Wheelchair Flashcards
The primary attention is given to
user and family goals for use of wheelchair as part of a functional mobility system.
The therapist evaluates
- the skills of the user
- the user’s ability to develop new skills
- changes expected from diagnosis
Evaluation of needs:
- interview
- observation
- examination
Trial with the following is useful to confirm appropriate prescription:
- seating stimulators
- trial seating systems
- self-propulsion methods
Contexts to consider:
- setting
- caregiver support
- physical contexts
- accessibility
- transportation
Functional skills consist of:
- transfers- level of assist
- self-care- FIM
- mobility, propulsion
- communication
- bowel/bladder function
- other equipment
Personal capacity and needs:
- age and stature
- developmental status
- living environment
- educational routines and work
- recreational pursuits
- assistive technology needs and uses
- anticipated future needs
What does the medical profile consist of:
- medical history and physical assessment
- neuromuscular status
- musculoskeletal status- exam and see if there are restrictions
- sensory status
- physiological status
- whether condition is temporary, stable, or progressive
What joints would be restricted to sit 90/90
- hip flexion- limited hip flexion
- knee flexion- causes them to slide out of chair
Seating assessment
- vision, visual perception
- tactile sensation
- cognitive skills
- psychosocial factors
Surgeries
- tendon release
- removal of heter-otopic ossification
- G-tube or peg
- Correction of scoliosis
Swallowing and digestion can be
high tone or low tone
High tone
reclining them 40 degrees makes it easier to swallow
Recommended guideline for swallowing
90-90-90
Skin history
- present breakdown
- past breakdown
- surgeries
- sensation
Social and environmental considerations
- work or school
- transportation
- desk space
- access to bathroom, cafeteria and playground
Special characteristics for wheel chairs:
- Ascending or descending stairs
- Use at the beach
- Cycling configurations or adaptions
- Sport wheel chairs for basketball or racing
Attention to the seating and posture needs is
critical in selecting a wheelchair system
Effective seating has several broad goals:
- enhancing posture, comfort, physiological maintenance, and skin protection
- preventing injury
- accomodating existing deformity
- enabling vision readiness and upper limb function
- attending to cosmetic apperance and social acceptance
- assisting with or enabling functional access and performance in specific settings or environments
Posture affects
vision and function
Candidates for manual mobility
-those who can propel and brake using upper extremities
Frame types
- folding
- amputee
- indoor frame
Weights:
- standard
- lightweight
- ultralightweight
Head and neck support would be for
Spinal cord injury
Wheel chair types: Manual chairs->
- hand rims- steel tube, vinyl coated, knobs, projections, hemi or two rims on one side, single-lever drive
- augmentation for braking systems- grade aid devices, electric motor to aide braking and propulsion
- antirotation locks on casters
Wheel chair sizing:
measurements of the individual form the basis of determining wheelchair frame size, needs for adjustable ranges in component parts, and needs customization to meet special needs
Sizing-
- seat width
- seat depth
- back height and width
- seat height and leg rests
- armrest height
Postural control is influenced by:
-the seat and back contact surfaces and by orientation adjustments to the seat-back angle and the angle in space
Common seating positions
sitting position- 90 degrees hip, knee and ankle
- slight anterior pelvic tilt
- 95 degrees seat back angle with 3-5 degree angle in space recline
Seating principles: solid base of support
- a major principle in seating is the need to provide the individual with a solid base of support that begins with appropriate pelvic positioning
- this is accomplished by stabilizing the pelvis on a firm surface with pressure distributed throughout the buttocks and the full length of each thigh
Obliquities are named by
higher side
By stabilizing the pelvis and aligning the spine you can enhance the function of
- respiration
- swallowing
- digestion
Head aligned over pelvis
pelvis does not have to sit evenly to align with the head and spine
Fixed
surgically fused
Flexible
Skeletally or muscularly limber and able to move into corrected position
Difficult to correct
skeletally or muscularly stiff and maintaining some flexibility to be able to move into a corrected posture with a lot of pressure or forced
Pressure forces:
Direct pressure is a perpendicular load or force exerted on a unit of area
Dealing with direct pressure you should
distribute pressure evenly, over all surfaces
What increases the risk of skin breakdown
posture and moisture
How can a proper seating system help to prevent skin breakdown?
Colorful map, shows where increased pressure is
Where is increased skin pressure?
IT’s and sacrum
Selection of seat surfaces and cushioning:
Cushion materials -variable -gels -air -honey comb -heat and moisture -friction -durability -cosmetic appearance -sitting schedules and skin inspection -additional pressure relieving techniques -Wheel chair pushups -side leans -forward leans -tilt in space -low pressure/alternating pressure -
Seat and back surfaces:
- planar
- precontoured
- custom contoured
Seat and back surfaces:
- planar
- precontoured
- custom contoured
- bead-seat molding
- foam in place techniques
- shape sensing technology
Cushion characteristics
- reduce peak pressures associated with bony lands
- postural stability and control
- ease of transfers
- ability to accommodate deformity
- moisture protection
- ease of maintenance
Seat belts help maintain the
90,90 angle
lateral supports
significant trunk rotation or problems with postural control
thigh supports
spasticity or tone
anterior supports
Across upper trunk Across knees Across ankles Neck supports Head supports Specialized arm tests or lap trays
Seating systems should allow for some ____
element of pressure release and freedom of movement
Research needs to be increased to
address wheelchair transportation, postural control, comfort, and tissue integrity
Final determinations
In making final determinations regarding seating components, size, style and control systems, the user and team take a comprehensive functional view
The team must consider:
- current and future mobility needs
- desires of the user
- resources of the user
- environments of participation
- anticipated changes in technology
Expensive technology and options should not be ordered until
less costly options are ruled out and unless justifiable for one of the following reasons: Increased function Health User satisfaction Safety
The clinicians responsibilities:
- OT’s must remain current
- with new technology, products and evaluations
- advantages and disadvantages of various wheel chair components and features
- issues related to availability
- serviceability
- Therapists are encouraged to explore wheelchair standards developed by the ANSI, Rehabilitation engineering society of North American, and the ISO
If client is posterior pelvic tilt what should you consider next
see if they are flexible
If client has lateral hip flexion->
Recline and tilt wheel chair
What is your client has limited knee flexion: what muscle group is restricted
hamstrings
