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Neuro Exam 3 > Wheelchair Presciption > Flashcards

Wheelchair Presciption Flashcards

0
Q

Power vs. Manual

A
  • Power : bulky, heavy; expensive; specialized transport; maintenance issues
  • Manual : smaller, lighter; less expensive; transport by car; improves fitness/can lead to overuse issues
  • Team decision in collaboration with the pt.
  • Delay decision until rehab well underway.
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1
Q

3 Types of Chairs

A
  • Manual
  • Power
  • Push Rim Activated Power Assist Wheelchair (PAPAW)
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2
Q

When to Select a Power Chair?

A
  • insufficient strength to propel a manual WC
  • need to cover long distances - uneven terrain
  • certain medical or orthotic problems
  • high risk for overuse injury
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3
Q

Manual Chair - C4-C6 level implications

A
  • C4 - unable to propel
  • C5 - limited distance indoors
  • C6 - may be too slow or tiring to use. Power chair may be more suitable for lifestyle or priorities.
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4
Q

Selecting a Manual Chair

A
  • lightest wt possible
  • stable frame for efficient use
  • quality
  • optimal wheel size
  • best combo of ease of propulsion and stability
  • fitted to prevent overuse injury
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5
Q

Manual Chairs - Types

A
  • folding frame

- rigid frame

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6
Q

Rigid vs. Folding Wheelchair - Pros and Cons

A
  • Rigid “+” = easier to propel; fewer components/stronger; usually lighter; seat to back angle adjustable
  • Rigid “-“ = bumpier on uneven surfaces; harder to store
  • Folding “+” = easier to store; smoother ride on uneven surfaces
  • Folding “-“ = seat to back angle non-adjustable; more components to break; harder to propel
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7
Q

Wheelchair Components

A

Handrim with vertical projections, molded wheels, handrim, tire, back post, tipping lever, wheel lever/lock, caster, cross brace, bottom rail bar, foot plate, heel loop, elevating adjustable leg rest with calf pad, seat raill, seat, clothing guard, bback tube, back, handgrip, full-length fixed armrest, full-length removable armrest, desk style removable armrest, height adjustable armrest with full length top.

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8
Q

Seat Depth

A
  • measure from posterior buttocks to popliteal fossa, then subtract 1-2 inches
  • important for good postural support (and pressure relief)
  • if too short - extra pressure on buttocks
  • if too long - impedes circulation if into popliteal fossa
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9
Q

Seat Width

A
  • measure the widest portion of the pt., add not more thann 1-1/4 in, account for braces, etc.
  • as narrow as possible for optimal function
  • if too narrow - skin breakdown - greater trochanter
  • if too wide - harder to propel, skin breakdown, limited on where you can take a wide w/c
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10
Q

Seat Height

A
  • seat rail to the floor
  • need to know the height of the cushion
  • finished seat height considerations: propelling chair with foot (lower to ground, leg rests need to clear the ground), transfers (surface transferring on to), approaching work surface (under desk/table, height of van, public transportation, etc.)
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11
Q

Seat Height - can be altered by:

A
  • altering frame construction
  • changing wheel size
  • thickness of seat insert/cushion
  • removing upholstery and add a seat board
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12
Q

Seat Surfaces

A
  • firm surface is more stable (and more comfortable)
  • different options available: sling (slumped sacral sitting posture), taut fabric, solid metal/plastic base, solid hook on seat
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13
Q

Seat

A
  • standard (thin cushion)

- solid (solid seat insert, put cushion on top, take out when fold)

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14
Q

Wheelchair Back

A

(for support and comfort)

  • can be fixed or adjustable
  • upholstery or solid (plastic)
  • if too high - impedes shoulder ROM
  • if too low - not enough postural support
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15
Q

Pelvic Positioner

A
  • several functions, angle between 45 and 60 degrees

- how to fasten - velcro, buckle (like seatbelt)

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16
Q

Arm Rests

A
  • consider height and length of arm rests
  • if too high - shoulder are in bad position
  • if too low - lean over to support themself on armrests, postural problems
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17
Q

Footrests/Legrests

A
  • swing away/elevating
  • if too long - slide out of chair, sacral sitting, slumped posture
  • if too short - sacral sitting - too much weight on sacrum
  • angle of front rigging - pt. may have tight HS
  • several styles of footrests
  • calf straps/heel loops
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18
Q

Casters/Hangers

A
  • little wheels in front
  • 4-8 inches in standard
  • smaller the caster, tighter the turn (the more maneuverable)
  • larger casters - easier for terrain
  • Hangers - part of leg rest that attaches to wheelchair (from 60 to 90 degrees)
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19
Q

Tires

A
  • standard or solid (don’t put air on it, not much tread - no traction, easier to roll, but bumpier ride)
  • pneumatic (put air in, easier ride, need to know how to change a tire)
  • airless inserts (hybrid, softer ride, no air in it, expensive)
  • grade aids (prevent from rolling backwards)
20
Q

