Wheelchairs And Wheelchair Seating Systems

Question 1

What are 2 goals for wheelchair seating related to client body structures and functions?

Answer 1

Improve skeletal alignment

Prevent, reduce, or accommodate deformity

Preserve skin integrity

Maintain physiological function of vital organs (respiratory and circulatory)

Question 2

What are 2 goals for wheelchair seating related to client performance?

Answer 2

Enable sitting (postural control and stability) and wheeled mobility

Increase comfort (decrease discomfort or pain)

Normalize muscle tone

Position head for visual input

Decrease fatigue.

Question 3

What are 2 goals for wheelchair seating related to client activity and participation?

Answer 3

Enhance movement to enable or optimize participation in self-care, educational, work, and play and leisure occupations

Promote social acceptance and self-esteem.

Question 4

What types of questions should be asked in the initial interview for a wheelchair seating system?

Answer 4

Goals
- What does the client want to achieve with the system?
- How are these goals prioritized?

Medical diagnoses and status
- What is the referring medical diagnosis? - Does it lead to permanent disability (e.g., spinal cord injury) or temporary disability (e.g., fractures)?
- Is the client’s condition expected to progress? To improve? To remain stable?
- How old is the client?

Body structures and functions
- How much does the client weigh?
- Does the client have any neuromuscular and/or musculoskeletal impairments deformities, loss of sensation, pressure ulcers, pain, abnormal muscle tone, or vision loss or deficits?

Occupations
- What occupations (ADLs, IADLs, education, work, play and leisure) will the seating and mobility system be used for?
- How active is the client? How active does the client want to be?

Physical context
- In what physical environments will the system be used? How accessible are they?
- How will the seating and wheeled mobility system be transported from place to place?
- Will the person be traveling by plane? If so, how will barriers to air travel be addressed?
- What different surfaces and terrains need to be considered?

Social context
- Who is available to assist the client in each of the physical environments in which it is to be used?
- When are they available?
- How skilled are they in assisting the client and in maintaining the seating and mobility system?

Physical skills
- Can the client independently maintain a seated position, maintain head alignment, perform pressure relief, and perform transfers?
- Does the client have the upper-extremity strength and physical endurance required to operate a manual wheelchair?
- Has the client fallen recently?

Cognitive-behavioral skills
- Does the client have the cognitive ability to learn to use the system?
- Does the client have sufficient safety awareness to use the system?

Equipment
- What technology does the client currently have?
- What is the client’s familiarity with seating and wheeled mobility systems?
- What equipment will need to be attached to the system (e.g., respiratory equipment, communication equipment, lapboard)?
- How will the wheelchair be transported?

Payment
- What seating and mobility systems are approved by the client’s health insurance?
- Are other sources of funding available?

Question 5

______________ is a type of wheelchair for a Client who can maintain a seated position without using the hands. The seating system design emphasizes mobility, stability (stable base of support), and comfort.

Answer 5

Hands-free sitter

Question 6

______________ is a type of wheelchair for a Client who uses one or both hands to maintain a seated position. Pelvic and trunk support are required of the seating system to free the hands for activities.

Answer 6

Hands-dependent sitter

Question 7

______________ is a type of wheelchair for a Client lacks the ability to sit without support. Total body support is required of the seating system for posture and repositioning.

Answer 7

Propped sitter

Question 8

When measuring for a wheelchair seating system, it’s important to observe the position of the client’s pelvis and trunk for flexible or inflexible deformity. What is the difference between flexible and inflexible regarding the type of seating system?

Answer 8

A flexible deformity can be reduced to some extent by a supportive seating system

An inflexible or fixed deformity needs to be accommodated with a seating system.

Question 9

Why is it important to assess a client’s upper and lower extremities when measuring for a wheelchair system?

Answer 9

1. Range of motion (ROM) for manual propulsion and for sitting upright (90° hip flexion)
2. Strength for manual propulsion
3. Quality of movement, presence of tone, spasticity, tremor, primitive reflexes

Question 10

What type of deformity is described below?

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

Answer 10

Pelvic obliquity

Question 11

What type of deformity is described below?

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

Answer 11

Kyphosis

Question 12

What type of deformity is described below?

The pelvis rotates to one side, resulting in the spine and trunk moving to the opposite side.

Answer 12

Scoliosis

Question 13

What type of deformity is described below?

