Wheelchair Presciption Flashcards
0
Q
Power vs. Manual
A
- Power : bulky, heavy; expensive; specialized transport; maintenance issues
- Manual : smaller, lighter; less expensive; transport by car; improves fitness/can lead to overuse issues
- Team decision in collaboration with the pt.
- Delay decision until rehab well underway.
1
Q
3 Types of Chairs
A
- Manual
- Power
- Push Rim Activated Power Assist Wheelchair (PAPAW)
2
Q
When to Select a Power Chair?
A
- insufficient strength to propel a manual WC
- need to cover long distances - uneven terrain
- certain medical or orthotic problems
- high risk for overuse injury
3
Q
Manual Chair - C4-C6 level implications
A
- C4 - unable to propel
- C5 - limited distance indoors
- C6 - may be too slow or tiring to use. Power chair may be more suitable for lifestyle or priorities.
4
Q
Selecting a Manual Chair
A
- lightest wt possible
- stable frame for efficient use
- quality
- optimal wheel size
- best combo of ease of propulsion and stability
- fitted to prevent overuse injury
5
Q
Manual Chairs - Types
A
- folding frame
- rigid frame
6
Q
Rigid vs. Folding Wheelchair - Pros and Cons
A
- Rigid “+” = easier to propel; fewer components/stronger; usually lighter; seat to back angle adjustable
- Rigid “-“ = bumpier on uneven surfaces; harder to store
- Folding “+” = easier to store; smoother ride on uneven surfaces
- Folding “-“ = seat to back angle non-adjustable; more components to break; harder to propel
7
Q
Wheelchair Components
A
Handrim with vertical projections, molded wheels, handrim, tire, back post, tipping lever, wheel lever/lock, caster, cross brace, bottom rail bar, foot plate, heel loop, elevating adjustable leg rest with calf pad, seat raill, seat, clothing guard, bback tube, back, handgrip, full-length fixed armrest, full-length removable armrest, desk style removable armrest, height adjustable armrest with full length top.
8
Q
Seat Depth
A
- measure from posterior buttocks to popliteal fossa, then subtract 1-2 inches
- important for good postural support (and pressure relief)
- if too short - extra pressure on buttocks
- if too long - impedes circulation if into popliteal fossa
9
Q
Seat Width
A
- measure the widest portion of the pt., add not more thann 1-1/4 in, account for braces, etc.
- as narrow as possible for optimal function
- if too narrow - skin breakdown - greater trochanter
- if too wide - harder to propel, skin breakdown, limited on where you can take a wide w/c
10
Q
Seat Height
A
- seat rail to the floor
- need to know the height of the cushion
- finished seat height considerations: propelling chair with foot (lower to ground, leg rests need to clear the ground), transfers (surface transferring on to), approaching work surface (under desk/table, height of van, public transportation, etc.)
11
Q
Seat Height - can be altered by:
A
- altering frame construction
- changing wheel size
- thickness of seat insert/cushion
- removing upholstery and add a seat board
12
Q
Seat Surfaces
A
- firm surface is more stable (and more comfortable)
- different options available: sling (slumped sacral sitting posture), taut fabric, solid metal/plastic base, solid hook on seat
13
Q
Seat
A
- standard (thin cushion)
- solid (solid seat insert, put cushion on top, take out when fold)
14
Q
Wheelchair Back
A
(for support and comfort)
- can be fixed or adjustable
- upholstery or solid (plastic)
- if too high - impedes shoulder ROM
- if too low - not enough postural support
15
Q
Pelvic Positioner
A
- several functions, angle between 45 and 60 degrees
- how to fasten - velcro, buckle (like seatbelt)
16
Q
Arm Rests
A
- consider height and length of arm rests
- if too high - shoulder are in bad position
- if too low - lean over to support themself on armrests, postural problems
17
Q
Footrests/Legrests
A
- swing away/elevating
- if too long - slide out of chair, sacral sitting, slumped posture
- if too short - sacral sitting - too much weight on sacrum
- angle of front rigging - pt. may have tight HS
- several styles of footrests
- calf straps/heel loops
18
Q
Casters/Hangers
A
- little wheels in front
- 4-8 inches in standard
- smaller the caster, tighter the turn (the more maneuverable)
- larger casters - easier for terrain
- Hangers - part of leg rest that attaches to wheelchair (from 60 to 90 degrees)
19
Q
Tires
A
- standard or solid (don’t put air on it, not much tread - no traction, easier to roll, but bumpier ride)
- pneumatic (put air in, easier ride, need to know how to change a tire)
- airless inserts (hybrid, softer ride, no air in it, expensive)
