SM - goals of seating and mobility

Question 1

what are the 3 goals of a seating system

Answer 1

1. optimal postural alignment
2. optimize dynamic stability
3. optimize functional ability

all related to each other:
postural alignment -> dynamic proximal stability -> functional mobility

Question 2

what goal of the seating system trumps the other two

Answer 2

optimizing functional ability

might sacrifice some postural alignment and stability to allow for function

Question 3

what are 4 goals of a mobility system

Answer 3

1. provide compensation for inability to ambulate
2. permit functional speed and distance
3. account for limitations in endurance
4. accommodate various terrain

Question 4

what are 4 things that you have to make compromises for in your seating/mobility system

Answer 4

• health and safety
• function
• comfort
• style/image

is someone isn’t comfortable (physically or mentally) w wc, they won’t use it

Question 5

what are 3 basic goals of a seating and mobility system

Answer 5

• correction
• accommodation
• compensation

Question 6

when do you correct vs accommodate

Answer 6

correct = flexible postural deformities
accommodate = fixed deformities

Question 7

what 4 systems do you screen

Answer 7

NM
integ
MSK
CVP

Question 8

what are the 3 main goals in addressing the NM system

Answer 8

correcting abnormal tone when possible
* normalize when possible
* refer to medical intervention

compensate for loss of motor/sensory function
account for differences in static vs progressive disorders

Question 9

what position should you assess tone in

Answer 9

important to assess in sitting
* will change depending on position they are in
* test in sitting bc that is where they will function

Question 10

how does a pt having a progressive NM disease impact the seating/mobility system

Answer 10

if progressive - build into system in the instance of worsening conditions

Question 11

what are 2 considerations with seating/mobility systems if the patient has strong extensor tone when sitting/excited? why?

Answer 11

1. put dynamic footrests and backrest to move w the pt and then when tone relaxes, can return to midline shape
   * if not dynamic -> can snap leg over time
   * dynamic prevents skin breakdown by limiting friction

2.minimize noxious stim that triggers that posturing

Question 12

what are the 3 main goals in addressing the MSK system

Answer 12

• correct flexible deformities
• accommodate rigid or semi rigid deformities
• compensate for funcitonal impairments

Question 13

why do you accommodate for rigid deformities instead of correcting them

Answer 13

the amt of force needed to correct would cause skin break down so you support the posture where it is

Question 14

what are the 2 main goals in addressing the integumentary system

Answer 14

• accommodate existing skin breakdown
• protect from future damage

Question 15

where is a common location for skin breakdown and why

Answer 15

sacrum
* post pelvic tilt is a common posture (esp if tired) –> shifts weight onto sacrum

ischial tubs are next big risk
breakdown over bony prominences

Question 16

what did she say about the utilization of pressure mapping and when does she use it

Answer 16

not essential
* she uses it more as an educational tool or as justification for a really expensive cushion

Question 17

what are the 2 main goals in addressing the CVP system

Answer 17

• compensate for any loss or absence of function
• maximize available endurance

Question 18

what measures do you use to assess the CVP system’s response to a wc and why

Answer 18

O2 sat, HR, RR

looking at energy expenditure w mobility

good measures for justification

Question 19

what are 5 common presentations for seating

Answer 19

1. requests for replacement
2. postural changes
3. pain
4. skin breakdown
5. loss of function

requests for replacement are easier
postural changes are more difficult
pain is a big reason pts come in

Question 20

what is the order of progression when determining the appropriate seating/mobility system

Answer 20

seating –> mobility
* if get seating right, can go on whatever you want (manual or power)

correction –> accommodation
proximal –> distal
* all ab BOS, head problem could originate from pelvic obliquity

less restrictive –> more
least costly –> more expensive

simplest solution is often the best

Question 21

where do you start when looking at pt’s alignment

Answer 21

pelvis!! always

Question 22

what is the most common postural deviation seen

Answer 22

posterior pelvic tilt

Question 23

what is the ideal alignment for the pelvis (most stable)

Answer 23

neutral rotation
neutral obliquity
slight ant tilt

Question 24

how is the pelvic alignment supported

Answer 24

3 point system of control
1. post from backrest
2. ant from pelvic belt (inf and ant to ASIS)
3. inf from seat (sloped or cutout)

3. using gravity w seat slope (“dump”) to lock pelvis in place

Question 25

what should you think ab if added a pelvic belt to the chair and where should it fall

Answer 25

think ab angle of pull keep below axis of rotation * if goes around belly (above/across ASIS) --> pulls pelvis into a post tilt

Question 26

what is the ideal hip alignment that will give the pelvis the best support

Answer 26

flex to 90deg or more neutral to slight ABD neutral to slight ER

Question 27

what is the ideal knee alignment

Answer 27

flexion 70-90deg if available

Question 28

what is an important consideration with the knee alignment and why

Answer 28

hamstring length * if HS don't have the length, elevating leg rests will pull pelvis into post tilt