Wheel Position

A
  • up and down affects seat height and overall stability
  • Moving wheel backward: pt. COM moves forward, more energy to steer, increases amount of shoulder extension, increases stress on UE
  • Moving wheel forward: pt. COM moves backward, easier to steer, less stressful on UE, but chair less stable (more likely to tip over backward, harder to transfer)
21
Q

Wheel Design

A
  • Mag Wheels - lightweight, maintenance free, less efficient

- Wire of Spoke Wheels - tightening spokes, maintenance

22
Q

Wheel Rims

A
  • Coated Rims - more comfortable, gives a little friction
  • The Natural-Fit - larger surface to grasp, over hand rims
  • Pegs or Projection
  • can get wheelchair gloves to protect hands
23
Q

Wheels

A
  • quick release wheels
  • camber (angled wheels, top close to wheelchair than bottom, done to make more stable, increases overall width of the wheelchair
24
Q

Locks

A
  • push vs. pull - depends on hand function
  • high vs. low - high = easier but in the way when propelling
  • front vs. back - back = convenience of the caregiver
  • extensions - longer LA, make it easier to reach and STR
  • anti-tip bars - keep from falling over
25
Q

Gradeaid

A
  • attached to WC locks

- prevents chairs from rolling backwards (when going up an incline)

26
Q

Accessories

A
  • Upper Extremity Supports
  • BFO - balanced FA orthosis
  • MAS - mobile arm support
  • can assist in feeding, can keep arm from sliding backward, etc.
27
Q

Power Chairs

A
  • order all parts separately
  • mobility base
  • seating system
  • control options
  • access devices
  • controller
  • battery
28
Q

Front Wheel Drive

A
  • intermediate turning radius
  • good fro traversing curbs, uneven terrain
  • tends to fishtail at higher speeds
29
Q

Rear Wheel Drive

A
  • largest turning radius
  • better shock absorption and foot clearance
  • better control at higher speeds
  • bigger wheel on back
30
Q

Mid-Wheel Drive

A
  • smallest turning radius
  • most stable on slopes
  • good indoor chairs
  • 6 tires
31
Q

Seating System

A
  • stationary - less expensive, pt. I with pressure relief
  • reline - backrest reclines, may elicit spasticity, good for intermittent caths, requires long wheel base
  • tilt - constant angle between seat and back, less likely to elicit spasticity or alter sitting position
  • requires long wheel base
  • tire/recline - allows both
  • can add an elevator feature
32
Q

Tilt in Space

A

-the chair tilts on the base

33
Q

Power Recline

A

-base of chair must be longer, folds out into laying position

34
Q

Control Options

A
  • proportional - works like a gas pedal, more you push, the faster you go (joystick)
  • non-proportional - off and on, speed may be set, puff and sip
  • momentary - as soon as you let go of the pedal, it stops
  • latched - move until do something to make it stop (for ex. - sip)
35
Q

Access Devices

A
  • chin nob operated
  • joystick - most often seen
  • sip-and-puff
36
Q

Controller

A
  • “brain” of the wheelchair

- can adjust: max speed, rate of acceleration/deceleration

37
Q

Battery

A

-rechargable
good for about a year
-charge every day

38
Q

Accessories

A
  • Head and Neck Support
  • headrests
  • neck collars
39
Q

Supports/Positioners

A
  • chest straps
  • lateral trunk supports
  • pelvic positioners
40
Q

PAPAW - stands for?

A

push rim activated power assist wheelchair

41
Q

Wheelchair Cushions

A

-pressure relief
-postural support
(try to get the best combination of pressure relief and postural support)
-weight
-maintenance
-expense - $400-$500

42
Q

Types

A
  • foam
  • air-filled - roho (great for pressure relief, not for posture, don’t inflate too much, heavy, high maintenance)
  • gel or fluid - Jay cushion
  • all are heavy
43
Q

Evaluating the Patient

A
  • examine in gravity minimized position (supine/SL)
  • sitting
  • Goal: neutral posture with good lumbar/trunk alignment
44
Q

Measurements (review picture)

A
  • seat depth
  • leg measurement
  • back height
  • hanging elbow
  • trunk width
  • trunk depth
  • hip width
  • foot length
45
Q

Wheelchair Skills

A
  • practice in the “real world”
  • propelling without full hand function: technique (push in, then forward), pegs, wrapping rim
  • hard surface/open space
  • practice builds skill and stamina
46
Q

Overuse Injuries

A
  • manual WC propulsion major contributor
  • proper position - hand at apex of the rim - 100 -120 degrees of elbow FL
  • risk factors: repetitive stress injuries (primarily shoulder), carpal tunnel
  • prevention strategies: properly fitted WC, training pt. in proper propulsion, ordering WC as light as possible, techniques (inertia), consider if need to be in power-assist or power WC
47
Q

Pt. with Marginal Potential for WC Use

A
  • pre-existing UE pathology
  • older
  • obese
  • longer distances/unlevel terrain

Neuro Exam 3 (2 decks)

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