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bmsc wheelchairs > Unit 3: Seating and Body Support > Flashcards

Unit 3: Seating and Body Support Flashcards

1
Q

What are the main groups that require specialised seating/body support

A 
The elderly
Cerebral palsy
RA (non-elderly)
Muscular dystrophy
MS
Motor neurone disease
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2
Q

What are the problems associated with insufficient support

A

Poor/asymmetrical postures
Prevents function
May encourage development of deformities

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3
Q

What are the problems associated with excessive support

A

Impedes function by obstructing movement

Encourages dependence on support (esp. in cerebral palsy children)

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4
Q

What pattern of hypertonia is commonly seen in cerebral palsy children

A

Extensor spasm pattern: all four limbs forced into extension

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5
Q

What stimuli can trigger extensor/flexor spasm pattern

A

Noise, movement, position, head orientation, heat, discomfort

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6
Q

How can the extensor pattern in cerebral palsy children be diminished

A

Flex the hips beyond 90degrees

Alternative: extend hips and support the body via the knees and chest

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7
Q

How should paresis be compensated for

A

Ensuring the centre of gravity is positioned as close to the mid-line as possible

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8
Q

What are the 3 main stability pathologies

A

Hypertonia
Paresis
Dyskinesia

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9
Q

What conditions is athetosis commonly seen in

A

Cerebral palsy and Friedrich’s ataxia

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10
Q

Why do disabled people tend to have different proportional body size segments

A

Due to lack of/excessive loading/movement imposed by their condition which can stimulate or inhibit growth

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11
Q

Why is obesity more common in disabled populations

A

Normal food intake is maintained despite reduced energy requirements
Hormonal and psychological problems

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12
Q

What is the ‘windswept’ configuration

A

Combination of pelvic obliquity, rib deformities, hip contractures and dislocations
Creates a z-shaped body due to muscle imbalance

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13
Q

Which conditions are characterised by pain during sitting

A

RA
MS
Back pain

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14
Q

Why might sitting lead to back pain

A

Compression on spinal nerve roots

Often the cause is unknown

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15
Q

Which condition is often associated with abdominal problems such as impaired swallowing ability and gastric reflux

A

Cerebral palsy

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16
Q

Why does prolonged sitting lead to oedema

A

Venous pooling because muscle pump is not active

Lack of lymphatic flow

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17
Q

What is the most common reason for seat rejection

A

Lack of comfort

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18
Q

What factors can lead to discomfort

A

Over-restriction of movement: sustained loading

Inadequate support: requires more muscle action

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19
Q

How are interface pressures kept to a minimum

A

Ensure a large surface area and contour to follow body shape

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20
Q

What are the 2 main categories of seating support

A

Sagittal support

Lateral support

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21
Q

Why is the ischial support so important

A

Area where the highest supporting pressures are encountered: may require extra consideration to avoid pressure sores

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22
Q

What materials are used to minimise peak pressures at the ischial supports

A

Foam
Gel
Air filled material

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23
Q

Why is the femoral support important

A

Governs hip angle and orientation of the femurs

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24
Q

What is the ideal positioning of the horizontal femur

A

The femoral support should be angled higher distally than proximally
Usually around 15degrees to the horizontal

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25
Q

What is the function of the posterior pelvic support

A

Maintain the upright pelvis in the sagittal plane

26
Q

What are the 2 applications of use of pelvic straps

A

Prevent person from falling out of chair

To hold the pelvis in the desired position

27
Q

What position should be pelvis straps be used at

A

At an angle that bisects the angle between the ischial and posterior pelvic supports

28
Q

What is the most effective way of holding the pelvis in position

A

The ASIS bar: padded metal bar locked in position across the ASIS, curves over the abdomen

29
Q

What can knee blocks be used for

A

Preventing forwards motion of the pelvis

Controlling windswept deformities (when combined with adduction blocks)

