Wheelchair Seating & Positioning Flashcards
Neurologic benefits of proper wheelchair positioning
- “Normalize tone”
- Decrease influence of pathological reflexes
- Increase stability and minimize patient effort required because of
proper body alignment - Facilitate orientation to midline and vertical position
musculoskeletal benefits of proper wheelchair positioning
- Increase and maintain ROM
- Prevent structural deformity
cognitive benefits of proper wheelchair positioning
Increase level of alertness
2. Increase interaction with environment
Physiological benefits of proper wheelchair positioning
- Improve/maintain maximal respiratory status
- Improve function of the autonomic nervous system
- Prevent decubiti
functional benefits of proper wheelchair positioning
- Facilitate maximal function within pathological movements
- Increase ease of care
a. Increase comfort
b. Increase sitting tolerance - Improve safety
Psychological benefits of proper wheelchair positioning
- Maximize social acceptability
- Increase interaction with environment/others
Physiologic factors that interfere with proper wheelchair positioning
- Tracheostomy
- Medical complications such as fractured rib, open head wounds, shunt
- Pain
Neurologic factors that interfere with proper wheelchair positioning
- Abnormal tone
- Pathological reflexes
Neurological factors that interfere with proper wheelchair positioning - Tactile System
a. Hyper-responsive (withdraw from supporting surface)
b. Hypo-responsive (absent or limited sensation)
Neurologic factors that interfere with proper wheelchair positioning - Visual System
a. Blindness
b. Hyper-responsive (visually distractible)
c. Perceptual- impaired body image and orientation to
midline and vertical
d. Involuntary movements
Neurologic factors that interfere with proper wheelchair positioning- Vestibular System
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)
Musculoskeletal factors that interfere with proper wheelchair positioning
- Joint contractures
- Muscle weakness
- Muscle imbalance
Cognitive factors that interfere with proper wheelchair positioning
- Decreased short term memory
- Decreased response to stimuli in environment
- Increased level of agitation and disordered behavioral responses
- Decreased safety awareness
Psychosocial factors that interfere with proper wheelchair positioning
- Decreased interaction with environment
- Non-acceptance by patient or family
- Decreased communication skills
Functional factors that interfere with proper wheelchair positioning
- Difficulty propelling chair
- Difficulty transferring
- Impaired voluntary movements
Flexible Deformity
- 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
Fixed Deformity
- 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
Positioning Sequence
- pelvic position
- posterior thigh provided with maximum support
- seat belt angled 45 or 90 degrees to the sitting surface
- knees, hips, and angles flexed to 90 degrees
- feet flat on supporting surface (WBing through heel and sole of foot)
- trunk in proper alignment
- head in proper alignment
- upper extremity positioning
Pelvic Position
Need stable base. Want stable, neutral pelvis
a. Symmetrical midline orientation
b. Level pelvis
c. Slight anterior tilt
Intrinsic factors affecting pelvic positioning
hamstrings, abdominals, hip extensors, rectus femoris, trunk extensors, muscle length, muscle tone, and lumbar mobility
Extrinsic factors affecting pelvic positioning
seating system, seat cushion, back support, seat to back angle interface, pelvic positioning belt, and foot placement
proper alignment of the trunk
- Lateral trunk supports
- Prevent forward flexion
Proper alignment of the head
- Head piece
- Neck piece
Upper extremity positioning - Scapula
Scapula in neutral elevation/protraction, either neutral protraction/retraction or slight protraction
Upper extremity positioning - shoulders
slightly flexed and abducted
upper extremity positioning - elbows
flexed to mid-range
upper extremity positioning - forearms
in neutral supination/pronation
upper extremity positioning - wrists
neutral flexion/extension or slight extension with no
radial or ulnar deviation
upper extremity positioning - hands
loosely opened with thumb out of palm
Seating systems - linear
flat, non contoured planes of support
seating systems - contoured
designed to ergonomically support the body
seating systems - custom contoured
- Designed to ergonomically support the body
- Custom-built with carved out or specially molded foam.
Screening Identification Tool
Screening tool designed to identify the need for formal seating
and wheelchair intervention among institutionalized elderly
Information needed for claims for wheelchairs
- Detailed written order
- supporting documentation in the medical record
- mobility limitation - defined by CMS
detailed written order
ncluding beneficiary’s name, prescribing practitioners name
and ID, signature and date
supporting documentation in the medical record
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
mobility limitation - defined by CMS
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
K0001 Standard Manual Wheelchair
a. Weight >36 lbs without riggings
b. Width 16 or 18 inches, Depth 16 inches, Height >19 inches <21 inches
K0001 Standard Manual Wheelchair - Clinical Considerations
- 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
K0002 Standard Hemi- Wheelchair
a. Weight >36 lbs without riggings
b. Width 16 or 18 inches, Depth 16 inches, Height 17-18 inches
K0002 Standard Hemi- Wheelchair Clinical Considerations
Same as for K0001 but patient’s lower leg length, short
stature, or hemi-technique for wheelchair mobility require lower seat height
K0003 Lightweight Wheelchair
a. Weight < 36 lbs without riggings
b. Width 16 or 18 inches, Depth 16 inches, Height > 17 inches and < 21 inches
K0003 Lightweight Wheelchair Clinical Considerations
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
K0004
High Strength Lightweight Wheelchair
K0005 Ultra Lightweight Wheelchair
a. Weight <30 lbs without riggings
K0005 Ultra Lightweight Wheelchair Clinical Considerations
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)
K0006
Heavy Duty Chair
Individual weighs more than 250 lbs
K0007
Extra Heavy Duty Chair
Individual weights more than 300 lbs
Considerations when choosing wheelchair
- Manual vs. Power vs. Power Assist
- Standard Height vs. Hemi Height
- Standard vs. Recliner vs. Tilt in Space
