Wheelchairs

Question 1

matching needs and resources

Answer 1

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

Question 2

postural support

Answer 2

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)

Question 3

mobility base

Answer 3

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

Question 4

electrically powered wheelchair

Answer 4

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

Question 5

wheelchair accessories

Answer 5

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

Question 6

what insurance covers wheelchairs?

Answer 6

wheelchairs are under DME coverage in Medicare part B

Question 7

lightweight wheelchairs

Answer 7

active, smaller patients

Question 8

bariatric wheelchairs

Answer 8

typically for patients over 300 lbs

wider, heavier, and can withstand more weight

Question 9

sports wheelchair

Answer 9

axle is more anterior for better mobility and tighter turns

Question 10

power/electric wheelchair

Answer 10

joystick typically on armrest

Question 11

integrated standing wheelchair

Answer 11

good wheelchair option for someone who can’t stand on their own to get the positive effects of gravity

Question 12

tilt in space wheelchair

Answer 12

whole seat moves

good for moving pressure to different places

Question 13

customized wheelchairs

Answer 13

may include long pole or help move the chair

Question 14

insurance coverage

Answer 14

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

Question 15

fitting a wheelchair

Answer 15

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

Question 16

seat depth

Answer 16

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)

Question 17

seat width

Answer 17

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)

Question 18

seat to floor height

Answer 18

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

Question 19

seat back height

Answer 19

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

Question 20

armrest measurement

Answer 20

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

Question 21

negative affects of an ill-fitting chair

Answer 21

skin breakdown, pressure, not able to support the patient

Question 22

dependent WC propulsion

Answer 22

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)

Question 23

independent WC propulsion

Answer 23

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

Question 24

wheelies

Answer 24

balancing on drive wheels only

necessary for independent populations to get around different terrain

should be practiced in a supervised setting

advanced skill

Question 25

competency checklist for safe use of powered scooters

Answer 25

speed control

effective braking

maneuvering through doorways, bedrooms, and bathrooms

smooth and safe parking at tables

BE ABLE TO MOVE SAFELY

Question 26

moving dependently through doorways: door opening away from the patient

Answer 26

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

Question 27

moving dependently through doorways: door opening towards the patient

Answer 27

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

Question 28

opening doors independently

Answer 28

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

Question 29

ramp slopes

Answer 29

maximum of 1:12 (1 degree for every 12 inches of length)

maximum overall rise of 30 inches

Question 30

ascending an incline dependently

Answer 30

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

Question 31

descending an incline dependently

Answer 31

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

Question 32

ascending a curb forward dependently

Answer 32

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

Question 33

descending a curb backwards dependently

Answer 33

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

Question 34

ascending a curb backwards dependently

Answer 34

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

Question 35

descending a curb forward dependently

Answer 35

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

Question 36

up steps dependently

Answer 36

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

Question 37

down steps dependently

Answer 37

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

Question 38

falling in a WC

Answer 38

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

Question 39

WC care and maintenance

Answer 39

use for designed purposes only

store in safe, dry place

routinely check tires, spokes, and locks

see owner’s annual for recommended maintenance