W/C Seating and Positioning

Question 1

purpose of wheelchair evaluation

Answer 1

improve functional mobility

promote postural control / alignment

enhance swallowing / respiratory function

skin protection

Question 2

seating principles

Answer 2

stabilize proximal to promote distal mobility

achieve / maintain pelvic alignment

facilitate optimal postural alignment by accommodating ROM impairments

limit abnormal movement

provide the minimum amount of support necessary to facilitate independence

comfort

Question 3

how should the pelvis be positioned

Answer 3

neutral to slight anterior pelvic tilt

Question 4

what does proper pelvic alignment promote

Answer 4

normal lumbar curve
weightbearing through ischial tuberosities
active trunk ROM
co-contraction of trunk muscles

Question 5

level pelvis allows for

Answer 5

equal weight-bearing / pressure distribution

Question 6

what can be implemented to maintain pelvic position

Answer 6

seat belt placed below ASISs

Question 7

who does the seating/positioning eval

Answer 7

PT or OT with advance training

Question 8

ATP and SMS stand for

Answer 8

ATP - assistive technology practitioner

SMS - seating and mobility specialist

Question 9

within the history portion of the evaluation, what should be considered

Answer 9

diagnosis / prognosis

reason for referral

recent/planned surgeries

anthropometrics

co-morbidities

cardio-respiratory status

skin integrity

cognition

activity level

Question 10

how does understanding a patient’s co-morbidities assist eval

Answer 10

understanding the deficits they are facing

Question 11

how does cardio-respiratory status assist in evaluation

Answer 11

if w/c needs to be manual or electric

Question 12

ratio related to ramps

Answer 12

1 inch of rise : 12 inches run

Question 13

doorway width necessary by ADA guidelines

Answer 13

32-34 in wide from inside wall

Question 14

during the evaluation, what should be asked about home environment

Answer 14

type of home
accessibility
ramps/doorways/flooring
support
transportation

Question 15

when will insurance not cover a device

Answer 15

if one is in LTC or SNF

if the home is not accessible

Question 16

during evaluation, how is level of independence assessed

Answer 16

ADLs
Transfers
Ambulation
fall risk
wheelchair skills
ability to perform weight shifts
time spent in w/c

Question 17

when evaluating ambulation, what is the thought process

Answer 17

could a lower level device achieve independent / safe ambulation

Question 18

objective examination in the evaluation

Answer 18

postural assessment
strength
rom
sensation
tone
balance
pain
gait

Question 19

important measurements for eval

Answer 19

total femoral contact length

lower leg length

foot depth

elbow height

axilla height

maximum sitting height

shoulder width

hip width

Question 20

important caveat to total femoral contact length

Answer 20

subtract 2in from measurement to account space between popliteal fold and edge of cushion, to determine seat depth

Question 21

important caveat to hip width in a manual w/c

Answer 21

add 2” to your measurement to allow for movement and avoid hips encountering wheels or armrests

Question 22

important caveat to lower leg length

Answer 22

including AFO, shoe and its cushion

Question 23

head position in a w/c

Answer 23

in midline
eyes forward
slight cervical extension

Question 24

UE positioning in w/c

Answer 24

if arm rests, resting at 90°

if no arm rests, elbow angle between 100-120 flexion with hand resting on top center of pushrim

arm extended = finger tips at axle of manual w/c

Question 25

LE positioning in w/c

Answer 25

hip, knee, ankle at 90° flex knees parallel / slightly higher than hips

Question 26

what is a windswept deformity

Answer 26

one hip is abducted and ER while the other is adducted and IR

Question 27

seat slope or "dump" definition

Answer 27

difference between rear seat floor heights

Question 28

pros of seat "dump"

Answer 28

passive pelvic stability improve hand access to wheels reduce forward slide

Question 29

cons of seat "dump"

Answer 29

decrease lumbar lordosis --> more forward posterior pelvic tilt add pressure to sacrum lateral transfers are uphill

Question 30

propulsion methods associated with manual w/c

Answer 30

bil UE or bil LE hemi-propel all 4 extremities

Question 31

propulsion method associated with power w/c

Answer 31

joystick finger/touch pad sip and puff head array

Question 32

recommended propulsion pattern to teach patients? pros of this?

Answer 32

semicircular - includes push and recovery phase - less stress on shoulders - lower stroke frequency

Question 33

pelvic deformities that could cause improper fitting

Answer 33

posterior pelvic tilt excessive anterior pelvic tilt rotation (anterior/posterior ASIS) obliquities

Question 34

cons of posterior pelvic tilt

Answer 34

sacral sitting slouched / kyphotic posture

Question 35

how are pelvic obliquities named

Answer 35

by lowest side - increased risk for skin break down - associated with scoliosis most often

Question 36

how to correct a fixed vs flexibile deformity

Answer 36

fixed = custom seating flex = positioning devices

Question 37

if seat depth is too long, what positional change occurs and what can that cause

Answer 37

posterior pelvic tilt - sliding forward - circulation impairment behind knee ----> skin break down

Question 38

if seat depth is too short, what positional change occurs and what can that cause

Answer 38

decreased overall surface area contact with thigh - decreased pressure distribution - excess hip abduction - skin breakdown on HS

Question 39

if seat width too narrow, what positional change occurs and what can that cause

Answer 39

increased pressure on trochanters --> risk of skin breakdown at greater trochanter

Question 40

if seat width too wide, what positional change occurs and what can that cause

Answer 40

asymmetrical posture - limit wheel access - postural deformities - obliquities - rotations

Question 41

if footrest height too high, what positional change occurs and what can that cause

Answer 41

decreased overall surface area - lack of thigh support - reduced pressure distribution - excess hip abduction - increased knee flexion

Question 42

if footrest height too low, what positional change occurs and what can that cause

Answer 42

increased pressure on distal thighs - lack of foot support - posterior pelvic tilt - sliding forward - PF Contracture

Question 43

if arm rest too low, what positional change occurs and what can that cause

Answer 43

decreased overall surface contact with forearm - trunk control diminished - shoulder sublux