Spinal Cord Wheelchair Prescription Flashcards
1
Q
Goals of a therapist when fitting a patient for a WC
A
- Provide pelvic & trunk stability
- Optimize function for ADLs
- Protect the skin to prevent and/or heal existing pressure injuries
- Max comfort for patient
- Max unwanted movement
- Correct or accommodate for postural abnormalities
- Prevent the progression of postural abnormalities
2
Q
What is DME
A
- The Durable Medical Equipment (DME) benefit category was created over forty years ago to support the medical equipment needs of elderly individuals
3
Q
What is CRT
A
- Complex rehab technology (CRT)
- Highly configurable manual and power wheelchairs
- Adaptive seating and positioning systems
- Other specialized equipment that is prescribed to meet the specific medical needs of individuals with disabilities and chronic medical conditions
- Problem is these highly specialized products are still categorized under the broad durable medical equipment (DME) benefit category
4
Q
Wheelchair fitting for a patient is a team approach (True/False)
A
- True
5
Q
Good indicators that your patient would benefit from wheeled mobility
A
- Patient is non-ambulatory
- Demos decreased safety with ambulation or is at risk for falls within the home
- Requires assistance for ambulation within the home & wheeled mobility would allow independence
- Requires increased time for ambulation within the home
- Unable to consistently ambulate throughout the day in the home which affects their ADLs
6
Q
Questions to help justify your patient’s need for a wheelcahir
A
- Does your pt have a mobility limitation that significantly impairs his/her ability to participate in one or more MRADLs in the home?
- Can the mobility limitation be resolved by a cane or walker?
- Do they have the desire or capability to propel o WC?
- Does the pt’s home have the space/layout for functional WC use?
7
Q
Describe wheelchairs for short-term use
A
- K levels 1-3
- These chairs are heavier, basic manual PCs with minimal adjustability & are most appropriate for short term use
8
Q
Describe wheelchairs for long-tern use
A
- K level 4: Pt qualifies for a basic manual chair but requires a seat width, depth, or height that can’t be accommodated by a basic MWC; unable to perform all ADLs efficiently in a basic MWC; they use a WC more than 2 hrs/day
- K level 5: Pt is a full time WC user, Pt requires customization such as axle configuration wheel camber angle or seat to back angle that can’t be accommodated by a K level 1-4; requires an evaluation by a pt/OT, a letter of medical necessity, & the involvement of an ATP in the equipment selection process
9
Q
When is a tilt in space appropriate
A
- Pt is dependent in mobility
- Pt is unable to perform independent pressure relief
- Pt requires gravity assisted positioning/repositioning
- Pt requires postural support, head & trunk control, and accommodation of postural asymmetries
- Goal is to increase sitting tolerance/endurance
- Pt needs improved line of sight due to forward head posture
- Pt will benefit from trunk support & open thoracic posture for increased respiratory function
- Pt requires safe positioning for feeding/gravity assisted swallowing
10
Q
Criteria for a power wheelchair
A
- Meets all criteria for manual WC
- Pt is unable to propel a manual WC due to UE limitations: strength, coordination, pain, ROM, etc.
- The home as adequate access for maneuvering of the power chair
- Use of the power WC will significantly improve their ability to perform MRADLs
11
Q
A scooter will often be ruled out due to
A
- Poor trunk strength
- difficulty with transfers
- Poor endurance
- Existing postural abnormalities
- Large turning radius
12
Q
Criteria for a group 2 power WC
A
- Meets all of the basic power WC criteria
- Group 2 models are typically characterized by “captain’s seating”
- The pt is unable to safely transfer, operate, & maintain postural stability in scooter
- The home does not provide adequate access for operating scooter
- Pt is able to safely operate a power WC or has a caregiver willing to operate who cannot push a manual WC
- Will improve the ability to participate in MRADLs in the home
- Some models have multi power options available if they qualify for a tilt/recline system or if they use a ventilator that mounts to the chair
13
Q
Criteria for a group 3 power WC
A
- Meets all criteria for a basic power WC and group 2 power
- Pt has a neurological condition, myopathy, or congenital skeletal deformity
14
Q
What makes a group 3 power WC different from a group 2 power WC
A
- Allows integration of rehab seating, & typically has better drive wheel suspension
- Offer multiple alternative drive control options
- Offer the option of power tilt, recline, and/or power legs, & power elevate
- Higher turning radius & increased speeds
15
Q
What is each body part doing during neutral pelvic posture and what is the goal
A
- Goal: maintain proper alignment with an appropriate cushion & back support
- Pelvis is in midline with no pelvic tilt, no obliquity, & no rotation
- Spine is balanced & upright with no rotation and no lateral curvature
- Head is functionally upright with only mild forward/lateral flexion or rotation
16
Q
Describe a fixed deformity
A
- Fixed = accommodate
