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WHEELCHAIRS

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SPRINGLOADED TEETH THAT KEEP THE CHAIR FROM ROLLING BACKWARD ... BY INCREASING THE AMOUNT OF KNEE EXTENSION IN CHAIR ... WC CUSHIONS. ANOTHER CHAPTER ... – PowerPoint PPT presentation

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Title: WHEELCHAIRS


1
WHEELCHAIRS
  • MANUAL WHEELCHAIR COMPONENTS
  • FRAME AND AXLE
  • WHEELS AND TIRES
  • HAND RIMS/ WHEEL LOCKS
  • GRADE AIDS
  • CASTERS/ARMRESTS/LEGRESTS
  • SEAT AND BACK

2
FRAME AND AXLE
  • FRAME MATERIAL MAY DETERMINE THE WEIGHT AND
    DURABILITY OF THE WHEELCHAIR
  • WEIGHT IS IMPORTANT IN TERMS OF LOADING WC INTO
    THE CAR

3
FRAME TYPE
  • RIGID FRAME IS MORE STABLE FOR ACTIVE USER
  • MAKE SURE PATIENT CAN LOAD THIS INTO THE CAR

4
FOLDING FRAME
  • FOLDING FRAME IS EASIER TO STORE AND TRANSPORT
  • NEWER LOCKING SYSTEM FOR FOLDING FRAME
  • IMPROVES RIGIDITY AND MAINTAINS BALANCE
  • SOME FRAMES HAVE FLEXIBILITY IN PLACEMENT OF REAR
    WHEELS WITH AN ADJUSTABLE AXLE PLATE

5
WHEEL AND TIRES
  • WHEEL SIZE AFFECTS
  • OVERALL HEIGHT
  • ROLLING EASE
  • TRANSFERRING IN AND OUT OF CHAIR
  • UE MECHANICS OF PUSHING

6
WHEEL TYPE
  • SOLID SMOOTH WHEELS
  • BEST ON
  • SMOOTH
  • HARD
  • INDOOR SURFACES

7
WHEEL TYPE
  • THREADED PNEUMATIC TIRES
  • GIVES SMOOTHER RIDE
  • EASIER MANUEVERABILITY ON ROUGH TERRAIN,WET OR
    ICY SURFACES

8
WHEEL TYPE
  • FLAT TIRES CAN BE MINIMIZED
  • WITH THORN RESISTANT TUBES
  • OR ADDITION OF LATEX GEL

9
HAND RIMS
  • VERY SMALL DIAMETER
  • SMOOTH RIMS FOR HIGH SPEED RACING
  • LARGE
  • TO MAXIMIZE MANEUVERABILITY AND POWER

10
HAND RIMS
  • MODIFICATIONS
  • IMPROVE GRIPPING
  • BY ADDING COATING
  • INCREASE TUBE SIZE
  • CHANGING SHAPE
  • ADDING RIM PROJECTIONS

11
WHEEL LOCKS
  • WHEEL LOCKS BRAKES
  • POSITION HANDLES TO PROVIDE EASY ACCESS
  • BUT NOT INTERFERE WITH WC PROPULSION

12
WHEEL LOCKS
  • BRAKE EXTENSIONS FOR PATIENTS
  • WITH U.E. DYSFUNCTION
  • OR POOR BALANCE

13
WHEEL LOCKS
  • FOR ACTIVE USER
  • WITH LONG PUSHING STROKE
  • POSITION BRAKES LOWER DOWN
  • TO PREVENT INJURY TO FINGERS AND THUMBS

14
GRADE AIDS
  • SPRINGLOADED TEETH THAT KEEP THE CHAIR FROM
    ROLLING BACKWARD
  • CAN BE SELECTIVELY ACTIVATED WHEN GOING UPHILL

15
GRADE AIDS
  • FOR PATIENTS WHO HAVE DIFFICULTY GOING UP
    INCLINES
  • DONT USE GRADE AIDS IN STRONG PUSHERS
  • MAY BE ACTIVATED IN WHEELIES

16
CASTER
  • THE SMALL WHEELS FOUND USUALLY IN FRONT OF THE
    CHAIR

17
CASTER
  • HARD SMALL CASTERS ALLOW EASIEST TURNING
  • SMALLEST 4 CASTORS GOOD FOR SPORTS BUT CANT BE
    USED WELL OUTDOORS

18
CASTER
  • LARGE PNEUMATIC CASTERS ARE LESS LIKELY TO GET
    STUCK ON UNEVEN OR SOFT GROUND
  • MAKE SURE THEY DONT HIT FOOT OR FOOT PLATE

