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That one thing you need > Wheelchairs > Flashcards

Wheelchairs Flashcards

1
Q

When determining the client’s needs for a WC, it is important to observe the client’s seated position when unsupported. When a client can maintain a seated position without using the hands, what is this called? What kind of WC support will he require?

A
  • Hands-free sitter

- Seating system design emphasizes mobility, stability (stable BOS), and comfort

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2
Q

When determining the client’s needs for a WC, it is important to observe the client’s seated position when unsupported. When a client uses one or both hands to maintain a seated position, what is this called? What kind of WC support is required?

A
  • Hands-dependent sitter

- Pelvic and trunk support is required of the seating system to free hands for activities

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3
Q

When determining the client’s needs for a WC, it is important to observe the client’s seated position when unsupported. When a client lacks the ability to sit without support, what kind of sitter is he? What kind of WC support is required?

A
  • Propped sitter

- Total body support is required of the seating system for posture and repositioning

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4
Q

How can you determine if deformity is flexible or inflexible? How does this affect choosing a suitable WC?

A
  • Apply manual pressure to determine whether deformity is flexible or inflexible?
  • If flexible, deformity can be reduced to some extent by a supportive seating system
  • If inflexible, needs to be accommodated with a seating system?
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5
Q

When one side of the pelvis is lower than the other side, which can lead to scoliotic posture and pressure ulcers on the ischial tuberosity

A

Pelvic obliquity

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6
Q

When the pelvis rotates posteriorly, resulting in sacral sitting and flexion of the lumbar spine; clients tend to slide forward on the seat

A

Kyphosis

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7
Q

Pelvis rotates to one side, resulting in spine and trunk moving to the opposite side

A

Scoliosis

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8
Q

The pelvis rotates anteriorly, increasing the curvature of the lumbar spine; clients tend to use UE for support

A

Lordosis

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9
Q

The pelvis rotates laterally, with the thighs moving to the other side

A

Windswept deformity

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10
Q

When assessing a cx for WC use, why is it important to assess them in supine and sitting?

A

Because the influence of gravity on the body is different in supine than seated

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11
Q

How to assess client’s musculoskeletal and neuromuscular capacities when determining WC to use

A
  • Observe client’s posture and stability in current seating system (baseline)
  • Check postural alignment and deformity
  • Transfer client to seated position and observe position and control of UE and head and neck
  • Observe seated position when unsupported (hand-free, hand-dependent, or propped sitter)
  • Observe position of client’s pelvis and trunk–check for deformities
  • Observe and assess UEs and LEs (both seated and supine)
  • ROM for manual propulsion and sitting upright
  • Strength for manual propulsion
  • Quality of movement, presence of tone, spasticity, tremor, primitive reflexes
  • Check for signs of pressure or shear on skin or pressure ulcers
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12
Q

What is the key to stability when seated?

A

Pelvic positioning! The pelvis can tilt and rotate, which introduces instability and influences the position of the spine, trunk, UE, and head

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13
Q

How can you provide stability for the pelvis while seated in WC?

A

Pelvis is the key to stability!

  • Provide a solid BOS by stabilizing pelvis on a firm surface, which distributes pressure throughout buttocks and thighs
  • Support posture with the seat and seat back. Provide cushioning for these surfaces
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14
Q

The following are benefits for cushioning on WC EXCEPT which?
A. Reduces peak pressures of bony prominence
B. Can accomodate deformities
C. Composition has varying abilities to manage moisture, heat, and friction
D. Unevenly distributes pressure over large area

A

D. A benefit of WC cushioning is that it EVENLY distributes pressure over large area
Also affects postural control and transfers, and can accommodate deformity. Consider durability and maintenance requirements

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15
Q

How can you determine the comparative effectiveness of different cushions for relieving pressures on the seating surface?

A

Pressure mapping. This is done by inserting a pressure-sensitive mat between the client and seating surface

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16
Q

When is choosing a flat (planar) cushion for a WC appropriate?

A

With clients who need no more minimal postural support and can reposition themselves independently. They do not accommodate body shape.

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17
Q

When are custom-contoured cushions for WCs appropriate?

A

Appropriate for clients who need support to maintain balance, have pelvic or spinal deformities, have muscle tone abnormalities, or need additional lumbar support. They are shaped to the client’s body and provide the most support, distribute pressure across their surface, and are more expensive than standard contoured surfaces.

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18
Q

Disadvantages of Custom-contoured cushions for WCs

A

Clients are limited to one position, transfers are more difficult to perform, and the system is not adaptable (e.g., cannot accommodate a child’s growth). Also very $$$ They are appropriate for clients who need support to maintain balance, have pelvic or spinal deformities, and have muscle tone abnormalities, or need additional lumbar support.

