Wheelchair Prescription Flashcards
What components separate a wheelchair from a prescription wheelchair?
a prescriptive wheelchair is an individualized dynamic seating system composed a postural support system and a mobility base, and each of these components can be individualized to meet unique patient needs
What is the first seating principle for wheelchair prescription?
Stabilize proximally to promote improved distal mobility and function
What becomes the central focus of stabilization once a patient is in a wheelchair?
Once the pelvis is stabilized what should be the next step?
The pelvis
evaluate control at joints distally from stabilized pelvic position
What is the second seating principle for wheelchair prescription?
Achieve and maintain pelvic alignment
What is optimal pelvic alignment positioning for wheelchair prescription?
What are the benefits of this position?
neutral to slight anterior tilt w/o oblique positioning or rotation
- improves weight bearing across the ischial tuberosity
- flexion at the pelvis can decrease tonal patterns
What is the third seating principle for wheelchair prescription?
What are important aspects to consider with this principle?
Facilitate Optimal postural alignment in all body segments
- Can an individual attain optimal alignment independently?
- Do I need accommodative support?
What does optimal alignment in a wheelchair enhance?
- stability
- comfort
- function
What is the fourth seating principle for wheelchair prescription?
What is a key skill for this principle?
Limit abnormal movement and improve function
Observational skills
- abnormal movement leads to secondary sequela related to seated postures and limits function
- hunt and look for abnormal movement patterns and their causes
What is the fifth seating principle for wheelchair prescription?
Provide the minimum support necessary to achieve anticipated goals and expected outcome
What is the sixth seating principle for wheelchair prescription?
Provide Comfort
What does a loss of comfort often lead to?
- abnormal movement
- asymmetry
- fatigue
- poor endurance
- lack of attention
- poor concentration
- avoidance
What are the 6 seating principles for wheelchair prescription?
- Stabilize proximally to promote improved distal mobility and function
- achieve and maintain pelvic alignment
- facilitate optimal postural alignment in all body segments
- limit abnormal movement and improve function
- provide the minimum support necessary to achieve anticipated goals and expected outcomes
- provide comfort
What makes up the support team for a patient in a wheelchair?
anybody invested in the individuals present and future function, this includes therapists, physicians, nurses, family, friends, caregivers, etc.
What is the process for prescribing a wheelchair?
- determine need
- perform exam
- prescribe wheelchair
- obtain funding/make order
- fit wheelchair
- wheelchair training
- maintenance
What tests and measures should be tested during the wheelchair examination?
What functional abilities should be assessed?
tests and measures include:
- strength and endurance
- sensation and skin integrity
- vision and hearing
- health status
- cognition and behavior
Functional abilities:
- toileting/bathing
- dressing
- eating
- communication
- transfers
- ambulation
- wheelchair mobility
Where does a majority of wheelchair prescription take place? Why?
On the mat table because it can highlight flexible vs. rigid deformities and is an opportunity to look at pelvic, spine and hip alignments
What are the measurements need to be made when performing the wheelchair prescription exam?
- sitting depth
- popliteal fossa to heel
- surface of lower scapula
- hanging elbow to sitting surface
- width of trunk
- depth of trunk
- width of hips
- knee flexion angle
- back height from surface of PSIS
- surface to top of shoulder
- surface to back of occiput
- surface to crown of head
- foot length
How deep should the wheelchair seat be?
True or False: floor to seat height should not include the cushion height
True or False: back height will improve trunk stability but can limit propulsion
1-2 inches back from popliteal space
false, it should include the cushion height and should aim for 2 inches of foot clearance
True
True or False: The chair should be as narrow as possible
True, but there should be space for weight fluctuation, clothes and to prevent skin irritation
How are pelvic obliquity deviations named?
What often accompanies pelvic obliquity?
named after the lower side of the pelvis
accompanied by a compensatory lateral flexion of the spine
How are pelvic rotation deviations named?
What often accompanies these deviations?
named after the posterior half of the pelvis
accompanied by a compensatory counter rotation of the spine
What measurement would lead you to adjust a wheelchairs back angle adjustment?
What would adjusting the seat frame angle and height do for a patient?
adjust based on available hip flexion
improve foot clearance or allow foot propulsion
What is the optimal seat back height?
What are the two types of seat back?
just below the inferior angle of the scapula for pushers, lower if patient has improved trunk control
Hard-can be more supportive and cushioned
Sling- can fold easily or tension adjusted
What are the risk factors for pressure injuries?
- sensory loss
- decreased mobility
- increased head and/or moisture
- poor posture
- previous pressure injury
- poor nutrition and/or hydration
- increased age
- body weight
- tobacco use
What are the pros and cons of foam cushions for sitting in a wheelchair?
Pros:
-light and inexpensive
Cons:
-can’t be washed, increased skin temp., must be replaced every 6 months
What are the pros and cons of air cushions for sitting in a wheelchair?
Pros:
-better weight distribution, lowest interface pressures if inflated properly
Cons:
-heavier, easily punctured, decreased stability, transfers are difficult
What are the pros and cons of gel or fluid cushions for sitting in a wheelchair?
Pros:
-better weight distribution, minimizing shear forces during transfers, good choice for the active individual
Cons:
-heavy, promote increased skin temp. and moisture build up at the sitting surface, stability is decreased, difficulty of transfers is increased
How often should wheelchair users perform pressure relief? How long should the relief be held for?
