Lecture 5: Assistive Technology: Orthoeses and Wheelchairs

Question 1

Assistive technology professional - a service provider who analyzes the needs of individuals with disabilities, assists in the selection of appropriate equipment, and trains the consumer on how to properly use the equipment. Certification requires passing an examination and paying a fee

Question 2

quizzes are only on slides speciicied in sylabus

Question 3

Seating and mobility specialist - advanced certifiction for those who already have assistive technology professional certification

Question 4

PT/OT/SLP

Documentation - letter of medical necessity, details the clinical justifcation specific to the patient and each component being requested (ex - armrests, leg rests, or wheels) and provides the clinical justifcation for funding by insurance companeies or other payers. Final decisions are the right and responsibility of the pt and/or caregiver

Question 5

slide 42 wheel chairs (Skipped)

Question 6

Device applied to the body designed to
* Stabilize or immobilize
* Prevent deformity
* Protect against injury
* Assist w/ function

Answer 6

Orthosis

A wheelchair is an orthosis on a mobility base

wheelchair allows pt to achieve
* Stability
* Controlled mobility
* Skill

Question 7

For a wheelchair

chairs can look very different depending on the functional of the pt

Question 8

Question 9

Goals of proper seating and positioning
* Promote function
* Prevent deformity
* Improve body alignment
* Prevent tissue damage
* Prevent additional complications
* Minimize energy expenditure
* Promote function
* Reduce discomfort
* Maintain trunk stability

Question 10

Potential secondary complications of wheelchairs - so all this stuff can lead to additional complications
* Decreased sensory awareness - if they arent hving full sensation can develop pressure uclers (these are preventable)
* Limited ability to alter position
* Decreased subQ sotft tissue - especially over bony prominences - can lead to pressure ulcer
* Impaired peripheral circulation
* Abnormal skin integrity
* Exrended periods of sitting

Question 11

going to actaully need a prescription to get a wheelchair

can do an outcome measure like 6mwt to show they need a wheel chair = additional documentation

Question 12

types of devices

manual = hands on wheels

power assist drive = goes in back and makes it a power chair

Question 13

be familiar w/ components

note: not every chair has all these

Question 14

note: armrests can be different between chairs

Note: the small wheel is called the caster
* large wheeel is the primary means of locomotion
* anti tippers = if someone tried to go into a wheelie in this chair it won’t let them go all the way bakwards (provides some saftey)

heel loops = sits heel nicely

cross bar = normally where were putting the saftey belt

Question 15

how do you measure for seat height?
* How far should the foot plates be from the floor?
* if too high what happens
* if too low what happens

Answer 15

Measure from the user’s heel to the popliteral folt and add 2 inches to allow clearance of the footrest (if a seat cushion is used, do not add inches)

The foot plates should be at least 2 inches from the floor to allow clerance for wheelchair mobility - don’t want to scrape that pedal

If its too high
* insufficient trunk/arm support because back unholstery too low
* Difficulty positioning knees beneath table or desk
* Difficulty propelling because of difficulty reaching hand rims or floor - difficulty reaching around side

If too low
* Difficulty performing transfers
* Poor posture, excessive trunk/hip/knee flexion
* Risks for pressure ulcer at sacrum or ischial tuberositites

Question 16

seat width
* how to measure
* if too wide
* if too narrow

Answer 16

Measure the widest aspect of the user’s buttocks, hips, or thighs, and add approximately 1-2 inches; this will provide space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel

If too wide
* difficulty propelling with UE’s distance to hand rims increased - hard to reach
* Difficulty performing lateral transfer-need to move body over greater distance - beacuse you have further distance to go
* Difficulty moving through narrow hallways or doorways or using public restroom facilities
* Postural deviations-increased tendency to lean to side for support - lots of gaping and stuff

If too narrow
* Difficulty changing positions - insufficient space needed for adjusting
* Increased contract w/ armrest panel-excessive pressure at greater trochanters
* Difficulty wearing bulky outer garments, orthoeses, or braces

Question 17

Seat Depth
* measure
* Too short
* Too long

Answer 17

Measure from the user’s posterior buttock, along the lateral thigh, to the popliteral fold; then subtract approximately 2 inches to avoid pressure from the front edge of the seat against the popliteal space

Too short (front to the back)
* Decreased trunk stability-less support under thighs
* Increased wt bearing on ischial tuberosities
* Poor sitting balance based of support has been reduced

