Session 11 Lab Guide - Wheelchair Parts and Options

Session 11 Lab Guide ==================== ### Learning Goal: Think Like a PT #### Course Goal 3: Document effectively using appropriate medical terminology #### Objective 3.12 Integrate all components of a well written goal when writing goals ### Learning Goal: Safely and effectively utilize fou...

Session 11 Lab Guide ==================== ### Learning Goal: Think Like a PT #### Course Goal 3: Document effectively using appropriate medical terminology #### Objective 3.12 Integrate all components of a well written goal when writing goals ### Learning Goal: Safely and effectively utilize foundational intervention strategies when working with non-complex patients #### Course Goal 9: Manage wheelchairs effectively A wheelchair with parts noted WHEELCHAIR PARTS and OPTIONS ---------------------------- **Wheelchair Trade-Offs** - **Stability vs. mobility** - **Size vs. maneuverability** - **Specificity vs. versatility** - **Cost vs. complexity** - **Structural support vs. size and weight** - **Shock absorption vs. energy expenditure** - **Support vs. portability** ### Wheelchair Prescription **Goal:** Prescribe the appropriate wheelchair components for each patient **What recommendations would you make and Why?** **Patient A** is 62 years old and lives with their partner in a single story house. They fell down a flight of stairs 2 weeks ago and is s/p ORIF R femur and tibia with a long leg cast, NWB R L/E for 6 weeks. They attend worship services 3 blocks away from his home. They are able to walk 10 feet with a standard walker then fatigues. They have been D/C from the hospital with the walker and a wheelchair **Patient B** is a 16 y.o. who was sustained a L4 SCI from a motorcycle accident 6 months ago. The patient is recovering well and participating in outpatient PT, where you help choose the options for their permanent w/c. The patient is able to sit on the plinth good balance. They will be returning to his high school in the fall and wants to return to drama and choir. -------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Key aspects of this case to consider Short term Long term Seat and Back Sling , easy to fold Rigid but light Cushion Comfortable, dissipate heat Arms Leg rest and Foot Plate Frame Easy to fold Light weight Drive Wheels Can canter out to increase maneuverability for sports but it lowers stability Push rims Can put spokes to grab if grip strength is weak Tires Tires to increase comfortability and make light weight but requires maintenance Casters Razor scooter wheels cuz they are cheap and durable Alignment Tilt seat back to adjust pressure relief You are recommending a ramp be built outside their homes for ease of access. What would you say about the following? - Maximum slope? No more than 1:12 inch rise:run - Maximum rise? 30 inches - Minimum width? 36 inches - When would handrails be needed? The rise is greater than 6 inches or run greater than 72 inches You are also planning a family education session. What instructions would you provide for each of the following tasks? - Go up a curb with help? - Go down a curb with help? - Go down a steep ramp with help? - Go up a steep ramp unassisted? - Go up a curb by unassisted? What safety considerations should be taught? PROPER WHEELCHAIR FIT --------------------- Proper Seated Position - Support the normal curves of the spine - Flex the hips to at least 90 degrees - Forearms supported with relaxed shoulder alignment - Remember, if the pelvis goes, so does the body! - Position the pelvis back and central in the seat - CCDD when repositioning Key Concepts for Fit: - Always use proper guarding and blocking as appropriate when transferring a patient - Key measurements: - Seat depth - Seat width - Seat-to-floor height - Seat back height - Confirming fit: - Symmetrical posture - 90/90/90 position - Hips flexed at or above the height of the hips - Normal spinal curves maintained - Remember the 2" rule for proper fit **Why is wheelchair fit important?