Wheelchairs and Posture Flashcards
Age distribution of wheelchair users (Tayside)
66%>65
20% >85
17% <45
process of provision for a wheelchair
Referral assessment prescription delivery review
What are the 4 main types of wheelchairs provided?
- manual attendant propelled
- manual occupant propelled
- powered occupant controlled (indoor only (EPIC) indoor/outdoor (EPIOC)
- powered attendant controlled (outdoor only)
Lighter weight Wheelchairs
Dash Lite
Active User Wheelchairs
Folding frame:
Sunrise Neon
Rigid frame:
Sunrise helium
Propulsion Systems
Levers--> Efficient, cumbersome Cranks--> Efficient, cumbersome Feet--> Immediate option Somebody else--> Dependency Handrims--> Simple, independent Electricity--> Complex Engine--> Noisy, smelly
What is important to bear in mind about foot propulsion wheelchairs?
Seat height
castor size
cross brace
What is important to bear in mind about handrim propulsion wheelchairs?
Wheel size Horizontal wheel position Vertical wheel position Handrim diameter Handrim cross section Camber Alignment Tyre type increased wheel base for stability
Preferred elbow angles
Able bodied 100o - 120o
(Amsterdam)
Able bodied 107o- 118o
(Dundee)
MS 90o - 110o
SCI 128o - 135o
Manoeuvrability
Castor rake
Castor diameter
Wheel position
Indoor Chair
Compact
Small turning circle
Small drive wheels
Low power
Electric Powered
Indoor/Outdoor Chair (EPIOC)
Larger drive wheels (rear, mid and front) Greater power Greater torque Greater Range Ability to climb kerbs
Stability
Wheelbase Position of centre of gravity (must be in front of the rear wheel axis) User weight Anti-tippers Castor orientation Camber
Obstacle climbing
Castor diameter
Wheel diameter
Anti tippers
Kerb climber
Device which enables the wheelchair to ascend kerbs
of up to 4” high
Contacts kerb first and lifts castors up onto
pavement
Central vs bilateral kerb climber
central simpler direction less critical impede transfer impede foot position Bilateral more complex direction more critical swing out of way for transfers
What two factors are important for directional stability?
wheelbase
castor trail
Skin Ulceration
Stage 1: Non-blanchable erythema of intact skin
Stage 2: Partial-thickness skin loss involving epidermis or dermis, or both
Stage 3: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue, which may extend down to but not through underlying fascia
Stage 4: Full-thickness skin loss with extensive destruction, tissue
necrosis, or damage to muscle, bone, or supporting structures
(such as tendon and joint capsule)
pressure sore factors
immobility impaired sensation Pressure & TIME Impact Shear Temperature Humidity Circulation Nutrition Skin Integrity Smoking low B.M.I.
formula for pressure
p=F/A
Measuring problems with pressure
Accuracy Hysteresis Creep Repeatability Temperature Deformation
Statistics on pressure sores
Cell values Overall Max Overall Min Average Variance Number of Cells
What are the desirable design objectives of a cushion?
Even pressure distribution Low temperature at skin surface Low humidity at skin surface Pelvic stability Practicality of usage
Watch Out For
Clinic Effect’ - patient adopts different posture when monitored
Accurate Information - what do they spend
significant time sitting on
‘Ideal’ Pelvic Posture
Neutral alignment: head balanced over spine, spine balanced over pelvis Neutral pelvis: ASIS and PSIS are level Natural spinal curves Shoulders slightly posterior to pelvis Head in neutral position with eyes (gaze) forward Equal weight bearing through ischial tuberosities
Spinal ‘Correction’
3 point fixation
Asymmetrical Postures
Posterior Pelvic Tilt
Anterior Pelvic Tilt
Pelvic Obliquity
Pelvic Rotation
Posterior Pelvic Tilt
Most common pelvic tendency ASIS in higher than the PSIS Flexed lumbar spine Thoracic kyphosis Shoulder protraction Increased cervical extension C-type posture
What Causes a Posterior Pelvic
Tendency?
Wheelchair considerations:
Seat depth too long Back support too short Sling back upholstery Elevating leg rests Lower extremities are not supported well
What Causes a Posterior Pelvic
Tendency?
Physical conditions
Tight hamstrings – Knee Extension
Reposition themselves by sliding
Can not maintain 90º of hip flexion
Anterior Pelvic Tilt
ASIS in lower than the PSIS Increased lumbar lordosis Thoracic kyphosis is reversed or reduced Shoulder retraction
What Causes an Anterior Pelvic Tilt?
Weak muscles/Low tone Weak hamstrings Weak abdominals Tight hip flexors (ilipsoas and rectus femorus)
Pelvic Obliquity
One ASIS is higher than the other Compensatory C-shaped curve in the lumbar and thoracic spine The shoulder on the side of obliquity tends to be elevated The obliquity is named for the side that is lower
What Causes a Pelvic Obliquity?
Wheelchair considerations
Sling back upholstery Wheelchair too wide
What Causes a Pelvic Obliquity?
Physical conditions
Muscle Imbalance
Irregular muscle tone
(high or low tone on one side of the trunk)
Pelvic Rotation
One side of the pelvis is more forward than the other side Keep in mind that some level of pelvic rotation is usually found in an individual who has a pelvic obliquity
Pelvic Positioning Considerations
3 points for pelvic stabilization: seat, back & anterior support The pelvis is the keystone of positioning Optimize independence Enhance function Promote comfort/Relieve pain Distribute pressure Correct flexible deformities Accommodate fixed deformities Minimize postural supports Do not over position: Sitting is a dynamic activity
Lower Body ‘Ideal’ Posture
Feet flat on footplate in neutral position Ankles 90 º Knees 105 º & neutral abduction Femurs parallel to seat Footplate position allows 2” clearance from floor 1” space from back of knee to front of seat
Lower extremity positioning directly affects the…..
position of the pelvis
Lower extremity positioning helps sustain the…..
position of the hips and knees
Correct positioning assists in the prevention of …..
deformities and distributes pressure
Footplates positioned too low increase….
pressure under the thigh
Footplates too high increase ….
sacral area
pressure
Do not over position
Balance function &
support
