Wheelchair!

Question 1

Describe the importance of adapting the wheelchair to the user. Include the wheelchair as a prosthetic or orthotic concept.

Answer 1

• Adapting the wheelchair to the user helps minimize overuse injuries, optimize posture, minimize pain, and enhance the user’s interaction with their environment.
• Thinking of the wheelchair as a prosthetic or orthotic emphasizes its role as an extension of the patient’s personal space.

Question 2

What are the factors influencing power vs. manual wheelchair prescription?

Answer 2

Power vs. manual wheelchair prescription depends on factors like the

• patient’s strength,
• endurance,
• sensation,
• prognosis,
• environmental factors,
• caregiver support

Question 3

Differentiate between the old-school and current paradigms for wheelchair fitting.

Answer 3

• Old school: The user must adapt to the wheelchair.
• Current: The wheelchair should adapt to the user, treating it as a prosthetic to maximize participation and minimize injury.

Question 4

Describe the components of the primary seating support system (seat, back, UE, LE supports).

Answer 4

The primary seating support system includes the seat, back support, upper extremity (UE) supports, and lower extremity (LE) supports.

Question 5

Compare the four main types of cushions (foam, gel, air flotation, urethane honeycomb). Include pros and cons for each.

Answer 5

Foam: Inexpensive but wears out quickly. Gel: Good pressure distribution but heavy. Air flotation: Excellent pressure relief but unstable. Urethane honeycomb: Durable and cleanable, but expensive.

Question 6

Differentiate between pre-contoured, custom contoured, and plantar cushion shapes.

Answer 6

Pre-contoured cushions provide a more individualized fit, while plantar cushions are flatter and provide less support. Custom contoured cushions are tailored to the individual’s body shape.

Question 7

What are the considerations for seat width, depth, and cushion height? Combine seat and cushion specifics.

Answer 7

Seat width should be 1-2 inches wider than the hips, seat depth 1-2 inches shorter than the thigh length, and cushion height should be chosen based on the user’s postural and pressure needs.

Question 8

Describe different back supports and lateral supports. Include posture considerations.

Answer 8

Back supports vary in material (foam, air, gel) and height, with adjustments needed to maximize interaction with the environment. Lateral supports may be necessary for trunk stability.

Question 9

Explain the importance of supine and seated measurements. Combine hip flexion, knee extension, and angles.

Answer 9

Supine measurements are essential for determining lower extremity ROM, such as hip flexion and knee extension, which are important for proper wheelchair fit.

Question 10

Differentiate between thigh length, calf length, and trunk-to-thigh measurements.

Answer 10

Thigh length and calf length determine seat depth and foot support height, respectively. Trunk-to-thigh measurements help position the back support for optimal posture.

Question 11

What are the general tips for seated measurements, including scapula positioning and seat depth/width?

Answer 11

When measuring, ensure the scapula is free to enhance propulsion. Seat width should be 1-2 inches wider than the hips, and seat depth 1-2 inches shorter than the thigh length.

Question 12

Describe the significance of lower leg, foot support angles, and how these affect wheelchair fit.

Answer 12

Lower leg length determines the height of footrests. Proper foot support prevents postural issues and optimizes comfort and propulsion.

Question 13

Compare the K0001–K0008 manual wheelchair codes. Highlight differences between standard, lightweight, and ultralight models.

Answer 13

K0001: Standard, K0002: Hemi, K0003: Lightweight, K0004: High strength lightweight, K0005: Ultralightweight, K0008: Custom manual wheelchair.

Question 14

Discuss pros and cons of adjustable vs. non-adjustable wheelchair frames.

Answer 14

Adjustable frames allow for customization and better fit but are more expensive. Non-adjustable frames are more affordable but less adaptable.

Question 15

Describe the advantages and disadvantages of using a manual wheelchair.

Answer 15

Manual wheelchairs are portable, cost-effective, and increase fitness but may cause upper extremity strain over time.

Question 16

What is the importance of axle positioning in manual wheelchairs, and how does it affect efficiency?

Answer 16

Axle positioning affects propulsion efficiency. A forward position decreases rolling resistance and requires less effort to push.

Question 17

Explain how UE overuse and posture relate to manual wheelchair use.

