July 2009 Seating Course

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By: garrettrickard (132 month(s) ago)

May I recieve a copy of your presentation. I found it very helpful and would like a copy for my personal use. Garrett Rickard, ATP

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Slide 1: 

SUSAN JOHNSON TAYLOR, OTR/L REHAB INSTITUTE OF CHICAGO GOOD MORNING!

Slide 2: 

WHO ARE YOU…, AND HOW LONG HAVE YOU BEEN DOING SEATING AND MOBILITY?

RIC WHEELCHAIR AND SEATING CLINICWHO ARE WE? : 

RIC WHEELCHAIR AND SEATING CLINICWHO ARE WE? 3 PTS AND 2 OTS WITH EXPERIENCE RANGING FROM 12-30 YEARS EACH RANGE OF EXPERIENCE WITH DIFFERENT DIAGNOSES WORK WITH REHABILITATION TECHNOLOGY SUPPLIERS; MOST OF WHOM ARE CERTIFIED AS ASSISTIVE TECHNOLOGY SUPPLIERS TRAVEL TO OFFSITES 1-2 TIMES/MONTH

OVERVIEW OF ASSISTIVE TECHNOLOGY : 

OVERVIEW OF ASSISTIVE TECHNOLOGY BROAD RANGE OF DEVICES USED TO AUGMENT/ REPLACE FUNCTION ETHICS CERTIFICATION LIABILITY ISSUES

WHAT IS SEATING? : 

WHAT IS SEATING? WHAT SEATING IS NOT: A THERAPEUTIC DEVICE A DEVICE MEANT TO PROVIDE RANGE OF MOTION A DEVICE MEANT TO CHALLENGE SOMEONE’S BALANCE SUPPORT SURFACES SUPPORT SURFACES SUPPORT SURFACES SUPPORT SURFACES For Function!

URBAN MYTHS OF SEATING : 

URBAN MYTHS OF SEATING THE GROIN IS NOT A WEIGHT BEARING SURFACE DYCEM IS NOT A METHOD TO KEEP SOMEONE’S BUTT IN THE CHAIR AN ANTERIOR CHEST STRAP CANNOT REMOVE THE EFFECT OF GRAVITY ON A KYPHOSIS A LONGER SEAT DEPTH WILL NOT PREVENT SLIDING DOWN IN THE SEAT

WHEN SHOULD YOU REQUEST A SEATING AND MOBILITY EVALUATION? : 

WHEN SHOULD YOU REQUEST A SEATING AND MOBILITY EVALUATION? ANY TIME A CLIENT’S NEEDS HAVE CHANGED IF THE CLIENT IS UNCOMFORTABLE IN THE WHEELCHAIR IT THE WHEELCHAIR AND/OR SEATING ARE IN POOR CONDITION YOU THINK THAT THE CLIENT COULD BE SITTING OR MOVING BETTER!

WHEN IS AN EVALUATION NOT APPROPRIATE? : 

WHEN IS AN EVALUATION NOT APPROPRIATE? THE CLIENT’S WHEELCHAIR ONLY NEEDS REPAIRS THE SUPPLIER SHOULD BE CONTACTED DIRECTLY THE CLIENT IS ONLY TEMPORARILY USING A WHEELCHAIR

THE TEAM : 

THE TEAM

THE CLIENT : 

THE CLIENT DON’T WORRY, SHE’LL GROW INTO IT…

THE THERAPIST : 

THE THERAPIST Why is a good therapist important? Letter of medical necessity Hands on evaluation Help define equipment characteristics

LAST BUT NOT LEAST… : 

LAST BUT NOT LEAST… Take part in the equipment fitting with the supplier to: Ensure proper POSITIONING AND SUPPORT Educate regarding USE AND CARE of equipment Provide MOBILITY TRAINING when necessary Set the time frame for FOLLOW-UP

THE SUPPLIER : 

THE SUPPLIER Why is a good supplier important? They are the EXPERTS on the RECOMMENDATION AND REPAIR of equipment With clear GOALS from the THERAPIST AND CLIENT, they can help match APPROPRIATE EQUIPMENT They are the one INTERFACING with the FUNDING AGENCY

OTHER POTENTIAL TEAM MEMBERS : 

OTHER POTENTIAL TEAM MEMBERS FAMILY/CAREGIVER ORTHOTIST PRIMARY THERAPIST NURSE PHYSICIAN

OVERVIEW OF SEATING GOALS : 

