Wheelchairs Flashcards
matching needs and resources
patients goals and desires
anticipated use
patients abilities and limitations
patients size and weight
caregiver needs
financial, community, and social resources
projected changes over time
postural support
seat: bottom and cushion
- different options for different needs (foam tends to wear down easier)
back
- sling vs rigid : rigid provides better support and can have molded or supportive back
- recline vs tilt-in-space: entire chair tilts in tilt in space, recline just brings back down
armrest:
- fixed vs removable:
- full length vs desk arm vs tubular:
–>full length: good for transfers, difficult for meals
–>desk arms: good for tables; can sometimes be removed and turned around for better leverage in transfers
–>tubular: have to have really good upper body strength; a bit out of the way; can be used in transfers if needed
front rigging:
- can have extra cushioning for patients with high risk for skin breakdown
- rigid for more athletic populations
- leg rests, foot plates, calf support (can swing out of the way)
mobility base
frame:
- rigid vs folding:
axle: connects the tires
- can be set out at an angle to provide a wider base of support, make it easier to push, but it takes up more space so turns can be difficult
drive wheels, tires, and locks:
casters: smaller wheels at the front
- help with turning and base of support
- move in all directions to help with directional movement
electrically powered wheelchair
4 wheeled-controls on armrests
3 wheeled-controls on side or can use visual cues
scooter-controls in the front
drive: front-wheel (helpful up ramps and on rough terrain), mid-wheel, and rear-wheel drives
controls are typically joystick/hand grip, but can be breath or eye controlled
can be dangerous in the wrong hands-may have to lower the speed
wheelchair accessories
LE support for LE amputations
eye and breath controls to move WCs
big tires to move in sand
big back wheels in the middle of the chair for athletic populations to do wheelies
what insurance covers wheelchairs?
wheelchairs are under DME coverage in Medicare part B
lightweight wheelchairs
active, smaller patients
bariatric wheelchairs
typically for patients over 300 lbs
wider, heavier, and can withstand more weight
sports wheelchair
axle is more anterior for better mobility and tighter turns
power/electric wheelchair
joystick typically on armrest
integrated standing wheelchair
good wheelchair option for someone who can’t stand on their own to get the positive effects of gravity
tilt in space wheelchair
whole seat moves
good for moving pressure to different places
customized wheelchairs
may include long pole or help move the chair
insurance coverage
Manual
- Unable to use cane/walker/crutch
- Upper body strength to self-propel
POV/Scooter
- Unable to use cane/walker/crutch
- Postural control to sit up in the seat
Power Mobility
- Unable to use a manual chair
- Does not qualify for POV/Scooter
fitting a wheelchair
Patient measurements are converted to WC dimensions.
Accommodate patient’s typical clothing, footwear, and cushions.
Make measurements with patient in optimal position (approximately 90°-90°-90°)-upright seated posture.
Do not contour tape measure
Positioning the pelvis well will help position the rest of the body well.
Important role of PTs
seat depth
beware of sacral sitting
measure from the back of the hips to the popliteal fold of the knees
subtract 2 inches for seat depth (don’t want back of knees rubbing against seat)
seat width
measure the distance between the outside edges of the hips
add an inch or 2 to determine the seat width (don’t want it to be rubbing against their hips)
seat to floor height
measure from the sole of the shoe to the popliteal fold of the knee
subtract the thickness of the compressed cushion if one is being used
add about 2 inches for foot clearance to determine the chair’s front rigging length
seat back height
will vary depending on the level of support needed
for a standard wheelchair, measure from the seating surface to the inferior angle of the scapula or axilla and subtract about 4 inches
add the compressed cushion thickness if one is being used
armrest measurement
position the upper arm close to the trunk and at 90 degrees of flexion at the elbow
measure from the olecranon process vertically to the seating surface
add the compressed cushion thickness if one is being used d
add 1 inch to determine the height of the WC armrest
negative affects of an ill-fitting chair
skin breakdown, pressure, not able to support the patient
dependent WC propulsion
use good body mechanics: LE for pushing
smooth pace
apply locks when stationary
may be necessary to tip back WC for rough terrain (caster up for rough terrain)
independent WC propulsion
use both hands, one or both feet, or hands and feet
start with hands at 10 o clock and move them forward to 2 or 3 o clock (small motion)
turn by moving one wheel still and the other forward or move one wheel backwards and one forwards for tighter turns
when using feet, make sure their is good shoe grip on the floor and that the seat is low enough
- step and pull with feet
- can use toes of heels
use the hand rims, not the tires, to propel
wheelies
balancing on drive wheels only
necessary for independent populations to get around different terrain
should be practiced in a supervised setting
advanced skill
competency checklist for safe use of powered scooters
speed control
effective braking
maneuvering through doorways, bedrooms, and bathrooms
smooth and safe parking at tables
BE ABLE TO MOVE SAFELY
moving dependently through doorways: door opening away from the patient
clinician moves backwards through the door, then turns the WC to face the direction of travel
use own to body to block the door as you pull the WC through
moving dependently through doorways: door opening towards the patient
make sure you have enough room to open the door without hitting the patient
bring WC at an angle and hold the door with foot
use front rigging or hand to block the closing door
stay close to the door to avoid getting hit too hard should the door hit you
opening doors independently
push the door wide open
propel the WC quickly through the door
use the front rigging or hand to block closing door
stay close to the door to avoid getting hit hard
ramp slopes
maximum of 1:12 (1 degree for every 12 inches of length)
maximum overall rise of 30 inches
ascending an incline dependently
go up facing forward with all 4 wheel on the ground
can zig zag if a slope
patient facilitates by leaning forward and pushing on the hand rims
descending an incline dependently
backwards with all 4 wheels on the ground
can move forward with WC tipped back and clinician with wide BOS and deep stance
could lift casters in a wheelie position
ascending a curb forward dependently
easier
get as close to the curb as possible
tip WC back and place casters up on the curb (use body weight to lift the caster up and make sure they are straight)
roll the drive wheels up against the curb (get drive wheels as close as you can) and get their body up onto the curb
descending a curb backwards dependently
easier
back the drive wheels up the the edge of the curb
control the roll of the drive wheels down over the curb, using the forward LE against the WC back
tip WC back to bring casters off the curb SLOWLY
TELL THE PATIENT WHAT IS GOING ON
if you don’t feel you can do it yourself, ASK FOR HELP
ascending a curb backwards dependently
more difficult
roll the drive wheels back against the curb
tip WC back
use LEs to roll drive wheels up onto the curb
set casters down gently once chair is fully on the curb
descending a curb forward dependently
more difficult
tip WC back
roll drive wheels forward to edge of curb
control descent of drive wheels off the curb with LEs in deep stance
set casters down gently once chair is fully down the curb
up steps dependently
3 attendants
tallest/strongest at the head of the chair leading in deep stance
other assistants hold sides on non-moving parts
slight tilt back
back wheelchair up against 1st step
tip WC well back
on 3, attendants control roll of wheels on steps
pause at every step
down steps dependently
roll WC close to edge of top step
tip WC well back
on 3 lead attendant controls roll of drive wheels down over step
pause at every step
falling in a WC
practice in an appropriate supervised setting
falling back: tuck in chin to protect head
falling forward: extend arms and trunk, attempting to land forward of the chair; elbows slightly flexed as hands contact floor
falling to side: tuck arms close to chest, round shoulders, and laterally flex head away from the ground
fall as far from the WC as possible to avoid WC from hitting you
tilt opposite way-falling left, tilt right
WC care and maintenance
use for designed purposes only
store in safe, dry place
routinely check tires, spokes, and locks
see owner’s annual for recommended maintenance