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19
Q

Pros and Cons of foam cushions for WCs? Custom-contoured form?

A

Pros: If soft and pliable, will mold itself around buttocks, lightweight, low cost
Cons: If too soft, may be totally compressed and useless for pressure management, heat and moisture can buildup.

-Custom-contoured foam is more expensive and provides better postural control; shearing is reduced, and weight-shifting capability is reduced

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20
Q

Type of cushion that conforms to the shape of the buttocks. It is adequate for postural control, heavy, and sensitive to temperature.

A

Gel filled cushion

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21
Q

Pros and Cons of air filled cushions

A

Lightweight, provide even pressure relief but have to be properly inflated to perform well. Also reduce postural stability

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22
Q

These cushions provide uneven pressure relief and are lightweight

A

Honeycomb-shaped plastic cushion

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23
Q

These cushions incorporate a combination of materials, typically foam and gel

A

Hybrid

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24
Q

These cushions provide scheduled pressure relief thorough alternating levels of inflation and deflation; they also reduce postural stability

A

Alternating pressure

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25
Q

What does a pelvic stabilizer (belt, SubASIS bar) do for WC clients?

A

Positioned at the front of the pelvis to limit pelvic tilt, rotation, or obliquity

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26
Q

What do thoracic supports do for clients in WC?

A

Placed lateral to trunk and below armpit to facilitate trunk stability and prevent or slow scoliosis; anterior trunk supports situated below the top and above bottom of breastbone

27
Q

What WC seating support should be considered for a client with windswept deformity?

A

Thigh support (lateral or medial to thighs) to control abduction or adduction

28
Q

How to measure seat width for WC?

A

Measure widest part of the thighs/hips and add 1-2 inches. This provides clearance between the thighs and chair to ease repositioning and transfers, avoid rubbing or pressure, and accommodate bulky clothing. Goal i s to distribute body weight over as much of seat as possible

29
Q

How to measure for seat depth of WC?

A

Measure from base of back to the popliteal space of each knee; subtract 1-2 inches so that the seat edge doesn’t reach the back of the knee and restrict motion or circulation. Measure both LEs to account for discrepancies in length

30
Q

How to measure WC seat height

A

Measure from popliteal space to the bottom of the client’s heel. Footrests should have a 2-inch clearance from the floor. Goal is to keep the thighs parallel to the floor, the feet resting comfortably on the footrests, and the footrests clearing the floor

31
Q

How to measure seat-back height of WC? If min. trunk support is needed?

A

Measure from seat surface (including cushion) to the top of the client’s shoulder; a higher back height may be needed if trunk control is poor. If minimal trunk support is required, measure from seat surface (with cushion) to midback, just under scapulae)

Measurement depends on degree of back support needed for trunk control, comfort, and UE activity, including propulsion. Goal is to provide support needed, allowing as much UE movement as possible

32
Q

If seat-back height of a WC is too high, contact with the push rim…

A

Contact with the push rim will be limited

33
Q

T/F: Lower back height in a WC e.g., sports chairs, increases functional mobility and stability

A

FALSE. lower back height increases functional mobility but decreases stability

34
Q

What will sloping WC seat down toward rear of WC (seat dump) help with?

A

Can help stabilize the pelvis. But too much can make transfers difficult and cause pressure

35
Q

What change can be made to a WC if there is discomfort associated with hip flexion?

A

The back can be reclined to ease discomfort associated with hip flexion. BUT too much of a backward angle makes the chair unstable

36
Q

How to measure armrest height for WC

A

Measure from the seating surface to the bottom of the client’s flexed elbow; the armrest should be about 1 inch higher

37
Q

Type of WC user that can walk short distances; may need a WC on occasion, especially outdoors; can benefit from intermittent use of a power mobility devices such as a scooter

A

Marginal ambulatory user

38
Q

Type of WC user that can propel a manual WC with both UEs, both LEs, or one upper and one lower extremity or is pushed by an attendant or caregiver

A

Manual WC user

39
Q

Type of WC user that can proper a manual WC for short distances; tolerates only limited use because of UE overuse injury, upper body weakness, lack of endurance, or respiratory problems; may at times use a manual or power WC

A

Marginal manual WC user

40
Q

Type of WC user that is unable to self-propel a manual WC; is dependent on a power chair or attendant

A

Totally or severely mobility-impaired user

41
Q

To provide pelvic stability, what should be done to the original vinyl sling WC seat?

