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Wheelchair SAM

Evaluation 1. baseline in current system 2. Transfer to mat-- control of UE, head, neck 3. Seated on mat-- assess sitting balance 4. Pelvis and trunk deformities 5. UE and LE--strength, ROM, tone, reflexes 6. Supine-reassess pelvic and trunk
Hands-free sitter emphasize mobility, stable BOS, and comfort
Hands dependent sitter pelvic and trunk support required
Propped sitter total body support
Pelvic obliquity one side of pelvis is lower than the other can lead to pressure ulcers on ischial tuberosity
Kyphosis pelvis rotates posterior-- sacral sitting and lumbar flexion, slides forward in seat
Scoliosis pelvis rotates to one side and spine/trunk move to opposite side
Lordosis pelvis anterior-- increase curvature of lumbar spine, use UE for support
Windswept pelvis rotates laterally, thighs moving to other side
Reference seated position trunk upright and midline hips, knees, ankle flexed at 90 deg pelvis neutral head midposition arms at side of trunk with elbows at 90 deg
Key to stability Pelvic positioning
Cushion shapes Flat vs countoured vs custom contoured
Foam cushion material lightweight and low cost heat and moisture can build up custom contoured foam more expensive better postural control
gel filled material adequate for postural control, heavy, and sensitive to temperature
air filled material lightweight, even pressure relief, reduce postural stability
honeycomb shaped plastic material uneven pressure relief and lightweight
Pelvic stabilizer front of pelvis to limit pelvic tilt, rotation, obliquity
thoracic support lateral to the trunk, below armpit to facilitate trunk stability and prevent scoliosis
thigh support lateral or medial to thighs to control ab/ad (windswept)
Seat width widest part of hips or thighs and add 1-2 inches
seat depth base of back of popliteal space and subtract 1-2 inches if using feet to propel, subtract more than 1-2 inches
seat height popliteal space to bottom of clients heel, footrests 2 inch clearance from floor thighs parallel to floor, seat cushion raises overall seat height
seat back height seat surface including cushion to top of clients shoulder higher back height needed if trunk control is poor minimal trunk support: measure from seat to midback
seat angle sloping the seat down toward the rear (Seat dump) can help stabilize pelvis
arm rest height seating surface to bottom of clients flexed elbow, armrest 1 inch higher
Marginal ambulatory user walk short distances, wheelchair on occasion, benefit from scooter
marginal manual wheelchair user may at times use a power wheelchair
total or severe mobility impaired user unable to propel self in manual, dependent on power wheelchair or attendant
transport chairs pushed by attendant, short distances or temporary
manual wheelchair self-propelled standard: short term and temporary lightweight vs ultra light vs heavy duty
Scooters walking ability limited, steered with a tiller, more difficult to steer than power chair large turning radius, seat swivels and makes transfers easier
power wheelchair Drive wheel with middle placement means a smaller turning radius
Recline seat to back angle changes to more than 90 deg appropriate for lcients who are unable to sit upright or spend considerable time in chair and need to rest during the day, eases personal care activities
Tilt seat to back angle is fixed, can be tiled 0-45 deg, changing orientation but not position
amputee chairs rear axle set back to increase stability
hand rim projections for weak grasp
brake lever extender for decreased ROM
adjustable tension backrest accommodates kyphosis
wedge cushion (antithrust) front higher than back to aid in preventing forward sliding
documentation symptoms, diagnoses, history, physical examination, functional assessment, recommendation and rationale