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Lower Limb Biomechanics and prosthetics > Wheelchairs and Posture > Flashcards

Wheelchairs and Posture Flashcards

1
Q

Age distribution of wheelchair users (Tayside)

A

66%>65
20% >85
17% <45

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2
Q

process of provision for a wheelchair

A 
Referral
assessment
prescription
delivery
review
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3
Q

What are the 4 main types of wheelchairs provided?

A
  • manual attendant propelled
  • manual occupant propelled
  • powered occupant controlled (indoor only (EPIC) indoor/outdoor (EPIOC)
  • powered attendant controlled (outdoor only)
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4
Q

Lighter weight Wheelchairs

A

Dash Lite

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5
Q

Active User Wheelchairs

A

Folding frame:
Sunrise Neon
Rigid frame:
Sunrise helium

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6
Q

Propulsion Systems

A 
Levers--> Efficient, cumbersome
Cranks--> Efficient, cumbersome
Feet--> Immediate option
Somebody else--> Dependency
Handrims--> Simple, independent 
Electricity--> Complex
Engine--> Noisy, smelly
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7
Q

What is important to bear in mind about foot propulsion wheelchairs?

A

Seat height
castor size
cross brace

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8
Q

What is important to bear in mind about handrim propulsion wheelchairs?

A 
Wheel size
 Horizontal wheel position
 Vertical wheel position
 Handrim diameter
 Handrim cross section
 Camber
 Alignment
 Tyre type
increased wheel base for stability
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9
Q

Preferred elbow angles

A

Able bodied 100o - 120o
(Amsterdam)
 Able bodied 107o- 118o
(Dundee)

 MS 90o - 110o
 SCI 128o - 135o

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10
Q

Manoeuvrability

A

Castor rake
 Castor diameter
 Wheel position

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11
Q

Indoor Chair

A

Compact
 Small turning circle
 Small drive wheels
 Low power

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12
Q

Electric Powered

Indoor/Outdoor Chair (EPIOC)

A 
Larger drive wheels (rear, mid and front)
 Greater power
 Greater torque
 Greater Range
 Ability to climb kerbs
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13
Q

Stability

A 
Wheelbase
 Position of centre of gravity (must be in front of the rear wheel axis)
 User weight
 Anti-tippers
 Castor orientation
 Camber
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14
Q

Obstacle climbing

A

 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

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15
Q

Central vs bilateral kerb climber

A 
central 
simpler
 direction less critical
 impede transfer
 impede foot position
Bilateral 
more complex
 direction more critical
 swing out of way for
transfers
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16
Q

What two factors are important for directional stability?

A

wheelbase

castor trail

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17
Q

Skin Ulceration

A

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)

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18
Q

pressure sore factors

A 
immobility
impaired sensation 
 Pressure &amp; TIME
 Impact
 Shear
 Temperature
 Humidity
 Circulation
 Nutrition
 Skin Integrity
 Smoking
 low B.M.I.
19
Q

formula for pressure

A

p=F/A

20
Q

Measuring problems with pressure

A 
 Accuracy
 Hysteresis
 Creep
 Repeatability
 Temperature
 Deformation
21
Q

Statistics on pressure sores

A 
Cell values
 Overall Max
 Overall Min
 Average
 Variance
 Number of Cells
22
Q

What are the desirable design objectives of a cushion?

A 
Even pressure distribution
 Low temperature at skin surface
 Low humidity at skin surface
 Pelvic stability
 Practicality of usage
23
Q

Watch Out For

A

Clinic Effect’ - patient adopts different posture when monitored
 Accurate Information - what do they spend
significant time sitting on

24
Q

‘Ideal’ Pelvic Posture

A 
 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
25
Q

Spinal ‘Correction’

A

3 point fixation

26
Q

Asymmetrical Postures

A

Posterior Pelvic Tilt
Anterior Pelvic Tilt
Pelvic Obliquity
Pelvic Rotation

27
Q

Posterior Pelvic Tilt

A 
 Most common pelvic tendency
 ASIS in higher than the PSIS
 Flexed lumbar spine
 Thoracic kyphosis
 Shoulder protraction
 Increased cervical extension
 C-type posture
28
Q

What Causes a Posterior Pelvic
Tendency?
Wheelchair considerations:

A 
Seat depth too long
Back support too short
Sling back upholstery
Elevating leg rests
Lower extremities are not supported well
29
Q

What Causes a Posterior Pelvic
Tendency?
Physical conditions

A

Tight hamstrings – Knee Extension
Reposition themselves by sliding
Can not maintain 90º of hip flexion

30
Q

Anterior Pelvic Tilt

A 
ASIS in lower than the
PSIS
 Increased lumbar lordosis
 Thoracic kyphosis is
reversed or reduced
 Shoulder retraction
31
Q

What Causes an Anterior Pelvic Tilt?

A 
Weak muscles/Low tone
 Weak hamstrings
 Weak abdominals
 Tight hip flexors
(ilipsoas and rectus femorus)
32
Q

Pelvic Obliquity

A 
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
33
Q

What Causes a Pelvic Obliquity?

Wheelchair considerations

A

Sling back upholstery Wheelchair too wide

34
Q

What Causes a Pelvic Obliquity?

Physical conditions

A

Muscle Imbalance
Irregular muscle tone
(high or low tone on one side of the trunk)

35
Q

Pelvic Rotation

A 
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
36
Q

Pelvic Positioning Considerations

A 
3 points for pelvic stabilization:
seat, back &amp; 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
37
Q

Lower Body ‘Ideal’ Posture

A 
 Feet flat on footplate in
neutral position
 Ankles 90 º
 Knees 105 º &amp; neutral
abduction
 Femurs parallel to seat
 Footplate position allows 2”
clearance from floor
 1” space from back of knee to
front of seat
38
Q

Lower extremity positioning directly affects the…..

A

position of the pelvis

39
Q

Lower extremity positioning helps sustain the…..

A

position of the hips and knees

40
Q

Correct positioning assists in the prevention of …..

A

deformities and distributes pressure

41
Q

Footplates positioned too low increase….

A

pressure under the thigh

42
Q

Footplates too high increase ….

A

sacral area

pressure

43
Q

Do not over position

A

Balance function &

support

Lower Limb Biomechanics and prosthetics (4 decks)

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