WC Modules Flashcards by Chavez Girls

What is the primary benefit of an appropriate wheelchair?

improve QoL

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Who is the most important team member of the wheelchair service delivery team?

the WC user

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How many steps are there in the wheelchair service delivery process recommended by the World Health Organization?

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A wheelchair user with an intermediate level of service delivery needs has which of the following characteristics?

a. Good sitting balance

b. Fair sitting balance

c. Able to achieve neutral posture without external support

d. Unable to achieve neutral posture, even with external support

fair sitting balance

basic = good sitting balance
- achieves neutral posture without external support
-
complex = poor sitting balance
- unable to achieve a neutral posture, even with external supports

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Which organization is responsible for drafting the “Convention on the Rights of Persons with Disabilities”?

WHO

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Which of the following best describes how a properly prescribed wheelchair might help improve someone’s health?

a. By allowing someone to move around in the community

b. By helping a person feel better about themselves

c. By allowing someone to access school or work environments

d. By increasing a person’s physical activity

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What are the two key components of the “wheelchair assessment” step (step 2)?

Performing an interview and physical assessment

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Brad is a 25-year-old man who sustained a T12 spinal injury 5 years ago. He has good sitting balance when assessed on the mat table in the clinic. He does not have any postural asymmetries and can achieve neutral posture without assistance. What “level” of wheelchair service delivery is most likely needed for Brad?

basic level

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You are working with an adolescent with cerebral palsy. She has severely increased muscle tone and has limitations in hip flexion and external rotation bilaterally. What is likely to be true of the wheelchair she will require?

She requires customized supports due to her complex needs

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The purpose of this introductory course on wheelchair seating is to allow optimal service provision for which types of wheelchair users?

ll wheelchair users with basic needs and some intermediate needs

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Why is the “reference neutral” sitting posture an important concept to understand in wheelchair seating?

Because it helps us have a position to reference when describing a person’s posture

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What view of the person would be best to assess trunk rotation in sitting?

top view

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T/F: Following is a description of a reference neutral sitting posture: pelvis is upright with the ASIS slightly lower than PSIS (slight APT); symmetrical and no rotation; trunk is upright, shoulders are posterior to the hips, legs are flexed approximately 90 degrees at the hips, knees and ankles, with neutral rotation at the hips bilaterally, the head is aligned with the shoulders. hips may be slightly ABD, neutral rotation

false

Shoulders should be aligned over hips, not posterior.

module says “shoulders balanced over pelvis (with slight posterior lean)”

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requirements for neutral sitting posture

neutral pelvis in all three planes

normal spine curves in all three planes

hip joints: 90 deg flex, 5-8 deg hip ABD, 0 deg IR/ER

90 deg knee flex with hips flexed to 90 deg

0 deg DF/PF

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Pelvic obliquity vs pelvic rotation vs pelvic tilt

obliquity = lateral flexion, seen in coronal plane (can occur with lateral tilt)

APT/PPT = sagittal plane

pelvic rotation = transverse plane, one side is rotated more forward

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how are pelvic obliquity and pelvic rotations names

obliquity = named for the lower side

pelvic rotation = names for the side more posterior (if R pelvis is scooted fwrd in the seat, its a L rotation)

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with a pelvic rotation, the fwrd hip is more ___, the hip in the back is more ____

ABD

ADD

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Benefits of an optimal sitting posture include all of the following EXCEPT:
a. Environmental

b. Comfort

c. Function

d. Health

environmental

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Which of the following is a functional benefit of an optimal sitting posture?

a. Improved aesthetic appearance

b. Digestion of food

c. Reduced risk of pressure injury

d. Improved fine motor control

improved fine motor control

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Comfort benefits of an optimal sitting posture include all of the following EXCEPT:
Increased sitting tolerance

b. Postural stability

c. Improved self confidence

improved self confidence

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fixed vs flexible vs partially flexible posture

Fixed: correction not possible, needs support but cannot be corrected in seating

Flexible: correction possible by repositioning or through applying gentle force

Partly flexible: some but not full correction possible by reposition or through application of gentle force

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T/F: Comfort and stability are internal factors that affect a person’s sitting posture.

false

Internal factors = tone, strength, ROM

Comfort/stability are outcomes, not internal factors

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Which of the following is considered an external factor that affects a person’s sitting posture in the wheelchair?

a. Abnormal muscle tone

b. Wheelchair propulsion

c. Seating component materials

d. Muscle weakness

seating component materials

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What is a possible negative consequence of poor sitting posture?

