Wheelchairs/DME

Question 1

Wheelchair Ramps

Answer 1

-1 foot of ramp: 1 inch of height
-include height of threshold
-Consider Pt endurance and abilities
-Consider rails
-Can attach “grade aids” on wheelchair to catch to prevent falling down ramps

Question 2

WC Considerations

Answer 2

-Manual/Power/Power-assist
-K levels
-Measurments
-Standard/tilt/recline
-Features

Question 3

K Level Considerations

Answer 3

1. Is a WC needed to perform ADLs?
2. Do they sit in it <3h a day?
3. How far can they walk?
4. Can they push a standard WC (50lbs)?
   -can they push lightweight (35lbs)?
   -Drive a scooter?
   -Motorized WC?

Question 4

Motorized WC vs Scooters

Answer 4

Scooters:
-less table side to side
-more trunk support needed
-less expensive
-ideal for walking shorter distances
-has one big pole

Question 5

Tilt vs Reclining WCs

Answer 5

Tilt:
-will not fold
-fixed hip angle

Reclining:
-can fold
-hip angle changes with recline

Question 6

Basic WC Parts

Answer 6

Frame: rigid vs folding (what we use)

Backrest: solid vs upholstery

Seat: Flat vs dump (more stable)

Wheels: fixed vs quick release (lighter)

Axel Position: fixed vs adjustable (alters BOS and stability, longer=stable)

Wheel Camber (rear wheels): Vertical (more stable) vs Cambered (for sports)

Wheel locks (UE ability: high vs low mount brakes

Tires: Pneumatic (comfy, more maintenance), Solid (decreased shock absorption, dec maintenance), solid inserts (combo)
Caster (front wheels)

Arm rests: fixes, removable, full length, desk length, adjustable

Question 7

Seat Width

Answer 7

-Hip to hip
- < 1 1/4 inch wider than hips

Question 8

Seat Depth

Answer 8

-Butt to popliteal
- 1-2 in less than post butt to popliteal fossa

Question 9

Seat Height

Answer 9

-frame to floor
-consider lower leg length, transfers, and propulsion
-Standard: 19-19.5”
-Hemi: 17-17.5”

Question 10

Backrest Height

Answer 10

-mid back to frame
-consider trunk support and motion of scap

Question 11

Footrest to Seat Distance

Answer 11

-popliteal space to heel
-measure with cushion and shoes on
-consider clearance from floor

Question 12

Armrest Height

Answer 12

-armrest to frame
-measure with cushion

Question 13

Posture in WC

Answer 13

-Shoulders even or ant to hips
-Scaps Protracted
-Shoulder ER and ABD
-Forearms Pronated
-APT
-Equal WB in ish tubs
-hips flx <90
-Knees lower than hips
-ankles in neutral

Question 14

DME Funding

Answer 14

-Medicare 80% under part B
-Must be in WC 4hr a day
-Medicare pays 0% for bathroom equipment
-Medicare wont pay for a fully electric bed

Question 15

Home Exercise Programs

Answer 15

-Self-ROM
-Closed chain exercises
-Weight Shifts

Question 16

Weight Shifts

Answer 16

-2 mins every 30 minutes

C4 and up: dependent unless tilt in space

C5: hook and lean for ward or to side
-arms but limited
-Biceps/traps/delts/brachioradialis

C6: hook and lean forward or to side
-if they have wrist extensors can lean more

C7: WC push-up if strong enough
-partial triceps

Para: WC push up

Question 17

Americans with Diabilities

Answer 17

-1990
-Expanded previous laws to require newly built or renovated buildings are accessible to people
-tenants have a rifght to modify rental properties
-physical barriers removed
-doesn’t apply to privately owned homes

Question 18

Medicareca

Answer 18

-federal funding
-65< OR 2yrs with a disabiliy
-medical neccesity in home mobility is priority
-1st time purchase or modification
-manual vs power
-change of function in less than 5 yrs needs a new diagnosis

Question 19

Medicaid

Answer 19

-state funding
-disabled OR low income OR 21 or younger

Documenation:
-Title X1X functions as the Rx
-letter of justification
-medicaid as go pay, medicaid pays leftover from medicare

Question 20

Comprehensive Rehabilitation Services

Answer 20

-last resort funnding
-TBI and SCI from external force
-at least 15
-medically stable
-citizen