Test 1: Lecture 7, seating and mobility

Question 1

3 postural tendencies

Answer 1

posterior
anterior
lateral

want to reduce

Question 2

proper posture is important to prevent

Answer 2

loss of ROM
skin breakdown
structural scoliosis
poor head alignment
impaired breathing support
impaired swallowing

Question 3

proper posture is important to allow functional access with

Answer 3

reach
sitting balance
dressing
eating
cathing
transfers

Question 4

reasons a pt may have posture deviations and associated important seating interventions

Answer 4

ROM - if so, do not want to set up seat at end ROM

hypertonicity/spasticity - seat to setup for tone management

hypotonia - critical to position against gravity

visual/perceptual - lateral support for trunk

Question 5

shear definition

Answer 5

distortion of soft tissue from opposing forces at surface of skin

skin stays still and is stretched as bone moves under skin

Question 6

seating/mobility interventions for skin breakdown

Answer 6

pt edu
pressure relief
pressure relieving and positioning cushion
WC/seat

Question 7

stage 1 skin breakdown

Answer 7

red
doesn’t go away after 15 min of offloading

Question 8

what to do if you see stage 1 skin breakdown

Answer 8

if related to WC - contact vendor immediately for modifications or evaluate by therapist; reduce time in WC

see MD if doesnt improve/gets worse

Question 9

weight shifts for skin

Answer 9

pressups in WC
FWD/LAT lean

need to hold for 2 min

do it every 20-30 min

powered options = power tilt/power recline

Question 10

categories for seat/back support

Answer 10

general use
positioning
pressure relief
pressure relieving and positioning

Question 11

types of materials in seating supports

Answer 11

air
gel
foam
combo products
offloading
pressure redistribution vs offloading

Question 12

seat supports to correct deviations

Answer 12

obliquity pads
abductors
adductors
trunk laterals
hip belts, chest harnesses

Question 13

what is interface pressure mapping

Answer 13

used for those at high risk for skin breakdown

gives feedback about effectiveness of pressure interventions

not recommended for use on offloading cushions

only measures pressure not friction, shear, moist, heat

Question 14

things to consider when selecting back support

Answer 14

do they have WC? cant get cushion w/o

how will it impact balance/transfers

can caregiver manage cushion/remove it?

will client go on bus? some things aren’t allowed on bus, need transit brackets, etc

Question 15

mobility limits occur when

Answer 15

pt can’t do it by themselves

takes more time than it should

can’t do it independently throughout the day

Question 16

what mobility considerations does insurance take into account

Answer 16

mobility limits in home

community is not considered unless it is peds in school

Question 17

what are WC codes/their importance

Answer 17

assigned to groups of WCs based on characteristics

if not coded = not covered by insurance

primary codes = K0001, K0002, K0003, K0004, K0005; funded based on diagnosis, not function

power WC codes = Group 1, Group 2, Group 3; funded based on diagnosis rather than function

Question 18

basic rental WC/hospital type characteristics

Answer 18

K0001-K0003

no appropriate for neuro

minimal sizes/options

Question 19

lightweight WC characteristics

Answer 19

K0004

vendors do not generally keep stocked - reimbursement reasons

usually vendors supply K0003

Question 20

custom ultralight WC characteristics

Answer 20

K0005

most appropriate long term manual WC for neuro pts

folding and rigid frames

rigid = lightes and most options regarding seat slope/balance; most often needed for neuro pts like SCI

Question 21

K0005 ultralightweight WC specific characteristics

Answer 21

adjustable seat width/depth

265 lb (folding) and 300 lb (rigid) weight capacity

heavy duty option

multiple configurations for front seat to floor hieght and rear seat to floor height

various axle positions available

seat to back angle adjustments

different foot rest hangar angles and foot plates

large back height ranges

folding/rigid frames

Question 22

what is seat slope

Answer 22

front seat to floor height compared to back seat to floor height

Question 23

ideal back angle

Answer 23

ideally with increased slope, close back angle to vertical position

Question 24

wheel access for manual wheelchairs

Answer 24

important for long term propellers

elbow angle 100-120 deg when hand is on wheel

Question 25

center of gravity for manual WC

Answer 25

adjusted per individual user further back = harder to do wheelie/negotiate curbs

Question 26

front hangar range/angle

Answer 26

range = 70-90 deg closer to 90 increases accessibility but you must have ankle ROM for this

