wheelchairs Flashcards
1
Q
postural support system
A
1: seating
2: back
3: arm rests
4: leg rests
5: foot rests
2
Q
seating
A
1: sling seat
2: insert or contour seat
3: seat cushion
3
Q
sling seat
A
standard: hips slide forward, adduct and IR, posterior pelvic tilt (promotes sacral sitting)
4
Q
insert or contour seat
A
wood or plastic padded with foam
stable, firm sitting surface=improves pelvic position
5
Q
Seat cushions
A
- distributes weight bearing pressure
- add to measurement to determine back height
- pressure relief push-ups required every 15-20 minutes or leaning side to side if unable to push up
1: pressure-relieving, contoured foam cushion
2: pressure-relieving fluid/gel or combo (fluid/gel plus foam)
3: pressure-relieving air cushion
6
Q
pressure-relieving , contoured foam cushion
A
- dense layered foam
- accommodates mod to severe posture deformities
- makes repositioning easy for caregivers, yet interferes with slide transfer
- low maintenance
7
Q
pressure-relieving fluid/gel or combo
A
(fluid/gel plus foam)
- custom molded
- mod to severe postural deformity
- some maintenance required
- heavier/more expensive
8
Q
pressure-relieving air cushion
A
- mod to severe postural deformity
- light weight, improved pressure distribution
- base maybe unstable for some patients
- expensive/continuous maintenance
9
Q
Back postural support system
A
1: low back heights:
2: high back heights:
3: insert or contour
4: lateral trunk supports
10
Q
Low back heights
A
increase functional mobility (sports chairs) also increase back strain
11
Q
high back heights
A
for patients with poor trunk stability/extensor spasticity
12
Q
insert or contour back
A
improve trunk extension and overall upright alignment
13
Q
lateral trunk supports
A
improve trunk alignment
patients with scoliosis, poor stability
14
Q
armrests
A
- full length or desk length
- fixed height or adjustable (for sit to stand transfers)
- removable (facilitate transfers)
- wraparound (space saver)- reduce width of chair by 1.5”
- UE support surface (trays, troughs) secured to arm rests, additional postural assistance for pts with decreased UE use.
15
Q
leg rests
A
- fixed
- swing away/detachable = ease in transfers
- elevating= LE edema, postural support. contraindicated for patients with hamstring hypertonicity/tightness
16
Q
footrests
A
- foot plates= neutral foot, knee flexion 90 deg; raised or removable for transfers
- heel loops= maintain foot position, prevent posterior sliding
- straps (ankle, calf) added to stabilize feet on foot plate
17
Q
wheeled mobility base
A
1: frame
2: wheels, handrims
3: casters
4: drive wheels
5: tires
6: brakes
18
Q
Frame
A
- the lighter the frame, the greater the ease of use
- the level of expected activity and environment is taken into account when deciding on frame construction
available in:
-heavy duty, standard, lightweight, active-duty lightweight, ultra lightweight
Folding: facilitates mobility in community; ease of storage
19
Q
fixed/rigid frame
A
facilitates stroke efficiency (increase distance per stroke)
20
Q
casters
A
small front wheels, 8” in diameter, locks can be added for stability during transfers
21
Q
drive wheels
A
large rear wheels, used to propel, outer rims allow for handgrip and propulsion. constructed of standard spokes or spoke-less wheels
Friction rims/leather gloves: increase hand grip friction, ease propulsion for pts with decrease grip strength
Projections: attached to rims (vertical, oblique, horizontal)
- used for patients with decreased grip strength
- horizontal or oblique widen chair width=limiting mobility in home
22
Q
tires
A
Standard: hard rubber= durable, low maintenance
Pneumatic: air filled= smoother ride, increase shock absorption,more maintenance
23
Q
brakes
A
- most consist of a level system with a cam
- always engaged for transfers in and out of chair
- extensions added for UE weakness/arthritis
24
Q
additional wheelchair attachments
A
- seat belts
- seat positioners
- seat back positioners
- anti-tipping devices
- hill-holder device
25
seat belts
(pelvic positioner)
| should grasp over pelvis at 45 degree angle to the seat
26
seat positioners
- add lateral positioner at hip and knee or medial at knee (adductor pummel).