Question 29

what is ideal ankle/foot alignment

Answer 29

neutral DF/PF, INV/EVE plantargrade foot supported ## Footnote want foot flat on foot plate

Question 30

what is a consideration with added foot straps

Answer 30

if adding more than 1 or 2 straps to foot rest, think ab an AFO to maintain position

Question 31

what does ideal ankle/foot alignment avoid

Answer 31

reflex activity

Question 32

what is ideal spinal alignment

Answer 32

plumb line posture slight thoracic kyphosis slight lumbar lordosis slight cervical lordosis

Question 33

how are lateral support systems for the trunk set up in the chair

Answer 33

3 points of control * 2 on concave above and below curve (upper ribs and pelvis) * 1 centered on convex (lower ribs)

Question 34

what is ideal UE alignment

Answer 34

shoulder neutral position UE relaxed free for propulsion should slight post to rear axle in MWC

Question 35

when relaxed, how should fingers align to a well fitted chair

Answer 35

at axle of chair

Question 36

what purpose can armrests serve w UE alignment

Answer 36

support UE and dec shoulder strain

Question 37

what is ideal head/eye alignment

Answer 37

head in midline eyes horizontal vision/hearing unobstructed ## Footnote when using lateral supports, make sure out of visual field and not obstructing hearing

Question 38

what are 3 goals of a SM system in both CP and MS

Answer 38

1. maximize functional level 2. accommodate changing needs w cost effective choices that can be modified 3. skin and soft tissue protection

Question 39

why might skin and soft tissue protection be an especially important goal in a certain type of CP

Answer 39

if athetoid mvmt - need good padding

Question 40

what might be a deciding factor between a MWC and a PWC in CP

Answer 40

cog ability

Question 41

how does the type of CP (spastic, athetoid, ataxic) impact the wc

Answer 41

leads to different seating components

Question 42

what are impairments of CP

Answer 42

**motor control** growth joint changes inc responsibilities comorbidities associated w aging

Question 43

what are 7 impairments of MS

Answer 43

motor control/coordination speech vision cog balance sensation B&B control

Question 44

what are characteristics of MS

Answer 44

fluctuating periods of exacerbation/remission unpredictable course function dec over time

Question 45

what type of wc is appropriate for a thoracic/lumbar SCI and why

Answer 45

full use of UEs lightweight, K5, rigid manual wc * protect wrist/shoulder joints bc high risk for shoulder impingement, tendinitis, etc.

Question 46

what are the 2 main goals of a wc in thoracic/lumbar and lower cervical SCI

Answer 46

1. optimize prox support to max UE function 2. skin and other soft tissue protection

Question 47

what type of wc/adaptations is appropriate for a lower cervical SCI and why

Answer 47

partial use of UEs * lightweight wc * power assist might not have full grip * tacky rim, spokes

Question 48

what type of wc is appropriate for a mid cervical SCI and why

Answer 48

minimal use of UEs manual wc if enough function for propulsion PWC - community distances, over thresholds in home need tilt/recline system to help w pressure relief/redistribution

Question 49

what are the 2 main goals with a mid cervical SCI

Answer 49

1. optimize prox support to max remaining UE 2. postural support and skin protection to maintain MSK and integ health

Question 50

what impairments might be seen in upper cervical SCI

Answer 50

C3 and up - ventilator neck strength may be impaired

Question 51

what type of wc is appropriate for an upper cervical SCI

Answer 51

PWC * tilt and recline system * drive - sip/puff, tongue touch * room for ventilator

Question 52

what are the 2 main goals with upper cervical SCI

Answer 52

1. careful assessment of appropriate drive mechanism 2. maximize independence thru externally powered: seating, mobility, environment control, communication

Question 53

what type of wc is appropriate for a CVA

Answer 53

manual - method of propulsion * lower seat to floor height to allow LE propulsion power if unable to manage manual

Question 54

why does medicare suck with wc in amputees

Answer 54

makes it hard for both prosthetic and chair to be covered

Question 55

what impairments are seen if the amputation is a complication of DM

Answer 55

vascular insufficiency inc risk for skin/soft tissue breakdown peripheral neuropathy weakness loss of sensation

Question 56

what are 3 common etiologies of LE amputations

Answer 56

complication of DM traumatic congenital

Question 57

what is an important consideration for the wc if the amp is a complication of DM

Answer 57

really focus on skin protection * special attention to residual limb to make sure has enough padding

Question 58

how does a B LE amputee impact the configuration of a manual wc

Answer 58

axle position/plate is further back to prevent tipping over since the COM changed

Question 59

what are reasons you might see a TIS in PD

Answer 59

not just bc of postural control prevalence of OH * trouble statically sitting for prolonged time w/o BP dropping (also can be SE of meds)