Too long (front to back)
* Increased pressure in popliteral area

Question 18

S/S of decreased circulation in LE
* Ankle edema
* color changes in toes, feet, or legs
* Decreased sensory response to surface stimuli
* Loss of hair follicles

so if someones in a wheelchair and not used to it this can happen

Question 19

Sling or Hammock seat
* how long do they use this?
* because of the sling they’re sitting in what happens at the femurs, pelvis, head pos

Answer 19

Short term temp use

internal rotation of femurs

posterior pelvic tilt

Forward head position

tendency for pelvis to slide forward

Transfers may be more difficult

they’re essentially in a bucket

Question 20

What are our 5 kinds of seat cushions?
* how often do they need pressure relief
* how long should that pressure relief be
* Do you need a cushion if your a long term user?

Answer 20

1) Foam
2) Air (inflatable cushions)
3) Gel
4) Fluid
5) Hybrid

May reduce or eliminate negative outcomes

Elevates person in chair
* Difficult to position chair under a table
* Difficult to use armrests for support
* Alters support from back upholstery
* May require footrests to be adjusted up

Require careful handling to prevent damage

Does not provide adequate pressure relief alone - still need frequent position changes

all long term uses require a cushion

Pressure relief
* every 15-30 minutes (fell)
* For at least 15 seconds
* pressure relieving techniques

Question 21

whatever works best for pt

would all have covers on them

Question 22

flat foam = least expensive, easist and simplist
* won’t provide lots of pressure relief
* replaced more frequently
* its just simple

Contoured = shapes thighs and bottom better
* inexpensive, basic

Fluid = less stable for pt

Air filled = light wt, different cells,

gel = could leak and is heavy
* expensive

Hybrid = gel plus foam

everyone needs a cushion for pressure relief

Question 23

knowledge check: person who is new to using a wheel chair has ankle swelling and difficulty feeling their feet. What do you think is most likely cause
* depth is proably too long

Question 24

does the cushion itself provide pressure relief?

Answer 24

No, your bottom is still contacting the cushion - you actaully need to be moved

i think it does help to some degree

Question 25

knowledge check: which wheelchair seat cushion is for short term use? * sling (so the seet is essentially like cloth across the wheelchair)

Question 26

Question 27

Question 28

brace = orthotic

Question 29

purpose of a brace *stabilize/support * Aid/assist movement * Restrict movement can be permanent or temporary Named for joints they encompass and motion controlled (EX - ankle-foot orthosis or AFO controls the foot and ankle)

Question 30

Braces * improves alignment * Increasing stability at a joint or segment * Facilitating weak muscles; inhibiting spastic muscles - if someone has foot drop w/ weak ankle DF, it can faiclitate increased DF (like giving DF's a quick stretch), can inhibit a spastic m (think seating heal in a pos that isnt going to encourage a big increase in tone) * Limiting or facilitating motion * Providing proprioceptive feedback - lets them know where limb is in space * Stimulating an eccentric or concentric muscle contraction * Preventing contracture or deformity (i.e., anticipating deformity on the basis of condition, maintaining corrected position after surgery or casting, or correcting mild deformitities) * Positioniong a body part for optimal function

Question 31

pt pop were using braces in

Question 32

this orthoeses are applied to the foot amd palced inside or outside a shoe

Answer 32

Foot orthoses

Question 33

Encompass a shoe and terminate below the knee

Answer 33

Ankle-foot orthoses

Question 34

This orthesis extends from the shoe to the thigh

Answer 34

Knee-ankle-foot orthoesis

Question 35

Is a knee ankle foot orthosis with a pelvic band that surrounds the lower torso

Answer 35

Hip-knee-ankle-foot orthosis

Question 36

this orthoesis covers part of the torso and the lower limbs

Answer 36

Trunk-hip-knee-ankle-foot orthosis

Question 37

knee orthosis and hip orthosis cover their respective joints cervical orthoeses encircle entire neck most trunk orthoses are named by the motions controlled Orthoses that manage scoliosis are usually named for the city where they were designed

Question 38

considerations for braces we would worry about that energy expensditure diagnosis specifically in MS, cardio impairments, pre fabricated = can just buy off amazon

Question 39

Foot orthosis Goal ideas * anatomical deformity * Support arches * Pain relief * Creating height in shoe - think leg length discrepency Patient population - EX * diabetic injury * Leg length discrepacy Considerations * Hygiene (as with all braces) * Wear and tear (as with all braces)

