Mod 5: W/C. mobility, numerical STANDARDS

A client who recently sustained a C3 Spinal Cord Injury (SCI) is returning home after an extended stay in an inpatient rehab facility. The OT Practitioner is conducting a home assessment and notes that the only entrance to the client's home has a 1 ½ -inch vertical rise. What is the recommended ramp length (according to ADA standards) needed for proper access to this client’s home?

A 1:12 slope ratio (ADA Recommended) means that for every inch of rise, you will need 12 horizontal inches (one foot) of ramp. Calculations: 1.5 x12 = 18

If the vertical rise to a building is 30 inches, what does the length of an ADA recommended ramp need to be?

The ADA requires that all business and public use wheelchair ramps adhere to a 1:12 slope ratio, meaning that for every one-inch of vertical rise there must be 12 horizontal inches (one foot) of ramp. i.e.: 1 inch vertical =12 inches (1 foot) horizontal. Therefore, a ramp rising 30 inches in height must be at least 360 inches long.

Levels of Asssist

8 total

I

Mod I

Sup.

SBA

MIN

MAX

MOD

total

Countertops

At counters having a cash register, a section of counter at least 36 inches long and not more than 36 inches above the floor will make the counter accessible.

Where food or drinks are served at counters and the counter height is more than 34 inches above the floor, providing a lowered section of the serving counter at least 60 inches long and no higher than 34 inches will make the counter accessible.

The tops of dining surfaces and work surfaces must be 28 inches minimum and 34 inches maximum in height above the floor. EXCEPTION: A counter that is adjustable to provide a kitchen work surface at variable heights, 29 inches (735 mm) minimum and 36 inches (915 mm) maximum, shall be permitted.

Doorways

At least 32'“ (32-26)

Which wheelchair seat width would be BEST for a client of medium stature (average weight and height) but often wears heavy clothing for colder climates?

20”

Standard widths for wheelchairs are 16" (narrow adult), 18" (average adult) and 20" (wide adult).

The general rule of thumb method, of determining the correct seat width is to add 2" to the measured width of the user (when seated at their widest point, usually at the hips). As the objective is to allow enough room for this patient to sit comfortably while wearing a thick winter coat, extra room is needed.

Standard W/C measurements for Proper Fit: Seat Width Measure the widest aspect of the user’s hips or thighs and add 2 inches. This will provide space for bulky clothing, Average adult size = 18 inches, therefore 18 + 2 = 20 inches

WIDTH: Standard W/C measurements

Standard widths for wheelchairs are 16" (narrow adult), 18" (average adult) and 20" (wide adult)

Kaden is a 7-year- old first grader with a diagnosis of ataxic quadriplegic cerebral palsy. The OTR® has asked the COTA® to assist with taking measurements for a new wheelchair for Kaden, since he is growing out of his current chair. What measurements should the COTA® expect to assist with? Select the best 3 choices.

1⃣ Seat WIDTH

What to measure:

• Widest part of hips/thighs

Rule:

Hips + 2 inches

Why:

• Prevents skin breakdown

• Allows clothing clearance

2⃣ Seat DEPTH (length)

What to measure:

• Back of buttock → back of knee (popliteal fossa)

Rule:

Buttock to knee − 2 inches

Important detail:

• Measure both legs

• Use the longer leg

Why:

• Prevents pressure behind knees

• Allows circulation

3⃣ Armrest HEIGHT

How to position client:

• Shoulders relaxed

• Elbows bent 90°

Rule:

Elbow height = armrest height

Why:

• Prevents shoulder elevation or slouching

4⃣ Backrest HEIGHT

Depends on trunk control:

• Good trunk control:
  → 1–2 inches below scapula

• Moderate trunk control:
  → Mid-scapula

• Poor trunk control:
  → Top of shoulders

Rule to remember:

Less control = higher back

5⃣ Footrests

Rule:

2 inches off the floor

Why:

• Prevents dragging

• Maintains proper posture

Wheelchair Measurement

Width = hips +2 | Depth = buttock-to-knee −2 | Armrest = elbow @ 90° | Back = based on trunk | Footrests = 2″ off floor

Toilet height

18

ADA toilet = 17–19″ (pick 18″)

Standard Narrow Adult Wheelchair

16″ W × 16″ D × 19.5″ H

 Depth of junior standard wheelchair?

Correct: 16 inches

Why you missed it:
You assumed kids = smaller depth

Rule:

Junior & adult depth = 16″

Junior wheelchair seat height

Correct: 18.5 inches

Why you missed it:
You underestimated height

W/C Measurement: Seat Height

Measurement used as part of a comprehensive w/c prescription, determined by measuring from popliteal fossa to the bottom of the heel

W/C: Armrest heigh

Seat surface to the olecranon process with the elbows flexed at 90*

W/C: Mid height back

Seat surface to the inferior angle of the scapula