A

The original vinyl sling seat is lightweight and folds and cleans easily, but it fosters pelvic instability and thigh malalignment. To provide pelvic stability, a solid seat is inserted on top of the sling seat; cushions are placed on top of the solid seat.

42
Q 
Which of the following WCs is very customizable?
A. Standard chairs
B. Lightweight chairs
C. Ultra lightweight chairs
D. Heavy duty chairs
A

C. Ultra lightweight chairs. They are available with rigid or folding frames, both of which fold for transport. They have an adjustable axle and quick-release wheels and are customizable. Lightweight chairs have features similar to those of a standard WC but are lighter in weight. Adjustability is limited

43
Q

WCs that recline and tilt assist what kind of clients?

A

Clients who have hip contractures, need to recline to reduce pressure or manage fatigue, or cannot reposition themselves independently or are unable to maintain an upright seated position. They assist in managing ROM, muscle tone, orthostasis, catheterization, and head and trunk control and in enabling visual contact

44
Q

Physiological benefits of WCs that stand

A
  • Improves circulation and bowel and bladder functions
  • reduces lower extremity spasticity
  • provides pressure relief
45
Q

WCs for clients with hemiplegia. Chair height is lower to permit foot propelling. Foot rest for nonhemiplegic extremity is removed

A

Hemi-height chairs

46
Q

With extra heavy duty-chairs, the real axle is displaced forward or backwards?

A

Forward

47
Q

How do rear axles accommodate clients with amputee chairs?

A

Because amputation moves the client’s center of gravity back when seated, have the rear axle set back to increase stability, which compensates for the loss of weight of the missing limb or limbs.

48
Q

Benefits of larger WC casters

A

Larger casters give a more comfortable ride; they are less likely to get stuck in a hole.

49
Q

Is the WC more stable when the client’s center of mass is ahead or behind of the drive wheels’ axle?

A

The WC is more stable when the client’s center of mass is ahead of the drive wheels’ axle. However, the chair is more easily moved when the client’s center of mass is close to or slightly behind the drive wheels axle

50
Q

Benefits to having WC axle aligned below the shoulder?

A

Access to the push rims is improved. Movement efficiency is increased because the user can go further with fewer strokes

51
Q

Benefits to moving the WC axle up relative to the seat?

A

This lowers seat height, which improves stability; if the seat is too low however, poor propulsion patterns may result because of abducted arms

52
Q

Benefits of full-length armrests

A

Provide more support for arms and better support for a lap tray than shorter ones; they promote ease of arm use for transfers

53
Q

T/F: Elevating leg rests provide little benefit for edema control

A

True. Because the LEs need to be above the heart for edema control, elevated leg rests provide little benefit for edema control

54
Q

Device that stabilizes the pelvis; should be positioned so that it pulls on the pelvis at 45 degrees angle to the base of the seat back

A

Positioning belt

55
Q

WC device that compensates for weak grasp in moving the WC?

A

Hand rim projections

56
Q

WC device that compensates for limited ROM in reaching the brakes

A

Brake lever extender

57
Q

Adjustable tension backrests accommodates for what kind of spine/back issue?

A

Kyphosis. It replaces the sling backrest; tension is adjusted by loosening and tightening the strapping system

58
Q

WC device that prevents client from sliding forward

A

Wedge cushion (antithrust seats). The front is higher than back

59
Q

How to descend curb with WC

A

Move the chair around to descend backward; guide the large wheels down the curb to the street. Clear the casters by tilting the chair; then turn the chair to face forward

60
Q

How to descend an incline with WC

A

Balance the chair backward and move in a forward direction, or go down backward with the client controlling the speed using hands on the push rim

61
Q

What does Medicare require to cover MAE (mobility-assisted equipment)?

A
  1. Have a “personal mobility deficit sufficient to impair their participation in MRADLs, such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home”
  2. Clients must be able to–or have caregiver–who is able to consistently and safely use the MAE in the home
    a. for manual WC: sufficient UE strength
    b. for scooter, sufficient strength and postural stability
    c. power WC, they must require features of power chair that are not available on scooter to participate in MRADLs e.g., joystick, lower seat height
62
Q

Documentation criteria for MAE (mobility assisted equipment)

A
  • Symptoms
  • Related diagnoses
  • History: clinical trajectory, interventions that have been tried and their results
  • Physical examination: height, weight, physical impairments (ROM, strength, tone), sitting balance, spinal posture, ability to reposition
  • Functional assessment: performance of MRADLs
  • Recommendation and rationale
63
Q 
Which of the following is NOT considered an MRADL? (mobility assistive equipment and mobility-related ADLs) 
A. Feeding
B. Cooking
C. Bathing
D. Grooming
E. Toileting
A

B. Cooking

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