OVERVIEW OF SEATING GOALS EFFECTS OF ABNORMAL TONE/ REFLEXES PROVIDE CORRECTIVE FORCES OR ACCOMMODATE FIXED ORTHOPEDIC DEFORMITIES MAXIMIZE INDEPENDENCE WITH MOBILITY IMPROVE FUNCTIONAL/ ADL SKILLS ACCOMMODATE SENSATION PROBLEMS IMPROVE COMFORT/ SITTING TOLERANCE IMPROVE SELF IMAGE

CLINICAL FRAMEWORK : 

CLINICAL FRAMEWORK EVALUATION GOAL SETTING SIMULATION FINAL GOALS MATCHED TO EQUIPMENT FUNDING FITTING

EVALUATION : 

EVALUATION CLIENT AND FAMILY GOALS SUBJECTIVE INFORMATION MEDICAL HISTORY SURGICAL HISTORY MAT EVALUATION FUNCTIONAL & ADL SKILLS

CLIENT AND FAMILY GOALS : 

CLIENT AND FAMILY GOALS LISTEN!!!!!

SUBJECTIVE INFORMATION : 

SUBJECTIVE INFORMATION SUPPORT SYSTEM ENVIRONMENT HOME SECONDARY TRANSPORTATION OCCUPATION LEISURE INTERESTS

MEDICAL HISTORY : 

MEDICAL HISTORY DIAGNOSES, ONSET, PROGNOSIS CO-MORBIDITES MEDICATIONS PRECAUTIONS

SURGICAL HISTORY : 

SURGICAL HISTORY PAST AND FUTURE especially orthopedic and skin

MAT ASSESSMENT : 

MAT ASSESSMENT ORTHOPEDIC EVALUATION NEUROMOTOR EVALUATION SKIN CONDITION/ SENSORY STATUS

Slide 25: 

SUPINE AND SITTING

ORTHOPEDIC EVALUATION : 

ORTHOPEDIC EVALUATION Determine FIXED postures vs. FLEXIBLE / REDUCIBLE postures Determine joint and spinal flexibility

Slide 27: 

Begin by observing ROM in supine in preparation for sitting

Slide 28: 

…THEN OBSERVE AND SUPPORT IN SITTING, UNDERSTANDING WHAT SITTING LIMITS MAY BE THERE. OBSERVE CLIENT SHAPES

The Pelvis is the “KEY” to Support : 

The Pelvis is the “KEY” to Support

PELVIC ANATOMY : 

PELVIC ANATOMY ASISs PSISs ISCHIAL TUBEROSITIES SACRUM & COCCYX GREATER TROCHANTERS

POSTERIOR PELVIC TILT : 

POSTERIOR PELVIC TILT PRESSURE ON SACRUM/COCCYX ENCOURAGES SLIDING DOWN IN SEAT PROMOTES KYPHOTIC SPINE POSTURE TROUBLE HOLDING HEAD UP TROUBLE WITH PHYSIOLOGIC FUNCTIONS, SUCH AS BREATHING IMPEDES UE FUNCTIONAL ROM

POSTERIOR PELVIC TILT/ KYPHOSIS : 

POSTERIOR PELVIC TILT/ KYPHOSIS

ANTERIOR PELVIC TILT : 

ANTERIOR PELVIC TILT PRESSURE ON PUBIS SYMPHISIS CAN ALSO HAVE PRESSURE BETWEEN ASISs AND THIGHS CENTER OF GRAVITY ANTERIOR; OFTEN LEADS TO ARM DEPENDENT SITTING LEADS TO LORDOTIC SITTING POSTURE

ANTERIOR PELVIC TILT/ LORDOSIS : 

ANTERIOR PELVIC TILT/ LORDOSIS

PELVIC OBLIQUITY : 

PELVIC OBLIQUITY PRESSURE ON ONE ISCHIAL TUBEROSITY CAN ALSO LEAD TO PRESSURE ON RIB CAGE LEADS TO SCOLIOTIC POSTURE PELVIC AND TRUNK ROTATION LEADS TO POOR LATERAL TRUNK STABILITY

PELVIC OBLIQUITY/ SCOLIOSIS : 

PELVIC OBLIQUITY/ SCOLIOSIS

PELVIC AND TRUNK ROTATION : 

PELVIC AND TRUNK ROTATION

IMPAIRED LOWER EXTREMITY ALIGNMENT : 

IMPAIRED LOWER EXTREMITY ALIGNMENT CAN LEAD TO PRESSURE ISSUES CAN LEAD TO POSTURAL INSTABILITY CAN PROMOTE FURTHER POSTURAL DEFORMITY CAN PROMOTE SLIDING

