Wheelchair Seating & Positioning

Question 1

Neurologic benefits of proper wheelchair positioning

Answer 1

1. “Normalize tone”
2. Decrease influence of pathological reflexes
3. Increase stability and minimize patient effort required because of
   proper body alignment
4. Facilitate orientation to midline and vertical position

Question 2

musculoskeletal benefits of proper wheelchair positioning

Answer 2

1. Increase and maintain ROM
2. Prevent structural deformity

Question 3

cognitive benefits of proper wheelchair positioning

Answer 3

Increase level of alertness
2. Increase interaction with environment

Question 4

Physiological benefits of proper wheelchair positioning

Answer 4

1. Improve/maintain maximal respiratory status
2. Improve function of the autonomic nervous system
3. Prevent decubiti

Question 5

functional benefits of proper wheelchair positioning

Answer 5

1. Facilitate maximal function within pathological movements
2. Increase ease of care
   a. Increase comfort
   b. Increase sitting tolerance
3. Improve safety

Question 6

Psychological benefits of proper wheelchair positioning

Answer 6

1. Maximize social acceptability
2. Increase interaction with environment/others

Question 7

Physiologic factors that interfere with proper wheelchair positioning

Answer 7

1. Tracheostomy
2. Medical complications such as fractured rib, open head wounds, shunt
3. Pain

Question 8

Neurologic factors that interfere with proper wheelchair positioning

Answer 8

1. Abnormal tone
2. Pathological reflexes

Question 9

Neurological factors that interfere with proper wheelchair positioning - Tactile System

Answer 9

a. Hyper-responsive (withdraw from supporting surface)
b. Hypo-responsive (absent or limited sensation)

Question 10

Neurologic factors that interfere with proper wheelchair positioning - Visual System

Answer 10

a. Blindness
b. Hyper-responsive (visually distractible)
c. Perceptual- impaired body image and orientation to
midline and vertical
d. Involuntary movements

Question 11

Neurologic factors that interfere with proper wheelchair positioning- Vestibular System

Answer 11

a. Hyper-responsive (anxiety or upset with some postural
changes)
b. Hypo-responsive (righting and equilibrium responses
depressed; may be constant excessive movement to get
feedback from vestibular in order to orient to gravity)

Question 12

Musculoskeletal factors that interfere with proper wheelchair positioning

Answer 12

1. Joint contractures
2. Muscle weakness
3. Muscle imbalance

Question 13

Cognitive factors that interfere with proper wheelchair positioning

Answer 13

1. Decreased short term memory
2. Decreased response to stimuli in environment
3. Increased level of agitation and disordered behavioral responses
4. Decreased safety awareness

Question 14

Psychosocial factors that interfere with proper wheelchair positioning

Answer 14

1. Decreased interaction with environment
2. Non-acceptance by patient or family
3. Decreased communication skills

Question 15

Functional factors that interfere with proper wheelchair positioning

Answer 15

1. Difficulty propelling chair
2. Difficulty transferring
3. Impaired voluntary movements

Question 16

Flexible Deformity

Answer 16

• Examiner can manually correct the position
• The seating system must have components that correct and enhance the desired position because the patient cannot maintain it independently

Question 17

Fixed Deformity

Answer 17

• Patient is sitting in an abnormal posture and examiner
  cannot manually correct the position
• The recommended seating must compensate for this deformity and support the patient in this posture.
• Help decrease the progression of the deformity and minimize excessive pressures from the deformity

Question 18

Positioning Sequence

Answer 18

1. pelvic position
2. posterior thigh provided with maximum support
3. seat belt angled 45 or 90 degrees to the sitting surface
4. knees, hips, and angles flexed to 90 degrees
5. feet flat on supporting surface (WBing through heel and sole of foot)
6. trunk in proper alignment
7. head in proper alignment
8. upper extremity positioning

Question 19

Pelvic Position

Answer 19

Need stable base. Want stable, neutral pelvis
a. Symmetrical midline orientation
b. Level pelvis
c. Slight anterior tilt

Question 20

Intrinsic factors affecting pelvic positioning

Answer 20

hamstrings, abdominals, hip extensors, rectus femoris, trunk extensors, muscle length, muscle tone, and lumbar mobility

Question 21

Extrinsic factors affecting pelvic positioning

Answer 21

seating system, seat cushion, back support, seat to back angle interface, pelvic positioning belt, and foot placement

