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Neuromuscular practice 2 > Wheelchair prescription > Flashcards

Wheelchair prescription Flashcards

1
Q

“a wheelchair is an individualized dynamic seating system composed of a ____”

A

Postural support system

mobility base

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2
Q

Seating Principle #1

A

Stabilize proximally to promote improved distal mobility and function
- for wheelchairs, central focus becomes the pelvis

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3
Q

Seating principle #2

A

Achieve and maintain pelvic alignment

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4
Q

What is the optimal positioning for pelvis alignment?

A

neutral to slight anterior tilt without oblique positioning or rotation

  • improves weight bearing across ischial tuberosities
  • flexion at the pelvis can decrease tonal patterns
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5
Q

Seating principle #3

A

Facilitate optimal postural alignment in all body segments

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6
Q

Optimal alignment enhances ______

A

Stability
Comfort
Function

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7
Q

Seating principle #4

A

Limit abnormal movement and improve function

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8
Q

_________ are KEY to limiting abnormal movement and improve function

A

Observational Skills

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9
Q

Seating Principle #5

A

Provide the minimum support necessary to achieve anticipated goals and expected outcomes

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10
Q

Seating principle #6

A

Provide comfort

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11
Q

Loss of comfort leads to…

A
  1. abnormal movement
  2. asymmetry
  3. fatigue
  4. poor endurance
  5. lack of attention
  6. poor concentration
  7. avoidance
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12
Q

The Wheelchair Process

A

determine need > examination > prescription > funding/order > fitting > training > maintenance

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13
Q

Test and Measures important to include in wheelchair prescription

A 
strength and endurance
sensation and skin integrity
vision and hearing
health status
cognition and behavior
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14
Q

Functional abilities important to include in wheelchair prescription

A 
toileting
bathing
dressing
eating
communication
transfers
ambulation
wheel chair mobility and skills
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15
Q

why is the mat table exam important?

A

It highlights flexible vs. rigid deformities

provides opportunity to look at pelvic, spine and hip alignments

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16
Q

Common postural deviations and corrections for wheelchair prescription

A

pelvic obliquity:
-named after lower side of the pelvis
-often accompanied by a compensatory lateral flexion of the spine
Pelvic Rotation:
-named after posterior half of the pelvis
-often accompanied by a compensatory counter rotation of the spine

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17
Q

What are the 7 wheelchair components?

A 
back angle adjustment
seat frame angle and height
footrest system
armrest system
wheel options
seat width and depth
seat back
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18
Q

What are the 4 stages of pressure injuries?

A

stage 1
stage 2– partial thickness
stage 3– full thickness
stage 4– deep tissue exposure

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19
Q

What are the risk factors for pressure injuries?

A 
sensory loss
decreased mobility
increased heat and/or moisture
poor posture
previous pressure injury
poor nutrition and/or hydration
increased age
body weight (increased or decreased)
tobacco use
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20
Q

“a way of testing at risk locations for skin break down, effectiveness of cushions and efficacy of pressure relief techniques”

A

pressure mapping

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21
Q

Advantages and disadvantages of foam cushions

A

advantages: light, inexpensive
disadvantages: cant be washed, increased skin temperature, must be replaced every 6 months

22
Q

Advantages and disadvantages of air cushions

A

Advantages: better weight distribution, lowest interfaces pressures if inflated properly
Disadvantages: heavier, easily punctured, decreased stability, transfers difficult

23
Q

Advantages and disadvantages of gel or fluid cushions

A

advantages: better weight distribution, minimizing shear forces during transfers, good choice for the active individual
disadvantages: heavy, promote increased skin temperature and moisture build-up at the surface, stability decreased, difficulty of transfers is increased

24
Q

Advantages and disadvantages of flexible matrix cushions

A

still unknown; minimal research in the literature

25
Q

how often should wheelchair users perform pressure relief?

