Lecture 10 - Assistive Devices and Standing Frames

Question 1

If child / family doesnt like the assistive device and says they won’t use it than don’t even try

Question 2

Posterior Walker - often called a kaye walker (brand name)

What it does:
* Improved gait efficiency - this is our goal for everything
* Normalized stide length
* Upright posture during ambulation - better than anterior for this
* Decreased O2 consumption rate (becaue its more efficient)
* Improved step length
* Increased single limb support time
* Flexion angles of the trunk, hip and knee lower using
* Energy conservation

So we want them to stand upright opposed to anterior walker where they might lean forward and flexed

main difference is that the walker is more behind them

Answer 2

can do harnis system. works when they’re modified wt bearing

this alters gait pattern quite a bit so don’t use if you don’t have to

Question 4

Anterior walkers
* these are more for short term issues.
* used for someone like a 5 year old who breaks there leg and doesnt have the balance and coordination to use crutches, but this isnt a perminant thing
* The posterior walker is more of a perm solution

Question 5

Gait Trainers

Indications:
* Used for people who do not have functional gait skills or postural control to safely and independently use a standard walker
* Not yet able to consistently bear full wt through legs
* Postural control developing
* Cognitive skills and motivation to move - they want to be able to move

Varied levels of support and modular accessories

Address pre-ambulatory skill development
* form of safe independent mobility in standing position - HOWEVER ITS NOT WALKING, DOES NOT PROMOTE A TYPICAL GAIT PATTERN, will build postural strength / reciprocal LE movements / improve endurance / upright promotes that social interaction

Form of sage, independent mobility in the standing position
* Build postural strength and stability
* Alternating / reciprocal leg movements
* Improve overall endurance
* Promotes social interactions
* Not “typical” gait pattern

Question 6

Do gait trainers promote a typical gait pattern

Answer 6

Nope

No research to show that they transition to functional gait

they’re big and not functional

Question 7

Arm Platforms: can wt bear through it

Arm Prompts - guide you not fully support you

Both addons to gait trainers and others

Question 8

Question 9

espeically when they start to sit to walk they lose that typical normal gait pattern

Question 10

Keep the legs where they’re supposed to be so they cant scissor or cross midline

Question 11

Tray for communcation device

Question 12

Good for kids who are in the walking range but have developmental delay and arent actually walking yet.

Assist w/ learning how to walk

Question 13

Supine Stander:
* pt goes on the stander on the back - for more medically complex pts.
* Significant msk weakness
* Help w/ inital standing
* NOTE: They arent always in supine, they start in supine and then are rotated up to the standing position

YOu have to worry about OH, because they’re going from lying down to standing up

Worried about lack of head control - could flop all around - their head is controlled w/ these

Question 14

What does the prone stander add that the supine did not?

Answer 14

Added challenge of working turnk / neck muscles (because head is unsupported) against gravity for better postural control

Question 15

Prone stander:
* Working on hip extension / incraesed ROM
* Upright social interaction
* For improving head and trunk control
* Minimize extensor tone - if you’re touching the extensors your incressing extensor tone
* Pressure relief - if they’re in a wheelchair all day in standing and now they’re in prone all that backside of their body is unweighted

typically have a tray so they can rest their arms - sometimes chin promt

Question 16

So this greatly helped w/ that knee extension, hip extension, DF (opposed to a wheelchair)
* then you don’t have to use your therapy session on that passive stretching - can utilize it for better things

Question 17

Mobile Stander - it moves and pt is upright

• vertical posture
• Self propelled exploration and freedom - they can push the wheels
• For social interaction
• For independent mobility
• To improve weight-bearing
• To improve weight-shifting and postural control
• To improve trunk contorl
• To improve ROM

Question 18

different kind of mobile stander for bigger pts

Question 19

Upright stander:
* Can provide varying levels of support and stability
* Can be used to slowly increase ROM
* Can facilitate social interaction
* Can have removable tray for activity
* Many levels of adjustability

Question 20

Supine stander = least social itneraction because you’re kind of looking into it

Question 21

Power mobility = powered wheel chairs

We need to check their cognitive status
* These chairs are heavy!

Don’t have to have great vision now to use them (AI)

Know where they’re going to use it (think small house w/o much turn radius)

Access Point = how you’re going to access the device
* How you’re going to drive it
* One option is.a joystick (this is standard)
* If you’re going to do anything other than a joystick you’re going to have to justify it

Other equipment - so things attached to the pt
* Lines, leads, tubes
* Adaptive communication
* Ventilator

Transfers - need to make sure they can get in and out of the chair

Seat cushion - standard - do not provide pressur releif, just some pressure redistribution

Positioning Features
* think Tilt

Question 22

What is tilt?