19
CASTERS
  • PLACING THE CASTER TO REAR OF CHAIR
  • DECREASES TURNING RADIUS
  • INCREASES THE TENDENCY TO TIP FORWARD

20
CASTER
  • CASTER LOCKS
  • NECESSARY FOR ABSOLUTE STABILITY OF CHAIR IN
    TRANSFERS

21
ARMRESTS
  • AID IN TRANSFERS
  • WEIGHT SHIFTS
  • REDUCE ISCHIAL PRESSURE
  • BY CARRYING THE WEIGHT OF THE ARMS AND
    MAINTAINING TRUNK BALANCE

22
ARM RESTS
  • NEED STURDY SUPPORTIVE ARMREST FOR THOSE WITH
    MARGINAL PRESSURE MANAGEMENT
  • PATIENTS WITH T6 OR ABOVE INJURY NEED THEM FOR
    STABILITY IN SITTING

23
ARMRESTS
  • NEEDED IF PATIENT HAS
  • LAPBOARD
  • ARM TROUGH
  • BALANCED FOREARM ARTHOSIS
  • ATHLETIC WC USERS MAY WANT TO ELIMINATE ARM RESTS

24
ARM RESTS
  • TYPES
  • FIXED
  • ADJUSTABLE
  • REMOVABLE
  • SWING AWAY

25
LEG RESTS
  • TO PROVIDE PROTECTION
  • PROPER POSITIONING
  • MAXIMUM BALANCE
  • WEIGHT BEARING OF LE

26
LEG RESTS
  • SUPPORT THE FOOT TO MAINTAIN CIRCULATION
  • KEEP THE ANKLE IN NEUTRAL POSITION
  • SHOULD NOT BE SO HIGH IT FORCES WEIGHT BACK ON
    ISCHIAL TUBEROSITIES OR SACRUM

27
LEG RESTS
  • TYPES
  • STANDARD
  • SWING AWAY
  • REMOVABLE

28
LEG RESTS
  • ELEVATING
  • MAY HELP WITH EDEMA
  • ALTER ACCESSIBILITY
  • MAKES TURNING MORE DIFFICULT

29
ELEVATING LEG RESTS
  • NEED CALFPADS
  • MORE EXPENSIVE
  • NEED A SPECIFIC DIAGNOSIS TO JUSTIFY

30
LEG RESTS
  • PATIENTS WITH A LOT OF SPASTICITY
  • MAY NEED A LARGE FOOTPLATE
  • WITH PROPER FOOT RESTRAINT SYSTEM

31
SEAT AND BACK
  • BACK SUPPORT
  • WC BACK
  • SHOULD BE HIGH ENOUGH TO SUPPORT
  • LOW ENOUGH TO GIVE AS MUCH FREEDOM AS POSSIBLE

32
BACK SUPPORT
  • PATIENTS WITH ABNORMAL TRUNK CONTROL ABOVE T8-10
  • BUT GOOD HEAD CONTROL
  • BACK SHOULD COME UP WITHIN 2 OF THE LOWER EDGE
    OF THE SCAPULA

33
BACK SUPPORT
  • IF BACK TOO LOW
  • IT CAN CAUSE INCREASED PRESSURE AT UPPER EDGE OF
    BACK
  • WHEELING EFFICIENCY IS DECREASED SECONDARY TO
    POOR STABILIZATION OF THE SHOULDER GIRDLE

34
SEAT TYPE
  • IF PATIENT HAS POOR MUSCLE CONTROL
  • SPASTICITY
  • DEFORMITY
  • THEY NEED A SOLID SEAT OR BACK OR BOTH

35
SEAT TYPE
  • A STABLE SEAT AND LUMBAR SURFACE
  • PREVENTS SACRAL SITTING

36
SACRAL SITTING
  • LEADS TO SACRAL AND ISCHIAL PRESSURE SORES
  • INCREASED KYPHOSIS
  • NECK AND UPPER BACK STRAIN

37
WHEELCHAIR STABILITY
  • DEPENDS ON REAR AXLE POSITION
  • IF REAR WHEELS ARE MOVED FORWARD
  • CHAIR MOVES EASIER
  • WEIGHT SHIFT FOR WHEELIES IS EASIER

38
WC STABILITY
  • IF REAR WHEELS ARE MOVED FORWARD
  • CHAIR TIPS BACKWARD MORE EASILY
  • ESPECIALLY WHEN GOING FAST OR UP RAMPS

