Wheelchair SAM
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| 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
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| Hands-free sitter | emphasize mobility, stable BOS, and comfort
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| Hands dependent sitter | pelvic and trunk support required
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| Propped sitter | total body support
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| Pelvic obliquity | one side of pelvis is lower than the other can lead to pressure ulcers on ischial tuberosity
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| Kyphosis | pelvis rotates posterior-- sacral sitting and lumbar flexion, slides forward in seat
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| Scoliosis | pelvis rotates to one side and spine/trunk move to opposite side
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| Lordosis | pelvis anterior-- increase curvature of lumbar spine, use UE for support
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| Windswept | pelvis rotates laterally, thighs moving to other side
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| 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
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| Key to stability | Pelvic positioning
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| Cushion shapes | Flat vs countoured vs custom contoured
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| Foam cushion material | lightweight and low cost
heat and moisture can build up
custom contoured foam more expensive better postural control
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| gel filled material | adequate for postural control, heavy, and sensitive to temperature
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| air filled material | lightweight, even pressure relief, reduce postural stability
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| honeycomb shaped plastic material | uneven pressure relief and lightweight
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| Pelvic stabilizer | front of pelvis to limit pelvic tilt, rotation, obliquity
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| thoracic support | lateral to the trunk, below armpit to facilitate trunk stability and prevent scoliosis
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| thigh support | lateral or medial to thighs to control ab/ad (windswept)
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| Seat width | widest part of hips or thighs and add 1-2 inches
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| seat depth | base of back of popliteal space and subtract 1-2 inches
if using feet to propel, subtract more than 1-2 inches
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| 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
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| 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
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| seat angle | sloping the seat down toward the rear (Seat dump) can help stabilize pelvis
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| arm rest height | seating surface to bottom of clients flexed elbow, armrest 1 inch higher
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| Marginal ambulatory user | walk short distances, wheelchair on occasion, benefit from scooter
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| marginal manual wheelchair user | may at times use a power wheelchair
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| total or severe mobility impaired user | unable to propel self in manual, dependent on power wheelchair or attendant
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| transport chairs | pushed by attendant, short distances or temporary
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| manual wheelchair | self-propelled
standard: short term and temporary
lightweight vs ultra light vs heavy duty
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| Scooters | walking ability limited, steered with a tiller, more difficult to steer than power chair
large turning radius, seat swivels and makes transfers easier
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| power wheelchair | Drive wheel with middle placement means a smaller turning radius
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| 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
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| Tilt | seat to back angle is fixed, can be tiled 0-45 deg, changing orientation but not position
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| amputee chairs | rear axle set back to increase stability
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| hand rim projections | for weak grasp
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| brake lever extender | for decreased ROM
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| adjustable tension backrest | accommodates kyphosis
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| wedge cushion (antithrust) | front higher than back to aid in preventing forward sliding
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| documentation | symptoms, diagnoses, history, physical examination, functional assessment, recommendation and rationale
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