- maintain alignment of LE's/control for spasticity.
- seat wedge or tilt-in-space seat used for extensor spasms or thrusting
27
seat back positioners
add lateral trunk positioning for alignment (scoliosis)
28
anti-tipping devices
posterior extension added to lower horizontal supports
| -prevent tipping backwards, but can also limit going up curbs or over door sills
29
hill-holder device
mechanical break allowing forward movement but automatically breaking when chair goes into reverse.
-useful for patients that cannot climb a hill/ramp without needing a break
30
primary outcome of wheelchair
promoting patient independence and maximum function
31
wheelchair prescription
- The size of the wheelchair must be proportional to the size of the patient, taking into account the demands of expected use/environment which the chair will be used
- Assessments should be taken with the patient on a firm surface (seated or supine)
32
6 key wheelchair measurements
1: seat width
2: seat depth
3: leg length/seat to footplate length
4: seat height
5: arm rest height
6: back height
33
seat width
Pt measurement: width of patient's hips at the widest part
-measure sitting or supine
Chair measurement: add 2 inches
34
seat width potential problems
- excess width
- too narrow
- should accommodate width of doorways
35
if there is excess width of wheelchair...
difficulties reaching the drive wheels and propelling chair
36
if width of w/c is too narrow...
increased pressure on lateral pelvis and thighs
37
seat depth
Pt measurement: posterior buttock to posterior aspect of lower leg in popliteal fossa
Chair measurement: subtract 2-3 inches
38
seat depth potential problems
- too short
| - too long
39
if seat depth is too long...
- compromises posterior knee circulation
- kyphotic posture
- sacral sitting
- posterior pelvic tilting
40
if seat depth is too short...
fails to support thighs accurately
41
leg length/seat to footplate length
Pt measurement: bottom of shoe to just below the thigh in the popliteal fossa
-when a seat cushion is used, the height of the cushion must be subtracted from the pt's measurement
42
leg length/seat to footplate length potential problems
- too short
| - too long
43
if leg length too short...
- uneven weight distribution on thigh
| - excessive weight on ischial seat
44
if leg length is too long...
- sacral sitting
| - posterior pelvic tilting, sliding forward in chair
45
seat height
Pt measurement: none
Chair measurement: minimum clearance between the floor and the foot plate is 2"
- measured from the lowest point on the bottom of the footplate
- add 2" to patient's leg length measurement
46
arm rest height (hanging elbow height)
Pt measurement: shoulder neutral position, elbow 90 degrees
-from seat platform to just below elbow
Chair measurement: add 1 inch
47
if arm rests are too high...
shoulder elevation
48
if arm rests are too low
leaning forward
49
back height
Pt measurement: seat platform to inferior angle of scap, mid scap, top of shoulders **based on how much support the patient needs*
-height of seat cushion should be added to this measurement!!
