• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

Card Range To Study



Play button


Play button




Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

77 Cards in this Set

  • Front
  • Back

What factors are associated with the selection of wheelchair type and components? ***

- patient’s disability and functional ability
- mental and physical condition or capacity of the patient
- potential or prognosis for change in the patient’s condition, especially as it affects mobility

- patient’s age, size, stature, and weight
- temporary vs. permanent use
- expected use or patient needs of the wheelchair (e.g., indoors, outdoors, recreation, transfer needs, ability to transport the chair)

Wheelchair seat types ***

- sling – tends to adduct and IR hips (potential cause of contractures)
- firm – eliminates adduction/IR
- cushion – on a sling seat, eliminates adduction/IR
- abduction/adduction supports

Wheelchair seat back types and factors to consider ***

(should be below scapulae!)
- sling vs. firm (sling encourages slouching)

- stationary, reclining (postural hypertension, hip replacement), semi-reclining, tilt in space. Pg. 148

- height
- head rest if needed
- trunk – lateral supports

Wheelchair restraint types ***

(permission required for restraint!)
- lap belt (seat belt) usually at 45˚
- chest
- various closures

Wheelchair armrest types ***
- fixed or removable
- adjustable
- desk top, full length
Wheelchair leg rests, front rigging and footplate types ***
- fixed to frame or detachable
- swing away
- elevating leg rests – use for patients with restricted motion, edema, vascular patients

- tubular
- foot plates
- heel/toe loops, ankle straps
Wheelchair wheel types ***

- 20 – 26 inches, 24 inch standard
- tires: hard rubber, pneumatic or semi-pneumatic

- drive wheel camber, especially if in chair long-term
- casters – usually on front of wheelchair

Wheelchair handrim types ***
- used by patient to propel; no part of hand should be on the wheel
- chrome (slippery, not for weak grip), friction coated, projections (horizontal or vertical)

- one-arm drive
- power assist axle – Pg. 144
Wheelchair frame types ***
- standard folding frame
- rigid frame
- heavy duty – obese patients
- light-weight (aluminum)
- ultra light weight (titanium)
Wheelchair brake types ***
- lever (high mount)
- scissor
- extensions - for weaker pt, or post back surgery (shouldn’t be twisting)
Wheelchair accessories ***
- lap trays
- anti-tips
- extended push handles – for child-sized chairs (so you're not bending in half to get down to the handles to push)
- hill grades - pg. 142 (7-10)
- spoke protectors
Types of wheelchairs ***
- standard adult
- heavy-duty adult (bariatric; >200 lbs)

- intermediate or junior (small adult)
- growing (adjustable for next 3 years)
- child or youth

- indoors
- sports
- reclining

- “hemiplegic”: able to pull along with 1 leg; lower to ground, but makes transfers more difficult
- “amputee”- counteracts loss of weight of LE
- one-hand drive
Proper seating and positioning in a wheelchair should.... ***
- promote function
- prevent deformity
- improve body alignment
- prevent tissue damage (protective cushion, pressure relief)
- prevent additional complications
Describe proper sitting posture in a wheelchair. ***
- hips at 90 degrees
- feet flat
- ankles neutral
Proper seat height for wheelchair ***

measure from user's heel to popliteal fold and add two inches for footrest clearance

(average adult will be about 19.5 - 20.5 inches)

Proper seat depth for wheelchair ***
measure from user's posterior buttock, along the lateral thigh, to the popliteal fold, then subtract 2 inches to avoid pressure from the front edge of the seat against the popliteal space

(average adult will be about 16 inches)
Proper seat width for wheelchair ***
measure the widest aspect of the user's buttocks, hips, or thighs, and add 2 inches to provide space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel

(average adult will be about 18 inches)
Proper back height for wheelchair ***
measure from the seat of the chair to the floor of the axilla with the user's shoulder flexed to 90 degrees, and then subtract 4 inches to allow the final back height to be below the inferior angles of the scapulae

(average adult will be about 16-16.5 inches)