39
WHEELCHAIR STABLILITY
  • ANTITIP DEVICES PREVENT BACKWARD TIPPING

40
WHEELCHAIR STABILITY
  • FOR LE AMPUTEES
  • MOVING REAR WHEEL POSTERIOR
  • KEEPS THE PATIENTS C.OF G. IN FRONT OF THE WHEEL
  • TO PREVENT TIPPING

41
WHEELCHAIR STABILITY
  • RAISING THE SEAT
  • WILL LESSEN THE OVERALL STABILITY OF THE CHAIR
  • MOST COMFORTABLE AND STABLE SEATING
  • WITH SEAT TILTED BACK BY 3-5

42
WHEELCHAIR STABILITY
  • CAMBER
  • THE ANGLE BETWEEN THE VERTICAL AXIS OF WHEELS AND
    A LINE PERPENDICULAR TO THE FLOOR

43
CAMBER
  • CAN BE ADJUSTED 7 TO MAXIMIZE LATERAL STABILITY
  • WITHOUT MAKING THE CHAIR TOO WIDE
  • CAMBER IS ADJUSTED FOR SPORTS TO ALLOW QUICK
    TURNS
  • OR LONG LATERAL REACHES

44
BIOMECHANICS OF SEATING
  • PELVIS
  • A KEY GOAL IN WC SEATING IS STABILIZING THE
    PELVIS
  • A LEVEL PELVIS IS NEEDED TO OPTIMIZE TRUNK
    CONTROL AND UE FUNCTION

45
PELVIS
  • EVALUATION
  • LOOK FOR
  • ANTERIOR PELVIC TILT
  • POSTERIOR PELVIC TILT
  • LATERAL SYMMETRY
  • ROTATION
  • RESTRICTION IN ANY DIRECTION

46
ANTERIOR PELVIC TILT
  • INCLINATION OF THE PELVIS IN THE SAGITTAL PLANE
    FORWARD OF ITS NEUTRAL POSITION
  • DUE TO THE HYPOTONICITY OF TRUNK MUSCULATURE

47
ANTERIOR PELVIC TILT
  • SHORTENING OF LOW BACK EXTENSORS
  • TIGHTENING OF ILIOTIBILA BAND
  • TIGHT HIP FLEXORS

48
POSTERIOR PELVIC TILT
  • DUE TO OVERACTIVITY OF HIP EXTENSORS
  • DUE TO TIGHT HAMSTRINGS
  • HYPOTONIC LOW BACK EXTENSORS

49
POSTERIOR PELVIC TILT
  • LOSS OF LUMBAR LORDOTIC CURVE
  • AFFECTS SPINAL ALIGNMENT
  • AFFECTS FUNCTION

50
POSTERIOR PELVIC TILT
  • TILTING OF PELVIS
  • MOVES C.OF G. POSTERIOR TO ISCHIAL TUBEROSITIES
  • INCREASES WT. BEARING THRU SACRUM

51
POSTERIOR PELVIC TILT
  • TILTING OF PELVIS
  • INCREASED THE FORCE ON LUMBAR SPINE IN SITTING
  • INCREASES SHEARING AND FORCE OVER SPINE AND PELVIS

52
PELVIC OBLIQUITY
  • SLANTING OF PELVIS IN THE FRONTAL PLANE
  • DUE TO
  • IMBALANCED POSTURE
  • MUSCLE TONE
  • SCOLIOSIS
  • HIP DISLOCATION

53
SCOLIOSIS
  • EVALUATION OF SEATING IS DIRECTED
  • TOWARD TYPE OF SUPPORT OR ACCOMODATION NEEDED
  • NOT A PRIMARY METHOD OF CONNECTION

54
KYPHOSIS/LORDOSIS
  • TRUNK SHOULD BE UPRIGHT
  • TRUNK SHOULD BE CENTERED OVER THE MIDDLE OF THE
    WHEELCHAIR

55
HAMSTRINGS
  • THE MOST IMPORTANT MUSCLE GROUP FOR OPTIONAL
  • POSITIONING
  • COMFORT
  • FUNCTION OF WC USER

56
HAMSTRINGS
  • CROSS TWO JOINTS
  • TIGHTNESS CAN DRAMATICALLY
  • CHANGE POSITION OF PELVIS AND KNEES
  • CAN INCREASE POSTERIOR PELVIC TILT
  • THIS INCREASES SACRAL SITTING