Answer 22

Entire chair tilts back

Angular repositioniong of the seat AND back relative to upright

Changes seat orientation in space

Assist with positioning, pressure relief, and posture

Full tilt system tilt at least 45 degrees

Incremental

Manual or electronic

Benefits of tilt: - great for pressure relief
* Accomodate for muscle weakness
* Accommodate for paralysis
* Accommodate for fatigue of neck and trunk muscles
* Provide neutral head/neck position for safe swallowing and saliva control
* Gravity assisted positioniong for rest
* Safety for traversing challenging terrian
* Minimum 45 degrees tilt for pressure relief/pressure redistribution
* Minimize shear forces of recline (nothing really moves under w/ tilt)

Question 23

What is recline?

Answer 23

The back of the wheelchair goes back (not the seat like tilt)

allows for change in position

increase hip angle for more ROM

Does not provide pressure relief on bottom

Gives you a new position for self catherization that allows for better hygene / cahnging clothing in

Recline:
* Gravity assisted positioning
* Accommodate hip extension contracture or cast
* Stretching
* Minimize risk of contracture or pain
* Weight relief / pressure redistribution
* Functional tasks w/o transfering out of chair
* Status post surgery
* Spica cast
* Halo
*. Longest wheelbase
* Largest overall turning radius
* Accessibility and maneuverability challenging

Question 24

How many degrees of tilt do you need for pressure relief?

Answer 24

45 degrees

Question 25

If chair has tilt or recline it will have a head rest

Question 26

can have tilt and recline

Question 27

Standing wheel chairs * Sitting to standing position * Are VERY heavy * Stand, stretch, reach, and work without needing to transfer * Needs huge BOS so it does tip over = heavy

Question 28

Transport chair: little wheel chairs that have 4 little small wheels that pt cannot move themseleves * Short term chair often in hospitals * Four small hweels * light wt * easily folded and lifted * Short term use * Someone else pushes them

Question 29

Strollers * Pediatric and adult adapative strollers * Light weight * normally have a hard seat * Minimal support * Folding and ease of transport * Some have positioning features, including tilt, recline, and combination tilt/recline * many meet transportation crash test standards * Integrated transit option may be required * Client cannot independently propel

Question 30

need to think about this stuff

Answer 30

if they're clsoe to the wt capcity going to run the battery a lot faster durability = normally will only cover new one ~5 years * need a chair that will last

Question 31

Integrated power wheelchair * combines the seating system and drive system * Cannot be separated * Limits sizes * Cannot be retrofitted with different seat frame systems

Question 32

Powerbase wheelchair * Modular system * Separate base contains * Drive control system * Batteries * Motors * wheels * Can be separated from seating system * Modified or replaced

Question 33

NOTE: to use a scooter you need trunk control

Question 34

Drive Wheel Configurations: * Reer drive * Center/mid drive * Front wheel drive * Learning curve when changing configuration - driving a chair w/ a front wheel drive is much different than reer Below the big wheel is the one that does the driving

Question 35

Rear wheel drive bases * Fixed drive wheels in reer * small front casters * Good contorl * Drive in a predictable manner in response to joystick input * Accurately maneuver in different situations and environments * Individuals can see where they are going * Able to watch feet to avoid walls, doors, or other items * Cannot position feet close to body * Unable to get close to objects from the front (Desk, sink, counter)

Question 36

Which chair type has the smallest turning radius?

Answer 36

Mid wheel drive - makes a ton of sense if you think about it - would be good for mobile homes

Question 37

Center and mid wheel drive bases * Fixed drive wheels in center or middle of chair * Small casters in front and rear of chair * Turn from the center * Smallest turning radius * Intuitive to operate * Center of mass is closest to center of mass of wheelchair * LE can be positioned clsoer to body than RWD w/o interfering w/ casters they turn where you think they're going to turn

Question 38

If you're driving on different surfaces which type of chair is best?

Answer 38

Front wheel drive chairs

Question 39

Front wheel drive * Fxied drive wheels in front of chair * Swiveling caster wheels in reer * Outperforms other 2 in multiple performance categoies while retaining many of the benefits and eliminating disadvantages * Excellent stability * Incline transition * Obstacle handling * Manerbreability * Positioniong feet positioned close to body with no caster clearance issues * **learning curve** * Back end moves first - not intutitive * Care to ensure sufficient posterior clearance * Allows clsoer access to tables and sinks

Question 40

Variable positionoing features for power wheelchairs * Any access site or integrated into the drive system * Power tilt * Power recline and power elevating legrest system * Edema: Best with elevating leg rests, tilt and recline - get rids of swelling by draining back to heart * Power seat elevation * Power standing - need to really be able to justify lots of these * Adjustable height foot plate if you have recline you need leg rests to balance it out

Question 41

showing pressure relief

Question 42

smart chair that won't let you push it to the point where it won't let you tip it over

Question 43

power elevation entire seat goes up

Question 44

Power Assist Wheelchairs turns normal wheelchairs into power chair Great because power chairs to very heavy and hard to transport will increase velocity good for people that want to use some manual and get this for that little extra boost