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Neuro Rehab > W/C Seating and Positioning > Flashcards

W/C Seating and Positioning Flashcards

1
Q

purpose of wheelchair evaluation

A

improve functional mobility

promote postural control / alignment

enhance swallowing / respiratory function

skin protection

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2
Q

seating principles

A

stabilize proximal to promote distal mobility

achieve / maintain pelvic alignment

facilitate optimal postural alignment by accommodating ROM impairments

limit abnormal movement

provide the minimum amount of support necessary to facilitate independence

comfort

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3
Q

how should the pelvis be positioned

A

neutral to slight anterior pelvic tilt

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4
Q

what does proper pelvic alignment promote

A

normal lumbar curve
weightbearing through ischial tuberosities
active trunk ROM
co-contraction of trunk muscles

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5
Q

level pelvis allows for

A

equal weight-bearing / pressure distribution

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6
Q

what can be implemented to maintain pelvic position

A

seat belt placed below ASISs

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7
Q

who does the seating/positioning eval

A

PT or OT with advance training

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8
Q

ATP and SMS stand for

A

ATP - assistive technology practitioner

SMS - seating and mobility specialist

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9
Q

within the history portion of the evaluation, what should be considered

A

diagnosis / prognosis

reason for referral

recent/planned surgeries

anthropometrics

co-morbidities

cardio-respiratory status

skin integrity

cognition

activity level

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10
Q

how does understanding a patient’s co-morbidities assist eval

A

understanding the deficits they are facing

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11
Q

how does cardio-respiratory status assist in evaluation

A

if w/c needs to be manual or electric

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12
Q

ratio related to ramps

A

1 inch of rise : 12 inches run

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13
Q

doorway width necessary by ADA guidelines

A

32-34 in wide from inside wall

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14
Q

during the evaluation, what should be asked about home environment

A

type of home
accessibility
ramps/doorways/flooring
support
transportation

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15
Q

when will insurance not cover a device

A

if one is in LTC or SNF

if the home is not accessible

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16
Q

during evaluation, how is level of independence assessed

A

ADLs
Transfers
Ambulation
fall risk
wheelchair skills
ability to perform weight shifts
time spent in w/c

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17
Q

when evaluating ambulation, what is the thought process

A

could a lower level device achieve independent / safe ambulation

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18
Q

objective examination in the evaluation

A

postural assessment
strength
rom
sensation
tone
balance
pain
gait

19
Q

important measurements for eval

A

total femoral contact length

lower leg length

foot depth

elbow height

axilla height

maximum sitting height

shoulder width

hip width

20
Q

important caveat to total femoral contact length

A

subtract 2in from measurement to account space between popliteal fold and edge of cushion, to determine seat depth

21
Q

important caveat to hip width in a manual w/c

A

add 2” to your measurement to allow for movement and avoid hips encountering wheels or armrests

22
Q

important caveat to lower leg length

A

including AFO, shoe and its cushion

23
Q

head position in a w/c

A

in midline
eyes forward
slight cervical extension

24
Q

UE positioning in w/c

A

if arm rests, resting at 90°

if no arm rests, elbow angle between 100-120 flexion with hand resting on top center of pushrim

arm extended = finger tips at axle of manual w/c

25
Q

LE positioning in w/c

A

hip, knee, ankle at 90° flex

knees parallel / slightly higher than hips

26
Q

what is a windswept deformity

A

one hip is abducted and ER while the other is adducted and IR

27
Q

seat slope or “dump” definition

A

difference between rear seat floor heights

28
Q

pros of seat “dump”

A

passive pelvic stability
improve hand access to wheels
reduce forward slide

29
Q

cons of seat “dump”

A

decrease lumbar lordosis –> more forward posterior pelvic tilt

add pressure to sacrum

lateral transfers are uphill

30
Q

propulsion methods associated with manual w/c

A

bil UE or bil LE

hemi-propel

all 4 extremities

31
Q

propulsion method associated with power w/c

A

joystick
finger/touch pad
sip and puff
head array

32
Q

recommended propulsion pattern to teach patients? pros of this?

A

semicircular
- includes push and recovery phase
- less stress on shoulders
- lower stroke frequency

33
Q

pelvic deformities that could cause improper fitting

A

posterior pelvic tilt
excessive anterior pelvic tilt
rotation (anterior/posterior ASIS)
obliquities

34
Q

cons of posterior pelvic tilt

A

sacral sitting
slouched / kyphotic posture

35
Q

how are pelvic obliquities named

A

by lowest side
- increased risk for skin break down
- associated with scoliosis most often

36
Q

how to correct a fixed vs flexibile deformity

A

fixed = custom seating
flex = positioning devices

37
Q

if seat depth is too long, what positional change occurs and what can that cause

A

posterior pelvic tilt
- sliding forward
- circulation impairment behind knee
—-> skin break down

38
Q

if seat depth is too short, what positional change occurs and what can that cause

A

decreased overall surface area contact with thigh
- decreased pressure distribution
- excess hip abduction
- skin breakdown on HS

39
Q

if seat width too narrow, what positional change occurs and what can that cause

A

increased pressure on trochanters
–> risk of skin breakdown at greater trochanter

40
Q

if seat width too wide, what positional change occurs and what can that cause

A

asymmetrical posture
- limit wheel access
- postural deformities
- obliquities
- rotations

41
Q

if footrest height too high, what positional change occurs and what can that cause

A

decreased overall surface area
- lack of thigh support
- reduced pressure distribution
- excess hip abduction
- increased knee flexion

42
Q

if footrest height too low, what positional change occurs and what can that cause

A

increased pressure on distal thighs
- lack of foot support
- posterior pelvic tilt
- sliding forward
- PF Contracture

43
Q

if arm rest too low, what positional change occurs and what can that cause

A

decreased overall surface contact with forearm
- trunk control diminished
- shoulder sublux

44
Q
A

Neuro Rehab (9 decks)

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