Nbcot Review: Wheelchair Prescription And Assessment, Seating And Positioning

Front 1

What are the purposes of wheelchair seating and positioning?

Back 1

1. Promote comfort during upright ADLs.
2. Promote functional posture by appropriate back and leg supports.
3. Provide physiological maintenance and tissue protection through prevention of shearing.
4. Promote sensory readiness through provision of proper eye and head position.
5. Facilitate upper limb function (which occurs with proper trunk support).

Front 2

What are the purposes of wheelchair seating and positioning (Cont'd)?

Back 2

6. Promote social acceptance by allowing eye contact.
7. Decrease progression of deformity through customized seating as needed.
8. Decrease pain through provision of proper support to all limbs.
9. Facilitate mobility with what means the person has available.
10. Increase self-esteem through provision of wheelchair that meets person's needs and facilitates mastery of the environment.

Front 3

What should you assess before prescribing an individual a wheelchair?

Back 3

- The person's sensory, neuromuscular, musculoskeletal, cognitive, and psychosocial needs.
- Leisure interests / pursuits
- Physical environment the person will use the w/c (areas of travel outside, house, transportability)

Front 4

Parts of the wheelchair.

Back 4

Frame
Armrests
Legrests
Footplates
Tires
Casters

Front 5

Wheelchair Measurement: Seat width, depth, height.

Back 5

Seat width: measure the widest point across the hips and thighs, add 2 inches to prevent friction/rubbing.

Seat depth: Measure both LE and take the greatest length. Measure from posterior portion of the buttocks to the popliteal fossa, subtract 2 inches to prevent rubbing and skin breakdown.

Seat height: knees and ankles at 90 degrees. Measure from distal thigh to heel. Keep in mind footrests need 2 inches to clear the floor.
*Standard height: 19.5 inches
*Hemi-height: 17.5 inches
*Super-low: 14.5 inches

Front 6

Wheelchair Measurement: Back height, armrest height.

Back 6

Back height: Measure from seat surface (incl. cushion) upward to one of the following, depending on trunk control, activity level, strength, and size of person:
- Mid-back under scapula (1-2 inches below)
- Mid-scapula or axilla
- Top of shoulder
*Lower back height increases functional mobility (sport chairs)
*Higher back height needed for poor trunk stability.

Armrest height: shoulders neutral, arms hanging at sides, elbows flexed to 90 degrees. Measure under each elbow to cushioned seating surface.
*armrests too low encourage leaning forward, too high cause shoulder elevation.

Front 7

Wheelchair Accessibility: Minimal Clearance Width

Back 7

32 inches, best is 36 inches

Front 8

Wheelchair Accessibility: turning space

Back 8

360 turning space requires clearance of 60x60 inches (5 feet x 5 feet)

Front 9

Wheelchair Accessibility: Parking spaces

Back 9

Need 4 feet aisle to allow w/c to maneuver the space

Front 10

Wheelchair Accessibility: maximal height person can reach forward from sitting

Back 10

48 inches

Front 11

Standard dimensions for wheelchairs: Adult

Back 11

18 inches wide, 16 inches deep, 20 inches high

If adult is narrow, 16 inches wide. All else the same.
If adult is slim, 14 inches wide. All else the same.

Front 12

Standard dimensions for hemi wheelchair: Adult

Back 12

17.5 inches high.

Front 13

Standard dimensions for a wheelchair: Child

Back 13

Junior: 16 inches wide, 16 inches deep, 18.5 inches high
Child: 14 inches wide, 11.5 inches deep, 18.75 inches high
Tiny Tot: 12 inches wide, 11.5 inches deep, 19.5 inches high

Front 14

Specialized wheelchairs

Back 14

Reclining back: for clients who are unable to independently maintain an upright sitting position.

Tilt-in-space: for pressure relief or a client with severe extensor spasms that may throw him out of the chair. Chair tilts to maintain normal seat to back angle.

Front 15

The 2 basic styles of seating

Back 15

Linear
Contoured and/or custom-contoured.

Linear:
- flat, non-contoured
- custom or factory ordered.
- firm, rigid seating
*Good for active clients, who perform independent transfers

Contoured:
- ergonomically supports individual
- enhances postural alignment
- decreases abnormal posturing
- provides pressure relief
*May be difficult for independent transfers if decreased UE strength.
*Good for clients with moderate to severe CNS dysfunction or neurological disease.

Front 16

Styles and accessories of seating systems: Cushions

Back 16

- Foam cushion can enhance posture and comfort

- Contoured foam cushion enhances pelvic and LE alignment

- Pressure relief cushions: Fluid and Air.

- Fluid facilitates pelvic and LE alignment, provides pressure relief w/out changing support, good for individuals who need increased stability.

- Air has minimal postural support, provides pressure relief, good trunk control needed to use this cushion.

- Wedge cushions (front higher than back): prevent sliding out

Front 17

Styles and accessories of seating systems (Cont'd): Other

Back 17

- To prevent hammock effect: solid seat or solid wood insert

- Lumbar back support helps to give proper lumbar curve

- Pelvic guides inserted on the interior sides of the w/c at hip level keep hips stable

- Lateral supports extend up the side of the chair to just below armpits to provide trunk support.

Front 18

Pediatric seating and positioning systems: Purpose

Back 18

- allow for contractures and deformities
- allow for function at home and school
- facilitate eye contact and social interactions

Front 19

Pediatric seating and positioning systems: Types

Back 19

- Usually custom molded.
- Standers are good for weight bearing, facilitating formation of acetabulum and long bone development, and aid in bowel and bladder function.
- Prone standers decrease effect of TLR.
- Supine standers provide more support posteriorly.
- Sidelyers decrease effects of TLR and put hands in visual field.
Abductor pads at hips to decrease scissoring extensor pattern.
Triwall construction for infants and toddlers.