Wheelchairs and Posture Flashcards by paddy porter

Age distribution of wheelchair users (Tayside)

66%>65
20% >85
17% <45

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process of provision for a wheelchair

Referral
assessment
prescription
delivery
review

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What are the 4 main types of wheelchairs provided?

manual attendant propelled
manual occupant propelled
powered occupant controlled (indoor only (EPIC) indoor/outdoor (EPIOC)
powered attendant controlled (outdoor only)

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Lighter weight Wheelchairs

Dash Lite

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Active User Wheelchairs

Folding frame:
Sunrise Neon
Rigid frame:
Sunrise helium

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Propulsion Systems

Levers--> Efficient, cumbersome
Cranks--> Efficient, cumbersome
Feet--> Immediate option
Somebody else--> Dependency
Handrims--> Simple, independent 
Electricity--> Complex
Engine--> Noisy, smelly

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What is important to bear in mind about foot propulsion wheelchairs?

Seat height
castor size
cross brace

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What is important to bear in mind about handrim propulsion wheelchairs?

Wheel size
 Horizontal wheel position
 Vertical wheel position
 Handrim diameter
 Handrim cross section
 Camber
 Alignment
 Tyre type
increased wheel base for stability

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Preferred elbow angles

Able bodied 100o - 120o
(Amsterdam)
 Able bodied 107o- 118o
(Dundee)

 MS 90o - 110o
 SCI 128o - 135o

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Manoeuvrability

Castor rake
 Castor diameter
 Wheel position

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Indoor Chair

Compact
 Small turning circle
 Small drive wheels
 Low power

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Electric Powered

Indoor/Outdoor Chair (EPIOC)

Larger drive wheels (rear, mid and front)
 Greater power
 Greater torque
 Greater Range
 Ability to climb kerbs

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Stability

Wheelbase
 Position of centre of gravity (must be in front of the rear wheel axis)
 User weight
 Anti-tippers
 Castor orientation
 Camber

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Obstacle climbing

 Castor diameter
 Wheel diameter
 Anti tippers

Kerb climber
Device which enables the wheelchair to ascend kerbs
of up to 4” high
 Contacts kerb first and lifts castors up onto
pavement

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Central vs bilateral kerb climber

central 
simpler
 direction less critical
 impede transfer
 impede foot position
Bilateral 
more complex
 direction more critical
 swing out of way for
transfers

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What two factors are important for directional stability?

wheelbase

castor trail

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Skin Ulceration

Stage 1: Non-blanchable erythema of intact skin

Stage 2: Partial-thickness skin loss involving epidermis or dermis, or both

Stage 3: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue, which may extend down to but not through underlying fascia

Stage 4: Full-thickness skin loss with extensive destruction, tissue
necrosis, or damage to muscle, bone, or supporting structures
(such as tendon and joint capsule)

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pressure sore factors

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immobility
impaired sensation 
 Pressure &amp; TIME
 Impact
 Shear
 Temperature
 Humidity
 Circulation
 Nutrition
 Skin Integrity
 Smoking
 low B.M.I.

formula for pressure

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p=F/A

Measuring problems with pressure

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 Accuracy
 Hysteresis
 Creep
 Repeatability
 Temperature
 Deformation

Statistics on pressure sores

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Cell values
 Overall Max
 Overall Min
 Average
 Variance
 Number of Cells

What are the desirable design objectives of a cushion?

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Even pressure distribution
 Low temperature at skin surface
 Low humidity at skin surface
 Pelvic stability
 Practicality of usage

Watch Out For

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Clinic Effect’ - patient adopts different posture when monitored
 Accurate Information - what do they spend
significant time sitting on

‘Ideal’ Pelvic Posture

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 Neutral alignment: head balanced
over spine, spine balanced over
pelvis
 Neutral pelvis: ASIS and PSIS
are level
 Natural spinal curves
 Shoulders slightly posterior to
pelvis
 Head in neutral position with eyes
(gaze) forward
 Equal weight bearing through
ischial tuberosities

Spinal ‘Correction’

3 point fixation

Asymmetrical Postures

Posterior Pelvic Tilt Anterior Pelvic Tilt Pelvic Obliquity Pelvic Rotation

Posterior Pelvic Tilt

```  Most common pelvic tendency  ASIS in higher than the PSIS  Flexed lumbar spine  Thoracic kyphosis  Shoulder protraction  Increased cervical extension  C-type posture ```

What Causes a Posterior Pelvic Tendency? Wheelchair considerations:

``` Seat depth too long Back support too short Sling back upholstery Elevating leg rests Lower extremities are not supported well ```

What Causes a Posterior Pelvic Tendency? Physical conditions

Tight hamstrings – Knee Extension Reposition themselves by sliding Can not maintain 90º of hip flexion

Anterior Pelvic Tilt

``` ASIS in lower than the PSIS  Increased lumbar lordosis  Thoracic kyphosis is reversed or reduced  Shoulder retraction ```

What Causes an Anterior Pelvic Tilt?

``` Weak muscles/Low tone  Weak hamstrings  Weak abdominals  Tight hip flexors (ilipsoas and rectus femorus) ```

Pelvic Obliquity

``` One ASIS is higher than the other  Compensatory C-shaped curve in the lumbar and thoracic spine  The shoulder on the side of obliquity tends to be elevated  The obliquity is named for the side that is lower ```

What Causes a Pelvic Obliquity? | Wheelchair considerations

Sling back upholstery Wheelchair too wide

What Causes a Pelvic Obliquity? | Physical conditions

Muscle Imbalance Irregular muscle tone (high or low tone on one side of the trunk)

Pelvic Rotation

``` One side of the pelvis is more forward than the other side  Keep in mind that some level of pelvic rotation is usually found in an individual who has a pelvic obliquity ```

Pelvic Positioning Considerations

``` 3 points for pelvic stabilization: seat, back & anterior support  The pelvis is the keystone of positioning  Optimize independence  Enhance function  Promote comfort/Relieve pain  Distribute pressure  Correct flexible deformities  Accommodate fixed deformities  Minimize postural supports  Do not over position: Sitting is a dynamic activity ```

Lower Body ‘Ideal’ Posture

```  Feet flat on footplate in neutral position  Ankles 90 º  Knees 105 º & neutral abduction  Femurs parallel to seat  Footplate position allows 2” clearance from floor  1” space from back of knee to front of seat ```

Lower extremity positioning directly affects the.....

position of the pelvis

Lower extremity positioning helps sustain the.....

position of the hips and knees

Correct positioning assists in the prevention of .....

deformities and distributes pressure

Footplates positioned too low increase....

pressure under the thigh

Footplates too high increase ....

sacral area | pressure

Do not over position

Balance function & | support

Wheelchairs and Posture Flashcards

(43 cards)