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