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

Answer 13

Lordosis

Question 14

What type of deformity is described below?

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

Answer 14

Windswept deformity

Question 15

What is the “reference seated position”?

Answer 15

The trunk is upright and in midline position.

The hips, knees, and ankles are flexed to 90°.

The pelvis is in neutral.

The head is in disposition.

The arms are at the side of the trunk with the elbows flexed to 90°.

Question 16

True or false: Pelvic positioning is the key to stability when considering wheelchair seating systems.

Answer 16

TRUE

Provide a solid base of support by stabilizing the pelvis on a firm surface, which distributes pressure throughout the buttocks and thighs.

Support posture with the seat and seat back. Provide cushioning for these surfaces.

Question 17

What type of cushion support is appropriate for a client who needs no or minimal postural support and can reposition/provide pressure relief independently?

Answer 17

Flat (planar) surfaces

Question 17

What type of cushion support provides more support than flat surfaces, distributes pressure across their surface, and is less expensive than custom-contoured surfaces?

Answer 17

Standard contoured surfaces

Question 18

What type of cushion support provides the most support, distributes pressure across their surface, and is more expensive than standard contoured surfaces?

Answer 18

Custom-contoured surfaces

Question 19

What type of cushion is described below?

Provides scheduled pressure relief through alternating levels of inflation and deflation

A. Air filled
B. Alternating pressure
C. Foam
D. Gel
E. Honey-comb shaped plastic

Answer 19

B. Alternating pressure

Disadvantage: Reduces postural stability

Question 20

What type of cushion is described below?

Adequate for postural control and Sensitive to temperature; Conforms to the shape of the buttocks

A. Air filled
B. Alternating pressure
C. Foam
D. Gel
E. Honey-comb shaped plastic

Answer 20

D. Gel

Disadvantage: heavy

Question 21

What type of cushion is described below?

Lightweight; Provides even pressure relief; Must be properly inflated to perform well

A. Air filled
B. Alternating pressure
C. Foam
D. Gel
E. Honey-comb shaped plastic

Answer 21

A. Air filled

Disadvantage: Reduces postural stability

Question 22

What type of cushion is described below?

Lightweight, yet provides uneven pressure relief

A. Air filled
B. Alternating pressure
C. Foam
D. Gel
E. Honey-comb shaped plastic

Answer 22

E. Honey-comb shaped plastic

Question 23

What type of cushion is described below?

Lightweight; Low in cost; can be soft and pliable and mold itself around the buttocks

A. Air filled
B. Alternating pressure
C. Foam
D. Gel
E. Honey-comb shaped plastic

Answer 23

C. Foam

Disadvantage: If the foam is too soft, the client may totally compress it, making it useless for pressure management; Heat and moisture can build up; Shearing and weight-shifting capability are reduced with custom-contoured foam.

Variable density; Custom-contoured foam is more expensive but provides better postural control.

Question 24

A ________________ is positioned at the front of the pelvis to limit pelvic tilt, rotation, or obliquity.

Answer 24

pelvic stabilizer (belt, SubASIS bar)

Question 25

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

Answer 25

Thoracic supports

Question 26

__________________ are placed lateral or medial to the thighs to control abduction or adduction (e.g., windswept deformity).

Answer 26

Thigh supports

Question 27

A _______________ supports the back of the head and is positioned at the occiput.

Answer 27

head rest

Question 28

True or false: Sizing measurements should not be taken while clients wear the braces, prosthetics, or orthotics they usually wear.

Answer 28

FALSE

Sizing measurements should be taken while clients wear the braces, prosthetics, or orthotics they usually wear.

Question 29

How many inches should be added to the widest part of the thighs or hips for the seat width?

Answer 29

1-2 inches

The added width provides clearance between the thighs and the chair to ease repositioning and transfers, avoid rubbing and pressure, and accommodate bulky clothing.

The goal is to distribute body weight over as much of the seat as possible.

In the presence of deformity, chest and shoulder width should be measured, and space should be allowed for any lateral trunk supports.

Question 30

How many inches should be subtracted from the base of the back of the knee to the back of the pelvis?

Answer 30

1-2 inches

Measure from the base of the back to the popliteal space of each knee; subtract 1–2 inches so that the seat edge does not reach the back of the knee and restricts motion or circulation.

Measure both lower extremities to account for discrepancies in length.

The goal is to distribute body weight along as much of the thigh as possible.

