Wheelchairs & Seating Flashcards
Options for improving ease of propulsion?
- Change A-P position of rear tire
- -Shoulder ROM is mid-range
- -COG over rear axle with less weight on caster
- Change caster type
- -Use larger, urethane caster for less rolling resistance
- Use a rigid frame
- Make sure any pneumatic tires are properly inflated
- Make sure all hardware is properly tightened
- Make sure the wheelchair tracks straight (during glide)
Options for improving ease of turning? (aka improve turning radius)
- Increase rear wheel camber
- Reduce size of caster
- Decrease overall length of chair
- Make sure all pneumatic tires are properly inflated
- Make sure all hardware is properly tightened
Options for decreasing overall chair length?
- Choose slightly longer cushion (up to 1” over front edge of seat) rather than extra wheelchair seat depth
- Select a tighter front frame angle (bend in upper portion of leg rests)
- Decrease rear tire size
- Move rear tire forward
- Use a smaller footplate
- Choose a mid- or rear-mounted footrest
Options for increasing static tilt in space of manual wheelchair? (to improve balance during propulsion)
- Move rear axle upward relative to frame**
- Use a smaller rear tire
- Use a larger caster
- Use a longer caster stem bolt or fork
Options for increasing overall height?
- Move rear axle down relative to frame
- Use larger diameter rear tire
- Use larger caster
- Larger caster stem bolt or fork.
- Order a larger height frame
Options for decreasing overall width?
- Watch for excessive frame flex and tighten hardware if needed
- Mount rear axle plate on inside of frame
- Remove all camber
- Remove push pins
- Narrower seat width (perhaps with slightly wider cushion)
- Remove arm rests
Different types of cushions? Pros and Cons?
Foam (lighter, but gets hot in warmer climates)
Gel-filled (more stable, but heavier and gel can pool to one section)
Tilt in Space vs Recline
Use tilt-in-space to prevent posterior pelvic tilt and “sacral sitting”
More than 45 degrees needed for pressure relief
When to get patients into optimal chair for home-use
Get into optimal chair ASAP.
- Do not compromise
- Do not make it hard for them either.
Try your best to put them in wheelchair they will be taking home.
If they can’t use that wheelchair yet, put them in a chair they can use but remind them it will not be the one they will be taking home!
*A wheelchair is not meant to be exercise.
Should you get patients out of their wheelchair for a physical exam?
Yes.
Good for determining if deformities are flexed or fixed.
What is the difference between Flexible & Fixed postural deformities?
Flexible - Correct the issue
Fixed - Compensate for the issue
Rear vs Center vs Front-Wheel Drive Power Chairs
Rear - best at going over bumps. Allows patient to see their feet.
Front - best turning radius
Center - 6 wheels on the ground - tries to combine features of rear and front-wheel drive chairs. Best for LE positioning.
What are the Six Seating Principles?
- Stabilize Proximally to Promote Improved Distal Mobility and Function
- Achieve and Maintain Pelvic Alignment
- Facilitate Optimal Postural Alignment in all Body Segments, Accomodating for Impairments in ROM
- Limit Abnormal Movement and Improve Function
- Provide the Minimum Support Necessary to Achieve Anticipated Goals and Expected Outcomes
- Provide Comfort
The pelvis should be the first are addressed, and aligned in a neutral to slight anterior pelvic tilt, and level.. Can help decrease abnormal tone patterns. Strap below ASIS at 45-90 degree angle to the seat surface.
Try to find the source of the problem, or “triggers.”
How to determine Seat-to-Back support Angle?
180 - Hip flexion angle = seat-to-back angle
eg. You have 75 degrees of hip flexion. Therefore, the seat-to-back angle is 105 degrees.
Seat-to-Leg angle?
Usually less than 90 due to hamstring tightness - determined by knee extension ROM
Lower Leg Support to Foot Support Angle
Determined by Ankle Dorsiflexion ROM (AFOs will affect it too)
How to measure seating depth?
Behind buttocks to popliteal fossa, per O’Sullivan
In Foundations, they said two finger lengths behind popliteal fossa
How to measure back height?
From sitting surface to Posterior Superior Iliac Crest or from sitting surface to lower sacpula, per O’Sullivan page 1413
-Can also use top of shoulder or occiput or crown of head if needed
(Foundations: Measure to T7/inf angle of scap)
How to measure seat width?
Use width of hips and width of trunk to determine.
USE WIDEST SPAN OF PATIENT’S BODY
Consider orthoses, clothing, weight loss/gain, possible growth, etc.
Info to gather during exam?
History Strength and Endurance Skin Integrity Vision and Hearing Health Status
Functional Abilities:
- Toileting
- Bathing and Washing
- Dressing
- Eating
- Communication
- Transfers
- Ambulation
- Wheelchair mobility
Environmental Issues
Transportation
Cognitive and Behavioral Issues.
Optimal Rear Wheel Diameter?
Couldn’t find it.
Effects of adding Camber?
Easier to turn and propel, but now, overall base is wider (harder to fit through doors).