Question 27

what to consider when getting a pt a manual WC

Answer 27

what region do they live in? lots of hills? is client a student? need to get around large campuses? UE overuse injuries common; power assist may be considered to preserve UE function

Question 28

when are power WCs indicated

Answer 28

client cannot functionally propel any level of manual WC in home or throughout day

Question 29

standard electronics for power WC

Answer 29

speed control program/adjustment tremor dampening joystick throw

Question 30

expandable electronic options for power WCs

Answer 30

multiple profiles to program speed and user has ability to adjust speed to each profile requried for running multiple powered seat functions tremor dampening joystick throw access seat functions through joystick alternative drive controls

Question 31

what is proportional controls and what motor control is required

Answer 31

proportional = deflection on joystick corresponds with given speed (like gas pedal); multiple directions of movement- veer motor control - ability to grade movement with joystick - ability to move on and off joystick - faster processing and reaction times than non-proportional

Question 32

what are non-proportional controls and what motor control is needed to operate them

Answer 32

switches - either on or off at set speed mechanical switches - require depression of switch to activate electronic switches - proximity, fiber optic, do not require physical touch motor control - ability to consistently activate and release switch - single switch - just single direction of movement - veer requires activation of 2 switches at same time - each switch type varies in amount of force needed to activate

Question 33

what is power tilt

Answer 33

primary medical use; pressure relief secondary = function; sitting balance, posture control for UE activities angle ~ 50 deg some clients may have fear of tilt

Question 34

power recline uses

Answer 34

primary = medical; catheterizations, spasticity, pressure that isn't helped with tilt alone secondary = function; dressing, cath, non-traditional transfers

Question 35

cautions with power recline chairs

Answer 35

can be problematic with extensor spasms/spasticity can contribute to clients sliding down in chair caution with sacral skin breakdowns, breathing supports, and swallowing

Question 36

what is most effective for pressure relief in terms of seating capabilities

Answer 36

power tilt + power recline order of use matters

Question 37

uses of power elevating leg rests

Answer 37

primary (medical) = edema in LE, loss of knee flex ROM secondary (function) = dressing ELRs move LEs from approximately 85 deg knee flex to full knee ext

Question 38

red flag for use of power elevating leg rests

Answer 38

must have adequate HS ROM with hips flexed to 90

Question 39

uses of power seat elevate and cautions

Answer 39

primary = transfers secondary = active reach to counters, cabinets, refrigerator, etc can elevate 12-14 in caution with driving on uneven terrain; inclines at full elevation

Question 40

powered anterior tilt functions, facts, and cautions

Answer 40

primary use = reach secondary = come to stand (i.e. clients with progressive diseases like ALS) angle around a 10 to 20 deg option 10 deg anterior tilt is standard with power seat; 20 degrees requires knee blocks with LE paralysis (cumbersome and difficult to get on and off) caution = impaired or absent trunk control

Question 41

power stand uses and red flags

Answer 41

primary(medical) = spasticity, bone density, LE ROM, digestion, etc secondary (function) = ADLs from standing position angle is at full standing position red flags = poor LE bone density for standing, hip joint dislocation, and ROM limits at hip/knee/ankle, knee flexion or PF contractures consider MD request for bone density study of LEs if client has LE paralysis and has not stood in a long time

Question 42

power assist options

Answer 42

popular = smart drive or smoov power assist powered rear wheels are an option but they require replacement of wheels and are heavy; assist with propulsion stroke joystick power unit = heavy; reduces ease of floding/breaking down chair