To allow wheelchair propulsion with the feet, seat clearance of more than 1–2 inches may be needed.

Question 31

What is the clearance of the footrest of a wheelchair to the floor?

Answer 31

2 inches

Question 32

What are some considerations for measuring a wheelchair for the seatback?

Answer 32

Measure from the seat surface (including the cushion) to the top of the client’s shoulder; a higher back height may be needed if trunk control is poor.

Measurement depends on the degree of back support needed for trunk control, comfort, and upper extremity activity, including propulsion. The goal is to provide the support needed, allowing as much upper-extremity movement as possible.

If minimal trunk support is required, measure from the seat surface (including the cushion) to the midback, just under the scapula.
– If the seat-back height is too low, the client will not have sufficient back support.
– If the seat-back height is too high, contact with the push rim will be limited.
– Lower back height (e.g., in sports chairs) increases functional mobility but decreases stability.
– For power wheelchair users, back heights to midscapula or the top of the shoulder may be needed to attach upper trunk and head supports.

Question 33

What are some considerations for measuring a wheelchair for the armrest?

Answer 33

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

The goal is to support the upper extremities, provide leverage for pushing up for pressure release, and assist in maintaining postural alignment.

If the armrest is too low, it elicits leaning.

If the armrest is too high, it positions the shoulder in elevation and makes manual propulsion difficult.

Question 34

What are the 3 requirements for a marginal ambulatory user?

Answer 34

1. Can walk short distances
2. May need a wheelchair on occasion, especially outdoors
3. Can benefit from intermittent use of a power mobility device such as a scooter.

Question 35

What are the 2 requirements for a manual wheelchair user?

Answer 35

1. Can propel a manual wheelchair with both upper extremities, both lower extremities, or one upper and one lower extremity
2. May be pushed by an attendant or caregiver.

Question 36

What are the 3 requirements for a marginal manual wheelchair user?

Answer 36

1. Can propel a manual wheelchair for short distances
2. Tolerates only limited use because of upper-extremity overuse injury, upper body weakness, lack of endurance, or respiratory problems
3. May at times use a manual, power assisted manual wheelchair, or power wheelchair.

Question 37

What are the 2 requirements for a totally or severely mobility-impaired wheelchair user?

Answer 37

1. Is unable to self-propel a manual wheelchair
2. Is dependent on a power chair or attendant.

Question 38

What type of wheelchair is described below?

Designed to be pushed by an attendant or caregiver. Have smaller rear wheels, making them lighter, narrower, and easily transportable. Used for short distances or temporary use. Do not usually have removable armrests. Can also be used inside the home to allow for access through narrow doorways.

Answer 38

Transport chair

Question 39

What type of wheelchair is described below?

Self-propelled or pushed by an attendant or care partner. For self-propulsion over long distances, clients must have adequate upper-extremity strength and endurance to push and brake. Can also be propelled with one arm and one foot or with both feet. Long-term self-propulsion may lead to repetitive motion injury.

Answer 39

Manual chair

Question 40

What type of wheelchair is described below?

For clients whose walking ability is limited
Have three (usually) or four wheels and are steered with a tiller. Do not look like wheelchairs and are more difficult to steer than power wheelchairs. Have a large turning radius, and the seat swivels, which may make transfers easier. Have limited adjustability.

Answer 40

Scooter

Question 41

What type of wheelchair is described below?

For clients who cannot propel a manual wheelchair or for whom propelling a chair is contraindicated. Have seating and power components (i.e., a motor, wheels, batteries). Drive wheel may be placed at the front, middle, or rear; middle placement generally means a smaller turning radius. Movement is controlled through a joystick or an alternative control type (e.g., breath, head, chin, eye, tongue).
Multiple seating options are available, ranging from automotive-type captain’s seats to seats that tilt, recline, elevate the leg rests, or stand.

Answer 41

Power wheelchair

Question 42

What is the difference between tilt and recline wheelchairs?

Answer 42

Tilt: Seat-to-back angle is fixed; the seating system can be tilted 0°–45°, changing orientation in space but not position, thus preventing shear while reducing pressure on the buttocks. This feature is recommended when control devices (communication) need to be attached to the wheelchair; it eases personal care activities.

Recline: The seat-to-back angle changes to greater than 90°, ranging from upright to nearly horizontal. This feature is appropriate for clients who are unable to sit upright (e.g., because of hip restrictions) or who spend considerable time in a wheelchair and need to rest during the day. This feature eases personal care activities.