NOTE: This measurement will be affected if a seat cushion is to be used--either measure the person while seated on the cushion or add the value of the thickness of the cushion to the measurement.
Proper armrest height for wheelchair ***
measure from the seat of the chair to the olecranon process with the user's elbow flexed to 90 degrees, then add 1 inch

(average adult will be about 9 inches)

NOTE: This measurement will be affected if a seat cushion is to be used--either measure the person while seated on the cushion or add the value of the thickness of the cushion to the measurement.
How should patient be seated during wheelchair fit confirmation? ***
- chair should be on a level, smooth surface

- patient must sit erect with pelvis in contact with back upholstery
How are wheelchair seat height and leg length fit confirmed? ***
- with hand parallel to floor, you should be able to insert 2-3 fingers lengthwise between the posterior area of the patient's thigh and the seat upholstery to a depth of approximately 2 inches

- bottom of the footplate must be at least 2 inches above the floor
How is wheelchair seat depth confirmed? ***

with your hand parallel to the floor, you should be able to place the width of 2-3 fingers between the front edge of the seat and the popliteal fold

How is wheelchair seat width confirmed? ***
with your hands vertical to the floor, you should be able to slide each hand between the patient's hips and the clothing guard of the chair with minimal contact
How is wheelchair back height confirmed? ***
with your hand vertical to the floor, you should be able to place the width of four fingers between the top of the back upholstery and the floor of the axilla
How is wheelchair armrest height confirmed? ***
- observe the angle made by the posterior aspect of the upper arm and the back post when the elbows rest on on the armrest approximately 4 inches in front of the back post

- observe the position of the shoulders; they should be level

- observe the position of the trunk; it should be erect
How is hip angle adjusted? ****
by raising or lowering the foot rests
How are armrests adjusted? ***
by pushing the buttons and selecting a higher/lower hole
Body mechanics ***
use of one’s body to produce motion that is safe, energy-conserving, and anatomically and physiologically efficient and that maintains body balance and control
Base of support ***
the area on which an object rests and which provides support for the object
Center of gravity ***

- the point at which the mass of a body or object is centered

- for the human body, the COG is approximately 2nd sacral vertebra

Lever arm ***
- a component of a mechanical lever

- it may be the force arm or the weighted (resistance) arm

- when the length of the force arm is increased or the length of the weight arm is decreased, a greater mechanical advantage is created for the lever system.
Lordosis ***
- an increase in one of the forward convexities of the normal vertebral columns

- a lumbar or cervical lordosis can occur
Pelvic tilt (inclination) ***
- movement of the pelvis so the anterior superior iliac spines move anteriorly or posteriorly to produce an anterior or a posterior tilt or inclination of the pelvis
Vertical gravity line (VGL) ***
an imaginary vertical line that passes through the center of gravity of an object
List the principles of proper body mechanics ***

(These are also the precautions for lifting, reaching for, pushing, pulling, or carrying an object.)
- roll, push, pull, or slide an object instead of lifting it
- perform all activities within your physical capability
- mentally and physically plan the activity before attempting it

- position yourself close to the object to be moved to use short lever arms
- maintain your vertical gravity line within your BOS to maintain stability and balance
- position your COG close to the object's COG to improve control of the object

- use the major muscles of the extremities and trunk (quads, hamstrings, abs, glutes) to perform movements or activities and maintain your normal lumbar lordosis
- avoid simultaneous trunk flexion and rotation when lifting or reaching

- do not lift an object immediately after a prolonged period of sitting, lying, or inactivity; perform some gentle stretches for the back/LE first
- when performing a lift with two or more persons, instruct everyone how and when they are to assist; use a mechanical lift if one is available (person at head is in charge if moving a person)
Common causes of back problems ***

- faulty posture
- faulty, improper use of body mechanics
- improper lift, push, pull, reach or carry

- decline in general physical fitness
- poor flexibility of muscles and ligaments of the back and trunk

- stressful living and work habits--inability to relax or staying in a prolonged posture

- repetitive, sustained microtrauma to structures of the back and trunk
- episodes of trauma that culminate in one specific or final event ("the final straw"); stress, strain, or tear of muscle or ligament; disk may change shape and impinge on nerve roots; vertebral joints may become irritated