Development of non-reducible spinal deformities Pressure injuries Risk of aspiration during swallowing

T/F: Assessing an individual’s posture while sitting in their wheelchair from the front, side and top, will allow you to determine if a postural deformity is fixed or flexible.

False: You must assess on a mat (supine/lying)

Stage 1 PI

non-blanchable erythema of intact skin

Stage 2 PI

partial thickness skin loss with exposed dermis - Looks like a ruptured, serum-filled blister - No slough or eschar present

Stage 3 PI

full thickness skin loss - visible adipose tissue - Slough or eschar may be present

Stage 4 PI

full thickness skin and tissue loss - visible fascia, muscle, tendon, ligament, cartilage, or bone - Undermining and tunneling occur

Unstageable PI

obscured full thickness skin and tissue loss - wound contains slough or eschar - slough/eschar removal reveals stage 3 or 4 PI

deep tissue PI

persistent non-blanchable deep red, maroon, or purple discoloration - intact or non-intact skin may be present - Dark wound bed or blood filled blister

Friction vs Shear

**Friction**: occurs when 2 objects that are in contact with each other move parallel to one another - Contributes to shear **Shear**: distortion of body tissues from two opposing forces parallel to the surface - Caused by combo of pressure and friction

High risk PI areas

- coccyx , sacrum - **Ischial tuberosities**: highest risk of pressure injuries - Greater trochanters - Proximal areas of femurs: lowest risk

primary causes of pressure injuries

pressure shear

stage 1 PI

non-blanchable erythema of intact skin

stage 2 PI

partial thickness skin loss with exposed dermis

stage 3 PI

full thickness skin loss - visible adipose tissue

stage 4 PI

full thickness skin and tissue loss - visible fascia, muscle tendon, ligament, cartilage, bone

unstageable PI

obscured full thickness skin and tissue loss - wound contains slough or eschar

Deep tissue PI

persistant non blancable deep red, maroon or purple discoloration, intact or non intact skin may be present

Why is the measurement of true hip flexion so critical to perform during the supine mat assessment?

It will help to determine the angle needed between the seat and the back support

If a postural deviation that is visible when the person is seated but “disappears” when the person lies down on the mat, what is the best description of that postural deviation?

flexible

Which of the following elements is NOT considered part of the physical assessment process? Wheelchair mobility Strength Posture of the pelvis in sitting Skin integrity

WC mobilty

If the amount of true hip flexion possible is 80 degrees, what would the corresponding seat-to-back support angle need to be?

Which of the following best explains why the physical assessment must be performed in both the sitting and supine positions? For determining range of motion To effectively assess muscle power To determine sitting balance skills To assess flexibility of postural deviations

To assess flexibility of postural deviations

If a postural deviation is observed when the person is sitting in the wheelchair, also observed when the person is sitting and when supine on the mat table, and can be corrected by applying force to the pelvis and trunk in supine, what is the “next step” in determining how to address this postural deviation in the wheelchair seating system?

Determine how much force is required to correct the deviation

Why is it important to document a history of pressure injuries (PI)?

Having a history of pressure injures is an important risk factor Healed pressure injuries permanently weaken the skin You should be careful of applying pressure in the location of a healed PI

A posterior pelvic tilt is frequently associated with which other postural deviations? A reduced or absent lumbar lordosis An increased lumbar lordosis A reduced thoracic kyphosis A scoliosis

a reduced or absent lumbar lordosis

What is an important ‘rule’ to follow when assessing sitting posture?

Be systematic in your approach

What is a key requirement for a person to be able to sit in a ‘neutral’ or ‘upright’ posture?

