Wheelchairs & Posture Flashcards by Alison Young

What are the 4 main types of wheelchair?

Manual attendant propelled wheelchairs
Manual occupant propelled wheelchairs
Powered attendant controlled wheelchairs
Powered occupant controlled wheelchairs

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What are the 4 manual wheelchair categories?

Occupant propelled
Attendant propelled
Seating wheelbases
Bariatric

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What is the brand name of the lighter weight wheelchair?

Dash Lite

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Name 2 standard semi-modular NHS wheelchairs?

Lomax Uni

Remploy Access

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What are the 2 active user wheelchairs?

Sunrise Neon (folding frame) 
Sunrise Helium (rigid frame)

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What are the 3 positions of seating wheelbases?

Tilt-in-Space
Recline
Recline and Tilt-in-Space

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Name 7 propulsion systems

Levers 
Cranks 
Feet
Somebody else 
Handrims 
Electricity 
Engine

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What are the disadvantages of an engine as a propulsion system?

Noisy

Smelly

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What factors should be considered in a foot propelled wheelchair?

Seat height
Castor size
Cross braces

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What s the preferred elbow angle for able bodied patients in Dundee?

107-118 degrees

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What is the preferred elbow angle for MS patients in Dundee?

90-110 degrees

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What is the preferred elbow angle for SCI patients in Dundee?

128-135 degrees

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What are cambered wheels?

Bottom of wheel angles out away from wheelchair

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What factors determine the manoeuvrability of a wheelchair?

Castor rake
Castor diameter
Wheel position

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What are the basic features of an Electric Powered Indoor Chair (EPIC)?

Compact
Small turning circle
Small drive wheels
Low power

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What are the basic features of an Electric Powered Indoor/Outdoor Chair (EPIOC)?

Larger drive wheels 
Greater power 
Greater torque 
Greater range 
Ability to climb kerbs

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What are the 3 drive wheel positions of an EPIOC?

Rear-wheel drive
Mid-wheel drive
Front-wheel drive

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What factors affect the stability of a wheelchair?

Wheelbase
Position of centre of gravity 
User wight 
Anti-tippers 
Castor orientation 
Camber

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What is the EPIOC kerb climber?

Device which enables the wheelchair to ascend kerbs of up to 4” high (contacts kerb first and lifts castors up to pavement)

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What are the 2 types of EPIOC kerb climber?

Central

Bilateral

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What are the advantages/disadvantages of a central kerb climber?

Adv

simpler
direction less critical

Disadv

impede transfer
impede foot position

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What are the advantages/disadvantages of a bilateral kerb climber?

Adv
- swing out of way for transfers

Disadv

more complex
direction more critical

What are the 2 options for flexibility of an EPIOC?

Folding frame

remove batteries
fold up as per manual wheelchair
still significant weight due to motors

Folding or removable backrest
- makes powerchair more compact for hoisting into a car

What is stage I of development of a pressure sore?

Nonblanchable erythema: heralding lesion of skin ulceration

How can stage I of a pressure sore present in individuals with darker skin?

``` Discolouration of the skin Warmth Oedema Induration Hardness ```

What is stage II of development of a pressure sore?

Partial thickness skin loss involving epidermis or dermis or both

How does a stage II pressure sore present clinically?

As an abrasion, blister or shallow crater

What is stage II of the development of a pressure sore?

Full-thickness skin loss involving damage or necrosis of subcut tissue which may extend down to but not through underlying fascia

How does a stage III pressure sore present clinically?

Deep crater with or without undermining of adjacent tissue

What is stage IV of development of a pressure sore?

Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures (such as tendon and joint capsule) Undermining and sinus tracts may also be asssociated

Name 6 extrinsic factors that can result in a pressure ulcer

``` Excessive uniaxial pressure Friction and shear forces Impact injury Heat Moisture Posture ```

Name 8 intrinsic factors that can result in a pressure ulcer

``` Immobility Sensory loss Age Disease Body type Poor nutriiton Infection Incontinence ```

Equation for pressure

P = F/A

What are the 5 at risk pressure areas when sitting?

``` Head Shoulder Sacrum Buttock Heel ```

What are the objectives of cushion design?

``` Even pressure distribution Low temperature at skin surface Low humidity at skin surface Pelvic stability Practicality of usage ```

When considering cushion design what is the 'clinic effect'?

When the patient adopts a different posture when monitored

In a neutral pelvis how are the ASIS and PSIS related?

Neutral pelvis: ASIS and PSIS are level

Describe the 'ideal' pelvic posture

Neutral alignment (head balanced over spine, sine balanced over pelvis) Neutral pelvis (ASIS and PSIS are level) Shoulders slightly posterior to pelvis Head in neutral position with eyes (gaze) forward Equal weight bearing through ischial tubersoties

What is the most common pelvic tendency?

Posterior pelvic tilt

Describe posterior pelvic tilt

``` ASIS higher than PSIS Flexed lumbar spine Thoracic kyphosis Shoulder protraction Increased cervical extension C-type posture ("slumped") ```

What wheelchair factors can cause posterior pelvic tilt?

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

What physical conditions can cause posterior pelvic tilt?

``` Tight hamstrings (knee extension) Reposition themselves by sliding Cannot maintain 90 degrees of hip flexion ```

Describe anterior pelvic tilt

ASIS lower than PSIS Increased lumbar lordosis Thoracic kyhosis is reversed or reduced Shoulder retraction

What causes an anterior pelvic tilt?

Weak muscles/low tone Weak hamstrings Weak abdominals Tight hip flexors (ilipsoas and rectus femorus)

Describe pelvic obliquity

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

How is a pelvic obliquity named?

Named for the side that is lower

What wheelchair facotrs cause a pelvic obliquity?

Sling back upholstery | Wheelchair too wide

Whta physical conditions cause pelvic bliquity?

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

Describe pelvic rotation

One side of the pelvis is more forward than the other side (some level of rotation is usually found in those who have a pelvic obliquity)

What are the 3 points for pelvic stabilizatoin?

Seat, back and anterior support

Describe the lower body 'ideal' posture?

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

Why is lower body positioning important?

Directly affects position of pelvis Helps sustain the position of th ehips and knees Correct positioning assist in the prevention of deformities and distributes pressure Do not over position

What affect can footplate height have?

Too low = increase pressure under thigh | Too high = increase sacral area pressure