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Semester 5 PMNM Exam 10 > Positioning > Flashcards

Positioning Flashcards

1
Q

Why is mobility necessary

A 
To be functional
QOL
ADLs and IADLs
Work
School
Community
Home mobility 
Social interaction
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2
Q

Mobility is very important for learning across the lifespan

A

If children are not provided with a means to move and explore, then how can they have an understanding of the world around them

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3
Q

If someone is limited in their mobility - then…

A

an assisted means is necessary - whether it be through the use of an aid or a wheelchair

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4
Q

Wheelchair vs. Seating System - Wheelchair

A

Mobility base

- Frame between the wheels

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5
Q

Wheelchair vs. Seating System - Postural Support System is the

A

Seating system
Based on medical necessity
Interface between the individual and the frame

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6
Q

Wheelchair vs. Seating system

A

A lot of things can cause for change in the seating postural support system - pressure sores, posture, communication and feeding needs

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7
Q

Indications for a Wheelchair - with or without a seating system

A

Non ambulatory
Unsafe or unsteady
Non functional ambulatory
Weakness/poor endurance
Infant/child with special healthcare needs
Orthopedic concerns
When an ambulatory is limited to short distances

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8
Q

Indications for a seating system

A 
Issues with comfort/decreased tolerance for sitting
Prevention of pressure sores
prevent deformity 
Accommodate ortho deformity
Dec pain
Inc sitting stability
Improve Resp Func
Enhance mob/function
May improve body image
Min influence of abnormal mm tone
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9
Q

When we say insurance only covers new wheelchair every 5 years for adults (3-5 for kids) we are talking about

A 
The base (the frame)
The seating/support system is based on medical necessity 
The seating system may change over time due to med necessity
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10
Q

What are your goals when seating and positioning - SAFE

A

Providing individual with SAFE mobility

Providing them with alternative seating options

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11
Q

What are your goals when seating and positioning - Pressure relief

A

Neutral alignment to WB

Prevent sheer forces

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12
Q

What are your goals when seating and positioning - independence

A

Provide them a new level of independence
For young - allow exploration
Brings child up to peer level
For older - might provide pain free mobility

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13
Q

What are your goals when seating and positioning - ACCESS

A

To their environment - work, school, home, community

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14
Q

What are your goals when seating and positioning - Communication

A

To level of peers for social interaction

Placement of adaptive communication equipment

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15
Q

What are your goals when seating and positioning - Psychological benefits

A

Interaction with peers
View of self as mobile
Confidence of abilities
Overall improved QOL

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16
Q

What are your goals when seating and positioning - Postural support and ___

A

Inhibit reflexive movements or increased mm tone

Extensor thrust example

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17
Q

What are your goals when seating and positioning - ROM

A

Maintain attainable ROM

You can support them into a position that they currently can obtain

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18
Q

What are your goals when seating and positioning - ROM - remember not to

A

Stretch the individual into a new position!!!

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19
Q

What are your goals when seating and positioning - ortho deformities

A

Can be utilized to dec/delay the progression of ortho deformities by providing postural support

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20
Q

What are your goals when seating and positioning - motor control

A

Suport motor control by increasing stability

By supporting trunk you can gain better control of head and arm - and support neutral alignment throughout the day

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21
Q

What are your goals when seating and positioning - medical benefits

A

Facilitate breathing through upright posturing
GI constipation
Urinary
Feeding/digestion - prevent/reduce reflux

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22
Q

What are your goals when seating and positioning - tolerance

A

Improve tolerance of activity
Endurance
Toleration of upright activity by providing support

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23
Q

What are your goals when seating and positioning - Power vs. Manual

A

Power - they are driving it

Manual - they propel it or have someone propel them

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24
Q

Before the exam - need to know

A

What DME provider will be used
Is the DME provider going to be present
Do you have enough time allotted for the evaluation

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25
Q

Patient evaluation

A

Exam

Trial/Demo (if needed - powered mobility, standing)

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26
Q

After exam

A

Letter of medical necessity (by PT)
Physicians order
DME provider obtains approval and orders equipment
Wheelchair fitting

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27
Q

Patient eval - pt hx

A

Why are they here today
What concerns require a wc/seating system
Make, model, condition, age of current chair
Priority issues/concerns of pt
What has/has not worked in past for this pt

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28
Q

Patient eval - pt hx - PMH

A 
Medical diagnosis
Medications
Coinciding med conditions
Age
Gender
Height 
Weight 
Nutrition
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29
Q

Patient eval - pt hx - Home needs

A

What barriers are present, and how has the family made accomodations

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30
Q

Patient eval - pt hx - Transportation

A

How does the pt plan to be transported

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31
Q

Patient eval - pt hx- work

A

what barriers are present and how has the employer made accommodations

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32
Q

Patient eval - pt hx - school setting

A

levels of school, elevator, classroom placement, accommodations

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33
Q

Patient eval - pt hx - Current needs

A

What mobility related ADLs and ADLs need to be performed

Dressing, bathing… Riding a bus (will need brackets!), self propelling or parent propelled, work

