W/C Seating and Positioning Flashcards
purpose of wheelchair evaluation
improve functional mobility
promote postural control / alignment
enhance swallowing / respiratory function
skin protection
seating principles
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
how should the pelvis be positioned
neutral to slight anterior pelvic tilt
what does proper pelvic alignment promote
normal lumbar curve
weightbearing through ischial tuberosities
active trunk ROM
co-contraction of trunk muscles
level pelvis allows for
equal weight-bearing / pressure distribution
what can be implemented to maintain pelvic position
seat belt placed below ASISs
who does the seating/positioning eval
PT or OT with advance training
ATP and SMS stand for
ATP - assistive technology practitioner
SMS - seating and mobility specialist
within the history portion of the evaluation, what should be considered
diagnosis / prognosis
reason for referral
recent/planned surgeries
anthropometrics
co-morbidities
cardio-respiratory status
skin integrity
cognition
activity level
how does understanding a patient’s co-morbidities assist eval
understanding the deficits they are facing
how does cardio-respiratory status assist in evaluation
if w/c needs to be manual or electric
ratio related to ramps
1 inch of rise : 12 inches run
doorway width necessary by ADA guidelines
32-34 in wide from inside wall
during the evaluation, what should be asked about home environment
type of home
accessibility
ramps/doorways/flooring
support
transportation
when will insurance not cover a device
if one is in LTC or SNF
if the home is not accessible
during evaluation, how is level of independence assessed
ADLs
Transfers
Ambulation
fall risk
wheelchair skills
ability to perform weight shifts
time spent in w/c
when evaluating ambulation, what is the thought process
could a lower level device achieve independent / safe ambulation
objective examination in the evaluation
postural assessment
strength
rom
sensation
tone
balance
pain
gait
important measurements for eval
total femoral contact length
lower leg length
foot depth
elbow height
axilla height
maximum sitting height
shoulder width
hip width
important caveat to total femoral contact length
subtract 2in from measurement to account space between popliteal fold and edge of cushion, to determine seat depth
important caveat to hip width in a manual w/c
add 2” to your measurement to allow for movement and avoid hips encountering wheels or armrests
important caveat to lower leg length
including AFO, shoe and its cushion
head position in a w/c
in midline
eyes forward
slight cervical extension
UE positioning in w/c
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
LE positioning in w/c
hip, knee, ankle at 90° flex
knees parallel / slightly higher than hips
what is a windswept deformity
one hip is abducted and ER while the other is adducted and IR
seat slope or “dump” definition
difference between rear seat floor heights
pros of seat “dump”
passive pelvic stability
improve hand access to wheels
reduce forward slide
cons of seat “dump”
decrease lumbar lordosis –> more forward posterior pelvic tilt
add pressure to sacrum
lateral transfers are uphill
propulsion methods associated with manual w/c
bil UE or bil LE
hemi-propel
all 4 extremities
propulsion method associated with power w/c
joystick
finger/touch pad
sip and puff
head array
recommended propulsion pattern to teach patients? pros of this?
semicircular
- includes push and recovery phase
- less stress on shoulders
- lower stroke frequency
pelvic deformities that could cause improper fitting
posterior pelvic tilt
excessive anterior pelvic tilt
rotation (anterior/posterior ASIS)
obliquities
cons of posterior pelvic tilt
sacral sitting
slouched / kyphotic posture
how are pelvic obliquities named
by lowest side
- increased risk for skin break down
- associated with scoliosis most often
how to correct a fixed vs flexibile deformity
fixed = custom seating
flex = positioning devices
if seat depth is too long, what positional change occurs and what can that cause
posterior pelvic tilt
- sliding forward
- circulation impairment behind knee
—-> skin break down
if seat depth is too short, what positional change occurs and what can that cause
decreased overall surface area contact with thigh
- decreased pressure distribution
- excess hip abduction
- skin breakdown on HS
if seat width too narrow, what positional change occurs and what can that cause
increased pressure on trochanters
–> risk of skin breakdown at greater trochanter
if seat width too wide, what positional change occurs and what can that cause
asymmetrical posture
- limit wheel access
- postural deformities
- obliquities
- rotations
if footrest height too high, what positional change occurs and what can that cause
decreased overall surface area
- lack of thigh support
- reduced pressure distribution
- excess hip abduction
- increased knee flexion
if footrest height too low, what positional change occurs and what can that cause
increased pressure on distal thighs
- lack of foot support
- posterior pelvic tilt
- sliding forward
- PF Contracture
if arm rest too low, what positional change occurs and what can that cause
decreased overall surface contact with forearm
- trunk control diminished
- shoulder sublux
