Wheelchair Management and Mobility

1
Wheelchair Management and Mobility

• Elizabeth Watson, DPT, NCS

2
Factors that Affect Selection of Wheelchair

• Level and completeness of injury
• Medical complications
• Functional skills
• Physical attributes
• Accessibility
• Previous life activities
• Transportation
• Funding

3
Mobility at Different Levels

• C1-4 Power mobility versus sip n puff, head
  array, or tongue touch key pad
• C5 Power mobility. May be able to push but
  non-functional on level tile surface for short
  distances
• C6 Power mobility for community may push MWC
  over level surfaces, but no functional grip and
  no triceps make pushing challenging

4
Mobility at Different Levels

• C7 Partial innervation of triceps- propelling
  MWC easier. No functional grip. May use PWC for
  community mobility
• C8 MWC in most cases. Finger flexors innervated
  providing functional grip for advanced skills and
  community propulsion
• T1 MWC propulsion primary means of locomotion.

5
Wheelchair Propulsion

• Evaluate ways in which the client can propel
• - Both UEs
• - Both LEs
• - One LE and one UE
• What additional equipment will be needed?
• - Plastic coated rims or rubber tubing
• - Lugs
• - Dycem gloves

6
Types of Wheelchairs

• Folding Frame
• Easier for transport, storage
• Better for patients who need to swing away leg
  rests for sit ltgt stand transfer
• - More moving parts, less durable
• - Heavier

7
Types of Wheelchairs

• Rigid Frame
• stronger, durable
• more energy efficient, maneuverable
• lighter weight
• sportier
• less maintenance
• - more expensive

8
Types of Wheelchairs

• Tilt- in- space
• Positioning wheelchair
• Provides pressure relief for dependent patients

9
Sports Wheelchairs

• Basketball

• Tennis

10
Postural Evaluation

• Is the pelvis fixed or flexible?
• A FIXED deformity is one that cannot be changed.
  You must ACCOMMODATE the seating system to the
  person to provide optimal pressure distribution
• A FLEXIBLE deformity is one that may be able to
  be CORRECTED through proper positioning
• Goal of seating system Achieve most optimal,
  biomechanical alignment possible so that it will
  provide even pressure distribution and enable the
  person to be as functionally I as possible

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Supine Assessment

• Pelvic Tilt
• Pelvic Elevation
• Pelvic Rotation
• Hip flexion ROM
• Hamstring ROM
• Hip abd/add and IR/ER ROM

12
Seated Assessment

• Posterior/ Anterior Pelvic Tilt
• Pelvic Obliquity
• Pelvic Rotation
• Spine- scoliosis, kyphosis

13
Wheelchair Measurements

• Patient Height
• Patient Weight
• Seat Width
• - Standard Adult- 18
• - Narrow Adult- 16
• - Large Adult- 20 or 22 Bariatric up to 30
• - Pediatric- 10-14
• - Too narrow
• - Too wide

14
Wheelchair Measurements

• Seat Depth
• - Standard Adult- 16
• - Long Adult- 18-20
• - Short Adult- 14-15
• - Too short
• - Too long

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Wheelchair Measurements

• Seat to Floor Height- proper seat height provides
  maximum function for
• - Transfers
• - Height from floor for standing transfers
• - Height in relation to bed/ chair/ toilet
• - Access to environment
• - Work surfaces/ counter tops/ tables
• - Steering wheels
• - Wheelchair propulsion
• - Access to wheels (upper extremities)
• - Access to floor (lower extremities)
• Standard height- 19.5 inches
• Hemi height- 17.5 inches
• Super hemi height- 14.5 inches

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Wheelchair Measurements

• Back Height- a properly adjusted back height
  provides
• - Amount of support needed for postural control
• - Sensation and comfort
• - Range of motion
• - Functional ability and skill
• - Function within environment
• - Standard Adult- 18
• - Tall Adult- 20-24

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Wheelchair Measurements

• Legrest type/ Length
• - swingaway
• - elevating
• - articulating
• Armrest Type/ Length
• - removable
• - adjustable height
• - swing back

18
Cushions

• Utilized for 3 main purposes
• - Pressure relief/ skin integrity
• - Comfort
• - Positioning
• If the cushion is not positioned properly in the
  chair or the patient is not positioned properly
  on the cushion, the above three purposes will not
  be met.
• Most of the cushions are contoured (ie some sort
  of cut out or divot where buttocks should be).
  The contour is always in the back.

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Letter of Medical Necessity

• Required for nearly all permanent equipment
• Wording is important for justification to
  insurance
• Justification must be provided for all items on
  spec sheet that has an up-charge as well as
  cushion and back for wheelchair

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Letter of Medical Necessity

• 1st paragraph- Identify client and equipment for
  which you are requesting funding. Identify
  diagnosis and any significant PMH
• 2nd paragraph- Brief summary of patients
  functional status
• 3rd paragraph- Identify what types of wheelchairs
  were trialed, the chair you are ordering and why
  it is medically necessary
• 4th paragraph- Justify items that are an
  up-charge on spec sheet
• Additional paragraphs- Identify cushion and back
  to be ordered and why medically necessary

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Advanced Wheelchair Skills

• Wheelies
• Propulsion in a wheelie position
• Up/down ramps
• Up/down curbs
• Up/down stairs
• D management of MWC on elevations
• howtoadapt.com/WheeliesWhy/WheeliesWhy.shtml
• www.wheelchairnet.org/WCN_ProdServ/Docs/MWTG/Sec4
  /sec4.html