Wheelchairs & Posture

Question 1

What wheelchair types are provided by the NHS?

Answer 1

Manual wheelchairs:

• Occupant propelled
• Attendant propelled
• Seating Wheelbases
• Bariatric (for fatties)

Powered wheelchairs:

• Occupant controlled (indoor only)
• Occupant controlled (indoor or outdoor)
• Attendant controlled (outdoor)

Question 2

Types of manual occupant propelled wheelchairs?

Answer 2

Standard semi-modular e.g. Lomax Uni
Light weight e.g. Dash Lite
Active user - folding frame or rigid frame

Question 3

Types of seating wheelbases?

Answer 3

Tilt-in-space
Recline
Recline and tilt-in-space

Question 4

How can wheelchair users ascend over obstacles such as kerbs?

Answer 4

Using a kerb-climber, wheelchairs are able to ascend kerbs of up to 4” high. Can be situated centrally on wheelchair or bilaterally

Question 5

What are the extrinsic and intrinsic pressure sore factors?

Answer 5

Extrinsic:

• Excessive unilateral pressure
• Friction and shear forces
• Impact injury
• Heat
• Moisture
• Posture

Intrinsic:

• Immobility
• Sensory loss
• Age
• Disease
• Body type
• Poor nutrition
• Infection

Question 6

Stage 1 of pressure sore development?

Answer 6

Non-blanching erythema of intact skin: the heralding lesion of skin ulceration

Question 7

Stage 2 of pressure sore development?

Answer 7

Partial thickness skin loss involving epidermis or dermis, or both. The ulcer is superficial and present clinically as an abrasion, blister, or shallow crater

Question 8

Stage 3 of pressure sore development?

Answer 8

Full-thickness skin loss involving damage or necrosis of subcutaneous tissue, which may extend down to but not through underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue

Question 9

Stage 4 of pressure sore development?

Answer 9

Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (such as tendon or joint capsule). Undermining and sinus tracts also may be associated with stage IV pressure ulcers

Question 10

Equation of pressure?

Answer 10

P = F/A

Question 11

Give 4 examples of asymmetrical postures?

Answer 11

Posterior pelvic tilt
Anterior pelvic tilt
Pelvic obliquity
Pelvic rotation

Question 12

Posterior pelvic tilt is the most common pelvic tendency. The ASIS is higher than the PSIS. C-type posture is observed. What can cause it?

Answer 12

Wheelchair considerations - seat depth too long, back support too short, sling back upholstery, elevating leg rests, lower extremities not being supported well

Physical conditions - Tight hamstrings (Knee extension), reposition themselves by sliding and can’t maintain 90 degrees of hip flexion

Question 13

Causes of anterior pelvic tilt?

Answer 13

Weak muscles/low tone
Weak hamstrings
Weak abdominals
Tight hip flexors (iliopsoas and rectus femoris)

Features of condition include increased lumbar lordosis, reduced or reversed thoracic kyphosis and shoulder retraction

Question 14

What is pelvic obliquity?

Answer 14

One ASIS is higher than the other. There is a compensatory C-shaped curve in the lumbar and thoracic spine. The shoulder on the side of the obliquity tends to be elevated. The obliquity is named for the shoulder side that is lower

Question 15

Cause of pelvic obliquity?

Answer 15

Wheelchair considerations - sling back upholstery. wheelchair too wide

Physical conditions - Muscle imbalance, irregular muscle tone (high or low tone on one side of the trunk)

Question 16

3 points for pelvic stabilisation for pelvic rotation?

Answer 16

Seat, back and anterior support

Question 17

What is the “ideal” lower body posture?

Answer 17

Feet flat on footplate in neutral position
Ankles at 90 degrees
Knees at 105 degrees and neutral abduction
Femurs parallel to the seat
Footplate position allows 2” clearance from the floor
1” space from back of knee to front of seat