WINDSWEPT DEFORMITY : 

WINDSWEPT DEFORMITY

LIMITED HIP FLEXION : 

LIMITED HIP FLEXION

HIP ADDUCTION : 

HIP ADDUCTION

HIP ABDUCTION : 

HIP ABDUCTION

TIGHT HAMSTRINGS : 

TIGHT HAMSTRINGS

KNEE FLEXION CONTRACTURE : 

KNEE FLEXION CONTRACTURE

IMPAIRED LOWER EXTREMITY ALIGNMENT : 

IMPAIRED LOWER EXTREMITY ALIGNMENT ANKLE MAINTAIN FLAT ON FOOTPLATE? DO THEY WEAR SHOES? ARE THE FEET SO DEFORMED THAT THERE IS NOT A WEIGHT BEARING SURFACE?

ANKLE DORSI/ PLANTARFLEXION CONTRACTURE : 

ANKLE DORSI/ PLANTARFLEXION CONTRACTURE

ANKLE INVERSION/ EVERSION : 

ANKLE INVERSION/ EVERSION

IMPAIRED HEAD ALIGNMENT : 

IMPAIRED HEAD ALIGNMENT DECREASED FUNCTIONAL/ ADL SKILLS IMPAIRED VISUAL FIELD CAN THIS LIMIT HEAD POSITION? REFLEXES ATNR STNR BALANCE OVER PELVIS

DECREASED HEAD CONTROL : 

DECREASED HEAD CONTROL

UPPER EXTREMITY ALIGNMENT : 

UPPER EXTREMITY ALIGNMENT SCAPULAR ALIGNMENT; ALLOWING SCAPULAR MOVEMENT SUPPORT CAN DECREASE SITTING PRESSURES CAN DECREASE SHOULDER SUBLUXATION CAN PROVIDE A FUNCTIONAL SURFACE

NEUROMOTOR STATUS : 

NEUROMOTOR STATUS TONE: HYPERTONIC (HIGH TONE) HYPOTONIC (LOW TONE) MOVEMENT DISORDERS: ATHETOID ATAXIC PRIMITIVE POSTURAL REFLEXES

HYPOTONICITY : 

HYPOTONICITY

HYPERTONICITY : 

HYPERTONICITY

ASYMMETRIC TONIC NECK REFLEX : 

ASYMMETRIC TONIC NECK REFLEX

SYMMETRIC TONIC NECK REFLEX : 

SYMMETRIC TONIC NECK REFLEX

TONIC LABYRINTHINE : 

TONIC LABYRINTHINE PRONE SUPINE

POSITIVE SUPPORTING REACTION : 

POSITIVE SUPPORTING REACTION

SPASTICITY : 

SPASTICITY UNCONTROLLED SPASMS CAN CAUSE: DECREASED RANGES OF MOTION IMPAIRED VENTILATION CHECK TO SEE IF CLIENT USES MEDICATION TO CONTROL SPASMS MAY USE SPASTICITY FOR FUNCTION

SENSORY STATUS : 

SENSORY STATUS ABSENT, IMPAIRED, INTACT DO THEY HAVE A WAY OF PERFORMING A WEIGHT/ POSTURAL SHIFT INDEPENDENTLY? DO THEY HAVE A HISTORY OF PRESSURE SORES? EVER HAD SURGERY FOR THEM? ARE THEY SUSCEPTIBLE TO SORE DEVELOPMENT?

MAT EVALUATION DEMO : 

MAT EVALUATION DEMO

MEASURING: ANATOMIC VS. EQUIPMENT : 

MEASURING: ANATOMIC VS. EQUIPMENT TAKE A FULL SET OF ANATOMIC MEASUREMENTS DURING MAT EVAL TAKE MEASUREMENTS AGAIN IN TRIAL EQUIPMENT

ANATOMIC MEASURING : 

ANATOMIC MEASURING MEASURE IN SEATED POSITION!!! USE YARDSTICK OR LESS FLEXIBLE MEASURING TAPE, IN A STRAIGHT LINE!

