Wheelchair and Orthotics

Question 1

General principles of sitting

Answer 1

• Maximise SADistribute the weight over as wide an area as possible to lessen force against bony prominences
• Maintain or improve postural alignmentIf client has a fixed deformity then need to build around this. If they have a flexibly deformity then this can altered.
• Provide stable base of supportEnsure firm base of support to have a stable and level pelvis (this may correct trunk posture). Firm BOS will also maximise function as increases stability will decrease energy use. There is a trade off and is important to not compromise independence by improving stability.
• Decrease abnormal tonal influencesAssessment of tone and spasticity, may increases due to effort required to compensate for poor stability, pain from poor position or reduction of length in certain muscles.
• Promote increased sitting toleranceWhat works best for the client, patient must want to use for prolonged period of time. It should be effortless.Minimise discomfort and fatigue = enhanced sitting tolerance
• Enhance cosmesisSee the person first not the deviceIndividual client factors. Don’t over do it with straps and things to ensure it is not unnecessarily cumbersome.

Question 2

Body measurements

Answer 2

Accurate measurements will decrease energy expenditure for sitting and propulsion. Width (pressure injuries or asymmetrical posture) Length (poor thigh contact for weight bearing, short, or posterior pelvic tilt if too long)

Hip width (GT to GT)

Chest width

Thing depth (most reward point/sacrum to popliteal fossa)

Lower leg length (popliteal fossa to heel)

Question 3

Other considerations for wheelchairs

Answer 3

Pressure redistribution cushions can be used to alter posture (if not fixed), backrests can be more useful with fixed deformity as they can be more rigid

Question 4

Crutches guidelines

Answer 4

20-30 degrees elbow flexion

Forearm cuff 2.5 cm to 5cm below elbow for forearm crutches

Forearm platform 1.5-2.5 cm below elbow for gutter (elbow in 90 flex)

Crutches 15cm anterior and lateral to foot

Question 5

When to use gutter crutches

Answer 5

When clients cannot weight bear through their wrist

Question 6

Mobilisation with crutches

Answer 6

• Non WB
  
  • Step to gait (crutches move together and feet move together)
  • Step through gait (crutches forward together, limbs forward together past crutches)
• PWB
  
  • Step to (crutches and affected limb together, unaffected follows)
  • Step through (crutches forward with affected unaffected follows and goes beyond)
  • 4 point reciprocal - RC, LL, LC, RL

Transfers ( both crutches in one hand, standing using arm rest or bed, transfer crutches)

Stairs - always lead with good leg and crutches stay with bad