Wheelchair Flashcards by Erin Harting

What is wheel configuration offers the best turning radius?

Mid/ center wheel drive

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4 types of seating surfaces

SM- P/C

Sling, Molded, Planar, Contour

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What type of seat is no extra cost and come as standard equipment form the manuafacturer? Usually _ or _ upholstery stretched from frame to frame

Sling

Vinyl or cloth upholstery

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What type of seating allows for maximum movement of patient on seating surface? Made of - _ upholstered with cloth or vinyl.

Planar

Made of FOAM-BACKED BOARD upholstered with cloth or vinyl

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The _ seating surface has increased comfort over planar systems, and offers increased _ _ over seating surface.

The CONTOUR seating surface has increased comfort over planar systems, and offers increased PRESSURE DISTRIBUTION over seating surface.

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Which type of seating surface offers maximum pressure distribution over a person’s entire seating surface? Allows for _ positioning, but also has the _ _.

Molded/ Custom Contour

Allows for OPTIMUM positioning, but also has the HIGHEST COST

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The advantage of tilt wheel chair is _ _ and _ _. The biggest benefit of a recline chair is that _ _, and helps with _ _.

Tilt wheelchair is PRESSURE RELIEF and WEIGHT DISTRIBUTION.

Recline chair is that EASES TRANSFERS, and helps with BLADDER MANAGMENT

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What are the differences between proportional vs. microswitch controls? Associated analogies?

Proportional
- “dimmer switch”, adjustable control

Microswitch
- “light switch”, it’s on or off (non-adjustable)

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How can controls be operated? Examples (6)

Anywhere on the body

Hand, food, jaw, cheek/face, back of the head, breath control

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What is the difference between upright, prone, and supine standers? Depends on? What is the difference between a gait trainer and a walker?

Difference b/w standers
- body position, dependent upon patient needs/ health condition

Difference between gait trainer and walker?
- Cost

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3 names of gait trainers from rehab symposium?

MK Gay!

Meywalk (Mayland Co)
Kidwalk (prime engineering)

Grillo (Ormesa)

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What type of wheel configuration is good for: Climbing over obstacles? Tighter living/ work/ school environments? Larger more rural spaces?

Climbing over obstacles- FWD

Tighter living/ work/ school environment- MID/ CENTER WD

Larger more rural spaces- RWD

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How can speed parameters be adjusted: where? Kinds of adjustments? (4)

Adjusted by the factory

Adjustments include: ramp up/ down, torque, joystick/ control sensitivity, Max/ min speed

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7 possible wheelchair seating components?

SF PATHS

Seat, foot rests, postural support straps, arm rests, trunk and thigh laterals, head rest, seat back

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Which component do you need to consider?-How much pelvic stability is needed, and How much pressure relief is needed.

Seat

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With which component do you need to consider? - How much trunk control does the client require, How much pressure relief does the client require (scoliosis, rib hump, biangular bracket), and what type of mounting hardware is needed.

Seat Back

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With which component should you consider?- How much pressure will be put on these devices and will the client be able to get up close to a table/ desk/ counter, etc.

Arm rests

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With which component do you need to consider?- how much support and positioning will be needed, how much pressure will be applied to these devices, and what type of transfer is the client able to do (swing away, or fixed) as well as castor height.

Foot Rests

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Which component should you consider?- How much voluntary control does the client have, is the chair going to have a tilt system, will the client be transported in a van or bus in the chair, and do they wear eyeglasses or hearing aides.

Head rest

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With which component do you need to consider?- How much lateral trunk control is there, How much pelvic control, is the spine straight and if not how much support is needed to get the head in a upright position.

Trunk and hip laterals/ pads

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If at all possible do not use? Why?

Do not use trunk and hip laterals/ pads

Too restraining

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With which component should you consider?- How much anterior trunk control is there, how much pelvic control is there, and are they going to transported in a van or bus while sitting in the chair? 2 types? Provide?

Postural support straps

2 types: chest harness, lap belt
- provide Sagittal plane control

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Goals of adaptive seating: support of _ _ _, provide support to _ _ and _, prevent _ problems and _. Which goal is not seen as important when justifying need to state agency?

Support of UPRIGHT BODY ALIGNMENT

Provide support to OPTIMIZE ALIGNMENT AND FUNCTION

Prevent PRESSURE problems and COMFORT (not seen as important by state agencies)

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Principle of control: provide _ _ and good _ _.

Provide PROXIMAL STABILITY and good PELVIC ALIGNMENT

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Components of good pelvic stability include: _ to _ _ tilt, and _ and _ _ pelvis.

NEUTRAL TO SLIGHT ANTERIOR tilt LEVEL AND NOT TILTED pelvis

Principle of control: After the pelvis provide optimal?

