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Rehab Tech Final > Intro to Complex Rehab Technology: pediatricmobilityandseating > Flashcards

Intro to Complex Rehab Technology: pediatricmobilityandseating Flashcards

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1
Q

Roles of the Team
Who are we?

A

Client & caregivers

PT/OT – lead eval and clinical justification

Supplier (e.g. Numotion) – matches tech to needs

ATP – complex seating configuration

Manufacturer rep – explains equipment options

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2
Q

DME vs CRT

purpose

A

DME: General medical support

CRT: Rehab-focused for long-term function and participation

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3
Q

DME vs CRT

population

A

DME: Basic or temporary needs

CRT: Individuals with neurological or complex impairments

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4
Q

DME vs CRT

adjustability

A

DME: Limited

CRT: Highly configurable and adjustable

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5
Q

DME vs CRT

evaluation required?

A

DME: ❌ Not required

CRT: ✅ Requires PT/OT evaluation

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6
Q

DME vs CRT

customization

A

DME: One-size-fits-most

CRT: Individually tailored and configured

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7
Q

DME vs CRT

ordering process

A

DME: Can be ordered without clinical input

CRT: Requires collaboration (client, therapist, ATP, supplier)

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8
Q

DME vs CRT

ATP involvement

A

DME: Not needed

CRT: Required for CRT reimbursement

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9
Q

DME: Durable Medical Equipment

A

Standard K0001
Standard hemi K0002
Lightweight K0003
High strength lightweight K0004
Scooter E1230
Group 1&2 pwc

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10
Q

CRT: Complex Rehab Technology

A

Ultra lightweight MWCs K0005
Power Assist E0986
Tilt-in-space MWCs E1161
Groups 3, 4 and 5 PWCs K0848-K0891

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11
Q

Manual WCs:

A

DME:
- K0001: Standard
- K0002: Standard hemi
- K0003: Lightweight
- K0004: High strength lightweight

CRT:
- K0005: Ultra lightweight MWC
- E1161: Tilt-in-space MWC

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12
Q

Scooters:

A

DME: E1230 (Standard POV)

CRT: (Rarely CRT unless justified by need)

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13
Q

Power Assist:

A

DME: ❌ Not included

CRT: E0986: Power assist wheels

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14
Q

Power Wheelchairs:

A

DME: Group 1 & 2 PWC (basic, non-programmable)

CRT: Groups 3–5 PWC (K0848–K0891) – customizable, programmable

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15
Q

Justification:

A

DME: Basic mobility, usually short-term or indoor-only

CRT: Long-term, individually configured based on clinical need

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16
Q

Evaluation requirement?

A

DME: ❌ No eval needed

CRT: ✅ PT/OT + ATP involvement required

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17
Q

Mobility Hierarchy (Least to Most Complex):

A

Ambulatory Aids
Manual Wheelchair (MWC)
Power-Assist MWC
Power Wheelchair (PWC)

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18
Q

Ambulatory Aids -

A

When person can walk safely and efficiently with support (e.g., cane, walker)

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19
Q

Manual Wheelchair (MWC) -

A

When ambulation is unsafe or fatiguing, and UE function supports propulsion

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20
Q

Power-Assist MWC -

A

When person needs help with endurance or propulsion, but wants independence

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21
Q

Power Wheelchair (PWC) -

A

For those with limited UE function, fatigue, or complex postural needs

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22
Q

The “best” option is the:

A

least restrictive device that still enables the person to complete essential daily tasks safely, efficiently, and independently

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23
Q

PT/OT Evaluation Steps:

A

Observation & Interview

Physical & Functional Evaluation

Mat Evaluation = Assess pelvic alignment, trunk support, and potential for positioning corrections without external support

Simulation

Measurements

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24
Q

Outcome of Evaluation:

