Wheelchairs and Positioning Flashcards
1
Q
Hands-free sitter
A
Patient can maintain seated position without use of hands, seating system emphasizes mobility, stability with base of support and comfort
2
Q
Hands-dependent sitter
A
Patient uses one or more hands to maintain seated position, pelvis/trunk support required to enable free hands for functional activity
3
Q
Propper sitter
A
Patient lacks ability to sit without support, total body support required for posture and repositioning
4
Q
What body structure should be observed first for wheelchair positioning
A
Position of pelvis and trunk
5
Q
If deformity exists seated in wheelchair what should you do
A
Apply manual pressure to determine if the deformity is flexible or inflexible
6
Q
Pelvic obliquity
A
One side of pelvis is lower than other side which can lead to scoliotic posture and pressure ulcers on ischial tuberosity
7
Q
Kyphosis
A
Pelvis rotates posteriorly
Sacral sitting
Flexion of lumbar spine
Clients slide forward in w/c
8
Q
Scoliosis
A
Pelvis rotates to one side
Spine and trunk move in opposite direction
9
Q
Lordosis
A
Pelvis rotates anteriorly
Increased curvature of lumbar spine
Patient use UE for support
10
Q
Windswept deformity
A
Abduction and external rotation of one hip while the opposite hip is in adduction and internal rotation
Pelvis rotates laterally with thighs moving to opposite side
11
Q
What hip ROM do you need for manual propulsion and sitting upright
A
90 degrees hip flexion
12
Q
Reference seated position
A
Trunk upright in midline
Hip, knees, ankles 90 flexion
Pelvis natural
Head in mid-position
Arms at the side of trunk
Elbows flexion to 90
13
Q
Prolonged sitting can result in
A
Pressure ulcers
Back pain
Joint contractures
LE edema
Postural deformity
14
Q
What is the key to stability
A
Pelvic positioning
15
Q
What provides the base of support for stability and movement when seated
A
Pelvis and thighs
16
Q
Seat supports
A
Pelvis and thighs
17
Q
Back supports
A
Posterior pelvis and spine
18
Q
Pressure mapping
A
Use of pressure sensitive mat between client and seating surface to determine effectiveness of different cushions for relieving pressure on seating surface
19
Q
Flat/planar cushion shape
A
- None to minimal postural support
- Patient can reposition themselves independently
- Do not accommodate body shape
20
Q
Standard contoured cushion shape
A
- Contours based on body size
- More support than flat
- Distribute pressure across surface
- Less expensive than custom-contoured
21
Q
Custom-contoured cushion shape
A
- Shaped to client body
- Provide most support
- Distribute pressure across surface
- More expensive
- Patients limited to one position
- Transfers are more difficulty to perform
- System not adaptable (child growth)
- For patients who need support to maintain balance, have spinal or pelvis deformities, have muscle tone abnormalities or need additional lumbar support
22
Q
Foam cushion
A
- Variable density
- Lightweight
- Low in cost
- Heat and moisture can build up
- Custom-contoured foam is more expensive and provides better postural control, shearing, and weight shifting
23
Q
Gel filled cushion
A
- Conform to shape of buttocks
- Heavy
- Adequate for postural control
- Sensitive to temperature
24
Q
Air filled cushion
A
- Lightweight
- Provide even pressure relief when properly inflated
- Reduce postural stability
25
Honeycomb-shape plastic cushion
- Uneven pressure relief
- Lightweight
26
Hybrid cushion
- Combination of materials
- Usually gel and foam
27
Alternating pressure cushion
- Provide scheduled pressure relief through alternating levels of inflation and delation
- Decrease postural stability
28
Pelvic stabilizer (SubASIS bar)
Positioned at front of pelvis to limit pelvis mobility (tilt, rotation, obliquity)
29
Thoracic supports
Places laterally to trunk and below armpit to facilitate trunk stability and prevent scoliosis
30
Thigh supports
Placed laterally or medially to thighs to control AB/AD for windswept deformity
31
