Wheelchair and Posture Flashcards
what are the broad categories of devices provided
manual attendant propelled wheelchairs
manual occupant propelled wheelchairs
powered occupant controlled wheelchairs
powered attendant controlled wheelchairs
what are the types of wheelchairs provided by NHS
manual attendant propelled wheelchairs
manual occupant propelled wheelchairs
seating wheelbases
occupant controlled (indoor only) occupant controlled (indoor/outdoor) attendant controlled (outdoor)
what are standard semi modular NHS wheelchairs
Lomax uni
Remploy access
(occupant and attendant propelled)
what are lighter weight NHS wheelchairs
Dash Lite
folding frame NHS wheelchair
sunrise neon
rigid frame NHS wheelchair
sunrise helium
examples of seating wheelbase
tilt-in-space
- tilt and fold (folding frame)
recline
- action 3 recliner (folding frame)
recline and tilt-in-space
- Rea Assist (rigid frame)
what are examples of power assisted wheelchairs (not on NHS)
powered handrims
add-on power packs
what are propulsion systems of wheelchairs
levers cranks feet somebody else handrims electricity engine
what needs to be considered about the wheelchair if the occupants feet are main source of propulsion
seat height
castor size
cross braces
what needs to be considered about the wheelchair if it is a handrim propulsion
wheel size
horizontal wheel position
vertical wheel position
handrim diameter
handrim cross section
camber
alignment
tyre type
what is the preferred elbow angles
107 degrees to 118 degrees
(MS = 90-110 degrees
Spinal Cord Injury - 128-135 degrees)
what can increase stability in a wheelchair
increased wheelbase
what needs to be considered in attendant propulsion wheelchairs
wheel size and position
castors
push handles = height and style
types
(un)importance of weight
what are the factors that affect manoeuvrability
castor rake
castor diameter
wheel position
what are features of electric powered indoor chairs (EPIC)
compact
small turning circle
small drive wheels
low power
what are features of electric powered indoor/outdoor chairs (EPIOC)
larger drive wheels greater power greater torque greater range ability to climb kerbs
what influences stability of wheelchairs (6 things)
wheelbase position of centre of gravity user weight anti-tippers castor orientation camber
what are kerb climbers
device which enables the wheelchair to ascend kerbs of up to 4 inches high
contacts kerb first and lifts castor up onto pavement
what is stage I of a pressure sore forming
nonblanchable erythema of intact skin
(heralding lesion of skin ulceration)
individuals w/ darker skin
- discolouration of skin, warmth, oedema, hardness
stage II of a pressure sore forming
partial-thickness skin loss involving epidermis or dermis or both
ulcer is superficial and present clinically as abrasion, blister or shallow crater
stage III of a pressure sore forming
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
stage IV of a pressure sore forming
full-thickness skin loss w/ extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures
undermining and sinus tracts
what are risk factors for pressure sores
immobility
impaired sensation
(two most important)
pressure and time temperature humidity circulation nutrition skin integrity smoking low BMI
what is equation for pressure
pressure = force / area
where are at risk areas for pressure sores when sitting
head shoulder sacrum buttock heel
what are the aim of cushions made to prevent pressure sores
even pressure distribution
low temp at skin surface
low humidity at skin surface
pelvic stability
what is the “clinic effect”
patients adopts different posture when monitored
what is the ideal pelvic posture
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
what incorrect, asymmetrical pelvic postures are seen
posterior pelvic tilt
anterior pelvic tilt
pelvic obliquity
pelvic rotation
what is the most common incorrect pelvic tendency
posterior pelvic tilt
what happens in posterior pelvic tilt
ASIS higher than PSIS flexed lumbar spine thoracic kyphosis shoulder protraction increased cervical extension
c type posture
what causes a posterior pelvic tilt
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
what happens in anterior pelvic tilt
ASIS lower than PSIS
increased lumbar lordosis
thoracic kyphosis is reversed or reduced
shoulder retraction
what causes anterior pelvic tilt
weak muscles/low tone
weak hamstrings
weak abdominals
tight hip flexors (ilipsoas and rectus femorus)
what happens in pelvic obliquity
one ASIS is higher than the other
what causes pelvic obliquity
wheelchair problems
- too wide
- sling back upholstery
physical conditions
- muscle imbalance
- irregular muscle tone
(high or low muscle tone on one side of trunk)
what happens in pelvic rotation
one side of pelvis is more forward than the other side
what is the lower body ideal posture
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
what happens if footplates are position too low or too high
too low
- increase pressure under thigh
too high
- increase sacral area pressure