Provide optimal alignment in the rest of the body

Alignment of the pelvis takes priority over alignment in the _ _, but _ _ _ is utmost to provide adequate _ of _ and _ _

Pelvis takes priority over alignment of the LOWER EXTREMITIES, but UPRIGHT HEAD POSTURE is utmost, to provide adequate FIELD OF VISION and ORAL INTAKE

Do not _ _, cannot be corrected in a wheelchair.

Do not OVERCORRECT CONTRACTURES

Pelvic obliquity is limited hip flexion _ or _ _ _ unilaterally.

Limited hip flexion UNILATERALLY or EXTERNAL ROTATION CONTRACTURE unilaterally

When considering a patients wheel chair needs do not _ or _ _, and make sure the system is _ for the client and _ their _.

Do not OVER or UNDER EQUIP, make sure the system is COMFORTABLE for the client and MEETS THEIR NEEDS.

Principles of control- Blocking movement: seating supports merely _ the _ applied to it by the _.

Seating supports merely COUNTERACT the FORCES applied to it by the BODY

Principle of control: The force direction and magnitude is determined by the _ not the _ _.

Determined by the BODY not the SEATING PAD

Principle of control: the larger the _ _ the body touches the more _ the _.

The larger the SURFACE AREA the body touches the more DISTRIBUTED THE PRESSURE

Principle of control: controlling a limb requires _ _- _ to _ the body and _ to _ the limb.

Requires THREE FORCES- 2 to IMMOBILIZE the body and 1 to CONTROL the limb

Principle of control: by maximizing the lever _ it decreases the _ _ to control

By maximizing the lever LENGTH it decreases the FORCE REQUIRED to control

#1 most common problem with adaptive seating?

Posterior pelvic tilt

What are the five things used to control a posterior pelvic tilt? Which one is the most effective?

P SACK Pelvic strap *most effective* SubASIS bar Anti-thrust block Crotch block (aka pommel stabilizer/ adductor block) Knee block

What is the most optimal and preferred way to manuever a wheelchair if the patient is able to use?

Joystick

#2 most common problem with adaptive seating? What 2 landmarks should you use to assess?

Pelvic obliquity and rotation ASIS and PSIS are used to asses for obliquity and rotation

Pelvic obliquity is named for the _ side, causes increased _ on the IT of the _ side and can cause _ _ of the _.

Named for the LOW side, causes increased PRESSURE on the IT of the LOW side and can cause LATERAL CURVATURE OF THE SPINE

#3 Most common problem with adaptive seating? Which side is most affected?

Windswept posturing ADDUCTED SIDE IS USUALLY DISLOCATED

What is a good solution for seating if patient has windswept posturing?

Split seat

#4 common problem with adaptive seating?

Scoliosis

Scoliosis and Adaptive seating: Corrective support of a C-curve requires _ _ _, generally not effective for _ curves. Ideal solution is custom _-_-_ _ system.

Corrective support of C-curve requires 3 POINT LOADING, generally not effective for LARGE curves. Ideal solution is custom FOAM-IN-PLACE MOLD system

#5 common problem with adaptive seating

90/90/90 seating

90 degree seat to back angle promotes: _ sitting posture, side _, cervical _ when _ _, and poor _ of _.

KYPHOTIC sitting posture, side LEAN, cervical HYPEREXTENSION when LOOKING UP, and poor LINE OF SIGHT.

If 90/90 is needed to control the pelvis, open the _ _ _ _ to allow head and thoracic spine to position themselves over the _, or try a _ _.

Open the SEAT TO BACK ANGLE to allow head and thoracic spine to position themselves over the BOS, or try a BILATERAL BACK.

With a bilateral back the break in the back is set in the _ _, at the level of the _. This holds the pelvis in a more _ _, but allows the thoracic spine to _.

The break in the back is set in the LUMBAR REGION, at the level of the PSIS. This holds the pelvis in a more NEUTRAL POSITION, but allows the thoracic spine to EXTEND.

Opened seat-to-back angle is optimally _ _ to accommodate severe kyphotic posturing with forward head.

Optimally 110 DEGREES . . .

Another common issue with adaptive seating is _ in the seating system, is caused by the pelvis _ being _ _ _ _ in the seat. Usually due to _ _ not being secured _, and allowing _ _.

Common issue . . .SLUMPING in the seating system, is caused by the pelvis NOT being ALL THE WAY BACK in the seat. Usually due to PELVIC STRAP not being secured TIGHTLY, and allowing FORWARD SLIDE

Common contractures at the hip which cause compensatory movement of the pelvis when over corrected: Limited hip flexion bilaterally causes _ _ _, limited hip flexion unilaterally causes _ _, and external rotation unilaterally causes _ _.