57
HAMSTRING TIGHTNESS
  • CORRECTIONS
  • INCREASE LENGTH OF HAMSTRINGS WITH STRETCHING
  • TRY TO INCREASE AMOUNT OF KNEE FLEXION ALLOWED
    IN WC
  • BY POSITIONING FEET MORE POSTERIORLY THAN USUAL

58
HAMSTRING TIGHTNESS
  • DONT TRY TO STRETCH HAMSTRINGS BY INCREASING THE
    AMOUNT OF KNEE EXTENSION IN CHAIR
  • THIS MAY INCREASE POSTERIOR PELVIC TILT

59
HAMSTRING TIGHTNESS
  • IF UNABLE TO INCREASE KNEE FLEXION
  • USE POSTERIOR WEDGE TO INCREASE HIP FLEXION
  • WITH A PELVIC WELL TO PREVENT SLIDING OUT OF CHAIR

60
HEAD
  • POSITION IN SITTING IS CRITICAL
  • BECAUSE OF INFLUENCE OF HEAD ON
  • PRIMITIVE REFLEXES
  • MUSCLE TONE
  • UE FUNCTION
  • SWALLOWING
  • VISUAL ORIENTATION

61
UPPER EXTREMITIES
  • UE FUNCTION AND STRUCTURE
  • AFFECT PROPULSION
  • WEIGHT SHIFT
  • TRANSFERS IN WC

62
UPPER EXTREMITIES
  • PROPER ARM SUPPORT
  • MAY HELP UNWEIGHT THE ISCHIAL TUBEROSITIES
  • BY 25-35

63
WC MEASUREMENT
  • SEAT WIDTH
  • 1 WIDER THAN THE WIDTH OF THE WIDEST PART OF
    BUTTOCK
  • SEAT HEIGHT
  • 2 HIGHER THAN THE DISTANCE FROM THE BOTTOM OF
    THE HEEL TO THE POPLITEAL FOSSA

64
WC MEASUREMENT
  • SEAT DEPTH
  • 1-2 LONGER THAN THE DISTANCE FROM THE POPLITEAL
    AREA TO THE BACK OF THE BUTTOCK
  • BACK HEIGHT
  • 2 LESS (MAY VARY) THAN THE DISTANCE FROM THE
    BOTTOM OF THE SCAPULA TO THE SITTING SURFACE

65
WC MEASUREMENT
  • ARM HEIGHT
  • DISTANCE FROM THE BOTTOM OF THE BUTTOCKS TO THE
    ELBOW

66
SEAT TYPE
  • SOLID SEAT, SOLID BACK OR BOTH
  • IF PATIENT HAS
  • POOR MUSCLE CONTROL
  • SPASTICITY
  • DEFORMITY

67
SEAT TYPE
  • STABLE SEAT AND LUMBAR SURFACE
  • PREVENTS SACRAL SITTING
  • WHICH
  • CAUSES SACRAL STRAIN
  • ISCHIAL PRESSURE SORES
  • INCREASED KYPHOSIS
  • NECK AND UPPER BACK STRAIN

68
WC CUSHIONS
  • ANOTHER CHAPTER
  • A CONTOURED CUSHION WITH A FIRM BASE MAY BE THE
    BEST CHOICE FOR PRESSURE RELIEF AND TO PREVENT A
    PERSON FROM SLIDING FORWARD

69
WC WEIGHT
  • USERS WHO NEED TO LOAD OWN WC INTO CAR
  • NEED FOLDING OR RIGID ULTRALIGHT FRAMES
  • LIGHTER, MORE EFFICIENT CHAIRS MAY NOT BE COVERED
    BY ALL INSURANCE CO.S

70
WC WEIGHT
  • HEAVIER CHAIRS
  • MORE PRACTICAL FOR
  • TEMPORARY USERS
  • SHORT DISTANCE MOBILITY
  • OBESE PATIENTS

71
WC WEIGHT
  • CONVENTIONAL Wc- 50 lb.
  • LIGHTWEIGHT WC- 40 lb.
  • ULTRA LIGHTWEIGHT WC- 15-28 lb.

72
WC PRESCRIPTION
  • DONE IN A MULTIDISCIPLINARY WC CLINIC
  • WITH P.T.
  • WC VENDOR
  • PHYSIATRIST

73
WC PRESCRIPTION
  • OBTAIN
  • MEDICAL HISTORY
  • SURGICAL HISTORY
  • SEATING HISTORY
  • WHAT HAS WORKED OR NOT WORKED IN THE PAST

