Wheelchair fitting Flashcards
Individuals with Disabilities Education Act (IDEA
the services a school district may need to provide to ensure assistive technology is useful in the school setting.
Law definition of assistive technology:
Any service that directly assists an individual with a disability in the selection, acquisition or use of an assistive technology device
No technology:
devices are not electronic. An example can range from a piece of foam glued onto the corners of book pages to make turning easier to a study carrel to reduce distraction
Low technology:
devices are electronic but do not include computer components. An example could be an electronic voice-recording device or a talking watch
High technology:
devices utilize multifunction technology in a complex way and usually include a computer and software
Step 1 implementation/selection of assistive technologies
Collect child and family information. Discussions begin about the child’s strengths, abilities, preferences, needs, and what strategies have worked
Step 2
implementation/selection of assistive technologies
Identify activities within the environments that a child encounters throughout the day and any limitations that may be presented by the environment
Step 3
implementation/selection of assistive technologies
Discuss indicators of a successful intervention and current levels of participation. Observed behaviors and independent interactions will be analyzed
Step 4
implementation/selection of assistive technologies
Brainstorming of Assistive Technologies begins. Activities and desired outcomes must be established and possible solutions discussed with educators, family members, physical therapist, and other people with whom the child interacts on a weekly basis. Supports should be included for movement, communication and/or use of materials if needed. Available supports in the environment should be considered first, then adaptations to those materials
Step 5
implementation/selection of assistive technologies
Test Assistive Technologies. Determine when the intervention will begin and create an observation plan to record the child’s participation with the additional supports
Step 6
implementation/selection of assistive technologies
Identify interventions that work and make any needed modifications. Implementation of Assistive Technologies is a continuous process
Hearing assistive technology systems (HATS)
are devices that are designed to help those with hearing disabilities function better in their day-to-day communication situations. They can be used with or without hearing aids or cochlear implants to make hearing easier and hopefully reduce stress and fatigue
What do sling seats lead to?
tend to hammock and lead to hip adduction and internal rotation
Antithrust seat:
“curb” to prevent forward sliding or migration of the pelvis into a posterior tilt
Lower height backs:
allow more trunk movement and do not interfere with access to the wheels for propelling a manual wheelchair
Higher backs:
provide more posterior support and the ability to mount lateral and anterior trunk supports, as well as a head support
Sling backs
the lightest-weight option but can lead to a rounded trunk or kyphotic posture
Linear or planar backs:
often used with children for ease of growth
Lower section of linear or planar backs:
The lower section, which is often mounted at a 90º angle to the seat, goes up to the top of the pelvis to support a neutral pelvic tilt
Upper section of linear or planar backs:
angled posteriorly to promote trunk extension
What do molded backs and molded seats do?
accommodate significant orthopedic asymmetries and provide maximum pressure distribution, support, and stability
What do secondary supports provide?
provide support but also to help with alignment and positioning
Where can secondary supports be placed?
laterally, anteriorly, or posteriorly to the body
What do lateral supports do?
generally on the trunk
What are hip guides for?
help control the pelvis
Anterior supports:
used to help maintain an upright posture and topromote trunk extension and scapular retraction;
Examples of anterior supports:
shoulder straps, shoulder retractors, chest straps, and vest
Anterior pelvic support:
maintain the pelvis in the best functional sitting posture
Pelvic belts are the most commonly used anterior pelvic support
Posterior supports:
headrests or head supports. Head supports prevent the head from falling rearward, support the head during recline or tilt, and help the client to hold his or her head upright in an aligned position
What can neck flexion or hyperextension lead to?
Neck flexion or hyperextension can lead to drooling, poor swallowing, breathing impairment, and a poor visual field
Measuring WC seat height/leg length
Measure from the user’s heel to the popliteal fold and add 2 inches to allow clearance of the footrest
Average adult size of seat height/leg length:
19.5-20.5 inches
How far is the bottom of the footrest from the floor?
2 inches
You can fit 2-3 fingers under the distal thigh (between the thigh and the seat)
Measurement of seat depth:
Measure from the user’s posterior buttock, along the lateral thigh to the poplitealfold; then subtract 2 inches to avoid pressure from the front edge of the seat against the poplitealspace
Average adult size of seat:
16 inches
Measure of seat depth:
Can you can fit 3-4 fingers between the front edge of the seat and the patient’s poplitealfold with your palm horizontal to the seat?
Measurement of seat width:
Measure the widest aspect of the user’s buttocks, hips or thighs and add 2 inches. This will provide space for bulky clothing, orthosesor clearance of trochantersfrom the armrest side panel
Average adult size of seat width:
18 inches
Hand placement for seat width
You should be able to place your hand between the patient’s trochanter, hip or thigh and the armrest panels with your hand positioned vertically to the seat, with slight contact to both
Both hands should be used at the same time
Measurement of back height:
Measure from the seat of the chair to the floor of the axillawith the user’s shoulder flexed to 90, then subtract 4 inches. This will allow the final back height to be below the inferior angles of the scapula
Average adult size of back height:
16-16.5 inches
Location of inferior angles of scapular:
approx. 1 finger-breadth above the back upholstery when the patient sits with erect posture
Measurement of armrest height:
Measure from the seat of the chair to the olecranonprocess with the user’s elbow flexed to 90, then add 1 inch
Average adult size of armrest:
9 inches above the chair seat
What can a seat too long cause?
posterior pelvic tilt
sliding out of wc
Seat too short:
pressure ulcer, lack of support under femur
sliding our of seat
Seat too wide:
pelvic obliquity
trunk scoliosis
feeling of instability
lateral shift or pelvis in chair
Seat too narrow
pressure ulcers over greater trochanter
difficulty transferring in and out of wc
Back too wide:
flexible scoliosis
lateral trunk bending
pelvic obliquity
feeling of instability
Solution for back too wide:
narrower back support
lateral thoracic support
lateral pelvic support
Back too narrow
lack of movement needed for function
skin breakdown on lateral trunk
discomfort caused by inability to move
Back too low:
upper trunk instability; limited function
excessive thoracic kyphosis
posterior pelvic tilt
Back too high:
falling forward in wc
inability to propel wc optimally
Rear wheels too far back:
shoulder pain; impingement
inability to optimally propel wc
Rear wheels too far forward:
wc tipping backwards; user unable to control