A

Identifies problems and limitations

Directly informs goal setting and equipment recommendations

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25
The Evaluation determines ____ and leads to ___
ISSUES GOAL SETTING
26
Seating Evaluation additions:
future plans for surgery measurements, access MRADLs skin integrity, pressure mgmt Sensation including seated surfaces current mobility solution vision sitting, mat evaluation wheelchair mobility Anatomical measurements Current equipment Transportation Clinical Prognosis
27
Typically Developing toddlers take ___ steps per day and walk over many different surfaces within their home and community
over 9000
28
What does early mobility look like? Younger children
Occurs in extremely short bouts Most steps are not goal directed = exploration
29
young children - Falls are common, according to one report up to ___ falls/hour
17
30
Manual WC may be limited for kids due to:
Small hands/arms = short push strokes Low endurance → fatigue quickly Limited shoulder/trunk ROM
31
Power WC for kids justified if:
Manual use is inefficient, unsafe, or delayed O2 cost or ambulation demands exceed safe limits Proven trial shows increased function/safety
32
Five Identified Pediatric Propulsion Patterns:
Single loop over Double loop Semicircular Arcing High hand recovery
33
Children may alternate propulsion patterns:
Between different activities or surfaces. Within a single session, depending on fatigue or engagement.
34
Younger Children (<4 years old):
Typically have shorter upper limbs relative to wheel size. Result: Shorter push strokes, usually contact the front 1/3 of the wheel. Leads to less efficient propulsion and potentially higher energy cost.
35
Manual Wheelchair Frame Styles
Folding Frame Rigid Frame
36
Folding Frame -
Pros: Easier to transport and store More forgiving on uneven terrain Cons: Heavier Less efficient energy transfer More moving parts = more maintenance
37
Rigid Frame -
Does not fold side-to-side (some have a fold-down backrest) More efficient, lighter, and responsive
38
Rigid Frame Subtypes:
Mono-Tube Dual-Tube
39
Mono-Tube
Single main bar; sleek, light, fewer weld points Active users; sportier design
40
Dual-Tube
Two parallel frame bars; slightly heavier, but more stable Users needing added durability
41
Key Manual Wheelchair Measurements
Seat Width Seat Depth Back Support Height Seat-to-Floor Height Center of Gravity (COG) Armrest Height Footrest Height
42
Seat Width
Measured at the widest part of the user’s hips or thighs (while seated), plus ½–1 inch on each side Ensures comfort and prevents pressure/rubbing
43
Seat Depth
From back of the buttocks to the popliteal fossa, minus 1–2 inches Supports thigh without pressing into knees
44
Back Support Height
Varies by need: Full support: Up to top of shoulders Functional freedom: Below inferior angles of scapulae Impacts trunk control and UE mobility
45
Seat-to-Floor Height
From floor to top of seat surface Depends on: Foot propulsion: Needs lower height Transfer needs Footplate clearance (minimum 2” from floor)
46
Center of Gravity (COG)
Refers to rear axle position More forward = easier propulsion, less stable More rearward = more stable, harder to push COG affects wheelie balance, maneuverability, and tipping risk
47
Armrest Height
From seat to elbow, with elbow at 90°, add ~1 inch Supports posture and UE function
48
Footrest Height
From popliteal fossa to bottom of heel (with footwear) Ensures appropriate knee/hip angle and avoids ground contact
49
If manual propulsion isn’t enough due to fatigue, pain, or limited strength—but a full power wheelchair isn’t appropriate—____ offers a great middle-ground solution.
SmartDrive Power Assist
50
What Is SmartDrive?
A power assist device that attaches to the rear axle of a manual wheelchair. Activated by a wrist-worn Bluetooth control (PushTracker) or tap assist. Maintains speed after a push, reducing the number and force of strokes needed.
51
When to Consider SmartDrive:
User has some UE function but: Tires easily with manual propulsion Experiences repetitive strain injuries (shoulders/wrists) Faces long distances or inclines (e.g., school, campus, work) Wants to maintain a lightweight, foldable chair (unlike power chairs)
52
Once manual mobility has been ruled out—due to fatigue, lack of strength, poor endurance, or inefficient propulsion—the next step is to consider ____
power mobility
53
When to Transition to Power Mobility:
Manual wheelchair trial shows: Unsafe or inefficient propulsion Exacerbation of pain or fatigue Inability to propel functional distances Lack of caregiver availability to assist User has cognitive and physical ability to operate powered controls Meets Medicare coverage criteria for in-home use for MRADLs
54
Types of Power Mobility to Consider:
Scooter (POV) Power Wheelchair (PWC) Power Assist (e.g., SmartDrive)
55
Scooter (POV)
Requires UE strength & stability; not ideal for indoor or tight spaces
56
Power Wheelchair (PWC)
Fully customizable; joystick or alternate control; supports seating systems
57
Power Assist (e.g., SmartDrive)
Bridge option for users with some manual ability
58
Deciding when to consider power mobility comes down to the ____versus the person’s functional capacity.
demands of ambulation
59
When to Consider Power Mobility: 🩺 Ask: Is ambulation…