- grade aids (prevent from rolling backwards)
20
Q
Wheel Position
A
- up and down affects seat height and overall stability
- Moving wheel backward: pt. COM moves forward, more energy to steer, increases amount of shoulder extension, increases stress on UE
- Moving wheel forward: pt. COM moves backward, easier to steer, less stressful on UE, but chair less stable (more likely to tip over backward, harder to transfer)
21
Q
Wheel Design
A
- Mag Wheels - lightweight, maintenance free, less efficient
- Wire of Spoke Wheels - tightening spokes, maintenance
22
Q
Wheel Rims
A
- Coated Rims - more comfortable, gives a little friction
- The Natural-Fit - larger surface to grasp, over hand rims
- Pegs or Projection
- can get wheelchair gloves to protect hands
23
Q
Wheels
A
- quick release wheels
- camber (angled wheels, top close to wheelchair than bottom, done to make more stable, increases overall width of the wheelchair
24
Locks
- push vs. pull - depends on hand function
- high vs. low - high = easier but in the way when propelling
- front vs. back - back = convenience of the caregiver
- extensions - longer LA, make it easier to reach and STR
- anti-tip bars - keep from falling over
25
Gradeaid
- attached to WC locks
| - prevents chairs from rolling backwards (when going up an incline)
26
Accessories
- Upper Extremity Supports
- BFO - balanced FA orthosis
- MAS - mobile arm support
- can assist in feeding, can keep arm from sliding backward, etc.
27
Power Chairs
- order all parts separately
- mobility base
- seating system
- control options
- access devices
- controller
- battery
28
Front Wheel Drive
- intermediate turning radius
- good fro traversing curbs, uneven terrain
- tends to fishtail at higher speeds
29
Rear Wheel Drive
- largest turning radius
- better shock absorption and foot clearance
- better control at higher speeds
- bigger wheel on back
30
Mid-Wheel Drive
- smallest turning radius
- most stable on slopes
- good indoor chairs
- 6 tires
31
Seating System
- stationary - less expensive, pt. I with pressure relief
- reline - backrest reclines, may elicit spasticity, good for intermittent caths, requires long wheel base
- tilt - constant angle between seat and back, less likely to elicit spasticity or alter sitting position
- requires long wheel base
- tire/recline - allows both
- can add an elevator feature
32
Tilt in Space
-the chair tilts on the base
33
Power Recline
-base of chair must be longer, folds out into laying position
34
Control Options
- proportional - works like a gas pedal, more you push, the faster you go (joystick)
- non-proportional - off and on, speed may be set, puff and sip
- momentary - as soon as you let go of the pedal, it stops
- latched - move until do something to make it stop (for ex. - sip)
35
Access Devices
- chin nob operated
- joystick - most often seen
- sip-and-puff
36
Controller
- "brain" of the wheelchair
| - can adjust: max speed, rate of acceleration/deceleration
37
Battery
-rechargable
good for about a year
-charge every day
38
Accessories
- Head and Neck Support
- headrests
- neck collars
39
Supports/Positioners
- chest straps
- lateral trunk supports
- pelvic positioners
40
PAPAW - stands for?
push rim activated power assist wheelchair
41
Wheelchair Cushions
-pressure relief
-postural support
(try to get the best combination of pressure relief and postural support)
-weight
-maintenance
-expense - $400-$500
42
Types
- foam
- air-filled - roho (great for pressure relief, not for posture, don't inflate too much, heavy, high maintenance)
- gel or fluid - Jay cushion
- all are heavy
43
Evaluating the Patient
- examine in gravity minimized position (supine/SL)
- sitting
- Goal: neutral posture with good lumbar/trunk alignment
44
Measurements (review picture)
- seat depth
- leg measurement
- back height
- hanging elbow
- trunk width
- trunk depth
- hip width
- foot length
45
Wheelchair Skills
- practice in the "real world"
- propelling without full hand function: technique (push in, then forward), pegs, wrapping rim
- hard surface/open space
- practice builds skill and stamina
46
Overuse Injuries
- manual WC propulsion major contributor
- proper position - hand at apex of the rim - 100 -120 degrees of elbow FL
- risk factors: repetitive stress injuries (primarily shoulder), carpal tunnel
- prevention strategies: properly fitted WC, training pt. in proper propulsion, ordering WC as light as possible, techniques (inertia), consider if need to be in power-assist or power WC
47
Pt. with Marginal Potential for WC Use
- pre-existing UE pathology
- older
- obese
- longer distances/unlevel terrain