MEASUREMENT DEMO : 

MEASUREMENT DEMO

Slide 80: 

SIMULATION: USING TRIAL EQUIPMENT TEST INITIAL GOALS ASSESS SKILLS ACCURATE MEASURING

FUNCTIONAL/ ADL SKILLS : 

FUNCTIONAL/ ADL SKILLS OBSERVE HOW SKILLS ARE PERFORMED, SO THEY ARE NOT INTERFERED WITH MOBILITY FEEDING HYGIENE COMMUNICATION WHEELCHAIR SKILLS

ACCESSIBILITY/TRANSPORTATION/ : 

ACCESSIBILITY/TRANSPORTATION/ HOME/ WORK LAYOUT (INCLUDING STRUCTURAL INTEGRITY) TRANSFER TYPE TRANSPORTATION METHOD(S) RAMP,LIFT/ TIE- DOWN TYPES AND MEASUREMENTS; VAN DOOR OPENING SIZE OBSERVE STORAGE OF CHAIR IN CAR

FINAL GOALS MATCHED TO EQUIPMENT : 

FINAL GOALS MATCHED TO EQUIPMENT PROBLEM GOAL CHARACTERISTICS OF EQUIPMENT NEEDED COMMERCIAL EQUIPMENT OPTIONS (“BUILDING A SEATING SYSTEM”)

BUILDING A SEATING SYSTEM : 

BUILDING A SEATING SYSTEM

DYNAMIC SEATING : 

DYNAMIC SEATING ALLOW MOVEMENT WITHIN A RANGE FOR ACCOMMODATION OF SPASTICITY/ FUNCTION

“SYMPTOMS” THAT MIGHT LEAD US TO CONSIDER DYNAMIC SEATING : 

“SYMPTOMS” THAT MIGHT LEAD US TO CONSIDER DYNAMIC SEATING PARTS OF THE WHEELCHAIR OR SEATING SYSTEM ARE CONSTANTLY BREAKING…….. FOOTREST ASSEMBLIES, BACKPOSTS, HEADREST HARDWARE, ETC

DURING THE MAT EVAL, YOU DISCOVER THAT THERE IS NO WAY TO “CONTROL” THIS CLIENT’S MOVEMENTS : 

DURING THE MAT EVAL, YOU DISCOVER THAT THERE IS NO WAY TO “CONTROL” THIS CLIENT’S MOVEMENTS

PRINCIPLES OF SEATING SUPPORTS : 

PRINCIPLES OF SEATING SUPPORTS SEATING SUPPORTS ASSIST WITH PROVIDING STABILITY FOR FUNCTION SEATING SUPPORTS CAN ASSIST WITH SLOWING PROGRESSION OF POSTURAL PROBLEMS

PRINCIPLES OF SEATING SUPPORTS : 

PRINCIPLES OF SEATING SUPPORTS THERE SHOULD BE GOOD CONTACT BETWEEN THE SEATING SUPPORTS AND THE CLIENT’S BODY GOOD PRESSURE DISTRIBUTION IS A PRIORITY

PRINCIPLES OF SEATING SUPPORTS : 

PRINCIPLES OF SEATING SUPPORTS REMEMBER, SEATING IS NOT MEANT AS A THERAPEUTIC DEVICE! THE WHEELCHAIR AND SEATING SYSTEM CANNOT DO EVERYTHING; SOMETIMES OTHER EQUIPMENT IS NECESSARY

PRIMARY SUPPORT SURFACES : 

PRIMARY SUPPORT SURFACES CUSHIONS BACKRESTS

WHAT DOES THE CUSHION SUPPORT? : 

WHAT DOES THE CUSHION SUPPORT? UNDER THE BONEY STRUCTURES OF THE PELVIS AND HIPS UNDER THE LOWER EXTREMITIES

CUSHION SELECTION CONSIDERATIONS : 

CUSHION SELECTION CONSIDERATIONS ABILITY TO DISTRIBUTE PRESSURE ABILITY TO SUPPORT/ ACCOMMODATE CLIENT’S BODY SHAPES AND SUPPORT NEEDS ABILITY OF CLIENT TO BALANCE AND FUNCTION EASE OF CARE; ABILITY OF CLIENT/ CAREGIVER TO MAINTAIN WEIGHT DURABILITY

PRIMARY SUPPORT SURFACES: CUSHION SELECTION : 

PRIMARY SUPPORT SURFACES: CUSHION SELECTION CLASSIFICATION OF MATERIALS FOAM FLUID AIR COMBINATION

SUPPORT SURFACES: CUSHIONS : 

SUPPORT SURFACES: CUSHIONS CUSHIONS FOAM BENEFITS LIGHTWEIGHT CONTOURED SHAPE INCREASES SURFACE AREA, INCREASING PRESSURE DISTRIBUTION CUSTOM CONTOURED OPTIONS ACCOMMODATE POSTURAL DEFORMITY SOME ARE LESS EXPENSIVE FIRM TRANSFER SURFACE