Guidelines for lifting activities ***
- move the object by pushing, pulling, sliding, or rolling rather than by lifting when possible; push rather than pull
- mentally plan the lift; be certain you can safely lift the object without assistance; have sufficient space to perform the lift, and test the weight of the object before you lift it

- stoop or squat to lift any object below the level of your hips
- widen your feet to increase your BOS and improve your balance and stability
- move close to the object before you lift; keep it close to your body as you lift or carry it (COG)
- Maintain the lumbar curve in your lower back as you lift; do not flatten your lower back

- do not lift and twist your back simultaneously; instead, pivot when you need to turn
- do not lift quickly or with a jerky motion

- avoid repetitive and sustained lifting; use equipment or assistance to lift heavy objects
- use care when removing groceries, tools, or other items from the trunk of a car; do not bend at the waist and lift; bend your hips and knees slightly, and move the object close to you before lifting it
Guidelines for pushing and pulling activities ***
- crouch and face the object squarely

- use your arms and legs to push or pull; push with your arms partially flexed

- push or pull in a straight line; your force should be parallel to the floor

- be certain there are no objects in your path and doorways are wide enough for the object to pass through
Guidelines for reaching activities ***
- stand on a footstool or ladder to reach or place an object above your head

- move the object close to you or move close to the object before grasping, lowering, or raising it; be certain you will be able to control the object safely

- hold the object close to your body as you step down from or onto the footstool (COG)

- do not simultaneously reach and twist your body
Guidelines for carrying activities ***
- carry all objects holding them close to your body; the best positions are in front of your body at the level of your waist or mid-chest, or on your back

- balance the load whenever possible
- when a backpack is used, apply both shoulder straps
- if you carry an object in one hand (e.g., a suitcase) alternate carrying it in one hand and then in the other; do not twist your back when moving the object from one hand to the other; stoop to lift it from the floor

- some bulky or heavy objects can be carried on your shoulders, especially if you must carry them for a substantial distance

- avoid carrying or balancing a small child on one hip; use an infant carrier, or hold the child close to your chest or on your back using an approved child carrier
Principles of proper posture ***
- maintain normal anterior and posterior curves of the spine for proper balance and alignment

- stand with your ankles, knees, hips, and shoulders aligned; keep your head over your body, not in front of the shoulders
- stand with abdominal wall flat, head in neutral, shoulders level, chin parallel to the floor and slightly tucked, and your body weight evenly placed on each leg; keep your knees slightly flexed; and maintain lumbar lordosis
- stand and sit with your body erect so the shoulders and pelvis are level; avoid slouching or "round back" positions

- sit with your head in neutral, chin tucked or parallel to the floor, and elbows, knees, and hips flexed to 90 degrees with your feet flat on the floor or supported in a slightly inclined position; your forearms and low back curve should be supported during prolonged sitting; avoid slouching or kyphotic posture
- avoid standing or sitting in one position for a prolonged time; occasionally alter the position; move your head, neck, shoulders, back hips, knees, and ankles periodically

- when supine or partially side-lying, flex the hips and knees; use a pillow under or between the knees for support and avoid lying prone; use a small or medium-sized pillow to support your head, but do not position it under the shoulders; use a bed mattress that is firm and provides support to the natural curves of the spine
Guidelines to reduce stress-producing positions or activities ***
- alter your posture or position frequently; avoid prolonged standing or sitting

- avoid bending at the waist while working, washing your face, brushing your teeth, or performing activities that are below your waist (e.g., bathing children in a bathtub, removing clothes from washer/dryer); sit, stoop, or kneel instead of bending

- for activities that require prolonged standing, use a cushioned mat and wear low-heeled shoes with good arch supports; place one foot on a footstool or railing, and alternate feet occasionally for comfort (as when ironing or washing dishes); perform a 30-second exercise routine every hour that includes low back flexion/extension, hip and knee flexion (knee to chest while standing), neck extension, lateral bending, and shoulder ROM in all planes

- when seated at a work station for prolonged periods, keep elbows, knees and hips level and bent at 90 degrees; feet should be flat on the floor or supported at a slight incline; forearms should be supported by armrests, and the back should be supported by the chair back or a lumbar roll