** WHEELCHAIR PROPULSION ON EVEN SURFACES -------------------------------------- - Skills Needed to Demonstrate: - Proper propulsion technique - Tight turns - Entering and exiting doors independently and as a caregiver pushing a w/c Key Concepts: - Remember the 10 and 2 or 3 o'clock position on the wheel - Long smooth stroke to optimize efficiency - Turning requires you to hold one rim while pushing with the other - Tight turns require you to move the wheels in opposite directions simultaneously - Seat alignment allowing for elbow flexion angle of 100-120^o^ optimizes the angle of the push and therefore efficiency - When moving through doorways, always be cognizant of the path of the door - SAFETY! Be sure to watch that fingers do not get caught between the door and the wheel WHEELCHAIR MANAGEMENT ON UNEVEN SURFACES ---------------------------------------- - Skills: ### Curbs - Curb navigation is easiest ascending forward and descending backward - If the patient is able they can assist going up the curb by pushing on the pushrim to go up and using a flat hand to slow the descent. If the pt is unable to assist then their hands should be in their lap. - Construction worker female with solid fillGuarding and Safety Considerations: Foot must stay in contact with the tip bar until the casters are securely on the surface, keep your leg in contact with the back of the chair to drive the chair onto and off of the curb. Ensure that your foot is not on the curb when you are bringing the curb off the edge. - Instructions: Going up the stairs-"I am going to tip the casters up onto the curb, then you will push on the rims to help me roll you onto the curb. Ready? 1-2-3-Tip, 1-2-3-Push" - ### Ramps - Ramp navigation is best ascending forward and descending backward - Steep slopes may require a zigzagging motion - If the patient is able they can assist going up the curb by pushing on the pushrim to go up and using a flat hand to slow the descent. If the pt is unable to assist then their hands should be in their lap. - Construction worker female with solid fillGuarding and Safety Considersations: Maintain your leg in contact with the wheelchair. - Cues: "1-2-3-Push, 1-2-3-Push" Key Concepts: - Remember body mechanics -- use your leg muscles! - Before attempting to tilt a wheelchair be sure the anti-tip bars are turned up Advanced Wheelchair Management ------------------------------ **Assisting someone in a wheelchair up and down stairs** Several people helping a person in a wheelchair Summary ------- - - - - Review Questions to Ponder regarding Seated Mobility: ----------------------------------------------------- 1. To optimize the efficiency of your pt's wc propulsion, where would you tell him to position his hand to start the push? Finish it? 2. What elbow angle would make the push most efficient? 3. What is the difference between a reclining back and a tilt-in-space wc? 4. How many pounds can a standard wc typically handle? 5. What direction should the wc be in if you want to bring your pt up the curb? 6. How would you teach your patient to turn his wc to the right? 7. Where should the CoM be when trying to perform a wheelie? 8. When and why would we teach our pts to perform wheelies? 9. What should be the maximum slope of a ramp? 10. What should be the maximum rise on a ramp? 11. What should be the minimum width of a ramp? 12. How should a patient be taught to ascend a ramp? What if it is steep? 13. How should you assist a patient down a ramp? 14. Why would you NOT assist a patient down an incline facing forward? 15. How should you assist a patient in a wc into the elevator? 16. What is the most typical method of ascending and descending a curb with a dependent patient? 17. How can a patient best assist the caregiver in ascending and descending a curb? 18. How would you position 3 individuals and your patient to bring a wheelchair upstairs? Downstairs? Where should the 3 grab onto the chair? It is important to realize the 3 do not completely lift the chair, what do they do? 19. What are the primary body parts that must be protected when falling forward, backward, laterally and how would you protect them? 20. What is the "two-finger confirmation check"? How would you perform it? 21. Why is it better to tilt the wheels of the WC? 22. Describe some of the trade-offs that must be considered when ordering a wc Here's a guide on wheelchair (WC) propulsion, positioning, and safety techniques for both patients and caregivers: 1\. \*\*Hand Position for WC Propulsion\*\*: \- \*\*Start Position\*\*: Hands should start at the \*\*top of the wheel (12 o'clock)\*\* position for optimal leverage. \- \*\*Finish Position\*\*: Complete the push at the \*\*back of the wheel (2-3 o'clock)\*\* to maximize the efficiency of each push. 2\. \*\*Elbow Angle for Efficient Propulsion\*\*: \- An angle of about \*\*100-120°\*\* at the elbow allows for the most effective push force without causing strain. 