Wheelchairs chap7 big red 33 Flashcards
Wheelchairs Objectives
By the end of the class, the student will be able to:
Identify and describe the purpose of key components and features of wheelchairs
fyi
“a device used to provide support or to straighten or to correct a deformity.”
Orthosis-
A wheelchair is a?
mobility orthosis
an artificial device to replace a part of the body
Prothesis
- Postural support + mobility base (p1288- Phys Rehab)
- PT will examine patient to determine appropriate wheelchair
- Insight from all team members is important
- Goal is to help patient achieve maximal function
- Goals must be discussed with patient to ensure realistic expectations are shared
The Prescriptive Wheelchair
Information Gathered to choose a wheelchair for a pt
- ROM
- Anthropometric measures
- Strength
- Current/existing wheelchair
- Postural alignment- big deal
- Caregiver’s attitude
- Caregiver’s comfort with technology
which wheels turn the wheelchair?
the caster wheels
Locks of wheelchair
- ALWAYS HAVE THE W/C IN A LOCKED MODE WHEN HAVING THE PATIENT TRANSFER OR SITTING AT REST
- Toggle- most typically seen
- Has an extension option (p143- P & T of Patient Care)
- Z or scissors lock
- Auxillary lock
- Reclining wheelchairs
Leg Rests
- Elevating-
- Great to accommodate for a patient’s ROM ability
- Calf panel for leg support
- Caution: when lowering the leg rest- support the patient’s lower extremity
- Leg rests can typically pivot outward to clear space for transfers
- Footrests (footplates) p144
When lowering the leg from a leg rest what should you do?
brace or hold the leg so it doesn’t swing down
Choosing a Wheelchair
Selecting the appropriate w/c (P&T, p134, Box 7-1)
Types of w/c (p134, Table 7-1)
- standard adult
- heavy-duty adult
- ultralight
- intermediate or junior
- growing child or youth
- indoor
- hemiplegic
- amputee
- one-hand drive
- externally powererd
- sports
- reclining
Measurements for Proper W/C Fit
Standard Wheelchair
Seat height/leg length
heel to popliteal fold (+ 2 inches)
Measurements for Proper W/C Fit-Standard Wheelchair
Seat depth
heel to popliteal fold (+ 2 inches)
Measurements for Proper W/C Fit-Standard Wheelchair
Seat width
widest aspect of buttocks, hips, or thighs (+ 2 inches)
Measurements for Proper W/C Fit-Standard Wheelchair
Back height
seat of chair to axilla (- 4 inches)
Measurements for Proper W/C Fit-Standard Wheelchair
Armrest height
seat of chair to olecranon process (+ 1 inch)
fyi
confirmation of fit of wheelchairs (p136 & 137)- KNOW
fyi
What if the armrests are too high? What difficulties might that pose for the patient?
Too low?
- too high- tightness in shoulders, postural stability off
- Too low? no support, may not be as functional
Folding Wheelchairs instructions
- Move heel loops forward and raise footrests
- Pull up on seat rails or on the front and back of the seat upholstery (p149)
- Reclining chair- back support bar is removed first
- To unfold- lift rear wheels using push handles and move handles away from each other.
Wheelchair Propulsion- Forward and Backward
- Hands positioned on handrims at top of the wheel
- Hands positioned at 2 o-clock position for forceful forward propulsion; hands in 10 o-clock position for forceful backward
Wheelchair Propulsion- Turning
Hold one handrim and pull/push the other handrim
Elevation of caster wheels
Use the tipping lever and push handles (p150)
Ascending a curb forward (p150)
- Tip up caster wheels
- W/C propelled forward until drive wheels touch curb
- Slow lowering of caster wheels
- Assistance getting drive wheels up and over the curb
Ascending a curb backward
- W/C propelled backward until drive wheels touch curb
- Tip up caster wheels
- Pull on push handles so chair ascends the curb on the rear drive wheels
- Turn chair
- Slow lowering of caster wheels
Descending a curb forward
- Get to edge of the area (close to curb)
- Tip caster wheels up
- Carefully and slowly push w/c forward and allow drive wheels to go over the curb
- Lower caster wheels using the tipping lever
Descending a curb backward
- Drive wheels to curb; caster wheels on sidewalk (area)
- Assist drive wheels down off the curb
- Elevate caster wheels to clear the curb; back up or turn w/c
- Lower caster wheels
Ascending and Descending Steps
- Ascending- drive wheels up first (p151)
- Descending- caster wheels will be tipped up and chair remains in reclined positioned as drive wheels are taken down each step.
Ramps and Inclines
Ascending
- Elevate caster wheels and pull up backward or push up forward
- Pulling up backward on all four wheels is not recommended (if assisting patient)
- What can a patient do to optimize ascending an incline if performing independently?
Ramps and Inclines-Descending
- Elevate caster wheels to slow down descending motion
- Descend backward with all four wheels on the ground
- What can a patient do to optimize descending if performing independently?
Independent Function-Wheelie or Pop-up
- Takes practice and continued practice
- Patient must have B UE strength, coordination and balance
- Instruct patient to pull back quickly and evenly on both handrims and then abruptly stop the rearward motion of the wheels
- Backward movement should be an attempt to create a momentum, not propel the chair backward
- Once casters are elevated a small forward movements cause rearward movements of the chair and small backward movements cause forward chair movement
Considerations for Doors and Elevators (Procedure 7-8 & 7-12)
Positioning for entering
Doors
- Open to
- Open away
Elevators
- Look at any differences in floor height versus elevator floor
Considerations for Doors and Elevators (Procedure 7-8 & 7-12)
Entering backward
- Will need assist
- Watch legs
Reaching Forward-P165 & 166
Note the position of the caster wheels
- Caster wheels are positioned forward
- Examine the picture in the text to visually understand what is considered a “forward facing caster wheel”
Protected Fall-Procedure 7-14
Hopefully seldom required by the patient; however, it does occur?
DrW will go over it in lab