Question 40

Ankle foot orthoesis - solid or rigid * in rigid you can't bend it at all Goal ideas * **Stabilize ankle** * **Neutralize foot** * Safety with mobility * Increased balance * Increased DF in swing - because pt is sitting in neutral and not moving into PF pt population - EX * Foot drop, toe drag, foot slap * Severe muscle weakness/atrophy * Hemiparesis/plegia Considerations * Limited ROM - near none at ankle allowed * Limited muscle use - EX = would be push off of plantarflexors (because they're in neutral) * There are also semi-rigid AFOs w/ different trimlines * Can be pre-fabricated (off the shelf)

Question 41

Ankle-foot Orthoses (AFO) - Articulating or Hinged (means the same thing) Goal ideas * Ankle stability * **Allows some ankle mobility** (unlike rigid/solid) * Can be set in certain degree of ROM to assist muscle control (DF/PF assist) Patient population - EX * Hemiparesis/plegia * TBI, stroke, SCI Considerations * Wear of hinges * **DF assist - improve foot clearance** - helps them into DF * **PF stop: limits knee hyperextension** (because PF goes w/ knee extension) - so it stops that knee hypertension which limits genu recurvatum (which is that over hypertension at the knee) * **DF stop: limits knee buckling** (remember, DF goes w/ knee flexion)

Question 42

Ankle-Foot Orthoses (AFO) - Posterior Leaf Spring (PLS) Goal ideas * Increased DF in swing * Increased gait speed pt population - example * higher functioning pt * EX: TBI, stroke * Unilateral weakness in ability to clear foot Considderations: * Can be pre-fabricated (off the shelf) * **Cannot use with high tone** - might kick them into higher tone (spasticity - velocity depndent) theres a small calf peice, and not strap at the malleoli * this is not meant to be the full length of their foot because we want their toes to do some work * less resitrictive = more mobility for pt * also this cannot be for a pt w/ ankle instability because theres nothing on here to stabilize the ankle. more for DF in swing

Question 43

Ankle foot orthoses - Carbon Fiber Goal ideas * increase DF in swing * Improved push off in gait cycle * Less restrictive, allows muscle control * Dynamic brace Patient population - EX * higher functioning pt * DF weakness Considerations * **May not be appropriate for high tone pts** - because might trigger spasticity / no support at ankles do increases DF swing where band is depends (can be on front/side) least resitrictive = most muscles can be active w/ this brace * need some affinity for dyanmic balance to use this brace

Question 44

Ankle-Foot Orthoses (AFO) - Ground or Floor Reaction Good ideas * Increase DF in swing * Increased stability in standing * Increased balance Patient population - Example * Looking for stability - MS * Can often see this brace bilaterally Considerations * Anterior shell adds bulk and heat more for pt that needs stability in standing * more bulky * lower functioning pt that needs icnreased stability * has malleoli support - showing that the whole idea w/ this is increasing support * often used bilataerally because they're unstable bilaterally

Question 45

Ankle-foot orthoses (AFO) - Conventional or Double Metal upright Good ideas * Increased DF in swing * increased balance Patient population - EX * **pt w/ LE edema or skin concerns** - part of what makes it unique Considerations * attaches directly to shoe litteraly fasioned to one pair of shoes, so pt has to use same shoes all the time = bad side

Question 46

**should not provide and AFO if goal is to improve tone/spasticity** (and FES) * we use all those tehcniques we learned prior AFO's more for gait pathologies / strength issues / decrease stiffness FES = often for stength problems **afo = use to improve gait / mobility** AFO used for lower gait speed FES = for faster walkers where you can rely more on their muscles estem / bracing often combined using AFO's early can enhance progress AFO = faster gait speed because if they can push off foot they can walker faster **FES = applied to fibular/peroneal nerve (because anterior tib is innervsated by this)**

Question 47

knowledge check: ehst motion would adding a DF stop limit? * DF goes w/ knee flexion, so knee flexion would be limited (would help decrease knee buckling)

Question 48

Knowledge check: Which of the following braces is not recommended in a pt w/ high tone? * posterior leaf spring (or carbon fiber one)

Question 49

Knee ankle foot orthosis: so now the knee is encompassed as well as the foot and ankle Goal ideas * adds more knee control pt population ex: * incomplete SCI w/ some LE function - this is more L2/L3 injury Considerations * Bulk * Donning/Doffing * Lock versus unlocked * Hip hiking - because this knee joint is locked out unlocked. If its locked then they have to hike their hip and bring it around to advance it because they've lost knee flexion which is needed for foot clearance in swing phase

