Wheelchair and Posture

Question 1

what are the broad categories of devices provided

Answer 1

manual attendant propelled wheelchairs

manual occupant propelled wheelchairs

powered occupant controlled wheelchairs

powered attendant controlled wheelchairs

Question 2

what are the types of wheelchairs provided by NHS

Answer 2

manual attendant propelled wheelchairs
manual occupant propelled wheelchairs
seating wheelbases

occupant controlled (indoor only)
occupant controlled (indoor/outdoor)
attendant controlled (outdoor)

Question 3

what are standard semi modular NHS wheelchairs

Answer 3

Lomax uni
Remploy access

(occupant and attendant propelled)

Question 4

what are lighter weight NHS wheelchairs

Answer 4

Dash Lite

Question 5

folding frame NHS wheelchair

Answer 5

sunrise neon

Question 6

rigid frame NHS wheelchair

Answer 6

sunrise helium

Question 7

examples of seating wheelbase

Answer 7

tilt-in-space
- tilt and fold (folding frame)

recline
- action 3 recliner (folding frame)

recline and tilt-in-space
- Rea Assist (rigid frame)

Question 8

what are examples of power assisted wheelchairs (not on NHS)

Answer 8

powered handrims

add-on power packs

Question 9

what are propulsion systems of wheelchairs

Answer 9

levers
cranks
feet
somebody else
handrims
electricity 
engine

Question 10

what needs to be considered about the wheelchair if the occupants feet are main source of propulsion

Answer 10

seat height
castor size
cross braces

Question 11

what needs to be considered about the wheelchair if it is a handrim propulsion

Answer 11

wheel size
horizontal wheel position
vertical wheel position

handrim diameter
handrim cross section

camber
alignment
tyre type

Question 12

what is the preferred elbow angles

Answer 12

107 degrees to 118 degrees

(MS = 90-110 degrees
Spinal Cord Injury - 128-135 degrees)

Question 13

what can increase stability in a wheelchair

Answer 13

increased wheelbase

Question 14

what needs to be considered in attendant propulsion wheelchairs

Answer 14

wheel size and position
castors

push handles = height and style

types
(un)importance of weight

Question 15

what are the factors that affect manoeuvrability

Answer 15

castor rake
castor diameter
wheel position

Question 16

what are features of electric powered indoor chairs (EPIC)

Answer 16

compact
small turning circle
small drive wheels
low power

Question 17

what are features of electric powered indoor/outdoor chairs (EPIOC)

Answer 17

larger drive wheels 
greater power
greater torque 
greater range
ability to climb kerbs

Question 18

what influences stability of wheelchairs (6 things)

Answer 18

wheelbase
position of centre of gravity 
user weight 
anti-tippers 
castor orientation 
camber

Question 19

what are kerb climbers

Answer 19

device which enables the wheelchair to ascend kerbs of up to 4 inches high

contacts kerb first and lifts castor up onto pavement

Question 20

what is stage I of a pressure sore forming

Answer 20

nonblanchable erythema of intact skin
(heralding lesion of skin ulceration)

individuals w/ darker skin
- discolouration of skin, warmth, oedema, hardness

Question 21

stage II of a pressure sore forming

Answer 21

partial-thickness skin loss involving epidermis or dermis or both

ulcer is superficial and present clinically as abrasion, blister or shallow crater

Question 22

stage III of a pressure sore forming

Answer 22

full-thickness skin loss involving damage or necrosis of subcut tissue, which may extend down to but not through underling fascia

ulcer presents clinically as deep crater with or without undermining of adjacent tissue

Question 23

stage IV of a pressure sore forming

Answer 23

full-thickness skin loss w/ extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures

undermining and sinus tracts

Question 24

what are risk factors for pressure sores

Answer 24

immobility
impaired sensation
(two most important)

pressure and time 
temperature 
humidity 
circulation 
nutrition 
skin integrity 
smoking
low BMI

Question 25

what is equation for pressure

Answer 25

pressure = force / area

Question 26

where are at risk areas for pressure sores when sitting

Answer 26

``` head shoulder sacrum buttock heel ```

Question 27

what are the aim of cushions made to prevent pressure sores

Answer 27

even pressure distribution low temp at skin surface low humidity at skin surface pelvic stability

Question 28

what is the "clinic effect"

Answer 28

patients adopts different posture when monitored

Question 29

what is the ideal pelvic posture

Answer 29

neutral alignment - head balanced over spine, spine balanced over pelvis neutral pelvis - ASIS and PSIS are level natural spine curves shoulders slightly posterior to pelvis equal weight bearing through ischial tuberosities

Question 30

what incorrect, asymmetrical pelvic postures are seen

Answer 30

posterior pelvic tilt anterior pelvic tilt pelvic obliquity pelvic rotation

Question 31

what is the most common incorrect pelvic tendency

Answer 31

posterior pelvic tilt

Question 32

what happens in posterior pelvic tilt

Answer 32

``` ASIS higher than PSIS flexed lumbar spine thoracic kyphosis shoulder protraction increased cervical extension ``` c type posture

Question 33

what causes a posterior pelvic tilt

Answer 33

wheelchair problems - seat depth too long - back support too short - sling back upholstery physical conditions - tight hamstrings (no knee extension) - reposition themselves by sliding - can not maintain 90 degrees hip flexion

Question 34

what happens in anterior pelvic tilt

Answer 34

ASIS lower than PSIS increased lumbar lordosis thoracic kyphosis is reversed or reduced shoulder retraction

Question 35

what causes anterior pelvic tilt

Answer 35

weak muscles/low tone weak hamstrings weak abdominals tight hip flexors (ilipsoas and rectus femorus)

Question 36

what happens in pelvic obliquity

Answer 36

one ASIS is higher than the other

Question 37

what causes pelvic obliquity

Answer 37

wheelchair problems - too wide - sling back upholstery physical conditions - muscle imbalance - irregular muscle tone (high or low muscle tone on one side of trunk)

Question 38

what happens in pelvic rotation

Answer 38

one side of pelvis is more forward than the other side

Question 39

what is the lower body ideal posture

Answer 39

feet flat on footplate in neutral position ankles 90 degrees knees 105 degrees and neutral abduction femurs parallel to seat footplate position allows two inch clearance from the ground 1 inch space from back of knee to front of seat

Question 40

what happens if footplates are position too low or too high

Answer 40

too low - increase pressure under thigh too high - increase sacral area pressure