At least 90 degrees of true hip flexion

The process of applying forces to the body to determine optimal locations and magnitude to support optimal posture is called…

simulation

If specialty equipment is not available to provide a simulation, which of the following is the next best option in the wheelchair evaluation process?

perform hand simulation

During the hand simulation process, the goals include which of the following? a) Determining the “optimal posture” b) Assessing the amount of force needed for correction c) Locating the best possible application points for the forces

all of the above

Which of the following is a basic measurement that is required for ALL wheelchair users?

hip width

Which of the following dimensions is used to determine the best seat depth of the wheelchair?

Buttock/thigh depth

Which of the following is a key consideration for taking body measurements? a) Use a flexible tape measure b) Measure the person sitting in the wheelchair c) Measure the person in supine on the mat d) Take measurements in the optimal sitting posture

Take measurements in the optimal sitting posture

Which of the following is a key benefit of the technology trial process? a) Determine which features work best for the wheelchair user b) Allowing accurate measurement of the body c) Determining the flexibility of any postural deviations d) Training the individual in optimal mobility

Determine which features work best for the wheelchair user

What is one example of the “person-technology match”?

Selecting the optimal wheelchair seat width based on hip width

Which of the following is an integral part of the “wheelchair assessment” part of the wheelchair seating and mobility examination and specialty evaluation? a) The functional assessment b) The sitting mat assessment c) The hand simulation d) Measurement of true hip flexion

the functional assessment

Which of the following is the BEST description of the “person-technology match”? The process of determining the optimal sitting posture by trialing a variety of postures sitting on the mat b) The process of identifying appropriate technology features based on physical assessment findings c) The process of determining the flexibility of the lower extremity joints for obtaining a neutral sitting posture d) The process of determining the functional goals for the equipment

The process of identifying appropriate technology features based on physical assessment findings

what to measure for seat width?

hip width Is usually about 2” wider than hip width of the person

what to measure for seat depth?

buttocks/thigh depth Is usually about 1 inch shorter than the buttock/thigh depth

what to measure to determine back height

scapula and shoulder height Depends on the trunk control and balance of the user - may be below or above the scapula

what to measure to determine armrest height?

elbow height: distance from top of seat to inferior aspect of elbow

what to measure to determine seat to floor height?

lower leg length: distance from back of knee to bottom of heel If not propelling with feet, 2 inches of ground clearance is usual

what to measure to determine leg rest or foot rest length

lower leg length: distance from back of knee to bottom of heel nee to keep thighs parallel to seat for good pressure distribution

what to measure to determine seat to back angle?

thigh to trunk angle (hip angle)

what to measure to determine seat to lower leg support angle?

thigh to lower leg angle: knee angle standard is 60 degrees need to measure knee flexion with hips flexed at 90 deg

what to measure to determine lower leg to foot support angle?

lower leg to foot angle (ankle angle) standard is 90 degrees

Which of the following does not describe an appropriate wheelchair seat width? a. Provides sufficient space on either side of the hips for the individual’s belongings that he/she requires during their day b. Supports the pelvis and lower extremities in good posture and alignment c. Allows accessibility into and throughout the individual’s usual environments d. Allows good access to the handrims for propulsion

Provides sufficient space on either side of the hips for the individual’s belongings that he/she requires during their day

Which of the following is true regarding a 90° seat to back angle in a wheelchair? a. It is the most comfortable angle for most individuals because the hip is in neutral b. It can be difficult to maintain posture and balance when sitting at this angle in an upright orientation c. It is the most common angle used for sitting surfaces for able-bodied individuals d. It can accommodate hip and/or pelvic contractures

It can be difficult to maintain posture and balance when sitting at this angle in an upright orientation

Your elderly client sits in a non-reducible posterior pelvic tilt and mild bilateral hip extension contractures. Which of the following would be the best choice for her wheelchair? a. A standard wheelchair with a welded 90° seat to back angle b. A wheelchair with adjustable back posts that create a closed seat to back angle c. A wheelchair with adjustable back posts that create an open seat to back angle d. A wheelchair with adjustable back posts that create a squeeze seat

A wheelchair with adjustable back posts that create an open seat to back angle

Your client has non-reducible plantarflexion contractures in both ankles. Which would be the best choice for his foot support? a. The 90° footplates that come standard on the wheelchair b. Eliminate the footplates altogether and just let the feet hang down c. Angle adjustable footplates d. None of the above

