Wheelchair And Seating Flashcards
Non wheelchair mobility devices
Hemiwalker, four wheeled walker, two wheeled walkers, canes, scooters, crutches, lofstrand cutch, trekking stick
Rollator
4 wheeled walker
Not appropriate for pts who need alot of stability or cognitive deficits impacting ability to lock brakes
Front wheeled/2 wheel walker
Used for balance deficits, front wheels can be turned inside to clear doorways, grip at wrist height
Cane
Walking aid, provide postural stability, maintaining good posture
Durable medical equipment
Withstands repeated use and primarily/customarily used to serve a medical purpose and not useful to a person in absence of illness/injury
Can be rented
Custom/complex rehab tech
Products and associated services including medically necessary, individually configured devices that require eval, configuration, fitting, adjustment, programming
Custom manual wheelchair, power wheelchair, adaptive seating, alternative positioning devices
Role of OT in seating and mobility
Holistic evals to assess skills, patterns of daily living and mobility
Identify needs, interest, goals, supports, and barriers
Assess/recommend environmental settings to understand type of mobility device
Assess/align equipment and specific features with client, needs, goals, and environment
Assist clients/caregiver education of device use
Remain current about policy/reimbursement
Assistive technology practitioner
Credential required for many type
Of systems and funding sources offered by rehab and assistive technology association of north america
rehab tech supplier ensures consumers best interest
Certified Rehab Technology specialist
Credential through national registry of rehab tech suppliers
Role of Rehab Technology supplier
Equipment vendor/distributor, access to various manufacturers, knowledge of equipment, equipment limitations, working knowledge of equipment applications, provider of equipment details for funding, helps get trial equipment
Seating evaluation
Assess all client factors to determine needs match equipment, medical information determines needs
1) primary dx that lead to mobility limitations
2) secondary dx comorbidities
3) past/future sx, hold off until after surgery posture
4) height/weight, instability need for alternative feeding
5) pertinent medical status prosthesis ventilators o2 tanke
6) environment
7) transportation
8)pain
9) functional sensory ability
10) skin integrity
11) current mobility base
12) seating system on mobility base
13) posture in current equipment
14) motor/mobility skills
Medicare mobility device algorithm
Cane/crutch to walker to manual wheelchair to manual wheelchair with power assist to scooter to power chair with joy stick to power wheelchair with alternative controls to dependent
Postural assessments
Complete on firm surface such as mat or armchair, bed will sag, wheelchair surface will hammock
Measurements
LE length=foot plate placemebt
Hip width = width of seat
Buttock to upper leg=depth of seat
Shoulder height= back support
Measure with yard stick or metal, soft measuring tape bends
If hips are abducted measure hip to hip
Seat depth measure pelvis to popliteal fossa
Back supports
Depends on need
-if you need alot of support want it to go to shoulders
-ultra low for access to wheels
Wheelchair angles
Pelvis to thigh = seat to back angle
Trunk to thigh = seat to back angle
Thigh to calf = seat to leg rest angle
Calf to foot = leg rest to foot angle
Make note of flexibility of spine against gravity, change gravitational pull for posture/head position
Posture assessment: anterior pelvic tilt
Lordosis, center of gravity forward, pressure on pubis
Posture assessment: posterior pelvic tilt
Kyphosis, sacral pressure, shoulder girdle moves forward, sliding
Posture assessment: pelvic obliquity
Pressure on ischial tuberosity, concavity at ribcage, may lead to scoliosis, lateral leaning/instability
Posture assessment: pelvic rotation
Leg length discrepancy vs rotation, R vs L, seat depth, may be equal but appear as discrepancy due to rotation
Mobility base
Dependent= smaller wheels
Tilt: anterior, posterior, lateral
Weight of base
Wheel size
Caster size
Armrest
Leg rest
Wheelchair lock placement
Propulsion technology
Transport wheelchair
Momentary use, considered
DME not CRT
Seating options
Ready made
Custom made
Custom molded (pressure mapping)
Accommodate asymmetries by providing external support for alignment
Cushion material
Foam, gel, air, combo
Cover- breathable (maintain temp) vs incontinent proofs
criteria for selection in power mobility
1) impairment impairs 1+ MRADLs, inability to complete, increased risk of injury, complete in reasonable time
2) r/o less expensive dme
3) document decrease UE strength endurance ROM coordination presence of deformity/pain
Power mobility device categories
1) scooters/POV
2) power wheelchairs
Category 1 scooters/POV
3-4 wheels, uses tiller for stearing, limited seating options
Funding limited in how much they pay for scooters
Used outside, part time assistance to replace ambulation, effective over some terrains
Require decreased exertion than manual w/c
Typical user: decreased strength/balance to ambulate with cane, RW, manual wheelchair, has trunk control and UE for steering
MS, CHF, arthritis, COPD
Category 1 scooter criteria
Safety in transferring to/from Power operated vehicle