Question 50

so brace would be unlocked for things like sitting

Question 51

Hip-Knee-Ankle-Foot orthosis adds in that hip control Goal ideas * adds more hip contorl Patient population - example * Requires more stability than KAFO or AFO * Lower thoracic/lumbar incomplete SCI - because were now stabilizing at the hips Considerations * Locked versus unlocked * Hip hiking

Question 52

Trunk-Hip-Knee-Ankle-Foot ORthosis Goal ideas * Adds lumbar/thoracic support Patient population - example * Lower thoracic SCI with trunk/LE involvement, incomplete Considerations * Bulk * Donning/Doffing * Clothing

Question 53

Reciprocating gait orthosis helps w/ movement helps faciliatte central pattern generator

Question 54

Other - Knee and Ankle Braces Goal ideas * athletes * support of arthritic change * Decrease pain during ADLs/leisure activities * Neuro? Patient population - example * Ankle sprain * Knee surgery * Neuro? Considerations * Off the shelf versus custom-made * Donning/doffing, abiding by ROM restrictions post OP

Question 55

note: adding afo changes proprioceptive input * alters normal movement

Question 56

Trunk Orthoses - SO/LSO LSO - Lumbar-sacral orthosis - think belt for SI joint SO - sacral orthosis double edged sword because they might become reliant on it and actaully weaken their core - note AFO's dont do this Goal ideas * immobilize or limit movement in spine PAtient population - example * Post-op spine surgery (SCI, TBI) * During certain activities * Blood pressure regulation Considerations * To wear or not to wear * Associated core weakness * Reliance * Donning/doffing

Question 57

Trunk Orthoses - TLSO TLSO - thoracic-lumbar-sacral orthosis Goal ideas * limit movement after spinal surgery Patient population - EX * post op spine surgery Considerations * Donning/Doffing - very hard * can't be seated to put this on, must be supine * because they have spine issues and can't bend typically post op

Question 58

cervical orthosis notice the aspen collar

Question 59

wont correct but may prevent worsening

Question 60

typically mostly OT

Question 61

Bracing: Pros: * Increased independence w/ ADLs, Leisure activities * increased safety w/ walking, transfers, sit to stand, ADLS * Increased balance * Pre-fabricated options * Gain vs loss Cons: * weight of brace * Cost * Maintenance * Donning/doffing * Patient compliance * Hygiene * Limiting factors/concerns * May need to wait for brace to be made * Gain vs loss

Question 62

Question 63

Back height for wheel chair Measure from the seat of the chair to the bottom of the axilla with the users shoulder flexed to 90 degrees, and then subtract approximatey 4 inches; this will allow the final back height to be below the inferior anglex of the scapula * NOTE: this measurement will be affected if a seat cushion is to be used; the person should be measured while seated on the cushion, or the thickness of the cushion must be considered by adding the value to the actual measurement Low back to maximize function May require/desire traditional higher back for safety, stability, and support Too high * difficulty propelling chair * Excessive irritation to skin over inferior angles of scapulae * Difficulty with balance-trunk inclined forward Too low * decreased trunk stability * increased postural deviations

Question 64

Arm rest height: Measure from the seat of the chair to the olecranon process with the users elbow flexed to 90 degrees, and then add approximately 1 inch * NOTE: this measurement will be affected if a seat cushion is to be used; the person should be measured while seated on the cushion, or the thickness of the cushion must be considered by adding that value to the actual measurement If too high * Propelling-difficult to reach over armrest to grasp hand rims - difficulty propelling * Difficulty using armrests for transfers - because it might get in the way * Postural deviations-elevated shouldrs when resting forearms on armrest * decreased trunk stability and fatigue If too low * Poor posture * back pain * Decreased balance * Difficulty w/ transfers - not an adequate push off

Question 65

Types of arm rests: Fixed armrests * permanently attached to chair frame - makes transfers hard because they'll actually have to stand up and pivot, won't be able to do sliding board transfer etc... * Recommended for those performing standing transfers * only if no need to remove arm rests Removable Armrests: - much easier for transfers * Recommended for users who perform lateral scoot, squat pivot, or sliding board transfers * Some pivot up when unlocked Desk or cutout armrests * Want to position wheelchair close to a permanent surface such as desk, table, sink, or countertop * Usually can be reversed to improve support when for standing transfer Adjustable armrests * Need to adjust armrest height for different activities * Cushions with different thickness or bulky outer garments