SUPPORT SURFACES: CUSHIONS : 

SUPPORT SURFACES: CUSHIONS FOAM LIMITATIONS IF FOAM IS TOO SOFT RISK “BOTTOMING OUT” POLY-FOAM “PUSHES BACK” VISCO-FOAM “CONFORMS” SHORT LIFE SPAN RETAINS HEAT MAY BE DIFFICULT TO CLEAN CUSTOM CONTOURS MAY INCREASE DIFFICULT OF TRANSFERS

SUPPORT SURFACES: CUSHIONS : 

SUPPORT SURFACES: CUSHIONS CUSHIONS FLUID BENEFITS CONFORM TO INDIVIDUAL SHAPE, INCREASING SURFACE AREA AND INCREASING PRESSURE DISTRIBUTION DECREASE SHEAR FORCES DO NOT RETAIN HEAT EASY TO CLEAN

SUPPORT SURFACES: CUSHIONS : 

SUPPORT SURFACES: CUSHIONS FLUID LIMITATIONS HEAVY LESS STABLE TRANSFER SURFACE EXTREME COLD CAN AFFECT PRESSURE DISTRIBUTION IF NOT ENOUGH FLUID RISK “BOTTOMING OUT”

SUPPORT SURFACES: CUSHIONS : 

SUPPORT SURFACES: CUSHIONS CUSHIONS AIR BENEFITS LIGHTWEIGHT IMMERSION INCREASES SURFACE AREA, INCREASING PRESSURE DISTRIBUTION EASY TO CLEAN SOME CAN ACCOMMODATE POSTURAL ASYMMETRIES

SUPPORT SURFACES: CUSHIONS : 

SUPPORT SURFACES: CUSHIONS AIR LIMITATIONS INITIAL ADJUSTMENT IS IMPORTANT REQUIRE MORE MAINTENANCE THAN FOAM OR FLUID CAN PUNCTURE, RESULTING IN “BOTTOMING OUT” SOME DO NOT ACCOMMODATE POSTURAL ASYMMETRIES UNSTABLE TRANSFER SURFACE

HOW IMPORTANT IS PRESSURE MAPPING? : 

HOW IMPORTANT IS PRESSURE MAPPING? BENEFITS CAN VIEW PEAK PRESSURE VALUES OVER CONTACT SURFACE IN REAL TIME CAN VIEW CHANGES IN PEAK PRESSURE STATICALLY VERSUS DYNAMICALLY IS A GOOD TEACHING TOOL CAN ASSIST WITH THE ADJUSTMENT OF AIR CUSHIONS

SOMETIMES “OFF THE SHELF” JUST WON’T WORK : 

SOMETIMES “OFF THE SHELF” JUST WON’T WORK

HOW IMPORTANT IS PRESSURE MAPPING? : 

HOW IMPORTANT IS PRESSURE MAPPING? LIMITATIONS CANNOT MEASURE SHEAR FORCES DOES NOT SHOW CHANGE IN PEAK PRESSURE OVER TIME MAP ITSELF CAN HAVE AN EFFECT ON PEAK PRESSURES THE TECHNOLOGY IS EXPENSIVE

HOW IMPORTANT IS PRESSURE MAPPING? : 

HOW IMPORTANT IS PRESSURE MAPPING? AVERAGE RECOVERY TIME FOR TISSUE PERFUSION IS 150 SECONDS, WHILE THE AVERAGE PUSH-UP PRESSURE RELIEF IS 50 SECONDS NO LITERATURE TO DEFINITIVELY SUPPORT HOW OFTEN A PRESSURE RELIEF SHOULD BE PERFORMED

HOW IMPORTANT IS PRESSURE MAPPING? : 

HOW IMPORTANT IS PRESSURE MAPPING? THE TAKE HOME MESSAGE USE A CONSISTENT PROTOCOL FOCUS ON RELATIVE COMPARISONS NEVER LET PRESSURE MAPPING REPLACE YOUR BRAIN

BACKREST SELECTION CONSIDERATIONS : 

BACKREST SELECTION CONSIDERATIONS ADJUSTABILITY; SEAT DEPTH, POSITION IN SPACE SHAPE; DOES IT MATCH THE CLIENT? CAN IT BE CUSTOMIZED TO MATCH THE CLIENT’S SHAPE BY ADDING FOAM, REMOVING FOAM, ETC. ABILITY TO CHANGE SHAPE RELATIVELY EASILY FOR CLIENTS WITH CHANGING CONDITIONS DURABILITY, ENVIRONMENT, USE FOR ADLS, EASE OF REMOVING/REPLACING

