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WheelChair
| Question | Answer |
|---|---|
| To qualify for a WC, the pt must meet the following | pt bed bound w/o it, pt is unable to ambulate safely in home indep. |
| Standard Wheelchair | K0001, Not intended for propulsion (transport only) weighs 45-50lbs. Ex. invacare, tracer, guardian GL 200. |
| Hemiheight wheelchair | K0002, must be short to qualify, 17.5" seat to floor. Ex. invacare, tracer DLX |
| Super hemiheight wheelchair | K0002, must be short to qualify, 15.5" seat to floor. Ex. invacare, tracer DLX |
| Lightweight/high strength lightweight WC | K0003, K0004, pt lacks LE/UE strength and endurance to qualify. 19.5" seat to floor Ex. invacare, tracer SX, invacare 9000XT series, Quickie Breezy 600, Quickie EX. |
| Ultra lightweight WC | K0005, pt to weak to propel lightweight wc, UE pain during propulsion, to prevent overuse strain, or pt requires axle plate/COG adjustment |
| Strength's of the ulta lightweight folding WC | 1. transport friendly 2. mild shock dampening 3. may be less expensive 4. easy to grow 5. swing away foot rests |
| Limitations of the ultra lightweight folding WC | 1. increased maintenance 2. less efficient to propel 3. heavier than rigid style |
| Strengths of the ultra lightweight rigid WC | 1. lighter than folding style 2. increased durability 3. more responsive |
| Limitations of the ultra lightweight rigid WC | 1. more difficult to transport 2. minimal shock absorption 3. no growth 4. can be expensive |
| Heavy Duty WC | K0006, pt must weigh at least 250lbs to qualify, Ex. quickie M6, invacare topaz |
| Extra heavy duty WC | K0007, pt must weigh at least 300lbs to qualify, Ex. quickie M6, invacare topaz |
| Manual tilt in space wc | E1161, pt who has abnormal tone, is at risk for falling out of wc, cannot indep. perform pressure relief. Ex. quickie IRIS, Invacare Solara |
| Power Wheelchairs | K010-K014, pt is unable to propel an ultra lightweight wc, must be indep in home environment, Ex. invacare TDX series, quickie S series, Quantum Q6 series |
| Cushions | Are used to provide comfort, aid in positioning, and reduce the effects of pressure. |
| Specialty backrests are used to: | Improve efficiency during propulsion, provide positional suppprt, provide lateral trunk stability. |
| Posterior pelvic tilt causes: | *trunk hypotonicity *LE extensor hypertonicity *decreased postural control *tight hamstrings *spinal deformities (kyphosis) *discomfort |
| Interventions for posterior pelvic tilt | *firm backrest/seat *open hip/back angle *provide lumbar support to shift COG + posterior BOS *lower foot plates *check seat depth *pre-ischial rise on cushion *positioning belt *tilted position |
| Pelvic asymmetries obliquities/rotation causes: | * decreased LE ROM * hypertonicity |
| Interventions for pelvic asymmetries obliquities/rotations | * Increase contact area of seating surface by: hip contours, wedges, hip guides, or molded seats |
| LE adD/IR or abD/ER causes" | *hypertonicity *heterotopic ossification *contractures *compensation for pelvic position *seat depth too short *footrest too high |
| Fixed obliquities | Wedge on opposite side |
| Pelvic asymmetries obliquities | named for lower side |
| Flexible obliquitie | Wedge on same side |
| Lateral trunk flexion causes: | *hypertonicity/spasticity *hypotonicity *poor pelvic postioning *seat too wide *incorrect armrest height |
| Interventions for lateral trunk flexion: | *decrease seat width *adjust armrest height *tilt seating *open back to seat angle *lateral supports |
| Forward trunk flexion causes: | *trunk hypotonicity *kyphosis *posteral pelvic tilt *decreased seat to back angle |
| Interventions for forward trunk flexion: | *firm backrest/seat *open hip/back angle *provide lumbar support to shift COG posterior to BOS *lower foot plates *check seat depth *pre-ischial rise on cushion *positioning belt *tilted position |
| Trunk rotation causes: | *asymmetrical tone *leg length discrepancy *spinal deformity |
| Interventions for trunk rotation: | *align pelvis *accommodate LE deformity *backrest adjustment or change *seat to back angle adjustment *lateral supports |
| Poor head control/positioning causes: | *hyper/hypotonicity *poor pelvic alignment *trunk alignment |
| Interventions for head control/positioning | *align pelvis *adjust seat to back angle *lateral support to correct trunk alignment *use tilt system if neccesary to keep head against headrest *use appropriate headrest |
| WC user statistics | *over 2 million use manual WC's *75% experience pain *65% have shoulder injuries *up to 70% have carpal tunnel syndrome (CTS) average person pushes a WC 2000-3000x a day |
| Factors to consider in manual WC propulsion | 1. velocity (must be functional) 2. push frequency (lower the better) 3. push force (lower the better) 4. push length (bigger the better, 10 and 2 principle) 5. push smoothness (the smoother the better) 6. push technique shape (should be elliptical |
| Smartwheel | "Gait analysis" for manual WC users Meaures: 1. WC selection 2. WC setup 3. propulsion training 4. exercise prescription 5. help justification to 3rd party payers |
| Advanced WC skills: | Important functionally 1. wheelies 2. curbs 3. inclines/side slopes 4. stairs 5. floor tranfers 6. car transfers |
| Switch Control: | all or nothing response-like "switching" the lights on or off |
| Proportional Control: | speed of response is dependent on strength of command given-gas pedel |
| Direct Control: | *user chooses which switch to activate and then does so *preferred choice when possible *joystick, sip n puff, head array |
| Indirect Control: | *intermediate steps are required in making a selection; only one switch is required *scanning is most common |
Created by:
Jamierezek
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