30
Q

Potential problem with knee blocks

A

May exacerbate hip dislocation/subluxation

31
Q

What position do foot supports normally create

A

Plantigrade foot position

32
Q

When does the degree of thoracic support become important

A

When backrest recline increases

33
Q

Should head support be maximised or minimised

A

Minimised

34
Q

What is the most effective chest/shoulder harness design

A

A waistcoat: prevents forwards trunk flexion

35
Q

How should lateral supports be applied

A

In combinations of 2 or 3 elements on opposite sides of the body

36
Q

What is the most effective method of providing lateral trunk support

A

Lateral pelvic supports

37
Q

What is the maximum height that lateral spinal support should reach

A

2cm below the axilla: nerves here are vulnerable to compression

38
Q

What is the difference in lateral spinal support for symmetrical and asymmetrical trunks

A

Symmetrical: use in pairs
Asymmetrical: use a 3-point loading system

39
Q

Why is lateral instability of the head a frequent problem

A

Lateral head supports can be overcome by the person moving their head forwards
(extending the supports forwards then limits visual fields)

40
Q

What is another name for adduction blocks

A

Pommels

41
Q

What benefits does using adduction blocks have

A

Reduces extensor tone/pattern

42
Q

What postural position is commonly seen in hypotonic patients. How can this be overcome

A

Wide hip abduction and external hip rotation

Overcome by using abduction blocks

43
Q

When are abduction and addiction knee blocks used together

A

To correct windswept deformities

44
Q

What is the benefit and disadvantage of tilting back a seat

A

More comfortable but less functional ability

45
Q

What is the difference between tilt and recline

A

Tilt: moving the seat and backrest angle back simultaneously
Recline: moving only the backrest angle

46
Q

When should lateral tilt be used

A

Only in some cases of asymmetrical postures in the frontal plane

47
Q

What is a benefit of a higher seat height

A

Facilitates for easier standing

48
Q

What are some basic features of ‘easy chairs; or ‘orthopaedic chairs’ produced for the elderly

A 
Minimal contouring = provide very upright posture
High seat height = facilitates rising
Small wheels = ease of movement
\+/- trays = for eating/leisure
\+/- restraints for confused patients
49
Q

What are benefits and disadvantages of using sling-seats

A

Benefit: folding ability
Disadvantage: sags, encourages flexed posture and pelvic obliquity

50
Q

Describe modular seating

A

Assembling a seat from a standard kit of components to give the desired size and configuration
Segments can be adapted to accommodate for changing needs

51
Q

Benefits of modular seating

A

Versatile and adjustable

Avoids expensive fabrication costs of customised sating

52
Q

Disadvantages of customised seating

A

Expensive
Limited lifespan
Tends to lock the person into one posture

53
Q

Disadvantages of foam and wood customisable seating designs

A

Time consuming
Requires high skill level to achieve acceptable quality of finish
Errors in configuration are difficult to adapt

54
Q

Describe Shapeable surface systems of seating

A

Relies on a series of small interlocking components which can be released to produce a flexible surface

55
Q

Benefits of Shapeable surface system

A

Allows a wide variety of shapes to be formed
Adjustable = can adapt to changing needs
Good ventilation to the seating surface
Can re-use the supporting framework

56
Q

Disadvantages of Shapeable surface system

A

Heavy
May be difficult to manipulate to the required shape
Require patient cooperating when setting up

57
Q

Describe the process of creating a moulded foam seat

A

Polyurethane foam obtained by mixing liquid components to release gas and foam. The foam sets into a honeycomb structure. When contained in an enclosed space, the foam will set into the shape of the container

58
Q

Benefits of moulded foam seat

A

Very comfortable

Useful for patients who dislike being confined to one position (e.g. muscular dystrophy patients)

59
Q

Disadvantages of moulded foam seat

A

Difficulty maintaining desired posture during foaming process
Cannot be adjusted other than by cutting away areas of foam

60
Q

Describe the bead bag vacuum consolidation technique

A

Uses plastic bags filled with small polystyrene beads that conform to shape of individual. Vacuum applied to the bag = consolidates into a rigid structure

61
Q

Disadvantage of bead bag system and method of overcoming this

A

Needs frequent reshaping

Use adhesive in with the beads

bmsc wheelchairs (4 decks)

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