ASSISTIVE DEVICES AND WHEELCHAIRS

Question 1

What is an assistive device (AD)?

Answer 1

System or device that is designed for the purpose of increasing/maintaining the capabilities of a person with a disability

Example of AD users: Elderly, post-op, injured, PWD or handicapped

Question 2

What functions does an assistive device (AD) serve?

Answer 2

1. Permits mobility
2. Improves stability
3. Helps relieve pain during standing and ambulation
4. Reduces weight bearing on 1 or both extremities
5. Helps with balance problems

Question 3

What are the types of ambulation aids from most to least stable?

Answer 3

1. Parallel bars
2. Walker
3. Axillary Crutches
4. Non-axillary crutches
5. Quad cane
6. B/L standard cane
7. U/L standard cane

Question 4

What are the functions of parallel bars?

Answer 4

1. Increases tolerance and balance in standing and ambulation
2. Teaches different gait patterns
3. Provides support while measuring other AD
4. Applicable to all AD

Question 5

What are the functions of a walker?

Answer 5

1. Improves balance tolerance
2. Widens BOS
3. Provides anterior and lateral support
4. Reduces speed of ambulation (except rolling walker)
5. Supports 85% of body weight

Question 6

What are the types of walkers?

Answer 6

1. Standard walker
2. Hemi-walker/Walk-cane
3. Stair-climbing walker
4. Reciprocal walker
5. Rollator/Rolling walker

Question 7

What are the functions of crutches?

Answer 7

1. Improves tolerance
2. Widens BOS
3. Provides lateral support

Question 8

What are the types of crutches?

Answer 8

1. Axillary crutches - supports 80-90% of body weight
2. Non-axillary crutches - supports 40-50% of body weight

Question 9

What is the 4-point gait pattern?

Answer 9

R crutch → L foot → L crutch → R foot

• Safest gait pattern
• Slowest gait pattern
• Most difficult when instructing

Question 10

When is the 3-point gait pattern used?

Answer 10

R crutch → bad leg (NWB) → good leg or crutches + bad leg (NWB) → good leg

• Used when the patient can bear full weight on one lower extremity

Question 11

What is the 2-point gait pattern?

Answer 11

R crutch + L foot → L crutch + R foot

• Used when the patient cannot support weight on one leg but has good muscular strength and coordination

Question 12

What are the two types of gait patterns to teach a patient?

Answer 12

Safety - 4 point gait
Speed - 2 point gait

Question 13

What is the Swing To gait pattern used for?

Answer 13

B crutches
B LE @ the level of crutches

Question 14

What is the Drag-To gait pattern?

Answer 14

B crutches → drags LE @ the level of crutches

Question 15

What is the Simultaneous Gait pattern for?

Answer 15

L Foot+ L crutch → R foot + R crutch

Question 16

How should a patient ascend stairs?

Answer 16

Good leg → bad leg → crutches/good leg → bad leg + crutches

Question 17

How should a patient descend stairs?

Answer 17

Crutches → bad leg → good leg/crutches + bad leg → good leg

Question 18

What muscles are involved in crutch walking?

Answer 18

Shoulder depressors, shoulder adductors, elbow extensor, wrist extensor, finger flexor

Question 19

What is the purpose of using a cane?

Answer 19

Improves balance and tolerance
Widens BOS
Supports 20-25% of total body weight

Question 20

How should a cane be positioned?

Answer 20

Opposite the affected extremity

Question 21

What is the method for safety in using a cane for gait pattern?

Answer 21

Cane → bad leg → good leg

Question 22

What is the method for speed in using a cane for gait pattern?

Answer 22

Cane + bad leg → good leg

Question 23

PATTERN - Method 1 for safety

Answer 23

Cane → bad leg → good leg

Question 24

PATTERN - Method 2 for speed

Answer 24

Cane + bad leg → good leg

Question 25

STAIR CLIMBING - Ascending stairs

Answer 25

Good leg → bad leg → cane or good leg → bad leg + cane

Question 26

STAIR CLIMBING - Descending stairs

Answer 26

Cane → bad leg → good leg or cane + bad leg → good leg

Question 27

TURNING

Answer 27

Turn on unaffected leg/side Make small circle Do not pivot

Question 28

WHEELCHAIR Types - Outdoor

Answer 28

For power, larger rear wheels

Question 29

WHEELCHAIR Types - Indoor

Answer 29

For mobility, larger front wheels, small rear wheels

Question 30

WHEELCHAIR MEASUREMENTS - Backrest Height

Answer 30

Height = from seat to the base of axilla subtract 4”, inferior angle of axilla subtract 2’

Question 31

WHEELCHAIR MEASUREMENTS - Backrest Width

Answer 31

Width: from 16-18’

Question 32

WHEELCHAIR MEASUREMENTS - Seat Depth

Answer 32

From backrest to popliteal fossa, subtract 2’

Question 33

WHEELCHAIR MEASUREMENTS - Seat Width

Answer 33

From widest portion of buttock, add 2, 1’ per side

Question 34

WHEELCHAIR MEASUREMENTS - Seat Height

Answer 34

From popliteal fossa down to heel, add 2” Clearance of footplate to ground: 2”

Question 35

WHEELCHAIR MEASUREMENTS - Arm Rest Height

Answer 35

Height: from seat to elbow distance (Elbow positioned 90 degrees elbow flexion)

