Wheelchair prescription Flashcards
“a wheelchair is an individualized dynamic seating system composed of a ____”
Postural support system
mobility base
Seating Principle #1
Stabilize proximally to promote improved distal mobility and function
- for wheelchairs, central focus becomes the pelvis
Seating principle #2
Achieve and maintain pelvic alignment
What is the optimal positioning for pelvis alignment?
neutral to slight anterior tilt without oblique positioning or rotation
- improves weight bearing across ischial tuberosities
- flexion at the pelvis can decrease tonal patterns
Seating principle #3
Facilitate optimal postural alignment in all body segments
Optimal alignment enhances ______
Stability
Comfort
Function
Seating principle #4
Limit abnormal movement and improve function
_________ are KEY to limiting abnormal movement and improve function
Observational Skills
Seating Principle #5
Provide the minimum support necessary to achieve anticipated goals and expected outcomes
Seating principle #6
Provide comfort
Loss of comfort leads to…
- abnormal movement
- asymmetry
- fatigue
- poor endurance
- lack of attention
- poor concentration
- avoidance
The Wheelchair Process
determine need > examination > prescription > funding/order > fitting > training > maintenance
Test and Measures important to include in wheelchair prescription
strength and endurance sensation and skin integrity vision and hearing health status cognition and behavior
Functional abilities important to include in wheelchair prescription
toileting bathing dressing eating communication transfers ambulation wheel chair mobility and skills
why is the mat table exam important?
It highlights flexible vs. rigid deformities
provides opportunity to look at pelvic, spine and hip alignments
Common postural deviations and corrections for wheelchair prescription
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
What are the 7 wheelchair components?
back angle adjustment seat frame angle and height footrest system armrest system wheel options seat width and depth seat back
What are the 4 stages of pressure injuries?
stage 1
stage 2– partial thickness
stage 3– full thickness
stage 4– deep tissue exposure
What are the risk factors for pressure injuries?
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
“a way of testing at risk locations for skin break down, effectiveness of cushions and efficacy of pressure relief techniques”
pressure mapping
Advantages and disadvantages of foam cushions
advantages: light, inexpensive
disadvantages: cant be washed, increased skin temperature, must be replaced every 6 months
Advantages and disadvantages of air cushions
Advantages: better weight distribution, lowest interfaces pressures if inflated properly
Disadvantages: heavier, easily punctured, decreased stability, transfers difficult
Advantages and disadvantages of gel or fluid cushions
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
Advantages and disadvantages of flexible matrix cushions
still unknown; minimal research in the literature
how often should wheelchair users perform pressure relief?
every 15-30 minutes and should be held for 15-30 seconds
what are the 3 methods for pressure relief
push up maneuver
leaning to the side (hook)
leaning forward (must be at least 45 degrees)
What are the benefits of manual mobility vs. power mobility
lower cost
maintain physical capacity
improved access
lower maintenance
what are the benefits of power mobility vs. manual mobility
- 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
components of a folding frame
- below seat cross bar
- provide a smoother ride
- heavier
components of a rigid frame
- lighter
- adjustable seat to back angle
- durable
Components of camber wheel placement
- the angle of the wheel
- out improves efficiency and stability with turning but decreases access
components of axel location for wheel placement
- is the chair “tippy”
- the further the axel is forward the more “tippy”
- optimal is just in line of the glenohumeral joint
benefit of rear wheel
improved speed
benefit of center wheel
improved turn radius
benefit of front wheel
improved terrain navigation
What are the two important elements for prescription of power mobility
awareness and cognition
two main types of power assist
- add on motors
- power assisted wheels
In addition to transfers, what are the other 4 wheelchair skills to consider for users?
propulsion
inclines/declines
wheelies
curbs
Keys to propulsion
- long symmetrical strokes
- leaning forward enhances the propulsive forces
- pushing forward on one side and pulling back on the other = sharp turns
Keys for inclines
- short forceful strokes
- leaning forward enhances the propulsive forces
- turning sideways allows the user to rest
Keys for declines
- slowly release pressure on the hand grips
- leaning back enhances the breaking forces
- turning sideways allows the user to rest
Keys for wheelies
- 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
Keys for curbs
- 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.
wheelchair expectations for C1-C4 lesions
- independent with POWER mobility
- electronic controlled pressure relief (tilt & recline)
- dependent with positioning in chair (head/trunk support)
wheelchair expectations for C5 lesion
- 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)
wheelchair expectations for C6 lesions
- 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)
wheelchair expectations for C7 lesions
- 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)
wheelchair expectations for C8 lesions
- 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)
wheelchair expectations for T1-T12 lesions
- 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
wheelchair expectations for L1-L3 lesions
-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)
wheelchair expectations for L4-S1 lesions
-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)