Answer 17

Upper extremity overuse can lead to pain, while poor posture increases strain on the body. Proper wheelchair fitting can help mitigate these issues.

Question 18

Compare the advantages and disadvantages of power vs. manual wheelchairs.

Answer 18

Manual wheelchairs are portable but cause more strain on the UE. Power wheelchairs reduce UE strain and fatigue but are heavier and more expensive.

Question 19

Describe the types of drive control systems (hand control, sip-and-puff, head array, eye control).

Answer 19

Drive systems include hand control, sip-and-puff, head array, and eye control. These allow varying levels of independence depending on the patient’s abilities.

Question 20

Explain different power wheelchair base configurations (rear wheel, midwheel, frontwheel).

Answer 20

Rear-wheel drive offers better LE positioning. Midwheel provides tighter turns, while front-wheel improves accessibility to tables.

Question 21

Discuss the different power wheelchair features for pressure relief (tilt-in-space, recline, elevating leg rest).

Answer 21

Tilt-in-space and recline systems help with pressure relief by changing the user’s position. Elevating leg rests provide additional comfort.

Question 22

Describe the benefits of different pressure-relief mechanisms in power wheelchairs.

Answer 22

Pressure relief mechanisms, like tilt-in-space, help prevent pressure ulcers and reduce discomfort by shifting the user’s position.

Question 23

Compare gel and air flotation cushions for pressure relief and stability.

Answer 23

Gel cushions provide stability and good pressure distribution but are heavy. Air flotation cushions are lighter and offer superior pressure relief but may lack stability.

Question 24

What are the potential risks and maintenance requirements for cushions (gel and air)?

Answer 24

Gel cushions require daily kneading and can leak, while air flotation cushions need careful inflation to avoid puncture.

Question 25

What are the requirements for wheelchair prescription, and how can PTs influence this with documentation?

Answer 25

To prescribe a wheelchair, PTs need to document medical necessity for home use, incorporating functional assessments, environmental considerations, and patient history.

Question 26

Describe the role of the Rehab Technology Specialist (ATP/CRTS) in wheelchair prescription.

Answer 26

The Rehab Technology Specialist (ATP/CRTS) ensures that the custom wheelchair fits the user’s needs, working closely with the PT and vendor.

Question 27

Compare the wheelchair fitting process to prosthetic fitting. Include both measurement accuracy and functional considerations.

Answer 27

Wheelchair fitting, like prosthetic fitting, requires accurate measurements, attention to posture, and consideration of the patient’s activity levels and environment.

Question 28

Explain how collaboration with DME vendors can help ensure proper wheelchair prescription.

Answer 28

Collaborating with DME vendors helps PTs ensure that all medical and functional needs are documented properly for insurance and fitting approval.

Question 29

Compare ADL-specific wheelchairs to sports-specific wheelchairs.

Answer 29

ADL-specific wheelchairs are designed for daily living tasks, while sports-specific wheelchairs are designed for performance and durability in athletic environments.

Question 30

Describe the different types of sports-specific manual wheelchairs (e.g., tennis, all-terrain).

Answer 30

Sports-specific wheelchairs are lightweight and adjustable for sports like tennis or basketball. They are designed for agility and speed.

Question 31

Explain the importance of wheelchair adjustments for ADLs and environmental interactions.

Answer 31

Wheelchair adjustments ensure the user can interact with their environment effectively and perform ADLs with comfort and ease.

Question 32

Differentiate between user-centered and environment-centered wheelchair considerations.

Answer 32

User-centered considerations focus on fitting the chair to the patient’s body and needs, while environment-centered considerations involve making sure the chair fits into the user’s home and activity spaces.

Question 33

Explain the impact of wheelchair fit on participation in daily activities and interactions with the environment.

Answer 33

A well-fitting wheelchair maximizes participation in activities, reduces fatigue, and helps the patient interact with their environment effectively.

Question 34

What are the long-term risks associated with improper wheelchair fitting (e.g., UE overuse, poor posture)?

Answer 34

Improper fit can lead to upper extremity overuse injuries, pressure sores, and postural problems, negatively impacting the user’s health.

Question 35

Describe how wheelchair design can influence user independence and mobility.

Answer 35

A well-designed wheelchair enhances the user’s independence, mobility, and ability to participate in daily activities and social interactions.