Assistive Devices & Wheelchair Prescription PDF

Assistive Devices & Wheelchair Prescription POAT 311 | Roselyn Maderse, PTRP Assistive Devices Improve stability by expanding base of support (BOS) Reduce weight bearing on one/both lower extremities Permit mobility Assistive Devices (greatest to least amount of suppor...

Assistive Devices & Wheelchair Prescription POAT 311 | Roselyn Maderse, PTRP Assistive Devices Improve stability by expanding base of support (BOS) Reduce weight bearing on one/both lower extremities Permit mobility Assistive Devices (greatest to least amount of support provided) Walker Bilateral crutches Single crutches Bilateral canes Quad canes Hemi canes Single canes Assistive Devices (least to most coordination needed) Parallel bars Walker Cane Axillary crutch Loftstrand crutch Tilt Table Not an assistive device Patients who need to physiologically acclimate to an upright position Manual or mechanical Parallel Bar Maximal patient stability and support Initiation of gait patterns Severely limits mobility Parallel Bar Measurements: Height: greater trochanter (Bar handle height: wrist crease, ulnar styloid) Width: approx. 2 inches wider than greater trochanter Bar handle: 20-25 deg elbow flexion 6 in. anterior to the hips Walker Maximum stability and support Improve balance Relieve weight-bearing Walker Measurements: Height: - distance from the pt’s greater trochanter to heel Handgrip - wrist crease - ulnar styloid process - greater trochanter Walker Most to least stable Non-folding standard walker Folding walker Rolling walker (ant, post) Reciprocal walker Axillary Crutch Less stability Greater selection of gait pattern Increase assistive device mass and restriction of hand use Coordination problems Axillary Crutch Measurements: Crutch length 77% x height Height 16 inches In supine: o Distance between anterior axillary fold to 6 8 inches lateral to heel In sitting o Abduct shoulders and flex one elbow to 90 o Olecranon of flexed elbow to tips of fingers of opposite arm Axillary Crutch Measurements: 2 fingerbreadths between the axillary rest and the bottom of the axilla Measure from a point at the anterior axillary fold to a point on the floor - 2 inches lateral - 6 inches anterior 20 25 elbow flexion Loftstrand crutch Forearm cuff with a narrow anterior opening Hands are freed up to perform other activities Good upper extremity strength and adequate trunk balance Measurements: Handgrip - Level of the greater trochanter, wrist crease, or ulnar styloid process Forearm cuff - 1 to 1.5 inches distal to the olecranon process Triceps crutch Extends just above the elbow Has a single aluminum upright attached to bilateral uprights Platform crutch Transfer body weight through forearm to the assistive device Unable to bear weight on wrist and hand Cane Compensation for impaired balance Improve stability More functional on stairs and in narrow, confined areas Cane Measurements: Height - Distance from the patient’s greater trochanter to the heel Handgrip - Level of the greater trochanter, wrist crease, or ulnar styloid process Standard and Adjustable Aluminum Quad Cane Hemi Cane Rolling Cane Laser Cane Weight Bearing Levels Gait Patterns Prescriptive Wheelchair Mobility orthosis - Allow maximum functional mobility Properly and correctly fitted Lightweight yet strong Cosmetically acceptable Wheelchair Components and Features SEAT Sling seat Inserts or contours - provides a stable base of support on which to mount upper body function Firm seat - enhances posture and provides stable base of support Wheelchair Components and Features ARMRESTS Fixed armrests -Standing transfers Removable or Reversible armrests -Lateral swinging/ sliding transfers Wheelchair Components and Features WHEELS AND TIRES Caster wheels - 5 to 8 inches in diameter Drive or Rear wheels - used to propel the wheelchair Wheelchair Components and Features WHEELS LOCKS Toggle lock Z or Scissors lock Auxiliary lock Wheelchair Components and Features FRONT RIGGING, LEG REST, & FOOT REST fixed foot rest swing-away or removable leg rest Wheelchair Components and Features FRONT RIGGING, LEG REST, & FOOT REST Elevating leg rest - Calf panel Foot rest/plate -Loop Heel loop Toe loop -Strap Wheelchair Components and Features BODY RESTRAINTS Lap (waist) belt - falling out or sliding forward - lower abdomen or pelvis Chest belt - mid chest level - trunk stability, falling out, maintain the body upright Wheelchair Types of Wheelchair Standard adult - 200lbs - For vigorous functional activities Ultralight - Efficient propulsion, reduced cumulative trauma - Weight capacity to 300 lbs Types of Wheelchair Intermediate/junior child < normal size , adult Growing – accommodate growth