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34
Q

Patient eval - pt hx - cognition

A

In addition to mobility issues, are there cognitive issues impacting ADLs, IADLs, or MRADLs
Vision

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35
Q

Pt eval - Exam

A

Systems review as it relates to wc assessment

CP, MSK, NM, Integ

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36
Q

Patient eval - Exam - Sensory/Skin

A

Sensory intact?
Skin - are they able to perform pressure relief
BB issues

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37
Q

Pt eval - Functional Exam - Ambulation

A

Non ambulatory vs. Ambulatory

Household distance vs. Community distance

38
Q

Pr eval - functional exam - propulsion and

A

transfers
bed mobility
hand function

39
Q

Pt eval - mat exam

A

Supine

Function hip flexion ROM

40
Q

Pt eval - mat exam - functional hip flexion ROM

A

Stabilize pelvis in best corrected neutral alignment
Bend the leg up (feeling ASIS) until 90 degrees
Idea is that if you are bending and the pelvis rotates before the 90 - degrees, then you know to stop and measure at that point where you feel the rotation - this is the angle you need to set for the back rest to prevent them from post tilting (sacral sitting) in their chair

41
Q

Pt eval - mat exam- 90/90 Hamstring length

A

With pelvis in neutral position hip at 90
Raise lower leg until feel resistance
Capture angle where you feel post pelvic tilt
Most wc are 90 angle at hip and 70 hanger at leg rest so if they can’t get to neg 70 or beyond then you might need to get a 90 or 80 degree angle leg rest! And you don’t want them resting at their end range so be careful if their end range is that 70 degrees!

42
Q

Pt eval - mat exam - What flexibility is sufficient to fit a standard wc

A

90 hip flexion
-70 popliteal angle
neutral ankle
IF NOT - poor postural support, poor alignment, scooting forward in chair, inc risk of pressure sores

43
Q

Pt eval - mat exam - what else

A

ROM
Strength
MM tone
Balance

44
Q

Equipment - the eval will determine what you will need for

A

Mobility base
Seating system
Features/Accessories

45
Q

Equipment - Mobility Bases - Strollers - Pros

A

Lightweight
Foldable for storage/transport
Semi-supportive (can be)
Appears normal

46
Q

Equipment - Mobility Bases - Strollers - Cons

A

Does not put them at kid level - they are at adult level

47
Q

Equipment - Mobility Bases - Manual WC

A

Standard large wheel for self propelling
One arm drive for propelling with one arm
Standard small wheel (propelled by caregiver)

48
Q

Equipment - Mobility Bases - Power WC

A

Unable to self propel
At risk for injury/sustained injury from propelling
Inefficient to self propel - too much effort, unable to propel household/community distances

49
Q

Equipment - Mobility Bases - Which power wc allows for most mobility in home

A

Mid wheel drive/center wheel drive

50
Q

Seating systems - your eval will help you determine your seating system needs -

A

Identify positioning support needs
Identify deformities and if they are flexible or fixed
Identify possible solutions to address specific problems to specific causes

51
Q

Seating systems - Identify possible solutions to address specific problems to specific causes - address ___ problems first

A

Proximal first!

Pelvis = BOS

52
Q

Optimal seating position

A

Head in neutral
Same spinal curve as standing
Neutral alignment with head over spine and spine over pelvis
Neutral pelvis alignment
Equal WB on ischial tub
Shoulders slightly back from pelvis
Femurs parallel to seat cushion and resting on seat cushion
Feet flat on footplates - fully supported in neutral

53
Q

Seating systems - sling back support

A

For somebody who does not need support
No pressure distribution
Never used for therapy with Dr. C

54
Q

Seating systems - planar back support

A

Flat support seating option
Limited postural support
Can add postural supportive features
Can add different foam for pressure relief - layered cushioning

55
Q

Seating systems - Curved/Contoured seating system

A

Supportive

Moderate ortho deformities

56
Q

Seating systems - Custom molded/foam in place seating

A

Fixed deformities
Moderate to severe postural deficits
Down side - growing child they will only last a year max
Positive - they are so customized since it is a mold of their body

57
Q

Seating systems - Otto bock shape systems

A

Like bean bag chair that sucks air out it as you position the child how you want it to fit - then when air is sucked out, it becomes firm and can be made into a seating system

58
Q

Postural Trunk Support - No lateral

A

Allows full mobility for actively moving patients

59
Q

Postural trunk support - with laterals

A

Planar (flat) or curved

Provides some trunk support for people with ec trunk control, mild to mod scoliosis, use with TLSO

