Wheelchairs, assistive devices, and gait training ch 15

Question 1

List are the goals of proper wheelchair seating and positioning

Answer 1

prevention of deformities and pressure ulcers normalization of tone
promotion of function
optimization of the respiratory function
proper body alignment
increased sitting comfort and tolerance

Question 2

Wheelchair back

Answer 2

Standard wheelchair back (sling back) supports only the middle back portion but not the lower back. If one has poor trunk stability, a high back height can be utilized

Question 3

Drive wheel

Answer 3

Two large drive wheels are used for propulsion and include two outer hand rims to propel the wheelchair

Question 4

Casters

Answer 4

Two small front wheels, usually 8 inches in diameter. There are also larger caster wheels which make it easier to climb curbs, but may flutter.

Question 5

Wheelchair armrests/legrests/footrests

Answer 5

These are where the individual can rest their arms/legs/feet while seated, and can be removable to help navigate a person to and from their bed/chair.

Question 6

Brake

Answer 6

There are two brakes that use a level system with a cam. The reverse brake is a mechanical brake tht automatically stops the wheelchair from going into reverse

Question 7

major measurements to be taken to prescribe a wheelchair

Answer 7

The wheelchair’s size must be proportional to the patients size. the patients personal needs, including the environment, determine the type of wheelchair or the type of additional attachments to the wheelchir. the patient’s measurements must be taken with the patient situated on a firm surface while sitting of lying supine

Question 8

seat depth measurement for wheelchair?

Answer 8

thigh length, back of bum to popiteal fossa minus 2”

Question 9

seat width measurement for wheelchair?

Answer 9

distance of the hips to greater trochanter

Question 10

seat height measurement ?

Answer 10

back of popliteal fossa down leg length + 2”

Question 11

backrest height measurement ?

Answer 11

seat to inferior scap, spine of scap, axilla or acromion

Question 12

armrest height measurement

Answer 12

arms need to be relaxed, seat to hanging elbow

Question 13

windsweat width measurement

Answer 13

distance between outer knees

Question 14

backrest height

Answer 14

width of chest at axilla

Question 15

Describe the traditional subphases of traditional gait

Answer 15

Traditional:

stance: heel strike, foot flat, mid-stance, heel of, toe off
swing: acceleration, mid-swing, deceleration

Question 16

Describe the traditional subphases of RLA gait

Answer 16

RLA:

stance: initial contact, loading response, mid-stance, terminal stance, pre-swing
swing: initial swing, mid swing, terminal swing

Question 17

canes

Answer 17

increases BOS, changes weight through LE through extension of BOS, but not for accepting weight with WB restrictions

Question 18

crutches

Answer 18

increase BOS, improve lateral stability, reduce eight bearing

Question 19

walkers

Answer 19

increased BOS, increased anterior and lateral support, decreased weight bearing

Question 20

parallel bars

Answer 20

supportive but immobile, useful for pregait activities and early ambulation

Question 21

How is a walker measured

Answer 21

Stand with feet just inside walker, handles should be level with the greater trochanter, elbows 20-30 degrees flexed

Question 22

What is the proper procedure for standing up and sitting down with the walker?

Answer 22

• walker positioned in front of wheelchair within the patients reach
• patient is told to scoot forward to the edge of chair
• patient is told to place the foot of the uninvolved lower extremity slightly posterior to the foot of the involved lower extremity.
• patient told to lean forward and pusth with both hands on the wheelchair’s armrests
• when standing the patient is instructed to reach and grasp the walker’s handgrip with one handwhile the other hand is still holding the chairs armrests.
• patient is told to reach and grasp thewalkers other handgrip with the other hand
• patient is told to establish proper balance prior to ambulation while holding onto the walkers handgrips.

Question 23

Explain the 5 weight bearing statuses

Answer 23

NWB – no weight bearing
TTWB – patient can just rest the heel/foot on the ground
PWB – up to 20-50% of patients weight
WBAT – weight bearing as tolerated
FWB – full weight bearing

Question 24

6 gait patterns

Answer 24

4 pt gait – RA, LL, LA, RL
3 pt gait – AD and involoved LE followed by uninvolved (hopping with weight through arms
Mod 3 pt gait – AD, involoved, uninvolved
2 pt gait – leg and opposite AD move simutaneously, followed by other leg and opposite AD
Swing to – crutches together, feet swing to the crutches
Swing through – feet swing past the crutches

Question 25

Special Wheel chairs?

Answer 25

Amputation chair – axis of rotation of drive wheels/COG shifted back to prevent tipping
Hemoplegic chair – lower to the ground
one arm drive chair, sport chair, power chair, pedi chair
Tilt In Space Chair – seat to back angle remains constant, tips back
reclining chair – opens seat to back angle

Question 26

Gait progression

Answer 26

explain technique and procedure and obtain verbal consent
monitor vitals especially the first time
pre-gait activities – weight shifting, hip hiking, marching, stepping forward and back, mini squats
initial walking, and turning in parallel bars
move to using AD over ground
sit to stands – No AD