- When seated at a computer terminal, the vision display terminal should be directed about 10 degrees below horizontal; the chair used should encourage a supported lumbar lordosis with a seat pan that is tilted slightly forward; the keyboard should be pushed forward to permit the arms to rest in front of it, ideally with the wrists supported on a padded surface; performing a 1-minute exercise break every hour to include neck flexion/extension and lateral bending stretching exercises, chin tucks, wrist flexion and extension stretches, shoulder pendulum exercises, tennis elbow stretch, and standing back bends is recommended

- enter and leave an automobile with a sideward, rather than a twisting motion of the trunk; adjust the car seat so your knees are at the same level as or slightly higher than your hips, your chin tucked and head held erect; use a lumbar support; stop frequently when driving long distances to walk or stretch your arms, legs, and back
Transfer definition ***
the safe movement of a person from one surface or location to another or from one position to another
Transfer training definition ***
to teach(!) a patient how to successfully transfer from one surface to another, with the goal of maximum independence of the patient
Impairment terminology ***

Independent definition
patient is able consistently to perform skill safely with no one present
Impairment terminology ***

Supervision definition

patient requires someone within arm's reach as a precaution; low probability of patient having a problem requiring assistance

Impairment terminology ***

Close guarding definition
person assisting is positioned as if to assist, with hands raised but not touching patient; full attention on patient; fair probability of patient requiring assistance
Impairment terminology ***

Contact guarding definition
therapist is positioned as with close guarding, with hands on patient but not giving any assistance; high probability of patient requiring assistance
Impairment terminology ***

Minimum assistance definition
patient is able to complete majority of the activity without assistance
Impairment terminology ***

Moderate assistance definition
patient is able to complete part of the activity without assistance
Impairment terminology ***

Maximum assistance definition
patient is unable to assist in any part of the activity
Descriptive terminology ***

Bed mobility
independent - no cuing* is given

the following may require cues:
- supervision
- minimum assistance
- moderate assistance
- maximum assistance

* types of cues: verbal, visual, or tactile; in some cases (e.g., person with memory deficit, short attention, learning disability, visual loss) a decrease in the number of cues may represent treatment progress, even though the level of dependence remains the same

interim progress notes can denote these changes by citing frequencies (e.g., 2/3 tries or an arbitrarily defined rank order scale (e.g., always/occasionally/rarely)
Descriptive terminology ***

Transfers: ambulation
independent - no cuing* is given

the following may require cues:
- supervision
- close guarding
- contact guarding
- minimum assistance
- moderate assistance
- maximum assistance

* types of cues: verbal, visual, or tactile; in some cases (e.g., person with memory deficit, short attention, learning disability, visual loss) a decrease in the number of cues may represent treatment progress, even though the level of dependence remains the same

interim progress notes can denote these changes by citing frequencies (e.g., 2/3 tries or an arbitrarily defined rank order scale (e.g., always,/occasionally/rarely)
Balance definitions ***

patient is able to maintain position with therapist maximally disturbing balance
Balance definitions ***

patient is able to maintain position with therapist moderately disturbing balance
Balance definitions ***

patient is able to maintain position for short periods of time unsupported
Balance definitions ***

patient attempts to assist but requires assistance from other person to maintain position
Balance definitions ***

No balance
patient is unable to assist in maintaining position
What should be done with the patient's medical records and other health care providers before a transfer? ***
- read PT's evaluation and daily progress notes

- communicate with the nurse/other pertinent HC providers, and the patient before transfer regarding current status
What types of things should be assessed pre-transfer? ***
- physiological condition
- mobility
- strength/endurance
- balance
- comprehension
- motivation
What factors should be assessed with respect to physiological condition pre-transfer? ***

- if it is first time up since surgery
- if they have postural hypotension
- if they have low HG or lower) and/or RBC counts
- if they have fatigue, pallor, SOB
- if they have/had a sudden onset of headache (may be high BP) and/or nausea

What factors should be assessed with respect to mobility pre-transfer? ***
- if any joint motions are restricted