60
Q

Postural trunk support - hip guides

A

Counters lateral support

Assists with pelvic and LE alignment

61
Q

Postural trunk support - Hardware

A

Planar or curved
Attaches accessories to the chair
Swing away - allows path for transfers

62
Q

Seat Cushions - Foam

A

Lightweight
Inexpensive
Compress over time though

63
Q

Seat cushions - Air

A

Expensive
Lightweight
Need adjustment overtime
(the Roho is often used in hospitals)

64
Q

Seat cushions - Thermoplastic Urethane (honeycomb)

A

Lightweight
Shock absorbing
Equal pressure distribution/beehive formation

65
Q

Accessories to help with either mobility or positioning - Tilt/Recline

A

Tilt - fixed hip angle and entire chair tilts

Recline - just back reclines backwards

66
Q

Accessories to help with either mobility or positioning - Tilt in space

A 
Assist with head/trunk control
Respiration
Digestion
Tone fluctuation
Pressure relief
Visual field
Oral motor/secretion management
67
Q

Accessories to help with either mobility or positioning - Recline

A

back reclines while seat maintains its position
Opens hip angle for ortho issues
Watch for sheer forces

68
Q

Fixed deformity

A

Permanent change that has been made to bone, ligament, mm, or tendon that prevents neutral positioning
Support the body in this position to prevent/limit further progression of the deformity

69
Q

Fixed deformity - the seating system is designed to

A

SUPPORT the deformity

70
Q

Flexible deformity

A

Able to mobilize the body into a neutral, or closer to neutral than normal presentation, position via an externally applied force

71
Q

Flexible deformity - designed to

A

A supportive force is applied that CORRECTS the positional deformity

72
Q

Pot pelvic tilt - possible physical causes

A

Lack of hip flexion angle
Excessive ext mm tone
Tight hamstrings

73
Q

Pot pelvic tilt - possible seating system causes

A

Sliding out of chair (insufficient support)
Lack of femur support (seat depth too short)
Lack of trunk support

74
Q

Posterior pelvic tilt - possible solutions

A 
Check available ROM/seat depth
Inc trunk/lumbar support
Change angle of seat or change style of lap belt
Anti thrust padding
Inc knee flex or hip flex 
Undercut front edge to accommodate tight hams 
Open hip angle 
Provide shoulder support/trunk support
75
Q

Pelvic obliquity - what is it

A

One side of the pelvis is elevated
Named for the lower side!
Often happens with pelvic rotation too

76
Q

Pelvic obliquity - Possible causes

A

Scoliosis
Asymmetrical tone
Hip dislocation/sublux
Unsupportive seat

77
Q

Pelvic obliquity - Soluations

A

Contoured/customized seat cushion to support both ischium

78
Q

Pelvic rotation - what is it

A

One side of the pelvis is anterior to the other
Rotation in transverse plane
Named for the forward side

79
Q

Pelvic rotation - possible causes

A

Scoliosis
Hip dislocation/sublux
Leg length discrepancy
Windswept deformity

80
Q

Pelvic rotation - possible solutions

A

Provide firm pelvic support with seat belt, 4 point seat belt, right sub ASIS bar
Custom seat - to accommodate

81
Q

Adduction/IR - possible causes

A

Excessive extensor tone
May see with post pelvic tilt
Hips flexed less than 90
Footrest too high/low

82
Q

Adduction/IR - possible solutions

A

Fully support thigh
Dec ext tone (neutral pelvis)
Add abductor pommel (medial thigh support)

83
Q

Scoliosis - causes

A

May be idiopathic or neuromuscular

As scoliosis progresses, it leads to increased pelvic obliquity and rotation

84
Q

Scoliosis - possible solutions

A

Lateral trunk support
Custom molded seat
Recline for support and pressure relief

85
Q

Custom seat - custom molded seating system - used for

A

Moderate to severe scoliosis
Poor trunk control
Total contact for pressure relief
Fixed pelvic rotation/pelvic obliquity

86
Q

Head support - aimed to

A

Attempting to obtain neutral alignment

87
Q

Head support - possible problems

A 
Excessive mm tone
Lack of mm tone
Reflexes - ATNR
Excessive hyperextension
Excessive flexion
88
Q

Letter of medical necessity - describes

A

Patients condition
Problems with current seating system or lack there of
How position impacts their condition
Why each component of the wc is medically necessary

89
Q

LMN - Medically necessary

A

Explains what the equipment is
Explains what impact the equipment will have on the individual
May explain what will happen if the individual does not receive the impact

90
Q

LMN should also include info for

A

How child will use the equipment
How it will impact their life
Other pertinent info - Use DME provider as a resource!

91
Q

End goals

A

Family/caregiver education on positioning and wc safety
Does the new seating system meet the individuals goals/needs
Safe, Prevention, Functional, Mobility in their environments, Resources for maintenance

Semester 5 PMNM Exam 10 (6 decks)

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