A

every 15-30 minutes and should be held for 15-30 seconds

26
Q

what are the 3 methods for pressure relief

A

push up maneuver
leaning to the side (hook)
leaning forward (must be at least 45 degrees)

27
Q

What are the benefits of manual mobility vs. power mobility

A

lower cost
maintain physical capacity
improved access
lower maintenance

28
Q

what are the benefits of power mobility vs. manual mobility

A
  • the user is a marginal self-propeller or cannot self-propel
  • limited endurance or community mobility
  • when manual use has the potential to lead to long term sequela
  • higher costs
  • more adaptable to the user
29
Q

components of a folding frame

A
  • below seat cross bar
  • provide a smoother ride
  • heavier
30
Q

components of a rigid frame

A
  • lighter
  • adjustable seat to back angle
  • durable
31
Q

Components of camber wheel placement

A
  • the angle of the wheel

- out improves efficiency and stability with turning but decreases access

32
Q

components of axel location for wheel placement

A
  • is the chair “tippy”
  • the further the axel is forward the more “tippy”
  • optimal is just in line of the glenohumeral joint
33
Q

benefit of rear wheel

A

improved speed

34
Q

benefit of center wheel

A

improved turn radius

35
Q

benefit of front wheel

A

improved terrain navigation

36
Q

What are the two important elements for prescription of power mobility

A

awareness and cognition

37
Q

two main types of power assist

A
  • add on motors

- power assisted wheels

38
Q

In addition to transfers, what are the other 4 wheelchair skills to consider for users?

A

propulsion
inclines/declines
wheelies
curbs

39
Q

Keys to propulsion

A
  • long symmetrical strokes
  • leaning forward enhances the propulsive forces
  • pushing forward on one side and pulling back on the other = sharp turns
40
Q

Keys for inclines

A
  • short forceful strokes
  • leaning forward enhances the propulsive forces
  • turning sideways allows the user to rest
41
Q

Keys for declines

A
  • slowly release pressure on the hand grips
  • leaning back enhances the breaking forces
  • turning sideways allows the user to rest
42
Q

Keys for wheelies

A
  • Balance point: where front casters are off the ground and in equilibrium
  • user pushes forward on the rims to lean back
  • pushes back on the rims to lean forward
43
Q

Keys for curbs

A
  • for ascent, the user props a wheelie to get the front casters over the curb and uses forward leverage of the wheel against the curb to ascend
  • for descent, the user pops a wheelie once the front casters are at the edge of the curb and uses leverage of the wheel against the curb to descend.
44
Q

wheelchair expectations for C1-C4 lesions

A
  • independent with POWER mobility
  • electronic controlled pressure relief (tilt & recline)
  • dependent with positioning in chair (head/trunk support)
45
Q

wheelchair expectations for C5 lesion

A
  • independent to some assist with MANUAL mobility
  • requires plastic-coat hand rims/extensions
  • recommend power-assist mobility
  • recommend electronic controlled pressure relief (tilt &recline)
  • dependent with positioning in chair (head/trunk support)
46
Q

wheelchair expectations for C6 lesions

A
  • independent with MANUAL mobility on level surfaces
  • Requires plastic-coat hand rims/extensions
  • recommend power-assist mobility in the community
  • recommend independent pressure relief
  • independent with chair positioning in chair (head/trunk support)
47
Q

wheelchair expectations for C7 lesions

A
  • independent with MANUAL mobility in home and community
  • recommend plastic-coat hand rims/extensions
  • some assist with ramps, curbs and uneven terrain
  • may benefit power-assist mobility in the community
  • independent pressure relief
  • independent with positioning in chair (head/trunk support)
48
Q

wheelchair expectations for C8 lesions

A
  • independent with MANUAL mobility in home and community
  • improved ability with ramps, curbs, and uneven terrain (due to improved hand control)
  • independent pressure relief
  • independent with positioning in chair (head/trunk support)
49
Q

wheelchair expectations for T1-T12 lesions

A
  • independent with MANUAL mobility in home and community
  • independent ability with ramps, curbs, and uneven terrain
  • independent pressure relief
  • independent with positioning in chair (head/trunk support)
  • improved trunk control with caudal head injury
50
Q

wheelchair expectations for L1-L3 lesions

A

-independent in home ambulation
(may choose to use chair for endurance)
-independent with MANUAL mobility in home and community
-independent ability with ramps, curbs and uneven terrain
-independent pressure relief
-independent with positioning in chair (head/trunk support)

51
Q

wheelchair expectations for L4-S1 lesions

A

-independent in ambulations
(may choose to use chair for endurance)
-independent with MANUAL mobility in home and community
-independent ability with ramps, curbs and uneven terrain
-independent pressure relief
-independent with positioning in chair (head/trunk support)

Neuromuscular practice 2 (8 decks)

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