Head rest positioing
Back to head on occiput
32
Seat width measurement
Widest part of hips/thighs plus 1-2 inches to leave room between thighs and chair for repositioning/transfers, to avoid rubbing/pressure and accommodate bulky clothing
33
Seat depth measurement
Measure base of back to popliteal space of knee minus 1-2 inches to ensure seat edge does not reach back of knee and restrict movement/circulation
34
Seat-back measurement
Measure from seat surface with cushion to top of shoulders
35
Seat height measurement
Measure popliteal space to bottom of clients heel with footrests having 2-inch clearance from floor to keep thighs parallel to flow and feet resting comfortability on footrests
36
If minimal trunk support is required
Can measure seat-back height to mid-back under the scapulae
37
If max trunk support is requried
Hight seat-back height may be needed
38
If seat-back hight is too
Contact with push rim will be limited
39
Sport chairs
Have lower seat-back height which increases functional mobility and decreases stability
40
Seat angle
Sloping of sat to the rear of wheelchair to help stabilize pelvis
41
Too much sloping of seat angle can
Make transfers more difficulty
Cause pressure
42
Back angle
Recline to ease pressure associated with hip flexion
43
Armrest height measurement
Seating surface to bottom of client flexed elbow plus one inch to support UE and provide leverage for pushing up for pressure release and assisting in postural alignment
44
If armrest too high
Shoulder elevation
45
If armrest too low
Elicits leaning
46
Marginal ambulatory user
- Can walk short distances
- May need w/c on occasion (outdoors)
- Can benefit from power mobility (scooter)
47
Manual wheelchair user
- Can propel manual w/c with BUE and BLE or one of each or is pushed by caregiver
48
Marginal manual wheelchair user
- Can propel manual for short distance due to UE weakness, poor endurance
- Use power wheelchair at times
49
Totally or severely mobility impaired used
- Unable to propel
- TD on power chair
50
Frame
Material chair is made of
51
Frame affects
1) w/c weight
2) w/c structure
3) Durability
4) storage
5) Transportability
52
Transport chair
- Pushed by caregiver
- Small rear wheels make them light and transportable
- Short distances
- Temporary use
53
Manual chairs
- Self-propelled or pushed by caregiver
- Temporary use
54
Types of manual chairs
1) Standard chair
2) Lightweight chair
3) Ultra-lightweight chiar
4) Heavy-duty chairs
55
Standard chairs
- Fold ability
- Heavy
- Made of steel
- Limited adjustability
- Read axil fixed
- One-arm drive attachment
56
Lightweight chairs
- Similar to standard
- Light
- Made of aluminum
- Limited adjustability
57
Ultra-light weight chairs
- Available as rigid or folding frames
- Fold for transport
- Adjustable axle
- Quick-release wheels
- Customizable
58
Heavy-duty chairs
- Clients > 300 lbs
- Obesity or extreme spasticity
59
Scooter
- Pt. with limited walking ability
- 3 or 4 wheels
- steered with tiler
- Swiveled seat for transfer
- Adjustability
60
Power chairs
- Pt. who cannot propel
- Controlled with joystick, breath, head, chin, eye, tongue
- Very customizable
- Drive wheel placed at front, middle or rear
61
Patients who require tilt and recline features
Hip contracure
Need pressure relief
Need fatigue relief
Cannot reposition independently
Unable to maintain upright seated position
62
Tilt and recline feature support
Muscle tone
Orthostasis
Catheterization
Head/trunk control
Visual contact
63
Tilt feature
Seat to back angle is fixed with 0-45 degrees change orientation in space but not position
Prevents shearing and reduced pressure
Good for self-care activities
64
Recline feature
Seat to back angle changes to more than 90 degrees moving from upright to horizontal position
Provides rest break
Good for self-care activities and orthostatic hypotension
65
Benefits of standing chairs
- Improve circulation
- Improve bowel/bladder function
- Reduce LE spasticity
- Provides pressure relief
- Can reach higher items
