Hi Tech Volume - MCCCbehrensb/documents/210Wheelchairs2013.pdf- ascend steep hill with wheelchair -...
Transcript of Hi Tech Volume - MCCCbehrensb/documents/210Wheelchairs2013.pdf- ascend steep hill with wheelchair -...
8/20/2013
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Wheelchairs
Wheelchairs
1.W/C Components
2.Types of wheelchairs
3.Wheelchair operation
4.Wheelchair Propulsion
Wheelchair Components
Wheel Locks
•One of the most important safety features
•Devices that stabilize the wheels of a wheelchair
–After the wheelchair has been stopped
–They operate differently than brakes, which stop a moving wheel.
–Must be engaged whenever pt is moving into or out of W/C
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Wheelchair Components
Wheel Locks - USE
General Safety
• Wheel locks must be engaged whenever an individual is moving into
or out of a wheelchair.
• Engaging wheel locks on the rear wheels prevents forward motion and backward motion of a wheelchair.
• Wheel locks must make secure contact with tires to prevent
movement of the wheels.
Wheelchair Components
Pelvic Positioners
• Devices that stabilize a patient’s pelvis in the proper position while
seated in a wheelchair.
–Not intended to be used to prevent a patient from falling out of a wheelchair
–Not intended to be used as a restraint to keep a patient from
getting out of a wheelchair unexpectedly
•they are part of a positioning system
Wheelchair Components
Caster Wheels
• small front wheels on a wheelchair
–standard solid rubber
•durable
–pneumatic
•air filled to provide a smoother ride
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Wheelchair Components
Drive (Push) Wheels
• large rear wheels of a wheelchair
• types
–standard spokes made of aluminum
–“Mag”
•8 thicker struts made of magnesium
–used for propulsion
•standard solid rubber
•pneumatic
–with or without a treads
Wheelchair Components
Drive (Push) Wheels (continued)
–outer hand rims for propelling
•with projections
–add weight and width
–make maneuvering in small places more difficult
•non slip coating
–more lightweight
–quick release
•for ease of transport into or out of a car
Wheelchair Components
Armrests
• full length
–the height is the same along the entire length of the armrest
• desk length
–the height of the arm rest is split into two heights so that the
wheelchair can be rolled up to a desk and the back of the arm rest is higher, supporting the elbow
•the arm rest is removable so that it can be reversed to make
transfers easier by placing the higher portion in the front
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Wheelchair Components
Foot plates & Foot rests
• a patient’s foot rests on foot plates
• heel loops constructed of cloth or webbing attach to foot plates and
prevent the feet from sliding off the foot plates and under the wheelchair
• foot plates may be raised to allow patients to transfer safely in and
out of a wheelchair
• Foot rests are fixed or removable & distance from seat to footplate
can be adjusted
• pivoting foot rests can be removed to provide more room for safe transfers into and out of a wheelchair
Wheelchair Components
Legrests:
-usually elevating
A calf pad cushions the calf & supports the leg
Wheelchair Components
Anti-Tipping Devices
-small extensions attached to the lower horizontal support bar
-used to prevent accidental backward tipping
-must permit some tipping, so front casters can roll up over doorsills, curbs, etc.
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Wheelchair Seats & Cushions Seats
-Flexible (Sling)
-Rigid
Cushions
-uniform or contoured in shape
-pressure and posture
-flat foam, contoured foam, fluid filled, air-filled, gel, hybrid
Wheelchair Cushions
Types of Wheelchairs
Standard W/C: comes with basic features
Reclining Back W/C: pt unable to sit upright for too long
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TYPES OF WHEELCHAIRS
Tilt-in-Space W/C: has a fixed seat-to-back angle, even when reclined
One-Arm Drive W/C: patients with one functional UE
Wheelchair
Folding a wheelchair
•raise the footplates
•pull up on the front and back aspect of
the cloth seat
Wheelchair
Opening a folded wheelchair
•push down on the seat
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Wheelchair Operation
All W/C users should be taught how to:
-operate wheel locks
-remove & replace armrests
-swing away, remove & replace footrests/plates
-elevate & lower the footplates
Self Propulsion with Bilateral UE
1. Grasp handrims at top of wheels (12 o’clock)
2. Push forward (to go forwards) or pull backward (to go backwards) with equal force on each wheel
3. To turn: hold one handrim stationary & push or pull on the opposite handrim
4. To turn more quickly: push one handrim forward while simultaneously pulling backward on the other
Self Propulsion with one UE & one LE
1.Grasp handrim at 12 o’clock & push forward or pull back, using the foot to push or pull simultaneously
2.The foot can also act as a “rudder” to assist with turning while the user holds the handrim
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Self Propulsion with Bilateral LE
A method in which the patient uses the heels and soles of both feet to propel forward and backward. Can use the feet as a “rudder” to turn left or right.