74
WC PRESCRIPTION
  • CHECK PATIENTS ABILITY TO DO WT. SHIFTS
  • IF UNABLE TO DO WT. SHIFTS PT. MAY NEED POWER
    RECLINE OR TILT IN SPACE SYSTEM

75
POWER RECLINE SYSTEMS
  • RECLINING MAY PRODUCE SHEAR DURING RECLINING
  • SYSTEM ADDS 1-2 TO SEAT HEIGHT
  • TILT IN SPACE PRODUCES BETTER REPOSITIONING WHEN
    UPRIGHT POSITION RESUMED

76
WC PRESCRIPTION
  • TO JUSTIFY POWER RECLINING SYSTEM OR
    TILT-IN-SPACE SYSTEM
  • HAVE TO SHOW PATIENT UNABLE TO SHIFT WEIGHT
  • OR TRANSFER INDEPENDENTLY
  • AND DOESNT HAVE SOMEONE TO ASSIST WITH THIS

77
WC PRESCRIPTION
  • EXAMINE PATIENT IN SITTYING AND LYING SUPINE ON A
    FLAT SURFACE
  • CHECK
  • SPASTICITY
  • JOINT R.O.M.
  • HIP FLEXION
  • HAMSTRING TIGHTNESS
  • POPLITEAL ANGLES

78
WC PRESCRIPTION
  • CHECK PELVIS
  • LOOK AT HOW THIGHS AND FEET WILL BE POSITIONED
  • EVALUATE THE NEED FOR HEAD AND BACK SUPPORTS

79
WC PRESCRIPTION
  • LOOK AT SEAT CONFIGURATION
  • EVALUATE HOW WEIGHT SHIFTS WILL BE DONE

80
WC PRESCRIPTION
  • BASED ON CLINIC EVALUATION
  • DEVELOP A PRECRIPTION
  • DEVELOP A LETTER OF MEDICAL NECESSITY FOR
    INSURANCE CO.
  • DISCUSS PRESCRIPTION WITH PATIENT
  • HAVE HIM SIGN IT AFTER DISCUSSION

81
POWER CHAIRS
  • FOR INDIVIDUALS WHO CANNOT PROPEL A MANUAL WC
  • DUE TO
  • WEAKNESS
  • POOR ENDURANCE
  • CARDIAC OR RESPIRATORY LIMITATIONS
  • LIMB ABSENCE
  • PARALYSIS
  • DEFORMITY

82
POWER CHAIRS
  • INDIVIDUALS MUST HAVE NECESSARY
  • COGNITIVE FUNCTION
  • JUDGEMENT
  • VISION
  • TO SAFELY DIRECT POWER CHAIR

83
POWER CHAIR
  • SELECT CHAIR ON SAME PRESCRIPTION PRINCIPLES AS
    MANUAL

84
POWER CHAIR
  • CONSIDER WHERE THE CHAIR WILL BE USED
  • MAY NOT BE PRACTICAL
  • IF PATIENT LIVES IN A TRAILER
  • OR DOESNT HAVE A VAN TO TRANSPORT IT

85
WC POWER BASES
  • TYPE I
  • DIRECT DRIVE MOTORS
  • SMALL BALLOON TIRES
  • MORE DURABLE
  • BETTER ABLE TO TRAVERSE ROUGH TERRAINE
  • SHORT BASED
  • INCREASED EASE OF TURNING IN SMALL SPACES

86
WC POWER BASES
  • TYPE II
  • DRIVE POWER LINKAGES
  • LARGE REAR HARD RUBBER TIRES
  • SMALL FRONT PNEUMATIC TIRES
  • ATTAIN HIGHER SPEEDS
  • PROVIDE MORE STABILITY

87
WC CHECKOUT
  • DO NOT HAVE WC DELIVERED DIRECTLY TO PATIENT
  • HAVE IT DELIVERED TO CLINIC
  • P.T. CAN CHECK IT TO MAKE SURE IT FITS THE
    PRESCRIPTION
  • CHAIR CAN BE RETURNED IF SOMETHING IS WRONG OR
    MISSING
  • HAVE P.T. CHECK OUT PATIENT IN WC TO MAKE SURE IT
    FITS AND THEY CAN USE IT CORRECTLY

88
WHEELCHAIRS
  • COSTLY
  • OFTEN COMPLICATED
  • EVALUATE PATIENT IN WC CLINIC OR BY SKILLED P.T.
  • IF PATIENT IS HARD TO FIT
  • TO MAKE SURE THEY GET APPROPRIATE WC

89
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