Exam 4 Study Guide: Wheeled Mobility and Neurorehabilitation

These flashcards cover key concepts and specific details related to wheeled mobility and neurorehabilitation as outlined in the final exam study guide.

What are the three levels of wheelchair need?

Basic, Intermediate, Complex.

What characterizes a Basic wheelchair need?

Can sit upright with minimal support, no major medical limits; standard manual chair usually adequate.

What characterizes an Intermediate wheelchair need?

Requires some postural support and/or pressure relief, possibly due to mild fixed deformity or increased risk; often needs custom components.

What characterizes a Complex wheelchair need?

Significant postural support and pressure relief, multiple fixed deformities, high risk of complications; may require advanced seating systems, power mobility, or custom molding.

What is the first step in the seating & mobility service delivery?

Identification of need & referral.

What are the eight basic steps in seating & mobility service delivery?

1. Identification of need & referral 2. Assessment 3. Prescription/selection 4. Funding & ordering 5. Product preparation 6. Fitting 7. User training 8. Maintenance, repairs, follow-up.

What does optimal sitting posture refer to?

Energy-efficient alignment that best supports function and health; may differ from neutral due to fixed deformity.

What is the purpose of seat width measurement in wheelchair fitting?

Width of hips + about 1 inch to avoid pressure and ensure stability.

At what angle is the seat-to-back typically recommended?

80–120°.

What does pressure relief entail in wheelchair use?

Unloading pressure every 15-30 minutes for 30-60 seconds.

What is a common risk factor for skin integrity in wheelchair users?

High daily sitting time and bony prominences.

What cushioning option is meant for high risk of pressure injury?

Custom-molded cushions.

Which propulsion method is recommended for wheelchair users?

Long, smooth propulsion strokes.

What are the indications for using power mobility?

Severe weakness, fatigue, cardiopulmonary limitations, poor motor control, and severe cognitive/perceptual deficits.

What are the key objectives of locomotor training?

Reduce impairments, modify gait pattern, and train adaptability for community mobility.

Name two principles of neuroplasticity important in rehabilitation.

Use it or lose it, and use it and improve it.

What is Fitts law?

Higher accuracy demands lead to slower movement time and lower accuracy allows for faster movement.

What are the key factors in reach and grasp movements?

Visual and somatosensory feedback, coordination of eye-head-trunk movements, and force of grasp depending on object perception.

What characterizes a Stage 1 pressure injury?

Non-blanchable erythema of intact skin.

What characterizes a Stage 2 pressure injury?

Partial-thickness skin loss with exposed dermis, appearing as a shallow open wound.

What characterizes a Stage 3 pressure injury?

Full-thickness skin loss, with adipose (fat) tissue visible, granular tissue often present, and epibole (rolled edges) common.

What characterizes a Stage 4 pressure injury?

Full-thickness skin and tissue loss with exposed fascia, muscle, tendon, ligament, cartilage, or bone.

What characterizes an Unstageable pressure injury?

Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.

What characterizes a Deep Tissue pressure injury?

Persistent non-blanchable deep red, maroon, or purple discoloration of intact or non-intact skin.

What is the most appropriate seating position for optimal alignment in a wheelchair?

Pelvis in a neutral tilt, hips flexed to 90°, knees flexed to 90°, feet flat on the footrests.

What is the significance of assessing pelvic alignment before positioning other segments?

Pelvic alignment forms the foundation for seated posture, influencing spinal and trunk positioning.

What component of wheelchair fitting addresses pelvic alignment and promotes upright posture?

Posterior pelvic positioning belt mounted at 45 degrees.

What is the purpose of seat depth measurement in wheelchair fitting?

To support the full length of the thigh, typically leaving 1-2 inches from the popliteal fossa to prevent pressure behind the knee while distributing weight effectively.

Why is appropriate footrest height important in wheelchair fitting?

To ensure feet are supported, hips and knees are at 90 degrees (or prescribed angle), and to prevent pressure on the sacrum or thighs from an unsupported or too high/low position.

What is the significance of correct armrest height in wheelchair fitting?

To provide support for the upper extremities, assist with trunk stability, aid in pressure relief (unloading weight from the buttocks), and facilitate transfers, all without causing shoulder impingement or excessive shrugging.

What is the primary function of the tilt-in-space feature in a wheelchair?

To change the client's seated angle while maintaining hip and knee angles, primarily for pressure redistribution, postural stability, and improving head control without altering body angles relative to each other.

What are some common intrinsic risk factors for pressure injury development in wheelchair users?

Impaired sensation, immobility, poor nutrition, incontinence, altered mental status, and circulatory problems.