Unsafe? (frequent falls, poor balance) Inefficient? (short distances, slow, extreme fatigue) Painful? (orthopedic or neurological conditions) Limiting function? (avoids participation to conserve energy) Exceeding energy reserves? (high O₂ cost, rapid HR increase)
60
What Is “Functional” Ambulation?
Ambulation is functional if it allows the person to complete necessary daily tasks (MRADLs) safely, efficiently, and independently without excessive fatigue or risk.
61
Examples of non-functional ambulation:
Walks 20 feet but can’t reach the bathroom or classroom in time Requires rest breaks every few steps Arrives at destination too tired to engage in the activity Walks at a pace unsafe for school, work, or public spaces
62
If ambulation is not functional, and a manual wheelchair is ruled out, ____ should be recommended.
power mobility
63
Drive Wheel Configuration Each impacts handling, stability, and maneuverability:
Front-Wheel Drive Mid-Wheel Drive Rear-Wheel Drive
64
Front-Wheel Drive =
Great curb climbing, smooth outdoors Larger turning radius, may fishtail at high speeds
65
Mid-Wheel Drive =
Tightest turning radius, great indoors May feel less stable on uneven terrain
66
Rear-Wheel Drive =
Good tracking at higher speeds, great for long distances Wide turning radius, not ideal for tight indoor spaces
67
Indoors: Tight turns, furniture navigation → ____-wheel ideal
Mid
68
Outdoors: Curbs, grass, uneven surfaces → ___-wheel preferred
Front or rear
69
Least amount of space for 90° turn =
FWD
70
Least amount of space for 180° turn =
MWD
71
Best for maneuvering in confined spaces =
MWD & FWD
72
Key Maneuverability Considerations:
Turning radius = how small a space the chair can rotate within Wheelbase length & center of gravity impact curb climbing and tight turns
73
Apartment? Narrow doorways? → ___-wheel preferred
Mid
74
Uneven terrain? Ramps or outdoor use? → ___-wheel preferred
Front or rear
75
90-Degree Turn – Front Turning Mid-Wheel Drive
Pivot point is under the user (center of base) Easiest to execute tight 90° turns in place
76
90-Degree Turn – Front Turning Front-Wheel Drive
Pivot point is behind user, but drive wheels lead Good for forward clearance in turns, wider arc needed
77
90-Degree Turn – Front Turning Rear-Wheel Drive
Pivot point is far behind user Widest front swing, harder to manage in tight areas
78
___: Ideal for small home environments and spaces requiring sharp turns.
Mid-wheel
79
___: Better for obstacle negotiation and straight driving but may “cut the corner” during tight turns.
Front-wheel
80
____: Best for outdoor tracking but not ideal for indoor turning at 90° angles.
Rear-wheel
81
Power seat functions:
Tilt * Posterior * Anterior (ActiveReach ) * Recline * Elevating legrests * Seat elevate (ActiveHeight ) * Standing
82
Its more than just the mobility base……
Driving method and seating system
83
🕹️ Driving Method
Standard Joystick: Most common, programmable for sensitivity and user needs Alternative Access Methods: Head array Sip-and-puff Switch scanning Touchpad or eye gaze Allows users with limited UE function or severe motor impairment to operate the chair independently Supports safety, efficiency, and access to environment
84
🪑 Seating System (Corpus®)
Fully modular and customizable: Tilt, recline, leg elevation → pressure relief, tone management Seat elevation (ActiveHeight™) → improves transfers, reach, social engagement Standing (ActiveReach™ + vertical) → offloading, functional reach, health benefits Supports trunk, pelvis, head, and limbs with optional: Lateral supports Headrests Pelvic belts or harnesses
85
Key Features of the F5 Corpus® VS:
Front-wheel drive: Excellent outdoor performance, curb climbing, and tight obstacle negotiation Enhanced suspension system: Smooth ride over uneven terrain Compact base: Better indoor maneuverability than typical rear-wheel models High speed: Up to 7.5 mph with stability even while tilted or reclined
86
Corpus® Seating System Fully adjustable and modular for:
Tilt Recline Leg elevation Seat elevation (ActiveHeight™) Standing (ActiveReach™ + vertical standing)
87
Standing Function Allows for full vertical stand:
Pressure relief Bone/joint health Improved digestion and circulation Psychosocial benefits (eye-level interaction) Access to workstations, kitchen counters, etc.
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Corpus® Seating System User Profile Ideal for:
SCI (especially cervical) ALS MS CP or pediatric users aging into adult systems Anyone needing pressure management + standing
89
A 6-, 12-, or 24-month-old is never ____ —and the same standard applies to children using assistive devices.
left unsupervised during early mobility development
90
Together they maximize seat & back contact for optimal: postural alignment postural stability pressure redistribution mobility
Cushion Back Support Optimally Configured Mobility Base Secondary Supports
91
Dependent mobility is not appropriate
Dependent mobility (e.g., caregiver pushing a stroller or transport wheelchair) does not allow for independent exploration, self-initiated movement, or active participation in the environment. This limits opportunities for cognitive, social, and motor development, especially during critical periods of growth. Restricts development of cause-effect understanding Reduces opportunities for decision-making and problem-solving Inhibits peer interaction and participation in age-appropriate activities Can create learned helplessness or reduce motivation

Rehab Tech Final (8 decks)

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