What methods help achieve this?
Every 15-30 minutes and held for 15-30 seconds
- push-up maneuver
- leaning to the side (hook)
- leaning forward (must reach 45 degrees)
What patients should use a powered wheelchair?
What patients should use a manual wheelchair?
Power:
- pt. who is a marginal self-propeller or cannot self propel
- limited endurance for community mobility
- when manual use has the potential to lead to long term sequela
Manual:
- lower cost
- patients who want to maintain physical capacity
- patients who want improved access and lower maintenance
What are the two basic frames for a manual wheelchair?
Folding (smoother ride but heavier) and rigid (durable and lighter, also has adjustable seat to back angle)
What is the camber of a manual wheelchair?
What is the optimal axle location for a manual wheelchair?
camber=angle of the wheels (outward angle improves efficiency and stability but decreases accessibility)
ideal axle location is just in line of the GH joint to have optimal “tipping”
What are the 3 wheel systems for powered chairs and what are the advantages of each?
Rear Wheel: improves speed
Center wheel: improves turn radius
Front Wheel: improved terrain navigation
What are the keys for propulsion in a wheelchair?
- long symmetrical strokes
- leaning forward enhances the propulsive forces
- pushing forward on one side and pulling back on the other =sharp turns
users must be able to propel forward, backward, and over multiple terrains
What are the keys for inclines/declines when in a wheelchair?
Inclines:
- short forceful strokes
- leaning forward enhances the propulsive forces
- turning sideways allows user to rest
Declines:
- slowly release pressure on the hand grips
- leaning back enhances the breaking forces
- turning sideways allows user to rest
What are the keys for wheelies in a wheelchair?
- 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
users need to be able to attain, maintain and move in the wheelie position
What are the keys for ascent/descent of curbs in a wheelchair?
Ascent: the user pops a wheelie to get the front casters over the curb and uses forward leverage of the wheel against curb to ascend
Descent: 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
What are the wheelchair expectations for a patient who had a C1-C4 spinal cord injury?
- independent w/ POWER mobility
- electronic controlled pressure relief (tilt and recline)
- dependent w/ positioning in chair (head/trunk support)
What are the wheelchair expectations for a patient who had a C5 spinal cord injury?
- independent to some assist with manual mobility
- requires plastic-coat hand rims/extensions
- recommend power-assist mobility
- recommend electronic controlled pressure relief (tilt and recline)
- dependent w. positioning in chair
What are the wheelchair expectations for a patient who had a C6 spinal cord injury?
- Independent w/ MANUAL mobility on level surfaces
- Requires plastic-coat hand rims/extensions
- recommend power-assist mobility in the community
- recommend independent pressure relief
- independent w/ positioning in chair
What are the wheelchair expectations for a patient who had a C7 spinal cord injury?
- independent w/ MANUAL mobility in home and community
- recommend plastic-coat hand rims/extension
- some assist w/ ramps, curbs and uneven terrain
- may benefit power-assist mobility in the community
- independent pressure relief
- independent w/ positioning in chair
What are the wheelchair expectations for a patient who had a C8 spinal cord injury?
- independent w/ manual mobility in home and community
- improved ability w/ ramps, curbs, and uneven terrain
- independent pressure relief
- independent w/ positioning in chair
What are the wheelchair expectations for a patient who had a T1-12 spinal cord injury?
- independent w/ manual mobility in home and community
- independent ability w/ ramps, curbs, and uneven terrain
- independent pressure relief
- independent w/ positioning in chair
- improved trunk control w/ caudal injury
What are the wheelchair expectations for a patient who had a L1-3 spinal cord injury?
Independent in home ambulation but may choose to use a chair for endurance
- independent w/ manual mobility in home and community
- independent ability w/ ramps, curbs, and uneven terrain
- independent pressure relief
- independent w/ positioning in chair
What are the wheelchair expectations for a patient who had a L4-S1 spinal cord injury?
Independent in ambulation but may choose a chair for endurance
- independent w/ manual mobility in home and community
- independent ability w/ ramps, curbs, and uneven terrain
- independent pressure relief
- independent w/ positioning in chair
What are the indicators for a standard wheelchair?
poor prognosis for independent walking in community but good prognosis to propel a standard wheelchair
What are the indicators for a lightweight wheelchair?
poor prognosis for independent walking in community and propulsion of a standard wheelchair but good prognosis to propel a lighter wheelchair
What are the indicators for a hemi-wheelchair?
poor prognosis for independent walking in community and propulsion of a standard standard wheelchair, but good prognosis to propel a wheelchair with 1 arm and 1 leg
What are the indicators for a power wheelchair?
poor prognosis for walking or pushing a wheelchair but can drive a power chair
What are the indicators for a dependent wheelchair?
poor prognosis for walking or propulsion in a wheelchair
What are the indicators for a sport-specific wheelchair?
if individual participates in athletic event using a wheelchair
What are the steps for prescribing a wheelchair?
1- determine need for wheelchair
2-select the wheelchair frame
3-determine the need for tilt and recline adaptations
4-select the frame components
5-select wheels, casters, and drive control
6- determine need to adapt base or seat height for power chairs
7-determine modifications for transportation
8-determine seating system components