Question 66

Leg Length Footplates too low * increased pressure on distal posterior aspect of thigh * Lack of footplate clearance-unsafe Footplates too high * Increased pressure to ischial tuberositites * Difficulty positioning chair beneath table or desk **TEST** S/s of decreased circulation in LE's * Ankle edema * Cholor changes in toes, feet, or legs * Decreased sensory response to surface stimuli * Loss of hair follicles

Question 67

Measurements: - wheelchair - normally taking measurements on plinth/matt - not actaully going to be in WC pt seated on hard surface for measurement * seated in wheelchair on level surface for confirmation of fit Wear usualy clothing - including shoes Cushions or other components need to be in place - because it changes measurements Patient sits erect with pelvis in contract with back upholstery - need to be in normal seated posture LEs on footplates/leg rests **Bottom of footplate at least 2 inches from the floor** Measure: 1) Seat height 2) Leg length 3) Seat depth 4) Seat width 5) Back height 6) Armrest height 7) Footplate length

Question 68

Confirmation of Fit * Chair on level, smooth surface * Patient sits erect with pelvis in contact w/ back upholstery * LEs on legrest * Bottom of footrest at least 2 inches from the floor * Let the patient try it - let them actaully move around in chair

Question 69

What is a standard wheel chair seat width

Answer 69

16-20 inches

Question 70

What is a normal standard wheelchair depth

Answer 70

16 to 17 inches

Question 71

What is a normal standard wheelchair back height

Answer 71

16 to 19 inches

Question 72

What is a normal standard wheel chair seat height?

Answer 72

17-19.5 inches

Question 73

What is a normal standard wheelchair armrest?

Answer 73

9 to 11 inches

Question 74

HOw much weight can a standard wheelchair support?

Answer 74

250-350 pounds

Question 75

biartric wheel chair = for bigger pts

Question 76

Inward angle of the drive wheel relative to the vertical position?

Answer 76

Camber basically the top of the wheels are angled in, increasing the BOS

Question 77

If the WC has high camber what happens to the wheels at the bottom?

Answer 77

Wider at bottom more narrow ontop (increase BOS which is why they use these w/ sports) * increased camber improves a wheelchairs stability and agility and reduces shoulder strain during propulsion

Question 78

What kind of lock is this?

Answer 78

Toggle lock (push or pull locks) (pull up to unlock, push down to lock) * Pushing forward or backward * Extension can be attached-poor trunk control or limited function of an UE - makes it longer and easier to reach from the contralateral UE (extension not shown)

Question 79

What kind of lock is this?

Answer 79

Z or Scissor Lock * Beneath chair seat * Must be able to reach under seat * Propulsion w/o interference from lock have to be able to bend and get underneath - needs trunk stbility / ROM * so used when you dont want to worry about that lock on the side of the chair getting in the way

Question 80

What kind of lock is this?

Answer 80

Auxiliary lock for a reclining back chair * Release back * Attendant needed - so need someone else unless custom electric WC this is in the back of the chair and releases it back * this is for someone who has someone push them * someone must help them w/ this unless electric

Question 81

What kind of lock is this?

Answer 81

Hill climber * Prevent WC from rolling down a hill/incline while propelling up (stops from rolling backwards)

Question 82

In the past, manual wheelchair locks have been referred to as" brackes". However, some wheelchair users assumed that wheelchair brakes were to be used to slow the chair, similar to the use of brakes in a car. The use of the term "locks" better conveys the intended purpose of securing the chair * So you can get sued for saying breaks

Question 83

Lock extensions - just goes right ontop

Question 84

Push Rims: * also called hand rims Most commonly used means of manually advancing a wheelchair * Other = power, lever/gears - can be powered or not powered want the pt to use the rim not the tire * hygene (not touching ground) * More smooth and better for the hands so, they're the part you're actually supposed to push

Question 85

What kind of leg rests is this?

Answer 85

Fixed w/ solid footplate * cannot be moved

Question 86

What kind of leg rests is this?

Answer 86

Swing away

Question 87

What kind of leg rests is this? (taking them off)

Answer 87

Removable (can be swing away as well, but also can just remove them)

Question 88

What kind of leg rests is this?

