Spinal Cord Wheelchair Prescription Flashcards
1
Q
Goals of a therapist when fitting a patient for a WC
A
- Provide pelvic & trunk stability
- Optimize function for ADLs
- Protect the skin to prevent and/or heal existing pressure injuries
- Max comfort for patient
- Max unwanted movement
- Correct or accommodate for postural abnormalities
- Prevent the progression of postural abnormalities
2
Q
What is DME
A
- The Durable Medical Equipment (DME) benefit category was created over forty years ago to support the medical equipment needs of elderly individuals
3
Q
What is CRT
A
- Complex rehab technology (CRT)
- Highly configurable manual and power wheelchairs
- Adaptive seating and positioning systems
- Other specialized equipment that is prescribed to meet the specific medical needs of individuals with disabilities and chronic medical conditions
- Problem is these highly specialized products are still categorized under the broad durable medical equipment (DME) benefit category
4
Q
Wheelchair fitting for a patient is a team approach (True/False)
A
- True
5
Q
Good indicators that your patient would benefit from wheeled mobility
A
- Patient is non-ambulatory
- Demos decreased safety with ambulation or is at risk for falls within the home
- Requires assistance for ambulation within the home & wheeled mobility would allow independence
- Requires increased time for ambulation within the home
- Unable to consistently ambulate throughout the day in the home which affects their ADLs
6
Q
Questions to help justify your patient’s need for a wheelcahir
A
- Does your pt have a mobility limitation that significantly impairs his/her ability to participate in one or more MRADLs in the home?
- Can the mobility limitation be resolved by a cane or walker?
- Do they have the desire or capability to propel o WC?
- Does the pt’s home have the space/layout for functional WC use?
7
Q
Describe wheelchairs for short-term use
A
- K levels 1-3
- These chairs are heavier, basic manual PCs with minimal adjustability & are most appropriate for short term use
8
Q
Describe wheelchairs for long-tern use
A
- K level 4: Pt qualifies for a basic manual chair but requires a seat width, depth, or height that can’t be accommodated by a basic MWC; unable to perform all ADLs efficiently in a basic MWC; they use a WC more than 2 hrs/day
- K level 5: Pt is a full time WC user, Pt requires customization such as axle configuration wheel camber angle or seat to back angle that can’t be accommodated by a K level 1-4; requires an evaluation by a pt/OT, a letter of medical necessity, & the involvement of an ATP in the equipment selection process
9
Q
When is a tilt in space appropriate
A
- Pt is dependent in mobility
- Pt is unable to perform independent pressure relief
- Pt requires gravity assisted positioning/repositioning
- Pt requires postural support, head & trunk control, and accommodation of postural asymmetries
- Goal is to increase sitting tolerance/endurance
- Pt needs improved line of sight due to forward head posture
- Pt will benefit from trunk support & open thoracic posture for increased respiratory function
- Pt requires safe positioning for feeding/gravity assisted swallowing
10
Q
Criteria for a power wheelchair
A
- Meets all criteria for manual WC
- Pt is unable to propel a manual WC due to UE limitations: strength, coordination, pain, ROM, etc.
- The home as adequate access for maneuvering of the power chair
- Use of the power WC will significantly improve their ability to perform MRADLs
11
Q
A scooter will often be ruled out due to
A
- Poor trunk strength
- difficulty with transfers
- Poor endurance
- Existing postural abnormalities
- Large turning radius
12
Q
Criteria for a group 2 power WC
A
- Meets all of the basic power WC criteria
- Group 2 models are typically characterized by “captain’s seating”
- The pt is unable to safely transfer, operate, & maintain postural stability in scooter
- The home does not provide adequate access for operating scooter
- Pt is able to safely operate a power WC or has a caregiver willing to operate who cannot push a manual WC
- Will improve the ability to participate in MRADLs in the home
- Some models have multi power options available if they qualify for a tilt/recline system or if they use a ventilator that mounts to the chair
13
Q
Criteria for a group 3 power WC
A
- Meets all criteria for a basic power WC and group 2 power
- Pt has a neurological condition, myopathy, or congenital skeletal deformity
14
Q
What makes a group 3 power WC different from a group 2 power WC
A
- Allows integration of rehab seating, & typically has better drive wheel suspension
- Offer multiple alternative drive control options
- Offer the option of power tilt, recline, and/or power legs, & power elevate
- Higher turning radius & increased speeds
15
Q
What is each body part doing during neutral pelvic posture and what is the goal
A
- Goal: maintain proper alignment with an appropriate cushion & back support
- Pelvis is in midline with no pelvic tilt, no obliquity, & no rotation
- Spine is balanced & upright with no rotation and no lateral curvature
- Head is functionally upright with only mild forward/lateral flexion or rotation