Clinician Propulsion on Level Surface
1.Use the push handles to move and control the W/C.
2.To turn the chair, hold one push handle still and push on the other.
3.Do not push the chair & then release the handles. You should always maintain control of the chair.
4.Start & stop the chair smoothly
5.Use caution moving through doorways
6.Stay to the right side of the corridor
7.If you need to tip the chair back on its rear wheels, first inform your patient.
Clinician Propulsion – Ascend a single
elevation (CURB) forwards
1.Position the chair facing the curb
2.Elevate the caster wheels by standing behind the chair & using 1 foot to push down & forward on one tipping lever while pushing down & back with both hands on the handles
3.Move the chair forward on its rear wheels until they contact curb lip & the caster wheels are above curb surface.
4.Carefully lower caster wheels onto curb surface
5.Roll the chair forward so the rear wheels ascend the curb & all 4 wheels are on the upper level of the curb
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Clinician Propulsion – Descending a single
elevation (CURB) Backwards
1.Position the chair so rear wheels are close to edge of curb
2.Stand behind chair & control the chair as it slowly rolls backward, with the rear wheels first, over the curb, while the caster wheels remain on the upper surface of the curb
3.You can use your thigh or the lateral hip against the back of the chair to help control the descent of the chair
4.When the rear wheels contact the street, turn the chair 90 degrees or back it up until the caster wheels clear the curb
5.Lower caster wheels to the surface
Clinician Propulsion –
ascending a flight of stairs
1.Two clinicians are needed
2.One stands behind the chair, one to the side of the chair
3.The rear wheels contact the bottom step, elevate the caster wheels, maintain this tipped position as you pull the chair up the stairs
4.The second person is standing on the side of the chair holding the frame (not a removeable part)
5.Move one step at a time
6.Person behind the chair verbally “leads”
7.At top of steps, either back up or turn 90 degrees, then lower caster wheels
Clinician Propulsion – descending a flight
of stairs
1.Safest with 2 clinicians, but can do with one
2.Position caster wheels at edge of top step, tip chair on rear wheels and maintain this tipped position throughout
3.On command of the leader, everyone retards the motion of the rear wheels down each step
4.Stop the chair on each step to avoid developing momentum
5.Lower the chair onto its caster wheels at the bottom
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Clinician Propulsion - Slopes
ASCENDING
-can push chair forward on all 4 wheels
-can push chair forward tipped back on the rear
wheels
-can pull chair backwards tipped back on rear
wheels
DESCENDING
-can elevate caster wheels, tipping chair back
on rear wheels and retarding the motion going
down the slope
-can leave all 4 wheels in contact with ground
and descend backwards
Clinician Propulsion
Elevators: can enter forward or backward, safer to enter forward (to reduce risk of LE injury if doors close early) and exit backwards (as rear wheels less likely to get caught in space between elevator and floor)
Escalators: Avoid unless it is an extreme emergency
You are responsible for:
•the safety of the person in the
wheelchair
•making sure that the patient is
securely seated in the chair and that his
or her dignity is preserved
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TAKE OUT A PIECE OF PAPER
Choose one of the following scenarios and draw (stick figures are okay) the correct way to do it:
- ascend curb with wheelchair
- descend curb with wheelchair
- ascend stairs with wheelchair
- descend stairs with wheelchair
- ascend steep hill with wheelchair
- descend steep hill with wheelchair
Put your name on it and place it in the bin up front
Review of Today’s Lecture
Components
Types of W/C
Patient Propulsion with Bilateral UE
Patient Propulsion with one UE & one LE
Up a curb
Down a curb
Up a slope
Down a flight of stairs
QUESTIONS????
Minor, M.A., Minor, S., (2006), Patient Care Skills, 6th ed. Pearson Prentice Hall: Upper Saddle River, NJ.
Pierson, F.M., (1999), Principles and Techniques of Patient Care, 2nd ed. W.B. Saunders Company: Philadelphia.