What is the primary function of Magnetic Resonance Imaging (MRI) in neurodiagnostics?

To produce detailed images of brain structures and soft tissues using strong magnetic fields and radio waves, without ionizing radiation.

What types of conditions is MRI particularly effective at detecting in the brain?

Tumors, strokes, demyelinating diseases (e.g., Multiple Sclerosis), infections, and structural abnormalities.

How does a Computed Tomography (CT) scan work in neuroimaging?

It uses X-rays from multiple angles to create cross-sectional images of the brain, particularly useful for visualizing bone, acute hemorrhage, and calcifications.

When would a CT scan be preferred over an MRI in an emergency neurodiagnostic setting?

For rapid assessment of acute trauma (e.g., skull fractures, intracranial hemorrhage) or in patients with contraindications for MRI (e.g., certain metallic implants).

What does functional Magnetic Resonance Imaging (fMRI) measure?

It measures brain activity by detecting changes associated with blood flow (BOLD response), often used to map brain regions for specific functions like language or motor tasks.

What is Electroencephalography (EEG) used for in neurodiagnostics?

To measure and record the electrical activity of the brain using electrodes placed on the scalp, primarily for diagnosing epilepsy, sleep disorders, and evaluating brain function.

What is the purpose of Positron Emission Tomography (PET) in neuroimaging?

To visualize metabolic activity (e.g., glucose metabolism) or receptor binding in the brain by using radioactive tracers, often used in oncology, dementia, and movement disorders.

What neurodiagnostic imaging technique is used to visualize blood vessels in the brain?

Cerebral angiography (or MRA via MRI, or CTA via CT), which uses contrast material to highlight blood flow and detect aneurysms, blockages, or malformations.

What does CAMP stand for in nerve studies?

Compound Action Muscle Potential.

What does CAMP refer to?

The sum of action potentials from multiple muscle fibers innervated by a nerve, representing the muscle's electrical response to nerve stimulation.

What can a reduced CAMP amplitude indicate?

Loss of axons (axonal damage) or a conduction block (failure of nerve impulse to propagate across a segment).

What does 'delayed onset latency' indicate in a nerve conduction study?

Slower conduction along the fastest conducting fibers of a nerve, often indicating demyelination (damage to the myelin sheath).

Besides latency and CAMP, what other key parameter is measured in nerve conduction studies?

Nerve conduction velocity (NCV).

What does a decrease in nerve conduction velocity (NCV) primarily suggest?

Demyelination, as myelin is responsible for rapid signal propagation.

What is often observed in the waveform morphology of a demyelinated nerve?

Temporal dispersion (spreading out of the compound muscle action potential) or conduction block.

What can an abnormally prolonged F-wave latency suggest?

Proximal nerve segment pathology (e.g., demyelination in the nerve root or plexus) or generalized slowing.

What is the significance of an absent or reduced F-wave response?

Indicates severe nerve damage, particularly in the proximal segments, or generalized nerve excitability issues.

Explain the "use it or lose it" principle of neuroplasticity in rehabilitation.

Neural circuits not actively engaged in their specific functions may degrade or be reassigned, leading to a loss of function.

Explain the "use it and improve it" principle of neuroplasticity in rehabilitation.

Training and engaging specific neural circuits can lead to their enhancement and improved functional capacity.

Why is an additional inch of space recommended for seat width beyond hip measurement in wheelchair fitting?

To avoid pressure on the hips and ensure sufficient stability and clearance.

Why is it important to leave 1-2 inches of space from the popliteal fossa during seat depth measurement?

To prevent pressure behind the knee, which could lead to skin breakdown or circulatory issues, while still adequately supporting the thigh.

What characterizes a Stage 3 pressure injury?

Full-thickness skin loss, with adipose (fat) tissue visible, granular tissue often present, and epibole (rolled edges) common.

What characterizes a Stage 4 pressure injury?

Full-thickness skin and tissue loss with exposed fascia, muscle, tendon, ligament, cartilage, or bone.

What characterizes an Unstageable pressure injury?

Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.

What characterizes a Deep Tissue pressure injury?

Persistent non-blanchable deep red, maroon, or purple discoloration of intact or non-intact skin.

What is the most appropriate seating position for optimal alignment in a wheelchair?

Pelvis in a neutral tilt, hips flexed to 90°, knees flexed to 90°, feet flat on the footrests.

What is the significance of assessing pelvic alignment before positioning other segments?

Pelvic alignment forms the foundation for seated posture, influencing spinal and trunk positioning.

What component of wheelchair fitting addresses pelvic alignment and promotes upright posture?

Posterior pelvic positioning belt mounted at 45 degrees.

What is the purpose of seat depth measurement in wheelchair fitting?

