ADLREHAB LECTURE LAB V

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ADL/REHAB LECTURE LAB V

• Veronica Southard PT MS GCS

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Wheelchair Features and Activities

• Functions of a Wheelchair
• Max function
• Comfort
• Stability
• Safety
• Protection of body structures

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Considerations in Wheelchair Prescription

• Pt disability
• Functional Ability
• Size
• Wt
• Functional needs
• Functional activities

• Expected use of chair
• Prognosis for change in pts condition

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Importance of proper fit

• Pt may have
• Decreased sensory awareness
• Limited ability to change position
• Decreased subcutaneous tissue
• Impaired peripheral circulation
• Abnormal skin

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Types of Wheelchairs

• Standard Adult
• Heavy Duty Adult
• Junior or intermediate
• Growing
• Child or Youth
• Indoor

• Hemiplegic
• Amputee
• One-hand drive
• Externally powered
• Sports
• Reclining

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Standard Lightweight Wheelchair
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Youth Reclining/Growing chair
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Rigid frame Sports chair
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Power Chair
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STANDARD
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TENNIS
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COMPANION/TRANSPORT
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Standard wheelchair measurement

• Pt is seated on firm, flat surface
• Clothed and wearing shoes/braces
• Comfortable
• Cushion should be under pt.
• Parameters specified at the time of order
• Wt., disability, expected use of chair,
  functional recreational activities

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Specific type considerations

• At the time of order these should be addressed
• Armrests
• Recliner
• Front rigging
• Legrests
• Caster wheels

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Standard Wheelchair Measurement

• 1. Seat height
• 2. Seat depth
• 3. Seat width
• 4. Back height
• 5. Armrest height
• 6. Leg length

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Teaching

• Use and functions of all features.
• Inspection of skin over bony prominences
• Pressure reliefs- w/c pushups hourly.
• Set pt up with a compliance schedule
• Cushion do not eliminate the need for pressure
  releases.
• Look for circulatory changes, pt may need to be
  removed from chair frequently

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Wheelchair Components

• Wheel locks
• Toggle- push lever. Forward is locked. Not meant
  to slow pt on a hill
• Lever or ratchet- push lever in toward chair to
  disengage. Several notches to move forward and
  back. Can be used to slow down the w/c on
  ramps/hills
• Extensions are placed on as assists for those
  with poor trunk control or limited UE function

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Wheel and tires

• Casters
• 5 solid rubber
• 8 solid rubber or pneumatic or semi pneumatic
• Drive wheels are the rear wheels. Used to propel
  w/c, solid rubber, pneumatic, semi pneumatic.
• Handrims are molded to wheelrim or are separated.
  Projections or coating

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Armrests

• 1. Fixed- permanently attached
• 2. Removable- Reversible armrests good for lat
  swing transfers, sliding board transfers. Can be
  reversed to increase distance bet armrest panals
• 3. Desk or Cutout Armrests sitting at
  desk/table/counter
• 4. Adjustable adjust height use different
  cushion/ clothes

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Front rigging/Legrest and Footrest

• 1. Fixed
• 2. Swingaway/removable legrests
• 3. Elevating Legrests
• 4. Footrests- footplate with or without heel
  loops

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Maintenance and General Care

• User should be sure to read and follow owners
  manual instructions.
• Periodically wash the frame with a nonabrasive
  metal polish
• Upholstery should be cleaned
• Chair should be wiped dry from rain Etc. as soon
  as possible
• The x brace center pin should be oiled every 6
  months
• Armpin posts should be lubricated.
• Inspect frame and upholstery for wear

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Functional Activities

• Teach use and care of w/c
• Prescribe chair based upon pts goals, needs
  anticipated lifestyle
• Home visit if possible

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Functional Tasks

• Upon receipt of w/c pt is taught
• 1. Locking/unlocking
• 2. Removal/replacement armrests
• 3. Elevate/release legrests
• 4. Commence propulsion training

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Independent propulsion

• Three methods
• 1. Bil UE
• 2. One UE and One LE
• 3. Bil LE

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Activities Included In Self Propulsion

• Steering straight forward and back
• Different surfaces
• Turning Left
• Turning Right
• Reaching for objects on the floor

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Assisted level propulsion

• Never push and let go!
• Smooth motion
• Inform a pt. prior to tipping
• Observe safe locking and footrest lengths

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Functional assisted tasks to practice

• Curbs
• Ascending single elevations backwards
• Descending single elevations backwards
• Ascending Steps backwards (2 people)
• Descending Mult Elevations Forward
• Ramps, inclines and Hills
• On Rough terrain, elevate casters

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Assisted functional tasks cont

• Elevators- roll in backwards
• NO ESCALATORS
• Wheelies