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Year 2: Neuromuscular II > Test 1: Lecture 7, seating and mobility > Flashcards

Test 1: Lecture 7, seating and mobility Flashcards

1
Q

3 postural tendencies

A

posterior
anterior
lateral

want to reduce

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2
Q

proper posture is important to prevent

A

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

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3
Q

proper posture is important to allow functional access with

A

reach
sitting balance
dressing
eating
cathing
transfers

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4
Q

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

A

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

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5
Q

shear definition

A

distortion of soft tissue from opposing forces at surface of skin

skin stays still and is stretched as bone moves under skin

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6
Q

seating/mobility interventions for skin breakdown

A

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

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7
Q

stage 1 skin breakdown

A

red
doesn’t go away after 15 min of offloading

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8
Q

what to do if you see stage 1 skin breakdown

A

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

see MD if doesnt improve/gets worse

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9
Q

weight shifts for skin

A

pressups in WC
FWD/LAT lean

need to hold for 2 min

do it every 20-30 min

powered options = power tilt/power recline

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10
Q

categories for seat/back support

A

general use
positioning
pressure relief
pressure relieving and positioning

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11
Q

types of materials in seating supports

A

air
gel
foam
combo products
offloading
pressure redistribution vs offloading

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12
Q

seat supports to correct deviations

A

obliquity pads
abductors
adductors
trunk laterals
hip belts, chest harnesses

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13
Q

what is interface pressure mapping

A

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

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14
Q

things to consider when selecting back support

A

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

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15
Q

mobility limits occur when

A

pt can’t do it by themselves

takes more time than it should

can’t do it independently throughout the day

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16
Q

what mobility considerations does insurance take into account

A

mobility limits in home

community is not considered unless it is peds in school

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17
Q

what are WC codes/their importance

A

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

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18
Q

basic rental WC/hospital type characteristics

A

K0001-K0003

no appropriate for neuro

minimal sizes/options

19
Q

lightweight WC characteristics

A

K0004

vendors do not generally keep stocked - reimbursement reasons

usually vendors supply K0003

20
Q

custom ultralight WC characteristics

A

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

21
Q

K0005 ultralightweight WC specific characteristics

A

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

22
Q

what is seat slope

A

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

23
Q

ideal back angle

A

ideally with increased slope, close back angle to vertical position

24
Q

wheel access for manual wheelchairs

A

important for long term propellers

elbow angle 100-120 deg when hand is on wheel

25
Q

center of gravity for manual WC

A

adjusted per individual user

further back = harder to do wheelie/negotiate curbs

26
Q

front hangar range/angle

A

range = 70-90 deg

closer to 90 increases accessibility but you must have ankle ROM for this

27
Q

what to consider when getting a pt a manual WC

A

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

28
Q

when are power WCs indicated

A

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

29
Q

standard electronics for power WC

A

speed control program/adjustment

tremor dampening

joystick throw

30
Q

expandable electronic options for power WCs

A

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

31
Q

what is proportional controls and what motor control is required

A

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

32
Q

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

A

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

33
Q

what is power tilt

A

primary medical use; pressure relief

secondary = function; sitting balance, posture control for UE activities

angle ~ 50 deg

some clients may have fear of tilt

34
Q

power recline uses

A

primary = medical; catheterizations, spasticity, pressure that isn’t helped with tilt alone

secondary = function; dressing, cath, non-traditional transfers

35
Q

cautions with power recline chairs

A

can be problematic with extensor spasms/spasticity

can contribute to clients sliding down in chair

caution with sacral skin breakdowns, breathing supports, and swallowing

36
Q

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

A

power tilt + power recline

order of use matters

37
Q

uses of power elevating leg rests

A

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

38
Q

red flag for use of power elevating leg rests

A

must have adequate HS ROM with hips flexed to 90

39
Q

uses of power seat elevate and cautions

A

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

40
Q

powered anterior tilt functions, facts, and cautions

A

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

41
Q

power stand uses and red flags

A

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

42
Q

power assist options

A

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

43
Q
A

Year 2: Neuromuscular II (18 decks)

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