To support the full length of the thigh, typically leaving 1-2 inches from the popliteal fossa to prevent pressure behind the knee while distributing weight effectively.

Why is appropriate footrest height important in wheelchair fitting?

To ensure feet are supported, hips and knees are at 90 degrees (or prescribed angle), and to prevent pressure on the sacrum or thighs from an unsupported or too high/low position.

What is the significance of correct armrest height in wheelchair fitting?

To provide support for the upper extremities, assist with trunk stability, aid in pressure relief (unloading weight from the buttocks), and facilitate transfers, all without causing shoulder impingement or excessive shrugging.

What is the primary function of the tilt-in-space feature in a wheelchair?

To change the client's seated angle while maintaining hip and knee angles, primarily for pressure redistribution, postural stability, and improving head control without altering body angles relative to each other.

What are some common intrinsic risk factors for pressure injury development in wheelchair users?

Impaired sensation, immobility, poor nutrition, incontinence, altered mental status, and circulatory problems.

What is the primary function of Magnetic Resonance Imaging (MRI) in neurodiagnostics?

To produce detailed images of brain structures and soft tissues using strong magnetic fields and radio waves, without ionizing radiation.

What types of conditions is MRI particularly effective at detecting in the brain?

Tumors, strokes, demyelinating diseases (e.g., Multiple Sclerosis), infections, and structural abnormalities.

How does a Computed Tomography (CT) scan work in neuroimaging?

It uses X-rays from multiple angles to create cross-sectional images of the brain, particularly useful for visualizing bone, acute hemorrhage, and calcifications.

When would a CT scan be preferred over an MRI in an emergency neurodiagnostic setting?

For rapid assessment of acute trauma (e.g., skull fractures, intracranial hemorrhage) or in patients with contraindications for MRI (e.g., certain metallic implants).

What does functional Magnetic Resonance Imaging (fMRI) measure?

It measures brain activity by detecting changes associated with blood flow (BOLD response), often used to map brain regions for specific functions like language or motor tasks.

What is Electroencephalography (EEG) used for in neurodiagnostics?

To measure and record the electrical activity of the brain using electrodes placed on the scalp, primarily for diagnosing epilepsy, sleep disorders, and evaluating brain function.

What is the purpose of Positron Emission Tomography (PET) in neuroimaging?

To visualize metabolic activity (e.g., glucose metabolism) or receptor binding in the brain by using radioactive tracers, often used in oncology, dementia, and movement disorders.

What neurodiagnostic imaging technique is used to visualize blood vessels in the brain?

Cerebral angiography (or MRA via MRI, or CTA via CT), which uses contrast material to highlight blood flow and detect aneurysms, blockages, or malformations.

What does CAMP stand for in nerve studies?

Compound Action Muscle Potential.

What does CAMP refer to?

The sum of action potentials from multiple muscle fibers innervated by a nerve, representing the muscle's electrical response to nerve stimulation.

What can a reduced CAMP amplitude indicate?

Loss of axons (axonal damage) or a conduction block (failure of nerve impulse to propagate across a segment).

What does 'delayed onset latency' indicate in a nerve conduction study?

Slower conduction along the fastest conducting fibers of a nerve, often indicating demyelination (damage to the myelin sheath).

Besides latency and CAMP, what other key parameter is measured in nerve conduction studies?

Nerve conduction velocity (NCV).

What does a decrease in nerve conduction velocity (NCV) primarily suggest?

Demyelination, as myelin is responsible for rapid signal propagation.

What is often observed in the waveform morphology of a demyelinated nerve?

Temporal dispersion (spreading out of the compound muscle action potential) or conduction block.

What can an abnormally prolonged F-wave latency suggest?

Proximal nerve segment pathology (e.g., demyelination in the nerve root or plexus) or generalized slowing.

What is the significance of an absent or reduced F-wave response?

Indicates severe nerve damage, particularly in the proximal segments, or generalized nerve excitability issues.

Explain the "use it or lose it" principle of neuroplasticity in rehabilitation.

Neural circuits not actively engaged in their specific functions may degrade or be reassigned, leading to a loss of function.

Explain the "use it and improve it" principle of neuroplasticity in rehabilitation.

Training and engaging specific neural circuits can lead to their enhancement and improved functional capacity.

Why is an additional inch of space recommended for seat width beyond hip measurement in wheelchair fitting?

To avoid pressure on the hips and ensure sufficient stability and clearance.

Why is it important to leave 1-2 inches of space from the popliteal fossa during seat depth measurement?

To prevent pressure behind the knee, which could lead to skin breakdown or circulatory issues, while still adequately supporting the thigh.