50
back height potential problems
- added back height= increases difficulty getting chair into car/van
- also prevents the pt from hooking onto the push handle for stabilization and weight relief
51
wheelchair training
instruct use and care of chair, cushions,wheel locks (brakes), foot supports, leg rest elevation and arm rests
- normal cleaning and maintenance
- power chair- battery maintenance
instruct periodic pressure relief:
- arm push ups
- weight shifting-leaning to one side than the other
- every 15-20 minutes
52
manual wheelchair propulsion
- both arms on drive wheels
- 1 arm on drive wheel/one foot pulls diagonally across the floor under chair (pt with hemiplegia)
- 1 arm on drive wheel (both outer rims located on 1 side)
53
power chair training
- focus on diving skill and safety
- instruct in use of switches (on/off, turns, joysticks)
- maneuverability
- safe stopping
54
turning
-push harder with one hand than other
Sharp turning: pull one wheel backward while pushing other wheel forward
55
Ascending ramps
forward lean of head and trunk; shorter strokes moving hands quickly
56
Descending ramps
grip hand rims loosely controlling chairs descent OR for steep ramps wheelie position
57
wheelies
- instruct patient to come up onto and balance on drive wheels with casters off the ground
- for curb negotiation and steep ramps
- patients with paraplegia
practice balance: therapist tips chair back and pt practices maintaining balance in wheelie position
practice moving in wheelie position
58
moving in wheelie position
1: place hands well back on hand rims
2: pull hands forward abruptly and forcefully
3: lean head and trunk forward to keep from going backwards
4: use lightweight wheelchair to facilitate training
59
balancing in wheelie position
chair tips further back when wheels are moved forward
chair tips upright when wheels are pulled back
60
ascending curbs
place front casters up on curb, then push rear wheels up on curb, momentum assists
61
descending curbs
backwards with forward head and trunk lean
| forward in wheelie position
62
Factors that help determine equipment recommendations for a client include:
- insurance/financial restraints
- client impairment and functional status
- client goals and expectations
63
Reasons for recommending an air flotation cushion for a client include:
- history or good performance for pt over time
- pressure distribution
- lightweight
64
The distinguishing feature of the K0005 ultra lightweight wheelchair is:
The adjustable axle plate
65
Which seating system may be the most therapeutic for a client with severe spastic tetraplegia due to cerebral palsy, scoliosis with pelvic obliquity, rotation, and history of skin breakdown over bony prominences in the spine?
Custom molded seat and back system
66
Advantages of a power wheelchair over a POV include:
- more available seating options
- increased maneuverability and stability
- more advanced electronics
67
Characteristics of a good letter of medical necessity include:
- Relevant clinical findings from the evaluation, including diagnosis, prognosis, functional status, height and weight
- Problems with the client's current equipment, including why it is no longer meeting his or her needs
- Clinical rationale for the recommendation of the new equipment and why it will provide maximal client independence and safety and prevent secondary complications
68
Power standing wheelchairs offer all of the following advantages to the end-user:
- Improved functional position for MRADLs and vocational activities
- Good pressure relief
- Improved bone density and circulation
69
Reasons to schedule a return visit to PT when the client's new wheelchair and seating system is delivered include:
- To ensure proper fit and adjustment of all the equipment ordered
- To educate clients on the proper use and care of the equipment they have received
- To instruct the client in wheelchair mobility techniques to maximize independence and safety with home and community mobility
70
factors that help determine equipment recommendations for a client include:
insurance/financial constraints
client impairment and functional level
client goals and expectations
71
reasons for recommending an air flotation cushion for a client include:
history or good performance for client over time
pressure distribution
lightweight
72
for a client with impaired UE strength who wants to continue to self propel, all of the following clinical interventions may assist in the prevention of repetitive stress injuries:
- adjustment of the axle plate anterior or posterior to facilitate optimal push rim biomechanics
- instruction in proper propulsion techniques
- utilizing spoke, instead of mag wheels
73
advantages of a power wheelchair over a POV include:
more available options for seating systems
ability to transport in the trunk of a car
increased maneuverability and stability
74
characteristics of a good letter of medical necessity include:
relevant clinical findings from the evaluation, including diagnosis, prognosis, functional status, height and weight
problems with the client's current equipment, including why it is no longer meeting his or her needs
equipment and why it will provide maximal client independence and safety and prevent secondary complications
75
power standing wheelchairs offer all of the following advantages to the end user:
improved functional position for MRADLs and vocational activities
good pressure relief
improved bone density and circulation
76
reasons to schedule a return visit to PT when the client's new wheelchair and seating system is delivered include all of the following:
to ensure proper fit and adjustment of all the equipment ordered
to educate clients on the proper use and care of the equipment they have received
to instruct the client in wheelchair mobility techniques to maximize independence and safety with home and community mobility