- Increased independence
- Social interactions at face-to-face level
66
Population for hemi-height chair
Short stature
Need to self-propel
Lower seat height
67
Population for heavy-duty chair
Obesity
Severe spasticity
68
Rear axle placement for heavy-duty chair
Displaced forward
69
Rear axle placement for amputee chair
Set back to increase stability and compensate for loss of weight of missing limb and changed centered of gravity
70
Rubber tires
No maintenance
71
Pneumatic tires (air filled)
Maintenance to keep filled with air due to shock absorbing during use
72
Drive wheel position for increases stability
Patient center of mass is ahead of drive wheel axle
73
Drive wheel position for increased mobility
Drive wheel close to or slightly in front of patient center of mass
74
When axle is aligned below shoulders
Access to push rims is improved resulting in increased movement efficiency
75
Power-assisted wheels
Motor component in wheel hub activated when patient pushes on rims to decrease effort required
76
Lapboard
Fits across armrests to support weak UE or provide work surface
77
Positioning belt
Stabilizes pelvis at a 45 degree angle to base of seat back
78
Hand rim projections
Compensate for weak grasp to propel chair
79
Break level extender
Compensate for limited ROM for reaching break
80
Anti-tip device
Prevents chair from tipping backward
81
Hill holder
Prevents chair from going backwards when traveling up hill/ramp but allows for forward movement
82
Push handles
Make pushing chair easier for caregiver
83
Adjustable-tension backrest
Replaces sling backrest to allow for adjusted tension to loosen or tighten (common for kyphosis)
84
Wedge cushion
Anti-thrust cushion that has higher front than back to prevent forward sliding
85
Wedge cushion
Anti-thrust cushion that has higher front than back to prevent forward sliding
86
Pressure relief techniques
Push ups
Side to side movement
Schedule for weight shifts and skin monitoring
87
Medical necessity includes
Increased function, health, safety, user satisfaction
88
Mobility-assisted equipment (MAE) documentation criteria
Symptoms
Related dx
History (intervention that have been tried with results)
Physical examination
Functional assessment of MRADL
Recommendation and rationale
89
Medicare clients are eligible for MAE if
They have personal mobility deficits that impact participation in MRADL in the home
90
Medicare MRADL
Toileting, feeding, dressing, grooming, or bathing.
91
What type of cushion is often needed for patient who need accommodations for deformities of the pelvis or spine
Custom-contoured foam
92
Transfer pelvis, heel and arm positioning
- Anterior pelvic tilt
- Heels point toward the surface to which the client is transferring
- Push up from wheelchair armrest
93
Why is it important to ensure wheelchairs have appropriate seat depth
Distribute body weight along entire surface
94
Hip flexion less than 90
Causes positioning in reclined position and increases pressure on the sacral region
95
Angle for SPT w/c to bed
Position the chair at a 0°–30° angle to the bed
96
Purpose of a wheelchair cushion
Redistribute pressure on the sitting surface away from the ischial tuberosities and the coccyx.
97
Tilt-in-space feature
Rotates the seat around a fixed axis, does not change the client's position, and provides pressure relief for the buttocks
98
Main objective for wheelchair seat width
Distribute weight over the widest possible surface while keeping the width of the chair as narrow as possible
99
In what conditions can the pelvis be flexible or fixed
scoliosis, windswept deformity, and kyphosis, lordosis
100
K0005
Ultra lightweight wheelchair that is fully adjustable
101
K0002 code
Standard hemi wheelchair for clients who need lower seat height due to short stature or to enable self-propulsion using BLE
102
K0007 code
Extra-heavy-duty for patients 300 pounds+
103
K0001 code
Standard chair, most basic, least adjustable wheelchair, meets the minimal standard for Medicare