Question 36

WHEELCHAIR MEASUREMENTS - Leg/Calf Rest Height

Answer 36

Height: from popliteal fossa to heel, add 2”

Question 37

WHEELCHAIR Wheel/Tire Diameter

Answer 37

Diameter: 22-24” Width: 1

Question 38

WHEELCHAIR Push/Hand Rail/Rim Diameter

Answer 38

Diameter: 18-20” Projections: Oblique: C5 Horizontal: C6 Vertical: C7 Friction: C7 Standard: C8 Elbow flexion angle = 110 degrees when in contact with pushrim

Question 39

WHEELCHAIR Casters Diameter

Answer 39

Diameter: 5-8” Change of direction 3” - for easy turning 12” - for rough surfaces

Question 40

WHEELCHAIR Foot plate/Rests Clearance

Answer 40

Clearance: 2” above the floor Types of modifications: Toe loop - prevents anterior displacement Heel loop - prevents posterior displacement Both for LE spasticity (post and ant)

Question 41

TYPES OF WHEELCHAIR - STANDARD (COLLAPSIBLE)

Answer 41

For easy storage For pt travel Lightweight- aluminum type Extra lightweight - <30lbs Heavy duty - pt weighing 200 lbs Extra heavy duty - >250 - 1000 lbs

Question 42

TYPES OF WHEELCHAIR - HEMI-WHEELCHAIR

Answer 42

17.5 For stroke pt Has one arm drive 2 handrail/ush rim Smaller hand rim propels = front wheels Larger hand rim propels = rear wheels When both rims are moved simultaneously = both wheels

Question 43

TYPES OF WHEELCHAIR - AMPUTEE

Answer 43

For pt c unilateral or bilateral above knee amputee Posterior displaced wheels: 2” To widen BOS and compensate loss of weight

Question 44

TYPES OF WHEELCHAIR - SPORTS

Answer 44

Low backrest height Lower seat height solid/rigid seat Lightweight Higher camber for wider BOS and for easy turning Normal camber angle: 3-9 degrees

Question 45

TYPES OF WHEELCHAIR - RECLINING

Answer 45

Can recline up to 180 degrees For pressure relief For postural instability (+) anti-tipping lever (+) elevating leg rest For pt c edema

Question 46

TYPES OF WHEELCHAIR - TILT-IN SPACE

Answer 46

Can tilt but maintains hips and knees in 90 degrees flexion For pressure relief For pt c extensor spasm or spasticity

Question 47

TYPES OF WHEELCHAIR - POWERED/ELECTRIC/MOTORIZED

Answer 47

Highlevel SCI pt Types: Push button Joystick Handle: C5 Sip and puff: C4 Sip:moves/propels Puff: stop R turn - long puff L turn - long sipp

Question 48

Proper Measurement - OUTSIDE ENVIRONMENT RAMPS

Answer 48

Height (rise) to length (run) ratio: 1:12/ 8.3% Inside ramps width: Min: 36” Ideal: 48” Handrail height: 32”

Question 49

Proper Measurement - RAMP APPROACH

Answer 49

Patient alone: Ascending ramp: forward approach Descending ramp: forward approach c wheelie With PT: Ascending ramp: forward approach Descending ramp: backward approach

Question 50

Proper Measurement - RISE

Answer 50

Level surface in the middle of ramps ADA require a maximum ramp rise of 30”. After a resting platform must be provided Resting platform should be = 60x60

Question 51

Proper Measurement - STAIRS

Answer 51

Height: 7:11

Question 52

Proper Measurement - DOOR WIDTH

Answer 52

Min: 32” Ideal: 36”

Question 53

Proper Measurement - HALLWAY/CORRIDOR WIDTH

Answer 53

Min: 36” Ideal: 42”

Question 54

Proper Measurement - BEDROOM

Answer 54

Distance of bed

Question 55

Approach for ascending ramp with PT

Answer 55

Forward approach

Question 56

Approach for descending ramp with PT

Answer 56

Backward approach

Question 57

ADA requirement for maximum ramp rise

Answer 57

30" ## Footnote ADA requires a maximum ramp rise of 30". After a resting platform must be provided

Question 58

Resting platform dimensions

Answer 58

60x60

Question 59

Stairs height ratio

Answer 59

7:11

Question 60

Minimum door width

Answer 60

32"

Question 61

Ideal door width

Answer 61

36"

Question 62

Minimum hallway/corridor width

Answer 62

36"

Question 63

Ideal hallway/corridor width

Answer 63

42"

Question 64

Distance of bed from wall for a 90 degrees turn

Answer 64

36"

Question 65

Distance of bed from wall for a 180 degrees turn

Answer 65

60"

Question 66

Distance of bed from wall for a 360 degrees turn

Answer 66

60x60

Question 67

Minimum height for sink

Answer 67

27" minimum for knee clearance ## Footnote For reaching, max height should be 34"

Question 68

Height range for toilet seat

Answer 68

17-19" ## Footnote Increased in patients with hip arthroplasty

Question 69

Grab bars height range

Answer 69

33-36" ## Footnote Diameter should be 30mm/3cm

Question 70

Reach forward height for low level

Answer 70

15"

Question 71

Reach forward height for side level

Answer 71

24"

Question 72

Reach forward height for high level

Answer 72

48"