- When a posture is fixed the skeleton does not move out of the posture
- Pt needs equipment that will accommodate the fixed posture providing optimal support & pressure redistribution
- Goal = preventing further progression
17
Q
Describe a flexible deformity
A
- Flexible = correct
- When a posture is flexible the skeleton still moves & equipment should be chosen with the goal to correct the abnormal posture
- Goal = prevention from becoming a fixed posture
18
Q
What is each body part doing during anterior pelvic tilt and what is the goal
A
- Goal: utilize cushion & back support that maximizes contact with seat surface, stability, & look for moldable back support to conform to the curvature of the spine
- Pelvis sits with PSIS higher than the ASIS
- Spine has excessive lordosis in the lumbar and cervical spine
- Head has excessive lordosis of cervical spine causing hyperextension of the neck & upward eye gaze
19
Q
What is each body part doing during pelvic obliquity and what is the goal
A
- Goal: pressure redistribution, flexible = level the pelvis by building up lower side, & fixed = accommodate for the deformity
- Pelvis sits with L/R ASIS higher than the other
- Thoracic spine curves away from the side of the raised hip
- Neck laterally flexes into the side where the hip is higher
20
Q
What is each body part doing during pelvic rotation and what is the goal
A
- Goal: stabilize pelvis in most neutral position and consider an anti-thrust cushion to reduce forward migration of the pelvis
- Pelvis sits with L/R ASIS more forward than the other
- Thoracic spine follows & rotates in the same direction as the pelvis
- Neck will go into lateral flexion as if the person is dropping the ear to his or her shoulder
21
Q
What is each body part doing during windswept posture and what is the goal
A
- Goal: avoid use of ELRs that decrease femoral contact with seat surface & promote windswept posture, often accompanied by rotation or obliquity of the pelvis, & look for a cushion that can be adjusted
- Pelvis goes hand in hand with a rotation of an obliquity causing one leg to adduct and the other leg to abduct
- Spine will present with a rotation or scoliosis
- Neck will go into lateral flexion & may be accompanied by forward flexion
22
Q
What are the top 8 measurements you MUST do for wheelchair fitting
A
- Shoulder width
- Chest width
- Hip width
- Seat to top of shoulder
- Inferior angle of scapula
- Seat to elbow
- Upper leg length
- Lower leg length
23
Q
What happens to the skin, tissue, & bone when constant pressure is applied without the appropriate pressure redistribution in the cushion & back support
A
- Initially it affects only the superficial epidermal layer causing a reddening of the skin (skin is still intact)
- Eventually the pressure moves into the dermis breaking the skin open & causing an open wound (blisters may appear)
- Continued pressure damages deeper into the hypodermic now affecting all 3 layers of skin
- Injury depth reaches the tissue under the skin potentially as low as the muscle & bone
24
Q
What are the mechanics of sheer force
A
- Gravity causes downward pressure from prolonged sitting
- Pt moves/slides in the chair causing friction
- Skin/tissue at the seat surface DOESN’T move while the underlying bone structure DOES
- Skin/tissue is strained by the combined pressure & friction
- Permanent cell deformation & distortion occurs at the deeper layers of tissue
- Blood vessel damage decreases oxygen delivery
- Ischemia
- Result is tissue death
25
Q
Define offloading
A
- Principle of taking pressure off of a small surface area & loading it onto a greater surface area that can withstand more pressure & prevent unwanted skin breakdown
26
Q
Define immersion
A
- Principle of conforming to the person’s curvature by “sinking the body in”
- We allow the cushion and/or back support to take the body’s shape alleviating the bony prominences from unwanted peak pressure to maximize pressure redistribution
27
Q
Benefits of using an offloading style cushion
A
- Firmer surface creates a safer end feel for pt
- Provides more stability
- Partially or completely suspends the ischial tubs, sacrum, and coccyx
- Redistributes pressure to areas that can withstand more pressure
28
Q
Considerations if using an offloading style cushion
A
- NOT good for pts with trochanter wounds
- May not be suitable for pts with hypersensitivity
- Stable surface may be more difficult for independent transfers
- Pt with contractures may not fit the pre-contoured shape
29
Q
Benefits of using an immersion cushion
A
- Less firm surface ideal for pain management
- Curvature increases pressure redistribution
- Good for any type of pressure injury at any stage
- May be easier for independent transfers
- Reduces peak pressures at the bony prominences
30
Q
Considerations when using an immersion cushion
A
- Less stable surface
- May not be suitable for someone who desires proprioceptive input from a firmer surface
- Some cushions require more maintenance & if not properly maintained can increase risk of a pressure injury
31
Q
Slide 37
A
32
Q
What should you check if your patient keeps sliding out of the wheelchair
A
- Check for tightened hamstrings
- Check hip ROM
- Check seat depth
- Check seat to floor height
- Check trunk stability & strength
