Wheelchair Seating, Positioning, and Mobility

3 types of wheelchairs

manual, power, scooters

k0001

standard/basic wheelchair, heaviest (40-50lb), least customizable (fixed axle)

k0002

standard hemi height wheelchair, similar to k0001, adjustable dual axle that can accommodate seat pos, seat lower to floor, easier to propel with feet, still very heavy

k0003

lightweight wheelchair, avg weight 38lb, adjustable seat height and depth, flip back arm rests

k0004

high strength, lightweight, avg weight ≤ 34lb, more customization; quick release rear axles, adjustable back height, various arm/leg rests

k0005

ultra lightweight, avg weight < 30lb, adjustable rear axle in both vertical and horizontal, allows for camber, adjustable seat height, allows for customization of all components, allows higher level wheelchair skills

what wc is intended for full time wc users

k0005

what are power assist devices

devices that can be added onto manual wc to assist manual wc users with propulsion

power assist wheels

amplify the force of each push

power add on unit

power wheel that goes on back of chair and propels the chair, user must steer chair; power wheels interchangeable with manual wheels, joystick to control

group 2 power wheelchairs

basic power wc that allows for powered mobility, does not have power seating

group 3 power wheelchairs

complex power wc that allows for powered mobility, with power seating

examples of power seating

power tilt, recline, elevating leg rests, seat elevate, anterior tilt, standing feature

customization options with group 3 power wc

seating, backrest, arm/leg rests, joystick, cushions

what is the most basic form of power mobility

scooters

scooter turning radius

large, not best for indoor mobility

insurance will only pay for a wc that the user needs...

inside the home

must determine if the client requires seating for...

pressure relief, positioning, or both

factors that put pt at high risk for skin breakdown

hx/current pressure sores, impaired sensation, incontinence, spasticity, inability to perform independent position changes and pressure relief

postural deformities that require passive supports

scoliosis, pelvic obliquities, windswept deformities, contractures

foam cushion

most basic option, typically for someone who doesnt have high needs for pressure relief/positioning

gel cushion

provides good pressure relief, can have a cooling effect, can be heavy, requires upkeep

air cushion

best for pressure relief, lightweight, can be unstable

hybrid cushion

combinations of gel/foam, air/foam, etc

pressure mapping use

to get a real time objective measure of increased pressure areas and surface area of pressure distribution; to make seating decisions and lower risk of skin breakdown while improving comfort

most basic option for a drive control for powered wc

basic joystick

alternative drive controls

head, chin, eye gaze, sip and puff, foot

process for a client to get new wc

must see dr and be referred to see PT/OT for wc eval

wc evaluation- subjective

dx, home environment, transportation, caregiver assistance, occupation/hobbies

wc evaluation- objective

posture, seated balance, sensation, ROM, MMT, tone/spasticity, coordinaton, cog, mobility

start fixing posture at _____

pelvis, then work up chain

common seated posture for pt in wc

posterior pelvic tilt and lumbar flexion

sitting balance outcome measures

modified functional reach, FIST

pt are eligible for a new chair through insurance every __ yrs

5

pt are eligible for a new cushion every __ yrs

2