Question 22

proper alignment of the trunk

Answer 22

1. Lateral trunk supports
2. Prevent forward flexion

Question 23

Proper alignment of the head

Answer 23

1. Head piece
2. Neck piece

Question 24

Upper extremity positioning - Scapula

Answer 24

Scapula in neutral elevation/protraction, either neutral protraction/retraction or slight protraction

Question 25

Upper extremity positioning - shoulders

Answer 25

slightly flexed and abducted

Question 26

upper extremity positioning - elbows

Answer 26

flexed to mid-range

Question 27

upper extremity positioning - forearms

Answer 27

in neutral supination/pronation

Question 28

upper extremity positioning - wrists

Answer 28

neutral flexion/extension or slight extension with no radial or ulnar deviation

Question 29

upper extremity positioning - hands

Answer 29

loosely opened with thumb out of palm

Question 30

Seating systems - linear

Answer 30

flat, non contoured planes of support

Question 31

seating systems - contoured

Answer 31

designed to ergonomically support the body

Question 32

seating systems - custom contoured

Answer 32

- Designed to ergonomically support the body - Custom-built with carved out or specially molded foam.

Question 33

Screening Identification Tool

Answer 33

Screening tool designed to identify the need for formal seating and wheelchair intervention among institutionalized elderly

Question 34

Information needed for claims for wheelchairs

Answer 34

- Detailed written order - supporting documentation in the medical record - mobility limitation - defined by CMS

Question 35

detailed written order

Answer 35

ncluding beneficiary’s name, prescribing practitioners name and ID, signature and date

Question 36

supporting documentation in the medical record

Answer 36

a. Face to face encounter within 6 months b. Mobility limitation impairs individuals ability to participate in one or more IADL in the home c. Mobility limitation cannot be resolved through use of assistive device d. Use of manual wheelchair will improve individual’s ability to participate in IADL e. Individual is able to propel wheelchair or has caregiver able to provide assistance

Question 37

mobility limitation - defined by CMS

Answer 37

a. Prevents an individual from accomplishing ADL, or b. Places individual at heightened risk of morbidity or mortality, or c. Prevents individual from completing ADL within a reasonable time frame

Question 38

K0001 Standard Manual Wheelchair

Answer 38

a. Weight >36 lbs without riggings b. Width 16 or 18 inches, Depth 16 inches, Height >19 inches <21 inches

Question 39

K0001 Standard Manual Wheelchair - Clinical Considerations

Answer 39

- Patient is able to propel standard weight wheelchair or is dependent in mobility - weight and body dimensions are accommodated - patient does not require specific back height or seat height other than standard - patient can perform independent pressure relief and/or is in the wheelchair for a limited time - patient does not have significant spasticity or deformities - patient does not have a progressive condition

Question 40

K0002 Standard Hemi- Wheelchair

Answer 40

a. Weight >36 lbs without riggings b. Width 16 or 18 inches, Depth 16 inches, Height 17-18 inches

Question 41

K0002 Standard Hemi- Wheelchair Clinical Considerations

Answer 41

Same as for K0001 but patient’s lower leg length, short stature, or hemi-technique for wheelchair mobility require lower seat height

Question 42

K0003 Lightweight Wheelchair

Answer 42

a. Weight < 36 lbs without riggings b. Width 16 or 18 inches, Depth 16 inches, Height > 17 inches and < 21 inches

Question 43

K0003 Lightweight Wheelchair Clinical Considerations

Answer 43

Same as for K0001 but patient is unable to propel standard weight wheelchair due to weakness, endurance, cardiopulmonary conditions, pain, fatigue, arthritis, spasticity, and/or decreased ROM and patient can independently propel lightweight wheelchair

Question 44

K0004

Answer 44

High Strength Lightweight Wheelchair

Question 45

K0005 Ultra Lightweight Wheelchair

Answer 45

a. Weight <30 lbs without riggings

Question 46

K0005 Ultra Lightweight Wheelchair Clinical Considerations

Answer 46

a. is unable to functionally/efficiently propel a standard lightweight, high strength lightweight chair b. patient can propel an ultra-lightweight chair c. individual must be a full time wheelchair user or require individualized fitting and adjustments d. is for “highly active, full time users (CMS)” (SCI)

Question 47

K0006

Answer 47

Heavy Duty Chair Individual weighs more than 250 lbs

Question 48

K0007

Answer 48

Extra Heavy Duty Chair Individual weights more than 300 lbs

Question 49

Considerations when choosing wheelchair

Answer 49

- Manual vs. Power vs. Power Assist - Standard Height vs. Hemi Height - Standard vs. Recliner vs. Tilt in Space