Specialty Seating Flashcards
Appropriate Seating
Improves QOL
facilitates community integration
Inappropriate Seating
Contributes to disability
barriers to independence, mobility
what is specialty seating
WC base
cushion
backrest
casters and rear wheels
armrests
drive mechanisms (power)
accessories
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
WC base frames
folding frame vs rigid frame
WC base - power mobility
not a scooter or basic electric wheelchair
power tilt and/or recline options
rear, front, midwheel drive
power recline is not for
pressure relief
power recline is for
people who self-dress and self-catheterize
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
pressure mapping
looking for hot spots to make adjustments via pressure relieving cushions
caster size determines
resistance, terrain considerations
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
seating steps 4-7 takes about how long
3 months
MD role in seating process
documents dx
face-to-face eval
makes referral for specialty seating
PT/OT role in specialty seating
identify need (NSG)
complete physical assessment
work with ATP
document medical necessity
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