Angle adjustable footplates

T/F: When choosing wheeled mobility devices, it is best practice to fit the equipment to the person rather than trying to fit the person into the equipment

True

Which of the following describes a benefit of matching the wheelchair’s dimensions and angles to the specific individual’s anatomical dimensions and angles? a. Helps the individual achieve and maintain best posture in the wheelchair b. Helps maintain good skin integrity c. Allows the most efficient mobility

all of the above

Which of the following is not true regarding an appropriate wheelchair seat depth? a. It can help maintain best alignment of the lower extremities b. It should touch the back of the knee to provide maximum support under the upper legs c. It can help prevent redistribute pressure from the buttocks by allowing appropriate loading of pressure onto the femurs

It should touch the back of the knee to provide maximum support under the upper legs

Which of the following describes the position of the thigh if the seat support to foot support length (legrest length) is optimal? a. Places the thigh in whatever position is most comfortable for the person b. Lifts the knee above the seat surface to help prevent pressure injuries on the distal thigh c. Allows the knee to point downward to help prevent pressure injuries on the buttocks d. Positions the thigh parallel to the seat surface to help prevent pressure injuries on the buttocks

Positions the thigh parallel to the seat surface to help prevent pressure injuries on the buttocks

Basic Manual WC

- temporary use to move from place to place - mobility: level surfaces, short distances **no one should sit in a basic non-adjustable MWC all day, every day for all mobility**

Minimally Adjustable WC

- lighter weight

Fully Adjustable WC

Variable Positioning Manual WC

Dependent Mobility WC

Of the following, which best describes how you should begin the selection process for a wheeled mobility device for a specific person? a. Start with the simplest type of device that has potential to meet the person’s needs based on the results of your clinical evaluation. b. Start with the type of device that has typically met the needs of other individuals with the same diagnosis or condition c. Start with the most complex type of device that might be covered by that person’s medical insurance d. Start with a device that meets the person’s current needs along with options that might also meet future needs that could potentially develop

Start with the simplest type of device that has potential to meet the person’s needs based on the results of your clinical evaluation.

hich of the following describe(s) a benefit of using an adjustable axle plate to change the position of the rear wheels on the frame of a manual wheelchair (choose all that apply)? Choose all that apply a. Changes the seat depth of the wheelchair to provide a more intimate fit for that person b. Changes the area of the handrim that the individual can access to allow the most efficient propulsion for that person c. Changes the person’s weight distribution in the wheelchair to provide appropriate stability of the wheelchair for that person d. Changes the seat to back angle of the wheelchair to more closely match the person’s hip angle.

b. Changes the area of the handrim that the individual can access to allow the most efficient propulsion for that person c. Changes the person’s weight distribution in the wheelchair to provide appropriate stability of the wheelchair for that person

Which of the following describes the least appropriate user for a basic non-adjustable wheelchair with sling seat and back upholstery and a basic seat cushion? a. Young, active individual who needs a wheelchair on a temporary basis to move from place to place post- surgery b. Older individual who needs a wheelchair for occasional use in the grocery store, the mall and the doctor’s office c. Nursing home resident who has poor skin integrity and postural issues, a very low activity level and sits in a wheelchair all day every day d. Elderly individual who needs a wheelchair for very short distances to move from one sitting surface (chair) to another within her home

Nursing home resident who has poor skin integrity and postural issues, a very low activity level and sits in a wheelchair all day every day

T/F: A manual wheelchair with a fully adjustable frame is only appropriate for a high functioning user who is a proficient propeller, engages in many activities throughout the day, and travels on multiple types of surfaces and terrain

False: These chairs are used for many users, not just highly active ones

Which of the following describes a benefit of most power scooters (choose all that apply)? a. Provide basic power mobility for part-time, short-term use when ambulation is inefficient b. Provide variable seating options in multiple sizes for postural support and stability c. Has a relatively short turning radius to allow easy maneuverability within the home d. Require very little upper extremity strength and hand function

Provide basic power mobility for part-time, short-term use when ambulation is inefficient Require very little upper extremity strength and hand function

