Wheelchair

Question 1

types of chairs

Answer 1

manual
power
PAPAW

Question 2

Type of chair power vs manual

Answer 2

power- bulky, heavy, expensive, specialized transport, maintenance issues
manual- smaller, lighter, less expensive, transport by car, improves fitness, overuse issues
delay decision until rehab underway for return

Question 3

when to pick power chair

Answer 3

insufficient strength to propel a manual WC
need to cover long distances- uneven terrain
certain medical or orthopedic problems (SH)
high risk for overuse injury (older obese)

Question 4

Manual chair levels of function

Answer 4

C4= unable to propel
C5= limited distance indoors
C6= may be too slow or tiring to use; power may be more suitable for lifestyle or priorities

Question 5

Selecting a manual chair

Answer 5

lightest wt possible
stable frame for efficient use
quality
optimal wheel size
best combo of ease of propulsion and stability
fitted to prevent overuse injury

Question 6

Rigid characteristics

Answer 6

+ easier to propel, fewer components, stronger, lighter, seat to back angle adjustable
- bumpier on uneven surfaces, harder to store

Question 7

Seat depth

Answer 7

measure butt to popliteal fossa and subtract 1-2”
important for good posture
too short, less body contact to distribute weight, pressure; excessive pressure, fear of falling off
too long, slide out and cause kyphotic posture

Question 8

seat width

Answer 8

as narrow as possible

measure widest part and add t go through doors

Question 9

seat height

Answer 9

seat rail to floor; take cushion into account
finished height considerations- propelling chair with foot needs to be lower to ground, height of transfer surface, work surface height (desk)

Question 10

Seat height can be altered by

Answer 10

altering frame construction
changing wheel size
thickness of seat insert/cushion
removing upholstery and add seat board

Question 11

seat surfaces

Answer 11

firm more stable and comfortable
can be sling, taut fabric, solid metal/plastic base, solid hook on seat
sling seat leads to slump sacral sitting

Question 12

wheelchair back

Answer 12

affects seat depth, may impede SH mvt
can be fixed or adjustable
upholstery or solid
if too high, impedes SH ROM
if too low, not enough posture support

Question 13

Pelvic positioner

Answer 13

seat belt, helps spasticity
45-60 deg from chair, depending on problem
fastened with buckle, velcro

Question 14

arm rests

Answer 14

consider height and length of arm rests
too high, poor SH position
too low, lean over to use, poor posture
consider any additional att needed

Question 15

footrest/legrest

Answer 15

swing away/elevating, several styles
if too long- slide out to reach, slumped, sacral sitting
if too short- too much weight on sacrum
angle of front rigging increases length chair
calf straps for FL tone, heel loops

Question 16

casters/hangers

Answer 16

4-8” standard, larger- smoother ride
smaller= tighter turn, more maneuverable
hangers- where leg rest att to WC- 60-90 deg

Question 17

tires

Answer 17

standard or solid- no traction, easier to roll, bumpier ride
pneumatic- smoother, air, can have a flat
airless inserts- hybrid, softer ride without maintenance, expensive
grade aids

Question 18

wheel position

Answer 18

affects seat height and overall stability
moving wheel back- COM moves forward, more energy to roll, more SH ext, stress on UE
move wheel forward- COM moves back, easier to steer, less stress on UE but chair less stable
can have quick release wheels or camber which puts at an angle to increase width and stability

Question 19

wheel design

Answer 19

mag wheel- light weight, no maintenance, less efficient

spoke- high performance, maintenance

Question 20

wheel rims

Answer 20

coated rims for more friction
oval rim, increases surface
pegs or projections
can use gloves, tap around rim for friction

Question 21

Locks

Answer 21

push vs pull- hand function
high vs low
front vs back, convenience of care giver
extensions- if weak, increase lever arm; use strong arm to reach over
anti-tip bars

Question 22

Gradeaid

Answer 22

att to WC locks

prevents chair from rolling backwards

Question 23

UE supports

Answer 23

BFO balanced forearm orthosis

MAS mobile arm support

Question 24

Power chair options

Answer 24

mobility base
seating system
control options
access devices
controller
battery

Question 25

front wheel drive

Answer 25

intermediate turning radius
good for traversing curbs, uneven terrain
tends to fishtail at higher speeds

Question 26

rear wheel drive

Answer 26

largest turning radius
better shock absorption and foot clearance
better control at higher speeds

Question 27

Mid wheel drive

Answer 27

smallest turning radius
most stable on slopes
good indoor chairs

Question 28

Seating System

Answer 28

stationary- less expensive, pt independent with pressure relief
recline- backrest reclines, may elicit spasticity, good for intermittent caths, requires long wheel base
tilt- constant angle between seat and back, less likely to elicit spasticity or alter sitting position, requires long wheel base
tilt/recline- allows either
elevator- increase chair height, reach countertops

Question 29

power recline

Answer 29

if pt self catheterizes
likely to elicit spasticity
longer base

Question 30

control options

Answer 30

proportional- gas pedal like
non-proportional- off or on, set speed, puff chair
momentary- stops as soon as take hand off, joystick
latched- move until tell stop, sip

Question 31

devices used to control WC

Answer 31

chin
sip puff
head rest
joystick
controller is "brain" of WC
can adjust max speed and rate of accel/decel

Question 32

Battery

Answer 32

rechargeable
good for about a year
charge every day

Question 33

Supporters/positioners

Answer 33

chest straps
lateral trunk supports
pelvic positioners

Question 34

Wheelchair cushion

Answer 34

pressure relief
postural support
weight
maintenance
expense $400-500
decisions- give and take
Foam
air-filled= like water bed, good pressure relief, heavy
gel or fluid= heavy, gel distribution

Question 35

Evaluating pt

Answer 35

examine in GE position (supine/ SL)
sitting
goal: neutral posture with good lumbar/trunk alignment

Question 36

wheelchair skills

Answer 36

practice in “real world”
propelling without full hand function- pegs, wrapping rim
hard surface/open space
practice builds skill and stamina

Question 37

overuse injuries

Answer 37

manual WC propulsion major contributor
risk factors
prevention strategies