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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