Your client is a 30-year old with C5 complete quadriplegia. He lives an active lifestyle involving home, work and community activities and needs to travel fairly long distances over varied types of terrain, including some inclines and uneven surfaces. Which of the following would you consider for his mobility needs? a. Complex rehab power base wheelchair b. Standard power base wheelchair c. Scooter d. Minimally adjustable manual wheelchair

Complex rehab power base wheelchair

Of the following, which body part(s) might be used to operate a power wheelchair using an alternative drive control? a. The head b. One or two fingers c. The chin d. Facial and mouth muscles

All of the above

Your client is a 75 year old female, s/p left CVA, with no functional use of her right upper and lower extremity and poor endurance. She is able to sit with minimal lateral support on the right side of her trunk, is of average size, leads a mildly active lifestyle and travels on flat to mildly uneven terrain both indoors and outdoors. She lives in a small apartment in elderly housing. Of the following, which would most likely meet her mobility needs? a. Manual wheelchair with power assist b. Scooter c. Standard power base wheelchair d. Complex rehab power base wheelchair

Standard power base wheelchair

Which of the following describe why the therapists themselves should complete all clinical documentation from their evaluations for wheeled seating and mobility devices (choose all that apply)? Choose all that apply a. Evaluation forms and letters of justification are part of the medical record b. The clinical facility is getting reimbursed for the evaluation, not the equipment company c. It is part of the therapist’s practice guidelines d. No equipment supplier has clinical training or licensure

Evaluation forms and letters of justification are part of the medical record It is part of the therapist’s practice guidelines

Which of the following is an element of a good evaluation form or letter of justification for wheeled seating and mobility devices? a. Each page is numbered (i.e., page 1 of 5) b. The document clearly indicates the date of the exam c. The name of each person who signs the document is typed or legibly printed above or below their signature

all of the above

T/F: The elements included in a good evaluation form for wheeled seating and mobility devices is very similar to those included on any other comprehensive initial evaluation.

true

Which of the following is not necessary when describing the individual’s current wheeled mobility devices and seating components? a. The manufacturer, model and age of the mobility device b. The manufacturer, model and age of the wheelchair cushion c. Their purchase price of the mobility base d. The reason(s) why new equipment is needed

Their purchase price of the mobility base

T/F: You only need to perform a postural assessment if the person has deformities that are non-reducible (fixed) and/or severe

false

Which of the following is a characteristic of appropriate clinical justifications in your assessment for wheeled seating and mobility devices? a. They contain as much technical language as possible to emphasize to the reviewer the need for the product or feature b. They provide information that is specific to that individual’s unique limitations and needs and are supported by the evaluation results c. They contain all possible reasons for the medical need of that product or feature by individuals with the same or similar disability d. They are written by the equipment supplier if the supplier has more knowledge and experience than the therapist

They provide information that is specific to that individual’s unique limitations and needs and are supported by the evaluation results

Which of the following does not describe a reason why you should include objective exam results in your documentation? a. They demonstrate that an actual exam took place and that the recommendations are not based solely on subjective information b. They help support the equipment recommendations for that specific individual c. They can help you measure physical and functional outcomes of the final equipment

none of the above

The individual’s funding source only requires a letter of justification for documentation for wheeled seating and mobility devices. Which of the following is best practice for what you provide to the equipment supplier as your documentation? a. Provide both the completed evaluation form and the letter of justification b. Provide just the letter of justification since it is the only document that is required c. Provide just the evaluation form if it contains better and more complete information d. Provide the letter of justification and let the equipment supplier provide any missing information

Provide both the completed evaluation form and the letter of justification

A postural exam describing sitting and supine non-reducible and reducible deformities of the pelvis and trunk can be a key factor in justifying which of the following (choose all that apply)? Choose all that apply a. The types and features of the wheelchair seating b. Secondary postural supports c. The type, adjustments and configurations of the mobility base d. The need for variable positioning such as tilt- in-space or recline

all of the above

If the individual has no ability to ambulate at all with or without an ambulatory device, you do not need to perform trials with a wheeled mobility device

false

WC Modules Flashcards

(102 cards)