- if there are flexion contractures present
What factors should be assessed with respect to strength/endurance pre-transfer? ***
whether fatigue or weakness will prevent completion of the transfer
What factors should be assessed with respect to balance pre-transfer? ***
- if the patient has a tendency to fall or lean to one side

- if there is hemiparesis present (CVA/CHI/TBI)
What factors should be assessed with respect to comprehension pre-transfer? ***

if the patient is
- lethargic
- confused
- combative
- visual- or hearing-impaired

What factors should be assessed with respect to motivation pre-transfer? ***
- whether patient is cooperative, willing, medicated

- whether patient is agitated, in pain, fearful, depressed
What are some general transfer principles? ***
- predetermine patient's mental and physical capabilities to perform the transfer, including weight-bearing status
- patient's clothing and footwear should be suitable for the transfer
- mentally pre-plan the activities and sequence associated with the transfer; teach and practice components of the transfer before attempting the transfer
- instruct the patient slowly and concisely; allow time for the patient to process and apply the information
- select, position, and secure needed equipment; apply a safety belt
- be alert for unusual events that may occur
- do not guard the patient using clothing or grasping the arm; use the safety belt and trunk
- position yourself to guard, guide, direct, and protect the patient throughout the transfer
- request the patient to initiate and perform the transfer in simple, directive terms; assist as necessary
- at the conclusion of the transfer, position the patient for comfort, stability, and safety; document changes in the patient's performance
If WB status is unknown, what is assumed? ***


How is WB status described? ***

- in pounds or % of body weight (use scale so they get a feel for it)

What precautions should be taken prior to transfer training? ***

- know WB status

- ensure all extraneous attachments are taken care of (casts, IVs, catheter bags, drainage/feeding tubes, armrests, footrests, orthotic devices, etc.)

- use care with the transfer belt, especially in cases of:
---- recent colostomy/iliostomy
---- severe cardiac or respiratory conditions
---- recent abdominal, chest, or back surgery

- do not allow patient to hang on your neck!!

What should you not allow patient to do to you during transfer training? ***
hang on your neck
What conditions require special precautions during transfers? ***

- total hip replacement (esp during initial 2 weeks after surgery)
- low back trauma or discomfort
- spinal cord injury
- burns
- hemiplegia

What special precautions are required during transfers for a total hip replacement patient? ***

the hip should not be
- adducted
- rotated
- flexed more than 90 degrees
- extended beyond neutral flexion-extension

do not
- cross the ankles/knees
- pull on the affected extremity
- allow the patient to lie on the replaced hip

keep hip
- abducted when moving and side lying (non-affected side)
- in semireclining position
- separated with abduction pillow

What special precautions are required during transfers for a patient with low back trauma or discomfort? ***

- avoid excessive lumbar rotation, lateral bending and flexion

- may be less painful to "logroll" when turning

- may be more comfortable with hips and knees partially flexed when supine or side-lying

What special precautions are required during transfers for a patient with a spinal cord injury? ***

- injury site may be protected by external device (brace, plaster/plastic body jacket or halo), internal fixation (bone graft, metal rods, wires), or a combination of the two; distracting and rotational forces should be avoided

- logrolling probably better than segmental turning

- protective positioning or restraints will be required when this patient is in a side-lying position or sits without a back support

- for patients with injuries that occurred months or years earlier, be aware that osteoporosis, especially in the long bones of LE and vertebral bodies, may be present and even mild to moderate stress or strain may lead to fracture

- be aware this patient may experience syncope when transferred from a supine to a sitting position b/c the blood pressure may not adapt to the positional change

What special precautions are required during transfers for a patient with burns? ***

- primary precaution is to avoid creating shear forces across surface of burn wound, graft site, or area from which the graft was taken

- sliding creates shear force, causing friction and disruption of the healing process

- patient should be instructed to elevate the body or extremities when moving an area with a burn to avoid shear forces

What special precautions are required during transfers for a patient with hemiplegia? ***

- pulling on the involved or weakened extremities to control or move the patient should be avoided, particularly for the affected shoulder, because the muscles will not provide adequate support to the joint due to the effects of paralysis

- many patients experience pain or discomfort when they lie on or roll over the involved shoulder