3\. \*\*Difference Between Reclining Back and Tilt-in-Space WC\*\*: \- \*\*Reclining Back\*\*: Only the backrest reclines, allowing the user to lean back while keeping the seat stationary. \- \*\*Tilt-in-Space\*\*: Both the seat and backrest tilt together, maintaining hip angles and redistributing weight for pressure relief. 4\. \*\*Weight Capacity of a Standard WC\*\*: \- Most standard wheelchairs handle up to \*\*250-300 pounds\*\*. 5\. \*\*WC Direction to Bring a Patient Up a Curb\*\*: \- Approach the curb \*\*backward\*\*, allowing the larger back wheels to make contact first for easier lifting. 6\. \*\*Teaching a Patient to Turn Right in a WC\*\*: \- Instruct the patient to \*\*pull back on the right wheel\*\* while \*\*pushing forward on the left wheel\*\* to create a smooth, controlled right turn. 7\. \*\*Center of Mass (CoM) for a Wheelie\*\*: \- The CoM should be positioned \*\*just behind the axle\*\* to help balance the chair on the back wheels. 8\. \*\*Teaching Patients to Perform Wheelies\*\*: \- Wheelies are useful for \*\*navigating curbs and small obstacles\*\*. They're taught to patients who need to be independent in difficult terrains to prevent tipping. 9\. \*\*Maximum Slope of a Ramp\*\*: \- The maximum recommended slope is \*\*1:12\*\* (1 inch of rise for every 12 inches of ramp length). 10\. \*\*Maximum Rise on a Ramp\*\*: \- A single ramp should not have a rise greater than \*\*30 inches\*\* without a landing for rest. 11\. \*\*Minimum Width of a Ramp\*\*: \- Ramps should be at least \*\*36 inches wide\*\* to accommodate standard WC dimensions. 12\. \*\*Teaching a Patient to Ascend a Ramp\*\*: \- Encourage the patient to \*\*lean forward\*\* to counterbalance and use smooth, steady pushes. If it's steep, \*\*zig-zagging\*\* or taking short breaks may help with fatigue. 13\. \*\*Assisting a Patient Down a Ramp\*\*: \- \*\*Position the chair backward\*\* to prevent runaway speed, and keep your hands ready for control. 14\. \*\*Why Not to Assist a Patient Down an Incline Facing Forward\*\*: \- Facing forward on a decline can cause the WC to gain too much speed, potentially making it hard to control and increasing fall risk. 15\. \*\*Assisting a Patient into an Elevator in a WC\*\*: \- \*\*Back the WC into the elevator\*\*, so the patient faces the door when exiting and maintains better control. 16\. \*\*Typical Method of Ascending and Descending a Curb with a Dependent Patient\*\*: \- For ascending: \*\*Back the chair up the curb\*\* by tipping onto the large wheels. For descending: \*\*Lower the chair forward\*\* onto the larger wheels while keeping control. 17\. \*\*How a Patient Can Assist the Caregiver with Curbs\*\*: \- The patient should \*\*lean forward\*\* when ascending and \*\*lean backward\*\* when descending to adjust their center of mass for stability. 18\. \*\*Positioning of Three Helpers and Patient for Stair Transfers\*\*: \- \*\*Two helpers at the back\*\*, holding the frame or handles; \*\*one helper at the front\*\* gripping the footrest or lower frame. Helpers \*\*guide and stabilize\*\* rather than lift the chair fully. 19\. \*\*Primary Body Parts to Protect in Falls\*\*: \- \*\*Forward fall\*\*: Use arms to protect the face, tucking in elbows. \- \*\*Backward fall\*\*: Tuck chin to protect the head and neck, avoid reaching back. \- \*\*Lateral fall\*\*: Extend one arm to break the fall, protecting the shoulder and head. 20\. \*\*Two-Finger Confirmation Check\*\*: \- Place \*\*two fingers between the patient's body and the WC\*\* at key pressure points (e.g., hips, knees) to ensure adequate spacing for comfort and circulation. 21\. \*\*Benefits of Tilted WC Wheels\*\*: \- Tilted wheels \*\*widen the base of support\*\*, enhancing stability and making it easier to turn the chair with less strain on the shoulders. 22\. \*\*Trade-Offs in Ordering a WC\*\*: \- \*\*Weight vs. Durability\*\*: Lightweight chairs are easier to transport but may not be as durable. \- \*\*Adjustability vs. Stability\*\*: More adjustable chairs allow customization but can sometimes sacrifice stability. \- \*\*Cost vs. Features\*\*: Advanced features (e.g., powered chairs, tilt functions) increase costs, so consider essential features first. These guidelines ensure that wheelchair mobility is optimized for both safety and efficiency, helping patients navigate effectively in various environments.