For clients who have hip contractures, need to recline to reduce pressure or manage fatigue, cannot reposition themselves independently, or are unable to maintain an upright seated position. Assist in managing ROM, muscle tone, orthostasis, catheterization, and head and trunk control and in enabling visual contact. Tilt and recline functions may be combined. Chairs may be manually or power controlled. Chairs may have elevating leg rests.

Question 43

What are the physiological, functional, and social benefits of a wheelchair that stands?

Answer 43

Physiological: Standing improves circulation and bowel and bladder functions, reduces lower extremity spasticity, and provides pressure relief.

Functional: Clients can more easily reach items higher than seated level. Performance and participation are increased, and some home and work adaptations may be avoided.

Social: Person-to-person interactions can occur at face-to-face level, which has a psychological benefit.

Question 44

True or false: The stability and maneuverability of a wheelchair is affected by the position of the drive wheels’ axle in relation to the client’s center of gravity.

Answer 44

True

The chair is more stable when the client’s center of mass is ahead of the drive wheels’ axle.

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

When the axle is aligned below the shoulder, access to the push rims is improved. Movement efficiency is increased because the user can go farther with fewer strokes.

Moving the axle higher relative to the seat lowers seat height, which improves stability; if the seat is too low, poor propulsion patterns may result because of abducted arms.

Question 45

What prevents a chair from going backward down a grade?

Answer 45

Hill holder

Question 46

What does a wedge cushion due?

Answer 46

(antithrust seats): front higher than back to prevent forward sliding

Question 47

What are 3 recommendations to caregivers to support a client in pressure relief?

Answer 47

Push-ups

Side-to-side movement

Schedule for weight shifts and skin monitoring

Question 48

What are some safety considerations for the client, care partner, and/or attendant?

Answer 48

Setting and releasing brakes during transfers

Swinging away leg rests (footrests); not standing on footrests

Removing armrests (if appropriate)

Recovery from a fall

Question 49

Name at least 2 safety precautions to educate a caregiver or attendant regarding wheelchairs?

Answer 49

When pushing, make sure that the client’s arms, hands, and feet are secure.

To ascend curbs, tilt the chair backward to lift the front casters onto the curb, then push the chair forward until the large rear wheels roll over the curb.

To descend curbs, move the chair around to descend backward; guide the large wheels down the curb to the street. Clear the casters by tilting the chair; and then turn the chair to face forward after reaching the street.

To ascend an incline, move the chair forward.

To descend an incline, balance the chair on the back wheels and move in a forward direction, or go down backward with the client controlling the speed using hands on the push rim.

Wheelchair maintenance includes upholstery cleaning, brake checking, tire inflation, and wheel alignment.

Question 50

What are some basic considerations for selecting and performing transfers? (Name 2)

Answer 50

Client status: physical, cognitive, perceptual, and behavioral strengths and limitations

Practitioner, client, and/or care partner physical abilities, communication of instructions

Correct moving and lifting techniques (body mechanics, preparing equipment and client for transfer, positioning the wheelchair, mobility from bed or other surface in preparation for transfer).

Question 51

What type of transfer is described below? What population is this best for?

For clients who are able to come to a standing position and pivot on both feet

Answer 51

Stand pivot

Hemiplegia, hemiparesis, general loss of strength or balance

Question 52

What type of transfer is described below? What population is this best for?

For clients who cannot adequately bear weight on lower extremities or who have paralysis, weakness, or poor upper extremity endurance

Answer 52

Sliding board

Lower extremity amputations, spinal cord injury; bariatric clients

Question 53

What type of transfer is described below? What population is this best for?

For clients who cannot initiate or maintain a standing position; generally bed to wheelchair

Answer 53

Bent pivot

ALS, spinal cord injury

Question 54

What type of transfer is described below? What population is this best for?

For clients with minimal or no functional ability; considerations include client body size, degree of disability or health, caregiver ability and well-being

Answer 54

One- and two-person dependent; techniques include dependent sliding board, bent pivot (bed to wheelchair, with or without sliding board), and mechanical lift

Neurologic conditions

Question 55

Medicare-covered clients are eligible for mobility-assistive equipment (MAE) if…

Answer 55

they have a “personal mobility deficit sufficient to impair their participation in mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home.”