote as a result she limits the use of this
58
what is the function of ABD pads
pads to hold pt into ADD
59
what are the 2 main kinds of foot supports
ELR footrests ## Footnote ELR = elevating leg rests
60
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
61
since she doesn't use ELRs often, when would she mainly use this (2)
if using recline function fixed LE cast
62
what is the problem if the ELR is too low
inc popliteal pressure
63
what is the problem if the ELR is too high
inc weight to pelvis and ITs * promotes posterior pelvic tilt and inc kyphosis
64
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
65
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
66
what is a con of ELRs besides implications of improper sizing
adds a lot of weight to chair
67
how can the back impact UE funciton
impacted if not below scap - in way of propulsion
68
how can the back impact sizing of a wc
impact on seat depth if mounted in front of back canes
69
what are the 2 mian goals of back support
* support natural curves of spine * counteract gravitational pull on spine/pelvis
70
what is the function of a back support being a higher vs lower height
higher = more support lower = inc UE ROM for propulsion
71
what are the 4 main cons to a sling or upholstery back
1. minimal postural support 2. inc thoracic kyphosis 3. dec lordosis 4. promotes post pelvic tilt
71
what are the 2 main pros to general lumbar support tighter to the pt
1. dec width of chair - improved alignment of UE for propulsion 2. better supports natural curves of spine
72
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 ## Footnote try to talk people into this if lose education battle for the back you want
73
what are the 2 main pt pops planar backs may be appropriate for
1. individuals who need limited support 2. pediatric - accommodates growth
74
why does she like planar backs
human back isn't flat get weight on SPs and scaps
75
what are the pros to a curved back
more closely matches human shape inc contact for inc support
76
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
77
# custom contour seating what 2 pt pops is a molded system appropriate for
fixed deformities scoliosis
78
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
79
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
80
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
81
what are 3 drawbacks to any accessories being added to chairs
1. added weight 2. can interfere w transfers (need to be removable) 3. parts can get lost w multiple caretakes (swing/flip away better)
82
who is lateral support meant for
individual w dec trunk control correct/accommodate scoliosis
83
how many points of control do lateral supports have
3
84
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 ## Footnote pts who spend time outside peds - body jacket
85
what are 4 cons/considerations for lateral supports
1. brachial plexus injuries if pt slides in system/back reclines 2. restrict arm mvmt for propulsion 3. adds wt to chair 4. positioned too close - constrict breathing, impact skin
86
why/how would you sacrifice lateral supports for function
restricts UE mvmt for propulsion she would curve te back more instead of laterals ## Footnote sacrifice form for function
87
what are 2 functions of anterior trunk supports
1. weak trunk ms, prevents client that lists forward 2. can assist in keeping shoulders from protracting
87
what are 2 cons/considerations of anterior trunk supports/harnessing
1. watch for Gtubes 2. could interfere w breathing - make sure pt doesn't slide down and get choked
88
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
89
what is a guiding principle for how headrests should look
unobtrustive and as small as possible "see individual not chair"
89
what is an important consideration if using an anterior head rest strap
direct supervision w any pt that has forward restraining device (choking hazard)
90
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
91
what is a drawback of armrests
can impede access to wheels
92
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
93
what are 4 uses of a laptray
* communication board * laptop * snacks/eating * UE support
94
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
95
what is an important consideration if putting a lap tray on a PWC
make it clear to that doesn't impede view of obstacles
96
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
97
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
98
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

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