SUPPORT SURFACES: BACKRESTS : 

SUPPORT SURFACES: BACKRESTS BACKRESTS HEIGHT GENERALLY INCREASE WITH DECREASED TRUNK CONTROL POWER TILT OR RECLINE REQUIRES INCREASED HEIGHT IMPROVED PRESSURE DISTRIBUTION WITH INCREASED CONTACT CONTOUR IMPROVED PRESSURE DISTRIBUTION WITH INCREASED CONTACT

SUPPORT SURFACES: BACKRESTS : 

SUPPORT SURFACES: BACKRESTS BACKRESTS INTEGRATED LATERAL TRUNK SUPPORTS HELP TO MAINTAIN MIDLINE TRUNK ALIGNMENT HELP SLOW PROGRESSION OF POSTURAL ASYMMETRY PROVIDE SUPPORT FOR FUNCTION

SECONDARY SUPPORT SURFACES : 

SECONDARY SUPPORT SURFACES LATERAL AND MEDIAL SUPPORTS HEADRESTS ARM SUPPORTS

SECONDARY SUPPORT SURFACES : 

SECONDARY SUPPORT SURFACES WEDGES UNDER CUSHION LATERAL PELVIC SUPPORTS LATERAL /MEDIAL THIGH SUPPORTS LATERAL TRUNK SUPPORTS HEAD SUPPORT ARM SUPPORTS

TERTIARY SUPPORTS : 

TERTIARY SUPPORTS USUALLY PROVIDE ANTERIOR SUPPORT ANTERIOR TRUNK/SHOULDER PELVIS FOOT

TERTIARY SUPPORTS : 

TERTIARY SUPPORTS PELVIS “ANTERIOR PELVIC SUPPORT” LAP BELTS SIZED TO THE CLIENT LINE(S) OF PULL APPROPRIATE FOR ORTHOPEDIC DEFORMITIES AND TONE RELY ON SEAT TO PROVIDE MAJORITY OF SUPPORT GROIN STRAPS CAREFULLY APPLIED IN TERMS OF LINE OF PULL AND PRESSURE

TERTIARY SUPPORTS : 

TERTIARY SUPPORTS LOWER EXTREMITIES: FOOT AND ANKLE SUPPORT FOOT PLATE LOCATION CRITICAL TO ACCOMMODATE TIGHT HAMSTRINGS AND DECREASE EFFECTS OF EXTENSOR TONE. CONSIDER USE OF ORTHOTICS IS FOOTPLATE MOVEMENT NECESSARY BECAUSE OF TONE? FOOT STRAPS- LINE OF PULL, PRESSURE DISTRIBUTION, TONE ANKLE SUPPORT- ALLOWING FREEDOM OF MOVEMENT WITHIN LIMITS

TERTIARY SUPPORTS : 

TERTIARY SUPPORTS ANTERIOR TRUNK/SHOULDER SUPPORT; MAKE SURE YOU ARE NOT ADDRESSING “SYMPTOMS”. ENSURE THE SHAPE OF THE BACK MATCHES THE CLIENT’S SHAPE AND SUPPORT NEEDS. ENSURE THE ANGLE OF THE WHEELCHAIR BASE MATCHES THE CLIENT’S ABILITY TO MAINTAIN COMFORTABLE BALANCE OF THE HEAD AND TRUNK. THE ANTERIOR TRUNK SUPPORT SHOULD NOT BE THE MAIN THING HOLDING CLIENT INTO THE BACK CHOOSE LEAST RESTRICTION NECESSARY PROVIDE A SUPPORT AS DYNAMIC AS POSSIBLE. ENSURE YOU ARE NOT PUSHING DOWNWARD ON THE SHOULDERS (WATCH THE LINE OF PULL).

Slide 123: 

LATERAL PELVIC/THIGH SECONDARYSUPPORTS ROHO CUSHION-PRIMARY SUPPORT LATERAL PELVIC/THIGH SECONDARYSUPPORTS LATERAL TRUNK SUPPORTS SECONDARY SUPPORTS FIP BACK PRIMARY SUPPORT

OVERVIEW OF MANUAL MOBILITY : 

OVERVIEW OF MANUAL MOBILITY

DECISION MAKING PROCESS : 

DECISION MAKING PROCESS FUNCTIONAL STATUS/POTENTIAL FOR CHANGE? CAN THE CLIENT PROPEL A MANUAL WHEELCHAIR? WHAT EXTREMITIES WILL THEY USE TO PROPEL THE WHEELCHAIR? DOES THE CLIENT NEED TO BE TILTED BACKWARD TO RELIEVE PRESSURE, IMPROVE BALANCE, CONTROL SPASTICITY, OR FOR POSTURAL STABILITY? HOW WILL THE CLIENT TRANSFER? HOW WILL THEY TRANSPORT THE WHEELCHAIR?