Limited hip flexion bilaterally causes- POSTERIOR PELVIC TILT Limited hip flexion and external rotation unilaterally causes- PELVIC OBLIQUITY

Results of sitting with a posterior pelvic tilt: _ sitting, _ trunk posture, _ _ posture and _ _, _ compromise, and difficulties with _ and _.

SACRAL sitting, KYPHOTIC trunk posture, FORWARD HEAD and NECK HYPEREXTENSTION, RESPIRATORY compromise, and difficulties with DIGESTION AND ELIMINATION

Pelvic straps should be mounted at a? Must be kept _, belts tend to _ as the pelvis _ and _.

Pelvic strap should be mounted at 45 DEGREE ANGLE Must be kept TIGHT, belts tend to DISTORT as the pelvis TWISTS AND TURNS

Which type pelvis control has the best mechanical advantage? Needs to be used _.

SubASIS Needs to be used CAREFULLY

An unlevel pelvis can cause? A rotated pelvis can cause?

Unlevel- LATERAL FLEXION OF THE SPINE Rotated- INCREASES SPINAL ROTATION AND LATERAL FLEXION

General goals of seating: provide _ and _, improve _ and body _, improve function of all _ _ _ and _ and _ systems, improves _ and _, prevents _ _, and helps with _.

``` Provide SUPPORT AND CONTROL Improve STABILITY and BODY ORIENTATION Improve function of all DISTAL BODY PARTS and GI and CARDIOPULMONARY systems Improves APPEARANCE and COMFORT Prevents PRESSURE SORES Helps with SOCIALIZATION ```

2 specific goals of seating: Maintains _ _ position, and optimize _ _.

Maintain GOOD PELVIC position Optimize SPINAL ALIGNMENT

Seating stability begins with _ _. Secondary rules of seating and positioning: the foot rules the _, the _ rule the _, and the _ rules the spine.

Seating stability begins with PELVIC STABILITY Secondary rules of seating and positioning: the foot rules the HIP, the HIP rules the PELVIS, and the SACRUM rules the spine.

Who is part of the seating team? (3) And sometimes the _ as appropriate.

The OT, PT, Rehab Technology supplier (RTS) And sometimes the PHYSICIAN as appropriate

What is the most important aspect of adaptive seating process? Who does it affect? For how long on average?

The assessment/ evaluation Affects the client and their families, for the next 3-5 years

How positive the outcome of the adaptive seating that is closed depends on how well the _ is _, and how _ the information gathered _ _.

Depends on well the ASSESSMENT IS CONDUCTED, and how ACCURATELY the information gathered IS USED.

6 parts of the Hypothesis Oriented Algorithm for Clinicians (HOAC): part 1- initial _ of _, part 2- _ statement, part 3- _, physical _, part 4- _/ _ statement, part 5- _ (clinical _), and part 6- treatment _ (_ and _)

``` Part 1- initial COLLECTION OF DATA Part 2- PROBLEM statement Part 3- EXAMINATION, physical ASSESSMENT Part 4- PROBLEMS/ GOALS statement Part 5- HYPOTHESIS (clinical IMPRESSION) Part 6- treatment STRATEGY (SOLUTION AND OUTCOME) ```

For all postural deviations/ deformities you should _ to _. If it can be _, than it is considered _, if it can't be, it is considered _ and must be _.

For all postural deviations/ deformities you should ATTEMPT TO CORRECT If it can be CORRECTED, than it is considered FLEXIBLE If it can't be, it is considered FIXED and must be ACCOMMODATED

When performing and examination/ physical assessment it is extremely important to place client on a _, _ _, such as a _ _.

Extremely important to place client on a LEVEL, SUPPORTIVE SURFACE, such as a MAT TABLE.

Proper _ _ adjustment is important for pressure distribution as well as to eliminate potential _ _ on the _ _ _ _ at the edge of the _/ _.

Proper FOOT REST adjustment is important for pressure distribution as well as to eliminate potential PRESSURE POINT on the BACK OF THE THIGH at the edge of the CUSHION/ SEAT.

When properly positioned _% of the seating pressure can be carried by the _, _% by the _, and _% by the _.

20% by the FEET 20% by the FEMURS 60% by the BUTTOCKS

Any changes in seat _, _ _ height or _ position can negatively affect pressure distribution.

Any changes in seat DEPTH, FOOT REST height, or PELVIC position can negatively affect pressure distribution

_ is the physical trauma that occurs due to the movement of skin or muscle over a bony prominence. Can occur during _, _ and even _ in the _. Other factors that can affect are _ and _ _.

SHEAR Can occur during TRANSFERS, TOILETING and even REPOSITIONING IN THE WHEELCHAIR Other factors that can affect shear are AGE AND WET SKIN