Specialty Seating Flashcards by Georgia Cook

Appropriate Seating

Improves QOL

facilitates community integration

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Inappropriate Seating

Contributes to disability

barriers to independence, mobility

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what is specialty seating

WC base
cushion
backrest
casters and rear wheels
armrests
drive mechanisms (power)
accessories

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WC base - Manual

K1-4 are not meant for everyday use - not long term or customizable

K5 (ultralite) and above is meant for everyday, community ambulation

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WC base frames

folding frame vs rigid frame

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WC base - power mobility

not a scooter or basic electric wheelchair

power tilt and/or recline options

rear, front, midwheel drive

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power recline is not for

pressure relief

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power recline is for

people who self-dress and self-catheterize

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common pressure areas

occiput - head support

scapula and spinous processes - back support

elbow - UE supports

greater trochanter, sacrum, coccyx, and ischial tuberosity - seat support along with back support to maintain proper positioning of the trunk and pelvis

heels - LE supports

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pressure mapping

looking for hot spots to make adjustments via pressure relieving cushions

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caster size determines

resistance, terrain considerations

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steps in seating process

identify need
medical referral
physical exam
WC eval
equipment recommendations/selection
medical necessity justification/funding
product delivery, fitting
follow-up maintenance and repairs

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seating steps 4-7 takes about how long

3 months

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MD role in seating process

documents dx

face-to-face eval

makes referral for specialty seating

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PT/OT role in specialty seating

identify need (NSG)

complete physical assessment

work with ATP

document medical necessity

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ATP role in specialty seating

assistive technology professional

works with PT in WC eval

identifies appropriate equipment components

guides process

Pt/Family role in seating selection

input on needs, preferences, resources

New WC user needs

non ambulatory
ambulation non-functional or poses risks
- decreased safety, increased fall risk
- requires assistance
- unable to consistently ambulate (look at 24hrs)
- endurance limits ambulation

current WC user needs

wc > 5yrs old

doesnt meet needs

in disrepair

change in function

obtaining specialty seating referral

MUST have MD specialty seating referral for WC eval to proceed

secondary face-to-face session
- IPR: daily rounds
- OP must visit MD (psychiatrist)

make medical dx

qualifying dx (ICD10 code) necessary but not sufficient for WC payment

physical exam for specialty seating

often interdisciplinary - NSG, PT, OT, RT

what do we need to examine?
- medical dx/chief complaint
- PMH
- family/social support
- home setup: steps, multiple levels, doorway width, floor materials, outdoor terrian
- transportation
- cognition

if existing WC user - current equipment assessment
- what works/doesn’t work
- patterns of wear

functional assessment - transfers, ambulatory status, ADLs, pressure relief

ambulatory pt’s can qualify for WC - must demonstrate need

performance on WC trial - show two things:

pt CANT function with LESS than you’re asking for

pt CAN function with what you’re asking for

physical exam eval

sensation
skin integrity
pain
posture/alignment
balance
strength
ROM
NM status - tone, reflexes, motor control

flexible postural deficits

correct with seating

fixed postural deficits

accommodate with seating

what role does our documentation play

present eval findings ID pt problems and potentials specify goals of positioning/mobility intervention specify recommend tech features provide medical rationale for each feature

WC eval and recommendations

seating clinics vs general clinic setting need 3 parties: ATP, PT, patient/family

must have these measurements for specialty seating

shoulder width chest width hip width top of shoulder inferior angle of scapula upper leg length lower leg length

the WC eval

APT measures pt on mat - body segment lengths - ROM - sitting balance - postural deviations - fixed or flexible PT +/- OT discuss clinical findings discussions with pt/family recommendations made per clinical findings and pt/family preferences

justifications, medical necessity

APT makes recommendations, but seating eval documentation must be completed by licensed therapist must justify all seating components relevant to pt our documentation forms the bulk of this process seating request reviewed by panel of HCPs - MD, nurses, PTs

product delivery/fitting

pt discharges with loaner chair APT responsible for these steps

maintenance/upkeep

WCs require maintenance - through APT pr qualifies for new equipment: - every 5 years - with a documented change in function

C4 and above SCI WC prescription

power WC + independent mobility, pressure relief - heavy, transportation/space requirements

C5/6 SCI WC prescription

power-assist manual WC vs power may propel but strength/endurance limits

C7 and below SCI WC prescription

manual ultra-lightweight WC folding vs rigid frame, minimize weight

L3/4 SCI WC prescription

may use ultralight WC for daily use para walking with equipment - EE, speed, safety issues

pressure relief time recommendations

1 min per 15-30 min in WC

Pressure Relief in WC

cushions help but pressure relief is critical C5 and above - power tilt C5-6 - lateral/front lean C7 and below - lateral front lean or pushup - encourage other pressure relief techniques, especially in strong patients