DEPENDENT MOBILITY : 

DEPENDENT MOBILITY MANUAL RECLINER MANUAL TILT MANUAL TILT AND RECLINE LIGHT WEIGHT WHEELCHAIR (ADJUSTED TO PROVIDE SOME FIXED TILT) STANDARD NON-ADJUSTABLE WHEELCHAIR. TRANSPORT WHEELCHAIR

MANUAL WHEELCHAIR OPTIONS : 

MANUAL WHEELCHAIR OPTIONS DEPENDENT MOBILITY BASES RECLINERS TILT IN SPACE TILT AND RECLINE

MANUAL WHEELCHAIR OPTIONS: RECLINERS : 

MANUAL WHEELCHAIR OPTIONS: RECLINERS BENEFITS FOLD FOR TRANSPORT/ STORAGE ALLOW EASE OF DEPENDENT CARE AND HYGIENE GENERALLY LESS EXPENSIVE CLIENT CAN PROPEL (NOT DESIGNED FOR FUNCTIONAL PROPULSION)

MANUAL WHEELCHAIR OPTIONS: RECLINERS : 

MANUAL WHEELCHAIR OPTIONS: RECLINERS LIMITATIONS CAN CAUSE LOSS OF POSITION WITH PRESSURE RELIEF SHEARING CAN INCREASE RISK OF IMPAIRED SKIN INTEGRITY LESS ADAPTABLE TO CUSTOM SEATING

MANUAL WHEELCHAIR OPTIONS: TILT IN SPACE : 

MANUAL WHEELCHAIR OPTIONS: TILT IN SPACE BENEFITS MORE LIKELY TO MAINTAIN SEATED POSTURE DURING PRESSURE RELIEF STATIC POSITIONING IN SOME TILT CAN ASSIST WITH BALANCE MORE ADAPTABLE TO SEATING COMPONENTS

MANUAL WHEELCHAIR OPTIONS: TILT IN SPACE : 

MANUAL WHEELCHAIR OPTIONS: TILT IN SPACE LIMITATIONS MORE COSTLY THAN RECLINER DOES NOT FOLD/BREAKDOWN WELL FOR TRANSPORT HEAVIER THAN A RECLINER

MANUAL WHEELCHAIR OPTIONS : 

MANUAL WHEELCHAIR OPTIONS INDEPENDENT MOBILITY BASE FOLDING RIGID ADJUSTABLE FRAME FIXED FRAME

MANUAL WHEELCHAIR OPTIONS : 

MANUAL WHEELCHAIR OPTIONS FOLDING FRAME BASES BENEFITS INCREASED SHOCK ABSORPTION DUE TO MOVING PARTS MAY FIND THEM EASIER TO STORE OR TRANSPORT DUE TO THE ABILITY TO FOLDING “FLAT” LIMITATIONS OFTEN HEAVIER DUE TO MOVING PARTS DECREASED DURABILITY

MANUAL WHEELCHAIR OPTIONS : 

MANUAL WHEELCHAIR OPTIONS RIGID FRAME BASES BENEFITS INCREASED DURABILITY DUE TO DECREASED MOVING PARTS OFTEN LIGHTER WEIGHT THAN FOLDING FRAME BASES LIMITATIONS PROVIDE DECREASED SHOCK ABSORPTION DUE TO DECREASED MOVING PARTS CAN BE MORE DIFFICULT TO TRANSPORT A FIXED FRAME HAS LITTLE TO NO ADJUSTABILITY

MANUAL WHEELCHAIR OPTIONS : 

MANUAL WHEELCHAIR OPTIONS POWER ASSIST CAN ADD TO ALMOST ANY ADJUSTABLE MANUAL FRAME MAY BE AN ALTERNATIVE FOR INDIVIDUALS WITH MARGINAL ABILITY TO PROPEL

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS AXLE ADJUSTABILITY CENTER OF GRAVITY SEAT HEIGHT CAMBER FRAME LENGTH CASTERS REAR WHEELS AND TIRES BACK ANGLE