Answer 88

Elevating with calf rests and movable footplates * Push-button adjustments for legrest length are visible along the shaft of the legrest

Question 89

Elevating LEgrests: * Entire front rigging can be elevated and maintained at different heights * Unable to fully flex knees - duh * Knee flexion must be avoided * Calf panel attached to legrest - need this to support leg * Lowering level that releases the adjustment lock * May need to take pressure off to lower * Protect LE when legrest is lowered * **LE/LEs elevated - greater tendency to tip backwards** This elevation is not a long term position - think edema where you need legs above heart

Question 90

What are casters?

Answer 90

Smaler wheels designed to provide stability and to allow **directional changes** Location compared to drive wheel will affect BoS * so can be further back I guess Vary in size from approximately 2 to 8 inches (5 to 20 cm) in diameter **Large casters create more stability (rough terrain) but are slower and require more room to turn** so casters turn in a full circle and allow directional changes

Question 91

Different kinds of tires: Pneumatic (air-filled) - better for outdoor activity * Light * Good shock absorption, traction and durability (outdoors) * Need proper inflation/risk going flat * Power chairs - sometimes Foam-Filled * Less maintenance * Increased weight * May be used in power chairs Solid Rubber - less energy - better indoors - more typical tire * Requires less energy to propel * Better indoors * Typical of standard chairs

Question 92

types of wheelchairs

Question 93

What kind of wheel chair is this?

Answer 93

Transport, Depot or Companion Chair (going to call it transport) * 3 different names * Designed to be inexpensive, accommodate a large variety of body sizes, and be attendant-propelled (so you can't push them yourself) * Not suited to long-term or independent use - these are the ones you'll often find in hospitals to transport pts NOTE: theres no big wheel - not long term chair (duh cant push yourself)

Question 94

What kind of chair is this? | know all areas of chair

Answer 94

Standard WC * Frames are now lighter in wt and constructed from aluminum, titanium, airplane steel, or carbon fiber reinforced materials * The standard manual WC box frame is fixed, depending on the model, supports 250-300 lbs * Bariatric WC frames are typically wider and support 350-850 lbs, although some manufacutres make chairs for up to 1k

Question 95

This is showing a rigid frame - fully configurable vs non adjustable basic frame

Question 96

Knowledge check: Which wheel chair tire best for an active pt navigating outdoors

Answer 96

pneumatic

Question 97

Notice how different the seat is. frame is similar

Question 98

customized = to adapt to the pt. on the left you can see the one made for an amputee reclining = axillary lock. Someone would have to push it back for them * I think reclining is just the seat

Question 99

lightweight = super light. For higher functioning pts who want more movement. Must have good trunk contorl (small backrest) * think lower thoracic SC injury (good trunk control) Notice the camber on the sports chairs * Small casters = move better

Question 100

One arm drive chairs - has a power rim (for when someone only has 1 functional UE and limited use of LE) - outer rim = for far drive, inner for near drive * One functional UE, limited functional use of LEs * Two hand rims attached to same wheel * outer, larger rim propels far-drive wheel * Inner, smaller rim propels near-drive wheel * Both hand rims simultaneously-chair propelled straight * Use of one hand rim independently causes chair to turn * Heavier and more difficult to hold than standard chair

Question 101

Hemi wheellchair similar to one arm drive. One side is for propulsion. The wheels look different - less on less involved side where they're dpendent

Question 102

Semi and fully reclining chairs * Vertically to fully horizontal * Adjustment knobs or levers side of back frame * Headrest and elevating leg rests required * Rear wheels more posterior - to prevent LOB Only the back rest goes back

Question 103

Tilt-in-space WC Adjustment at various angles and can be wheeled with the user positioned at any angle Entire chair able to tilt opposed to reclining chair this one has tilt on the entire chair great for MS pts for pressure relief - if they could adjust on their own they could use the other one. This is for when you really need pressure relief * the reclining WC should be used for more longer term users (who can adjust on their own) - however, if they're a long term user you dont want to have to sit up all day - so use that chair just to lay back for comfort

Question 104

Externally powered WC - not always w/ joystick - need hand contorl for that Insufficient strength or motor control of extremitites to propel standard chair **Front, mid or rear wheel drive** Various controls * Head * Finger * Chin * Head * Tongue * Mouth * Eye gaze

Answer 104

wheel position can change per chair

Question 105

Scooter

Question 106

**W/ falls you should do what first? (from WC's)** * what else do you do?

Answer 106

Tuck the head first to protect it then cross the arms, with the hands placed on knees pushing them away (to prevent knees from coming into face) - they may not have contorl of legs if they're in a WC