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Neuro Eval > Wheelchair Seating & Positioning > Flashcards

Wheelchair Seating & Positioning Flashcards

1
Q

Neurologic benefits of proper wheelchair positioning

A
  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
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2
Q

musculoskeletal benefits of proper wheelchair positioning

A
  1. Increase and maintain ROM
  2. Prevent structural deformity
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3
Q

cognitive benefits of proper wheelchair positioning

A

Increase level of alertness
2. Increase interaction with environment

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4
Q

Physiological benefits of proper wheelchair positioning

A
  1. Improve/maintain maximal respiratory status
  2. Improve function of the autonomic nervous system
  3. Prevent decubiti
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5
Q

functional benefits of proper wheelchair positioning

A
  1. Facilitate maximal function within pathological movements
  2. Increase ease of care
    a. Increase comfort
    b. Increase sitting tolerance
  3. Improve safety
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6
Q

Psychological benefits of proper wheelchair positioning

A
  1. Maximize social acceptability
  2. Increase interaction with environment/others
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7
Q

Physiologic factors that interfere with proper wheelchair positioning

A
  1. Tracheostomy
  2. Medical complications such as fractured rib, open head wounds, shunt
  3. Pain
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8
Q

Neurologic factors that interfere with proper wheelchair positioning

A
  1. Abnormal tone
  2. Pathological reflexes
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9
Q

Neurological factors that interfere with proper wheelchair positioning - Tactile System

A

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

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10
Q

Neurologic factors that interfere with proper wheelchair positioning - Visual System

A

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

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11
Q

Neurologic factors that interfere with proper wheelchair positioning- Vestibular System

A

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)

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12
Q

Musculoskeletal factors that interfere with proper wheelchair positioning

A
  1. Joint contractures
  2. Muscle weakness
  3. Muscle imbalance
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13
Q

Cognitive factors that interfere with proper wheelchair positioning

A
  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
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14
Q

Psychosocial factors that interfere with proper wheelchair positioning

A
  1. Decreased interaction with environment
  2. Non-acceptance by patient or family
  3. Decreased communication skills
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15
Q

Functional factors that interfere with proper wheelchair positioning

A
  1. Difficulty propelling chair
  2. Difficulty transferring
  3. Impaired voluntary movements
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16
Q

Flexible Deformity

A
  • 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
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17
Q

Fixed Deformity

A
  • 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
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18
Q

Positioning Sequence

A
  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
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19
Q

Pelvic Position

A

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

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20
Q

Intrinsic factors affecting pelvic positioning

A

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

21
Q

Extrinsic factors affecting pelvic positioning

A

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

22
Q

proper alignment of the trunk

A
  1. Lateral trunk supports
  2. Prevent forward flexion
23
Q

Proper alignment of the head

A
  1. Head piece
  2. Neck piece
24
Q

Upper extremity positioning - Scapula

A

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

25
Q

Upper extremity positioning - shoulders

A

slightly flexed and abducted

26
Q

upper extremity positioning - elbows

A

flexed to mid-range

27
Q

upper extremity positioning - forearms

A

in neutral supination/pronation

28
Q

upper extremity positioning - wrists

A

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

29
Q

upper extremity positioning - hands

A

loosely opened with thumb out of palm

30
Q

Seating systems - linear

A

flat, non contoured planes of support

31
Q

seating systems - contoured

A

designed to ergonomically support the body

32
Q

seating systems - custom contoured

A
  • Designed to ergonomically support the body
  • Custom-built with carved out or specially molded foam.
33
Q

Screening Identification Tool

A

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

34
Q

Information needed for claims for wheelchairs

A
  • Detailed written order
  • supporting documentation in the medical record
  • mobility limitation - defined by CMS
35
Q

detailed written order

A

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

36
Q

supporting documentation in the medical record

A

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

37
Q

mobility limitation - defined by CMS

A

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

38
Q

K0001 Standard Manual Wheelchair

A

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

39
Q

K0001 Standard Manual Wheelchair - Clinical Considerations

A
  • 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
40
Q

K0002 Standard Hemi- Wheelchair

A

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

41
Q

K0002 Standard Hemi- Wheelchair Clinical Considerations

A

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

42
Q

K0003 Lightweight Wheelchair

A

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

43
Q

K0003 Lightweight Wheelchair Clinical Considerations

A

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

44
Q

K0004

A

High Strength Lightweight Wheelchair

45
Q

K0005 Ultra Lightweight Wheelchair

A

a. Weight <30 lbs without riggings

46
Q

K0005 Ultra Lightweight Wheelchair Clinical Considerations

A

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)

47
Q

K0006

A

Heavy Duty Chair
Individual weighs more than 250 lbs

48
Q

K0007

A

Extra Heavy Duty Chair
Individual weights more than 300 lbs

49
Q

Considerations when choosing wheelchair

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

Neuro Eval (18 decks)

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