of user Child/youth – up to 6 years old Indoor – caster wheels more posterior Types of Wheelchair Hemiplegic Amputee One hand drive - two hand rims - smaller vs larger hand rims (Small: same side, near wheel) (Larger: opp side, far wheel) Types of Wheelchair Externally powered Sports - Low profile, fixed frame, lightweight Reclining - Semi vs Full Tilt in space Wheelchair for SCI patients WHEELCHAIR DEPENDENCE C4 SIP AND PUFF POWER WHEELCHAIR C5 POWER WHEELCHAIR WITH JOYSTICK - HANDRIM PROJECTION C6 -HANDRIM PROJECTION MANUAL WHEELCHAIR C7 -FRICTION HANDRIM PROJECTION C8 -STANDARD HANDRIMS Wheelchair Measurements Wheelchair for SCI patients WHEELCHAIR DEPENDENCE C4 SIP AND PUFF POWER WHEELCHAIR C5 POWER WHEELCHAIR WITH JOYSTICK - HANDRIM PROJECTION (OBLIQUE) C6 -HANDRIM PROJECTION MANUAL WHEELCHAIR (VERTICAL) C7 -FRICTION HANDRIM PROJECTION C8 -STANDARD HANDRIMS Wheelchair Measurements Seat Height/ Leg Length Heel to popliteal fold Add 2 inches 19.5-20.5 inches (normal) Seat Height Seat too low Seat too high Difficulty performing transfers Insufficient trunk support Improper weight distribution Difficulty positioning wheelchair beneath a table or desk Decreased mobility Difficulty propelling wheelchair Unsafe use Poor posture Leg Length Footplates too low Footplates too high Increased pressure on the distal Increased pressure to the ischial posterior aspect of thigh tuberosities Decreased upper extremity Difficulty positioning chair function when propelling beneath a table of desk Unsafe mobility Decreased trunk stability Wheelchair Measurements Seat Depth 16 inches Posterior buttock, along lateral thigh to popliteal fold Subtract 2 inches Seat Depth Seat too short Seat too long Decreased trunk stability Increased pressure on the popliteal fossa Increased weight bearing on ischial tuberosities Poor balance Wheelchair Measurements Seat Width 18 inches Widest aspect of the user’s buttocks, hips, or thighs Add 1.5 inches Seat Width Seat too wide Seat too narrow Difficulty propelling the chair Difficulty changing position Difficulty performing transfers Excessive pressure to the greater trochanters Difficulty moving through narrow hallways or doorways Difficulty wearing bulky outer garments, orthoses, or braces Postural deviations Wheelchair Measurements Back Height 16 to 16.5 inches Seat of he chair to the floor of the axilla Shoulder flexed to 90 deg Subtract 4 inches Seat cushion Back Height Back too high Back too low Difficulty propelling the chair Decreased trunk stability Excessive irritation to the skin Difficulty with balance Wheelchair Measurements Armrest Height 9 inches Seat of the chair to the olecranon process User’s elbow flexed to 90 deg Add 1 inch Seat cushion Armrest Height Armrest too high Armrest too low Difficulty propelling wheelchair Poor posture/back discomfort Difficulty performing standing Increased abdominal discomfort transfer Inadequate balance Postural deviation Difficulty rising to a standing position Limited use of armrests Standard dimensions (in inches) Chair Style Seat Width Seat Depth Seat Height Adult 18 16 20 Narrow adult 16 Slim adult 14 Junior 16 16 18.5 Child 14 11.5 18.75 Tiny toddler 12 11.5 19.5 Independent Functional Activities WHEELIE Elevation of the caster wheels Necessary so the wheel can clear objects on the floor, sidewalk, or ground and to ascend and descend curbs and curb cut outs Independent Functional Activities WHEELIE Pull back quickly and equally on both hand rims and then abruptly stop the rearward motion of the rear wheels by firmly grasping the hand rims Reach back on the hand rim and forcefully push forward to lift the front casters off the ground Independent Functional Activities NEGOTIATING RAMPS ASCENDING - forward lean of the head and trunk - if ramp is long: use long, strong pushes - if ramp is short & steep: short, quick pushes Independent Functional Activities NEGOTIATING RAMPS DESCENDING (FACE FORWARD) a. Lean back b. Descent is controlled by hand rim c. Allow equal rolling of rims on hand straight path Independent Functional Activities NEGOTIATING CURBS ASCEND Wheelie front caster - ONCE casters are clear, LEAN FORWARD and push on hand rims Independent Functional Activities NEGOTIATING CURBS DESCEND Forward a. As patient approaches curb, do wheelie b. Rear wheel are allowed to roll or bounce off the curb c. Patient leans forward to lower the caster wheels The end. Fairchild, S. L., O’Shea, R. K., & Washington, R. D. (2018). Pierson and Fairchild’s principles & techniques of patient care (Sixth edition). Elsevier. Reference: Fairchild, S. L., O’Shea, R. K., & Washington, R. D. (2018). Pierson and Fairchild’s principles & techniques of patient care (Sixth edition). Elsevier.