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS CENTER OF GRAVITY (COG) TYPICALLY WANT HAND TO FALL AT HUB OF WHEEL WANT WHEEL AS FAR FORWARD AS POSSIBLE WITHOUT COMPROMISING STABILITY MAKE SURE THAT BACK ANGLE IS ADJUSTED PRIOR TO AXLE ADJUSTMENT

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS CENTER OF GRAVITY ADJUSTMENTS AXLE POSITIONED FORWARD TO USER’S CENTER OF GRAVITY USER’S WEIGHT IS BEHIND WHEEL DECREASED STABILITY, EASIER TO “POP WHEELIE” SHORTER WHEEL BASE FOR BETTER MANEUVERABILITY IMPROVED ACCESS TO WHEEL AXLE POSITIONED BEHIND USER’S CENTER OF GRAVITY USER’S WEIGHT IN FRONT OF THE AXLE INCREASED STABILITY LONGER WHEEL BASE LESS ACCESS TO WHEEL

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS REAR SEAT HEIGHT ADJUSTMENTS DIFFERENT POSITION OF THE AXLE PLATE/CAMBER TUBE FOR REAR SEAT HEIGHT ADJUSTABILITY CONSIDER SEAT POSITION RELATIVE TO REAR WHEEL (120 DEGREES OF ELBOW FLEXION WITH HAND AT 12 O’CLOCK) CAN PROVIDE IMPROVED POSTURAL SUPPORT WITH DECREASED TRUNK STRENGTH

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS CAMBER BENEFITS LATERAL STABILITY IMPROVED TURNING RADIUS EFFICIENT PUSH STROKE LIMITATIONS INCREASED OVERALL CHAIR WIDTH

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS FRAME LENGTH USUALLY DICTATED BY SEAT DEPTH MANUFACTURERS MAY PROVIDE SEVERAL FRAME LENGTHS

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS CASTERS INCLUDES THE WHEEL, FORK, AND STEM BOLT-ALL INFLUENCE THE FRONT SEAT TO FLOOR HEIGHT AND MANEUVERABILITY CASTER MUST ALWAYS BE PERPENDICULAR TO THE GROUND

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS CASTER A LONGER STEM BOLT, SHORTER FORK, AND SMALLER CASTER ALL LEAD TO A TIGHTER TURNING RADIUS

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS CASTER LARGER WHEELS BETTER NEGOTIATION OF UNEVEN SURFACES INCREASED TURNING RADIUS INCREASED ROLLING RESISTANCE SMALLER WHEELS BETTER TURNING RADIUS DECREASED ROLLING RESISTANCE LESS RISK OF LOWER EXTREMITY INTERFERENCE MORE DIFFICULT TO NEGOTIATE UNEVEN SURFACES

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS CASTERS TRAILING POSITION SHORTER WHEELBASE DECREASED INTERFERENCE WITH FOOTPLATES DECREASED FORWARD STABILITY LEADING POSITION LONGER WHEELBASE INCREASED FORWARD STABILITY USUAL CONFIGURATION FROM THE MANUFACTURER

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS REAR WHEELS MAG WHEELS-LOW MAINTENANCE, HEAVY, POOR SHOCK ABSORPTION SPOKE-SOME MAINTENANCE, LIGHT, GOOD SHOCK ABSORPTION SPINERGY (FIBER GLASS)-SOME MAINTENANCE, GOOD SHOCK ABSORPTION, EXPENSIVE

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS TIRES PNEUMATIC-SOME MAINTENANCE, GOOD SHOCK ABSORPTION SOLID-LOW MAINTENANCE, POOR SHOCK ABSORPTION FLAT-FREE-LOW MAINTENANCE NARROW WIDTH DECREASES ROLLING RESISTANCE DEEPER TREAD INCREASES ROLLING RESISTANCE (TRACTION)

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS : 

MANUAL WHEELCHAIR COMPONENTS AND PERFORMANCE ADJUSTMENTS BACK ANGLE ADJUSTABLE CAN ACCOMMODATE DECREASED RANGE OF MOTION OR FIXED DEFORMITIES CAN ACCOMMODATE DECREASED TRUNK STRENGTH/BALANCE ADDS WEIGHT AND MANTAINENCE FIXED LIGHTER WEIGHT DECREASED MAINTENANCE DECREASED ABILITY TO ACCOMMODATE FOR POSTURAL NEEDS

A FINAL WORD : 

A FINAL WORD IMPLEMENT REGULAR FOLLOW-UP EDUCATE CLIENTS ON EQUIPMENT CARE AND MAINTENANCE

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