Wheelchair Seating & Positioning Terms | Psychology Study Set

durable medical equipment

not custom to the patient

some adjustability within each category

width and depth in 2" increments, height

fewer accessories and functions

complex rehab technology

custom ordered for the patient

the most customizability of accessories and functions of the seating system

requires more extensive justification

a wheelchair is a medical necessity when

the person's condition is such that, without the use of a wheelchair, the person would otherwise be unable to ambulate about the home to complete MRADLs

factors affecting risk for skin breakdown

decreased sensation

mobility limitations

postural deformities

age

nutrition

previous skin breakdown

incontinence

shear forces with mobility

weight shifts when sitting should occur every

30 minutes

postural evaluation

observation with and without support

palpate and examine the pelvis in unsupported sitting

examine the trunk in unsupported sitting

postural examination of pelvis

sagittal plane: tilt

coronal plane: obliquity

transverse plane: rotation

postural examination of trunk

sagittal plane: kyphosis/lordosis

coronal plane: scoliosis

transverse plane: rotation

fixed/non-reducible posture

the skeleton does not move out of that posture

the equipment needs to accommodate the abnormal posture

goal is to prevent further progression

flexible/reducible posture

posture can be changed

not all can be corrected to neutral

find a posture that can be maintained overtime that optimizes function

goal is to prevent the posture from becoming non-reducible (might be gradual based on tolerance)

pelvis sagittal plane examination: tilt

assess ASIS and PSIS on same side

neutral pelvis

has the ASIS/PSIS in parallel to seat plane

anterior pelvic tilt

has the ASIS inferior to PSIS

posterior pelvic tilt

has the PSIS inferior when compared to the ASIS

pelvis coronal plane examination: obliquity

anatomical landmarks PSIS OR iliac crest

pelvic obliquity is named for

the side that is depressed

causes of pelvic obliquity

leg length discrepancy, contractures, muscle imbalance, scoliosis

pelvis transverse plane: rotation

anatomical landmark: bilateral ASIS

assess depth of one side to the other

pelvic rotation is caused by

muscle imbalances such as hemiplegia or decreased ROM on one side

how to assess true hip flexion

requires 2 therapists

therapist A palpates the ASIS and PSIS on same side while therapist B passively ranged the hip into flexion on the ipsilateral side

therapist A assessed when the first movement of the pelvis into posterior tilt occurs

DETERMINES SEAT TO BACK ANGLE

too open seat to back angle

impacts interaction with the environment and performance of ADLs and MRADLs, could also promote sliding forward

too narrow seat to back angle

forcing the body to sit at an angle that their body cannot tolerate will cause them to slide forward and sit more on bony prominences, increasing skin breakdown risk

how to assess true knee extension

assessed in supine with the hip positioned in true flexion

palpate the lateral femoral condyle (axis)

one arm is stabilizing femur and the other arm is mobilizing the shaft of the tibia into knee extension

once hamstring tension is felt (while hip flexion is maintained), complete goniometric measurement of knee extension

why does knee extension matter?

if leg rest is positioned at an angle that is greater than their hamstring ROM their feet may slide back off the footplates or may slide pelvis forward

the less tucked someone is, the longer the chair is and the total turning radius

true ankle dorsiflexion

true hip flexion, knee extended, limb stabilized in this position the ankle is flexed to the point of tissue tension and a goniometric measurement is taken

trunk position

the ability to interact with the environment and use upper extremities within ADLs

if upper extremities are needed for balancing the trunk they can not propel a manual wheelchair efficiently or drive a power wheelchair

manual tilt in space

utilized frequently by patients who require total A for weight shifts

user can not typically self propel, heavy in weight, more difficulty to transport

axle placement upwards

center of gravity moves down which provides increased stability

axle placement downwards

moves the user up in wheelchair

axle placement forward

most efficient propulsion when axis is anterior to user's shoulder

pro: decreased risk of shoulder injury, more ease with functional wheelies

con: increased risk of tipping chair backwards

seat to back angle

often dictated by true hip flexion measurements

can be adjusted via the back canes or backrest

seat to back angle > 15 degrees from 90 degrees not recommended due to increased pressure on sacrum in sitting

group 1 power mobility

no specialized seating

no power seat functions

drive control is via arms on center tiller

group II power mobility

limited specialized seating

less power

few power seating options

primarily sit and go

group III power mobility

highly customizable

power seat functions

specialized electronics for alternative drive controls

group IV power mobility

not recognized by medicare and therefore not covered by medical insurance

can accommodate a power standing feature

better suspension while riding

better batteries/longer battery life

recline with legs

repositioning, pain reduction, personal care access, edema management, bladder management/toileting, decrease need for transfers

caution with sheering forces

tilt

good if not able to perform pressure relief independently or consistently

consider cognition, strength against gravity in UE, multi step direction following

seat elevator

useful for transfers, eye contact with social interactions, return to school/work

power mobility drive control options

UE driven, head driven (chin mount, head array), breath driven (sip and puff), eye gaze driven