Operate tiller systems (BUE skills)
Posture, maintaining position
Access to rooms, maneuvering spaces scooter has large turning radius
Demonstrate willingness to use equipment
Utilize judgement/vision for safe mobility
Cons to power operated vehicles/scooters
Need a-lot of space
Decreased stability on uneven terrain
Difficulty use while seated at a variety of settings
Need UE strength to operate
Category 2 power wheelchairs
Used for fulltime mobility assistance
Lack sufficient strength/postural stability for manual wheelchair or power operated vehicle, used inside and outside, typically controlled with 1 hand, greater maneuverability compared to POV
No frontal obstruction for access to work surfaces allows for greater access, maneuverability, and stability
Types of drive systems
Rear wheel drive
Midwheel/center wheel drive
Front wheel drive
Rear wheel drive
Motor in back, larger casters, provides stability, improved comfort secondary to suspension, can handle higher speeds, wider turning radius, decreased maneuverability, larger may not fit in certain environments
Have to push, least one provided
Midwheel/center wheel drive
Motor in middle, 4 casters 2 in front/back, can pivot smaller turning radius, increased maneuverability, more intuitive to drive, increased stability up/down inclines, difficulty navigating terrain/obstacles due to casters
Needs ramp or running start, looses contact casters get hung up
Front wheel drive
Motor is in the front, larger wheels in front, casters in back, decreased turning radius, better over terrain, navigating hills/curbs, feel like it fishtailing due to back casters
Pulls base over obstacle, grab and go, snow, curbs, grass
Optional functions of power chairs
Power recline
Tilt
Seat elevation
Height adjustability
Power standing
Power leg rst
Power recline justification
Pressure distribution, decreased hop flexion, maintaining muscle length/joint ROM, BP management, respiratory abilities, catheter care, edema management
Power rear tilt justification
Pressure relief, increased chewing/swallowing, head uptight, visual field orientation, BP management, respiratory distress, increased sitting tolerance, helps with transfer, manage tone/soasticity, manage autonomic dysreflexia
Power anterior tilt justification
Increase (I) with transfers, increase (I) with ADLs, decrease pain, minimize eliciting STNR, pressure distribution away from scapula, sacrum, coccyx, ischial tuberosity, “work ready”, accommodate hip contracture
Power lateral tilt justification
Reorient trunk for functional posture
Power seat height justification
Increase (I) with transfers, decrease fall risk, increased functional reach, decrease over shoulder reaching, decrease overuse injury, decreased hyperextension when conversing with someone in standing, decrease pain
Power standing justification
Supported stand, can move wheelchair in standing, lower speed for safety, increased functional reach, increased (I) with ADLs, decrease risk of overreaching/overuse injury, decrease hyperlordotic neck, decreased stnr, decrease pain, facilitate eye positioning for communication, increased weight bearing, decreased contracture, increased elimination/digestion, difficult to get funding
Power leg rest justification
LE edema management, increased circulation, maintain LE muscle length, joint ROM, prolong stretch, increase clearance threshold
Power Assist wheelchair
Motorized wheels for decreased UE strength and decreased effort to propel
Assistive manual power
Smart Drive powers wheel while user uses wheel to steer, increase terrain
Power add-ons system attaches to front of wheelchair and lift casters to turn manual to 3 wheel power mobility device, more stable than scooter, need UE to steer
Power assist wheelchair justification
Can’t fully operate manual wheelchair ie shoulder pain
Less expensive than power wheelchair, ECT, decrease repetitive strain, assist navigating ramps/curbs
Group 1 power wheelchair
Basic joy stick, captain chair, needs to be initiated by consumer or physician
Does not need specialist evaluation
Characteristics:
5 mile range on battery/3 mph
Manual elevating leg rest
6* incline
Non expandable joy stick, nonpowered recline, cant have ventilator, intermittent use less than 2 hours/days, 3/4” obstacle
Group 2 power wheelchair
Captains chair or sling seat/back
Can accommodate back support cushion and add on seating, no power or power options
Characteristics:
7 mile battery range/3 mph
4 wt capacities
6* incline
1.5” obstacle
Standard or remote joy stick
Single/multi-power seat function
Full time use
Power option accommodates ventilator, alternative switches/controls
Justification: skin integrity, chronic/progressive disease processes, irreversible condition, use of ventilator
Group 3 power wheelchair
Mobility limitations must be neurological, myopathy, or congenital skeletal deformities
Requires specialty evaluation performed by license/certified professional, supplier must be ATP certified
12 mile range, 4.5 mph, 7.5* incline, 72” obstacle, single/multifxn power seat, full time use, accommodates ventilator/seating, suspension
Suspension decreases vibration of wheelchair, smoother ride, decreased tipping on uneven terrain
Group 4 wheelchair
Offers features not needed for in home use, 16 miles/charge, 6 mph, 9* incline, 3” curb climb
